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DOCUMENTS


The Tentacle


December 3, 2014

CDC Questionnaire for Students Isn’t Academic – Part 2 – Middle School

John W. Ashbury

Here are questions 34 through 66.

 

 

The next 3 questions ask about secondhand smoke.

 

34. Does anyone who lives with you now smoke cigarettes or cigars?

A. Yes

B. No

 

35. Which of the following statements best describes the rules about smoking inside the home where you live?

A. Never allowed inside my home

B. Allowed only at some times or in some places

C. Always allowed inside my home

 

36. During the past 7 days, on how many days were you in the same room with someone who was smoking cigarettes?

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

G. 6 days

H. 7 days

 

The next 2 questions ask about electronic vapor products, such as blu, NJOY, or Starbuzz. Electronic  vapor products include e-cigarettes, e-cigars, epipes, vape pipes, vaping pens, e-hookahs, and hookah pens.

 

37. Have you ever used an electronic vapor product?

A. Yes

B. No

 

38. During the past 30 days, on how many days did you use an electronic vapor product?

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

 

The next 3 questions ask about drinking alcohol. This includes drinking beer, wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey. For these questions, drinking alcohol does not include drinking a few sips of wine for religious purposes.

 

39. Have you ever had a drink of alcohol, other than a few sips?

A. Yes

B. No

 

40. How old were you when you had your first drink of alcohol other than a few sips?

A. I have never had a drink of alcohol other than a few sips

B. 8 years old or younger

C. 9 years old

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old or older

 

41. During the past 30 days, on how many days did you have at least one drink of alcohol?

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

 

Marijuana also is called grass or pot.

 

42. Have you ever used marijuana?

A. Yes

B. No

 

43. How old were you when you tried marijuana for the first time?

A. I have never tried marijuana

B. 8 years old or younger

C. 9 years old

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old or older

 

44. During the past 30 days, how many times did you use marijuana?

A. 0 times

B. 1 or 2 times

C. 3 to 9 times

D. 10 to 19 times

E. 20 to 39 times

F. 40 or more times

 

The next 7 questions ask about other drugs.

 

45. Have you ever used any form of cocaine, including powder, crack, or freebase?

A. Yes

B. No

 

46. Have you ever used heroin (also called smack, junk, or China White)?

A. Yes

B. No

 

47. Have you ever sniffed glue, breathed the contents of spray cans, or inhaled any paints or sprays to get high?

A. Yes

B. No

 

48. Have you ever taken steroid pills or shots without a doctor's prescription?

A. Yes

B. No

 

49. Have you ever taken a prescription drug (such as OxyContin, Percocet, Vicodin, codeine, Adderall, Ritalin, or Xanax) without a doctor's prescription?

A. Yes

B. No

 

50. During the past 30 days, how many times did you take a prescription drug (such as OxyContin, Percocet, Vicodin, codeine, Adderall, Ritalin, or Xanax) without a doctor's prescription?

A. 0 times

B. 1 or 2 times

C. 3 to 9 times

D. 10 to 19 times

E. 20 to 39 times

F. 40 or more times

 

51. During the past 12 months, has anyone offered, sold, or given you an illegal drug on school property?

A. Yes

B. No

 

The next 4 questions ask about sexual intercourse.

 

52. Have you ever had sexual intercourse?

A. Yes

B. No

 

53. How old were you when you had sexual intercourse for the first time?

A. I have never had sexual intercourse

B. 8 years old or younger

C. 9 years old

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old or older

 

54. With how many people have you ever had sexual intercourse?

A. I have never had sexual intercourse

B. 1 person

C. 2 people

D. 3 people

E. 4 people

F. 5 people

G. 6 or more people

 

55. The last time you had sexual intercourse, did you or your partner use a condom?

A. I have never had sexual intercourse

B. Yes

C. No

 

The next 2 questions ask about body weight.

 

56. How do you describe your weight?

A. Very underweight

B. Slightly underweight

C. About the right weight

D. Slightly overweight

E. Very overweight

 

57. Which of the following are you trying to do about your weight?

A. Lose weight

B. Gain weight

C. Stay the same weight

D. I am not trying to do anything about my weight

 

The next question asks about eating breakfast.

 

58. During the past 7 days, on how many days did you eat breakfast?

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

G. 6 days

H. 7 days

 

The next 6 questions ask about physical activity.

 

59. During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? (Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time.)

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

G. 6 days

H. 7 days

 

60. On an average school day, how many hours do you watch TV?

A. I do not watch TV on an average school day

B. Less than 1 hour per day

C. 1 hour per day

D. 2 hours per day

E. 3 hours per day

F. 4 hours per day

G. 5 or more hours per day

 

61. On an average school day, how many hours do you play video or computer games or use a computer for something that is not school work? (Count time spent on things such as Xbox, PlayStation, an iPod, an iPad or other tablet, a smartphone, YouTube, Facebook or other social networking tools, and the Internet.)

A. I do not play video or computer games or use a computer for something that is not school work

B. Less than 1 hour per day

C. 1 hour per day

D. 2 hours per day

E. 3 hours per day

F. 4 hours per day

G. 5 or more hours per day

 

62. In an average week when you are in school, on how many days do you go to physical education (PE) classes?

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

 

63. During an average physical education (PE) class, how many minutes do you spend actually exercising or playing sports?

A. I do not take PE

B. Less than 10 minutes

C. 10 to 20 minutes

D. 21 to 30 minutes

E. 31 to 40 minutes

F. 41 to 50 minutes

G. 51 to 60 minutes

H. More than 60 minutes

 

64. During the past 12 months, on how many sports teams did you play? (Count any teams run by your school or community groups.)

A. 0 teams

B. 1 team

C. 2 teams

D. 3 or more teams

 

The next 7 questions ask about other health-related topics.

 

65. Have you ever been taught about AIDS or HIV infection in school?

A. Yes

B. No

C. Not sure

 

66. Has a doctor or nurse ever told you that you have asthma?

A. Yes

B. No



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