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[p. 239]

Thank you for agreeing to participate in the United States Public Health Service's study of the health activities of young people. This questionnaire will be given to several thousand young people to get a picture of behaviors which are good or bad for their health. Before I begin, please take a few seconds to adjust the VOLUME wheel on top of the tape player so my voice is loud enough.

Let's begin. Please remember that your answers will be kept confidential and your responses will in no way be identified with you. So that you can answer all of the questions honestly, without worrying about seeing your answers, the questions will be read on this tape.

It is important that you answer each question accurately so that the information you give us will be useful for developing programs to protect the health of young people throughout the U.S.

I will always read the question two times. On some questions, where there are several answers to choose from, I will read the question and the answer choices two times. There will be a short pause after I read each question so that you can mark your answer on the answer sheets. To indicate your answer, make a check mark in the square. Before you check an answer, please look at the question number on the answer sheet to be sure it matches the number of the question that you heard on the tape.

If you have any questions, lose your place, or need help, you can stop the tape by pushing the STOP button the side of the tape player and ask the interviewer for help. Push the PLAY button to start the tape again.

If you would like more time to think about your answer to a question, push the STOP button on the side of the tape player. When you are ready to begin again, push the PLAY button.

If you need to have a question repeated, push the REWIND button the side of the tape player for just a few seconds. To start the tape again, push the PLAY button.

Take a moment right now and find these buttons on the side of the tape player.

If you have any questions about how to run the tape player please stop the tape and ask the interviewer for help.

[p. 240]

The first questions ask about some things that may affect health and safety.

1. How often do you wear a seat belt when riding in a car driven by someone else?

2. During the past 12 months, how many times did you ride a motorcycle?

3. When you rode a motorcycle during the past 12 months, how often did you wear a helmet?

4. During the past 12 months, how many times did you ride a bicycle?

5. When you rode a bicycle during the past 12 months, how often did you wear a helmet?

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6. During the past 12 months, when you went swimming in places such as a pool, lake, or ocean, how often was an adult or a lifeguard watching you?

These next questions ask about things young people sometimes do that may led to injuries.

7. During the past 12 months, how many times were you in a physical fight?

8. The last time you were in a physical fight, with whom did you fight?

9. During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse?

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10. During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club?

11. During the past 30 days, what one kind of weapon did you carry most often?

The next few questions ask about cigarette smoking and the use of tobacco.

12. Have you ever tried cigarette smoking, even one or two puffs?

13. Do you think you will try cigarette smoking during the next 12 months?

14. How old were you when you smoked a whole cigarette for the first time?

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15. Have you ever smoked cigarettes regularly, that is, at least one cigarette every day for 30 days?

16. How old were you when you first started smoking cigarettes regularly? (At least one cigarette every day for 30 days.)

17. During the past 30 days, on how many days did you smoke cigarettes?

18. During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?

19. During the past 6 months, did you try to quit smoking cigarettes?

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20. During the past 30 days, did you use chewing tobacco, such as Redman, Levi Garrett, or Beechnut?

21. During the past 30 days, did you use snuff, such as Skoal, Skoal Bandits, or Copenhagen?

The following questions ask about drinking alcohol. This includes beer, wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey.

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

23. During your life, on how many days have you had at least one drink of alcohol?

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

25. During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row? (Within a couple of hours)

26. During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been drinking alcohol?

27. During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol?

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The next questions ask about the use of marijuana, grass, or pot.

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

29. During your life, how many times have you used marijuana?

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

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The next questions ask about drugs which may affect health. These questions may be sensitive but it is important that we get accurate information.

31. How old were you when you tried any form of cocaine, including powder, crack, or freebase, for the first time?

32. During your life, how many times have you used any form of cocaine, including powder, crack, or freebase?

33. During the past 30 days, how many times did you use any form of cocaine, including powder, crack, or freebase?

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34. During your life, how many times have you used the crack or freebase forms of cocaine?

35. During your life, how many times have you used any other type of illegal drug, such as LSD, PCP, ecstasy, mushrooms, speed, ice, heroin, or pills without a doctor's prescription?

36. During your life, how many times have you taken steroid pills or shots without a doctor's prescription?

37. During your life, have you ever injected (shot up) any illegal drug?

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

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39. Have you ever talked about AIDS or HIV infection with your parents or other adults in your family?

40. How much do you think people risk harming themselves by using illegal drugs occasionally?

41. How much do you think people risk harming themselves by using illegal drugs regularly?

The next few questions ask about your weight.

42. How do you think of yourself?

43. Which of the following are you trying to do?

44. During the past 7 days, did you diet to lose weight or to keep from gaining weight?

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45. During the past 7 days, did you exercise to lose weight or to keep from gaining weight?

46. During the past 7 days, did you use some other method besides dieting or exercising to lose weight or to keep from gaining weight?

47. During the past 7 days, did you make yourself vomit to lose weight to keep from gaining weight?

48. During the past 7 days, did you take diet pills to lose weight or to keep from gaining weight?

49. During the past 7 days, did you use some other method besides vomiting or taking diet pills to lose weight or to keep from gaining weight?

The following questions ask about food you ate yesterday. Think about all meals and snacks you ate yesterday from the time you got up until you went to bed. Be sure to include food you ate at home, at school, at restaurants, or anywhere else.

50. Yesterday, did you drink fruit juice?

51. Yesterday, did you eat fruit?

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52. Yesterday, did you eat green salad?

53. Yesterday, did you eat cooked vegetables?

54. Yesterday, did you eat hamburger, hot dogs, or sausage?

55. Yesterday, did you eat french fries or potato chips?

56. Yesterday, did you eat cookies, doughnuts, pie, or cake?

The next questions ask about physical activities that you did in the past 7 days.

57. On how many of the past 7 days did you do stretching exercises, such as toe touching, knee bending or leg stretching?

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58. On how many of the past 7 days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting?

59. On how many of the past 7 days did you do any house cleaning or yard work for at least 30 minutes at a time?

60. On how many of the past 7 days did you walk or bicycle for at least 30 minutes at a time? Include walking or bicycling to or from school or work.

61. On how many of the past 7 days did you play baseball, softball, or frisbee?

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62. On how many of the past 7 days did you play basketball, football, or soccer?

63. On how many of the past 7 days did you roller skate, ice skate, ski, or skateboard?

64. On how many of the past 7 days did you run, jog, or swim for exercise?

65. On how many of the past 7 days did you play tennis, racquetball, or squash?

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66. On how many of the past 7 days did you do aerobics or dance?

67. On how many of the past 7 days did you exercise or take part in sports that made you sweat and breathe hard, such as basketball, jogging, fast dancing, swimming laps, tennis, fast bicycling, or other aerobic activities?

68. Are you now either going to school or on vacation from school?

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Today many young people and adults are spending the night wherever they can find a place to sleep. The next questions ask about places like this where you may have spent the night in the past 12 months.

69. During the past 12 months, did you spend at least one night in a youth or adult shelter?

70. During the past 12 months, did you spend at least one night in a public place, like a train or bus station, a restaurant, or an office building?

71. During the past 12 months, did you spend at least one night in an abandoned building?

72. During the past 12 months, did you spend at least one night in a car, truck, or van?

73. During the past 12 months, did you spend at least one night outside in a park, on the street, under a bridge or overhang, or on a roof top?

74. During the past 12 months, did you go home with someone you did not know because you needed a place to stay?

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75. During the past 12 months, did you spend at least one night in the subway, or other public place underground?

76. During the past 12 months, have you stayed out overnight without permission?

77. During the past 12 months, about how many nights have you stayed out without permission?

If you are 12 or 13 years old, please stop and tell the interviewer you are done.

If you are 14 years of age or older, please continue.

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The next questions ask about sexual relations you may have had.

78. Have you ever had sexual intercourse?

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

80. During your life, with how many people have you had sexual intercourse?

81. During the past 3 months, with how many people did you have sexual intercourse?

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The next questions ask about the last time you had sexual intercourse.

82. Did you drink alcohol or use drugs before you had sexual intercourse the last time?

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

84. The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy? (Check only one answer.)

85. How many times have you been pregnant or gotten someone pregnant?

86. Have you ever been told by a doctor or nurse that you had a sexually transmitted disease? (Genital herpes, genital warts, chlamydia, syphilis, AIDS, or HIV infection)

These are all the questions we have. Thanks very much for your cooperation in answering these questions. Please stop and tell the interviewer you are done.