Traffic Safety Traffic Safety During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been smoking

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1 Demographics Core How old are you? Demographics Core What is your sex? Demographics Core In what grade are you? Demographics Core Are you Hispanic or Latino? Demographics Core What is your race? (Select one or more responses.) Demographics Core During the past 12 months, how would you describe your grades in school? Demographics Acculturation How long have you lived in the United States? Demographics Acculturation How often do the people in your home speak a language other than English? Demographics Acculturation How often do people in your home speak the Ojibwe language? Demographics Acculturation Do you live in Wauwatosa? Demographics Sexual Identity Which of the following best describes you? Height and Weight Core How tall are you without your shoes on? (If you are 5 feet 8 inches you would click the 5 under feet and 8 under inches.) Height and Weight Core How much do you weigh without your shoes on? (If you are 145 pounds you would click the 1 in the first column, 4 in the second column, and 5 in the third column.) Health Status Core How do you describe your health in general? Health Status Core During the past 30 days, on how many days was your physical health not good? (Physical health includes physical illness and injury.) Health Status Core During the past 30 days, on how many days was your mental health not good? (Mental health includes stress, depression, and problems with emotions.) Traffic Safety Core How often do you wear a seat belt when riding in a car driven by someone else? Traffic Safety Core 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? Traffic Safety Core During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol? Traffic Safety Motorcycle Helmet Use When you rode a motorcycle during the past 12 months, how often did you wear a helmet? Traffic Safety Traffic Safety How often do you wear a seatbelt when driving a car? Traffic Safety Traffic Safety During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been smoking marijuana? Traffic Safety Traffic Safety During the past 30 days, how many times did you drive a car or other vehicle when you had been smoking marijuana? Weapons Core During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club? Weapons Core During the past 30 days, on how many days did you carry a gun? Weapons Core During the past 30 days, on how many days did you not go to school because you felt you would be unsafe at school or on your way to or from school? Weapons Core During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club on school property? Weapons Core During the past 12 months, how many times has someone threatened or injured you with a weapon such as a gun, knife, or club on school property? Weapons Weapons During the past 30 days, on how many days did you carry a gun on school property? Weapons Weapons During the past 30 days, on how many days did you carry a knife as a weapon? Weapons Weapons Have you ever carried any type of object to use as a weapon, such as a gun, knife, club, padlock, scissors, box cutter, chain, brass or ceramic knuckles, expandable baton or pepper spray on school property? 1

2 Weapons Weapons Have you ever carried any type of object to use as a weapon at school to protect yourself from bullying or harassment? Physical Fighting Core During the past 12 months, how many times were you in a physical fight? Physical Fighting Core 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? Physical Fighting Core During the past 12 months, how many times were you in a physical fight on school property? Physical Fighting Physical Fighting The last time you were in a physical fight, with whom did you fight? Physical Fighting Physical Fighting Have you ever used electronic means (cell phone, texting, Facebook) to call in reinforcements to help you settle a fight at school? Physical Fighting Physical Fighting The last time you were in a physical fight on school property, who did you contact to help you fight? Threats and Personal Safety Core During the past 12 months, how many times has someone tried to hurt you by hitting, punching, or kicking you while on school property? Threats and Personal Safety Core When you are at school, how often do you feel safe from physical harm? Threats and Personal Safety Core Do you agree or disagree that violence is a problem at your school? Threats and Personal Safety Core During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose? Threats and Personal Safety Core Have you ever been forced, either verbally or physically, to take part in a sexual activity? Threats and Personal Safety Core During the past 12 months, how many times did you do something to hurt yourself without wanting to die, such as cutting or burning yourself on purpose? Threats and Personal Safety Bullying During the past 12 months, how many times have you been harassed or bullied on school property? Threats and Personal Safety Bullying During the past 12 months, have you been harassed, picked on, or bullied while riding on a school bus? Threats and Personal Safety Community Connectedness How often do you feel safe and secure in your neighborhood? Threats and Personal Safety School Experience Do you agree or disagree that harassment and bullying by other students is a problem at your school? Threats and Personal Safety School Experience How often do you feel safe and secure at school? Threats and Personal Safety School Experience Do you agree or disagree that violence is a problem at your school? Threats and Personal Safety School Experience During the past 12 months, have you been harassed, picked on, or bullied so much that you felt unsafe at school or that it was hard to do your best at school? Threats and Personal Safety Self Harm During the past 12 months, how many times did you do something to purposely hurt yourself without wanting to die, such as cutting or burning yourself on purpose? Threats and Personal Safety Sexual Harassment Have you ever been asked to send or post a sexually explicit photo of yourself? Threats and Personal Safety Sexual Harassment Have you ever sent or posted a sexually explicit photo of yourself? Threats and Personal Safety Threats and Personal Safety During the past 12 months, how many times has someone tried to hurt you by hitting, punching, or kicking you while on school property? Threats and Personal Safety Threats and Personal Safety During the past 12 months, how many times has someone stolen or deliberately damaged your property such as your car, clothing, or books on school property? Threats and Personal Safety Threats and Personal Safety During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose while on school property? Threats and Personal Safety Threats and Personal Safety Have you ever been forced, either verbally or physically, to take part in a sexual activity while on school property? Harassment Harassment During the past 30 days, have you been the victim of a verbal slur because of your race or ethnic background? Harassment Harassment During the past 30 days, have you been the victim of a verbal slur because of your weight, size, or physical appearance? Harassment Harassment During the past 30 days, have you been the victim of a verbal slur because of your gender? Harassment Harassment During the past 12 months, how many times have you been harassed because someone thought you were gay, lesbian, or bisexual? 2

3 Harassment Harassment Has anyone at your school ever touched you, said something to you, or displayed a picture or photograph that was sexual in nature and made you uncomfortable? Gang Activity Gang Activity During the past 12 months, have you been a member of a gang? Gang Activity Gang Activity Is there gang activity in your school? Gang Activity Gang Activity During the past 12 months, how many times have you felt threatened or been injured as a result of gang activity on school property? Gang Activity Gang Activity During the past 12 months, how many times have you felt threatened or been injured as a result of gang activity? Gang Activity Gang Activity During the past 12 months, did you not come to school because you were fearful of a gang or gang activity? Gang Activity Gang Activity Do you consider it "normal" to be part of a gang? Gang Activity Gang Activity How often do you see gang related colors, graffiti, or behavior at school or during a school related function? Bullying Core During the past 12 months, have you ever been bullied on school property? Bullying Core Do you agree or disagree that harassment and bullying by other students is a problem at your school? Bullying Core During the past 12 months, have you ever been electronically bullied? (Include being bullied through e mail, chat rooms, instant messaging, Web sites, or texting.) Bullying Miscellaneous Have you ever been electronically bullied? (Include being bullied through e mail, chat rooms, instant messaging, Web sites, or texting.) Bullying Miscellaneous During the past 12 months, have you ever electronically bullied someone else on school property? Depression and Suicide Core During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities? Depression and Suicide Core During the past 12 months, did you ever seriously consider attempting suicide? Depression and Suicide Core During the past 12 months, did you make a plan about how you would attempt suicide? Depression and Suicide Core During the past 12 months, how many times did you actually attempt suicide? Depression and Suicide Core If you attempted suicide during the past 12 months, did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse? Depression and Suicide Miscellaneous During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities? Depression and Suicide Miscellaneous During the past 12 months, did you ever seriously consider attempting suicide? Depression and Suicide Miscellaneous During the past 12 months, did you make a plan about how you would attempt suicide? Depression and Suicide Miscellaneous During the past 12 months, how many times did you actually attempt suicide? Depression and Suicide Miscellaneous If you attempted suicide during the past 12 months, did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse? Tobacco Use Core Have you ever tried cigarette smoking, even one or two puffs? Tobacco Use Core How old were you when you smoked a whole cigarette for the first time? Tobacco Use Core During the past 30 days, on how many days did you smoke cigarettes? Tobacco Use Core During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day? Tobacco Use Core During the past 30 days, on how many days did you smoke cigarettes on school property? Tobacco Use Core Have you ever smoked cigarettes daily, that is, at least one cigarette every day for 30 days? Tobacco Use Core During the past 12 months, did you ever try to quit smoking cigarettes? Tobacco Use Core During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen? Tobacco Use Core During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars? Tobacco Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they smoke one to five cigarettes per day? 3

4 Tobacco Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they smoke one or more packs of cigarettes per day? Tobacco Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they use smokeless tobacco regularly? Tobacco Use Peer Use How many of your friends would you estimate smoke cigarettes? Tobacco Use Peer Use How many of your friends would you estimate use smokeless tobacco? Tobacco Use Tobacco Use When you bought or tried to buy cigarettes in a store during the past 30 days, were you ever asked to show proof of age? Tobacco Use Tobacco Use How old were you when you first: Smoked a cigarette, even a puff? Tobacco Use Tobacco Use How frequently have you smoked cigarettes during the past 30 days? Tobacco Use Tobacco Use During the past 30 days, how did you usually get your own cigarettes? (Select only one response.) Tobacco Use Tobacco Use During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip on school property? Alcohol Use Core During your life, on how many days have you had at least one drink of alcohol? Alcohol Use Core How old were you when you had your first drink of alcohol other than a few sips? Alcohol Use Core During the past 30 days, on how many days did you have at least one drink of alcohol? Alcohol Use Core During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours? Alcohol Use Core During the past 30 days, how did you usually get the alcohol you drank? Alcohol Use Core During the past 30 days, how many days did you get drunk from drinking alcohol? Alcohol Use Core How much do you approve or disapprove of people having 5 or more drinks of alcohol in a row, that is, within a couple of hours once or twice each weekend? Alcohol Use Core How many people your age would say it is okay to have 5 or more drinks of alcohol in a row, that is, within a couple of hours once or twice each weekend? Alcohol Use Core How much do you think people risk harming themselves (physically or in other ways) if they have 5 or more drinks of alcohol in a row, that is, within a couple of hours once or twice each weekend? Alcohol Use Core How wrong do your parents feel it would be for you to drink alcohol at least twice a month? Alcohol Use Alcohol Use During the past 30 days, what brand of beer did you usually drink? (Select only one response.) Alcohol Use Alcohol Use During the past 30 days, what type of alcohol did you usually drink? (Select only one response.) Alcohol Use Alcohol Use During the past 30 days, where did you usually drink alcohol? Alcohol Use Alcohol Use How old were you when you first: Had more than one sip or two of beer, wine or hard liquor (for example, vodka, whiskey or gin)? Alcohol Use Alcohol Use On how many occasions (if any) have you had beer, wine, or hard liquor during the past 30 days? Alcohol Use Alcohol Use How much do you approve or disapprove of people having 5 or more drinks of alcohol in a row, that is, within a couple of hours once or twice each weekend? Alcohol Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they try one or two drinks of an alcoholic beverage (beer, wine, liquor)? Alcohol Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they take one or two drinks of an alcoholic beverage (beer, wine, liquor) nearly every day? Alcohol Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they have five or more drinks of an alcoholic beverage (beer, wine, liquor) once or twice each weekend? Alcohol Use Parent Attitudes How would your parents or other adults in your family feel if you attended a party where alcoholic beverages were available? Alcohol Use Parent Attitudes How would your parents or other adults in your family feel if you had five or more drinks of alcohol in a row, that is, within a couple of hours? 4

5 Alcohol Use Peer Use How many of your friends would you estimate drink alcoholic beverages (liquor, beer, wine)? Alcohol Use Peer Use How many of your friends would you estimate get drunk at least once a week? Marijuana Use Core During your life, how many times have you used marijuana? Marijuana Use Core How old were you when you tried marijuana for the first time? Marijuana Use Core During the past 30 days, how many times did you use marijuana? Marijuana Use Core How much do you approve or disapprove of people smoking marijuana? Marijuana Use Core How many people your age would say it is okay to smoke marijuana? Marijuana Use Core How much do you think people risk harming themselves (physically or in other ways) if they smoke marijuana? Marijuana Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they smoke marijuana regularly? Marijuana Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they try marijuana once or twice? Marijuana Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they smoke marijuana occasionally? Marijuana Use Marijuana Use During your life, how many times have you used marijuana? Marijuana Use Marijuana Use How old were you when you first: Smoked marijuana? Marijuana Use Marijuana Use How old were you when you tried marijuana for the first time? Marijuana Use Marijuana Use On how many occasions (if any) have you used marijuana during the past 30 days? Marijuana Use Marijuana Use During the past 30 days, how many times did you use marijuana? Marijuana Use Parent Attitudes How would your parents or other adults in your family feel if you smoked marijuana? Marijuana Use Peer Use How many of your friends would you estimate smoke marijuana or hashish? Marijuana Use Peer Use How many people your age would say it is okay to smoke marijuana? Marijuana Use Perceptions and Attitudes How much do you approve or disapprove of people smoking marijuana occasionally? Other Drug Use Core During your life, how many times have you taken a prescription drug (such as OxyContin, Percocet, Vicodin, codeine, Adderall, Ritalin, or Xanax) without a doctor s prescription? Other Drug Use Core During your life, how many times have you taken a over the counter drug to get high? Other Drug Use Core During your life, how many times have you used any form of cocaine, including powder, crack, or freebase? Other Drug Use Core During the past 30 days, how many times did you use any form of cocaine, including powder, crack, or freebase? Other Drug Use Core During your life, how many times have you sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high? Other Drug Use Core During your life, how many times have you used methamphetamines (also called speed, crystal, crank, or ice)? Other Drug Use Core During your life, how many times have you used heroin (also called smack, junk, or China White)? Other Drug Use Core During your life, how many times have you used ecstasy (also called MDMA)? Other Drug Use Core During the past 12 months, has anyone offered, sold, or given you an illegal drug on school property? Other Drug Use Cocaine How old were you when you tried any form of cocaine, including powder, crack or freebase, for the first time? Other Drug Use Cocaine During your life, how many times have you used the crack or freebase forms of cocaine? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they try cocaine in powder form once or twice? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they take cocaine powder occasionally? 5

6 Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they try "crack" cocaine once or twice? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they take "crack" cocaine occasionally? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they sniff glue, gases, or sprays once or twice? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they sniff glue, gases, or sprays regularly? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they try heroin once or twice without using a needle? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they take heroin occasionally without using a needle? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they take LSD once or twice? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they take LSD regularly? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they try MDMA ("ecstasy") once or twice? Other Drug Use Health Risk How much do you think people risk harming themselves (physically or in other ways), if they take MDMA ("ecstasy") occasionally? Other Drug Use Inhalant How old were you when you sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high for the first time? Other Drug Use Inhalant During the past 30 days, how many times have you sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high? Other Drug Use Other Drug Use During your life, how many times have you used hallucinogenic drugs, such as LSD, acid, PCP, angel dust, mescaline, or mushrooms? Other Drug Use Other Drug Use During the past 30 days, how many times have you used methamphetamines (also called speed, crystal, crank, or ice)? Other Drug Use Other Drug Use During the past 30 days, how many times have you taken steroid pills or shots without a doctor's prescription? Other Drug Use Other Drug Use How old were you when you tried heroin (also called smack, junk, or China White) for the first time? Other Drug Use Other Drug Use During the past 12 months, how many times have you attended school under the influence of alcohol or other illegal drugs, such as marijuana or cocaine? Other Drug Use Over the counter During your life, how many times have you taken over the counter drugs to get high? Other Drug Use Over the counter During the past 30 days, how many times have you taken over the counter drugs to get high? Other Drug Use Peer Use How many of your friends would you estimate take crack cocaine? Other Drug Use Peer Use How many of your friends would you estimate take cocaine in powder form? Other Drug Use Peer Use How many of your friends would you estimate take heroin? Other Drug Use Peer Use How many of your friends would you estimate sniff glue, gases, or sprays? Other Drug Use Prescription During your life, how many times have you taken painkillers, such as OxyContin, Percocet, or Vicodin, without a doctor s prescription? Other Drug Use Prescription During your life, how many times have you used barbiturates (also called barbs, downers, sleepers, or yellow jackets) without a doctor's prescription? Other Drug Use Prescription During the past 30 days, how many times have you used barbiturates (also called barbs, downers, sleepers, or yellow jackets) without a doctor's prescription? 6

7 Other Drug Use Prescription During your life, how many times have you taken a prescription drug, such as Ritalin, Adderall, or Xanax, without a doctor s prescription? Other Drug Use School Experience Do you agree or disagree that illegal drugs are a problem at your school? Sexual Behavior Core It is important to me to delay having sexual intercourse until... (Select only one response.) Sexual Behavior Core Have you ever had sexual intercourse? Sexual Behavior Core How old were you when you had sexual intercourse for the first time? Sexual Behavior Core During your life, with how many people have you had sexual intercourse? Sexual Behavior Core During the past 3 months, with how many people did you have sexual intercourse? Sexual Behavior Core Did you drink alcohol or use drugs before you had sexual intercourse the last time? Sexual Behavior Core The last time you had sexual intercourse, did you or your partner use a condom? Sexual Behavior Core The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy? (Select only one response.) Sexual Behavior Core During your life, with whom have you had sexual contact? Sexual Behavior Core Which of the following best describes you? Sexual Behavior Parent Communication Have your parents or other adults in your family ever talked with you about what they expect you to do or not to do when it comes to sex? Sexual Behavior Sexual Behavior The first time you had sexual intercourse, how old was your partner? Sexual Behavior Sexual Behavior The last time you had sexual intercourse, how old was your partner? Sexual Behavior Sexual Behavior During the past 3 months, how often did you or your partner use a condom when you had sexual intercourse? Sexual Behavior Sexual Behavior During your life, with whom have you had sexual contact? Sexual Behavior Sexual Behavior Have you ever had oral sex? Sexual Behavior Sexual Behavior Have you ever had anal sex? Sexual Behavior Sexual Behavior How old were you when you had sexual intercourse for the first time? Sexual Behavior Sexual Behavior During your life, with how many people have you had sexual intercourse? Sexual Behavior Sexual Behavior During the past 3 months, with how many people did you have sexual intercourse? Sexual Behavior Sexual Behavior Did you drink alcohol or use drugs before you had sexual intercourse the last time? Sexual Behavior Sexual Behavior The last time you had sexual intercourse, did you or your partner use a condom? Sexual Behavior Sexual Behavior The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy? (Select only one response.) Sexual Behavior Sexual Behavior During your life, with whom have you had sexual contact? Weight Loss Core Which of the following are you trying to do about your weight? Eating Habits Core During the past 7 days, how many times did you drink 100% fruit juices such as orange juice, apple juice, or grape juice? (Do not count punch, Kool Aid, sports drinks, or other fruit flavored drinks.) Eating Habits Core During the past 7 days, how many times did you eat fruit? (Do not count fruit juice.) Eating Habits Core During the past 7 days, how many times did you eat green salad? Eating Habits Core During the past 7 days, how many times did you eat potatoes? (Do not count french fries, fried potatoes, or potato chips.) Eating Habits Core During the past 7 days, how many times did you eat carrots? Eating Habits Core During the past 7 days, how many times did you eat other vegetables? (Do not count green salad, potatoes, or carrots.) Eating Habits Core During the past 7 days, how many times did you drink a can, bottle, or glass of soda or pop, such as Coke, Pepsi, or Sprite? (Do not include diet soda or diet pop.) Eating Habits Core During the past 7 days, on how many days did you eat breakfast? Eating Habits Dietary Behaviors On how many of the past 7 days did you eat breakfast? 7

8 Eating Habits Dietary Behaviors When you drink milk, what kind of milk do you usually drink? (Select only one response.) Eating Habits Dietary Behaviors During the past 7 days, how many times did you drink a power drink, such as Red Bull, Monster, or Volt? Eating Habits Dietary Behaviors During the past 7 days, how many times did you eat fruit? (Do not count fruit juice.) Eating Habits Dietary Behaviors During the past 7 days, how many times did you eat other vegetables? (Do not count green salad, potatoes, or carrots.) Eating Habits Dietary Behaviors During the past 7 days, how many times did you drink a can, bottle, or glass of soda or pop, such as Coke, Pepsi, or Sprite? (Do not include diet soda or diet pop.) Eating Habits Dietary Behaviors During the past 7 days, how many glasses of milk did you drink? (Include the milk you drank in a glass or cup, from a carton, or with cereal. Count the half pint of milk served at school as equal to one glass.) Eating Habits Dietary Behaviors During the past 30 days, did you choose healthier foods (fruit, vegetables, whole grains) to lose weight or to keep from gaining weight? Eating Habits Dietary Behaviors During the past 7 days, how many glasses of milk did you drink? (Include the milk you drank in a glass or cup, from a carton, or with cereal. Count the half pint of milk served at school as equal to one glass.) Eating Habits Dietary Behaviors During the past 30 days, did you vomit or take laxatives to lose weight or to keep from gaining weight? Eating Habits Dietary Behaviors Have you ever taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight (Do not include meal replacement products such as Slim Fast)? Eating Habits Dietary Behaviors Have you ever gone without eating for 24 hours or more (also called fasting) to lose weight or to keep from gaining weight? Eating Habits Dietary Behaviors Have you ever eaten less food, fewer calories, or food low in fat to lose weight or to keep from gaining weight? Eating Habits Dietary Behaviors During the past 7 days, how many times did you eat vegetables? (Do not count vegetable juice.) Eating Habits Family Interaction/Support Yesterday, did you eat a meal with your family? Eating Habits Family Interaction/Support About how often do you eat meals with one or more of the adults in your home? Eating Habits Food Security During the past 30 days, how often did you go hungry because there was not enough food in your home? Eating Habits Food Security During the past 30 days, how often did you go hungry because there was not enough food in your home? Physical Activity Core 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 increases your heart rate and makes you breathe hard some of the time.) Physical Activity Core On an average school day, how many hours do you watch TV? Physical Activity Core 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? (Include activities such as Xbox, PlayStation, Nintendo DS, ipod touch, Facebook, and the Internet.) Physical Activity Core In an average week when you are in school, on how many days do you go to physical education (PE) classes? Physical Activity Exercise On how many of the past 7 days did you do stretching exercises, such as toe touching, knee bending, or leg stretching? Physical Activity Exercise 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? Physical Activity Exercise On how many of the past 7 days did you exercise or participate in physical activity for at least 20 minutes that made you sweat and breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities? Physical Activity Exercise On how many of the past 7 days did you participate in physical activity for at least 30 minutes that did not make you sweat or breathe hard, such as fast walking, slow bicycling, skating, pushing a lawn mower, or mopping floors? 8

9 Physical Activity Exercise During an average physical education (PE) class, how many minutes do you spend actually exercising or playing sports? Physical Activity Exercise During the past 30 days, did you increase your physical activity to lose weight or to keep from gaining weight? Physical Activity Exercise Do you agree or disagree that being physically active on most days is important to your health? Physical Activity Exercise In an average week when you are in school, on how many days do you walk or ride your bike to school when weather allows you to do so? Physical Activity Injured While Exercising During the past 30 days, did you see a doctor or nurse for an injury that happened while exercising or playing sports? Other Health Issues Core Have you ever been taught about AIDS or HIV infection in school? Other Health Issues Core Have you ever talked about AIDS or HIV infection with your parents or other adults in your family? Other Health Issues Asthma During the past 12 months, how many times did you go to an emergency room or urgent care center because of your asthma? Other Health Issues Diabetes Has a doctor or nurse ever told you that you have diabetes? Other Health Issues Health Check Up When was the last time you saw a doctor or nurse for a check up or physical exam when you were not sick or injured? Other Health Issues Health Check Up When was the last time you saw a dentist for a check up, exam, teeth cleaning, or other dental work? Other Health Issues Health Check Up Have you ever been tested for HIV, the virus that causes AIDS? (Do not count tests done if you donated blood). Other Health Issues Health Check Up Have you ever been told by a doctor or nurse that you had a sexually transmitted disease (STD)? Other Health Issues Health Check Up During your last check up, did your doctor or nurse discuss ways to prevent pregnancy, AIDS, or other sexually transmitted diseases (STDs)? Other Health Issues Health Check Up During your last check up, did your doctor or nurse discuss ways to avoid alcohol use? Other Health Issues Health Check Up During your last check up, did your doctor or nurse discuss ways to avoid tobacco use? Other Health Issues Health Check Up During your last check up, did your doctor or nurse discuss how to maintain a healthy weight? Other Health Issues Health Check Up During your last check up, did your doctor or nurse discuss ways to deal with feelings of hopelessness or sadness? Other Health Issues Health Practices How often do you wash your hands before you eat? Other Health Issues Health Practices On an average school night, how many hours of sleep do you get? Other Health Issues Health Practices On an average school night, how many hours of sleep do you get? Other Health Issues Health Status How do you describe your health in general? Other Health Issues Health Status During the past 30 days, on how many days was your physical health not good? (Physical health includes physical illness and injury.) Other Health Issues Health Status During the past 30 days, on how many days was your mental health not good? (Mental health includes stress, depression, and problems with emotions.) Other Health Issues Physical And Mental Disabilities Do you have any physical disabilities or long term health problems? (Long term means 6 months or more.) Other Health Issues Physical And Mental Disabilities Do you have any long term emotional problems or learning disabilities? (Long term means 6 months or more.) Other Health Issues Physical And Mental Disabilities Would other people consider you to have any disabilities or long term health problems, including physical health, emotional, or learning problems? (Long term means 6 months or more.) Other Health Issues Physical And Mental Disabilities Are you limited in any activities because of any disabilities or long term health problems, including physical health, emotional, or learning problems? (Long term means 6 months or more.) Social Support Core Do you agree or disagree that your family loves you and gives you help and support when you need it? Social Support Core Do you agree or disagree that your teachers really care about you and give you a lot of encouragement? Social Support Core Do you agree or disagree that you feel like you belong at this school? 9

10 Social Support Core Is there at least one teacher or other adult in this school that you can talk to if you have a problem? Social Support Adult Interaction/Support Outside of school, is there an adult you can talk to about things that are important to you? Social Support Adult Interaction/Support Besides your parents, how many adults would you feel comfortable seeking help from if you had an important question affecting your life? Social Support Community Connectedness Do you agree or disagree that in your community you feel like you matter to people? Social Support Parent Attitudes How often do your parents or other adults in your family talk with you about what you are doing in school? Social Support Parent Attitudes Do you agree or disagree that your parents or other adults in your family have clear rules and standards for your behavior? Social Support Parent Attitudes How often do your parents or other adults in your family ask where you are going or with whom you will be? Social Support Parent Attitudes When you are away from home, how often do your parents or other adults in your family know where you are? Social Support Parent Attitudes How often is there an adult at your home in the afternoon when you return from school? Social Support Parent Attitudes On a school day, how many hours do you usually spend after school without an adult present? Social Support Parent Attitudes Do you agree or disagree that your family loves you and gives you help and support when you need it? Social Support Parent Attitudes During the past 12 months, how many times have you run away from home for more than 24 hours? Social Support School Experience How often do you feel that you are accepted at school? Social Support School Experience Do you agree or disagree that you feel like you belong at this school? Social Support School Experience Do you agree or disagree that your school has clear rules and consequences for behavior? Social Support School Support Is there at least one teacher or other adult in this school that you can talk to if you have a problem? Social Support School Support Do you agree or disagree that your teachers really care about you and give you a lot of encouragement? Social Support Social Support When you feel sad, empty, hopeless, angry, or anxious, how often do you get the kind of help you need? Social Support Social Support When you feel sad, empty, hopeless, angry, or anxious, with whom would you most likely talk to about it? Social Support Social Support If you had a problem with tobacco, alcohol, or other drugs, with whom would you most likely talk to about it? Social Support Social Support Do you agree or disagree that you feel alone in your life? Miscellaneous Attitudes And Beliefs Do you agree or disagree that you care about other people's feelings? Miscellaneous Attitudes And Beliefs Do you agree or disagree that you are good at making decisions and following through on them? Miscellaneous Attitudes And Beliefs Do you agree or disagree that you stand up for your beliefs? Miscellaneous Attitudes And Beliefs Do you agree or disagree that you can resist negative peer pressure and dangerous situations? Miscellaneous Attitudes And Beliefs Do you agree or disagree that you feel good about yourself? Miscellaneous Attitudes And Beliefs How often do you feel stress in your life? Miscellaneous Attitudes And Beliefs How do you describe your weight? Miscellaneous Attitudes And Beliefs The next question refers to the Choking Game, also called Knock Out, Space Monkey, Flatlining, or The Fainting Game. This is an activity that some youth participate in to get a high by cutting off blood and oxygen to the brain with a belt, towel, rope, or other item. Which of the following is true for you?/ Miscellaneous Community Service During the past 30 days, how many times did you perform any organized community service as a non paid volunteer, such as serving meals to the elderly, picking up litter, helping out at a hospital, or building homes for the poor? Miscellaneous Community Service During an average week when you are in school, how many hours do you spend in clubs or organizations (other than sports) outside of school, such as 4 H, Boys and Girls Clubs, YWCA, or YMCA? Miscellaneous Community Service Do you participate in any extracurricular activities at school such as sports, band, drama, clubs, or student government? Miscellaneous Community Service How important is it to you to help other people? Miscellaneous Drug Free Community How old were you when you first: Smoked a cigarette, even a puff? Miscellaneous Drug Free Community How frequently have you smoked cigarettes during the past 30 days? 10

11 Miscellaneous Drug Free Community How much do you think people risk harming themselves (physically, or in other ways) if they: Smoke one or more packs of cigarettes per day? Miscellaneous Drug Free Community How wrong do your parents feel it would be for you to: Smoke cigarettes? Miscellaneous Drug Free Community How old were you when you first: Had more than one sip or two of beer, wine or hard liquor (for example, vodka, whiskey or gin)? Miscellaneous Drug Free Community On how many occasions (if any) have you had alcoholic beverages (beer, wine, or hard liquor) to drink more than a few sips during the past 30 days? Miscellaneous Drug Free Community How much do you think people risk harming themselves (physically or in other ways) if they: Take one or two drinks of an alcoholic beverage (beer, wine, liquor) nearly every day? Miscellaneous Drug Free Community How wrong do your parents feel it would be for you to drink beer, wine, or hard liquor (for example, vodka, whiskey, or gin) regularly? Regular use of alcohol is defined as one or two drinks of an alcoholic beverage (beer, wine, liquor) nearly every day. Miscellaneous Drug Free Community How old were you when you first: Smoked marijuana? Miscellaneous Drug Free Community On how many occasions (if any) have you used marijuana during the past 30 days? Miscellaneous Drug Free Community How much do you think people risk harming themselves (physically or in other ways) if they: Smoke marijuana regularly? Miscellaneous Drug Free Community How wrong do your parents feel it would be for you to: Smoke marijuana? Miscellaneous Future Plans How likely is it that you will complete a post high school program such as a vocational training program, military service, community college, or 4 year college? Miscellaneous Miscellaneous Do you participate in extra curricular activities? Please check all that apply: Miscellaneous Religion About how often do you usually attend religious services? Miscellaneous School Absence In the past 30 days, on how many days did you miss classes or school without permission? Miscellaneous School Absence During the past 30 days, on how many days did you not go to school because you were sick? Miscellaneous School Experience How important is it for schools to help students address the problems of today such as drug abuse, violence, AIDS/HIV, teen pregnancy, abuse, and suicide? Miscellaneous School Experience Do you agree or disagree that students help decide what goes on in your school? Miscellaneous School Work How often do you try to do your best work in school? Miscellaneous School Work How often do you come to classes without your homework finished? Miscellaneous School Work On an average school day, how many hours do you spend doing homework outside of school? Miscellaneous School Work How often do you feel that schoolwork you are assigned is meaningful and important? Miscellaneous SPF SIG Do you believe that your parents support the minimum legal drinking age of 21 years old? Miscellaneous SPF SIG During the past 12 months, do you recall hearing, reading, or watching an advertisement about prevention of substance use? Miscellaneous SPF SIG During the past 12 months, have you driven a vehicle while you were under the influence of alcohol? Miscellaneous SPF SIG How do you feel about someone your age having one or two drinks of an alcoholic beverage nearly every day? Miscellaneous SPF SIG How do you feel about someone your age smoking one or more packs of cigarettes a day? Miscellaneous SPF SIG How do you feel about someone your age trying marijuana or hashish once or twice? Miscellaneous SPF SIG How do you feel about someone your age using marijuana once a month or more? Miscellaneous SPF SIG HOW MUCH do you think people RISK HARMING themselves physically or in other ways when they do the following: When they have five or more drinks of an ALCOHOLIC BEVERAGE once or twice a week? Miscellaneous SPF SIG HOW MUCH do you think people RISK HARMING themselves physically or in other ways when they do the following: When they smoke MARIJUANA once or twice a week? 11

12 Miscellaneous SPF SIG How wrong do your parents feel it would be for you to: Drink beer, wine or hard liquor (for example, vodka, whiskey, or gin) regularly (at least twice a month)? Miscellaneous SPF SIG How wrong do your parents feel it would be for you to: Have five or more drink of alcohol (beer, wine hard liquor) in a row, that is, within a couple of hours? Miscellaneous SPF SIG How wrong do your parents feel it would be for you to: Smoke cigarettes? Miscellaneous SPF SIG How wrong do your parents feel it would be for you to: Smoke marijuana? Miscellaneous SPF SIG Now think about the past 12 months through today. DURING THE PAST 12 MONTHS, have you talked with at least one of your parents about the dangers of tobacco, alcohol, or drug use? By PARENTS, we mean your biological parents, adoptive parents, step parents, or adult guardians whether or not they live with you. Miscellaneous SPF SIG Would you be more or less likely to want to work for an employer that tests its employees for drug or alcohol use on a random basis? Miscellaneous Sun Protection When you are outside for more than one hour on a sunny day, how often do you wear sunscreen with an SPF of 15 or higher? Miscellaneous Sun Protection When you are outside for more than one hour on a sunny day, how often do you do one or more of the following: stay in the shade, wear long pants, wear a long sleeved shirt, or wear a hat that shades your face, ears, and neck? Miscellaneous Television/Computer Use Do you have a TV in your room? Miscellaneous Television/Computer Use Do your parents have rules about what you watch on TV? Miscellaneous Television/Computer Use Do your parents have rules about what you do on the Internet? Miscellaneous Work During an average week when you are in school, how many hours do you work at a paying job outside your home? Safe & Supportive Schools Core During the past 12 months, have you been harassed on school property because of your gender? Safe & Supportive Schools Safe & Supportive Schools How long have you lived in the United States? Safe & Supportive Schools Safe & Supportive Schools Which of the following best describes you? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, on how many days did you miss classes or school without permission? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, on how many days did you not go to school because you felt you would be unsafe at school or on your way to or from school? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club on school property? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, on how many days did you carry a gun on school property? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, how many times has someone threatened or injured you with a weapon such as a gun, knife, or club on school property? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, how many times were you in a physical fight on school property? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, how many times has someone tried to hurt you by hitting, punching, or kicking you while on school property? Safe & Supportive Schools Safe & Supportive Schools When you are at school, how often do you feel safe from physical harm? Safe & Supportive Schools Safe & Supportive Schools Do you agree or disagree that violence is a problem at your school? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, have you ever been bullied on school property? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, have you ever been electronically bullied? (Include being bullied through e mail, chat rooms, instant messaging, Web sites, or texting.) Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, have you ever bullied someone else on school property? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, have you ever been harassed on school property? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, have you been harassed on school property because of your race or ethnic background? 12

13 Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, have you been harassed on school property because of your weight, size, or physical appearance? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, have you been harassed on school property because of your gender? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, have you been harassed on school property because someone thought you were gay, lesbian, or bisexual? Safe & Supportive Schools Safe & Supportive Schools Do you agree or disagree that harassment and bullying by other students is a problem at your school? Safe & Supportive Schools Safe & Supportive Schools Is there gang activity in your school? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, on how many days did you have at least one drink of alcohol? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, how did you usually get the alcohol you drank? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, how many times did you use marijuana? Safe & Supportive Schools Safe & Supportive Schools During the past 30 days, how many times have you taken an over the counter drug to get high? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, how many times have you attended school under the influence of alcohol or other illegal drugs, such as marijuana or cocaine? Safe & Supportive Schools Safe & Supportive Schools During the past 12 months, has anyone offered, sold, or given you an illegal drug on school property? Safe & Supportive Schools Safe & Supportive Schools Do you agree or disagree that your teachers really care about you and give you a lot of encouragement? Safe & Supportive Schools Safe & Supportive Schools Is there at least one teacher or other adult in this school that you can talk to if you have a problem? Safe & Supportive Schools Safe & Supportive Schools Do you agree or disagree that you feel like you belong at this school? Safe & Supportive Schools Safe & Supportive Schools In my school, students have lots of chances to help decide things like class activities and rules. Safe & Supportive Schools Safe & Supportive Schools There are lots of chances for students in my school to talk with a teacher one on one. Safe & Supportive Schools Safe & Supportive Schools Teachers ask me to work on special classroom projects. Safe & Supportive Schools Safe & Supportive Schools There are lots of chances for students in my school to get involved in sports, clubs, and other activities outside of class. Safe & Supportive Schools Safe & Supportive Schools There are lots of chances to be part of class discussions or activities. Safe & Supportive Schools Safe & Supportive Schools My teacher(s) notices when I am doing a good job and lets me know about it. Safe & Supportive Schools Safe & Supportive Schools The school lets my parents know when I have done something well. Safe & Supportive Schools Safe & Supportive Schools I feel safe at my school. Safe & Supportive Schools Safe & Supportive Schools My teachers praise me when I work hard in school. Safe & Supportive Schools Safe & Supportive Schools How often do you feel that the school work you are assigned is meaningful and important? Safe & Supportive Schools Safe & Supportive Schools How interesting are most of your courses to you? Safe & Supportive Schools Safe & Supportive Schools How important do you think the things you are learning in school are going to be for your later life? Safe & Supportive Schools Safe & Supportive Schools Over the past school year how often did you enjoy being at school? Safe & Supportive Schools Safe & Supportive Schools Over the past school year how often did you hate being at school? Safe & Supportive Schools Safe & Supportive Schools Over the past school year how often did you try to do your best work in school? Safe & Supportive Schools Safe & Supportive Schools Do you agree or disagree that this school has a friendly and welcoming atmosphere? Safe & Supportive Schools Safe & Supportive Schools Do you agree or disagree that you understand the rules for student behavior and conduct at this school? Safe & Supportive Schools Safe & Supportive Schools Do you agree or disagree that this school has clear consequences for breaking the rules? Safe & Supportive Schools Safe & Supportive Schools Do you agree or disagree that staff at this school enforce the rules for student behavior and conduct? Safe & Supportive Schools Safe & Supportive Schools Do you plan on going to college after high school? 13