2005 STEPS

Youth Risk Behavior Survey

This survey is about health behavior. It has been developed so you can tell us

what you do that may affect your health. The information you give will be used to

develop better health education for young people like yourself.

 

DO NOT write your name on this survey. The answers you give will be kept

private. No one will know what you write. Answer the questions based on what

you really do. Completing the survey is voluntary. Whether or not you answer the questions will not affect your grade in this class. If you are not comfortable answering a question, just leave it blank.

 

The questions that ask about your background will be used only to describe the

types of students completing this survey. The information will not be used to find

out your name. No names will ever be reported.

 

Make sure to read every question. Fill in the ovals completely. When you are

finished, follow the instructions of the person giving you the survey.

 

Thank you very much for your help.

 

1. How old are you?

A. 12 years old or younger

B. 13 years old

C. 14 years old

D. 15 years old

E. 16 years old

F. 17 years old

G. 18 years old or older

 

2. What is your sex?

A. Female

B. Male

 

3. In what grade are you?

A. 9th grade

B. 10th grade

C. 11th grade

D. 12th grade

E. Ungraded or other grade

 

4. How do you describe yourself?

(Select one or more responses.)

A. American Indian or Alaska

Native

B. Asian

C. Black or African American

D. Hispanic or Latino

E. Native Hawaiian or Other

Pacific Islander

F. White

 

5. How do you describe your health in

general?

A. Excellent

B. Very good

C. Good

D. Fair

E. Poor

 

6. How tall are you without your shoes

on?

 

7. How much do you weigh without

your shoes on?

 

8. Have you ever tried cigarette

smoking, even one or two puffs?

A. Yes

B. No

 

9. How old were you when you smoked

a whole cigarette for the first time?

A. I have never smoked a whole

cigarette

B. 8 years old or younger

C. 9 or 10 years old

D. 11 or 12 years old

E. 13 or 14 years old

F. 15 or 16 years old

G. 17 years old or older

 

10. During the past 30 days, on how

many days did you smoke cigarettes?

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

 

11. During the past 30 days, on the days

you smoked, how many cigarettes

did you smoke per day?

A. I did not smoke cigarettes

during the past 30 days

B. Less than 1 cigarette per day

C. 1 cigarette per day

D. 2 to 5 cigarettes per day

E. 6 to 10 cigarettes per day

F. 11 to 20 cigarettes per day

G. More than 20 cigarettes per

day

 

12. During the past 30 days, how did

you usually get your own cigarettes?

(Select only one response.)

A. I did not smoke cigarettes

during the past 30 days

B. I bought them in a store such

as a convenience store,

supermarket, discount store,

or gas station

C. I bought them from a vending

machine

D. I gave someone else money

to buy them for me

E. I borrowed (or bummed)

them from someone else

F. A person 18 years old or

older gave them to me

G. I took them from a store or

family member

H. I got them some other way

 

13. During the past 30 days, on how

many days did you smoke cigarettes

on school property?

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

 

14. Have you ever smoked cigarettes

daily, that is, at least one cigarette

every day for 30 days?

A. Yes

B. No

 

15. During the past 12 months, did you

ever try to quit smoking cigarettes?

A. I did not smoke during the

past 12 months

B. Yes

C. No

 

16. During your last check-up, did your

doctor or nurse discuss ways to

avoid tobacco use?

A. Yes

B. No

C. Not sure

 

The next 7 questions ask about body

weight.

 

17. How do you describe your weight?

A. Very underweight

B. Slightly underweight

C. About the right weight

D. Slightly overweight

E. Very overweight

 

18. 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

 

19. During the past 30 days, did you

exercise to lose weight or to keep

from gaining weight?

A. Yes

B. No

 

20. During the past 30 days, did you eat

less food, fewer calories, or foods

low in fat to lose weight or to keep

from gaining weight?

A. Yes

B. No

 

21. During the past 30 days, did you go

without eating for 24 hours or

more (also called fasting) to lose

weight or to keep from gaining

weight?

A. Yes

B. No

 

22. During the past 30 days, did you

take any 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.)

A. Yes

B. No

 

23. During the past 30 days, did you

vomit or take laxatives to lose

weight or to keep from gaining

weight?

A. Yes

B. No

 

The next 6 questions ask about food you

ate or drank during the past 7 days.

Think about all the meals and snacks you

had 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.

 

24. 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.)

A. I did not drink 100% fruit

juice during the past 7 days

B. 1 to 3 times during the past 7

days

C. 4 to 6 times during the past 7

days

D. 1 time per day

E. 2 times per day

F. 3 times per day

G. 4 or more times per day

 

25. During the past 7 days, how many

times did you eat fruit? (Do not

count fruit juice.)

A. I did not eat fruit during the

past 7 days

B. 1 to 3 times during the past 7

days

C. 4 to 6 times during the past 7

days

D. 1 time per day

E. 2 times per day

F. 3 times per day

G. 4 or more times per day

 

26. During the past 7 days, how many

times did you eat green salad?

A. I did not eat green salad

during the past 7 days

B. 1 to 3 times during the past 7

days

C. 4 to 6 times during the past 7

days

D. 1 time per day

E. 2 times per day

F. 3 times per day

G. 4 or more times per day

 

27. During the past 7 days, how many

times did you eat potatoes? (Do not

count french fries, fried potatoes, or

potato chips.)

A. I did not eat potatoes during

the past 7 days

B. 1 to 3 times during the past 7

days

C. 4 to 6 times during the past 7

days

D. 1 time per day

E. 2 times per day

F. 3 times per day

G. 4 or more times per day

 

28. During the past 7 days, how many

times did you eat carrots?

A. I did not eat carrots during

the past 7 days

B. 1 to 3 times during the past 7

days

C. 4 to 6 times during the past 7

days

D. 1 time per day

E. 2 times per day

F. 3 times per day

G. 4 or more times per day

 

29. During the past 7 days, how many

times did you eat other vegetables?

(Do not count green salad, potatoes,

or carrots.)

A. I did not eat other vegetables

during the past 7 days

B. 1 to 3 times during the past 7

days

C. 4 to 6 times during the past 7

days

D. 1 time per day

E. 2 times per day

F. 3 times per day

G. 4 or more times per day

 

The next question asks about the kind of

milk you drink.

 

30. When you drink milk, what kind of

milk do you usually drink? (Select

only one response)

A. I do not drink milk

B. Whole milk

C. 2% milk

D. 1% milk

E. Skim or non-fat milk

F. Not sure

 

The next question asks about soft drinks.

 

31. During the past 30 days, how many

times per day did you usually drink

carbonated soft drinks, such as

Coke?

A. I did not drink carbonated

soft drinks during the past 30

days

B. Less than 1 time per day

C. 1 time per day

D. 2 times per day

E. 3 times per day

F. 4 times per day

G. 5 or more times per day

 

The next question asks about fast food.

 

32. During the past 7 days, on how many

days did you eat at a fast food

restaurant, such as McDonald’s?

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 3 questions ask about food and

nutrition in school.

 

33. During the past 30 days, how often

did you eat lunch at school?

A. Never

B. Rarely

C. Sometimes

D. Most of the time

E. Always

 

34. During this school year, were you

taught in any of your classes the

benefits of eating more fruits and

vegetables?

A. Yes

B. No

C. I do not know

 

35. During this school year, were you

taught in any of your classes how to

make healthy meals and snacks?

A. Yes

B. No

C. I do not know

 

The next 13 questions ask about physical

activity.

 

36. 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?

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

G. 6 days

H. 7 days

 

37. 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?

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

G. 6 days

H. 7 days

 

38. 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 spend in

any kind of physical activity that

increases your heart rate and makes

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

 

39. 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?

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

G. 6 days

H. 7 days

 

40. 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

Nintendo, Game Boy, Play Station,

computer games, 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

 

41. 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

 

42. 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

 

43. 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

 

44. During the past 12 months, on how

many sports teams did you play?

(Include any teams run by your

school or community groups.)

A. 0 teams

B. 1 team

C. 2 teams

D. 3 or more teams

 

45. During the past 30 days, did you see

a doctor or nurse for an injury that

happened while exercising or

playing sports?

A. I did not exercise or play

sports during the past 30 days

B. Yes

C. No

 

46. During this school year, were you

taught in any of your classes the

benefits of physical activity?

A. Yes

B. No

C. I do not know

 

47. During this school year, were you

taught in any of your classes how to

develop a physical fitness plan for

yourself?

A. Yes

B. No

C. I do not know

 

48. During this school year, were you

taught in any of your classes about

opportunities for physical activity in

your community?

A. Yes

B. No

C. I do not know

 

The next 3 questions ask about asthma

and diabetes.

 

49. Has a doctor or nurse ever told you

that you have asthma?

A. Yes

B. No

C. Not sure

 

50. During the past 12 months, have you

had an episode of asthma or an

asthma attack?

A. I do not have asthma

B. No, I have asthma, but I have

not had an episode of asthma

or an asthma attack during

the past 12 months

C. Yes, I have had an episode of

asthma or an asthma attack

during the past 12 months

D. Not sure

 

51. Has a doctor or nurse ever told you

that you have diabetes?

A. Yes

B. No

C. Not sure

 

This is the end of the survey.

Thank you very much for your help.