Georgia Student Health Survey II

Instructions

This survey is designed to collect information about a variety of topics including alcohol, tobacco, and other drugs; school violence; school climate; and nutrition. You must answer every question in each section before you can continue. Once you complete a section, you are not allowed to return. The survey is completely anonymous, so please answer all questions honestly. Thank you for your participation.

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Personal Information

Gender:	Female Male
Ethnicity:	Black or African American Hispanic or Latino White or Caucasian Asian or Pacific Islander Other
Grade:	10th 12th

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School Climate

1. I like school.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
2. I feel successful at school.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
3. I feel my school has high standards for achievement.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
4. My school sets clear rules for behavior.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
5. I know what to do if there is an emergency at my school.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
6. Teachers treat me with respect.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
7. The behaviors in my classroom allow the teacher to teach so I can learn.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
8. Students are frequently recognized for their good behavior.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
9. I feel my school counselor would be helpful to me if I needed assistance.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

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Within the past 30 days I have used…

1. alcohol (wine, wine coolers, beer, liquor)
2. smoking tobacco (cigarettes, cigars, pipes)
3. chewing tobacco (dip, snuff, spit tobacco)
4. marijuana (grass, pot)
5. cocaine (powder, rock, freebase, crack)
6. inhalants (sniffing or huffing glue, solvents, gas)
7. steroids
8. ecstasy
9. methamphetamines (meth, ice, crank)
10. hallucinogens (LSD, mescaline, etc.)
11. prescription medicines that were not prescribed for me

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It is easy to get.…

1. alcohol (wine, wine coolers, beer, liquor)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
2. smoking tobacco (cigarettes, cigars, pipes)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
3. chewing tobacco (dip, snuff, spit tobacco)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
4. marijuana (grass, pot)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
5. cocaine (powder, rock, freebase, crack)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
6. inhalants (sniffing or huffing glue, solvents, gas)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
7. steroids	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
8. ecstasy	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
9. methamphetamines (meth, ice, crank)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
10. hallucinogens (LSD, mescaline, etc.)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
11. prescription medicines that were not prescribed for me	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

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I started using ____ when I was…

1. alcohol (wine, wine coolers, beer, liquor)
2. smoking tobacco (cigarettes, cigars, pipes)
3. chewing tobacco (dip, snuff, spit tobacco)
4. marijuana (grass, pot)
5. cocaine (powder, rock, freebase, crack)
6. inhalants (sniffing or huffing glue, solvents, gas)
7. steroids
8. ecstasy
9. methamphetamines (meth, ice, crank)
10. hallucinogens (LSD, mescaline, etc.)
11. prescription medicines that were not prescribed for me

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I think the following are harmful to my health.

1. alcohol (wine, wine coolers, beer, liquor)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
2. smoking tobacco (cigarettes, cigars, pipes)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
3. chewing tobacco (dip, snuff, spit tobacco)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
4. marijuana (grass, pot)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
5. cocaine (powder, rock, freebase, crack)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
6. inhalants (sniffing or huffing glue, solvents, gas)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
7. steroids	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
8. ecstasy	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
9. methamphetamines (meth, ice, crank)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
10. hallucinogens (LSD, mescaline, etc.)	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
11. prescription medicines that were not prescribed for me	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

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Adults in my life would disapprove if I used…

1. alcohol	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
2. tobacco	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
3. marijuana	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
4. other illegal drugs	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

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My friends would disapprove if I used…

1. alcohol	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
2. tobacco	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
3. marijuana	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
4. other illegal drugs	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

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Where do your friends usually use ____?

(You may mark more than one response for each question)

1. alcohol	Do Not Use At Home At School In a Car Friend’s House Other
2. tobacco	Do Not Use At Home At School In a Car Friend’s House Other
3. marijuana	Do Not Use At Home At School In a Car Friend’s House Other
4. other illegal drugs	Do Not Use At Home At School In a Car Friend’s House Other

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When do your friends usually use ____?

(You may mark more than one response for each question)

1. alcohol	Do Not Use On the Way to School During School On the Way Home From School Week Nights Weekends
2. tobacco	Do Not Use On the Way to School During School On the Way Home From School Week Nights Weekends
3. marijuana	Do Not Use On the Way to School During School On the Way Home From School Week Nights Weekends
4. other illegal drugs	Do Not Use On the Way to School During School On the Way Home From School Week Nights Weekends

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During the past 30 days I…

1. have been bullied or threatened by other students
2. bullied or threatened other students
3. brought a weapon (gun, knife, club) to school
4. have been absent from school because I have felt I would be unsafe at school or on my way to or from school.
5. have participated in illegal gang activities.	Yes No
6. have friends who have participated in illegal gang activities.	Yes No
7. have been picked on or teased at school.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

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Nutrition Information

1. I eat at least three servings of dairy products each day (dairy includes cheese, yogurt, and milk).	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
2. I eat at least five servings of fruits or vegetables each day.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
3. School meals in my school cafeteria are healthy.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
4. Facts about nutrition are available in my school cafeteria.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
5. I eat school lunch three or more times per week.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
6. I make healthy food choices in my school cafeteria.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
7. There are whole wheat and multigrain breads and cereals available in my school cafeteria.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
8. If only healthy snacks and beverages were available in the vending machines during the school day, I would purchase them.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
9. If breakfasts were available at school, but outside the cafeteria, I would eat breakfast at school more often.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

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Student Information

1. I was taught about alcohol, tobacco and other drugs within the last year at school.	Yes No
2. I have been taught about AIDS or HIV infection within the last year at school.	Yes No
3. I have been taught about character education within the last year at school.	Yes No
4. Have you ever thought about dropping out of school?	Yes No
5. If you were going to drop out of school, what would most likely be the reason?	I have not thought about dropping out of school Boring school work Family reasons Being bullied Other
6. Do you know who your Graduation Coach is?	Yes No
7. Have you contacted your Graduation Coach?	Yes No
8. If so, did you receive assistance from your Graduation Coach?	Yes No NA
9. On an average school day, how much unsupervised time do you spend watching TV?	I do not watch TV on an average school day Less than l hour per day l hour per day 2-3 hours per day 4-5 hours per day 6 or more hours per day
10. On an average school day, how much unsupervised time do you spend on the computer?	I do not spend any time on the computer on an average school day Less than l hour per day 1 hour per day 2-3 hours per day 4-5 hours per day 6 or more hours per day
11. I have instant messaged people I do not even know.	Yes No
12. Have you ever smoked a cigarette?	Yes No
13. Have you ever used the drug zenabrillatol (street name ‘ZB’)?	Yes No
14. In the past 30 days I have driven a car or other vehicle while I was drinking alcohol.	Yes No
15. In the past 30 days I have ridden in a car with a driver who had been drinking alcohol.	Yes No
16. I have drunk five or more drinks of alcohol at one sitting during the last 30 days.
17. I get along with other students and adults.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
18. I would help someone who was being bullied.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
19. In Georgia, new drivers who pass their driving test receive a provisional driver’s license. During the first 6 months of driving with a provisional license, the only passengers who can ride with the driver are:	Driver’s parent or guardian Driver’s family members Friends Anyone can ride with a driver who has a provisional driver’s license I don’t know
20. Seventeen year old drivers with a provisional driver’s license cannot drive between the hours of:	Midnight and 6 AM 1 AM and 5 AM 1 AM and 6 AM There is no curfew once you reach the age of 17 I don’t know
21. For drivers age 21 and older, a blood alcohol level of 0.08 or more is considered evidence of “driving under the influence” (DUI). For drivers under age 21, what level of alcohol is considered evidence of DUI?	Any amount, no matter how little 0.02 0.04 0.06 0.08 I don’t know
22. A driver under age 21 automatically loses his or her license if caught exceeding the posted speed limit by:	15 miles per hour or more 25 miles per hour or more 35 miles per hour or more It depends on the judge A driver cannot lose his or her license simply for speeding I don’t know
23. A Georgia teenager with family connections or a good lawyer can break a teen driving law and keep their driver’s license.	Yes No I don’t know
24. I personally know a friend or classmate who broke a Georgia teen driving law, but was allowed to keep his or her driver’s license.	Yes No I don’t know
25. A student under the age of 18 can lose his or her driving privileges if he or she:	Has 10 or more days of unexcused absences in a school year. Drops out of school without graduating. Brings alcohol, drugs, or weapons to school. All of the above.

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Student Information Continued

1. During the past 12 months, I have been offered, sold, or given illegal drugs on school property.	Yes No
2. School is a place at which I feel safe.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
3. During the past 12 months, I harmed myself on purpose.	Yes No
4. During the past 12 months, I seriously considered attempting suicide	Yes No
5. I have attempted suicide in the last year.	Yes No
6. I feel safe at home.	Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree
7. I know an adult at school that I can talk with if I need help.	Yes No

I'm Finished!