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Page 1 of 45
Adolescent Survey
Start of Block: DEMOGRAPHICS
Survey participation is voluntary. You can skip questions you choose not to answer and you can stop
participating at any time.
1. AGE: Youth Risk Behavior Survey (YRBS) 2021
What is your date of birth? MM/DD/YYYY (dropdown responses)
2. SEX: Child Trends
What sex were you assigned at birth, meaning on your original birth certificate?
o Male
o Female
3. GENDER IDENTITY: Child Trends
Which gender do you identify with most?
o Male
o Female
o Different identity (please specify): ________________________________________________
4. ETHNICITY: YRBS 2021
Are you of Hispanic, Latino, or Spanish origin?
o No
o Yes
Page 2 of 45
5. RACE: YRBS 2021
What is your race? Please select all that apply.
▢
▢
▢
▢
▢
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
6. BORN IN U.S.: Joint Advertising Market Research & Studies (JAMRS) Youth Poll 2020
Were you born in the United States (U.S.)?
o No
o Yes
7. ENGLISH PROFICIENCY: YRBS 2021
How well do you speak English?
o Very well
o Well
o Not well
8. EMPLOYMENT STATUS: JAMRS Youth Poll 2020
Are you currently working for pay outside the home, either full-time or part-time?
o No
o Yes
Page 3 of 45
9. IF YES TO EMPLOYMENT: On average, how many total hours per week do you work for pay outside the
home?
o Less than 1 hour
o 1-4 hours
o 5-9 hours
o 10-14 hours
o 15-19 hours
o 20-24 hours
o 25-29 hours
o 30 or more hours
10. HOUSEHOLD COMPOSITION: Family Study Survey
Including yourself, how many people currently live in your household? Please only include people who live and
sleep in your household most of the time. Do not include anyone who does not live or sleep in your
household most of the time, such as visiting relatives. If you live in more than one household, please think
about the household where you spend the most time.
Adults (18 or older):____ Children (17 and younger): ____ (dropdown responses)
Page 4 of 45
11. HOUSEHOLD COMPOSITION: Family Study Survey
Who currently lives in your household most of the time with you? Please select all that apply.
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
Biological father
Biological mother
Adoptive father
Adoptive mother
Foster father
Foster mother
Stepfather
Stepmother
Legal guardian
Brother(s)/Sister(s) (include biological, adoptive, foster, and step siblings)
Grandparent(s)
Other(s) (please specify e.g., aunt, uncle, cousin, friend; do not include any names in your response):
________________________________________________
Page 5 of 45
12. FAMILY MILITARY SERVICE HISTORY: JAMRS Youth Poll 2020
Have any of the following family members ever served in the U.S. military? Please select all that apply.
▢
▢
▢
▢
▢
▢
▢
Father
Mother
Legal guardian
Brother or sister
Grandparent
Uncle or aunt
Cousin
End of Block: DEMOGRAPHICS
Start of Block: PHYSICAL AND PSYCHOLOGICAL HEALTH
The next section of questions is about your health and how you feel about yourself. Please answer as honestly
as you can. There are no right or wrong answers. Your answers are confidential and will not be shared with
anyone outside of the research team.
13. OVERALL HEALTH: Adapted from the National Survey on Drug Use and Health 2020 (NSDUH 2020)
Would you say your health in general is:
o Poor or fair
o Good
o Very good or excellent
Page 6 of 45
14. PUBERTAL DEVELOPMENT: Puberty Development Scale
The questions below are about changes that may be happening to your body. These changes normally happen
to different young people at different ages. Please do your best to answer carefully.
(For boys) Have you noticed a deepening
of your voice?
(For boys) Have you begun to grow hair on
your face?
(For girls) Have you begun to menstruate
(started to have your period)?
No
Yes
o
o
o
o
o
o
15. (For girls) IF YES TO MENSTRUATE: How old were you when you started to menstruate?
____ years old (dropdown response)
16. BODY ESTEEM: Body-Esteem Scale for Adolescents and Adults (BESAA)Below is a list of sentences that
describe how people feel. Read each phrase and decide if it is "Not true or Hardly ever true" or "Somewhat
true or Sometimes true" or "Very true or Often true" for you.
Not true or Hardly
ever true
There are lots of
things I'd change
about my looks if I
could.
I like what I see when
I look in the mirror.
I like what I look like
in pictures.
Somewhat true or
Sometimes true
Very true or Often
true
o
o
o
o
o
o
o
o
o
Page 7 of 45
17. EMOTIONAL SYMPTOMS, CONDUCT PROBLEMS, HYPERACTIVITY, PEER PROBLEMS, AND
PROSOCIAL BEHAVIORS: Strengths and Difficulties Questionnaire (SDQ)
For each item, please mark the box for “Not true,” “Somewhat true,” or “Certainly true.” It would help us if you
answered all items as best you can even if you are not absolutely certain.
During the last 30 days...
Not true
I try to be nice to other
people. I care about their
feelings.
Somewhat true
Certainly true
o
o
o
I have one good friend or
more.
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
I fight a lot. I can make
other people do what I
want.
o
o
o
o
o
o
o
o
o
o
o
o
I am restless, I cannot stay
still for long.
I get a lot of headaches,
stomach-aches or sickness.
I usually share with others,
for example, clothes, food.
I get very angry and often
lose my temper.
I would rather be alone than
with people of my age.
I usually do as I am told.
I worry a lot.
I am helpful if someone is
hurt, upset or feeling ill.
I am constantly fidgeting or
squirming.
I am often unhappy,
depressed or tearful.
Other people my age
generally like me.
I am easily distracted, I find
it difficult to concentrate.
Page 8 of 45
I am nervous in new
situations. I easily lose
confidence.
o
o
o
I am often accused of lying
or cheating.
o
o
o
o
o
o
Other children or young
people pick on me or bully
me.
o
o
o
I often volunteer to help
others (parents, teachers,
children).
o
o
o
I think before I do things.
o
o
o
I take things that are not
mine from home, school or
elsewhere.
o
o
o
I get along better with
adults than with people my
own age.
o
o
o
o
o
o
o
o
o
I am kind to younger
children.
I have many fears, I am
easily scared.
I finish the work I’m doing.
My attention is good.
Page 9 of 45
18. DEPRESSION: Center for Epidemiologic Studies Depression Scale--Revised Version for Adolescents
How often have you experienced each of the following:
Not at all or
less than 1
day in the last
week
My appetite
was poor.
1-2 days in
the last week
3-4 days in
the last week
5-7 days in
the last week
Nearly every
day for 2
weeks
I felt like a
bad person.
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
I lost interest
in my usual
activities.
o
o
o
o
o
I felt like I
was moving
too slowly.
o
o
o
o
o
I was tired all
the time.
o
o
o
o
o
I could not
focus on the
important
things.
o
o
o
o
o
I felt irritable.
o
o
o
o
o
My sleep was
restless.
I felt sad.
Page 10 of 45
19. ANXIETY: Screen for Child Anxiety Related Emotional Disorders (SCARED)
Below is a list of sentences that describe how people feel. Read each phrase and decide if it is “Not true or
Hardly ever true” or “Somewhat true or Sometimes true” or “Very true or Often true” for you. Then, for each
sentence, fill in one circle that corresponds to the response that seems to describe you for the last 30 days.
Not true or Hardly
ever true
Somewhat true or
Sometimes true
Very true or Often
true
When I feel
frightened, it is hard
to breathe.
o
o
o
When I get
frightened, I feel like
passing out.
o
o
o
People tell me that I
look nervous.
o
o
o
When I get
frightened, I feel like
things are not real.
o
o
o
When I get
frightened, my heart
beats fast.
o
o
o
I get shaky.
o
o
o
When I get
frightened, I sweat a
lot.
o
o
o
I get really frightened
for no reason at all.
o
o
o
When I get
frightened, I feel like I
am choking.
o
o
o
I am afraid of having
anxiety (or panic)
attacks.
o
o
o
When I get
frightened, I feel like
throwing up.
o
o
o
When I get
frightened, I feel
dizzy.
o
o
o
Page 11 of 45
20. MEDICATION USE: Family Study Survey
Are you currently taking any prescription medication for anxiety or depression?
o No
o Yes
End of Block: PHYSICAL AND PSYCHOLOGICAL HEALTH
Start of Block: ACADEMICS AND CAREER ASPIRATIONS
The next section of questions is about your experiences in school. If you are not currently in school, please
think about the last school year that you completed. Please include home schooling as well.
21. SCHOOL ATTENDANCE: YRBS 2021
Are you currently attending school?
o No
o Yes
22. GRADE LEVEL: YRBS 2021
What grade are you currently in? If you are not currently in school, what is the last grade that you completed?
o 5th grade or below
o 6th grade
o 7th grade
o 8th grade
o 9th grade
o 10th grade
o 11th grade
o 12th grade
o I am currently attending college.
Page 12 of 45
23. GRADES: YRBS 2021
In general, how would you describe your grades in school?
o Mostly A’s
o Mostly B’s
o Mostly C’s
o Mostly D’s
o Mostly F’s
o My school does not give these grades.
24. SCHOOL ENGAGEMENT: Adapted from NSDUH 2020
How interesting do you think most of your courses at school have been during the last 12 months?
o Very interesting
o Somewhat interesting
o Not interesting
25. SCHOOL ENGAGEMENT: Adapted from NSDUH 2020
During the last 12 months, how often did you feel that the school work you were assigned to do was
meaningful and important?
o Always or Almost always
o Sometimes
o Seldom or Never
Page 13 of 45
26. SCHOOL ENGAGEMENT: Adapted from NSDUH 2020
How important do you think the things you have learned in school during the last 12 months are going to be to
you later in life?
o Very important
o Somewhat important
o Not important
Page 14 of 45
29. CAREER ASPIRATIONS
Do you plan to...
No
Graduate from high
school?
Yes
Not sure
o
o
o
o
o
o
o
o
o
Graduate from a 2year community
college (e.g.,
Associate's degree)?
o
o
o
Graduate from a 4year college or
university (e.g.,
Bachelor's degree)?
o
o
o
Obtain a master's,
doctoral, or
professional degree
(e.g., PhD, MD, JD)?
o
o
o
Start a small business
or take over a family
business?
o
o
o
Become an
entrepreneur?
o
o
o
Pursue a career in
the performing arts
(e.g., dance, music,
entertainment) or in
professional sports?
o
o
o
Join the military?
Graduate from trade
or technical school?
Page 15 of 45
30. TEACHER QUALITY: Adapted from the National Assessment of Educational Progress (NAEP 2016) and
NSDUH 2020
During the last 12 months, how often have you felt any of the following ways about your school?
Never or Hardly ever
About half of the time
All or Almost all of the
time
I felt that I was
treated fairly by my
teachers.
o
o
o
I felt that teachers
encouraged me to do
my best.
o
o
o
My teachers let me
know when I was
doing a good job with
my school work.
o
o
o
31. SCHOOL ENVIRONMENT: Adapted from NAEP 2016
During the last 12 months, how often have you felt any of the following ways about your school?
Never or Hardly ever
About half of the time
All or Almost all of the
time
I felt like I belong at
school.
o
o
o
I looked forward to
going to school in the
morning.
o
o
o
I felt safe at school.
o
o
o
32. MILITARY PEERS: RAND Deployment Life Study
Are you friends with other kids/teens from military families?
o No
o Yes
Page 16 of 45
33. SCHOOL-BASED MENTAL HEALTH SERVICES: Military Community and Family Policy (MC&FP)
Have you ever received any mental health services at school, such as counseling or attending small group
sessions?
o No
o Yes
34. IF YES TO SCHOOL-BASED MENTAL HEALTH SERVICES:
How helpful would you say these services were for you?
o Not helpful
o Somewhat helpful
o Very helpful
35. SCHOOL-BASED SPECIAL NEEDS SERVICES: MC&FP
Have you ever received any services for special medical and/or educational needs at school?
o No
o Yes, I received services for medical needs only.
o Yes, I received services for educational needs only.
o Yes, I received services for both medical and educational needs.
36. IF YES TO SCHOOL-BASED SPECIAL NEEDS SERVICES:
How helpful would you say these services were for you?
o Not helpful
o Somewhat helpful
o Very helpful
Page 17 of 45
37. EXTRACURRICULAR ACTIVITIES: Adapted from NSDUH 2020
During the last 12 months, in how many of the following kinds of activities have you participated?
None
One
Two
Three or more
Activities offered through
the military or at a military
base (e.g., youth center,
open rec, teen center,
sports, classes)?
o
o
o
o
Activities at your school
(e.g., sports, choir, band,
student government, clubs,
Junior ROTC)?
o
o
o
o
Activities in your community
NOT offered through the
military or at your school
(e.g., 4-H, Boys & Girls
Club Mission Youth
Outreach (MYO), YMCA,
volunteering, sports, clubs,
groups)?
o
o
o
o
Activities at a church or
faith-based organization
(e.g., clubs, youth groups,
Saturday or Sunday school,
prayer groups, youth trips,
service or volunteer
activities)?
o
o
o
o
Other activities NOT offered
through the military, at your
school, in your community,
or at a church or faith-based
organization (e.g., dance,
piano, karate, horseback
riding lessons)?
o
o
o
o
Page 18 of 45
IF >NONE TO SCHOOL ACTIVITIES:
Are you currently enrolled in the Junior Reserve Officers’ Training Corps (JROTC) program?
o No
o Yes
38. IF >NONE TO MILITARY ACTIVITIES:
Which of the following installation facilities have you visited, services have you used, or activities and programs
have you participated in?
Page 19 of 45
No
Youth Center
Yes
o
o
o
o
o
o
o
o
o
o
o
o
STEM programs (e.g.,
National Science Day,
robotics camp)
o
o
Health and wellness programs
(e.g., cooking class, Smart
Girls, Passport to Manhood)
o
o
Leadership and service
programs (e.g., community
service, keystone or torch
clubs, teen council,
sponsorship)
o
o
Education and career
programs (e.g., homework
assistance, college fair,
volunteering, job assistance)
o
o
Sports and recreation
programs (e.g., fun runs, sport
camps, dances)
o
o
Arts programs (e.g., fine arts
exhibits, field trip to museum
or theater, talent show)
o
o
Camps (e.g., Operation
Purple, Teen Adventure,
sports, specialty and
leadership)
o
o
Morale, Welfare, and
Recreation (MWR) (e.g.,
outdoor recreation, library,
fitness center, golf, bowling)
o
o
Teen Center
Computer or Internet Service
Sports (e.g., baseball,
basketball, cheerleading)
Classes (e.g., dance, martial
arts, music)
4-H Clubs
Page 20 of 45
39. IF >NONE TO MILITARY ACTIVITIES:
Do you feel your participation in activities offered through the military or at a military base during the last 12
months helped you to...
No
Be more confident?
Yes
o
o
o
Make new friends?
Feel like you belong to a
larger group?
o
o
o
End of Block: ACADEMICS AND CAREER ASPIRATIONS
Start of Block: MILITARY AND GENERAL LIFE EXPERIENCES
The next section is about your experiences being connected to the military. Please be as honest as you can.
There are no right or wrong answers. Your answers are confidential and no one will see your responses
outside of the research team.
40.
Have you ever experienced any of
the following because of your
parent's job in the U.S. military?
No
You moved to a
new home.
Yes
IF YES: Has this happened during
the last 12 months?
No
Yes
o
o
o
o
o
o
o
o
Your military
parent was away
from home for
more than 30
consecutive
days.
o
o
o
o
Your military
parent was
discharged or
retired from the
military.
o
o
o
o
You changed
schools.
Page 21 of 45
41. IF YES TO EVER CHANGED SCHOOLS:
The last time you changed schools because of your parent's job in the U.S. military, how easy was it for you
to...
Not easy
Fit in at your new
school?
Somewhat easy
Very easy
Make friends at your
new school?
o
o
o
o
o
o
Keep up with the
school work at your
new school?
o
o
o
42. IF YES TO MILITARY PARENT EVER AWAY FROM HOME:
Overall, how stressful was it to have your military parent away from home?
o Not stressful
o Somewhat stressful
o Very stressful
43. IMPACT OF MILITARY EXPERIENCES:
Has being connected to the military had a positive or negative impact on the following aspects of your life:
Negative impact
Positive impact
No impact
Your friendships?
o
o
o
Feeling like you
belong at your
school?
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Your grades in
school?
Your relationship with
your teachers?
Your physical health?
Your mental health?
Page 22 of 45
44. MILITARY FAMILY PRIDE: RAND Deployment Life Study
How true is the following statement about being in a military family? If your parent(s) is not currently in the U.S.
military, think about how you felt when they were in the U.S. military.
I am glad to be a part of a military family.
o Not true or Hardly ever true
o Somewhat true or Sometimes true
o Very true or Often true
45. MILITARY FEELINGS AND SUPPORT: Family Study Survey
How do you feel about your parent(s) being in the U.S. military? If your parent(s) is not currently in the
U.S. military, think about how you felt when they were in the U.S. military.
o Very happy about it
o Somewhat happy about it
o Not happy about it
46. MILITARY FEELINGS AND SUPPORT: Family Study Survey
Do you think your parent(s) should stay or leave the U.S. military? If your parent(s) is not currently in the U.S.
military, think about how you felt when they were in the U.S. military.
o I favor staying
o I have no opinion one way or the other
o I favor leaving
47. CAREGIVING: National Alliance for Caregiving Youth Study
During the last 12 months, have you helped care for any of the following people in your household who are
Page 23 of 45
sick, elderly, frail, disabled, or mentally ill? This may include help with personal needs, meals, household
chores, shopping, paperwork, medication, getting around, or providing emotional support.
Your father
Your mother
Your brother(s)/sister(s)
Your grandparent(s)
Other (please specify e.g., aunt, uncle, cousin, friend; do
not include any names in your response):
____________________________
No
Yes
o
o
o
o
o
o
o
o
o
o
48. IF YES TO CAREGIVING:
Overall, how stressful is it to help care for this person/people in your household?
o Not stressful
o Somewhat stressful
o Very stressful
End of Block: MILITARY AND GENERAL LIFE EXPERIENCES
Start of Block: BEHAVIORAL HEALTH
This section contains questions about your health behaviors. There are no right or wrong answers. Your
responses are confidential and will not be shared with anyone outside of the study team.
The next questions ask about drinking alcohol, which includes beer, wine, flavored alcoholic beverages, and
liquor such as rum, gin, vodka, or whiskey. For these questions, drinking alcohol does not include drinking a
few sips of wine for religious purposes.
49. ALCOHOL USE: YRBS 2021
Have you ever had a drink of alcohol other than a few sips?
o No [SKIP TO CIGARETTE USE SECTION]
o Yes
Page 24 of 45
50. ALCOHOL USE AGE: YRBS 2021
How old were you when you had your first drink of alcohol other than a few sips?
o 8 years old or younger
o 9 years old
o 10 years old
o 11 years old
o 12 years old
o 13 years old
o 14 years old
o 15 years old
o 16 years old
o 17 years old or older
51. ALCOHOL USE FREQUENCY: YRBS 2021
During the last 30 days, on how many days did you have at least one drink of alcohol?
o I did not drink alcohol during the last 30 days. [SKIP TO CIGARETTE USE SECTION]
o 1 or 2 days
o 3 to 5 days
o 6 to 9 days
o 10 to 19 days
o 20 to 29 days
o All 30 days
Page 25 of 45
52. BINGE DRINKING: YRBS 2021
During the last 30 days, on how many days did you have 4 or more drinks of alcohol in a row, within a couple
of hours (if you are female), or 5 or more drinks of alcohol in a row, within a couple of hours (if you are male)?
o 0 days
o 1 day
o 2 days
o 3 to 5 days
o 6 to 9 days
o 10 to 19 days
o 20 or more days
53. CIGARETTE USE: YRBS 2021
Have you ever tried cigarette smoking, even one or two puffs?
o No [SKIP TO ELECTRONIC VAPOR USE SECTION]
o Yes
Page 26 of 45
54. CIGARETTE USE AGE: YRBS 2021
How old were you when you first tried cigarette smoking, even one or two puffs?
o 8 years old or younger
o 9 years old
o 10 years old
o 11 years old
o 12 years old
o 13 years old
o 14 years old
o 15 years old
o 16 years old
o 17 years old or older
55. CIGARETTE USE FREQUENCY: YRBS 2021
During the last 30 days, on how many days did you smoke cigarettes?
o I did not smoke cigarettes during the last 30 days. [SKIP TO ELECTRONIC VAPOR USE SECTION]
o 1 or 2 days
o 3 to 5 days
o 6 to 9 days
o 10 to 19 days
o 20 to 29 days
o All 30 days
Page 27 of 45
56. CIGARETTE USE INTENSITY: YRBS 2021
During the last 30 days, on the days you smoked, about how many cigarettes did you smoke per day?
o Less than 1 cigarette per day
o 1 cigarette per day
o 2 to 5 cigarettes per day
o 6 to 10 cigarettes per day
o 11 to 20 cigarettes per day
o More than 20 cigarettes per day
57. ELECTRONIC VAPOR USE FREQUENCY: YRBS 2021
During the last 30 days, on how many days did you use an electronic vapor product, such as JUUL, SMOK,
Suorin, Vuse, and blu? Electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, e-hookahs,
hookah pens, and mods.
o I did not use an electronic vapor product during the last 30 days.
o 1 or 2 days
o 3 to 5 days
o 6 to 9 days
o 10 to 19 days
o 20 to 29 days
o All 30 days
Page 28 of 45
58. OTHER TOBACCO USE FREQUENCY: YRBS 2021
During the last 30 days, on how many days did you use smokeless tobacco (chewing tobacco, snuff, dip, snus,
or dissolvable tobacco products), cigars (including little cigars or cigarillos), shisha or hookah tobacco, or pipe
tobacco? (Do not count any electronic vapor products.)
o I did not use smokeless tobacco, cigars, shisha or hookah tobacco, or pipe tobacco during the last 30
days.
o 1 or 2 days
o 3 to 5 days
o 6 to 9 days
o 10 to 19 days
o 20 to 29 days
o All 30 days
The next questions ask about marijuana use, which is also called pot or weed. For these questions, do not
count CBD-only or hemp products, which come from the same plant as marijuana, but do not cause a high
when used alone.
59. MARIJUANA USE AGE: YRBS 2021
Have you ever tried marijuana?
o No [SKIP TO PRESCRIPTION DRUG MISUSE SECTION]
o Yes
Page 29 of 45
60. MARIJUANA USE AGE: YRBS 2021
How old were you when you tried marijuana for the first time?
o 8 years old or younger
o 9 years old
o 10 years old
o 11 years old
o 12 years old
o 13 years old
o 14 years old
o 15 years old
o 16 years old
o 17 years old or older
61. MARIJUANA USE FREQUENCY: YRBS 2021
During the last 30 days, how many times did you use marijuana?
o I did not use marijuana during the last 30 days.
o 1 or 2 times
o 3 to 9 times
o 10 to 19 times
o 20 to 39 times
o 40 or more times
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62. PRESCRIPTION DRUG MISUSE FREQUENCY: YRBS 2021
During the last 30 days, how many times did you take prescription pain medicine, such as codeine, Vicodin,
OxyContin, Hydrocodone, and Percocet, without a doctor's prescription or differently than how a doctor told
you to use it?
o I did not take prescription pain medicine during the last 30 days.
o 1 or 2 times
o 3 to 9 times
o 10 to 19 times
o 20 to 39 times
o 40 or more times
63. SEXUAL INTERCOURSE: YRBS 2021
Have you ever had sexual intercourse?
o No [SKIP TO SEXUAL CONTACT SECTION]
o Yes
64. SEXUAL INTERCOURSE AGE: YRBS 2021
How old were you when you had sexual intercourse for the first time?
o 11 years old or younger
o 12 years old
o 13 years old
o 14 years old
o 15 years old
o 16 years old
o 17 years old or older
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65. SEXUAL INTERCOURSE PARTNERS: YRBS 2021
During your life, with how many people have you had sexual intercourse?
o 1 person
o 2 people
o 3 people
o 4 people
o 5 people
o 6 or more people
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66. SEXUAL CONTACT: YRBS 2021
During your life, with whom have you had sexual contact?
o I have never had sexual contact
o Males
o Females
o Males and females
67. SEXUAL IDENTITY: YRBS 2021
Which of the following best describes you?
o Heterosexual (straight)
o Gay or lesbian
o Bisexual
o I describe my sexual identity some other way (please specify): ________________________________
o I am not sure about my sexual identity (questioning)
o I do not know what this question is asking
68. SLEEP: YRBS 2021
On an average night, how many hours of sleep do you get?
o 4 or less hours
o 5 hours
o 6 hours
o 7 hours
o 8 hours
o 9 hours
o 10 or more hours
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69. PHYSICAL ACTIVITY: YRBS 2021
During the last 7 days, on how many days were you physically active for a total of at least 60 minutes per day?
(Add up all the time you spent in any kind of physical activity that increased your heart rate and made you
breathe hard some of the time.)
o 0 days
o 1 day
o 2 days
o 3 days
o 4 days
o 5 days
o 6 days
o 7 days
70. SEDENTARY BEHAVIORS: YRBS 2021
On an average day, how many hours do you spend in front of a TV, computer, smart phone, or other electronic
device watching shows or videos, playing games, accessing the Internet, or using social media (also called
"screen time")? (Do not count time spent doing schoolwork.)
o Less than 1 hour per day
o 1 hour per day
o 2 hours per day
o 3 hours per day
o 4 hours per day
o 5 or more hours per day
End of Block: BEHAVIORAL HEALTH
Start of Block: YOUTH RESILIENCE FACTORS
The next set of questions is about how you feel about yourself and how you deal with stress. Please answer
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these items as honestly as you can. There are no right or wrong answers. Your responses will be kept
confidential and will not be shared with anyone outside of the study team.
71. MASCULINE EXPRESSION: Maryland Adolescent Development in Context Study (MADICS)
Please rate your opinion of the following statements about yourself.
Very masculine
I feel as though I am...
I look as though I am...
Other people see me as...
Somewhat masculine
o
o
o
o
o
o
Not at all masculine
o
o
o
72. FEMININE EXPRESSION: MADICS
Very feminine
I feel as though I am...
I look as though I am...
Other people see me as...
o
o
o
Somewhat feminine
o
o
o
Not at all feminine
o
o
o
73. SELF-ESTEEM: Rosenberg Self-Esteem Scale
How true is each of the following statements?
Not true or Hardly
ever true
On the whole, I am
satisfied with myself.
I feel that I have a number
of good qualities.
I take a positive attitude
toward myself.
o
o
o
Somewhat true or
Sometimes true
o
o
o
Very true or Often
true
o
o
o
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74. EMPATHY: Adolescent Measure of Empathy and Sympathy (AMES)
For each statement below, please indicate how often this occurs.
Never or Hardly ever
Sometimes
Often or Very often
When my friend is
sad, I become sad
too.
o
o
o
I can tell when a
friend is angry even if
they try to hide it.
o
o
o
When a friend is
scared, I feel afraid.
o
o
o
I can tell when
someone acts happy,
when they actually
are not.
o
o
o
When people around
me are nervous, I
become nervous too.
o
o
o
75. CHARACTER: Positive Youth Development (PYD) Questionnaire
How important is each of the following to you?
Not important or A
little important
Moderately or
Somewhat important
Important or Very
important
Helping to make the
world a better place
to live in.
o
o
o
Helping to make sure
all people are treated
fairly.
o
o
o
Standing up for what I
believe, even when
it’s unpopular to do.
o
o
o
Telling the truth, even
when it’s not easy.
o
o
o
Accepting
responsibility for my
actions when I make
a mistake or get in
trouble.
o
o
o
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76. RELIGIOSITY: Adapted from NSDUH 2020
During the last 12 months, how many times did you attend religious services? Please do not include special
occasions such as weddings, funerals, or other special events in your answer.
o 0 times
o 1 to 2 times
o 3 to 5 times
o 6 to 24 times
o 25 to 52 times
o More than 52 times
End of Block: YOUTH RESILIENCE FACTORS
Start of Block: PARENT-ADOLESCENT RELATIONSHIP
The next set of questions is about your relationship with your parent(s).
77. RULE/BOUNDARY SETTING: Adapted from NSDUH 2020
During the last 12 months, how often did your parent(s)...
Never or Rarely
Sometimes
Most of the time or
Always
Check on whether you
had done your
homework?
o
o
o
Provide help with your
homework when you
needed it?
o
o
o
Limit the amount of time
you watched TV?
o
o
o
Limit the amount of time
you went out with
friends?
o
o
o
Make you do chores
around the house?
o
o
o
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78. MONITORING/SUPERVISION: Adapted from Monitoring the Future 2018
During the course of a typical day, how often do your parent(s)...
Never or Rarely
Most of the time or
Always
Sometimes
Know where you are
when you are away from
home?
o
o
o
Know whom you are with
when you are away from
home?
o
o
o
Know what you are
doing when you are
away from home?
o
o
o
79. DECISION MAKING/AUTONOMY GRANTING: MADICS
How do you and your parent(s) make most of the decisions about the following topics:
My parent(s) decide
without talking to me
about it
How late you can stay
out at night?
Which friends you can
spend time with?
Whether you can date?
o
o
o
My parents and I decide
together
o
o
o
I decide without talking to
my parent(s) about it
o
o
o
80. PARENTAL RELATIONSHIP QUALITY: Adapted from NIH Toolbox
How true is each of the following statements about your relationship with your parent(s)? Note: If more than
one parent is enrolled in the study, the adolescent will be asked to think about each parent separately using a
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name code (e.g., second and third letters of parent’s given first name and their birth month and day) to
distinguish each parent.
Not true or Hardly
ever true
Somewhat true or
Sometimes true
Very true or Often
true
I enjoy doing things
with [parent].
o
o
o
I share ideas and talk
about things that
really matter with
[parent].
o
o
o
I feel close to
[parent].
o
o
o
81. COMMUNICATION: Adapted from PROMIS Family Relationships
How true is each of the following statements about your relationship with your parent(s)? Note: If more than
one parent is enrolled in the study, the adolescent will be asked to think about each parent separately using a
name code (e.g., second and third letters of parent’s given first name and their birth month and day) to
distinguish each parent.
Not true or Hardly
ever true
I can tell [parent] how
I feel about things.
[Parent] listens to me.
I can talk to [parent]
about my problems.
o
o
o
Somewhat true or
Sometimes true
o
o
o
Very true or Often
true
o
o
o
82. CONFLICT: Adapted from NSDUH 2020
During the last 12 months, how many times have you argued or had a fight with [parent]? Note: If more than
one parent is enrolled in the study, the adolescent will be asked to think about each parent separately using a
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name code (e.g., second and third letters of parent’s given first name and their birth month and day) to
distinguish each parent.
o 0 times
o 1 or 2 times
o 3 to 5 times
o 6 to 9 times
o 10 or more times
End of Block: PARENT-ADOLESCENT RELATIONSHIP
Start of Block: PEER, DATING PARTNER, AND SIBLING RELATIONSHIPS
This section is about your relationships with your friends, dating partners, and sibling(s). Please answer each
question as honestly as you can. There are no right or wrong answers. Your responses are confidential and
will not be shared with anyone outside of the research team.
83. BULLYING VICTIMIZATION AND PERPETRATION: Olweus Bullying Questionnaire
The next questions are about bullying, which could include calling other kids/teens mean names, making fun of
them, or teasing them in a hurtful way; hitting, kicking, punching, or shoving other kids/teens; telling lies or
spreading false rumors about other kids/teens; trying to get other kids/teens to fight or dislike someone; and
being ignored or excluded from activities on purpose by other kids/teens. Bullying can happen in person or
electronically through texting or social media.
During the last 30 days...
Never
1 or 2 times
3 or 4 times
5 or more times
How often have
you been bullied
by other
kids/teens your
age?
o
o
o
o
How often have
you bullied other
kids/teens your
age?
o
o
o
o
PEER RELATIONSHIPS: Network of Relationships Inventory (NRI-RQV)
Please think about the person whom you consider to be your best or closest friend when answering the next
set of questions. Do not choose a sibling.
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84. PEER SEX
Is your best or closest friend...?
o Male
o Female
o Person self-identifies as something other than male or female
o I don't have a best or closest friend. [SKIP TO DATING PARTNER RELATIONSHIP SECTION]
85. How long have you been friends with this person?
o Less than 1 year
o 1-5 years
o 6-10 years
o More than 10 years
86. PEER RELATIONSHIP QUALITY: NRI-RQV
During the last 30 days, how often did you...
Never or Hardly ever
Sometimes
Often or Very often
Go places and do
things with your best
or closest friend?
o
o
o
Share secrets and
private feelings with
your best or closest
friend?
o
o
o
Depend on your best
or closest friend for
help with a personal
problem?
o
o
o
Argue with your best
or closest friend?
o
o
o
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87. DATING RELATIONSHIPS
Have you ever been in a dating relationship (i.e., had a boyfriend or girlfriend)?
o No [SKIP TO SIBLING RELATIONSHIP SECTION]
o Yes
88. CURRENT DATING RELATIONSHIP
Are you currently in a dating relationship (i.e., have a boyfriend or girlfriend)?
o No [SKIP TO SIBLING RELATIONSHIP SECTION]
o Yes
89. DATING PARTNER SEX
Is this person...?
o Male
o Female
o Person self-identifies as something other than male or female
90. CURRENT DATING RELATIONSHIP LENGTH
How long have you been in a relationship with this person?
o Less than 1 month
o 1-3 months
o 4-6 months
o 7-9 months
o 10-12 months
o More than 12 months
When answering the next questions, please think about the person with whom you are currently in a dating
relationship.
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91. DATING PARTNER RELATIONSHIP QUALITY: NRI-RQV
How often do you...
Never or Hardly ever
Sometimes
Often or Very often
Go places and do
things with this
person?
o
o
o
Share secrets and
private feelings with
this person?
o
o
o
Depend on this
person for help with a
personal problem?
o
o
o
Argue with this
person?
o
o
o
92. SIBLING RELATIONSHIPS
Do you have any siblings (i.e., brothers or sisters)?
o No [END SURVEY]
o Yes
93. NUMBER OF SIBLINGS
How many siblings (i.e., brothers or sisters) do you have?
o1
o2
o3
o4
o 5 or more
IF MORE THAN ONE SIBLING: Please think of the sibling who is closest in age to you when responding to the
following questions.
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94. SIBLING AGE
How old is your sibling?
o 5 years old or younger
o 6-10 years old
o 11-12 years old
o 13-14 years old
o 15-17 years old
o 18 years old or older
95. SIBLING SEX
Is your sibling...?
o Male
o Female
o Person self-identifies as something other than male or female
96. SIBLING SCHOOL
Do you and your sibling currently attend the same school? If you are not currently in school, think about the
last school year that you completed.
o No
o Yes
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97. SIBLING RELATIONSHIP QUALITY: NRI-RQV
During the last 30 days, how often did you...
Never or Hardly ever
Sometimes
Often or Very often
Spend time with your
sibling alone or with
the same group of
friends?
o
o
o
Share secrets and
private feelings with
your sibling?
o
o
o
Depend on your
sibling for help with a
personal problem?
o
o
o
Argue with your
sibling?
o
o
o
End of Block: PEER, DATING PARTNER, AND SIBLING RELATIONSHIPS
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| File Type | application/pdf |
| File Title | Adolescent Survey |
| Author | Qualtrics |
| File Modified | 2022-01-19 |
| File Created | 2021-10-15 |