SOAR Adolescent Follow Up Survey

OMB CONTROL NUMBER: 0704-0635
OMB EXPIRATION DATE: XX/XX/XXXX

2024 SOAR Adolescent Follow Up Survey
The 2024 Adolescent Follow-Up Survey is web-only. This paper survey
was designed to provide the study team with an operational document as is
not intended to be completed by participants or to serve as a substitute for
the experience of completing the web-survey.
The web-survey uses numerous skip patterns and allows for
personalization of questions. By tailoring the survey to each participant’s
particular situation, we hope to increase the quality of the data collected
and to enhance the user experience.
Italicized text is instructional only and will not appear on the survey.
Blue text indicates skip patterns within the survey and will not appear on
the survey.
Purple text indicates the standardized instruments and measures from
which the survey questions were sourced and will not appear on the
survey.

Privacy Act Statement
You have rights under the Privacy Act.
The following statement describes how that Act applies to this study:
Authority: 32 CFR Part 219, Protection of Human Subjects; 45 CFR Part 46, Protection of Human
Subjects; DoDD 3216.02, "Protection of Human Subjects and Adherence to Ethical Standards in DoDSupported Research," March 25, 2002; 45 CFR Parts 160 and 164, Health Insurance Portability and
Accountability Act (HIPAA) Privacy and Security Rules; and E.O. 9397 (SSN), as amended. Authority to
request this information is granted under Title 5, U.S. Code 136, Department of Defense Regulations,
Executive Order 9396. Personal identifiers will be used to link survey data with medical and other military records.
Purpose: Information is collected to enhance basic medical knowledge, or develop tests, procedures,
and equipment to improve diagnosis, treatment, or prevention of illness, injury, or performance
impairment under research protocol NHRC.2021.0018, entitled "Millennium Cohort Study of Adolescent
Resilience (SOAR)," which includes the adolescent component.
Routine Uses: The information provided in this questionnaire will be maintained in data files at the
Deployment Health Research Department at the Naval Health Research Center and used only for
medical research purposes. Use of these data may be granted to other federal and non-federal medical
research agencies as approved by the Naval Health Research Center's Institutional Review Board. In
addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, the
DoD "Blanket Routine uses" under 5 U.S.C. 552a(b)(3) apply to this collection. Medical research
information will be used for analysis and reports by the Department of the Navy and Defense, and other
U.S. Government agencies, provided this use is compatible with the purpose for which the information
was collected. Use of the information may be granted to non-Government agencies or individuals by the
Navy Surgeon General following the provisions of the Freedom of Information Act or as may be indicated
in the accompanying Informed Consent Form.
Anonymity: All responses will be held in confidence by the Deployment Health Research Department.
Information you provide will be considered only when statistically summarized with the responses of
others. Your personal identifiers (name, etc.) will only be used to link data sets and then the identifiers will
be stripped from study data such that medical researchers cannot identify you individually.
Voluntary Disclosure: Completion of the questionnaire is voluntary. Failure to respond to any of the
questions will NOT result in any disadvantages or penalties except possible lack of representation of your
views in the final results and outcomes.
PUBLIC BURDEN STATEMENT: Public reporting burden for this collection of information is estimated at
30 minutes. Comments on the burden or content of the instrument should be sent to the Millennium
Cohort Study of Adolescent Resilience (SOAR) team, PO Box 503310, San Diego, CA 92150. Under 5
CFR 1320.5(b), an Agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless the collection displays a valid control number.

2|Study of Adolescent Resilience (SOAR) Follow-Up Survey

Start of Block: LIVING SITUATION
Thank you for participating in this study. Survey participation is voluntary. You can skip any
questions you choose not to answer, and you can stop participating at any time.
Throughout the survey, we have used a 6-digit name code to identify your parent(s). This name
code uses the second and third letters of this person's given first name and their month and day
of birth. Please think about this person when responding to items using their name code.
1. Do you live with [MilCo Parent Name Code]?
• No
• Yes
2. IF ‘YES’ TO OTHER PARENT FROM P1 BASELINE: Do you live with your other parent,
[Other Parent Name Code]?
• No
• Yes
a. IF ‘NO’ TO LIVING WITH P1 AND P2: Who do you live with?
•
I live alone.
•
Roommate(s)
•
Relative(s)
•
Other (Please do not include any names): ____________
3. Is [MilCo Parent Name Code] currently in the military?
• No [GO TO 3A]
• Yes, Active Duty (Navy, Army, Marines, Coast Guard, Air Force, Space Force)
[GO TO 3B]
• Yes, Reserve or National Guard [GO TO 3B]
• I don’t know [GO TO 3B]
[IF MISSING, GO TO 3B]
a. Did [MilCo Parent Name Code] get out of the military (retired or discharged) recently,
that is, since you completed your last survey [insert date]?
• No [GO TO 8B]
• Yes [GO TO 3B]
b. Since your last survey on [insert date], have you experienced any of the following
because of your parent's job in the U.S. military?
You moved to a new home.
You changed schools.

No

o
o

Yes

3|Study of Adolescent Resilience (SOAR) Follow-Up Survey

o
o

[MilCo Parent name code] was away from home for
more than 30 consecutive days.

o

o

4. IF ‘YES’ TO CHANGED SCHOOLS: After you changed schools, how easy was it for you
to...
Not easy
Fit in at your new school?
Make friends at your new
school?
Keep up with the school
work at your new school?

Somewhat easy

Very easy

o

o

o

o

o

o

o

o

o

a. IF ‘YES’ TO CHANGED SCHOOLS: After you changed schools, did you connect
with a school military liaison (i.e., someone that helps with school transitions for
military kids)?
• Yes, someone contacted me.
• Yes, I reached out or my family reached out for help.
• No, I didn’t want help.
• I didn’t know about this person.
• I don’t think there was this resource available.
5. IF ‘YES’ TO MILCO PARENT AWAY FROM HOME: How stressful was it to have [MilCo
parent name code] away from home?
• Not at all stressful
• Slightly stressful
• Moderately stressful
• Very stressful
6. IF ‘YES’ TO MILCO PARENT AWAY FROM HOME: How stressful was your reunion
with [MilCo parent name code] when they came back from being away for military
duties?
• Not at all stressful
• Slightly stressful
• Moderately stressful
• Very stressful

4|Study of Adolescent Resilience (SOAR) Follow-Up Survey

7. IF ‘YES’ TO PARENT SEPARATED FROM MILITARY SINCE LAST SURVEY: How
stressful was it for you when your parent got out of the military?
• Not at all stressful
• Slightly stressful
• Moderately stressful
• Very stressful
8. MILITARY FEELINGS AND SUPPORT: Family Study Survey
a. IF ‘YES’ TO #3 PARENT STILL IN THE MILITARY: Do you think [MilCo Parent
Name Code] should stay or leave the U.S. military?
• I favor staying.
• I favor leaving.
• I have no opinion one way or the other.
b. IF ‘NO’ to #3: Think about how you felt when [MilCo Parent Name Code] was in
the U.S. military. Did you think they should stay or leave the U.S. military?
• I favored staying.
• I favored leaving.
• I had no opinion one way or the other.
• I don’t remember my parent serving in the U.S. military.
c. IF ‘I FAVOR STAYING’ OR ‘I FAVOR LEAVING’ TO 8a OR 8b: If you’d like to
comment, we’d love to know more about why you favor staying or favor leaving the
military. Please do not include any identifying information, such as people’s names,
in your response.

9. PARENT RELATIONSHIP STATUS
Since your last survey on [insert date], did your parents separate or divorce?
•
No
•
Yes
10. Since your last survey on [insert date], did either parent remarry?
• No
• Yes

5|Study of Adolescent Resilience (SOAR) Follow-Up Survey

11. Since your last survey on [insert date], were any new children added to your family
because of adoption, new birth, or new blended family?
• No
• Yes
12. If there have been any changes to your living situation that we haven’t addressed in this
section, please feel free to comment here. Do not include any identifying information,
such as people’s names, in your response.

End of Block: LIVING SITUATION
Start of Block: DEMOGRAPHICS
13. GENDER IDENTITY: Adapted from Child Trends
How would you describe your current gender?
• Male
• Female
• Transgender, male to female
• Transgender, female to male
• Something else (please specify):_______________________
• Prefer not to answer
14. EMPLOYMENT STATUS: JAMRS Youth Poll 2020
IF AGES 16+: Are you currently working for pay outside the home, either full-time or
part-time?
• No
• Yes
a. IF ‘YES’ TO WORKING: On average, how many total hours per week do you work
for pay outside the home?
• Less than 1 hour
• 1-4 hours
• 5-9 hours
• 10-14 hours
• 15-19 hours
• 20-24 hours
• 25-29 hours
• 30 or more hours

6|Study of Adolescent Resilience (SOAR) Follow-Up Survey

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.
15. OVERALL HEALTH: Adapted from the National Survey on Drug Use and Health 2020
(NSDUH 2020)
In general, would you say your health is:
• Poor or Fair
• Good
• Very good or Excellent
16. Are you taking any prescription medication for ADD or ADHD?
• No
• Yes
17. Are you taking any prescription medication for anxiety or depression?
• No
• Yes
18. 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

7|Study of Adolescent Resilience (SOAR) Follow-Up Survey

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

Somewhat true or
Sometimes true

Very true or
Often true

There are lots of things
I'd change about my
looks if I could.

o

o

o

I like what I see when I
look in the mirror.

o

o

o

I like what I look like in
pictures.

o

o

o

19. EMOTIONAL SYMPTOMS, CONDUCT PROBLEMS, HYPERACTIVITY, PEER
PROBLEMS, AND PROSOCIAL BEHAVIORS: Strengths and Difficulties Questionnaire
(SDQ) S11-17
IF AGES 11-17:
Please give your answers on the basis of how things have been for you over the last 30 days...

8|Study of Adolescent Resilience (SOAR) Follow-Up Survey

Not true

Somewhat true

Certainly true

I try to be nice to other people. I
care about their feelings.

o

o

o

I am restless, I cannot stay still
for long.

o

o

o

I get a lot of headaches,
stomach-aches, or sickness.

o

o

o

I usually share with others, for
example, clothes, food.

o

o

o

I get very angry and often lose
my temper.

o

o

o

I would rather be alone than with
people of my age.

o

o

o

I usually do as I am told.

o

o

I worry a lot.

o

o

I am helpful if someone is hurt,
upset, or feeling ill.

o

o

o

I am constantly fidgeting or
squirming.

o

o

o

I have one good friend or more.

o

o

o

I fight a lot. I can make other
people do what I want.

o

o

o

I am often unhappy, depressed,
or tearful.

o

o

o

Other people my age generally
like me.

o

o

o

9|Study of Adolescent Resilience (SOAR) Follow-Up Survey

o

o

I am easily distracted; I find it
difficult to concentrate.

o

o

o

I am nervous in new situations. I
easily lose confidence.

o

o

o

I am kind to younger children.

o

o

o

Other children or young people
pick on me or bully me.

o

o

o

I often offer 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

I have many fears, I am easily
scared.

o

o

o

I finish the work I was doing. My
attention is good.

o

o

o

o

I am often accused of lying or
cheating.

o

o

20. ANXIETY: Generalized Anxiety Disorder Screen (GAD-2)
Over the last 2 weeks, how often have you been bothered by the following problems?
Not at all

Feeling nervous, anxious,
or on edge

o

Several
days

o

More than
half the
days

o

Nearly every
day

o

10 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

Not being able to stop or
control worrying

o

o

o

o

21. DEPRESSION: Patient Health Questionnaire (PHQ-2)
Over the last 2 weeks, how often have you been bothered by the following problems?
Not at all

Little interest or pleasure in
doing things
Feeling down, depressed
irritable or hopeless

o
o

Several
days

o
o

More than
half the
days

Nearly
every day

o

o

o

o

22. SUICIDE: YRBS 2021
Sometimes people feel so depressed about the future that they may consider attempting
suicide, that is, taking some action to end their own life.
During the past 12 months, did you ever seriously consider attempting suicide?
• No
• Yes (INCLUDE POP UP FOR SUICIDE HOTLINE)
23. CHILDHOOD TRAUMA/STRESS: Family Study Survey; Adapted from the Felitti
Adverse Childhood Experiences (ACE) Questionnaire
Since your last survey on [insert date]….
Did you live with a parent or guardian who got divorced or separated?
Did you live with a parent or guardian who died?
Did you live with a parent or guardian who served time in jail or prison?
Did you see or hear your parents, guardians, or any other adults in your
home slap, hit, kick, punch, or beat each other up?
Were you the victim of violence or witnessed any violence in your
neighborhood?
Did you live with anyone who was mentally ill or suicidal, or was severely
depressed for more than a couple of weeks?
Did you live with anyone who had a problem with alcohol or drugs?

No

o
o
o
o
o
o
o

Yes

11 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

o
o
o
o
o
o
o

24. 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 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.
No
Your father

Yes

o

o

o

o

o

Your mother
Your brother(s)/sister(s)

o

o

Your grandparent(s)
Other (please specify e.g.,
aunt, uncle, cousin, friend; do
not include any names in your
response):
_____________________

o

o

o

a. IF ‘YES’ TO CAREGIVING FOR ANYONE: Overall, how stressful is it to help care for
this person/people in your household?
• Not stressful
• Somewhat stressful
• Very stressful
25. BARRIERS TO ADOLESCENTS SEEKING HELP: Adapted from Barriers to
Adolescents Seeking Help Scale (BASH), Barriers to Adolescents Seeking Help Scale
— Brief Version (BASH-B), and the Family Study
The statements below reflect feelings you may have about seeking care for an emotional
or psychological problem from a mental health professional (e.g., a therapist,
psychologist, or counselor). Please rate how much you agree or disagree with each
statement.

If I had a problem, I
would solve it myself.

Strongly
disagree

Disagree

o

o

Neither
Agree
agree
nor
disagree

o

o

Strongly
agree

o

12 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

Even if I wanted to, I
wouldn’t have time to
see a therapist.
If I had a problem and
told a therapist, they
would not keep it
secret.
My parents don’t
approve of me seeing
a therapist
My friends would
judge me if I saw a
therapist.
Even If I had a
problem, I’d be too
embarrassed to talk
to a therapist about it.
No matter what I do, it
will not change the
problems I have.
If I had a problem, my
friends could help me
more than a therapist.
It would make me feel
inferior to ask a
therapist for help.

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

o

o

o

o

o

o

o

o

o

o

26. When was the last time you had counseling, therapy, or any mental health services?
• Never
• During the last 12 months
• Between 12 and 24 months ago
• More than 24 months ago
• Not sure
End of Block: PHYSICAL AND PSYCHOLOGICAL HEALTH
Start of Block: ACADEMICS AND CAREER ASPIRATIONS

13 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

The next few questions are about your experiences in school. Please include home schooling, if
applicable.
27. GRADE LEVEL
What is your current grade or education level?
• 5th grade or below
• 6th grade
• 7th grade
• 8th grade
• 9th grade
• 10th grade
• 11th grade
• 12th grade
• Classes for General Equivalency Exam (GED)
• Technical or vocational school (e.g., carpentry, automotive technology,
cosmetology)
• 2-year community college (Associate's degree)
• 4-year college or university (Bachelor’s degree)
• Master’s, doctoral, or professional degree (e.g., PhD, MD, JD)
• I am not currently in school or college [SKIP TO EDUCATIONAL AND CAREER
ATTAINMENT]

14 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

28. SCHOOL TYPE: Survey of Active Duty Spouses (ADSS) 2017
IF 5TH GRADE THRU 12TH GRADE: In which type of school are you enrolled?
• Public school (no tuition, traditional teaching methods)
• Public school – charter/magnet (no tuition, unique teaching methods)
• Department of Defense School (no tuition, usually on a military base when living
overseas)
• Home school (primarily taught at home by a parent or tutor)
• Private school (pay tuition to attend)
• Other (please specify): __________________
29. SCHOLARSHIPS
IF CURRENTLY ATTENDING POST-SECONDARY SCHOOL: Did you use any of the
following scholarship programs for school (select all that apply)?
GI Bill
Yellow Ribbon
Other military scholarship programs
I did not use any military scholarship programs
30. SCHOOL ENGAGEMENT: Adapted from NSDUH 2020
IF 5TH GRADE THRU 12TH GRADE: How interesting do you think most of your courses
at school have been during the last 12 months?
• Very interesting
• Somewhat interesting
• Not interesting
31. SCHOOL ENGAGEMENT: Adapted from NSDUH 2020
IF 5TH GRADE THRU 12TH GRADE: 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?
• Very important
• Somewhat important
• Not important
32. GRADES: YRBS 2021
In general, how would you describe your current grades in school?
• Mostly A’s
• Mostly B’s
• Mostly C’s
• Mostly D’s
• Mostly F’s
• My school does not give these grades.
15 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

33. EXTRACURRICULAR ACTIVITIES: Family Study Survey

IF 5TH GRADE THRU 12TH GRADE: During the last 12 months, in how many of the
following kinds of activities have you participated?
None
One
Two
Three or
more
Leadership and community service
(e.g., Youth of the Year, Congressional
Awards, youth councils, 4-H, Scout
programs)

o

o

o

o

Education, STEM, and career
development (e.g., homework
assistance, tutoring, mentor programs,
internships, college fairs)

o

o

o

o

Health and wellness (e.g., financial
readiness, cooking)

o

o

o

o

Art programs (e.g., art classes, music
lessons, band, dance classes, theater)

o

o

o

o

Sports or recreation programs (e.g.,
individual or team sports, fishing,
swimming lessons, geo-hunt)

o

o

o

o

a. IF GREATER THAN ‘NONE’ FOR EACH ACTIVITY: Was the program(s)
military-sponsored or on a military installation?
• No
• Yes

16 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

34. IF 9TH GRADE THRU 12TH GRADE: Are you currently enrolled in the Junior Reserve
Officers' Training Corps (JROTC) program?
• No
• Yes
35. IF CURRENTLY ATTENDING POST-SECONDARY SCHOOL: Are you currently
enrolled in the Reserve Officers' Training Corps (ROTC) program or military college?
• No
• Yes
36. IF AGES 16+: How likely is it that you will be serving in the U.S. military in the next few
years?
• Definitely
• Probably
• Probably not
• Definitely not

17 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

37. SCHOOL ENVIRONMENT: Adapted from NAEP 2016
During the last 12 months (OR “SINCE YOU CHANGED SCHOOLS”, IF APPLICABLE),
how often have you felt any of the following ways about your school?
Never or
Hardly ever
I felt like I belong at
school.
I looked forward to
going to school in the
morning.
I felt safe at school.

About
half of the time

All or
Almost all of the time

o

o

o

o

o

o

o

o

o

38. MILITARY PEERS: RAND Deployment Life Study
Are you friends with other kids/teens from military families?
• No
• Yes
39. EDUCATIONAL/CAREER ASPIRATIONS
Do you plan to...
No
IF 5TH GRADE THRU 12TH
GRADE
Graduate from high school?

Yes

Not sure

o

o

o

o

o

o

o

o

o

IF AGES 16+: Graduate
from a 2-year
community college
(e.g., Associate's
degree)?

o

o

o

IF AGES 16+: Graduate
from a 4-year college
or university (e.g.,
Bachelor's degree)?

o

o

o

Join the military?
IF AGES 13-15:
Graduate from
college?

18 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

IF AGES 16+: 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

o

o

o

o

o

o

Become an entrepreneur (e.g.,
start a new company on your
own)?
Pursue a career in the performing
arts (e.g., dance, music,
entertainment) or in professional
sports?

40. IF ‘NO’ TO SCHOOL/COLLEGE ENROLLMENT: EDUCATIONAL/CAREER
ATTAINMENT
No

Did you graduate from high school?
Did you graduate from a 2-year community college
(earn an Associate's
degree)?
Did you graduate from a 4-year college or university (earn
a Bachelor's degree)?
Did you obtain a master's, doctoral, or professional degree
(PhD, MD, or JD)?
Have you taken over a family business?
Have you become an entrepreneur (e.g., started a new
company on your own)?
Are you pursuing a career in the performing arts (e.g.,
dance, music, entertainment) or in professional sports?
Are you employed in your chosen field?

Yes

o

o

o

o

o

o

o

o

o
o
o
o

o
o
o
o

19 | S t u d y o f A d o l e s c e n t R e s i l i e n c e ( S O A R ) F o l l o w - U p S u r v e y

41. IF ‘NO’ TO CURRENTLY IN SCHOOL: Are you currently serving in the U.S. military?
•
•
•
•

No
Yes, regular active duty (not a member of the national guard or reserve)
Yes, activated national guard or reserve (full-time active duty program:
AGR/FTS/AR)
Yes, traditional national guard or reserve (e.g., drilling unit, IMA, IPR)

a. ATTITUDES TOWARD MILITARY from Chaudhuri & Holbrook 2009 adapted by
Cistulli et al 2012
IF ‘YES’ TO CURRENTLY SERVING IN THE MILITARY: What is your overall feeling about
your military service?
Strongly
Somewhat
Neither
Somewhat
Strongly
disagree
disagree
disagree
agree
agree
nor agree
I trust the United States
Armed Forces.
The United States
Armed Forces keep me
safe.
I am happy with the
United States Armed
Forces.

o
o

o
o

o
o

o
o

o
o

o

o

o

o

o

b. ENLISTMENT REFERRAL DECISION
IF ‘YES’ TO CURRENTLY SERVING IN THE MILITARY: How likely are you to recommend
enlistment in the armed forces to…
Not at all
Unlikely
Neither
Likely
Extremely
likely
unlikely
likely
nor likely
A friend
A family member

o
o

o
o

o
o

o
o

o
o

End of Block: ACADEMICS AND CAREER ASPIRATIONS
Start of Block: HEALTH BEHAVIORS
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.
42. CAFFEINE DRINKS
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During the past 7 days, how many times did you drink a cup, can, or bottle of caffeinated
coffee or tea?
•
•
•
•
•
•
•

I did not drink coffee or tea during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day

43. During the past 7 days, how many times did you drink a can, bottle, or glass of an
energy drink, such as Red Bull, Monster, or Jolt?
• I did not drink energy drinks during the past 7 days
• 1 to 3 times during the past 7 days
• 4 to 6 times during the past 7 days
• 1 time per day
• 2 times per day
• 3 times per day
• 4 or more times per day
44. ALCOHOL USE: YRBS 2021
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.
Have you ever had a drink of alcohol other than a few sips?
• No [SKIP TO CIGARETTE USE SECTION]
• Yes

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a. ALCOHOL USE AGE: YRBS 2021
IF ‘YES’ TO ALCOHOL USE: How old were you when you had your first drink of
alcohol other than a few sips?
• 8 years old or younger
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old or older
b. ALCOHOL USE FREQUENCY: YRBS 2021
IF ‘YES’ TO ALCOHOL USE: During the last 30 days, on how many days did you
have at least one drink of alcohol?
• I did not drink alcohol during the last 30 days. [SKIP TO CIGARETTE USE
SECTION]
• 1 or 2 days
• 3 to 5 days
• 6 to 9 days
• 10 to 19 days
• 20 to 29 days
• All 30 days
c. BINGE DRINKING: YRBS 2021
IF ‘YES’ TO ALCOHOL USE: 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

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female), or 5 or more drinks of alcohol in a row, within a couple of hours (if you are
male)?
• 0 days
• 1 day
• 2 days
• 3 to 5 days
• 6 to 9 days
• 10 to 19 days
• 20 or more days
45. CIGARETTE USE: YRBS 2021
Have you ever tried cigarette smoking, even one or two puffs?
• No [SKIP TO ELECTRONIC VAPOR USE SECTION]
• Yes
a. CIGARETTE USE AGE: YRBS 2021
IF ‘YES’ TO CIGARETTE USE: How old were you when you first tried cigarette
smoking, even one or two puffs?
• 8 years old or younger
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old or older
b. CIGARETTE USE FREQUENCY: YRBS 2021
IF ‘YES’ TO CIGARETTE USE: During the last 30 days, on how many days did you
smoke cigarettes?
• I did not smoke cigarettes during the last 30 days. [SKIP TO ELECTRONIC
VAPOR USE SECTION]
• 1 or 2 days
• 3 to 5 days
• 6 to 9 days
• 10 to 19 days
• 20 to 29 days
• All 30 days
c. CIGARETTE USE INTENSITY: YRBS 2021
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IF ‘YES’ TO CIGARETTE USE: During the last 30 days, on the days you smoked,
about how many cigarettes did you smoke per day?
• Less than 1 cigarette per day
• 1 cigarette per day
• 2 to 5 cigarettes per day
• 6 to 10 cigarettes per day
• 11 to 20 cigarettes per day
• More than 20 cigarettes per day
46. 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 ecigarettes, vapes, vape pens, e-cigars, e-hookahs, hookah pens, and mods.
• I did not use an electronic vapor product during the last 30 days.
• 1 or 2 days
• 3 to 5 days
• 6 to 9 days
• 10 to 19 days
• 20 to 29 days
• All 30 days
47. 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

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or cigarillos), shisha or hookah tobacco, or pipe tobacco? (Do not count any electronic
vapor products.)
• I did not use smokeless tobacco, cigars, shisha or hookah tobacco, or pipe tobacco
during the last 30 days.
• 1 or 2 days
• 3 to 5 days
• 6 to 9 days
• 10 to 19 days
• 20 to 29 days
• All 30 days
48. MARIJUANA USE AGE: YRBS 2021
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.
Have you ever tried marijuana?
• No [SKIP TO PRESCRIPTION DRUG MISUSE SECTION]
• Yes
a. MARIJUANA USE AGE: YRBS 2021
IF 'YES' TO MARIJUANA: How old were you when you tried marijuana for the first
time?
• 8 years old or younger
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old or older
b. MARIJUANA USE FREQUENCY: YRBS 2021
IF 'YES' TO MARIJUANA: During the last 30 days, how many times did you use
marijuana?
• I did not use marijuana during the last 30 days.
• 1 or 2 times
• 3 to 9 times
• 10 to 19 times
• 20 to 39 times
• 40 or more times
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49. 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
• I did not take prescription pain medication not prescribed during the last 30 days.
• 1 or 2 times
• 3 to 9 times
• 10 to 19 times
• 20 to 39 times
• 40 or more times
50. SEXUAL ASSAULT: Adapted from YRBS 2021
Has anyone ever forced you to do sexual things that you did not want them to do?
(Count such things as kissing, touching, or being physically forced to have sexual
intercourse.)
• No
• Yes
51. SEXUAL INTERCOURSE: YRBS 2021
Have you ever had sexual intercourse?
• No
• Yes
a. SEXUAL INTERCOURSE AGE: YRBS 2021
IF 'YES' TO SEXUAL INTERCOURSE: How old were you when you had sexual
intercourse for the first time?
• 11 years old or younger
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old or older
b. SEXUAL INTERCOURSE PARTNERS: YRBS 2021
IF 'YES' TO SEXUAL INTERCOURSE: During the last year or so, with how many
people have you had sexual intercourse?
NOTE: IF AGES 11-12, ONLY ASK “1 PERSON” “2 PEOPLE” OR “3 OR MORE
PEOPLE”
• 1 person
• 2 people
• 3 people
• 4 people
• 5 people
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•

6 or more people

52. SEXUAL IDENTITY: Adapted from YRBS 2021
Which of the following best describes you?
• Heterosexual/Straight
• Gay or lesbian
• Bisexual
• I describe my sexual identity some other way (please specify):
__________________________
• I am not sure about my sexual identity (questioning).
• I do not know what this question is asking.
53. SLEEP: YRBS 2021
On an average night, how many hours of sleep do you get?
• 4 hours or less
• 5 hours
• 6 hours
• 7 hours
• 8 hours
• 9 hours
• 10 or more hours
54. PHYSICAL ACTIVITY: YRBS 2021
During the last 7 days, on how many days were you physically active for a total of at

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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.)
• 0 days
• 1 day
• 2 days
• 3 days
• 4 days
• 5 days
• 6 days
• 7 days
• I cannot physically exercise.
55. TRAUMATIC BRAIN INJURY: YRBS 2017
A concussion is when a blow or jolt to the head causes problems such as headaches,
dizziness, being dazed or confused, difficulty remembering or concentrating, vomiting,
blurred vision, or being knocked out.
How many times have you had a concussion?
• 0 times
• 1 time
• 2 times
• 3 times
• 4 or more times
56. SEDENTARY BEHAVIORS: YRBS 2021
On an average day, about 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.)
• Less than 1 hour per day
• 1 hour per day
• 2 hours per day
• 3 hours per day
• 4 hours per day
• 5 or more hours per day
57. SOCIAL MEDIA USE: MC&FP
On an average day, how many hours do you spend on social media (e.g., Instagram,
Snapchat, TikTok)?

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•
•
•
•
•
•
•

I do not use social media.
Less than 1 hour per day
1 hour per day
2 hours per day
3 hours per day
4 hours per day
5 or more hours per day

58. Could you get a firearm and shoot it right now if you wanted to?
• No
• Yes
a. IF ‘YES’ TO FIREARM: Where would you obtain that firearm?
• From my home
• From elsewhere/outside my home
• Both my home and elsewhere/outside my home
End of Block: HEALTH BEHAVIORS
Start of Block: YOUTH RISK & RESILIENCE FACTORS
The next set of questions is about how you feel about yourself. Please answer 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.
59. IF AGES 13+: MASCULINE EXPRESSION: Maryland Adolescent Development in
Context Study (MADICS)
Please rate your opinion of the following statements about yourself.
Not at all masculine
I feel as though I
am...
I look as though I
am...
Other people see me
as...

Somewhat masculine

Very masculine

o

o

o

o

o

o

o

o

o

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60. IF AGES 13+: FEMININE EXPRESSION: MADICS
Please rate your opinion of the following statements about yourself.
Not at all feminine
I feel as though I
am...
I look as though I
am...
Other people see me
as...

Somewhat feminine

Very feminine

o

o

o

o

o

o

o

o

o

61. 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.

Somewhat true or
Sometimes true

Very true or
Often true

o

o

o

o

o

o

o

o

o

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62. 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

Getting to know
people who are of a
different race than I
am.

o

o

o

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

Speaking up for
equality (everyone
should have the
same rights and
opportunities).

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

o

o

o

Accepting
responsibility for my
actions when I make
a mistake or get in
trouble.

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63. FAMILY SOCIOPOLITICAL DISCUSSIONS: Youth Civic and Character Measures
Toolkit
How often does your family do the following?
Never or
Hardly Ever

Sometimes

Often or
Very often

In my family, we talk
about politics and
current events.

o

o

o

In my family, we talk
about times when
people are treated
unfairly.

o

o

o

In my family, we talk
about problems
facing our
community.

o

o

o

64. RELIGIOSITY: Adapted from NSDUH 2020
During the last 12 months, how many times did you participate in religious services?
Please do not include special occasions such as weddings, funerals, or other special
events in your answer.
• 0 times
• 1 to 2 times
• 3 to 5 times
• 6 to 24 times
• 25 to 52 times
• More than 52 times
End of Block: YOUTH RISK & RESILIENCE FACTORS
Start of Block: PARENT-ADOLESCENT RELATIONSHIP

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65. Accountable Health Communities – Health-Related Social Needs (ACH–HRSN)
Screening tool
a. IF ‘YES’ TO LIVING WITH P1 AND/OR P2: How hard is it for your family to pay for
the very basics like food, housing, medical care, and heating/air conditioning? Would
you say it is…
• Very hard
• Somewhat hard
• Not hard at all
b. IF ‘NO’ TO LIVING WITH P1 AND P2: How hard is it for you to pay for the very
basics like food, housing, medical care, and heating/air conditioning? Would you say
it is…
• Very hard
• Somewhat hard
• Not hard at all
66. FINANCIAL MANAGEMENT
b. IF 'YES’ TO LIVING WITH P1 AND/OR P2: I feel secure about our family's financial
future.
• Strongly disagree
• Somewhat disagree
• Neither disagree nor agree
• Somewhat agree
• Strongly agree
•
c. IF ‘NO’ TO LIVING WITH P1 AND P2: What is your living situation today?
• I have a steady place to live
• I have a place to live today, but I am worried about losing it in the future
• I do not have a steady place to live (I am temporarily staying with others, in a
hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned
building, bus or train station, or in a park)
The next set of questions is about your relationship with your parent(s).
67. MONITORING/SUPERVISION: Adapted from Monitoring the Future 2018
IF ‘YES’ TO LIVING WITH P1 AND/OR P2: During the course of a typical day, how often
do your parent(s)...

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Never or
Rarely

Sometimes

Most of the time or
Always

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

68. PARENTAL RELATIONSHIP QUALITY: Adapted from NIH Toolbox
[NOTE: IF MORE THAN ONE PARENT IS ENROLLED IN THE STUDY, THE
ADOLESCENT WILL BE ASKED TO THINK ABOUT EACH PARENT SEPARATELY
USING THE MILCO PARENT / OTHER PARENT’S NAME CODE.]
During the last year or so…
Not true or
Hardly ever true

Somewhat true or
Sometimes true

Very true or
Often true

I enjoyed doing
things with
[MilCo/Other parent
name code].

o

o

o

I shared ideas and
talk about things that
really matter with
[MilCo/Other parent
name code].

o

o

o

I felt close to
[MilCo/Other parent
name code].

o

o

o

69. COMMUNICATION: Adapted from PROMIS Family Relationships
[NOTE: IF MORE THAN ONE PARENT IS ENROLLED IN THE STUDY, THE

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ADOLESCENT WILL BE ASKED TO THINK ABOUT EACH PARENT SEPARATELY
USING THE MILCO PARENT / OTHER PARENT’S NAME CODE.]
During the last year or so…
Not true or
Hardly ever true

Somewhat true or
Sometimes true

Very true or
Often true

I could tell
[MilCo/Other parent
name code] how I
feel about things.

o

o

o

[MilCo/Other parent
name code] listened
to me.

o

o

o

I could talk to
[MilCo/Other parent
name code] about my
problems.

o

o

o

70. CONFLICT: Adapted from NSDUH 2020
During the last 12 months, how many times have you argued or had a fight with
[MilCo/Other parent name code]?
[NOTE: IF MORE THAN ONE PARENT IS ENROLLED IN THE STUDY, THE
ADOLESCENT WILL BE ASKED TO THINK ABOUT EACH PARENT SEPARATELY
USING THE MILCO PARENT / OTHER PARENT’S NAME CODE.]
• 0 times
• 1 or 2 times
• 3 to 5 times
• 6 to 9 times
• 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.
71. 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;
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trying to get other kids/teens to fight or dislike someone; and ignoring or excluding other
kids/teens from activities on purpose.
Bullying can happen in person or electronically through texting or social media
(cyberbullying).
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.
72. PEER SEX
Is your best or closest friend...?
• Male
• Female
• Person self-identifies as something other than male or female.
• I don't have a best or closest friend. [SKIP TO DATING PARTNER RELATIONSHIP
SECTION]

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a. PEER RELATIONSHIP LENGTH
IF 'YES' TO PEER RELATIONSHIP: How long have you been friends with this
person?
• Less than 1 year
• 1-5 years
• 6-10 years
• More than 10 years
b. PEER RELATIONSHIP QUALITY: NRI-RQV
IF 'YES' TO PEER RELATIONSHIP: 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

73. DATING RELATIONSHIPS
In the last year or so, have you been in a dating relationship (i.e., had a boyfriend or
girlfriend)?
• No [SKIP TO SIBLING RELATIONSHIP SECTION]
• Yes
a. CURRENT DATING RELATIONSHIP
IF 'YES' TO DATING RELATIONSHIP: Are you currently in a dating relationship (i.e.,
have a boyfriend or girlfriend)?
• No [SKIP TO SIBLING RELATIONSHIP SECTION]
• Yes

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b. DATING PARTNER SEX
IF 'YES' TO DATING RELATIONSHIP: Is this person...?
• Male
• Female
• Person self-identifies as something other than male or female.
c. CURRENT DATING RELATIONSHIP LENGTH
IF 'YES' TO DATING RELATIONSHIP: How long have you been in a relationship
with this person?
• Less than 1 month
• 1-3 months
• 4-6 months
• 7-9 months
• 10-12 months
• More than 12 months
d. DATING PARTNER RELATIONSHIP QUALITY: NRI-RQV
IF 'YES' TO DATING RELATIONSHIP: When answering the next questions, please
think about the person with whom you are currently in a dating relationship.
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

e. IF 'YES' TO DATING RELATIONSHIP AND IF AGES 13+: Has your partner pushed
you, hit you, or thrown something at you that could hurt?
• Often (INCLUDE POP UP FOR SUICIDE HOTLINE)
• Sometimes (INCLUDE POP UP FOR SUICIDE HOTLINE)
• Never
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f.

IF 'YES' TO DATING RELATIONSHIP AND IF AGES 13+: Have you pushed, hit, or
thrown something at your partner that could hurt?
• Often
• Sometimes
• Never

74. SIBLING RELATIONSHIPS
Do you have any siblings (i.e., brothers or sisters)?
• No [SKIP TO FINAL COMMENTS]
• Yes
a. NUMBER OF SIBLINGS
IF 'YES' TO SIBLINGS: How many siblings (i.e., brothers or sisters) do you have?
• 1
• 2
• 3
• 4
• 5 or more
b. IF 'YES' TO SIBLINGS AND IF MORE THAN ONE SIBLING: Please think of the
sibling who is closest in age to you when responding to the following questions.
SIBLING AGE
How old is your sibling?
• 5 years old or younger
• 6-10 years old
• 11-12 years old
• 13-14 years old
• 15-17 years old
• 18 years old or older
c. SIBLING SEX
IF 'YES' TO SIBLINGS: Is your sibling...?
• Male
• Female
• Person self-identifies as something other than male or female.
d. SIBLING SCHOOL
IF 'YES' TO SIBLINGS: Are you and your sibling currently enrolled in the same

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school? If you are not currently enrolled in school, think about the last school year
that you completed.
• No
• Yes
e. SIBLING RELATIONSHIP QUALITY: NRI-RQV
IF 'YES' TO SIBLINGS: 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
Start of Block: COMMENTS
75. Do you have any comments that you would like to share? Please do not include any
identifying information, such as people’s names, in your response.

Thank you for taking the time to complete this survey.

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