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2013 Youth Risky Behavior Surveillance System High School Questionnaire

2013 Youth Risky Behavior Surveillance System High School Questionnaire

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Published by Shane Vander Hart
This is the survey distributed by states from the Centers for Disease Control and Prevention to survey high school students on their risky behavior.
This is the survey distributed by states from the Centers for Disease Control and Prevention to survey high school students on their risky behavior.

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Published by: Shane Vander Hart on May 29, 2013
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07/10/2013

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2013 State and Local
Youth Risk Behavior Survey
This survey is about health behavior. It has been developed so you cantell us what you do that may affect your health. The information yougive will be used to improve health education for young people likeyourself.DO NOT write your name on this survey. The answers you give will bekept private. No one will know what you write. Answer the questions based on what you really do.Completing the survey is voluntary. Whether or not you answer thequestions will not affect your grade in this class. If you are notcomfortable answering a question, just leave it blank.The questions that ask about your background will be used only todescribe the types of students completing this survey. The informationwill not be used to find out your name. No names will ever be reported.Make sure to read every question. Fill in the ovals completely. Whenyou are finished, follow the instructions of the person giving you thesurvey.
Thank you very much for your help.
1
2013 standard YRBS
 
 
DIRECTIONSUse a #2 pencil only.Make dark marks.Fill in a response like this:
 
A
 
B C DIf you change your answer, erase your old answer completely.
1. How old are you?A. 12 years old or younger B. 13 years oldC. 14 years oldD. 15 years oldE. 16 years oldF. 17 years oldG. 18 years old or older 2. What is your sex?A. FemaleB. Male3. In what grade are you?A. 9th gradeB. 10th gradeC. 11th gradeD. 12th gradeE. Ungraded or other grade4. Are you Hispanic or Latino?A. YesB. No5. What is your race?
(Select one or more responses.)
A. American Indian or Alaska NativeB. AsianC. Black or African AmericanD. Native Hawaiian or Other Pacific Islander E. White
2
2013 standard YRBS
 
 
6. How tall are you without your shoes on?
Directions: Write your height in the shaded blank boxes. Fill in the matching oval below each number.
Example
HeightFeet Inches
5 73 04 15 26 37 4567891011
HeightFeet Inches
3 04 15 26 37 4567891011
7.
How much do you weigh without your shoes on?
Directions: Write your weight in the shaded blank boxes. Fill in the matching oval below each number.Example
WeightPounds
1 5 20 0 01 1 12 2 23 3 34 45 56 67 78 89 9
WeightPounds
0 0 01 1 12 2 23 3 34 45 56 67 78 89 9
3
2013 standard YRBS

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