Questionnaire outline for common part of survey

Thank you for joining us in this investigation. With this questionnaire we want to get information about your health, your friends, your feelings and behaviour. This questionnaire is strictly anonymous: No one will be able to link any of the answers to you personally. Because it is anonymous, we would very much appreciate it if you answer these questions as honestly and truthfully as you can, and also respect other people’s privacy in that matter. It’s no use consulting your neighbor!

After you have answered the questions, we will add up the answers and make a report about all students who filled out the questionnaires together. These questions are very important for the health policy in our town.

Please mark with a cross the square that denotes the answer you want to give. When you make a mistake, make the square that belongs to the correct answer entirely black.

Remember there are no right or wrong answers! We are interested in your opinions. When you don’t think any of the answers really apply, mark the answer that comes closest to it. You can always ask the person administrating the questionnaires for help.

Good luck and thanks again! To start with, some questions about your background.

1 What is your gender? □ Male □ Female

2 What is your age? □ 15 or younger □ 16 □ 17 □ 18 □ 19 or older

3 What is your type of school? □ Vocational school □ College □ General secondary school □ University □ Etc.

4 Are you religious? □ No □ Yes, I am Orthodox □ Yes, I am Muslim □ Yes, I am Jewish □ Etc.

5 Is religion important to you? □ Very important □ Important □ Not really important □ Absolutely not important

6 In what kind of family do you live? □ Single-parent family □ Two parent family □ Other

These are a few questions about your current health:

7 How do you estimate your health in general? □ Very good □ Good □ All right □ Not that good □ Very bad 8 During the last 4 weeks, how often did you □ Very often sleep badly? (with sleeping badly, we mean: □ Often having trouble getting into sleep or waking □ Sometimes up often during the night) □ Hardly ever □ Never

9 During the last 4 weeks, how often did you □ Very often have headaches, nausea or stomach □ Often problems? (for girls: we don’t mean □ Sometimes problems related to your menstrual cycle) □ Hardly ever □ Never

10 During the last 12 months, how often were □ Never you absent from school because of health □ 1 -2 times reasons? (we refer to the number of times, □ 3- 5 times not the number of days) □ 6-10 times □ 11-20 times □ More than 20 times

11 During the last 12 months, how often did □ Never you visit a doctor for health reasons? □ 1-2 times □ 3-10 times □ More than 10 times

12 During the last 12 months, did you visit a doctor for any of the following reasons? a  Headache □ yes □ no b  Problem with intestines □ yes □ no c  Sporting injuries □ yes □ no d  Broken limb □ yes □ no e  Pregnancy □ yes □ no f  Depression problems □ yes □ no g  Anxiety problems □ yes □ no h  Sexually transmitted disease □ yes □ no i  Other

Some questions about what you eat and drink…

1 2 3 4 5 6 7 Never day days days days days days days

13 How many days of the week do you □ □ □ □ □ □ □ □ usually have breakfast?

14 How many days of the week do you □ □ □ □ □ □ □ □ usually eat fruit? 15 How many days of the week do you □ □ □ □ □ □ □ □ usually eat vegetables?

16 How many glasses of orange juice or □ I never drink orange juice or grapefruit juice grapefruit juice do you drink each day □ Less than 1 glass per day □ 1 glass per day □ More than 1 glass per day

17 How many glasses (cans) of soda or □ None other drinks that contain sugar (e.g. □ Less than 1 a day Cola, Sprite, etc.) do you usually drink □ 1 per day each day? □ More than 1 per day

Some questions about what you do for leisure…

18 How many days in a week do you go to □ Never school by walking or biking? □ 1 day □ 2 days □ 3 days □ 4 days □ 5 days □ 6 days

19 How long does it take each day to get to □ I never walk or bike to school and from school by walking or biking? (Add □ 10-20 minutes per day the minutes from both the travel to and □ 20-30 minutes per day from school.) □ 30 – 60 minutes per day □ More than 60 minutes per day

20 Are you a member of a sports team or □ Yes club? □ No

21 How many days in a week do you train for □ Never your sport? □ 1 day □ 2 days □ 3 days □ 4 days □ 5 days □ 6 days □ Every day 22 How many hours do you on average watch □ I never watch TV, video or DVD TV, video or DVD? □ Less than 1 hour per day □ 1 hour per day □ 2 hour per day □ 3 hour per day □ 4 hour per day □ 5 hour per day or more

23 How many hours do you on average use a I never use a (game)computer (game)computer, not including school Less than 1 hour per day time? 1 hour per day 2 hour per day 3 hour per day 4 hour per day 5 hour per day or more

Drinking & smoking…

24 Have you ever smoked a □ No, I have never smoked (-> proceed to 26) cigarette in your life? □ I did smoke once or twice (-> proceed to 26) □ I used to smoke, but I quit completely (-> proceed to 26) □ I sometimes smoke, but not every day (-> proceed to 26) □ I smoke every day

25 How many cigarettes do you □ 1 cigarette usually smoke each day? □ 2-5 cigarettes □ 6-10 cigarettes □ 11-15 cigarettes □ 16 or more cigarettes

26 Do you ever drink alcohol (such □ No, I never drink alcohol (-> proceed to 29) as beer, wine, vodka, whisky, or □ Yes, I do drink alcohol cocktails containing alcohol)?

27 How often did you drink alcohol □ Never (-> proceed to 29) during the last 4 weeks? □ 1-2 times □ 3-4 times □ 5-6 times □ 7-10 times □ More than 10 times

28 How often during the last two □ Never weeks did you have 0.5 l of beer □ 1-2 times or 100 ml of strong alcohol □ 3-5 times (vodka, whisky, etc.)? □ 6-10 times □ More than 10 times 29 Did you ever smoke marihuana □ Never (-> proceed to 31) (anasha, hashish) during your □ 1-2 times life? □ 3-4 times □ 5-6 times □ 7-10 times □ More than 10 times

30 Have you ever used intravenous □ Never (injection) drugs? □ 1-2 times □ 3-4 times □ 5-6 times □ 7-10 times □ More than 10 times

31 How old were you when you for Never 10 or 11 12 13 14 15 16 17 or the first time… younger older a Smoked a cigarette? □ □ □ □ □ □ □ □ □ b Drank alcohol? □ □ □ □ □ □ □ □ □ c Used marihuana? □ □ □ □ □ □ □ □ □ d Used XTC, cocaine? □ □ □ □ □ □ □ □ □ e Used intravenous □ □ □ □ □ □ □ □ □ (injection) drugs (amphetamines, heroin, etc.)?

32 How do you feel about it when someone of your age… Very Bad Rather I don’t Good Very bad bad know good a … smokes? □ □ □ □ □ □ b … is drunk? □ □ □ □ □ □ c … uses marihuana? □ □ □ □ □ □ d … uses XTC, cocaine? □ □ □ □ □ □ e … uses intravenous (injection) □ □ □ □ □ □ drugs (amphetamines, heroin, etc.)?

33 How big do you estimate the Very chance that someone’s health is at Not high, low/ no Very high high not low Low risk risk when he (she)… a … smokes? □ □ □ □ □ b … drinks alcohol? □ □ □ □ □ c … uses marihuana? □ □ □ □ □ d … uses XTC, cocaine? □ □ □ □ □ e … uses intravenous (injection) □ □ □ □ □ drugs (amphetamines, heroin, etc.)?

How about your friends? 34 How many really good friends do you have? □ I don’t have really good friends □ I have 1 really good friend □ I have 2 to 5 really good friends □ I have more than 5 good friends

35 Think about your four best friends of your age, meaning the four persons you spend most time with. Can you state how many of them, during the last 12 months… none 1 2 3 4

A Smoked cigarettes? □ □ □ □ □ B Drank alcohol? □ □ □ □ □ C Used marihuana? □ □ □ □ □ D Used XTC, cocaine? □ □ □ □ □ E Used intravenous (injection) drugs (amphetamines, heroin, etc.)? 36 When you have problems, who do you usually turn to □ My father to talk about these problems? (multiple answers are □ My mother possible) □ My brother or sister □ Another family member □ A teacher □ Someone else at school (a grow-up or a peer) □ A friend □ No one

How do you feel? 37- SDQ (20 items) Insert appendix A 56

The following questions have to do with your sexlife…

57 Do you have a girl- or boyfriend? □ No □ Yes

58 Did you ever kiss and cuddle with someone (without □ Never really sleeping with someone)? □ Once □ A couple of times □ Very often

59 Have you ever slept with someone (had sex with □ Never -> proceed to 66 someone)? □ Once □ A couple of times □ Very often

60 When you have sex with someone, do you use a □ Yes, always condom? □ Sometimes □ No, never

61 When you have sex with someone, do you use another □ Yes, always contraceptive (such as a birth control pill, IUD)? □ Sometimes □ No, never □ I don’t know □ Does not apply, I always 62 If you have had sex without using a condom, use one can you state why you didn’t do so the last time? □ I wanted to become pregnant (for girls) □ I didn’t have one at hand □ I couldn’t get one □ It was too expensive □ My partner didn’t want it □ I don’t like to use them □ I don’t think it’s necessary □ I didn’t think of it □ I don’t know

□ Does not apply, I always 63 If you have had sex without using a contraceptive, use one can you state why you didn’t do so the last time? □ I wanted to become pregnant □ I didn’t have one at hand □ I couldn’t get one □ It was too expensive □ My partner didn’t want it □ I don’t like to use them □ I don’t think it’s necessary □ I didn’t think of it □ I don’t know

64 If you have had sex and used a condom, can you state □ Does not apply, I don’t use a where you got it from? condom □ Kiosk □ Pharmacy □ A friend □ My parents □ Other

□ To prevent pregnancy 65 If you have had sex and used a condom, can you state why you did so? □ To protect against venereal disease □ To protect against HIV/AIDS

66 With how many persons that you don’t have a steady □ 0 relationship did you have sex during the last 12 □ 1 months? □ 2 □ more than 2

67 What do you think about unsafe sex (without using a □ I could never do that condom)? □ That could happen to me □ I did have unsafe sex

68 Have you ever had sex against your will? Or were you □ Never ever pressed to do sexual acts against your will? □ Once □ More than once

69 Do you think that gay people could be your friends? □ No □ Yes Almost done: some questions about HIV/AIDS…

70 Have you ever heard of HIV/AIDS? □ Yes □ No

yes No Don’t know 71 Do you think people can protect themselves against □ □ □ HIV/AIDS 72 Do you think a person who looks healthy may actually be □ □ □ infected with HIV/AIDS? 73 Can people reduce the probability of infection with the HIV □ □ □ virus if they use condoms during the entire sexual act? 74 Can people reduce the probability of infection with the HIV □ □ □ virus by having only one partner and when both partners are faithful to each other? 75 Can a person be infected by the HIV virus if he or she uses □ □ □ the same dishes and silverware as a person who has a HIV infection or AIDS? 76 Can the HIV-virus be transmitted from mother to child □ □ □ during pregnancy or childbirth? 77 Can the HIV-virus be transmitted from mother to child □ □ □ during breastfeeding? 78 If a member of your family would become infected with □ □ □ HIV, would you agree to care for him of her in your house? 79 If a teacher is HIV-infected, but he or she doesn’t have □ □ □ AIDS yet, should he or she be allowed to continue teaching at school? 80 If a grocer is HIV-infected, but he doesn’t have AIDS yet, □ □ □ would you buy vegetables from him?

81 What do you think you can do to protect yourself from HIV/AIDS (multiple answers can be given) a □ Refuse to have sex B □ Insist on using condoms c □ Disinfect yourself after sex d □ Take drugs e □ Not use injection drugs f □ Nothing g □ I don’t know Finally, what do you think about it? Yes ? No

82 I thought this questionnaire was difficult □ □ □

83 I think this questionnaire discussed serious topics □ □ □

84 I liked answering the questions □ □ □

85 I answered the questions seriously □ □ □

86 If you were the Mayor of your city, what would you do for young people? (feel free to write down anything you can think of!)

Thank you very much for answering these questions…

If you want to discuss any of the subjects in this questionnaire with someone from the school, please contact ……….