Nebraska Youth Survey (YTS) 2014/2015 Questionnaire

This survey is about tobacco. We would like to know about you and things you do that may affect your health. Your answers will be used for programs for young people like yourself.

DO NOT write your name on this survey. The answers you give will be kept private. NO one will know what you write. Answer the questions based on what you really do and know. Completing the survey is voluntary. Whether or not you answer the questions will not affect your grade in this class. Try to answer all the questions. If you do not want to answer a question, just leave it blank. There are no wrong answers. The questions that ask about your background will only be used to describe the types of students completing this survey. The information will not be used to find out your name. No names will ever be reported. Please read every question. Try to answer all the questions. Fill in the circles in the booklet completely. When you are finished, follow the instructions of the person giving you the survey.

Thank You Very Much For Your Help.

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The first questions ask for some 6. During the last 30 days, about how much money background information about you . did you have each week to spend any way you want to? 1. How old are you? None 9 years old Less than $1 10 years old $1 to $5 11 years old $6 to $10 12 years old $11 to $20 13 years old $21 to $50 14 years old More than $50 15 years old 16 years old 17 years old The next six sets of questions ask 18 years old about your use of certain tobacco 19 years old or older products.

2. What is your sex? Female Male 7. Have you ever tried , even one or two puffs? Yes 3. What grade are you in? No 6th 7th 8th 8. Do you think you will smoke a cigarette in the 9th next year? 10th Definitely yes 11th Probably yes 12th Probably not Ungraded or other grade Definitely not

4. Are you Hispanic or Latino? 9. Do you think that you will try a cigarette soon? No I have already tried smoking Yes, I am Mexican, Mexican cigarettes American, or Chicano Yes Yes, I am Puerto Rican No Yes, I am Cuban or Cuban American Yes, I am some other Hispanic or Latino not listed here 10. If one of your best friends were to offer you a cigarette, would you smoke it? Definitely yes 5. What race or races do you consider yourself to be? Probably yes (You can CHOOSE ONE ANSWER or MORE Probably not THAN ONE ANSWER ) Definitely not American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

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11. How old were you when you first tried 15. When was the last time you smoked a cigarette, cigarette smoking, even one or two puffs? even one or two puffs? (PLEASE CHOOSE I have never smoked cigarettes, not THE FIRST ANSWER THAT FITS ) even one or two puffs I have never smoked cigarettes, not 8 years old or younger even one or two puffs 9 years old Earlier today 10 years old Not today but sometime during the 11 years old past 7 days 12 years old Not during the past 7 days but 13 years old sometime during the past 30 days 14 years old Not during the past 30 days but 15 years old sometime during the past 6 months 16 years old Not during the past 6 months but 17 years old sometime during the past year 18 years old 1 to 4 years ago 19 years old or older 5 or more years ago

12. About how many cigarettes have you smoked in 16. During the past 30 days, what brand of cigarettes your entire life ? did you usually smoke? (CHOOSE ONLY ONE I have never smoked cigarettes, not ANSWER ) even one or two puffs I did not smoke cigarettes during the 1 or more puffs but never a whole past 30 days cigarette I did not smoke a usual brand 1 cigarette American Spirit 2 to 5 cigarettes Camel 6 to 15 cigarettes (about 1/2 a pack GPC, Basic, or total) Kool 16 to 25 cigarettes (about 1 pack total) Lucky Strike 26 to 99 cigarettes (more than 1 pack, Marlboro but less than 5 packs) Newport 100 or more cigarettes (5 or more Parliament packs) Virginia Slims Some other brand not listed here

13. During the past 30 days , on how many days did you smoke cigarettes? 17. Menthol cigarettes are cigarettes that taste like 0 days mint. During the past 30 days, were the cigarettes 1 or 2 days that you usually smoked menthol? 3 to 5 days I did not smoke cigarettes during the 6 to 9 days past 30 days 10 to 19 days Yes 20 to 29 days No All 30 days Not sure

14. During the past 30 days, on the days you smoked , how many cigarettes did you smoke per day? I did not smoke cigarettes during the past 30 days 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 58968 3

18. During the past 30 days, how did you get your 22. How old were you when you first tried smoking own cigarettes? ( You can CHOOSE ONE a cigar, , or little cigar, even one or two ANSWER or MORE THAN ONE ANSWER ) puffs? I did not smoke cigarettes during the I have never smoked cigars, , past 30 days or little cigars, not even one or two I bought them myself puffs I had someone else buy them for me 8 years old or younger I borrowed or bummed them 9 years old Someone gave them to me without my 10 years old asking 11 years old I took them from a store or another 12 years old person 13 years old I got them some other way 14 years old 15 years old 16 years old 19. During the past 30 days , where did you buy your 17 years old own cigarettes? ( You can CHOOSE ONE 18 years old ANSWER or MORE THAN ONE ANSWER ) 19 years old or older I did not buy cigarettes during the past 30 days A gas station 23. During the past 30 days , on how many days did A convenience store you smoke cigars, cigarillos, or little cigars? A grocery store 0 days A drugstore 1 or 2 days A vending machine 3 to 5 days Over the Internet 6 to 9 days Through the mail 10 to 19 days Some other place not listed here 20 to 29 days All 30 days

20. During the past 30 days , did anyone refuse to sell you cigarettes because of your age? I did not try to buy cigarettes during 24. During the past 30 days , how did you get your the past 30 days own cigars, cigarillos, or little cigars? ( You can Yes CHOOSE ONE ANSWER or MORE THAN No ONE ANSWER ) I did not smoke cigars, cigarillos, or little cigars during the past 30 days Cigars I bought them myself I had someone else buy them for me 21. Have you ever tried smoking cigars, cigarillos, or I borrowed or bummed them little cigars, even one or two puffs? Someone gave them to me without my Yes asking No I took them from a store or another person I got them some other way

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25. During the past 30 days , where did you buy your 29. During the past 30 days , how did you get your own cigars, cigarillos, or little cigars? (You can own chewing tobacco, snuff, or dip? (You can CHOOSE ONE ANSWER or MORE THAN CHOOSE ONE ANSWER or MORE THAN ONE ANSWER ) ONE ANSWER ) I did not buy cigars, cigarillos, or little I did not use chewing tobacco, snuff, cigars during the past 30 days or dip during the past 30 days A gas station I bought it myself A convenience store I had someone else buy it for me A grocery store I borrowed or bummed it A drugstore Someone gave it to me without my A vending machine asking Over the Internet I took it from a store or another person Through the mail I got it some other way Some other place not listed here

30. During the past 30 days , where did you buy your Smokeless Tobacco own chewing tobacco, snuff, or dip? (You can CHOOSE ONE ANSWER or MORE THAN ONE ANSWER ) 26. Have you ever used chewing tobacco, snuff, or I did not buy chewing tobacco, snuff, dip, such as Redman, Levi Garrett, Beechnut, or dip during the past 30 days Skoal, Skoal Bandits, or Copenhagen, even just a A gas station small amount? A convenience store Yes A grocery store No A drugstore A vending machine Over the Internet 27. How old were you when you used chewing Through the mail tobacco, snuff, or dip for the first time? Some other place not listed here I have never used chewing tobacco, snuff, or dip 8 years old or younger Tobacco Pipe other than a waterpipe or hookah 9 years old 10 years old 31. Have you ever tried smoking tobacco in a pipe, 11 years old even one or two puffs? 12 years old Yes 13 years old No 14 years old 15 years old 16 years old 32. During the past 30 days , on how many days did 17 years old you smoke tobacco in a pipe? 18 years old 0 days 19 years old or older 1 or 2 days 3 to 5 days 6 to 9 days 28. During the past 30 days , on how many days did 10 to 19 days you use chewing tobacco, snuff, or dip? 20 to 29 days 0 days All 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

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Bidis (small brown cigarettes wrapped in Other tobacco products a leaf) and (clove cigarettes)

33. Have you ever tried smoking any of the 36. Which of the following tobacco products have following, even one or two puffs: you ever tried, even just one time? (You can I have never smoked bidis (small CHOOSE ONE ANSWER or MORE THAN brown cigarettes wrapped in a leaf) or ONE ANSWER ) kreteks (clove cigarettes) Roll-your-own cigarettes Bidis Flavored cigarettes, such as Camel Kreteks Crush I have tried both bidis and kreteks Clove cigars Flavored little cigars Smoking tobacco from a hookah or a 34. During the past 30 days , on how many days did waterpipe you smoke bidis? Snus, such as Camel or Marlboro Snus 0 days Dissolvable tobacco products, such as 1 or 2 days Ariva, Stonewall, Camel orbs, Camel 3 to 9 days sticks, or Camel strips 10 to 19 days Electronic Cigarettes or E-cigarettes, 20 to 29 days such as Ruyan or NJOY All 30 days Some other new tobacco products not listed here I have never tried any of the products 35. During the past 30 days , on how many days did listed above or any new tobacco you smoke clove cigarettes? product 0 days 1 or 2 days 3 to 9 days 37. In the past 30 days , which of the following 10 to 19 days products have you used on at least one day ? 20 to 29 days (You can CHOOSE ONE ANSWER or MORE All 30 days THAN ONE ANSWER ) Roll-your-own cigarettes Flavored cigarettes, such as Camel Crush Clove cigars Flavored little cigars Smoking tobacco from a hookah or a waterpipe Snus, such as Camel or Marlboro Snus Dissolvable tobacco products, such as Ariva, Stonewall, Camel orbs, Camel sticks, or Camel strips Electronic Cigarettes or E-cigarettes, such as Ruyan or NJOY Some other new tobacco products not listed here I have not used any of the products listed above or any new tobacco product

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The next question s will ask about 42. During the past 30 days, did you receive coupons from a tobacco company through… (You can your thoughts about getting tobacco CHOOSE ONE ANSWER or MORE THAN products and if you think tobacco ONE ANSWER ) companies are trying to get young I did not receive coupons from a people to use tobacco. tobacco company The mail E-mail 38. How easy would it be for you to get tobacco The Internet products if you wanted some? Facebook Very easy Myspace Somewhat easy A text message Not easy at all

43. During the past 30 days, did you receive ads from 39. Do you believe that tobacco companies try to get a tobacco company through… (You can young people under 18 to use tobacco products? CHOOSE ONE ANSWER or MORE THAN Yes ONE ANSWER ) No I did not receive ads from a tobacco company The Mail The next questions ask about E-mail The Internet advertisements you have seen or Facebook heard on the Internet, or in Myspace newspapers, magazines, television, A text message movies, or stores.

40. When you are using the Internet, how often do you see ads for tobacco products? 44. When you go to a convenience store, supermarket, I do not use the Internet or gas station, how often do you see ads or Never promotions for cigarettes and other tobacco Rarely products? Sometimes I never go to a convenience store, Most of the time supermarket, or gas station Always Never Rarely Sometimes 41. When you read newspapers or magazines, how Most of the time often do you see ads or promotions for cigarettes Always and other tobacco products? I do not read newspapers or magazines Never 45. During the past 30 days, how often did you see an Rarely ad for cigarettes or smokeless tobacco that was Sometimes outdoors on a billboard or could be seen from Most of the time outside a store? Always I did not see an ad for cigarettes or smokeless tobacco during the past 30 days Never Rarely Sometimes Most of the time Always

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46. When you watch TV or go to the movies, how 50. During the past 30 days, how often did you see often do you see actors and actresses using content about the dangers of tobacco use on social cigarettes or other tobacco products? media sites, like Facebook, Twitter, or YouTube? I do not watch TV or go to the movies I did not see commercials, posts, or Never comments about the dangers of Rarely tobacco during the past 30 days Sometimes 1-3 times in the past 30 days Most of the time 1-3 times per week Always Daily or almost daily More than once a day

47. What is the name of the cigarette brand of your favorite cigarette ad? (You can CHOOSE ONE Some cigarette or other tobacco ANSWER or MORE THAN ONE ANSWER ) companies make items like sports American Spirit gear, T-shirts, , hats, jackets, Camel GPC, Basic, or Doral sunglasses, or other items that Kool people can buy or receive for Marlboro free. The next questions are about Newport your opinions about these types of Some other brand not listed here items . I don’t have a favorite cigarette ad Not Sure 51. During the past 12 months , did you buy or receive anything that has a tobacco company 48. A warning label tells you if a product is harmful name or picture on it? to you and can be either a picture or words. Yes During the past 30 days, how often did you see a No warning label on a ? I did not see a cigarette pack during the past 30 days 52. How likely is it that you would ever use or wear Never something--such as a , T-shirt, hat, or Rarely sunglasses --that has a tobacco company name or Sometimes picture on it? Most of the time Very likely Always Somewhat likely Somewhat unlikely Very unlikely 49. During the past 30 days, how often did you see a warning label on a smokeless tobacco product? I did not see a smokeless tobacco The next questions are about product during the past 30 days questions asked and advice given by Never any doctor, dentist, nurse, or other Rarely Sometimes health professional. Most of the time Always 53. During the past 12 months , did any doctor, dentist, or nurse ask you if you use tobacco of any kind? I did not see a doctor, dentist, or nurse during the past 12 months Yes No

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54. During the past 12 months , did any doctor, 58. When you last tried to quit for good, how long dentist, or nurse advise you not to use tobacco of did you stay off cigarettes? ( PLEASE CHOOSE any kind? THE FIRST ANSWER THAT FITS ) I did not see a doctor, dentist, or nurse I have never smoked cigarettes during the past 12 months I have never tried to quit Yes Less than a day No 1 to 7 days More than 7 days but less than 30 days More than 30 days but less than 6 The next questions are about quitting months tobacco products . More than 6 months but less than 1 year 1 year or more 55. Do you want to stop smoking cigarettes for good? I do not smoke now Yes 59. Are you seriously thinking about quitting the use No of all tobacco? I have never used tobacco Yes, within the next 30 days 56. I plan to stop smoking cigarettes for good within Yes, within the next 6 months the next… ( PLEASE CHOOSE THE FIRST Yes, within longer than 6 months ANSWER THAT FITS ) I am not thinking about quitting the I do not smoke now use of all tobacco 7 days 30 days 6 months 60. In the past 12 months , did you do any of the 1 year following to help you quit using tobacco of any I do not plan to stop smoking cigarettes kind for good? (You can CHOOSE ONE within the next year ANSWER or MORE THAN ONE ANSWER ) I did not use tobacco of any kind during the past 12 months I did not try to quit during the past 12 57. During the past 12 months , how many times months have you stopped smoking for one day or longer Attended a program at my school because you were trying to quit smoking Attended a program in the community cigarettes for good? Called a telephone help line or I did not smoke during the past 12 telephone quit line months Used gum I did not try to quit during the past 12 Used nicotine patch months Used any medicine to help quit 1 time Visited an Internet quit site 2 times Got help from family or friends 3 to 5 times Used another method such as hypnosis 6 to 9 times or acupuncture 10 or more times Tried to quit on my own or quit “cold turkey”

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The next questions ask about your 64. During the past 7 days , on how many days did exposure to other people’s tobacco you breathe the smoke from someone who was smoking tobacco products in the place where you smoke. work? I do not have a job 61. During the past 7 days , on how many days did I have a job but did not work in the someone smoke tobacco products in your home past 7 days while you were there? 0 days 0 days 1 day 1 day 2 days 2 days 3 days 3 days 4 days 4 days 5 days 5 days 6 days 6 days 7 days 7 days

65. During the past 7 days , on how many days did 62. During the past 7 days , on how many days did you breathe the smoke from someone who was you ride in a vehicle where someone was smoking smoking tobacco products in an indoor or outdoor a tobacco product? public place? Examples of indoor public places 0 days are school buildings, stores, restaurants, and 1 day sports arenas. Examples of outdoor public places 2 days are school grounds, parking lots, stadiums and 3 days parks. 4 days 0 days 5 days 1 day 6 days 2 days 7 days 3 days 4 days 5 days 63. During the past 7 days , on how many days did 6 days you breathe the smoke from someone who was 7 days smoking a tobacco product at your school, including school buildings, school grounds, and school parking lots? The next questions ask about 0 days smoking rules in your home and 1 day vehicle. 2 days 3 days 4 days 66. Inside your home (not counting decks, garages, or 5 days porches) is smoking… 6 days Always allowed 7 days Allowed only at some times or in some places Never allowed

67. In the vehicles that you and family members who live with you own or lease, is smoking… Always allowed Sometimes allowed Never allowed

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The next questions ask about the use 72. In your opinion, in their vehicles, people should… of tobacco products for people who Always allow smoking live with or are close to you . Sometimes allow smoking Never allow smoking 68. Does anyone who lives with you now…? (CHECK ALL THAT APPLY ). Smoke cigarettes 73. Do you think that breathing smoke from other Use chewing tobacco, snuff, or dip people's cigarettes or other tobacco products is…? Use snus Very harmful to one's health Smoke cigars, cigarillos, or little cigars Somewhat harmful to one's health Smoke tobacco using a hookah or Not very harmful to one's health waterpipe Not harmful at all to one's health Smoke tobacco out of a pipe other than a hookah or waterpipe Smoke bidis (small brown cigarettes 74. Do you think smoking cigarettes makes young wrapped in a leaf) people look cool or fit in? Smoke kreteks (clove cigarettes) Definitely yes Use any other form of tobacco Probably yes No one who lives with me now uses Probably not any form of tobacco Definitely not

69. How many of your four closest friends smoke 75. Do you think young people who smoke cigarettes cigarettes? have more friends? None Definitely yes One Probably yes Two Probably not Three Definitely not Four Not sure 76. How strongly do you agree with the statement ‘All tobacco products are dangerous’? 70. How many of your four closest friends use Strongly agree chewing tobacco, snuff, or dip? Agree None Disagree One Strongly disagree Two Three Four The next questions are about your Not sure experiences at home and in your community.

The next questions ask about your 77. During the past 12 months , have your parents or guardians talked with you, even once, about not thoughts about tobacco. using any type of tobacco product? Yes 71. In your opinion, inside your home, smoking No tobacco products should…. Always be allowed Be allowed only at some times or in 78. During the past 12 months , have you been some places involved in any organized activities to keep Never be allowed people your age from using any form of tobacco product? Yes No 58968

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The last questions ask about experiences at school.

79. During this school year , were you taught in any of your classes about why you should not use tobacco products? Yes No

80. During the past 30 days , to your knowledge, has anyone, including yourself, smoked a tobacco product on school property when he or she was not supposed to? Yes No

81. During the past 30 days , to your knowledge, has anyone, including yourself, used some other type of tobacco product ( that is, one that is not smoked) on school property when he or she was not supposed to? Yes No

82. During the past 30 days , how many days did you miss at least one class period because you skipped or "cut" or just did not want to be there? 0 days 1 day 2 to 5 days 6 to 10 days 11 or more days

END OF SURVEY

THANK YOU FOR COMPLETING THE YOUTH TOBACCO SURVEY!!

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