This survey is about health behavior. It has been developed so you can tell us what you do that may affect your health. You know, things like eating, breathing, sexing and drinking first thing in the morning. The information you give will be used to develop better health education for young people like yourself. DO NOT write your name on this survey. And please do not write someone else’s name either. The answers you give will be kept private. No one will know what you write. Seriously, we’re just going to throw these away and nobody will ever see them. Completing the survey is voluntary. If you are not comfortable answering a question, just leave it blank. The questions that ask about your background will be used only 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. Your names are worthless to us. Make sure to read every question. Fill in the circles completely. Thank you very much for your help. Sorry if the questions about sex make you feel uncool, Andover nerds. Please answer the following questions _______________ • Use a #2 pencil only. • Make dark marks. • To change your answer, erase completely. 1. How tall are you without your shoes on? Feet Inches 2. How tall are you with your shoes on? Feet Inches Therefore, how tall are your shoes? (3 pts.; show all work, no calculator) Feet Inches 3. At school, what is your primary reason for lack of sleep? A. Academic workload B. Night terrors C. www.dancingjesus.com D. Socializing E. Taking surveys 4. On average, during this school year, how pressured or stressed have you felt? A. Not at all pressured or stressed B. Enough that I use two sticks of deodorant each week C. Moderately pressured or stressed D. Well, last night I pulled out my eyelashes in my sleep E. I’m so stressed I’ve stopped having my period 5. On average, during this school year, how homesick have you felt? A. Not at all homesick; I hate my parents B. Just a little homesick; my friends at home make me feel smarter C. Moderately homesick D. Very homesick; I miss my servants and chauffeur 6. During the past 30 days, on how many days did you carry a weapon such as a gun, knife, club, mace, rapier, board with nail in it, large rock, sharpened spoon or shark tooth necklace? A. 0 days B. Most Thursdays C. 2 or 3 days D. 5 or more days 7. During the past 12 months, did your boyfriend or girlfriend ever hit, slap or physically hurt you on purpose? A. Yes, he slapped me, but he said he was just reaching for his gun B. No, I’m single 8. During the past 30 days, did you vomit or take laxatives to lose weight or to keep from gaining weight? A. Last week, my roommate gave me a cake mixed with Ex-Lax B. No 10. During the past 30 days, on how many days did you sniff glue, with brands such as Elmer’s, Krazy Glue, Gorilla Glue, Rubber Cement, Super Glue, Sam’s Club Glue, CVS Brand Glue and RoseArt Glue? A. 0 days B. 1 or 2 days C. 3 or 4 days D. To be honest, I’ve been sniffing so much glue it’s hard to remember 11. During the past 12 months, if you felt sad or hopeless almost every day for two weeks or more in a row, from whom did you seek help? A. Ask Amanda in the Phillipian Arts Section B. Friends C. Graham House counselors D. A motivational speaker at a nearby Holiday Inn 12. How many alcoholic drinks can you hold (without passing out)? A. I don’t drink B. One drink, I weigh 64 pounds C. Two drinks – one in each hand D. 4 drinks or more 13. Do you sometimes take a drink in the morning when you first get up? A. Yes, of mouthwash B. Only if I have double math first period C. No 14. Have you ever gotten into a verbal or physical fight while under the influence of alcohol? A. Yes, but the other guy said he was going to turn my hand into a garden gnome B. No 15. During your life, how many times have you used any form of cocaine, including powder, crack, freebase, snowball, speedball, Florida snow or gutter glitter? A. Are those examples all really names for cocaine? B. 0 times C. 1 or 2 times D. More than 3 times 16. During your life, how many times have you used heroin, also called smack, junk or China White? A. China White? Awesome B. 0 times C. 1 or 2 times D. A few times, but not enough to know it was called China White 17. Think of your four best friends (the friends you feel closest to, you moron). In the past year (12 months, 52 weeks, 365 days), how many of your best friends have used marijuana, LSD, cocaine, amphetamines or other illegal drugs? A. 0 B. 1, but he’s an international student C. 2 D. 3 E. 4, so I’m always the designated driver for my screw-up friends 18. Have you ever had sexual intercourse? A. No, I’m a hopeless virgin B. Yes, about a dozen times C. Yes and I’m having sex right now D. Yes, and it was the best thirty seconds? of my life 19. Have you ever had oral sex? A. No, thanks for reminding me B. Oh yeah! 20. Have you ever had oral sex followed by sexual intercourse? A. No, I haven’t, and I’m starting to feel like a loser B. Yes! 10. Did you answer A on the previous three questions, you nerd? A. Yes, I did, and now I need to reassess my answers to those depression questions B. No 21. On an average school day, how many hours do you watch TV, streaming videos or movies? A. Streaming video? Well, every night in my room from about midnight until 2 a.m. I…. B. Less than one hour per day C. 1 hour – I watch “Lost,” then talk about it for another three hours D. 2 hours per day E. More than 3 hours per day 22. How many times have you been pregnant or gotten someone pregnant? A. 0 times B. 1 time C. 2 or more times D. Not sure – I get so much action that I can’t keep track of all my illegitimate children 23. How many pregnancies have you terminated in the last 30 days? A. under 100 B. 100-500 C. more than 500 D. I don’t work at an abortion clinic 24. How do you describe your weight? A. Very underweight B. Well, it fluctuates from meal to meal, and sometimes I’m really sensitive about it, especially at pool parties. But most of the time I think I do a good job of keeping it at a healthy level. C. 137.54 lbs. or 62.5 kg. D. Morbidly obese 25. On how many of the past 7 days did you exercise or participate in physical activity for at least 60 minutes that made you sweat and breathe hard, such as basketball, soccer, running, fencing, cockfighting, thumb-twiddling, fast dancing or similar aerobic activities? A. 0 days B. I don’t do physical activities. It interferes with my G.P.A. C. At least 60 minutes? I can’t stay standing for more than 20. That’s not even a fair question. 26. Are you done with this survey? A. Yes, finally B. Well, how would you define “done?” C. Only if this is the last question D. Wait, there are five more choices for this question? E. This seems kind of unnecessary F. Why are there so many options? G. This is so hard. I can’t decide H. Okay, I think I’m going to go with this one I. Well, definitely not this one 27. You’re finally done! What are you going to do now? A. Take more surveys! B. China White? Really? This is the end of the survey. Thank you very much for your help. —Jonathan Adler
