Sociodemographic status
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Age |
How old are you? |
11–15/>15 |
Sex |
What is your sex? |
Male/Female |
Grade |
In what grade are you? |
8–9/10/11–12 |
Socioeconomic status |
During the past 30 days, how often did you go hungry because there was not enough food in your home? |
Most of the time, Always/Sometimes, Rarely, Never |
Psychosocial distress
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Anxiety |
During the past 12 months, how often have you been so worried about something that you could not sleep at night? |
Most of the time, Always/Sometimes, Rarely, Never |
Loneliness |
During the past 12 months, how often have you felt lonely? |
Most of the time, Always/Sometimes, Rarely, Never |
Physically attacked |
During the past 12 months, how many times were you physically attacked? |
1/2–3/4–5/6–7/8–9/10–11/>12 |
Involved in a physical fight |
During the past 12 months, how many times were you in a physical fight? |
1/2–3/4–5/6–7/8–9/10–11/>12 |
Environmental factors
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Parental support |
During the past 30 days, how often did your parents or guardians check to see if your homework was done? |
Most of the time, Always/Sometimes, Rarely, Never |
Health risk behaviors
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Tobacco |
During the past 30 days, on how many days did you smoke cigarettes? |
0/1/2–3/3–5/6–9/10–19/20–29/30 |
Alcohol |
During the past 30 days, on how many days did you have at least one drink containing alcohol? |
0/1/2–3/3–5/6–9/10–19/20–29/30 |
Physical activity |
During the past 7 days, on how many days were you physically active for a total of at least 60 min per day? |
0 1 2 3 4/5 6 7 |
Suicidality
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Consideration |
During the past 12 months, did you ever seriously consider attempting suicide? |
Yes/No |
Planning |
During the past 12 months, did you make a plan about how you would attempt suicide? |
Yes/No |
Attempt |
During the past 12 months, how many times did you actually attempt suicide? |
0/1/2-3/4–5/>6 |