GSHS Core Modules 2013 English

8/12/2019 GSHS Core Modules 2013 English

1/16

2013 GSHS Core Questionnaire ModulesUpdated: 01 January 2013

GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY (GSHS)

2013 CORE QUESTIONNAIRE MODULES

FINAL


2/16


20__ _______GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY

This survey is about your health and the things you do that may affect your health.Students like you all over your country are doing this survey. Students in many other

countries around the world also are doing this survey. The information you give will beused to develop better health programs for young people like yourself.

DO NOT write your name on this survey or the answer sheet. The answers you givewill be kept private. No one will know how you answer. Answer the questions based onwhat you really know or do. There are no right or wrong answers.

Completing the survey is voluntary. Your grade or mark in this class will not be affectedwhether or not you answer the questions. If you do not want to answer a question, justleave it blank.

Make sure to read every question. Fill in the circles on your answer sheet that matchyour answer. Use only the pencil you are given. When you are done, do what theperson who is giving you the survey says to do.

Here is an example of how to fill in the circles:

Fill in the circles like this Not like this or

Survey1. Do fish live in water?

A. Yes

B. No

Answer sheet1. A B C D E F G H

Thank you very much for your help.


3/16

GSHS Core Questionn aire Respondent Demographi cs Mod ule


1. How old are you?

11 years old or younger12 years old13 years old14 years old

15 years old16 years old17 years old18 years old or older

2. What is your sex?

MaleFemale

3. In what grade/class/ standard are you?COUNTRY SPECIFIC RESPONSE OPTIONS

OPTION 1OPTION 2OPTION 3OPTION 4OPTION 5OPTION 6

A

B

C

D

E

F

A

B

A

B

C

D

E

F

G

H


4/16

GSHS Core Questionnaire Alcohol Use Module


The next 6 questions ask about drin king alcohol.This inclu des d rinki ng COUNTRY SPECIFICEXAMPLES. Drinki ng alcohol does not inclu dedrinking a few sips of wine for religious pur poses.

A dr in k is a g lass of wine, a bot tle of b eer, asmall glass of liquor, or a mixed drink.

1. How old were you when you had your first drinkof alcohol other than a few sips?

I have never had a drink of alcohol otherthan a few sips7 years old or younger8 or 9 years old10 or 11 years old12 or 13 years old14 or 15 years old16 or 17 years old18 years old or older

2. During the past 30 days, on how many days didyou have at least one drink containing alcohol?

0 days1 or 2 days3 to 5 days6 to 9 days10 to 19 days20 to 29 days

All 30 days

3. During the past 30 days, on the days you drankalcohol, how many drinks did you usually drinkper day ?

I did not drink alcohol during the past 30daysLess than one drink1 drink2 drinks3 drinks4 drinks5 or more drinks

4. During the past 30 days, how did you usually getthe alcohol you drank? SELECT ONLY ONERESPONSE.

I did not drink alcohol during the past 30days

I bought it in a store, shop, or from a streetvendorI gave someone else money to buy it formeI got it from my friendsI got it from my familyI stole it or got it without permissionI got it some other way

Staggering when walking, not being able to speakright, and throwing up are some signs of beingreally drunk.

5. During your life, how many times did you drink somuch alcohol that you were really drunk?

0 times1 or 2 times3 to 9 times10 or more times

6. During your life, how many times have you gotinto trouble with your family or friends, missedschool, or got into fights, as a result of drinkingalcohol?

0 times1 or 2 times3 to 9 times10 or more times

A

B

C

D

E

F

G

A

B

C

D

A

B

C

D A

B

C

D

F

G

A

B

C

DD

E

F

A

B

C

D

F

G

E

G

E

H


5/16


6/16

GSHS Core Questionn aire Dietary B ehaviours Mod ule


7. During the past 7 days, on how many days didyou eat food from a fast food restaurant, such asCOUNTRY SPECIFIC EXAMPLES?

0 days1 day2 days3 days4 days5 days6 days7 days

A

B

C

D

E

F

G

H


7/16

GSHS Core Questionnaire Drug Use Module


The next 4 question s ask about drug use. Thisincludes using marijuana, amphetamines,cocaine, inhalants, and COUNTRY SPECIFICEXAMPLES.

1. How old were you when you first used drugs?

I have never used drugs7 years old or younger8 or 9 years old10 or 11 years old12 or 13 years old14 or 15 years old16 or 17 years old18 years old or older

2. During your life, how many times have you usedmarijuana (also called COUNTRY SPECIFICSLANG TERMS FOR MARIJUANA)?

0 times1 or 2 times3 to 9 times10 to 19 times20 or more times

3. During the past 30 days, how many times haveyou used marijuana (also called COUNTRYSPECIFIC SLANG TERMS FOR MARIJUANA)?

0 times1 or 2 times3 to 9 times10 to 19 times20 or more times

4. During your life, how many times have you usedamphetamines or methamphetamines (alsocalled COUNTRY SPECIFIC SLANG TERMSFOR AMPHETAMINES ANDMETHAMPHETAMINES)?

0 times1 or 2 times

3 to 9 times10 to 19 times20 or more times

A

B

C

D

A

B

C

D

E

E

A

B

C

D

F

G

E

A

B

C

D

E

H


8/16

GSHS Core Questionnaire Hygiene Module


The next 4 questions ask about cleaning yourteeth and washing your hands.

1. During the past 30 days, how many times per daydid you usually clean or brush your teeth?

I did not clean or brush my teeth duringthe past 30 daysLess than 1 time per day1 time per day2 times per day3 times per day4 or more times per day

2. During the past 30 days, how often did you washyour hands before eating?

NeverRarelySometimesMost of the time

Always

3. During the past 30 days, how often did you washyour hands after using the toilet or latrine?


Always

4. During the past 30 days, how often did you usesoap when washing your hands?


Always

A

B

C

D

A

B

C

D

E

A

B

C

D

E

A

B

C

D

E

E

F


9/16

GSHS Core Questionnaire Mental Health Module


The next 6 questions ask about your feelings andfriendships.

1. During the past 12 months, how often have youfelt lonely?


Always

2. During the past 12 months, how often have youbeen so worried about something that you couldnot sleep at night?

NeverRarelySometimes

Most of the time Always

3. During the past 12 months, did you everseriously consider attempting suicide?

YesNo

4. During the past 12 months, did you make a planabout how you would attempt suicide?

YesNo

5. During the past 12 months, how many times didyou actually attempt suicide?

0 times1 time2 or 3 times4 or 5 times6 or more times

6. How many close friends do you have?

0123 or more

A

B

C

D

E

A

B

A

B

C

D

E

A

B

A

B

D

A

B

C

D

E

C


10/16

GSHS Core Questionnaire Physical Activi ty Modul e


The next 3 questions ask about physical activity.Physical activity is any activity that increasesyour h eart rate and makes you breathe hard.Physical activity can be done in sports, playingwith friends, or walking to school. Someexamples of physical activity are running, fast

walkin g, biking , dancing, footb all, and COUNTRYSPECIFIC EXAMPLES.

1. During the past 7 days, on how many days wereyou physically active for a total of at least 60minutes per day? ADD UP ALL THE TIME YOUSPENT IN ANY KIND OF PHYSICAL ACTIVITYEACH DAY.

0 days1 day2 days3 days

4 days5 days6 days7 days

2. During the past 7 days, on how many days didyou walk or ride a bicycle to or from school?

0 days1 day2 days3 days4 days5 days6 days7 days

3. During this school year, on how many days didyou go to physical education (PE) class eachweek?

0 days1 day2 days3 days

4 days5 or more days

The next question asks about the time you sp endmostly sitting when you are not in school or doinghomework.

4. How much time do you spend during a typical or usual day sitting and watching television, playing

computer games, talking with friends, or doingother sitting activities, such as COUNTRYSPECIFIC EXAMPLES?

Less than 1 hour per day1 to 2 hours per day3 to 4 hours per day5 to 6 hours per day7 to 8 hours per dayMore than 8 hours per day A

B

C

D

E

F

G

H

A

B

C

D

E

F

A

B

C

D

E

F

G

H

A

B

C

D

E

F


11/16

GSHS Core Questionn aire Protective Factors Module


The next 6 questions ask about your experiencesat school and at home.

1. During the past 30 days, on how many days didyou miss classes or school without permission?

0 days1 or 2 days3 to 5 days6 to 9 days10 or more days

2. During the past 30 days, how often were most ofthe students in your school kind and helpful?


Always

3. During the past 30 days, how often did yourparents or guardians check to see if yourhomework was done?


Always

4. During the past 30 days, how often did yourparents or guardians understand your problemsand worries?


Always

5. During the past 30 days, how often did yourparents or guardians really know what you weredoing with your free time?

NeverRarely

SometimesMost of the time

Always

6. During the past 30 days, how often did yourparents or guardians go through your thingswithout your approval?


Always

A

B

C

D

E

A

B

C

D

A

B

C

D

E

A

B

C

D

E

E

A

B

C

D

E

A

B

C

D

E


12/16

GSHS Core Questionnaire Sexual Behaviours That Contribute to HIV Infection, Other STI, andUnintended Pregnancy Module


The next 5 questions ask about sexu alintercourse.

1. Have you ever had sexual intercourse?

Yes

No

2. How old were you when you had sexualintercourse for the first time?

I have never had sexual intercourse11 years old or younger12 years old13 years old14 years old15 years old16 or 17 years old18 years old or older

3. During your life, with how many people have youhad sexual intercourse?

I have never had sexual intercourse1 person2 people3 people4 people5 people6 or more people

4. The last time you had sexual intercourse, didyou or your partner use a condom or [COUNTRYSPECIFIC SLANG TERM FOR CONDOM]?

I have never had sexual intercourseYesNo

5. The last time you had sexual intercourse, didyou or your partner use any other method of birthcontrol, such as withdrawal, rhythm (safe time),birth control pills, or any other method to preventpregnancy?

I have never had sexual intercourseYesNoI do not know

A

B

A

B

C

D

E

F

G

A

B

C

D

E

F

G

A

B

C

A

B

C

D

H


13/16

GSHS Core Questionnaire Tobacco Use Module


The next 6 questions ask about ci garette andother tobacco use.

1. How old were you when you first tried a cigarette?

I have never smoked cigarettes

7 years old or younger8 or 9 years old10 or 11 years old12 or 13 years old14 or 15 years old16 or 17 years old18 years old or older

2. During the past 30 days, on how many days didyou smoke cigarettes?


All 30 days

3. During the past 30 days, on how many days didyou use any tobacco products other thancigarettes, such as COUNTRY SPECIFICEXAMPLES?


All 30 days

4. During the past 12 months, have you ever tried tostop smoking cigarettes?

I have never smoked cigarettesI did not smoke cigarettes during the past12 months

YesNo

5. During the past 7 days, on how many days havepeople smoked in your presence?

0 days1 or 2 days3 or 4 days

5 or 6 days All 7 days

6. Which of your parents or guardians use any formof tobacco?

NeitherMy father or male guardianMy mother or female guardianBothI do not know

A

B

C

D

E

F

G

A

B

C

D

A

B

C

D

E

A

B

C

D

E

A

B

C

D

E

F

G

A

B

C

D

E

F

G

H


14/16

GSHS Core Questionnaire Violence and Unint entional Injur y Modul e


The next question asks about physi cal attacks. Aphysical attack occurs when one or more peoplehit or strike someone, or when one or morepeople hurt another person with a weapon (suchas a stick, knife, or gun). It is not a physi cal attackwhen two students of about the same strength or

power choose to fight each other.

1. During the past 12 months, how many times wereyou physically attacked?

0 times1 time2 or 3 times4 or 5 times6 or 7 times8 or 9 times10 or 11 times12 or more times

The next question asks about physical fights. Aphysical fight occurs when two students ofabout the same strength or power cho ose tofight each other.

2. During the past 12 months, how many times wereyou in a physical fight?


The next 3 questions ask about serious injuriesthat happened to you. An injury is serious when itmakes you miss at least one full day of usualactivities (such as school, sports, or a job) orrequires treatment by a docto r or nurse.

3. During the past 12 months, how many timeswere you seriously injured?


4. During the past 12 months, what was the mostserious injury that happened to you?

I was not seriously injured during the past12 monthsI had a broken bone or a dislocated jointI had a cut or stab woundI had a concussion or other head or neckinjury, was knocked out, or could notbreatheI had a gunshot woundI had a bad burnI was poisoned or took too much of a drugSomething else happened to me

5. During the past 12 months, what was the majorcause of the most serious injury that happenedto you?

I was not seriously injured during the past12 monthsI was in a motor vehicle accident or hit bya motor vehicleI fellSomething fell on me or hit meI was attacked or abused or was fighting

with someoneI was in a fire or too near a flame orsomething hotI inhaled or swallowed something bad formeSomething else caused my injury

A

B

C

D

E

F

G

A

B

C

D

E

F

G

H

A

B

C

D

E

F

G

H

A

B

C

D

E

F

G

H

A

B

C

D

E

F

G

H

H


15/16

GSHS Core Questionnaire Violence and Unint entional Injur y Modul e


The next 2 questions ask about bullying. Bullyingoccurs when a student or gro up of students sayor do bad and unpleasant things to anotherstudent. It is also bullying when a student isteased a lot in an unpleasant way or wh en astudent is left out of things on purpose. It is not

bullying w hen two students of about the samestrength or power argue or figh t or when teasingis done in a friendly and fun w ay.

6. During the past 30 days, on how many dayswere you bullied?


All 30 days

7. During the past 30 days, how were you bulliedmost often ?

I was not bullied during the past 30 daysI was hit, kicked, pushed, shoved around,or locked indoorsI was made fun of because of my race,nationality, or colorI was made fun of because of my religionI was made fun of with sexual jokes,comments, or gesturesI was left out of activities on purpose orcompletely ignoredI was made fun of because of how mybody or face looksI was bullied in some other way

A

B

C

D

E

F

G

H

A

B

C

D

E

F

G


16/16

GSHS Option al Core Module for Count ries That Cannot Ask Sexual Behaviour Questions


The next 4 questions ask about HIV infection or AIDS.

1. Have you ever heard of HIV infection or thedisease called AIDS?

YesNo

2. During this school year, were you taught in any ofyour classes about HIV infection or AIDS?

YesNoI do not know

3. During this school year, were you taught in any ofyour classes how to avoid HIV infection or AIDS?

YesNoI do not know

4. Have you ever talked about HIV infection or AIDSwith your parents or guardians?

YesNo

A

B

C

B

A

A

B

C

B

A

Date post:	03-Jun-2018
Category:	Documents
Upload:	owais-khan
View:	217 times
Download:	0 times

GSHS Core Modules 2013 English

Documents