I. MYSELF (S3, 2011)

HEALTHS3 I1 In general, would you say your health is... (Circle one number only.)

1 Excellent

2 Very good

3 Good

4 Fair

5 Poor

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I2 In an average week, how many days do you...

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MYRT1S3 Eat Breakfast

MYRT2S3 Do moderate physical activity for at least 30 minutes, such as walking or biking

MYRT3S3 Do vigorous physical activity for at least 30 minutes, such as running, football, or swimming

I3 What is your current weight and height?

Height Feet:    MYHTS3     and    Inches:    MYINS3

Weight Pounds:    MYWTS3

I4 How many hours of sleep do you usually get in a 24 hour period?

MYSLPLS3 Low number of hours

MYSLPHS3 High number of hours

I5 Please indicate how much you agree or disagree with the following statements?

                                        1 Definitely disagree

2 Mostly disagree

3 Neither agree nor disagree

4 Mostly agree

5  Definitely agree

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MYHLCS3 I like my looks just the way they are

MYHLDS3 I check my appearance in a mirror whenever I can

MYHLES3 Before going out, I usually spend a lot of time getting ready

MYHLHS3 I use very few beauty or styling products

MYHLKS3 I don't care what people think about my appearance

MYHLLS3 I am physically unattractive

MYWT1S3 I6 I have tried to lose weight by fasting or going on diets.

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very often

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MYWT2S3 I7 I think I am:

1 Very underweight

2 Somewhat underweight

3 Normal weight

4 Somewhat overweight

5 Very overweight

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MYINTS3 I8 The next question is about intelligence--having a quick mind, catching on to things fast. How intelligent do you think you are, compared with others your age?

1 Far above average

2 Above average

3 Average

4 Below average

5 Far below average

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MYREAS3 I9 How good a reader do you think you are, compared with others your age?

1 Far above average

2 Above average

3 Average

4 Below average

5 Far below average

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MYSCHS3 I10 How do you rate yourself in school ability?

1 Far above average

2 Above average

3 Average

4 Below average

5 Far below average

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How strongly do you agree or disagree with each of the following statements? (Circle one number for each)


1 Strongly disagree

2 Disagree

3 Agree

4 Strongly Agree

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MY4AS3 I11 I feel I have a number of good qualities.

MY4BS3 I12 I certainly feel useless at times.

MY4CS3 I13 I feel I do not have much to be proud of.

MY4ES3 I14 There is really no way I can solve some of the problems I have.

MY4FS3 I15 I take a positive attitude toward myself.

MY4GS3 I16 On the whole, I am satisfied with myself.

MY4HS3 I17 Sometimes I feel that I'm being pushed around in life.

MY4JS3 I18 I have little control over the things that happen to me.

MY4KS3 I19 I wish I could have more respect for myself.

MY4LS3 I20 I can do just about anything I really set my mind to do.

MY4MS3 I21 At times I think I am no good at all.

MY4NS3 I22 What happens to me in the future mostly depends on me.

MY4OS3 I23 I often feel helpless in dealing with the problems of life.

MY4PS3 I24 There is little I can do to change many of the important things in my life.

I25 Have you used any of these strategies to help you deal with stress?

1 Never

2 Once

3 Couple of times

4 Frequently

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MY7CS3 Go out

MY7HS3 Listen to music

MY7IS3 Exercise

MY7JS3 Play sports

MY7LS3 Go shopping

MY7NS3 Stop eating

MY7OS3 Drink

MY7PS3 Hit someone

MY7RS3 Do drugs

MY7SS3 Smoke

MY7US3 Hurt myself on purpose

During the past month, how much of the time: (Circle one number for each)

1 None of the time

2 A little of the time

3 Some of the time

4 Most of the time

5 All of the time

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MY5BS3 I26 Have you been under any strain, stress, or pressure?

MY5ES3 I27 Have you felt downhearted and blue?

MY5FS3 I28 Have you been moody or brooded about things?

MY5HS3 I29 Have you felt depressed?

MY5IS3  I30 Have you been in low or very low spirits?

How many times in the past 6 months has someone your age done the following in school or out of school?

1 Never

2 Once

3 Twice

4 3-4 times

5 5+ times

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I31      Made fun of you, called you names, or insulted you?BULA3S3
I32     Spread rumors about you?BULB3S3
I33     Threatened to hurt you?BULC3S3
I34     Pushed you, shoved you, or spit on you?BULD3S3
I35     Tried to make you do things you did not want to do, like giving them money or other things?BULE3S3
I36     Excluded you from activities on purpose?BULF3S3
I37     Destroyed your property on purpose?BULG3S3

BULHS3 I38 Did you tell a teacher or some other adult about any of these events?

1 Yes

2 No

3 These events did not happen to me

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MY6S3 I39 Do you have issues regarding sadness or other mental heath problems that you would like some help with?

0 No

1 Yes

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H. Leisure and Civic Activities (S3, 2011)
J. Rule Breaking and Substance Use (S3, 2011)