Garrett County Adolescent Survey Developed by the Garrett County Adolescent Health Work Group Question Title * 1. What grade are you currently enrolled in? 9th Grade 10th Grade 11th Grade 12th Grade College Question Title * 2. What is your gender? Female Male Non-Binary Prefer Not to Answer Question Title * 3. Regarding the rate of births to teens ages 15-19 years (per 1,000 population of teenaged females), which number do you think comes closest to Garrett County’s rate for the year 2017? 6 births per 1,000 teenaged females 12 births per 1,000 teenaged females 18 births per 1,000 teenaged females 24 births per 1,000 teenaged females Question Title * 4. Maryland’s 2017 goal was that >57% of adolescents receive an annual physical exam (annual check-up) by a primary provider (physician or nurse practitioner). The state of Maryland averaged 54.6%. Approximately what percent of adolescents in Garrett County do you think received annual physical exams in 2017? 27% 32% 38% 56% Question Title * 5. What percent of Garrett County high school students do you think seriously considered suicide during the year leading up to the 2016 Youth Risk Behavior Survey (YRBS)? 3% 7% 14% 21% Question Title * 6. What percentage of Garrett County high school students do you think have ever engaged in sex before graduating? 40% 50% 60% 70% Question Title * 7. True or false: Tobacco use among adolescents is highest in Garrett County, compared to all of the counties in Maryland. True False Question Title * 8. Do you think electronic nicotine delivery systems (also known as vaping devices) are addictive? Yes No Question Title * 9. Do you think electronic nicotine delivery systems are safe (referring to the effect on health rather than the possible explosiveness of the device.)? Yes No Question Title * 10. What percentage of Garrett County high school students do you think reported binge drinking on at least 1 day during the 30 days before the 2016 YRBS survey? 15% 23% 40% 55% Question Title * 11. During the last 12 months, I saw a health care provider (doctor, nurse practitioner, physician assistant) for the following reasons: (Check all that apply.) Adolescent wellness check-up. New illness (ex: flu, cough, fever) Established illness (ex: asthma follow-up) Vaccination services Sports physical Other (please specify) Question Title * 12. What kept you from attending routine adolescent wellness/preventive medicine check-ups in the past 12 months, if any? Choose as many as apply to you. Not enough time I am generally well, and not in need of routine wellness checks I am uncertain about bringing up sensitive issues like sexuality, substance use, and mental illness I don’t have a medical clinic that caters to my needs I do not have medical insurance My parents are unwilling (or probably unwilling) to allow me to have full range of services Adolescent issues are best addressed within the home by my parents Other (please specify) Question Title * 13. What would you like to talk to your health care provider about if you could see them?Choose as many as apply: Weight gain/obesity Weight loss or eating disorders Bullying Anxiety Depression Stress Home life Dating violence Abuse of any type (physical, sexual,verbal,emotional) Drinking alcohol Addiction to any substance Suicidal thoughts Sexual health (birth control, STI prevention) Sexuality/orientation Gender identification Future goals Financial stressors How much sleep I need What’s the best amount of exercise to get How to avoid pitfalls of peer pressure Healthiest diet for me Maximum amount of non-academic screen time I should have Advice before I go away to college Other (please specify) Question Title * 14. What would help you be healthier? Question Title * 15. What is your zip code? Finished
