# Questionnaires

The questionnaire below is for reference only.  Please do not print and complete this questionnaire.  The links below will allow you will allow you to jump to the different topic areas of the questionnaire.

Tobacco Use

Alcohol Use

Marijuana/Cannabis Use

Other Drug Use

Bullying and Sleep

Thousands of students across Canada, just like you, have been asked to take part in this survey. This important survey will help Health Canada to better understand tobacco, alcohol, and drug use among young people in Canada.

Please use a pencil to complete this questionnaire.

• Even if you don't use tobacco, alcohol, or drugs, please make sure you answer each question so that all students take the same amount of time to complete the questionnaire.
• This is NOT a test. All of your answers will be kept confidential. No one, not even your parents or teachers, will ever know what you answered. Please be honest when you answer the questions.
• Mark only one option per question unless the instructions tell you to do something else.
• If you do not understand a question, or do not wish to answer a question, leave it blank and continue to the next question.
• Choose the option that is the closest to what you think/feel is true for you.

### 1) What grade are you in?

Quebec students only

• Secondary I
• Secondary II
• Secondary III
• Secondary IV

### 2) How old are you today?

• 11 years or younger
• 12 years
• 13 years
• 14 years
• 15 years
• 16 years
• 17 years
• 18 years
• 19 years or older

• Male
• Female

### 4) What is your gender?

Gender refers to current gender which may be different from sex assigned at birth and may be different from what is indicated on legal documents.

• Man / boy
• Woman / girl

### 5) Which of the following best describes you?

• Gay or lesbian
• Straight, that is, not gay or lesbian
• Bisexual
• Asexual, that is, someone who doesn't experience sexual attraction
• I am not yet sure of my sexual identity
• Something else. I identify as __________________________
• I am not sure what this question means

### 6) How many years have you lived in Canada?

• I was born in Canada
• 1 to 2 years
• 3 to 5 years
• 6 to 10 years
• 11 or more years

## Tobacco Use

• Yes
• No

### 8) How old were you when you first tried smoking cigarettes, even just a few puffs?

• I have never done this
• I do not know
• 8 years or younger
• 9 years
• 10 years
• 11 years
• 12 years
• 13 years
• 14 years
• 15 years
• 16 years
• 17 years
• 18 years or older

### 9) At any time during the next 12 months do you think you will smoke a cigarette?

• Definitely yes
• Probably yes
• Probably not
• Definitely not

### 10) At any time during the next 12 months do you think you will use an e-cigarette (vape, vape pen, tank & mod)?

• Definitely yes
• Probably yes
• Probably not
• Definitely not

• Yes
• No

• Yes
• No

### 13) On how many of the last 30 days did you smoke one or more cigarettes?

• None
• 1 day
• 2 to 3 days
• 4 to 5 days
• 6 to 10 days
• 11 to 20 days
• 21 to 29 days
• 30 days (every day)

### 14) Thinking back over the last 7 days, which days did you smoke at least one whole cigarette?

• I have never smoked
• I did not smoke in the last 7 days
• I smoked every day
• I smoked on weekend days only (after school Friday - Sunday)
• I smoked on week days only
• I smoked on week days and weekend days, but not every day

### 15) Thinking back over the last 7 days, how many whole cigarettes did you smoke each day?

• Sunday: (enter the number of whole cigarettes you smoked on Sunday)
• Monday: (enter the number of whole cigarettes you smoked on Monday)
• Tuesday: (enter the number of whole cigarettes you smoked on Tuesday)
• Wednesday: (enter the number of whole cigarettes you smoked on Wednesday)
• Thursday: (enter the number of whole cigarettes you smoked on Thursday)
• Friday: (enter the number of whole cigarettes you smoked on Friday)
• Saturday: (enter the number of whole cigarettes you smoked on Saturday)

### 16) Have you ever tried to quit smoking cigarettes?

• I have never smoked
• I have only smoked a few times
• I have never tried to quit
• I have tried to quit once
• I have tried to quit 2 or 3 times
• I have tried to quit 4 or 5 times
• I have tried to quit 6 or more times

### 17) Where do you usually get your cigarettes?

(Mark only one)

• I do not smoke
• I buy them myself at a store
• I buy them from a First Nation Reserve (i.e. delivery service)
• I buy them on a First Nation Reserve I buy them from a friend
• I buy them from someone else
• My brother or sister gives them to me
• My mother or father gives them to me
• A friend gives them to me
• Someone else gives them to me
• I take them from my mother, father, or siblings
• Other

### 18) Thinking about the last time you bought cigarettes in the last 12 months, what did you buy?

• I did not buy cigarettes in the last 12 months
• A single cigarette
• A pack of 20 cigarettes
• A pack of 25 cigarettes
• A bag of 200 cigarettes
• A carton (200 cigarettes)
• A can or pouch of tobacco (loose tobacco)
• Another amount

### 19) Thinking about the last time you bought cigarettes in the last 12 months, how much did you pay?

• I did not buy cigarettes in the last 12 months
• I do not remember the price
• $1.00 or less •$1.01 to $6.00 •$6.01 to $8.00 •$8.01 to $10.00 •$10.01 to $15.00 •$15.01 to $20.00 •$20.01 to $40.00 •$40.01 to $60.00 •$60.01 to $80.00 •$80.01 or more

### 20) When you first tried a tobacco product (not including e-cigarettes), was it flavoured (including menthol)?

• I have never used a tobacco product
• Yes
• No

### 21) Which did you try first: a cigarette or an e-cigarette (vape, vape pen, tank & mod)?

• I have never tried a cigarette nor an e-cigarette
• I have only tried a cigarette and never tried an e-cigarette
• I have only tried an e-cigarette and never tried a cigarette
• I have tried both and tried a cigarette first
• I have tried both and tried an e-cigarette first
• I do not remember

### 22) On how many of the last 30 days did you use an e-cigarette (vape, vape pen, tank & mod)?

• Daily or almost daily
• Less than daily, but at least once a week
• Less than weekly, but at least once a month
• Less than monthly
• Not at all
• I do not know

### 23) Where do you usually get your e-cigarettes and supplies (vape, vape pen, tank & mod, e-juice)?

(Mark all that apply)

• I do not use e-cigarettes
• I buy them from a vape shop
• I buy them from a convenience store
• A family member gives them to me
• A friend gives them to me
• Someone else gives them to me
• I use my mother’s, father’s, or siblings’ without their permission
• I use someone else’s without their permission
• Other

### 24) In the last 30 days, did you use any of the following?

#### a) Cigars, little cigars or cigarillos (plain or flavoured)

• Daily or almost daily
• Less than daily, but a least once a week
• Less than weekly, but at least once in the last 30 days
• Tried, but did not use in the last 30 days
• I have never tried

#### b) Smokeless tobacco (chewing tobacco, pinch, dip, snuff, or snus)

• Daily or almost daily
• Less than daily, but a least once a week
• Less than weekly, but at least once in the last 30 days
• Tried, but did not use in the last 30 days
• I have never tried

#### c) Nicotine patches, nicotine gum, nicotine lozenges, nicotine inhalers, or nicotine spray

• Daily or almost daily
• Less than daily, but a least once a week
• Less than weekly, but at least once in the last 30 days
• Tried, but did not use in the last 30 days
• I have never tried

#### d) A water-pipe (hookah) to smoke shisha (tobacco)

• Daily or almost daily
• Less than daily, but a least once a week
• Less than weekly, but at least once in the last 30 days
• Tried, but did not use in the last 30 days
• I have never tried

#### e) Heated tobacco products (iQOSTM   or GloTM )

• Daily or almost daily
• Less than daily, but a least once a week
• Less than weekly, but at least once in the last 30 days
• Tried, but did not use in the last 30 days
• I have never tried

#### f) E-cigarettes (vape, vape pen, tank & mod) with nicotine

• Daily or almost daily
• Less than daily, but a least once a week
• Less than weekly, but at least once in the last 30 days
• Tried, but did not use in the last 30 days
• I have never tried

#### g) E-cigarettes (vape, vape pen, tank & mod) without nicotine

• Daily or almost daily
• Less than daily, but a least once a week
• Less than weekly, but at least once in the last 30 days
• Tried, but did not use in the last 30 days
• I have never tried

## Alcohol Use

A DRINK means: 1 regular sized bottle, can, or draft of beer; 1 glass of wine; 1 bottle of cooler; 1 shot of liquor (rum, whisky, Baileys®, etc.); or 1 mixed drink (1 shot of liquor with pop, juice, energy drink, etc.).

• Yes
• No

### 26) In the last 12 months, how often did you have a drink of alcohol that was more than just a sip?

• I have never had a drink of alcohol that was more than just a sip
• I did not drink alcohol in the last 12 months Less than once a month
• Once a month
• 2 or 3 times a month
• Once a week
• 2 or 3 times a week
• 4 to 6 times a week
• Every day
• I do not know

### 27) How old were you when you first had a drink of alcohol that was more than just a sip?

• I have never had a drink of alcohol that was more than just a sip
• I do not know
• 8 years or younger
• 9 years
• 10 years
• 11 years
• 12 years
• 13 years
• 14 years
• 15 years
• 16 years
• 17 years
• 18 years or older

### 28) In the last 30 days, how often did you have a drink of alcohol that was more than just a sip?

• I have never had a drink of alcohol that was more than just a sip
• I have not done this in the last 30 days
• Once or twice
• Once or twice a week
• 3 or 4 times a week
• 5 or 6 times a week
• Every day
• I do not know

### 29) In the last 12 months, how often did you have 5 or more drinks of alcohol on one occasion?

• I have never had 5 or more drinks of alcohol on one occasion
• I have not done this in the last 12 months
• Less than once a month
• Once a month
• 2 to 3 times a month
• Once a week
• 2 to 5 times a week
• Daily or almost daily
• I do not know

### 30) How old were you when you first had 5 or more drinks of alcohol on one occasion?

• I have never had 5 or more drinks of alcohol on one occasion
• I do not know
• 8 years or younger
• 9 years
• 10 years
• 11 years
• 12 years
• 13 years
• 14 years
• 15 years
• 16 years
• 17 years
• 18 years or older

### 31) In the last 30 days, how often did you have 5 or more drinks of alcohol on one occasion?

• I have never had 5 or more drinks of alcohol on one occasion
• I have not done this in the last 30 days
• Once or twice
• Once or twice a week
• 3 or 4 times a week
• 5 or 6 times a week
• Every day
• I do not know

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

## Marijuana/Cannabis Use

• Yes
• No

### 34) In the last 12 months, how often did you use marijuana or cannabis?

• I have never used marijuana or cannabis
• I have not done this in the last 12 months
• Less than once a month
• Once a month
• 2 or 3 times a month
• Once a week
• 2 or 3 times a week
• 4 to 6 times a week
• Every day
• I do not know

### 35) How old were you when you first used marijuana or cannabis?

• I have never used marijuana or cannabis
• I do not know
• 8 years or younger
• 9 years
• 10 years
• 11 years
• 12 years
• 13 years
• 14 years
• 15 years
• 16 years
• 17 years
• 18 years or older

### 36) In the last 30 days, how often did you use marijuana or cannabis?

• I have never used marijuana or cannabis
• I have not done this in the last 30 days
• Once or twice
• Once or twice a week
• 3 or 4 times a week
• 5 or 6 times a week
• Every day
• I do not know

### 37) Indicate whether you have used marijuana or cannabis (a joint, pot, weed, hash, or hash oil) in the following ways:

#### a) Smoked a joint, bong, pipe or blunt

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this but not in the last 12 months

#### b) Eaten it in food such as brownies, cakes, cookies or candy

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this but not in the last 12 months

#### c) Drank it in tea, cola, alcohol, or other drinks

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this but not in the last 12 months

#### d) Vaporized it (vape)

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this but not in the last 12 months

#### e) Dabbed it

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this but not in the last 12 months

#### f) Used it some other way

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this but not in the last 12 months

### 38) In the last 12 months, how did you usually get the marijuana or cannabis you used?

(Mark only one)

• I have never used marijuana or cannabis
• I have not done this in the last 12 months
• I grow my own
• It was shared around a group of friends
• I took it from a family member or friend without their permission
• I took it from someone else without their permission
• I got or bought it from a family member or a friend
• I got or bought it from someone else
• I bought it from a store
• Someone bought it for me at a retail store
• Other

### 39) The use of cannabis was made legal for adults in Canada. Has it been easier to get marijuana or cannabis for yourself after legalization?

• I have never bought/got cannabis/marijuana
• It has been easier
• It has been harder
• Neither easier nor harder

### 40) In the last 12 months, how often did you have alcohol AND marijuana or cannabis on the same occasion? (e.g., at a party, in the same evening, etc.)

• I have never had alcohol AND cannabis on one occasion
• I have not done this in the last 12 months
• Less than once a month
• Once a month
• 2 to 3 times a month
• Once a week
• 2 to 5 times a week
• Daily or almost daily
• I do not know

## Other Drug Use

### 41) Have you used a drug or substance to get high without knowing what it was?

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this, but not in the last 12 months

### 42) Have you ever used a drug or substance to get high that was not what you thought it was?

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this, but not in the last 12 months

### 43) Indicate whether you have ever used or tried any of the following drugs:

#### a) Amphetamines (speed, crystal meth or ice, meth, crank, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### b) MDMA (ecstasy, E, X, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### c) Hallucinogens (LSD, acid, PCP, magic mushrooms or 'shrooms', mesc, ketamines, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### d) Heroin (smack, junk, horse, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### e) Cocaine (crack, blow, snow, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### f) Synthetic cannabinoids (spice, synthetic marijuana, scence, herbal mixtures, herbal incense, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### g) BZP/TFMPP (legal X, A2, piperazine, frenzy, nemesis, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### h) Bath salts (mephedrone, MDPV, meph, MCAT, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### i) 2C (nexus, 2C-B, 2C-I, 2C-C, …) or NBOMe (25C-NBOMe, 25B-NBOMe, 25I-NBOMe, …)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

### j)Tryptamines (DMT, 'psychosis', AMT, foxy, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### k) Glue, gasoline, or other solvents to get high

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### l) Salvia (divine sage, magic mint, sally D, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

### 44) Have you ever used or tried any of the following medications for non-medical reasons or to get high?

#### a) Sleeping medicine from a store (Nytol®, Unisom®, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### b) Stimulants (diet pills, stay awake pills, uppers, bennies, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### c) Dextromethorphan such as cold and cough medicine (Robitussin DM®, Benylin DM®, robos, dex, DXM, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### d) Gravol®

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

Now we would like to ask you about medicines that are only available with  a prescription from a Health Care Provider, such as a doctor, dentist, or a nurse practitioner.

### 45) In the last 12 months, were you given a prescription by a Health Care Provider for medicine to treat hyperactivity or concentration difficulty, also called ADHD (Ritalin®, Concerta®, Adderall®, Dexedrine®, ...)?

• Yes
• No
• I do not know

### 46) Have you used ADHD medicine for non-medical reasons or to get high (Ritalin®, Concerta®, Adderall®, Dexedrine®, ...)?

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this, but not in the last 12 months

### 47) In the last 12 months, were you given a prescription by a Health Care Provider for sedatives or tranquilizers to help you sleep, calm down, or relax your muscles (Ativan®, Xanax®, Valium®, ...)?

• Yes
• No
• I do not know

### 48) Have you used sedatives or tranquilizers for non-medical reasons or to get high (Ativan®, Xanax®, Valium®, ...)?

• No, I have never done this
• Yes, I have done this in the last 12 months
• Yes, I have done this, but not in the last 12 months

### 49) In the last 12 months, were you given a prescription by a Health Care Provider for prescribed pain relievers (oxycodone, fentanyl, morphine, codeine, T3 ...)? This does not include pain relievers such as Advil®, Aspirin®, or regular Tylenol® that anyone can buy in a drug store.

• Yes
• No
• I do not know

### 50) Have you used the following prescription pain relievers for non-medical reasons or to get high?

#### a)Oxycodone (oxy, OC, APO, OxyContin®, percs, roxies, OxyNEO®, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### b)Fentanyl

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

#### c)Other prescription pain relievers (morphine, codeine, ...)

• No, I have never used this
• Yes, I have used this in the last 12 months
• Yes, I have used this but not in the last 12 months

### 51) In the last 12 months if you did use prescribed pain relievers for non-medical reasons or to get high, how did you get them?

• I have never taken prescribed pain relievers for non-medical reasons or to get high
• I did not do this in the last 12 months
• I used pain relievers from my own prescription for non-medical reasons or to get high
• I took them from a family member or friend without their permission
• I took them from someone else without their permission
• I got or bought them from a family member or friend
• I got or bought them from someone else
• Other

### 52) How much do you think people risk harming themselves when they do each of the following activities?

1. Smoke cigarettes once in a while
2. Smoke cigarettes on a regular basis
3. Smoke a water-pipe with tobacco (hookah) once in a while
4. Smoke a water-pipe with tobacco (hookah) on a regular basis
5. Use an e-cigarette with nicotine once in a while
6. Use an e-cigarette with nicotine on a regular basis
7. Use an e-cigarette without nicotine once in a while
8. Use an e-cigarette without nicotine on a regular basis
9. Drink alcohol once in a while
10. Drink alcohol on a regular basis
11. Smoke marijuana or cannabis once in a while
12. Smoke marijuana or cannabis on a regular basis
13. Other than smoking it, use marijuana or cannabis once in a while
14. Other than smoking it, use marijuana or cannabis on a regular basis
15. Use prescribed medication such as prescribed pain relievers, tranquilizers, or medicine to treat ADHD, "to get high" once in a while
16. Use prescribed medication such as prescribed pain relievers, tranquilizers, or medicine to treat ADHD, "to get high" on a regular basis

Response options: No risk / Slight risk / Moderate risk / Great risk / I do not know

### 53) How difficult or easy do you think it would be for you to get each of the following types of substances, if you wanted some?

1. A cigarette
2. An e-cigarette with nicotine
3. An e-cigarette without nicotine
4. Alcohol
5. Marijuana or cannabis
6. Amphetamines (speed, crystal meth or ice, meth, ...)
7. MDMA (ecstasy, E, X, ...)
8. Hallucinogens (LSD, acid, PCP, magic mushrooms, mesc, ...)
9. Cocaine (crack, blow, snow, ...)
10. Prescribed pain relievers (oxycodone, fentanyl, morphine, codeine, T3, ...)

Response options: Very difficult / Fairly difficult / Fairly easy / Very easy / I do not know

### 54) Have you driven a vehicle (e.g., car, snowmobile, motor boat, or all-terrain vehicle (ATV))...

1. within an hour of drinking one or more drinks of alcohol?
2. within 2 hours of using marijuana or cannabis?

Response options: No, never / Yes, in the last 30 daysYes, more than 30 days ago

### 55) Have you ever been a passenger in a vehicle (e.g., car, snowmobile, motor boat, or all-terrain vehicle (ATV))...

1. driven by someone who had one or more drinks of alcohol in the last hour?
2. driven by someone who had been using marijuana or cannabis in the last 2 hours?

Response options: No, never / Yes, in the last 30 daysYes, more than 30 days ago / I do not know

### 56) Which behaviours are allowed, or do you think are allowed, at your house?

1. smoking cigarettes?
2. smoking cannabis?
3. vaping e-cigarettes?
4. vaping cannabis?

Response options: Allowed inside and outside / Allowed inside only / Allowed outside only / Not allowed inside or outside

## Bullying and Sleep

### 57) In the last 30 days, in what ways were you bullied by other students?

1. Physical attacks (getting beaten up, pushed, or kicked, ...)
2. Verbal attacks (getting teased, threatened, or having rumours spread about you, ...)
3. Non-verbal attacks (being ignored, being left out or excluded, being given dirty looks, …)
4. Cyber-attacks (being sent mean text messages or having rumours spread about you on the internet, ...)

Response options: Yes / No

### 58) In the last 30 days, how often have you been bullied by other students?

• I have not been bullied by other students in the last 30 days
• Less than once a week
• 2 or 3 times a week
• Daily or almost daily

### 59) In the last 30 days, in what ways did you bully other students?

1. Physical attacks (beat up, pushed, or kicked them, ...)
3. Non-verbal attacks (ignoring, leaving someone out or excluding them, giving dirty looks, …)
4. Cyber-attacks (sent mean text messages or spread rumours about them on the internet, ...)
5. Stole from them or damaged their things

Response options: Yes / No

### 60) In the last 30 days, how often did you bully other students?

• I have not bullied other students in the last 30 days
• Less than once a week
• 2 or 3 times a week
• Daily or almost daily

For questions 61 to 63, please answer with the closest minute. For example, if you go to bed at 10:25pm, fill in the circles like this:

### 61) On a typical school night (Sunday to Thursday), what time do you…

1. go to bed? (select option between 6:00pm and 4:45am)
2. fall asleep? (select option between 6:00pm and 4:45am)

### 62) On a typical school morning (Monday to Friday), what time do you…

1. wake up? (select option between 5:00am and 4:45pm)
2. leave your house to get to school? (select option between 5:00am and 4:45pm)
3. arrive at school? (select option between 5:00am and 4:45pm)

### 63) On a typical WEEKEND, what time do you…

1. go to bed? (Friday and Saturday night) (select option between 6:00pm and 4:45am)
2. fall asleep? (Friday and Saturday night) (select option between 6:00pm and 4:45am)
3. wake up? (Saturday and Sunday morning) (select option between 5:00am and 4:45pm)

### 64) Do you use electronics (e.g., TV, video games, computer, tablet or smartphone) before bedtime?

• No
• Yes, within 30 minutes before bedtime
• Yes, within 1 hour before bedtime
• Yes, within 2 hours before bedtime

### 65. In the last two weeks, how often have you….

1. felt satisfied with your sleep?
• Every day / night
• Several times
• Twice
• Once
• Never
2. arrived late to class because you overslept?
• Every day / night
• Several times
• Twice
• Once
• Never
3. fallen asleep in a morning class?
• Every day / night
• Several times
• Twice
• Once
• Never
4. fallen asleep in an afternoon class?
• Every day / night
• Several times
• Twice
• Once
• Never
5. stayed up until at least 3am?
• Every day / night
• Several times
• Twice
• Once
• Never
6. stayed up all night?
• Every day / night
• Several times
• Twice
• Once
• Never
7. slept past noon?
• Every day / night
• Several times
• Twice
• Once
• Never
8. felt tired, dragged out, or sleepy during the day?
• Every day / night
• Several times
• Twice
• Once
• Never
9. needed more than one reminder to get up in the morning?
• Every day / night
• Several times
• Twice
• Once
• Never
10. had an extremely hard time falling asleep?
• Every day / night
• Several times
• Twice
• Once
• Never
11. gone to bed because you just couldn’t stay awake any longer?
• Every day / night
• Several times
• Twice
• Once
• Never
12. struggled to stay awake while reading, studying, or doing homework?
• Every day / night
• Several times
• Twice
• Once
• Never