Questionnaires

Please note that the following questionnaire is for reference only.  Participating students will complete paper versions of this questionnaire.

If you wish to see questionnaires from previous years, please visit the questionnaire archive.

Question topics:

Tobacco

Alcohol

Marijuana

Other drugs

Bullying and Well-Being

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. We value your help today.

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.

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

• Female
• Male

4. How would you describe yourself? (Mark all that apply)

• White
• Black
• West Asian/Arab
• South Asian (Indian, ...)
• East/Southeast Asian (Chinese, ...)
• Latin American/Hispanic
• Aboriginal (First Nations, Métis, Inuit, ...)
• Other:

• Yes
• No

6. 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

7.  Do you think in the future you might try smoking cigarettes?

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

8.  If one of your best friends was to offer you a cigarette, would you smoke it?

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

9.  At any time during the next year do you think you will smoke a cigarette?

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

• Yes
• No

• 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. Over the last 7 days, in total, how many whole cigarettes did you smoke?

Number of whole cigarettes smoked: _________________________

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 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
• Less than 10 cents
• 10 cents to 50 cents
• 51 cents to $1.00 •$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 (vaporizer with e-juice, 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 (vaporizer with e-juice, vape pen, tank, mod)?

• 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)

23. Where do you usually get your e-cigarettes and supplies (vaporizers, e-juice, vape pens, tanks, mods)? (Mark all that apply)

• I do not use e-cigarettes
• I buy them from a vape shop
• 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. Have you ever tried any of the following?

Response options for each item: yes, no

1. Smoking little cigars or cigarillos (plain or flavoured)
2. Smoking cigars (not including little cigars or cigarillos, plain or flavoured)
3. Smoking roll-your-own cigarettes (tobacco only, in rolling papers)
4. Using smokeless tobacco (chewing tobacco, pinch, snuff, or snus)
5. Using nicotine patches, nicotine gum, nicotine lozenges, nicotine inhalers, or nicotine spray
6. Using a water-pipe (hookah) to smoke shisha (herbal or tobacco)
7. Using blunt wraps (a tube made of tobacco used to roll cigarette tobacco)
8. Using e-cigarettes (vaporizers with e-juice, vape pens, tanks, mods)

25. In the last 30 days, did you use any of the following?

Response options for each item: yes, no

1. Little cigars or cigarillos (plain or flavoured)
2. Cigars (not including little cigars or cigarillos, plain or flavoured)
3. Roll-your-own cigarettes (tobacco only, in rolling papers)
4. Smokeless tobacco (chewing tobacco, pinch, snuff, or snus)
5. Nicotine patches, nicotine gum, nicotine lozenges, nicotine inhalers, or nicotine spray
6. A water-pipe (hookah) to smoke shisha (herbal or tobacco)
7. Blunt wraps (a tube made of tobacco used to roll cigarette tobacco)
8. E-cigarettes (vaporizers with e-juice, vape pens, tanks, mods)

26. In the last 30 days, how often did you smoke little cigars or cigarillos (plain or flavoured)?

• 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)

27. In the last 30 days, did you use any of the following flavoured tobacco products?

(Yes or No response option to each item)

1. Menthol cigarette
2. Flavoured little cigar or cigarillo
3. Flavoured cigar
4. Flavoured smokeless tobacco
5. Flavoured tobacco in a water-pipe (hookah)
6. Flavoured e-cigarette (vaporizer with e-juice, vape pen, tank, mod)

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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. We are interested to know how youth are drinking alcohol and energy drinks like Red Bull®, Monster® and Rockstar®, not sports drinks. In the last 12 months, did you drink any of the following?

(Yes or No response option to each item)

1. An energy drink
2. Alcohol and an energy drink drank separately on one occasion
3. Alcohol and an energy drink hand-mixed together by you or someone else
4. Store-bought pre-mixed alcoholic beverages with energy drink names (such as Rockstar®+Vodka)

Marijuana Use

• Yes
• No

37. 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

38. 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

39. 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

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

Response options for each item: 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

1. Smoked a joint, bong, pipe or blunt
2. Eaten it in food such as brownies, cakes, cookies or candy
3. Drank it in tea, cola, alcohol, or other drinks
4. Vaporized it (vape)
5. Dabbed it
6. Used it some other way

41. In the last 12 months how did you usually get the marijuana or cannabis you used?

• 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
• Other

Other Drug Use

42. 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

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

Response options for each item: 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

1. Amphetamines (speed, crystal meth or ice, meth, ...)
2. MDMA (ecstasy, E, X, ...)
3. Hallucinogens (LSD, acid, PCP, magic mushrooms or 'shrooms', mesc, ...)
4. Heroin (smack, junk, crank, ...)
5. Cocaine (crack, blow, snow, ...)
6. Synthetic cannabinoids (spice, synthetic marijuana, K2, K3, scence, herbal mixtures, herbal incense, ...)
7. BZP/TFMPP (legal E, legal X, A2, piperazine, frenzy, nemesis, ...)
8. Bath salts (mephedrone, MDPV, meow, meph, MCAT, ...)
9. 2C (nexus, 2C-B, 2C-I, 2C-C, …) or NBOMe (25C-NBOMe, 25B-NBOMe, 25I-NBOMe, …)
10. Tryptamines (DMT, 'psychosis', AMT, foxy, ...)
11. Glue, gasoline, or other solvents to get high
12. Salvia (divine sage, magic mint, sally D, ...)

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

Response options for each item: 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

1. Sleeping medicine from a store (Nytol®, Unisom®, ...)
2. Stimulants (diet pills, stay awake pills, uppers, bennies, ...)
3. Dextromethorphan such as cold and cough medicine (Robitussin DM®, Benylin DM®, robos, dex, DXM, ...)
4. Gravol®

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 if you did use ADHD medicine for non-medical reasons or to get high, how did you get it?

• I have never taken this medicine for non-medical reasons or to get high
• I did not do this in the last 12 months
• I used medicine 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

48. 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

49. 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

50. In the last 12 months if you did use sedatives or tranquilizers for non-medical reasons or to get high, how did you get them?

• I have never taken this medicine for non-medical reasons or to get high
• I did not do this in the last 12 months
• I used medicine 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

51. 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

52. Have you used the following prescribed pain relievers for non-medical reasons or to get high?

Response options for each item: yes, no

1. Oxycodone (oxy, OC, APO, OxyContin®, percs, roxies, OxyNEO®, ...)
2. Fentanyl (china white, synthetic heroin, china girl, ...)
3. Other prescribed pain relievers (morphine, codeine, ...)

53. 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

54. How much do you think people risk harming themselves when they do each of the following activities?

Response options for each item: no risk, slight risk, moderate risk, great risk, I do not know

1. Smoke cigarettes once in a while
2. Smoke cigarettes on a regular basis
3. Smoke a tobacco water-pipe (hookah) once in a while
4. Smoke a tobacco water-pipe (hookah) on a regular basis
5. Use an e-cigarette once in a while
6. Use an e-cigarette on a regular basis
7. Drink alcohol once in a while
8. Drink alcohol on a regular basis
9. Smoke marijuana or cannabis once in a while
10. Smoke marijuana or cannabis on a regular basis
11. Other than smoking it, use marijuana or cannabis once in a while
12. Other than smoking it, use marijuana or cannabis on a regular basis
13. Use prescribed medication such as prescribed pain relievers, tranquilizers, or medicine to treat ADHD, "to get high" once in a while
14. Use prescribed medication such as prescribed pain relievers, tranquilizers, or medicine to treat ADHD, "to get high" on a regular basis

55. 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?

Response options for each item: very difficult, fairly difficult, fairly easy, very easy, I do not know

1. A cigarette
2. An e-cigarette
3. Alcohol
4. Marijuana or cannabis
5. Amphetamines (speed, crystal meth or ice, meth, ...)
6. MDMA (ecstasy, E, X, ...)
7. Hallucinogens (LSD, acid, PCP, magic mushrooms, mesc, ...)
8. Cocaine (crack, blow, snow, ...)
9. Prescribed pain relievers (oxycodone, fentanyl, morphine, codeine, T3, ...)

56. 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?
• No, never
• Yes, in the last 30 days
• Yes, more than 30 days ago
1. within 2 hours of using marijuana or cannabis?
• No, never
• Yes, in the last 30 days
• Yes, more than 30 days ago

57. 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?
• No, never
• Yes, in the last 30 days
• Yes, more than 30 days ago
• I do not know
1. driven by someone who had been using marijuana or cannabis in the last 2 hours?
• No, never
• Yes, in the last 30 days
• Yes, more than 30 days ago
• I do not know

58. During the last 30 days, did you ride in a car with someone who was smoking cigarettes?

• I did not ride in a car in the last 30 days
• Yes
• No

Bullying and Well-Being

59. In the last 30 days, in what ways were you bullied by other students?

Response options for each item: yes, no

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, ...)

60. 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

61. In the last 30 days, in what ways did you bully other students?

Response options for each item: yes, no

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

62. 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

63. How strongly do you agree or disagree with each of the following?

Response options for each item: strongly agree, agree, disagree, strongly disagree.

1. I feel close to people at my school
2. I feel I am part of my school
3. I am happy to be at my school
4. I feel the teachers at my school treat me fairly
5. I feel safe in my school
6. I believe getting good grades is important

64. On a scale from 1 to 6, where 1 is "Definitely not like me" and 6 is "Definitely like me," please fill in the circle that best describes you as a person.

Response options for each item: 1, 2, 3, 4, 5, 6.

1. I cut classes or skip school
2. I make other people do what I want
3. I disobey my parents
4. I talk back to my teachers
5. I get into fights
6. I often say mean things to people to get what I want
7. I take things that are not mine from home, school, or elsewhere
8. I often do favours for people without being asked
9. I often lend things to people without being asked
10. I often help people without being asked
11. I often compliment people without being asked
12. I often share things with people without being asked

65. We are interested in how you feel about yourself and how you think other people see you. For each item, fill in the circle that best describes your feelings and ideas in the past week.

Response options for each item: really false for me, sort of false for me, sort of true for me, really true for me

1. I feel I do things well at school
2. My teachers like me and care about me
3. I feel free to express myself at home
4. I feel my teachers think I am good at things
5. I like to spend time with my parents
6. I feel free to express myself with my friends
7. I feel I do things well at home
8. My parents like me and care about me
9. I feel I have a choice about when and how to do my school work
10. I feel my parents think that I am good at things
11. I like to be with my teachers
12. I feel I have a choice about which activities to do with my friends
13. I feel I do things well when I am with my friends
14. My friends like me and care about me
15. I feel free to express myself at school
16. I feel my friends think I am good at things
17. I like to spend time with my friends
18. I feel like I have a choice about when and how to do my household chores