2014 Bangladesh GSHS Questionnaire Global School-based Student Health Survey (GSHS)

advertisement
Global School-based Student Health Survey (GSHS)
2014 Bangladesh
GSHS Questionnaire
For more information:
www.cdc.gov/gshs or
www.who.int/chp/gshs/en/
2014 BANGLADESH 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 be
used 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 give
will be kept private. No one will know how you answer. Answer the questions based on
what 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 affected
whether or not you answer the questions. If you do not want to answer a question, just
leave it blank.
Make sure to read every question. Fill in the circles on your answer sheet that match
your answer. Use only the pencil you are given. When you are done, do what the
person 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
Survey
1. Do fish live in water?
A. Yes
B. No
Answer sheet
1.
A
B
C
D
E
F
G
H
Thank you very much for your help.
Bangladesh GSHS Questionnaire - 2014
2
1.
How old are you?
The next 3 questions ask about your height,
weight, and going hungry.
A.
11 years old or younger
B.
12 years old
C.
13 years old
ON THE ANSWER SHEET, WRITE YOUR
D.
14 years old
HEIGHT IN THE SHADED BOXES AT THE TOP
E.
15 years old
OF THE GRID. THEN FILL IN THE OVAL
F.
16 years old
BELOW EACH NUMBER.
4.
How tall are you without your shoes on?
G. 17 years old
H.
18 years old or older
Example
Height (cm)
2.
What is your sex?
1
5
0
A.
Male
B.
Female
2
3.
In what class are you?
0
1
1
2
2
3
4
A.
Class 7
B.
Class 8
C.
Class 9
D.
Class 10
4
5
9
Bangladesh GSHS Questionnaire - 2014
3
0
6
6
7
7
8
8
9
9
I do not know
1
5.
How much do you weigh without your shoes on?
The next 4 questions ask about what you might
ON THE ANSWER SHEET, WRITE YOUR
eat and drink.
WEIGHT IN THE SHADED BOXES AT THE TOP
OF THE GRID. THEN FILL IN THE OVAL
7.
During the past 30 days, how many times per day
did you usually eat fruit, such as bananas,
BELOW EACH NUMBER.
guava, mango, pineapple, apples, oranges, jackExample
fruit, boroi, or amra?
Weight (kg)
0
5
1
2
2
0
0
1
1
2
A.
I did not eat fruit during the past 30 days
B.
Less than one time per day
C.
1 time per day
D.
2 times per day
E.
3 times per day
3
3
F.
4 times per day
4
4
G. 5 or more times per day
5
6
6
7
7
8
8
9
9
8.
During the past 30 days, how many times per day
did you usually eat vegetables, such as potatoes,
potol, cauliflower, cabbage, beans, brinjal, ladies
finger, or chichinga?
9
I do not know
A.
I did not eat vegetables during the past 30
days
6.
B.
Less than one time per day
During the past 30 days, how often did you go
C.
1 time per day
hungry because there was not enough food in
D.
2 times per day
your home?
E.
3 times per day
F.
4 times per day
A.
Never
B.
Rarely
C.
Sometimes
D.
Most of the time
did you usually drink carbonated soft drinks, such
E.
Always
as Coke, Fanta Orange, or 7-Up? (Do not include
G. 5 or more times per day
9.
During the past 30 days, how many times per day
diet soft drinks.)
A.
I did not drink carbonated soft drinks during
the past 30 days
B.
Less than one time per day
C.
1 time per day
D.
2 times per day
E.
3 times per day
F.
4 times per day
G. 5 or more times per day
Bangladesh GSHS Questionnaire - 2014
2
10. During the past 7 days, on how many days did
you eat food from a fast food restaurant, such as
The next 11 questions ask about cleaning your
teeth and washing your hands.
KFC, BFC, or Pizza Hut?
15. During the past 30 days, how many times per
A.
0 days
B.
1 day
C.
2 days
D.
3 days
E.
4 days
B.
Less than 1 time per day
F.
5 days
C.
1 time per day
G. 6 days
D.
2 times per day
H.
E.
3 times per day
F.
4 or more times per day
7 days
day did you usually clean or brush your teeth?
A.
I did not clean or brush my teeth during the
past 30 days
The next 4 questions ask about what you were
taught in class during the school year.
16. Which of the following do you use most often to
clean your teeth or gums?
11. During this school year, were you taught in any of
your classes the benefits of healthy eating?
A.
Toothbrush
B.
Wooden toothpicks
A.
Yes
C.
Plastic toothpicks
B.
No
D.
Dental floss or thread
C.
I do not know
E.
Charcoal
F.
Chew stick or datun
12. During this school year, were you taught in any of
G. Something else
your classes the benefits of eating more fruits
and vegetables?
17. How would you describe the health of your teeth?
A.
Yes
A.
Excellent
B.
No
B.
Very good
C.
I do not know
C.
Good
D.
Average
E.
Poor
F.
Very poor
13. During this school year, were you taught in any of
your classes healthy ways to gain weight?
A.
Yes
B.
No
C.
I do not know
14. During this school year, were you taught in any of
your classes healthy ways to lose weight?
18. How would you describe the health of your
gums?
A.
Excellent
B.
Very good
C.
Good
D.
Average
A.
Yes
E.
Poor
B.
No
F.
Very poor
C.
I do not know
Bangladesh GSHS Questionnaire - 2014
3
19. During the past 12 months, did a tooth ache
24. During this school year, were you taught in any of
cause you to miss classes or school?
your classes the importance of hand washing?
A.
Yes
A.
Yes
B.
No
B.
No
C.
I do not know
20. During the past 12 months, how many times did
you go to the dentist?
25. During this school year, were you taught in any
of your classes how to avoid worm infections?
A.
0 times
B.
1 time
A. Yes
C.
2 times
B. No
D. 3 times
E.
4 times
F.
5 or more times
C. I do not know
The next question asks about physical attacks. A
physical attack occurs when one or more people
21. During the past 30 days, how often did you wash
your hands before eating?
hit or strike someone, or when one or more
people hurt another person with a weapon (such
as a stick, knife, or gun). It is not a physical attack
A.
Never
when two students of about the same strength or
B.
Rarely
power choose to fight each other.
C.
Sometimes
D.
Most of the time
E.
Always
22. During the past 30 days, how often did you wash
your hands after using the toilet or latrine?
26. During the past 12 months, how many times were
you physically attacked?
A.
0 times
B.
1 time
C.
2 or 3 times
A.
Never
D.
4 or 5 times
B.
Rarely
E.
6 or 7 times
C.
Sometimes
F.
8 or 9 times
D.
Most of the time
G. 10 or 11 times
E.
Always
H.
12 or more times
23. During the past 30 days, how often did you use
soap when washing your hands?
A.
Never
B.
Rarely
C.
Sometimes
D.
Most of the time
E.
Always
Bangladesh GSHS Questionnaire - 2014
4
The next question asks about physical fights. A
physical fight occurs when two students of about
29. During the past 12 months, what was the most
serious injury that happened to you?
the same strength or power choose to fight each
other.
A.
27. During the past 12 months, how many times were
B.
I had a broken bone or a dislocated joint
C.
I had a cut or stab wound
D.
I had a concussion or other head or neck
I was not seriously injured during the past 12
months
you in a physical fight?
A.
0 times
injury, was knocked out, or could not breathe
B.
1 time
E.
I had a gunshot wound
C.
2 or 3 times
F.
I had a bad burn
D.
4 or 5 times
G. I was poisoned or took too much of a drug
E.
6 or 7 times
H.
F.
8 or 9 times
Something else happened to me
G. 10 or 11 times
The next question asks about bullying. Bullying
H.
occurs when a student or group of students say
12 or more times
or do bad and unpleasant things to another
The next 2 questions ask about serious injuries
student. It is also bullying when a student is
that happened to you. An injury is serious when it
teased a lot in an unpleasant way or when a
makes you miss at least one full day of usual
student is left out of things on purpose. It is not
activities (such as school, sports, or a job) or
bullying when two students of about the same
requires treatment by a doctor or nurse.
strength or power argue or fight or when teasing
is done in a friendly and fun way.
28. During the past 12 months, how many times were
you seriously injured?
30. During the past 30 days, on how many days were
you bullied?
A.
0 times
B.
1 time
A.
0 days
C.
2 or 3 times
B.
1 or 2 days
D.
4 or 5 times
C.
3 to 5 days
E.
6 or 7 times
D.
6 to 9 days
F.
8 or 9 times
E.
10 to 19 days
G. 10 or 11 times
F.
20 to 29 days
H.
G. All 30 days
12 or more times
The next 6 questions ask about your feelings and
friendships.
31. During the past 12 months, how often have you
felt lonely?
Bangladesh GSHS Questionnaire - 2014
A.
Never
B.
Rarely
C.
Sometimes
D.
Most of the time
E.
Always
5
32. During the past 12 months, how often have you
The next 6 questions ask about cigarette and
been so worried about something that you could not
other tobacco use.
sleep at night?
37. How old were you when you first tried a
A.
Never
B.
Rarely
C.
Sometimes
A.
I have never smoked cigarettes
D.
Most of the time
B.
7 years old or younger
E.
Always
C.
8 or 9 years old
D.
10 or 11 years old
E.
12 or 13 years old
F.
14 or 15 years old
33. During the past 12 months, did you ever
seriously consider attempting suicide?
cigarette?
G. 16 or 17 years old
A.
Yes
B.
No
H.
18 years old or older
38. During the past 30 days, on how many days did
34. During the past 12 months, did you make a plan
you smoke cigarettes?
about how you would attempt suicide?
A.
0 days
A.
Yes
B.
1 or 2 days
B.
No
C.
3 to 5 days
D.
6 to 9 days
E.
10 to 19 days
F.
20 to 29 days
35. During the past 12 months, how many times did
you actually attempt suicide?
G. All 30 days
A.
0 times
B.
1 time
C.
2 or 3 times
you use any tobacco products other than
D.
4 or 5 times
cigarettes, such as biri, jarda, tobacco leaf, gul,
E.
6 or more times
or shisha?
36. How many close friends do you have?
39. During the past 30 days, on how many days did
A.
0 days
B.
1 or 2 days
A.
0
C.
3 to 5 days
B.
1
D.
6 to 9 days
C.
2
E.
10 to 19 days
D.
3 or more
F.
20 to 29 days
G. All 30 days
Bangladesh GSHS Questionnaire - 2014
6
40. During the past 12 months, have you ever tried to
44. During the past 30 days, on how many days did
stop smoking cigarettes?
you have at least one drink containing alcohol?
A.
I have never smoked cigarettes
A.
0 days
B.
I did not smoke cigarettes during the past 12
B.
1 or 2 days
months
C.
3 to 5 days
C.
Yes
D.
6 to 9 days
D.
No
E.
10 to 19 days
F.
20 to 29 days
41. During the past 7 days, on how many days have
G. All 30 days
people smoked in your presence?
45. During the past 30 days, on the days you drank
A.
0 days
alcohol, how many drinks did you usually drink
B.
1 or 2 days
per day?
C.
3 or 4 days
D.
5 or 6 days
E.
All 7 days
42. Which of your parents or guardians use any form
of tobacco?
A.
I did not drink alcohol during the past 30
days
B.
Less than one drink
C.
1 drink
D.
2 drinks
E.
3 drinks
A.
Neither
F.
4 drinks
B.
My father or male guardian
G. 5 or more drinks
C.
My mother or female guardian
D.
Both
E.
I do not know
46. During the past 30 days, how did you usually get
the alcohol you drank? SELECT ONLY ONE
RESPONSE.
The next 6 questions ask about drinking alcohol.
This includes drinking Bangla modh or taari.
A.
Drinking alcohol does not include drinking a few
sips of wine for religious purposes. A “drink” is a
days
B.
glass of wine, a bottle of beer, a small glass of
liquor, or a mixed drink.
43. How old were you when you had your first drink
of alcohol other than a few sips?
I did not drink alcohol during the past 30
I bought it in a store, shop, or from a street
vendor
C.
I gave someone else money to buy it for me
D.
I got it from my friends
E.
I got it from my family
F.
I stole it or got it without permission
G. I got it some other way
A.
I have never had a drink of alcohol other
than a few sips
B.
7 years old or younger
C.
8 or 9 years old
D.
10 or 11 years old
E.
12 or 13 years old
F.
14 or 15 years old
G. 16 or 17 years old
H.
18 years old or older
Bangladesh GSHS Questionnaire - 2014
7
Staggering when walking, not being able to speak
right, and throwing up are some signs of being
51. During the past 30 days, how many times have
you used marijuana (also called ganja or weed)?
really drunk.
47. During your life, how many times did you drink so
much alcohol that you were really drunk?
A.
0 times
B.
1 or 2 times
C.
3 to 9 times
D.
10 or more times
A.
0 times
B.
1 or 2 times
C.
3 to 9 times
D.
10 to 19 times
E.
20 or more times
52. During your life, how many times have you used
amphetamines or methamphetamines?
48. During your life, how many times have you got
A.
0 times
into trouble with your family or friends, missed
B.
1 or 2 times
school, or got into fights, as a result of drinking
C.
3 to 9 times
alcohol?
D.
10 to 19 times
E.
20 or more times
A.
0 times
B.
1 or 2 times
The next 4 questions ask about sexual
C.
3 to 9 times
intercourse.
D.
10 or more times
53. Have you ever had sexual intercourse?
The next 4 questions ask about drug use. This
includes using marijuana, amphetamines,
A.
Yes
cocaine, inhalants, yaba, or phensedyl.
B.
No
49. How old were you when you first used drugs?
54. How old were you when you had sexual
intercourse for the first time?
A.
I have never used drugs
B.
7 years old or younger
A.
I have never had sexual intercourse
C.
8 or 9 years old
B.
11 years old or younger
D.
10 or 11 years old
C.
12 years old
E.
12 or 13 years old
D.
13 years old
F.
14 or 15 years old
E.
14 years old
G. 16 or 17 years old
F.
15 years old
H.
G. 16 or 17 years old
18 years old or older
H.
18 year old or older
50. During your life, how many times have you used
marijuana (also called ganja or weed)?
55. The last time you had sexual intercourse, did
you or your partner use a condom?
A.
0 times
B.
1 or 2 times
A.
I have never had sexual intercourse
C.
3 to 9 times
B.
Yes
D.
10 to 19 times
C.
No
E.
20 or more times
Bangladesh GSHS Questionnaire - 2014
8
56. The last time you had sexual intercourse, did
59. During this school year, on how many days did
you or your partner use any other method of birth
you go to physical education (PE) class each
control, such as withdrawal, rhythm (safe time),
week?
birth control pills, or any other method to prevent
pregnancy?
A.
0 days
B.
1 day
A.
I have never had sexual intercourse
C.
2 days
B.
Yes
D.
3 days
C.
No
E.
4 days
D.
I do not know
F.
5 or more days
60. During the past 7 days, on how many days did
The next 5 questions ask about physical activity.
you do exercises to strengthen or tone your
Physical activity is any activity that increases
muscles, such as push-ups, sit-ups, or weight
your heart rate and makes you get out of breath
lifting?
some of the time. Physical activity can be done in
sports, playing with friends, or walking to school.
A.
0 days
Some examples of physical activity are running,
B.
1 day
fast walking, biking, dancing, football, kabaddi,
C.
2 days
cricket, basketball, and badminton.
D.
3 days
E.
4 days
F.
5 days
57. During the past 7 days, on how many days were
you physically active for a total of at least 60
G. 6 days
minutes per day? ADD UP ALL THE TIME YOU
H.
7 days
SPENT IN ANY KIND OF PHYSICAL ACTIVITY
EACH DAY.
61. During the past 7 days, on how many days did
you do stretching exercises, such as toe
A.
0 days
B.
1 day
C.
2 days
A.
0 days
D.
3 days
B.
1 day
E.
4 days
C.
2 days
F.
5 days
D.
3 days
G. 6 days
E.
4 days
H.
F.
5 days
7 days
touching, knee bending, or leg stretching?
G. 6 days
58. During the past 7 days, on how many days did
H.
7 days
you walk or ride a bicycle to or from school?
A.
0 days
B.
1 day
C.
2 days
D.
3 days
E.
4 days
F.
5 days
G. 6 days
H.
7 days
Bangladesh GSHS Questionnaire - 2014
9
The next question asks about the time you spend
65. During the past 30 days, how often were most of
mostly sitting when you are not in school or doing
the students in your school kind and helpful?
homework.
A.
Never
62. How much time do you spend during a typical or
B.
Rarely
usual day sitting and watching television, playing
C.
Sometimes
computer games, talking with friends, or doing
D.
Most of the time
other sitting activities, such as sewing?
E.
Always
A.
Less than 1 hour per day
B.
1 to 2 hours per day
parents or guardians check to see if your
C.
3 to 4 hours per day
homework was done?
D.
5 to 6 hours per day
E.
7 to 8 hours per day
A.
Never
F.
More than 8 hours per day
B.
Rarely
C.
Sometimes
The next question asks about how much sleep
D.
Most of the time
you get.
E.
Always
63. On an average school night, how many hours of
sleep do you get?
66. During the past 30 days, how often did your
67. During the past 30 days, how often did your
parents or guardians understand your problems
and worries?
A.
4 or less hours
B.
5 hours
A.
Never
C.
6 hours
B.
Rarely
D.
7 hours
C.
Sometimes
E.
8 hours
D.
Most of the time
F.
9 hours
E.
Always
G. 10 or more hours
68. During the past 30 days, how often did your
The next 10 questions ask about your experiences
parents or guardians really know what you were
at school and at home.
doing with your free time?
64. During the past 30 days, on how many days did
A.
Never
you miss classes or school without permission?
B.
Rarely
C.
Sometimes
A.
0 days
D.
Most of the time
B.
1 or 2 days
E.
Always
C.
3 to 5 days
D.
6 to 9 days
E.
10 or more days
Bangladesh GSHS Questionnaire - 2014
10
69. During the past 30 days, how often did your
73. During the past 30 days, how often did your
parents or guardians go through your things
parents or guardians ignore you (for example,
without your approval?
walk away from you or not pay attention to you)?
A.
Never
A.
Never
B.
Rarely
B.
Rarely
C.
Sometimes
C.
Sometimes
D.
Most of the time
D.
Most of the time
E.
Always
E.
Always
70. During the past 30 days, how often did your
The next 4 questions ask about HIV infection or
parents or guardians spend time with you?
AIDS.
A.
Never
74. Have you ever heard of HIV infection or the
B.
Rarely
C.
Sometimes
D.
Most of the time
A.
Yes
E.
Always
B.
No
71. During the past 30 days, how often did your
disease called AIDS?
75. During this school year, were you taught in any of
parents or guardians give you money?
your classes about HIV infection or AIDS?
A.
Never
A.
Yes
B.
Rarely
B.
No
C.
Sometimes
C.
I do not know
D.
Most of the time
E.
Always
76. During this school year, were you taught in any of
your classes how to avoid HIV infection or AIDS?
72. During the past 30 days, how often did your
parents or guardians embarrass you in public or
A.
Yes
in front of your friends?
B.
No
C.
I do not know
A.
Never
B.
Rarely
C.
Sometimes
D.
Most of the time
E.
Always
Bangladesh GSHS Questionnaire - 2014
77. Have you ever talked about HIV infection or AIDS
with your parents or guardians?
A.
Yes
B.
No
11
Related documents
Download