Teen Girl Survey

How old are you?

• 13
• 14
• 15
• 16
• 17
• 18
• 19

What would you say is your body type (open a new tab and go to http://www.nhlbisupport.com/bmi/ if you don't know what your BMI is)

• Normal BMI
• Round and Fat, above average BMI
• Obese BMI
• Under weight BMI
• Alomost-overwieght BMI
• Almost-underwieght BMI

Have you ever had/do you have and eating disorder? (right click, open in new tab) http://web4health.info/el/ed-dia-classification.htm

• Yes, Binge disorder (often eat too much when not hungry)
• No, i never have
• Yes, Anorexia (not taking in enough calories in effort to lose weight)
• Yes, Bulimia (purging by induced vomiting or using laxatives)
• Yes, non-classified (mixed symptoms that don'tperfectly fit any of the main 3)
• Some of my friends/ family/ people I know have

Have you ever been abused by your parents?

• Yes, all the time
• Sometimes when they get really mad
• Only when they are intoxicated (drunk or high)
• No, but someone I know has
• No, I never have been abused

What is your sexuality

• Strait
• Lesbian
• Bisexual
• Bi-curious
• I'm not sure

Do you have what would be considered a mental disorder/ learning disability?

Please select all that apply.

• Yes, I am ADD/ADHD
• I think I have one but I'm not diagnosed
• Yes, I am dyslexic
• No, I don't have a mental/learning disability
• Yes, but it's not listed in the questions above

Do you have any pets?

• No
• Yes (1-2)
• Yes (3-4)
• Yes (5-6)
• Yes (7+)

How easy would it be for you to get drugs of any kind (legal or illegal)?

• Easy, my parents wouldn't mind if I did take them
• Not extremely easy, I have to search for them and hide them
• In the middle, I'd have to get them outside the house
• Hard, I'd have to get them from my friends and hide them very well
• Almost impossible, my parents watch me like hawks

Do your parents use drugs? If so what kind and how often?

Please select all that apply.

• Yes, lower danger drugs (weed, tobacco, alcohol, ect.)
• Yes, high danger drugs (prescription pills, heroin, ect.)
• Yes, medium danger drugs (cocain, paint, sharpies, ect.)
• Only recreationally
• All the time
• No, not that I know of
• They have before, but they no longer do

Are you a virgin?

• Yes
• Yes, but I don't want to be
• No, but I was raped
• No
• No, but I wish I could take back my mistake

Do you use drugs? If so what kind and how often?

Please select all that apply.

• Yes, lower danger drugs (weed, tobacco, alcohol, ect.)
• Yes, high danger drugs (prescription pills, heroin, ect.)
• Yes, medium danger drugs (cocain, paint, sharpies, ect.)
• Only recreationally
• All the time
• I have before, but I no longer do
• No, never

Have you ever been sexually abused by anyone?

Please select all that apply.

• Yes, my parents
• Yes, my parents friend
• Yes, someone I work with/a school employee
• Yes, a friend/boyfriend
• No, but my friend has been
• No, never
• Yes, by someone I don't know

What do you think is child abuse?

Please select all that apply.

• Beating to a point that there are bruises and/or bleeding, a little smack isn't that bad if you deserve it
• Smacking for punishment, causing any sort of pain to the child
• Yelling commands and being just plain mean
• Forcing a child to work very hard with no reward, a little work around the house isn't bad though
• Calling names and putting down
• Touching in privat places unless a small child is being bathed or treated/checked for injury by parents
• I'm not sure
• forcing the child to work at all, that is the parents' job

How are your living conditions?

• Filthy, not just cluttered, but roaches, filth, no clean water or food
• Dirty but livable, some dirt and water that is okay to drink but not very good, little but enough food
• Cluttered, clean but there are things with no place, good food and water
• Good, maybe a little dirty but definatly livable, plenty of food and good water maybe a little bug here-and-there
• Clean, plenty of food and water, almost no dirt, and a bug might crawl in through the door every now and then
• Luxurious, perfectly clean, no bugs, great food, great water

Are you/ have you ever been seriously depressed?

• Yes, and I have a good reason
• Yes, I go through random depression often
• Yes, and it was stupid for me to get so worked up
• No, but my friend(s) have/are
• No, I never have

What is your religion?

• Christian
• Jewish
• Athiest
• Agnostic
• Muslum
• Not listed