Items:

Aggression and Violence
1.Verbally attacked someone
2.Damaged others’ property
3.Made fun of someone for their appearance or physical defect
4.Bullied, threatened, or intimidated someone
5.Been in a physical fight
6.Hit, crushed, pushed, kicked or confined another
7.Ignored driving consequences
8.Planned revenge on someone
9.Blackmailed someone for money
10.Carried a weapon

Suicide and Self-Injurious Behaviors
11.Attempted to cut or scald self
12.Had ideas of suicide
13.Hurt self by biting, scratching, or knocking
14.Attempts at suicide
15.Attempted suicide

Unprotected Sex
16.Ever had sexual intercourse
17.Had sexual intercourse with at least one person
18.Drank alcohol or used drugs before sexual intercourse
19.Caused girl pregnancy (boy) or caused yourself pregnancy (girl)
20.Had sexual intercourse with stranger

Substance Use
21.Used cigarettes
22.Smoked under the pressure of companion
23.Binge drank
24.Were irritable, lost temper, headache, or insomnia due to quit smoking
25.Drank alcohol out of control at a party
26.Drank alcohol to save face

Rule Breaking
27.Skipped classes
28.Ran away from home
29.Received warning, record a demerit, or punishment from school
30.Cheated or plagiarized during examination
31.Lied to family member
32.Gambled
33.Stole money from home

Response Options:
Never - 0
1 time per month - 1
2– 4 times per month - 2
2– 3 times per week - 3
4 times or more per week - 4