Thousands of students across Canada, just like you, have been asked to takepart 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.

Please mark all youranswers with full, darkmarks like this:

• Even if you don't use tobacco, alcohol, or drugs, please make sure youanswer each question so that all students take the same amount of time tocomplete 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 dosomething 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.

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© Her Majesty the Queen in Right of Canada (2016)

YOUR ANSWERS ARE CONFIDENTIAL For office use only

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2. How old are you today?

11 years or younger12 years13 years14 years15 years

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

WhiteBlackWest Asian/ArabSouth Asian (Indian, ...)East/Southeast Asian (Chinese, ...)Latin American/HispanicAboriginal (First Nations, Métis, Inuit, ...)Other:

Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12

1. What grade are you in?

3. Are you female or male?

FemaleMale

6. How old were you when you first tried smokingcigarettes, even just a few puffs?

YesNo

5. Have you ever tried cigarette smoking, even just a few puffs?

7. Do you think in the future you might trysmoking cigarettes?

Definitely yesProbably yesProbably notDefinitely not

Definitely yesProbably yesProbably notDefinitely not

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

Definitely yesProbably yesProbably notDefinitely not

10. Have you ever smoked a whole cigarette?

YesNo

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

11. Have you ever smoked 100 or more whole cigarettes in your life?

YesNo

None1 day2 to 3 days4 to 5 days6 to 10 days11 to 20 days21 to 29 days30 days (every day)

12. Have you ever smoked every day for at least 7 days in a row?

YesNo

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

16 years17 years18 years19 years or older

14 years15 years16 years17 years18 years or older

8 years or younger9 years10 years11 years12 years13 years

I have never done thisI do not know

Tobacco Use

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I did not buy cigarettes in the last 12 monthsI do not remember the priceLess than 10 cents10 cents to 50 cents51 cents to $1.00$1.01 to $6.00$6.01 to $8.00$8.01 to $10.00

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

$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

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

14. Thinking back over the last 7 days, which daysdid you smoke at least one whole cigarette?

15. Over the last 7 days, in total, how many wholecigarettes did you smoke?

I have never used a tobacco productYesNo

20. When you first tried a tobacco product (notincluding e-cigarettes), was it flavoured(including menthol)?

21. Which did you try first: a cigarette or ane-cigarette (vaporizer with e-juice, vape pen,tank, mod)?

I have never tried a cigarette nor an e-cigaretteI have only tried a cigarette and never tried ane-cigarette I have only tried an e-cigarette and never trieda 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 usean e-cigarette (vaporizer with e-juice, vapepen, tank, mod)?

None1 day2 to 3 days4 to 5 days6 to 10 days11 to 20 days21 to 29 days30 days (every day)

I have never smokedI have only smoked a few timesI have never tried to quitI have tried to quit onceI have tried to quit 2 or 3 timesI have tried to quit 4 or 5 timesI have tried to quit 6 or more times

16. Have you ever tried to quit smoking cigarettes?

I do not smokeI buy them myself at a storeI buy them from a friendI buy them from someone elseI ask someone to buy them for meMy brother or sister gives them to meMy mother or father gives them to meA friend gives them to meSomeone else gives them to meI take them from my mother, father, or siblingsOther

17. Where do you usually get your cigarettes? (Mark only one)

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

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

For office use only

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Number of whole cigarettes smoked:

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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-cigarettesI buy them from a vape shopI ask someone to buy them for meI buy them onlineA family member gives them to meA friend gives them to meSomeone else gives them to meI use my mother’s, father’s, or siblings’ without their permissionI use someone else’s without their permissionOther

24. Have you ever tried any of the following?

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

a) Little cigars or cigarillos (plain or flavoured)b) Cigars (not including little cigars or cigarillos, plain or flavoured) c) Roll-your-own cigarettes (tobacco only, in rolling papers) d) Smokeless tobacco (chewing tobacco, pinch, snuff, or snus) e) Nicotine patches, nicotine gum, nicotine lozenges, nicotine inhalers, or nicotine sprayf) A water-pipe (hookah) to smoke shisha (herbal or tobacco)g) Blunt wraps (a tube made of tobacco used to roll cigarette tobacco) h) E-cigarettes (vaporizers with e-juice, vape pens, tanks, mods)

None1 day2 to 3 days4 to 5 days6 to 10 days11 to 20 days21 to 29 days30 days (every day)

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

a) Smoking little cigars or cigarillos (plain or flavoured)b) Smoking cigars (not including little cigars or cigarillos, plain or flavoured) c) Smoking roll-your-own cigarettes (tobacco only, in rolling papers) d) Using smokeless tobacco (chewing tobacco, pinch, snuff, or snus) e) Using nicotine patches, nicotine gum, nicotine lozenges, nicotine inhalers, or nicotine spray f) Using a water-pipe (hookah) to smoke shisha (herbal or tobacco)g) Using blunt wraps (a tube made of tobacco used to roll cigarette tobacco) h) Using e-cigarettes (vaporizers with e-juice, vape pens, tanks, mods)

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

a) Menthol cigaretteb) Flavoured little cigar or cigarilloc) Flavoured cigard) Flavoured smokeless tobaccoe) Flavoured tobacco in a water-pipe (hookah)f) Flavoured e-cigarette (vaporizer with e-juice, vape pen, tank, mod)

NoYes

NoYes

NoYes

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

YesNo

28. Have you ever 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 sipI have not done this in the last 30 daysOnce or twiceOnce or twice a week3 or 4 times a week5 or 6 times a weekEvery dayI do not know

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

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I have never had a drink of alcohol that wasmore than just a sipI 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 wasmore than just a sipI did not drink alcohol in the last 12 monthsLess than once a monthOnce a month2 or 3 times a monthOnce a week2 or 3 times a week4 to 6 times a weekEvery dayI do not know

29. In the last 12 months, how often did you have adrink of alcohol that was more than just a sip?

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 alcoholon one occasionI have not done this in the last 12 monthsLess than once a monthOnce a month2 to 3 times a monthOnce a week2 to 5 times a weekDaily or almost dailyI do not know

14 years 15 years 16 years 17 years 18 years or older

8 years or younger9 years 10 years 11 years 12 years 13 years

I have never had 5 or more drinks of alcoholon one occasionI do not know

33. How old were you when you first had 5 ormore drinks of alcohol on one occasion?

14 years 15 years 16 years 17 years 18 years or older

8 years or younger9 years 10 years 11 years 12 years 13 years

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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 occasionI have not done this in the last 30 daysOnce or twiceOnce or twice a week3 or 4 times a week5 or 6 times a weekEvery dayI do not know

a) An energy drinkb) Alcohol and an energy drink drank separately on one occasion c) Alcohol and an energy drink hand-mixed together by you or someone elsed) Store-bought pre-mixed alcoholic beverages with energy drink names (such as Rockstar®+Vodka)

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

36. Have you ever used or tried marijuana or cannabis (a joint, pot, weed, hash, or hash oil)?

YesNo

39. In the last 30 days, how often did you use marijuana or cannabis?

I have never used marijuana or cannabisI have not done this in the last 30 daysOnce or twiceOnce or twice a week3 or 4 times a week5 or 6 times a weekEvery dayI do not know

Marijuana Use

37. In the last 12 months, how often did you usemarijuana or cannabis?

I have never used marijuana or cannabisI have not done this in the last 12 monthsLess than once a monthOnce a month2 or 3 times a monthOnce a week2 or 3 times a week4 to 6 times a weekEvery dayI do not know

38. How old were you when you first used marijuana or cannabis?

14 years 15 years 16 years 17 years 18 years or older

8 years or younger9 years 10 years 11 years 12 years 13 years

I have never used marijuana or cannabisI do not know

NoYes

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42. Have you used a drug or substance to get high without knowing what it was?

No, I have never done thisYes, I have done this in the last 12 monthsYes, I have done this, but not in the last 12 months

40. 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 bluntb) Eaten it in food such as brownies, cakes, cookies or candyc) Drank it in tea, cola, alcohol, or other drinksd) Vaporized it (vape)e) Dabbed itf) 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 cannabisI have not done this in the last 12 monthsI grow my ownIt was shared around a group of friendsI took it from a family member or friend without their permissionI took it from someone else without their permissionI got or bought it from a family member or a friendI got or bought it from someone elseOther

No, I have neverdone this

Yes, I have donethis in the

last 12 months

Yes, I have donethis but not in the

last 12 months

Other Drug Use

No, I have neverdone this

Yes, I have donethis in the

last 12 months

Yes, I have donethis but not in the

last 12 months43. Indicate whether you have ever used or tried any of the following drugs:

a) Amphetamines (speed, crystal meth or ice, meth, ...)b) MDMA (ecstasy, E, X, ...)c) Hallucinogens (LSD, acid, PCP, magic mushrooms or 'shrooms', mesc, ...)d) Heroin (smack, junk, crank, ...)e) Cocaine (crack, blow, snow, ...)f) Synthetic cannabinoids (spice, synthetic marijuana, K2, K3, scence, herbal mixtures, herbal incense, ...)g) BZP/TFMPP (legal E, legal X, A2, piperazine, frenzy, nemesis, ...)h) Bath salts (mephedrone, MDPV, meow, meph, MCAT, ...)i) 2C (nexus, 2C-B, 2C-I, 2C-C, …) or NBOMe (25C-NBOMe, 25B-NBOMe, 25I-NBOMe, …)j) Tryptamines (DMT, 'psychosis', AMT, foxy, ...)k) Glue, gasoline, or other solvents to get highl) Salvia (divine sage, magic mint, sally D, ...)

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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®, ...)?

YesNoI do not know

No, I have never done thisYes, I have done this in the last 12 monthsYes, I have done this, but not in the last 12 months

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

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

No, I have neverdone this

Yes, I have donethis in the

last 12 months

Yes, I have donethis but not in the

last 12 months

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

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

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

d) Gravol®

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

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 highI did not do this in the last 12 monthsI used medicine from my own prescription for non-medical reasons or to get highI took them from a family member or friend without their permissionI took them from someone else without their permissionI got or bought them from a family member or friendI got or bought them from someone elseOther

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®, ...)?

YesNoI do not know

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No, I have never done thisYes, I have done this in the last 12 monthsYes, I have done this, but not in the last 12 months

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

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 highI did not do this in the last 12 monthsI used medicine from my own prescription for non-medical reasons or to get highI took them from a family member or friend without their permissionI took them from someone else without their permissionI got or bought them from a family member or friendI got or bought them from someone elseOther

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.

YesNoI do not know

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

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?

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

No, I have neverdone this

Yes, I have donethis in the

last 12 months

Yes, I have donethis but not in the

last 12 months

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

b) Fentanyl (china white, synthetic heroin, china girl, ...)

c) Other prescribed pain relievers (morphine, codeine, ...)

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

a) Smoke cigarettes once in a whileb) Smoke cigarettes on a regular basisc) Smoke a tobacco water-pipe (hookah) once in a whiled) Smoke a tobacco water-pipe (hookah) on a regular basise) Use an e-cigarette once in a whilef) Use an e-cigarette on a regular basisg) Drink alcohol once in a whileh) Drink alcohol on a regular basisi) Smoke marijuana or cannabis once in a whilej) Smoke marijuana or cannabis on a regular basisk) Other than smoking it, use marijuana or cannabis once in a whilel) Other than smoking it, use marijuana or cannabis on a regular basism) Use prescribed medication such as prescribed pain relievers, tranquilizers, or medicine to treat ADHD, "to get high" once in a whilen) Use prescribed medication such as prescribed pain relievers, tranquilizers, or medicine to treat ADHD, "to get high" on a regular basis

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Norisk

I do notknow

Slightrisk

Moderaterisk

Greatrisk

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

a) within an hour of drinking one or more drinks of alcohol?

b) within 2 hours of using marijuana or cannabis?

No, never

Yes, morethan 30 days

ago

Yes, in thelast 30 days

Fairlydifficult

Verydifficult

I do not know

Very easy

Fairlyeasy

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?

a) A cigaretteb) An e-cigarettec) Alcohold) Marijuana or cannabis e) Amphetamines (speed, crystal meth or ice, meth, ...)f) MDMA (ecstasy, E, X, ...)g) Hallucinogens (LSD, acid, PCP, magic mushrooms, mesc, ...)h) Cocaine (crack, blow, snow, ...)i) Prescribed pain relievers (oxycodone, fentanyl, morphine, codeine, T3, ...)j) Medicine to treat ADHD (Ritalin®, Concerta®, Adderall®, Dexedrine®, ...)

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57. Have you ever been a passenger in avehicle (e.g., car, snowmobile, motorboat, or all-terrain vehicle (ATV))...

a) driven by someone who had one or more drinks of alcohol in the last hour?

b) driven by someone who had been using marijuana or cannabis in the last 2 hours?

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

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 daysLess than once a weekAbout once a week2 or 3 times a weekDaily or almost daily

I have not bullied other students in the last 30 daysLess than once a weekAbout once a week2 or 3 times a weekDaily or almost daily

62. In the last 30 days, how often did you bully other students?

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

a) Physical attacks (beat up, pushed, or kicked them, ...) b) Verbal attacks (teased, threatened, or spread rumours about them, ...)c) Non-verbal attacks (ignoring, leaving someone out or excluding them, giving dirty looks, …)d) Cyber-attacks (sent mean text messages or spread rumours about them on the internet, ...)e) Stole from them or damaged their things

a) Physical attacks (getting beaten up, pushed, or kicked, ...) b) Verbal attacks (getting teased, threatened, or having rumours spread about you, ...) c) Non-verbal attacks (being ignored, being left out or excluded, being given dirty looks, …)d) Cyber-attacks (being sent mean text messages or having rumours spread about you on the internet, ...)e) Had someone steal from you or damage your things

NoYes

NoYes

I did not ride in a car in the last 30 daysYesNo

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

Bullying and Well-Being

Yes, morethan 30 days

ago

No, never

Yes, in thelast 30 days

I do not know

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a) I feel close to people at my schoolb) I feel I am part of my schoolc) I am happy to be at my schoold) I feel the teachers at my school treat me fairlye) I feel safe in my schoolf) I believe getting good grades is important

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

Stronglyagree

Agree DisagreeStronglydisagree

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1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

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.

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

a) I cut classes or skip schoolb) I make other people do what I wantc) I disobey my parentsd) I talk back to my teacherse) I get into fightsf) I often say mean things to people to get what I wantg) I take things that are not mine from home, school, or elsewhereh) I often do favours for people without being askedi) I often lend things to people without being askedj) I often help people without being askedk) I often compliment people without being askedl) I often share things with people without being asked

Definitelylike me

1 2 3 4 5 6

Definitely notlike me

Sort of falsefor me

Sort of true for me

Really falsefor me

Really true for me

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.

a) I feel I do things well at schoolb) My teachers like me and care about mec) I feel free to express myself at homed) I feel my teachers think I am good at thingse) I like to spend time with my parentsf) I feel free to express myself with my friendsg) I feel I do things well at homeh) My parents like me and care about mei) I feel I have a choice about when and how to do my school workj) I feel my parents think that I am good at thingsk) I like to be with my teachersl) I feel I have a choice about which activities to do with my friendsm) I feel I do things well when I am with my friendsn) My friends like me and care about meo) I feel free to express myself at schoolp) I feel my friends think I am good at thingsq) I like to spend time with my friendsr) I feel like I have a choice about when and how to do my household chores

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