Copyright ACHA, Reproduction Prohibited. National College Health Assessment. The ACHA-NCHA asks about various aspects of your health and is completely

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Copyright ACHA, Reproduction Prohibited National College Health Assessment The ACHA – NCHA asks about various aspects of your health and is completely voluntary. You may skip any question you do not want to answer. You may complete the survey in multiple sessions. This survey link is unique to you. You may begin the survey on one d evice and continue where you left off on another device. Use the buttons at the bottom of survey to navigate through the survey. Do not use your browser’s back button. The survey is the survey, the link between your email address and your survey responses is destroyed. By clicking the ‘Begin Survey’ button below, you agree that: the purpose of this study has been thoroughly explained to you; you are at least 18 years of ag e; and you consent to participate in the survey. Please direct any questions about the survey to the campus contact identified in your survey invitation email. Health, Health Education, and Safety 1) How would you describe your general health? Excellent Very Good Good Fair Poor Don’t Know

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Copyright ACHA, Reproduction Prohibited 2A) Have you received information on the following topics from your college or university? (Please mark the appropriate column for each row) No Yes Alcohol and other drug use Cold/Flu/Sore throat Depression/Anxiety Eating disorders Grief and loss How to help others in distress Injury prevention Nutrition Physical activity Pregnancy prevention 2B) Have you received information on the following topics from your college or university? (Please mark the appropriate column for each row) No Yes Problem use of Internet/computer games Relationship difficulties Sexual assault/Relationship violence prevention Sexually transmitted disease/infection (STD/I) prevention Sleep difficulties Stress reduction Suicide prevention Tobacco use Violence prevention

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Copyright ACHA, Reproduction Prohibited 3A) Are you interested in receiving information on the following topics from your college or university? (Please mark the appropriate column for each row) No Yes Alcohol and other drug use Cold/Flu/Sore throat Depression/Anxiety Eating disorders Grief and loss How to help others in distress Injury prevention Nutrition Physical activity Pregnancy prevention 3B) Are you interested in receiving information on the following topics from your college or university? (Please mark the appropriate column for each row) No Yes Problem use of Internet/computer games Relationship difficulties Sexual assault/Relationship violence prevention Sexually transmitted disease/infection (STD/I) prevention Sleep difficulties Stress reduction Suicide prevention Tobacco use Violence prevention

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Copyright ACHA, Reproduction Prohibited 4) Within the last 12 months , how often did you: (Please mark the appropriate column for each row) N/A, did not do this activity within the last 12 months Never Rarely Sometimes Most of the time Always Wear a seat belt when you rode in a car? Wear a helmet when you rode a bicycle? Wear a helmet when you rode a motorcycle? Wear a helmet when you were in – line skating? 5) Within the last 12 months : (Please mark the appropriate column for each row) No Yes Were you in a physical fight? Were you physically assaulted (do not include sexual assault)? Were you verbally threatened? Were you sexually touched without your consent? Was sexual penetration attempted (vaginal, anal, oral) without your consent? Were you sexually penetrated (vaginal, anal, oral) without your consent? Were you a victim of stalking (e.g., waiting for you outside your classroom, residence, or office; repeated emails/phone calls)?

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Copyright ACHA, Reproduction Prohibited 6) Within the last 12 months , have you been in an intimate (coupled/partnered) relationship that was: (Please mark the appropriate column for each row) No Yes Emotionally abusive? (e.g., called derogatory names, yelled at, ridiculed) Physically abusive? (e.g., kicked, slapped, punched) Sexually abusive? (e.g., forced to have sex when you perform or have an unwanted sexual act performed on you) 7) How safe do you feel: (Please mark the appropriate column for each row) Not safe at all Somewhat unsafe Somewhat safe Very safe On this campus (daytime)? On this campus (nighttime)? In the community surrounding this school (daytime)? In the community surrounding this school (nighttime)?

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Copyright ACHA, Reproduction Prohibited Alcohol, Tobacco, and Drugs 8A) Within the last 30 days , on how many days did you use: (Please mark the appropriate column for each row) Never used Have used, but not in last 30 days 1 – 2 days 3 – 5 days 6 – 9 days 10 – 19 days 20 – 29 days Used daily Cigarettes E – cigarettes Tobacco from a water pipe (hookah) Cigars, little cigars, clove cigarettes Smokeless tobacco Alcohol (beer, wine, liquor) Marijuana (pot, weed, hashish, hash oil) Cocaine (crack, rock, freebase) Methamphetamine (crystal meth, ice, crank) Other amphetamines (diet pills, bennies)

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Copyright ACHA, Reproduction Prohibited 9A) Within the last 30 days , how often do you think the typical student at your school used: (State your best estimate; Please mark the appropriate column for each row) Never used Have used, but not in last 30 days 1 – 2 days 3 – 5 days 6 – 9 days 10 – 19 days 20 – 29 days Used daily Cigarettes E – cigarettes Tobacco from a water pipe (hookah) Cigars, little cigars, clove cigarettes Smokeless tobacco Alcohol (beer, wine, liquor) Marijuana (pot, weed, hashish, hash oil) Cocaine (crack, rock, freebase) Methamphetamine (crystal meth, ice, crank) Other amphetamines (diet pills, bennies)

104 KB – 32 Pages