MINISTRY OF HEALTH & SOCIAL SECURITY
DOMINICA SECONDARY SCHOOL SURVEY (DOSSS)
TOPZONE / 1. TODAY’S DATE: Day: __ __ Month: __ __ Year: __ __ / 5. School Type: Public ( ) Govt-Assisted ( ) Private ( )
2. CURRENT TIME: Hour: __ __ Minute: __ __ / 6. Area surrounding the school: Rural ( ) Urban ( )
3. LEAD ASSESSOR’S ID NUMBER: __ __ / 7. Gender: Male ( ) or Female ( ) / 8. Your Current Age: __ __
4. NUMBER OF YOUR FORM & CLASSROOM ___ - ___ / 9. Community where you live:
INSTRUCTIONS FOR COMPLETING THE REST OF THE QUESTIONNAIRE
Please respond to all the questions, even if they do not fit your experience exactly.
Mark your answers (X) in the corresponding circle. In most questions, please respond with respect to the last six months.
Mark <Yes>, if the statement is true for you, and mark <No>, if the statement is false or untrue for you.
RESPOND WITH RESPECT TO THE LAST SIX MONTHS
/Zone 1 / Yes / No / Zone 2 / Yes / No
1 / During the past 6 months, have you had good health? / ¡ / ¡ / 7. / During the past 6 months, I have been free of headaches / ¡ / ¡
2. / I often spend my free time with other people. / ¡ / ¡ / 8. / Do you generally feel angry? / ¡ / ¡
3. / During the past 6 months, people around me think of me as a friendly person. / ¡ / ¡ / 9. / Except for unintentional accidents, I have not damaged other people's belongings. / ¡ / ¡
4. / Do you feel sad a lot? / ¡ / ¡ / 10. / Have any of your friends ever been in trouble with the law? / ¡ / ¡
5. / Are your parents or guardians aware of what you think or feel about things that are important to you? / ¡ / ¡ / 11. / Most of the time, I do not complete my homework assignments. / ¡ / ¡
6. / During the past 6 months, I have been free of stomach problems. / ¡ / ¡ / 12. / During the past 6 months, have your grades been higher than most of your classmates? / ¡ / ¡
Proceed to Zone 2: / 13. / Are you bored most of the time? / ¡ / ¡
14. / During the past 6 months, have you stolen things? / ¡ / ¡
15. / I have many friends who think that using drugs is a bad idea. / ¡ / ¡
------
RESPOND WITH RESPECT TO THE LAST SIX MONTHSZone 3 / Yes / No / Zone 4 / Yes / No
16. / Have you done most of your recreational activities with others rather than by yourself? / ¡ / ¡ / 22. / I always ask my parents for permission when I go out to have fun. / ¡ / ¡
17. / Are your parents or guardians aware of your likes and dislikes? / ¡ / ¡ / 23. / Have you generally felt calm and at peace with yourself and others? / ¡ / ¡
18. / Have your friends stolen things or damaged other’s property on purpose? / ¡ / ¡ / 24. / Compared to most kids, do you have few friends? / ¡ / ¡
19. / Do you enjoy being with other people? / ¡ / ¡ / 25. / Are you absent from school a lot? / ¡ / ¡
20. / During the past six months have you argued a lot? / ¡ / ¡ / 26. / Are you a nervous person? / ¡ / ¡
21. / Have you taken advantage of people? / ¡ / ¡ / 27. / During the past six months, I have done nothing that was dangerous or risky. / ¡ / ¡
28. / I have had excellent relationships with my teachers. / ¡ / ¡
29. / Many of my friends smoke cigarettes. / ¡ / ¡
30. / During the last six months, have you been sick more often than the rest of your classmates? / ¡ / ¡
RESPOND WITH RESPECT TO THE LAST SIX MONTHS
Zone 5 / Yes / No / Zone 6 / Yes / No
31. / During the past six months, I have generally been a sociable person, spending my time with others rather than being by myself. / ¡ / ¡ / 46. / Have you been able to keep your concentration when studying? / ¡ / ¡
32. / Do you often feel like you want to cry? / ¡ / ¡ / 47. / Are your parents or guardians often aware of where you are and what you are doing? / ¡ / ¡
33. / Is it easy for you to defend your opinions and points of view? / ¡ / ¡ / 48. / During the past year, have you harmed animals? / ¡ / ¡
34. / Have you threatened to hurt other people? / ¡ / ¡ / 49. / Have you been tempted to steal? / ¡ / ¡
35. / Do you feel that your parents or guardians care about you? / ¡ / ¡ / 50. / During the last 6 months, I have had very few friends who cheat on school tests. / ¡ / ¡
36. / I have done my school assignments well. / ¡ / ¡ / 51. / Do you worry a lot? / ¡ / ¡
37. / Do you belong to a gang? / ¡ / ¡ / 52. / Has it been difficult to ask for help from others? / ¡ / ¡
38. / Sometimes I have failed to complete my homework assignments on time. / ¡ / ¡ / 53. / Have your friends skipped school a lot? / ¡ / ¡
39. / Sometimes people act without thinking. Other times they think about the consequences before they act. During the past six months, I almost always thought about the consequences of my actions before I took action. / ¡ / ¡ / 54. / Some youths think it’s a good idea to use drugs; others think it’s a bad idea. I have many friends who think that using drugs is a bad idea. / ¡ / ¡
40. / I hear things around me that no one else hears? / ¡ / ¡ / 55. / Have you seriously thought about dropping out of school? / ¡ / ¡
41. / Have you felt unhappy with how well you do in activities with your friends? / ¡ / ¡ / 56. / Have you frequently raised your voice when talking? / ¡ / ¡
42. / Is it difficult to keep your concentration during classes? / ¡ / ¡ / 57. / During the last 6 months, have you been afraid or felt fear? / ¡ / ¡
43. / Are you easily upset? / ¡ / ¡ /
RESPOND WITH RESPECT TO THE LAST TWELVE MONTHS
44. / Have you had many friends who disobey the rules? / ¡ / ¡ / 58. / During the last twelve months, have you teased animals? / ¡ / ¡45 / During the last six months, have you generally been a good and honest person? / ¡ / ¡ / 59. / During the last twelve months, have you been in trouble with the police? / ¡ / ¡
60. / During the last twelve months, going to church has been an important activity for me. / ¡ / ¡
RESPOND WITH RESPECT TO THE LAST SIX MONTHS
Zone 7 / Yes / No / Zone 8 / Yes / No
61. / During the past six months have you been able to make new friends easily? / ¡ / ¡ / 76. / Do you cut or skip school more than 2 days a month? / ¡ / ¡
62. / Do you have trouble concentrating? / ¡ / ¡ / 77. / Have you been suspended from school? / ¡ / ¡
63. / Do you swear or use dirty language a lot? / ¡ / ¡ / 78. / Is it easy to make new friends when you’re in a new group? / ¡ / ¡
64. / Have you been in a bad mood? / ¡ / ¡ / 79. / Has it been hard to get rid of a fixed thought from your mind? / ¡ / ¡
65. / Some youth tell their parents where they’re going when they leave the house, and others sometimes don’t tell their parents where they’re going. During the past six months, when you have left the house, have you always told your parents where you were going? / ¡ / ¡ / 80. / Sometimes young people come home to an empty house when they return from school. During the past year, when you have come home after school, most of the time has there been a parent or other adult at home? / ¡ / ¡
66. / Are you a loner who is happiest being by yourself? / ¡ / ¡ / 81. / Have you teased others frequently? / ¡ / ¡
67. / Have you usually talked with your parents about your plans for the upcoming day? / ¡ / ¡ / 82. / Have you gotten mad when others have made you wait? / ¡ / ¡
68. / Sometimes parents ask or tell their children to stay away from certain people who might get them into trouble. During the past six months, have your parents told you to stay away from people who might get you into trouble? / ¡ / ¡ / 83. / Some young people think it is all right to cheat in order to win at games, and others think it is wrong to cheat. During the past year, have you had any close friends who think it is wrong to cheat? / ¡ / ¡
69. / At home, there are very clear rules about what I can do and cannot do. / ¡ / ¡ / 84. / Are you stubborn? / ¡ / ¡
70. / I have rarely felt fearful during the past six months. / ¡ / ¡ / 85. / Do you feel like you don't belong when you participate in school clubs or extracurricular activities? / ¡ / ¡
71. / Do your parents or guardians disapprove of your friends? / ¡ / ¡ / 86. / Have you disobeyed adults on occasion? / ¡ / ¡
72. / Do you feel that people stare at you? / ¡ / ¡ / 87. / Are your grades in school worse than they used to be? / ¡ / ¡
73. / During the past six months, I have had very few friends who start fights. / ¡ / ¡ / 88. / Some young people would like to cut or skip school rather than go to school. During the past year, have you preferred to go to school? / ¡ / ¡
74. / Have you had many friends who cheat? / ¡ / ¡ / 89. / Some of my friends smoke marijuana. / ¡ / ¡
75. / Do kids your own age dislike you? / ¡ / ¡ / 90. / During the past 6 months, have you slept well? / ¡ / ¡
RESPOND WITH RESPECT TO THE LAST SIX MONTHS
Zone 9 / Yes / No / Zone 10 / Yes / No
91. / Some young people like to be left alone, have you often wanted to be left alone? / ¡ / ¡ / 103. / I have had many friends who try very hard to have excellent conduct. / ¡ / ¡
92. / Some young people prefer to be studying at school rather than working at a job. During the past 6 months, would you prefer to be studying at school instead of working at a job? / ¡ / ¡ / 104. / Sometimes people throw things around or break things when they get angry. During the past 6 months, have you thrown or broken things when you got angry? / ¡ / ¡
93. / During the past 6 months, none of my friends have smoked tobacco cigarettes. / ¡ / ¡ / 105. / Some people like to be with other people, and others like to be alone and by themselves. During the past 6 months, have you wanted to be with other people during your free time? / ¡ / ¡
94. / Many of my friends have smoked tobacco cigarettes / ¡ / ¡ / 106. / Some people generally are in a bad mood, while others always are in a good mood. During the past 6 months, have you always been in a good mood? / ¡ / ¡
95. / A few of my friends have smoked tobacco cigarettes / ¡ / ¡ / 107. / During the past 6 months, have you tried to take advantage of other people by being dishonest? / ¡ / ¡
96. / Some young people like to disobey the rules, and others prefer to obey the rules. This past 6 months, have you had any friends who like to disobey the rules? / ¡ / ¡ / 108. / During the past 6 months, have you had many friends who obey the rules? / ¡ / ¡
97. / Have you had many friends who like to disobey the rules? / ¡ / ¡ / 109. / Sometimes we have friends who try very hard to be good and have excellent conduct. During the past 6 months, have you had any friends who tried very hard to have excellent conduct? / ¡ / ¡
98. / These past 6 months, have you remained calm when you could not have your own way? / ¡ / ¡ / 110. / Some young people would prefer to go to work rather than go to school. Would you prefer going to work rather than school? / ¡ / ¡
99. / Sometimes our friends are people who steal or cheat. During the last 6 months, have you had any friends who stole or cheated? / ¡ / ¡ / 111. / Have you often gotten angry when you didn't get to do what you wanted? / ¡ / ¡
100. / Some young people feel happy when they think about going to school. During the last 6 months, have you often felt happy when you thought about going to school? / ¡ / ¡ / 112. / Some people like to go to school and others feel happy when they think about going to school. During the last 6 months, have you often felt happy when you thought about going to school? / ¡ / ¡
101. / During the last 6 months, have you had a friend you could tell about problems or issues in your life? / ¡ / ¡ / 113. / During the last 6 months, have you felt very happy? / ¡ / ¡
102. / During the last 6 months, I have thought about quitting school altogether. / ¡ / ¡ / 114. / During the past six months, have you argued just a little? / ¡ / ¡
RESPOND WITH RESPECT TO THE LAST SIX MONTHS / In the next questions, ‘neighborhood’ means the area and streets closest to your own home where you live.
Zone 11 / Yes / No / Zone 12 / Yes / No
115. / I have rarely forgotten what I've learned at school. / ¡ / ¡ / 129. / There are plenty of safe places to walk or spend time outdoors in my neighborhood. / ¡ / ¡
116. / During the last 6 months, have you had friends who like to sniff glue or gasoline? / ¡ / ¡ / 130. / A few times a month, some kid in my neighborhood gets beat-up or mugged. / ¡ / ¡
117. / Some young people are happier when they think about work than when they think about going to school. During the last 6 months, have you been happier to think about work? / ¡ / ¡ / 131. / There are broken bottles and garbage in the street and peoples' yards in my neighborhood. / ¡ / ¡
118. / Sometimes young people say, "Everything is fine for me." During the last 6 months, has everything been fine for you? / ¡ / ¡ / 132. / I have seen people using or selling drugs in my neighborhood. / ¡ / ¡
119. / Have you had many friends who think it is a bad idea to try drugs? / ¡ / ¡ / 133. / Early in the morning or at dusk, I frequently see people who are drunk on the streets of my neighborhood. / ¡ / ¡
120. / Have you been in a bad mood quite often? / ¡ / ¡ / 134. / Most of the adults in my neighborhood obey the law. / ¡ / ¡
121. / During the last 6 months, I haven't done anything risky. / ¡ / ¡ / 135. / I feel safe when I walk around my neighborhood by myself. / ¡ / ¡
122. / Some people have started to use crack, cocaine powder, or coca paste. During the last 6 months, have you had any friends who have used crack or cocaine powder? / ¡ / ¡ / 136. / The people in my neighborhood frequently damage or steal other people's property. / ¡ / ¡
123. / Have you had many friends who have used crack, or cocaine powder? / ¡ / ¡ / 137. / For many people in my neighborhood, going to church is a very important activity. / ¡ / ¡
124. / Sometimes young people say, "School is a waste of my time." During the last 6 months, has school been a waste of your time? / ¡ / ¡ / 138. / During the last 6 months, has participating in church activities been important to you? / ¡ / ¡