ADOLESCENT HEALTH SCREENING QUESTIONNAIRE (FAPS)

You can check the health risk level by yourself through a questionnaire programmed after long research. The questionnaire is completely anonymous. The answer you give will not be associated with your name, so please answer all questions as honestly as you can. The identity of the Adolescent child is kept secret by imparting an identity number to him/her and his/her date of birth noted. The software used to implement this tool generates, the level of health risk aquired by the adolescence.

  • You should answer all the questions to get optimum result.
  • You may stop participating at any time. Your decision not to participate, will not affect you negatively in any way

If you have any questions regarding the questionnaire or would like more information about the study, please contact Project Co-coordinator  - Prof. Sukanta Chatterjee at Adolescence Health Clinic, Head, Dept. of Pediatrics, Medical College Kolkata, 88, College Street, Kolkata; Phone : - 91.33.2219-8118, Email : sukantachatterjee@hotmail.com.
1. Tell about the relation with your mother
  Perfectly happy Mix of happy and unhappy Not at all happy
2. How much your mother knows about your friends, free time or pocket money?
  Knows a lot Knows a little Doesn't know
3. Tell about the relation with your father
  Perfectly happy Mix of happy and unhappy Not at all happy
4. How much your father knows about your friends, free time and pocket money?
  Knows a lot Knows a little Doesn't know
5. Are you happy with your family members and their behaviour?
  Perfectly happy Want to tell something Not at all happy
6. Do you enjoy relation with your friends?
  Yes always Sometimes I am concerned Trouble most of the time
7. Do you think your friends are involved in substance use trouble with teacher, young people or have sex partner?
  No answer Few of my friends Most of my friends
8. Does your friends take drugs, alcohol or smoke cigarettes?
  No Tried once Yes
9. Do you think its a problem if young people like you smoke cigarettes or take alcohol or drugs?
  Agree Somewhat agree Don't agree
10. Have you tried smoking, alcohol or drugs?
  No Tried once Try often
11. Are you happy with your school performance and your relation with your classmates and teachers?
  Happy Mix of happy and unhappy Unhappy
12. Are you happy living in your locality/town
  Happy Mix of happy and unhappy Almost always
13. Do you see nude picture, pornography, blue films or had sexula exposure?
  Never Occasionally Often
14. Test your knowledge on reproductive health : Condom protects against sexually transmitted infection and pregnancy. Is this statement?
  True False No answer
15. Can pregnancy be prevented by any method after using condom?
  Yes No
16. Do you have any health problem or concern
  No Not sure Yes
17. Are you worried about sexual abuse?
  No Yes
18. Are you concerned about your body weights?
  No Slightly concerned Definitely concerned
19. Are you and your parents happy with your diet habit?
  Yes Parents happy but myself not All unhappy
20. Do you carry weapons or ever got seriously injured by violence?
  No Got injured but don't carry weapon Carry weapons
21. Do you feel alone or sad?
  No Sometimes Frequently
22. Have you seriously thought of running away from home or using alcohol/drugs to releave your worries?
  No Sometimes Frequently
23. Have you ever thought of or attempted suicide?
  No Sometimes Very often
24. Where do you get informations on sexual & reproductive health or alcohol/tobacco/drug or what to do when you feel sad and or depressed?
  Parents/Teachers Friends/Newspaper/TV Internet, special magazines, boy-friend or girl-friend
HERE IS THE END OF THE QUESTIONNAIRE. YOU CAN NOW CALCULATE THE SCORE OR CLEAR THE ANSWER AND START AFRESH. AFTER YOU HAVE CALCULATED THE SCORE, PLEASE DO NOT FORGET TO SUBMIT THE SAME FOR OUR RECORD AND ANALISYS TO INTERACT WITH YOU IN THE FUTURE. pLEASE BE INFORMED THAT THE INFORMATION RECORDED WILL BE KEPY CONFIDENTIAL. THANK YOU.
      You received a score of
SCORE COMMENT
187 Low score - you have optimum health habits
188 to 374 Moderate score - meet a counselor
375 to 561 High score - need health check up
> 562 Very high score - need health check up

Contact Clinic/Counselor 91.33.22198118, E-mail : sukantachatterjee@hotmail.com
 
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