Parent and peer influence on substance usage
Answers marked with a * are required.
1.
Parent and peer influence on substance usage
This survey is to gather information for a paper on parent and peer influence on substance or non-substance usage. This is for personal academic paper. Thank you ahead for helping with this project.
1.
Age:
*
Age
2.
sex :
*
Male
Female
3.
Highest education:
*
less tham 9th grade
9th grade
10th grade
11th grade
12th grade
1 year of college
2 years of college
did not complete a degree
trade school/degree
Associate degree
BA/BS degree
Masters degree
PHD
Other (Please Specify)
4.
Age you began to use and what substance
*
never used
less than 9years old
9 - 12
12-15
16-18
19-21
22-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
greater than 60
5.
Substances you continue to use today or have used Please include what age you began to the substance.
*
6.
Father :
*
Alive
Dead
7.
If father is dead what was the cause of death
*
8.
Father's History of substance abuse?
*
9.
Father’s side of the family history of substance abuse:
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no one used substances
relationship and substance used
10.
Father’s influence on you to use or not to use substances:
*
11.
Mother alive or dead?
*
Alive
Dead
12.
Mother's History of substance abuse:
*
Alive
age and cause
13.
Mother's substance abuse history
*
14.
Mother’s side of the family history of substance abuse
*
no one used
relationship and substance used
15.
Mother’s influence on you to use or not to use substances:
*
16.
Did/do your peers use?
*
17.
Their influence on you to use or not to use substances. If they influenced your usage at what age and what substance was involved.
*
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