|
|
|
|
1.
What School do you attend?
*
|
|
|
|
|
|
|
|
2.
What grade are you in?
*
|
|
|
|
|
|
|
|
3.
How old are you?
*
|
|
|
|
|
|
|
|
4.
What is your sex?
*
|
|
|
|
|
|
|
|
5.
How do you describe yourself?
*
|
|
|
|
|
|
|
|
6.
If you are Asian or Pacific Islander, which groups best describe you?
*
|
|
|
|
|
|
|
|
7.
If you are Hispanic or Latino/Latina, which groups best describe you?
*
|
|
|
|
|
|
|
|
8.
What best describes where you live? A home includes a house, apartment, trailer, or mobile
home. (Mark All That Apply.)
*
|
|
|
|
|
|
|
|
9.
During your life, how many times have you used or tried a whole cigarette?
*
|
|
|
|
|
|
|
|
10.
During your life, how many times have you used or tried smokeless tobacco (chew, dip or snuff such as Redman, Skoal, Beechnut)?
*
|
|
|
|
|
|
|
|
11.
During your life, how many times have you used or tried one full drink of Alcohol (such as a can of beer, glass of wine, wine cooler, or shot of liquor)?
*
|
|
|
|
|
|
|
|
12.
During your life, how many times have you used or tried Marijuana (pot, weed, grass, hash)?
*
|
|
|
|
|
|
|
|
13.
During your life, how many times have you used or tried Inhalants (things you sniff, huff, or breathe to get high such as glue, paint, aerosol sprays, gasoline, poppers, gases)?
*
|
|
|
|
|
|
|
|
14.
During your life, how many times have you used or tried Cocaine (any form–coke, crack, rock, base, snort)?
*
|
|
|
|
|
|
|
|
15.
During your life, how many times have you used or tried Methamphetamine or any Amphetamines (meth, speed, crystal, crank, ice)?
*
|
|
|
|
|
|
|
|
16.
During your life, how many times have you used or tried LSD or other Psychedelics (acid, mescaline, peyote, mushrooms)?
*
|
|
|
|
|
|
|
|
17.
During your life, how many times have you used or tried Ecstasy (E, X, EXTC, MDMA)?
*
|
|
|
|
|
|
|
|
18.
During your life, how many times have you used or tried Heroin (smack, junk, China white, black tar)?
*
|
|
|
|
|
|
|
|
19.
During your life, how many times have you used or tried any other illegal drug or pill to get “high”?
*
|
|
|
|
|
|
|
|
20.
During your life, how many times have you used or tried prescription pain killers (Vicodin®, OxyContin®, Percodan®, Lortab®)?
*
|
|
|
|
|
|
|
|
21.
During your life, how many times have you used or tried Barbiturates (Seconol®, Nembutol®, Amital®, reds, yellow jackets)?
*
|
|
|
|
|
|
|
|
22.
During your life, how many times have you used or tried tranquilizers, or sedatives, (tranks, libs, Xanax®, Valium®, Ativan®, Librium®, Klonipin®), Bezodiazepine (benzos)?
*
|
|
|
|
|
|
|
|
23.
During your life, how many times have you used or tried Cold/Cough Medicines (Triple-C’s, Coricidin Cough, Sudafed, TheraFlu, Tylenol Cough)?
*
|
|
|
|
|
|
|
|
24.
During your life, how many times have you used or tried Diet Pills (Didrex, Dexedrine, Zinadrine, Skittles, M&M’s)?
*
|
|
|
|
|
|
|
|
25.
During your life, how many times have you used or tried Ritalin® or Adderall® (JIF, R-ball, Skippy, the smart drug)?
*
|
|
|
|
|
|
|
|
26.
During your life, how many times have you been very drunk or sick after drinking alcohol?
*
|
|
|
|
|
|
|
|
27.
During your life, how many times have you been “High” (loaded, stoned, or wasted) from using drugs?
*
|
|
|
|
|
|
|
|
28.
During your life, how many times have you been drunk on alcohol or “high” on drugs on school property?
*
|
|
|
|
|
|
|
|
29.
During the past six months, about how many times did you drink an alcoholic beverage?
*
|
|
|
|
|
|
|
|
30.
During the past six months, about how many times did you use Marijuana (pot, weed, grass, hash, bud)?
*
|
|
|
|
|
|
|
|
31.
During the past six months, about how many times did you use Inhalants (things you sniff, huff, or breathe to get high)?
*
|
|
|
|
|
|
|
|
32.
During the past six months, about how many times did you use Methamphetamine or Amphetamines (meth, speed, crystal, crank, ice)?
*
|
|
|
|
|
|
|
|
33.
During the past six months, about how many times did you use Cocaine (coke, crack, rock, base, snort)?
*
|
|
|
|
|
|
|
|
34.
During the past six months, about how many times did you use Metabene (rollers, wagon wheels)?
*
|
|
|
|
|
|
|
|
35.
During the past six months, about how many times did you use LSD or other psychedelics (acid, mescaline, peyote, mushrooms)?
*
|
|
|
|
|
|
|
|
36.
During the past six months, about how many times did you use Ecstasy (E, X, EXTC, MDMA)?
*
|
|
|
|
|
|
|
|
37.
During the past six months, about how many times did you do any other drug or pill to get "high"?
*
|
|
|
|
|
|
|
|
38.
During the past six months, about how many times did you use two or more drugs at the same time (for example, alcohol with marijuana, ecstasy with mushrooms)?
*
|
|
|
|
|
|
|
|
39.
About how old were you the first time you had an alcoholic beverage (other than a sip or two)?
*
|
|
|
|
|
|
|
|
40.
About how old were you the first time you smoked all or part of a cigarette?
*
|
|
|
|
|
|
|
|
41.
About how old were you the first time you used smokeless tobacco or other tobacco product?
*
|
|
|
|
|
|
|
|
42.
About how old were you the first time you used marijuana or hashish?
*
|
|
|
|
|
|
|
|
43.
About how old were you the first time you used any other illegal drug or pill to get “high”?
*
|
|
|
|
|
|
|
|
44.
During the past 30 days, on how many days did you use cigarettes?
*
|
|
|
|
|
|
|
|
45.
During the past 30 days, on how many days did you use smokeless tobacco (chews or snuffs)?
*
|
|
|
|
|
|
|
|
46.
During the past 30 days, on how many days did you use at least one drinks of alcohol?
*
|
|
|
|
|
|
|
|
47.
During the past 30 days, on how many days did you use five or more drinks of alcohol in a row, that is, within a couple of hours?
*
|
|
|
|
|
|
|
|
48.
During the past 30 days, on how many days did you use marijuana (pot, weed, grass, hash)?
*
|
|
|
|
|
|
|
|
49.
During the past 30 days, on how many days did you use inhalants (things you sniff, huff, or breathe to get high)?
*
|
|
|
|
|
|
|
|
50.
During the past 30 days, on how many days did you use cocaine (any form–coke, crack, rock, base, snort)?
*
|
|
|
|
|
|
|
|
51.
During the past 30 days, on how many days did you use methamphetamine or any amphetamines (meth, speed, crystal, crank)?
*
|
|
|
|
|
|
|
|
52.
During the past 30 days, on how many days did you use ecstasy, LSD or other psychedelics?
*
|
|
|
|
|
|
|
|
53.
During the past 30 days, on how many days did you use any other illegal drug or pill to get “high”?
*
|
|
|
|
|
|
|
|
54.
During the past 30 days, on how many days did you use two or more drugs at the same time (for example, alcohol with marijuana, or ecstasy with mushrooms)?
*
|
|
|
|
|
|
|
|
55.
During the past 30 days, on how many days on school property did you smoke cigarettes?
*
|
|
|
|
|
|
|
|
56.
During the past 30 days, on how many days on school property did you have at least one drink of alcohol?
*
|
|
|
|
|
|
|
|
57.
During the past 30 days, on how many days on school property did you smoke marijuana?
*
|
|
|
|
|
|
|
|
58.
During the past 30 days, on how many days on school property did you use any other illegal drug or pill to get "high"?
*
|
|
|
|
|
|
|
|
59.
How do you like to drink alcohol?
*
|
|
|
|
|
|
|
|
60.
If you use marijuana or other drugs, how high (stoned, faded, wasted, trashed) do you
usually like to get?
*
|
|
|
|
|
|
|
|
61.
In your life, how many times have you driven a car when you had been drinking alcohol or
been in a car driven by a friend when he or she had been drinking?
*
|
|
|
|
|
|
|
|
62.
During the past 12 months, have you taken any steroids (roids) to build up muscle or increase performance or endurance?
*
|
|
|
|
|
|
|
|
63.
During the past 12 months, did you use any performance-enhancing supplement that claims to build muscle or increase strength or endurance (andro, ephedrine, DHEA)?
*
|
|
|
|
|
|
|
|
64.
How much do people risk harming themselves physically or in other ways when they smoke cigarettes occasionally?
*
|
|
|
|
|
|
|
|
65.
How much do people risk harming themselves physically or in other ways when they smoke 1-2 packs of cigarettes each day?
*
|
|
|
|
|
|
|
|
66.
How much do people risk harming themselves physically or in other ways when they drink alcohol occasionally?
*
|
|
|
|
|
|
|
|
67.
How much do people risk harming themselves physically or in other ways when have five or more drinks of an alcoholic beverage once or twice a week?
*
|
|
|
|
|
|
|
|
68.
How much do people risk harming themselves physically or in other ways when they smoke marijuana occasionally?
*
|
|
|
|
|
|
|
|
69.
How much do people risk harming themselves physically or in other ways when they smoke marijuana once or twice a week?
*
|
|
|
|
|
|
|
|
70.
How difficult is it for students in your grade to get cigarettes?
*
|
|
|
|
|
|
|
|
71.
How difficult is it for students in your grade to get alcohol?
*
|
|
|
|
|
|
|
|
72.
How difficult is it for students in your grade to get marijuana?
*
|
|
|
|
|
|
|
|
73.
How do most kids at your school who drink alcohol usually get it?
*
|
|
|
|
|
|
|
|
74.
How do you feel about someone your age smoking one or more packs of cigarettes a day?
*
|
|
|
|
|
|
|
|
75.
How do you feel about someone your age having one or two drinks of any alcoholic beverage nearly every day?
*
|
|
|
|
|
|
|
|
76.
How do you feel about someone your age trying marijuana or hashish once or twice?
*
|
|
|
|
|
|
|
|
77.
How do you feel about someone your age using marijuana once a month or more?
*
|
|
|
|
|
|
|
|
78.
How do you feel about someone your age carrying a weapon to school?
*
|
|
|
|
|
|
|
|
79.
How do you think your close friends would feel about your smoking one or more packs of cigarettes a day?
*
|
|
|
|
|
|
|
|
80.
Think about a group of 100 students, (or about three classrooms) in your grade. About how many students do you think have smoked cigarettes at least once a month?
*
|
|
|
|
|
|
|
|
81.
Think about a group of 100 students, (or about three classrooms) in your grade. About how many students do you think have ever tried marijuana?
*
|
|
|
|
|
|
|
|
82.
Has drinking alcohol ever caused you to have any of the following problems?
*
|
|
|
|
|
|
|
|
83.
Has using marijuana or other drugs ever caused you to have any of the following problems?
*
|
|
|
|
|
|
|
|
84.
If you use alcohol, marijuana, or another drug, have you had any of the following
experiences?
*
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
85.
How many times have you tried to quit or stop using Cigarettes?
*
|
|
|
|
|
|
|
|
86.
How many times have you tried to quit or stop using Alcohol?
*
|
|
|
|
|
|
|
|
87.
How many times have you tried to quit or stop using Marijuana?
*
|
|
|
|
|
|
|
|
88.
Have you ever felt that you needed help (such as counseling or treatment) for your alcohol or other drug use?
*
|
|
|
|
|
|
|
|
89.
In your opinion, how likely is it that a student would find help at your school from a
counselor, teacher, or other adult to stop or reduce using alcohol or other drugs?
*
|
|
|
|
|
|
|
|
90.
During the past 12 months, have you talked with at least one of your parents [or guardians] about the dangers of tobacco, alcohol, or drug use?
*
|
|
|
|
|
|
|
|
91.
During the past 12 months, have you heard, read, or watched any messages about not using alcohol, tobacco, or drugs?
*
|
|
|
|
|
|
|
|
92.
During the past 12 months, how many times on school property have you been pushed, shoved, slapped, hit, or kicked by someone who wasn’t just kidding around?
*
|
|
|
|
|
|
|
|
93.
During the past 12 months, how many times on school property have you been threatened or injured with a weapon (gun, knife, or club)?
*
|
|
|
|
|
|
|
|
94.
During the past 12 months, how many times on school property have you seen someone carrying a gun, knife, or other weapon?
*
|
|
|
|
|
|
|
|
95.
During the past 12 months, how many times on school property have you been afraid of being beaten up?
*
|
|
|
|
|
|
|
|
96.
During the past 12 months, how many times on school property have you been in a physical fight?
*
|
|
|
|
|
|
|
|
97.
During the past 12 months, how many times on school property have you had mean rumors or lies spread about you?
*
|
|
|
|
|
|
|
|
98.
During the past 12 months, how many times on school property have you had sexual jokes, comments, or gestures made to you?
*
|
|
|
|
|
|
|
|
99.
During the past 12 months, how many times on school property have you been made fun of because of your looks or the way you talk?
*
|
|
|
|
|
|
|
|
100.
During the past 12 months, how many times on school property have you had your property stolen or deliberately damaged, such as your car, clothing, or books?
*
|
|
|
|
|
|
|
|
101.
During the past 12 months, how many times on school property were you harassed or bullied for your race, ethnicity, or national origin?
*
|
|
|
|
|
|
|
|
102.
During the past 12 months, how many times on school property were you harassed or bullied about your religion?
*
|
|
|
|
|
|
|
|
103.
During the past 12 months, how many times on school property were you harassed or bullied about your gender (being male or female)?
*
|
|
|
|
|
|
|
|
104.
During the past 12 months how many times on school property where you were harrassed or bullied because you are gay or lesbian or someone thought you were?
*
|
|
|
|
|
|
|
|
105.
During the past 12 months how many times on school property were you harassed or bullied for a physical or mental disability?
*
|
|
|
|
|
|
|
|
106.
During the past 12 months how many times on school property were you harassed or bullied for any other reason?
*
|
|
|
|
|
|
|
|
107.
During the past 12 months how many times have you been in a physical fight between groups of kids?
*
|
|
|
|
|
|
|
|
108.
During the past 12 months how many times have you used any weapon to threaten or bully someone?
*
|
|
|
|
|
|
|
|
109.
During the past 12 months how many times have you sold drugs to someone?
*
|
|
|
|
|
|
|
|
110.
During the past 12 months have you gambled (bet) for money or valuables in any of the following ways?
*
|
|
|
|
|
|
|
|
111.
During the past 12 months, how many times have you gambled (bet) for money or valuables in any way?
*
|
|
|
|
|
|
|
|
112.
During the past 12 months how many times on school property have you been offered, sold, or given an illegal drug?
*
|
|
|
|
|
|
|
|
113.
During the past 12 months how many times on school property have you carried a gun?
*
|
|
|
|
|
|
|
|
114.
During the past 12 months how many times on school property have you carried any other weapon(such as a knife or bat)?
*
|
|
|
|
|
|
|
|
115.
During the past 12 months have you damaged school property on purpose?
*
|
|
|
|
|
|
|
|
116.
How safe do you feel when you are at school?
*
|
|
|
|
|
|
|
|
117.
How safe do you feel when you are in the neighborhood where you live?
*
|
|
|
|
|
|
|
|
118.
Do you consider yourself a member of a gang?
*
|
|
|
|
|
|
|
|
119.
During the past 12 months did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?
*
|
|
|
|
|
|
|
|
120.
During the past 12 months did you ever feel so sad or hopeless almost everyday for 2 weeks or more that you stopped doing some usual activities?
*
|
|
|
|
|
|
|
|
121.
During the past 12 months how would you describe the grades you mostly recieve in school?
*
|
|
|
|
|
|
|
|
122.
During the past 12 months about how many times did you skip school or cut class?
*
|
|
|
|
|
|
|
|
123.
I feel close to people at this school?
*
|
|
|
|
|
|
|
|
124.
I'm happy to be at this school?
*
|
|
|
|
|
|
|
|
125.
I feel like i'm part of this school?
*
|
|
|
|
|
|
|
|
126.
The teachers treat students fairly?
*
|
|
|
|
|
|
|
|
127.
I feel safe in my school?
*
|
|
|
|
|
|
|
|
128.
At my school there is a teacher or some other adult who really cares about me?
*
|
|
|
|
|
|
|
|
129.
At my school there is a teacher or some other adult who tells me when I do a good job.
*
|
|
|
|
|
|
|
|
130.
At my school there is a teacher or some other adult who notices when i'm not there.
*
|
|
|
|
|
|
|
|
131.
At my school there is a teacher or some other adult who always wants me to do my best.
*
|
|
|
|
|
|
|
|
132.
At my schoool there is a teacher or some other adult who listens to me when I have something to say.
*
|
|
|
|
|
|
|
|
133.
At my school there is a teacher or some other adult who believes that I will be a success.
*
|
|
|
|
|
|
|
|
134.
At school I do interesting activities.
*
|
|
|
|
|
|
|
|
135.
At school I help decide things like class activitiies or rules.
*
|
|
|
|
|
|
|
|
136.
At school I do things that make a difference.
*
|
|
|
|
|
|
|
|
137.
Outside of my home and school there is an adult who really cares about me.
*
|
|
|
|
|
|
|
|
138.
Outside of my home and school there is an adult who tells me when I do a good job.
*
|
|
|
|
|
|
|
|
139.
Outside of my home and school there is an adult who notices when I am upset about something.
*
|
|
|
|
|
|
|
|
140.
Outside of my home and school thereis an adult who believes I will be a success.
*
|
|
|
|
|
|
|
|
141.
Outside of my home and school there is an adult who aways wants me to do my best.
*
|
|
|
|
|
|
|
|
142.
Outside of my home and school there is an adult whom I trust.
*
|
|
|
|
|
|
|
|
143.
Outside of my home and school I am part of clubs, sports teams, church/temple, or other group activities.
*
|
|
|
|
|
|
|
|
144.
Outside of my home and school I am involved in music, art, literature, sports or hobbies.
*
|
|
|
|
|
|
|
|
145.
Outside of my home and school I help other people.
*
|
|
|
|
|
|
|
|
146.
Did you eat breakfast today?
*
|
|
|
|
|
|
|
|
147.
How many questions in this survey did you answer honestly?
*
|
|
|
|
|
|
|
|
148.
Would you be more or less likely to want to work for an employer that tested his employees for drugs or alcohol use on a random bases?
*
|
|
|
|
|
|
|
|
149.
Have you ever had unprotected sex (without contraceptives)?
*
|
|
|
|
|
|
|
|