F Survey

OMB #: 0925-0542

Expiration Date: 4-30-08

Form F

Brain Power!

The NIDA Junior Scientists Program

Grades 4–5

Student Attitudes Questionnaire

Please fill in one bubble for your answer to each question. Remember to fill in your response darkly and completely like this: 

First, please tell us about yourself.

1. What grade are you in?

 4th grade

 5th grade

2. Are you a…

 Boy

 Girl

3. These questions ask about what you think about science. (Fill in one bubble for each line.)

	Agree	Disagree	Not sure
a. Science is fun.			
	Agree	Disagree	Not sure
b. Science is my favorite subject.			
	Agree	Disagree	Not sure
c. I would like to be a scientist when I grow up.			
	Agree	Disagree	Not sure
d. The things we do in science class are too hard for me.			
	Agree	Disagree	Not sure
e. Scientists have boring jobs.			
	Agree	Disagree	Not sure
f. Scientists are nerds and geeks.			
	Agree	Disagree	Not sure
g. Science is useful in everyday life.			
	Agree	Disagree	Not sure
h. Scientists are important people.			

5. These questions ask about what you think about alcohol. Alcohol includes beer, wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey. (Fill in one bubble for each line.)

	Agree	Disagree	Not sure
a. Drinking alcohol creates problems.			
	Agree	Disagree	Not sure
b. Teenagers drink to be part of a group.			
	Agree	Disagree	Not sure
c. Drinking alcohol gets rid of aches and pains.			
	Agree	Disagree	Not sure
d. People drink alcohol when they have problems or are sad.			
	Agree	Disagree	Not sure
e. People become mean and hurt others when they drink alcohol.			
	Agree	Disagree	Not sure
f. Drinking is OK as long as someone only drinks on the weekend.			

6. Have you ever drank alcohol (does not include drinking a few sips of wine for religious purposes)?

 Yes

 No

7. Have you ever felt sick or gotten drunk from alcohol?

 Yes

 No

8. How often IN YOUR LIFETIME have you…

	Never	1–2 times	3–6 times	7 or more times
a. Drank alcohol				
b. Gotten drunk				

9. Why do you like to drink? (Fill in all that apply.)

 I don’t like to drink.

 I drink to fit in with everybody else.

 I drink so I can feel it a little.

 I drink so I can feel it a lot.

10. How many of your friends drink alcohol?

 None

 A few

 Most of them

 All of them

11. These questions will tell us what you think about nicotine, which is used in cigarettes and in chewing tobacco (also called dip or chew). (Fill in one bubble for each line.)

	Agree	Disagree	Not sure
a. Smoking cigarettes is OK as long as someone doesn’t smoke very often.			
	Agree	Disagree	Not sure
b. Chewing tobacco (such as Redman, Beechnut, Skoal, Skoal Bandit, or Copenhagen) is OK as long as someone only chews a little.			
	Agree	Disagree	Not sure
c. Smoking cigarettes is a nasty habit.			
	Agree	Disagree	Not sure
d. It is easy to quit smoking.			
	Agree	Disagree	Not sure
e. When I see a teenager smoking, I think they look cool.			

12. IN YOUR LIFETIME, have you ever smoked cigarettes?

 Yes

 No

13. How often do you smoke cigarettes?

 I don’t smoke.

 Once or twice a year

 Once or twice a month

 Once or twice a week

 Every day

14. How many of your friends smoke?

• None

• A few

• Most of them

• All of them

These questions will tell us what you think about sniffing products, like glue, gas, or sprays. (Fill in one bubble for each question.)

15. Have you ever sniffed (or “huffed”) glue, gas, sprays, or anything like that to get high?

 Yes

 No

16. How often IN YOUR LIFETIME have you sniffed (or “huffed”) glue, gas, or anything like that to get high?

 Never

 1–2 times

 3–9 times

 10 or more times

17. How many of your friends sniff (or “huff”) glue, gas, or anything like that to get high?

• None

• A few of them

• Most of them

• All of them

18. These questions tell us what you think about illegal drugs such as marijuana (also called weed or pot) and cocaine/crack cocaine. (Fill in one bubble for each line.)

	Agree	Disagree	Not sure
a. Illegal drugs help people get rid of problems.			
	Agree	Disagree	Not sure
b. Illegal drugs can cause people to steal things to get more drugs.			
	Agree	Disagree	Not sure
c. Illegal drugs help people to play sports better.			
	Agree	Disagree	Not sure
d. Illegal drugs make people feel powerful.			
	Agree	Disagree	Not sure
e. Marijuana or pot is really not that bad for people.			
	Agree	Disagree	Not sure
f. Cocaine helps people to have more energy.			
	Agree	Disagree	Not sure
g. Illegal drugs are OK as long as people only use them on the weekends.			

19. IN YOUR LIFETIME, have you ever tried marijuana (also called weed or pot)?

 Yes

 No

20. How often IN YOUR LIFETIME have you smoked or eaten marijuana (weed or pot)?

 Never

 1–2 times

 3–9 times

 10 or more times

21. Why do you use marijuana (weed or pot)?

 I don’t use it.

 I smoke just a puff or eat just a bite to try it.

 I smoke or eat just a little bit to feel it some.

 I smoke or eat enough to feel it a lot.

22. How many of your friends use marijuana (weed or pot)?

 None

 A few

 Most of them

 All of them

23. When I answered the questions about alcohol…

 I was very honest

 I said I drank it more times than I really do

 I said I drank it fewer times than I really do

24. When I answered the questions about the other drugs….

 I was very honest

 I said I used them more times than I really do

 I said I used them fewer times than I really do

25. If one of your friends asked you to try any one of the following drugs, how easy or hard would it be for you to say no? (Fill in one bubble for each line.)

	Easy	Hard	I wouldn’t say no because I’d be embarrassed	I wouldn’t say no because I would want to do it
a. Alcohol				
b. Cigarettes, dip, or chew				
c. Marijuana				
d. Another illegal drug				

26. If one of your friends wanted to try any of the drugs above, how easy or hard would it be for you to stop him or her from doing it?

 Easy

 Hard

 I wouldn’t be able to stop my friend.

27. Which of the statements below best describes you? (Do not count alcohol or tobacco use for this question.)

I have…

 Never used illegal drugs and never will

 Never used illegal drugs but may in the future

 Used illegal drugs but don’t plan to use them again

 Used illegal drugs and probably will use them again

29. How much have you learned about the bad things that drugs can do from each of the following? (Fill in one bubble for each line.)

	A lot	Some	Nothing at all
Parents			
Friends			
Teachers or school counselors			
TV, radio, newspaper, magazines			
The lives of famous people like TV and movie stars, or athletes			
Adults in school who talk about D.A.R.E., Allstars, Brain Power!, or other anti-drug programs			

THANK YOU