Form Approved
OMB No.: 09300230
Expiration Date: 04/30/2012
Center for Substance Abuse Prevention
National Outcome Measures
Adult Community Form
(Adults ages 18 and older)
Use this Adult Community Form for communities in which data may be collected at a single point in time or at multiple time points, each time using different samples of individuals.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0230. Public reporting burden for this collection of information is estimated to average 0.4 hours per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.
Center
for Substance Abuse Prevention
National Outcome Measures
Adult Community Form
This form is voluntary. If you choose to take it, you may skip any question you don’t want to answer. If you decide not to fill out this form, it will have no effect on your participation in direct service programs.
This form asks about your experience and opinion on a number of topics related to alcohol, tobacco, and drug use. No one will connect your answers with your name or other identifying information. To help us protect the privacy of your answers, please do not write your name on this form.
The information in this form will be used to learn more about the effectiveness of programs in preventing substance abuse.
This is not a test, so there are no right or wrong answers. Some questions may ask you to select all of the answers that are relevant, and others ask you to select a single answer. If the question asks for a single answer and you don’t find an answer that exactly fits, choose one that comes closest.
Thank you for agreeing to participate.
RECORD MANAGEMENT: Your form administrator will tell you what to fill in for these administrative questions. You may leave all but Date Completed blank if you are not given any instructions.
Participant ID
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Contract/Grant ID
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Date Completed
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/ |
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/ |
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Month |
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Day |
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Year |
Program Name
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Cohort Number
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These questions ask for general information about you. Please mark the response that best describes you. |
What is your gender?
(Check one)
Male
Female
Are you Hispanic or
Latino? (Check one)
Yes
No
What is your race?
(Select one or more)
American
Indian or Alaska Native
Asian
Black
or African American
Native
Hawaiian or Other Pacific Islander
White
What is your date of birth?
|
/ |
|
Month |
|
Year |
Have you ever served in the Armed Forces, in the Reserves, or the National Guard [select all that apply]?
No, (Skip to #6]
Yes, in the Armed Forces
Yes, in the Reserves
Yes, in the National Guard
5a. Are you currently on active duty in the Armed Forces, in the Reserves, or the National Guard [select all that apply]?
Yes, in the Armed Forces
Yes, in the Reserves
Yes, in the National Guard
No, separated or retired from Armed Forces, Reserves, or National Guard
5b. Have you ever been deployed to a combat zone [select all that apply]?
Never deployed
Iraq or Afghanistan (e.g., Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn)
Persian Gulf (Operation Desert Shield or Desert Storm)
Vietnam/Southeast Asia
Korea
WWII
Deployed to a combat zone not listed above (e.g., Somalia, Bosnia, Kosovo)
Is anyone in your family or someone close to you on active duty in the Armed Forces, in the Reserves, or the National Guard, or separated or retired from Armed Forces, Reserves, or the National Guard?
Yes
Yes, more than one
No, (Skip to #8)
If yes (answer for up to six people):
7a. What is the relationship of that person (Service Member) to you: |
Mother/Father Brother/Sister Spouse/Partner Child Other, Specify___________
|
The next few questions ask about your use of and attitudes
toward tobacco, |
Think back over the past 30 days and report how many days, if any, you used the following substances:
|
|
|
Fill in number of days |
Check if don’t know or can’t say |
|
Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes |
8a. |
During the past 30 days, on how many days did you smoke part or all of a cigarette? |
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|
|
Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe |
8b. |
During the past 30 days, on how many days did you use other tobacco products? |
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|
|
Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor |
8c. |
During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage? |
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|
|
Marijuana or hashish: Also known as grass, pot, hash, or hash oil |
8d. |
During the past 30 days, on how many days did you use marijuana or hashish? |
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|
|
Other illegal drugs: Include substances like:
|
8e. |
During the past 30 days, on how many days did you use any other illegal drug? |
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|
Think back over your entire lifetime and try to remember whether you have EVER used any of the following substances. If so, what was your age the FIRST TIME you used the substance:
|
|
|
Check if NEVER |
Fill in your age when you first used (in years) |
Check if don’t know or can’t say |
|
Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes |
9a. |
Ever smoked part or all of a cigarette?
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|
|
|
|
Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe |
9b. |
Ever used any other tobacco product?
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|
Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor |
9c. |
Ever had a drink of an alcoholic beverage? Do NOT include any time when you only had a sip or two from a drink.
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|
|
Marijuana or hashish: Also known as grass, pot, hash, or hash oil |
9d. |
Ever used marijuana or hashish? |
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|
Other illegal drugs: Include substances like:
|
9e. |
Ever used any other illegal drug? |
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For each of the three questions below check one box that shows HOW MUCH you think people RISK HARMING themselves physically or in other ways when they engage in the following behaviors:
|
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No risk |
Slight risk |
Moderate risk |
Great risk |
Don’t know or can’t say |
10a. |
When they smoke one or more packs of CIGARETTES per day? |
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|
10b. |
When they smoke MARIJUANA once or twice a week? |
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10c. |
When they have five or more drinks of an ALCOHOLIC BEVERAGE once or twice a week? |
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|
This section asks just a few additional questions about your attitudes and experiences. |
|
More likely Less likely Would make no difference Don’t know or can’t say |
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Don’t have any children 0 times 1 to 2 times A few times Many times Don’t know or can’t say |
Form Approved OMB No.: 09300230
Expiration Date: 04/30/2012
Center for Substance Abuse Prevention
National Outcome Measures
Youth Community Form
(Youth ages 12-17)
Use this Youth Community Form for communities in which data may be collected at a single point in time or at multiple time points, each time using different samples of individuals.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0230. Public reporting burden for this collection of information is estimated to average 0.4 hours per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.
Center for Substance Abuse Prevention
National Outcome Measures
Youth Community Form
This form is voluntary. If you choose to take it, you may skip any question you don’t want to answer. If you decide not to fill out this form, it will have no effect on your participation in direct service programs.
This form asks about your experience and opinion on a number of things related to alcohol, tobacco, and drug use. No one will connect your answers with your name or any other information about you that can identify who you are. To help us keep your answers secret, please do not write your name on this form.
The information in this form will be used to learn more about the effectiveness of programs in preventing substance abuse and protecting youth.
This is not a test, so there are no right or wrong answers. Some questions may ask you to select all of the answers that are relevant, and others ask you to select a single answer. If the question asks for a single answer and you don’t find an answer that exactly fits, choose one that comes closest.
Thank you for agreeing to participate.
RECORD MANAGEMENT: Your form administrator will tell you what to fill in for these administrative questions. You may leave all but Date Completed blank if you are not given any instructions.
Participant ID
|
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|
|
|
|
|
|
|
|
|
Contract/Grant ID
|
|
|
|
|
|
|
|
|
|
|
Date Completed
|
/ |
|
/ |
|
Month |
|
Day |
|
Year |
Program Name
|
Cohort Number
|
These questions ask for general information about you. Please mark the response that best describes you. |
What is your gender?
(Check one)
Male
Female
Are you Hispanic or
Latino? (Check one)
Yes
No
What is your race?
(Select one or more)
American
Indian or Alaska Native
Asian
Black
or African American
Native
Hawaiian or Other Pacific Islander
White
What is your date of birth?
|
/ |
|
Month |
|
Year |
Is anyone in your family or someone close to you on active duty in the Armed Forces, in the Reserves, or the National Guard, or separated or retired from Armed Forces, Reserves, or the National Guard?
Yes
Yes, more than one
No, (Skip to #7)
If yes (answer for up to six people):
6a. What is the relationship of that person (Service Member) to you: |
Mother Father Brother/Sister Aunt/Uncle Grandparent Other, Specify_____________
|
The next few questions
ask about your use of and attitudes toward tobacco,
|
Think back over the past 30 days and report how many days, if any, you used the following substances:
|
|
|
Fill in number of days
|
Check if don’t know or can’t say |
|
Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes |
7a. |
During the past 30 days, on how many days did you smoke part or all of a cigarette? |
|
|
|
Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe |
7b. |
During the past 30 days, on how many days did you use other tobacco products? |
|
|
|
Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor |
7c. |
During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage? |
|
|
|
Marijuana or hashish: Also known as grass, pot, hash, or hash oil |
7d. |
During the past 30 days, on how many days did you use marijuana or hashish? |
|
|
|
Other illegal drugs: Include substances like:
|
7e. |
During the past 30 days, on how many days did you use any other illegal drug? |
|
|
Think back over your entire lifetime and try to remember whether you have EVER used any of the following substances. If so, what was your age the FIRST TIME you used the substance:
|
|
|
Check if NEVER |
Fill in your age when you first used (in years) |
Check if don’t know or can’t say |
|
Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes |
8a. |
Ever smoked part or all of a cigarette?
|
|
|
|
|
Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe |
8b. |
Ever used any other tobacco product?
|
|
|
|
|
Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor |
8c. |
Ever had a drink of an alcoholic beverage? Do NOT include any time when you only had a sip or two from a drink.
|
|
|
|
|
Marijuana or hashish: Also known as grass, pot, hash, or hash oil |
8d. |
Ever used marijuana or hashish? |
|
|
|
|
Other illegal drugs: Include substances like:
|
8e. |
Ever used any other illegal drug? |
|
|
|
For each of the following five questions below check the box that shows how YOU think or feel.
|
|
Neither approve nor disapprove |
Somewhat disapprove |
Strongly disapprove |
Don’t know or can’t say |
9a.
|
How do you feel about someone your age smoking one or more packs of cigarettes a day? |
|
|
|
|
9b. |
How do you think your close friends would feel about YOU smoking one or more packs of cigarettes a day? |
|
|
|
|
9c.
|
How do you feel about someone your age trying marijuana or hashish once or twice? |
|
|
|
|
9d.
|
How do you feel about someone your age using marijuana once a month or more? |
|
|
|
|
9e.
|
How do you feel about someone your age having one or two drinks of an alcoholic beverage nearly every day? |
|
|
|
|
For each of the three questions below check one box that shows HOW MUCH you think people RISK HARMING themselves physically or in other ways when they do the following things:
|
|
No risk |
Slight risk |
Moderate risk |
Great risk |
Don’t know or can’t say |
10a. |
When they smoke one or more packs of CIGARETTES per day? |
|
|
|
|
|
10b. |
When they smoke MARIJUANA once or twice a week? |
|
|
|
|
|
10c. |
When they have five or more drinks of an ALCOHOLIC BEVERAGE once or twice a week? |
|
|
|
|
|
This section asks just a few additional questions about your attitudes and experiences. |
|
|
More likely Less likely Would make no difference Don’t know or can’t say |
|
Yes No Don’t know or can’t say |
|
Yes No Don’t know or can’t say |
Form Approved
OMB No.: 09300230
Expiration Date: 04/30/2012
Center for Substance Abuse Prevention
National Outcome Measures
Adult Programs Form
(Adult participants ages 18 and older)
Use this Adult Programs Form for participants in prevention interventions who are expected to complete forms at baseline, exit, and followup periods.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0230. Public reporting burden for this collection of information is estimated to average 0.4 hours per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857
Center for Substance Abuse Prevention
National Outcome Measures
Adult Programs Form
This form is voluntary. If you choose to take it, you may skip any question you don’t want to answer. If you decide not to fill out this form, it will have no effect on your participation in direct service programs.
This form asks about your experience and opinion on a number of topics related to alcohol, tobacco, and drug use. No one will connect your answers with your name or other identifying information. To help us protect the privacy of your answers, please do not write your name on this form.
The information in this form will be used to learn more about the effectiveness of programs in preventing substance abuse.
This is not a test, so there are no right or wrong answers. Some questions may ask you to select all of the answers that are relevant, and others ask you to select a single answer. If the question asks for a single answer and you don’t find an answer that exactly fits, choose one that comes closest.
Thank you for agreeing to participate.
RECORD MANAGEMENT: Your form administrator will tell you what to fill in for these administrative questions. You may leave all but Date Completed blank if you are not given any instructions.
Participant ID
|
|
|
|
|
|
|
|
|
|
|
Contract/Grant ID
|
|
|
|
|
|
|
|
|
|
|
Date Completed
|
/ |
|
/ |
|
Month |
|
Day |
|
Year |
Form Type (Check one)
Baseline Exit First followup after exit Second followup
Program Name
|
Cohort Number
|
These questions ask for general information about you. Please mark the response that best describes you. |
What is your gender?
(Check one)
Male
Female
Are you Hispanic or
Latino? (Check one)
Yes
No
What is your race?
(Select one or more)
American
Indian or Alaska Native
Asian
Black
or African American
Native
Hawaiian or Other Pacific Islander
White
What is your date of birth?
|
/ |
|
Month |
|
Year |
Have you ever served in the Armed Forces, in the Reserves, or the National Guard?
No, (Skip to #6]
Yes, in the Armed Forces
Yes, in the Reserves
Yes, in the National Guard
5b. Are you currently on active duty in the Armed Forces, in the Reserves, or the National Guard [select all that apply]?
Yes, in the Armed Forces
Yes, in the Reserves
Yes, in the National Guard
No, separated or retired from Armed Forces, Reserves, or National Guard
5c. Have you ever been deployed to a combat zone [select all that apply]?
Never deployed
Iraq or Afghanistan (e.g., Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn)
Persian Gulf (Operation Desert Shield or Desert Storm)
Vietnam/Southeast Asia
Korea
WWII
Deployed to a combat zone not listed above (e.g., Somalia, Bosnia, Kosovo)
Is anyone in your family or someone close to you on active duty in the Armed Forces, in the Reserves, or the National Guard, or separated or retired from Armed Forces, Reserves, or the National Guard?
Yes
Yes, more than one
No, (Skip to #8)
If yes (answer for up to six people):
7a. What is the relationship of that person (Service Member) to you: |
Mother/Father Brother/Sister Spouse/Partner Child Other, Specify___________
|
The next few questions ask about your use of and attitudes toward tobacco, alcohol, and other substances. |
Think back over the past 30 days and report how many days, if any, you used the following substances:
|
|
|
Fill in number of days (0 – 30) |
|
|
Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes |
8a. |
During the past 30 days, on how many days did you smoke part or all of a cigarette? |
|
|
|
Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe |
8b. |
During the past 30 days, on how many days did you use other tobacco products? |
|
|
|
Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor |
8c. |
During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage? |
|
|
|
Marijuana or hashish: Also known as grass, pot, hash, or hash oil |
8d. |
During the past 30 days, on how many days did you use marijuana or hashish? |
|
|
|
Other illegal drugs: Include substances like:
|
8e. |
During the past 30 days, on how many days did you use any other illegal drug? |
|
|
Think back over your entire lifetime and try to remember whether you have EVER used any of the following substances. If so, what was your age the FIRST TIME you used the substance:
|
|
|
Check if NEVER |
Fill in your age when you first used (in years ) |
Check if don’t know or can’t say |
|
Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes |
9a. |
Ever smoked part or all of a cigarette?
|
|
|
|
|
Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe |
9b. |
Ever used any other tobacco product?
|
|
|
|
|
Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor |
9c. |
Ever had a drink of an alcoholic beverage? Do NOT include any time when you only had a sip or two from a drink. |
|
|
|
|
Marijuana or hashish: Also known as grass, pot, hash, or hash oil |
9d. |
Ever used marijuana or hashish? |
|
|
|
|
Other illegal drugs: Include substances like:
|
9e. |
Ever used any other illegal drug? |
|
|
|
For each of the three questions below check one box that shows HOW MUCH you think people RISK HARMING themselves physically or in other ways when they engage in the following behaviors:
|
|
|
|
Moderate risk |
Great risk |
Don’t know or can’t say |
10a. |
When they smoke one or more packs of CIGARETTES per day?
|
|
|
|
|
|
10b. |
When they smoke MARIJUANA once or twice a week?
|
|
|
|
|
|
10c. |
When they have five or more drinks of an ALCOHOLIC BEVERAGE once or twice a week? |
|
|
|
|
|
This section asks just a few additional questions about your attitudes and experiences. |
|
More likely Less likely Would make no difference Don’t know or can’t say
|
|
|
Yes No Don’t know or can’t say
|
|
|
|
Form Approved
OMB No.: 09300230
Expiration Date: 04/30/2012
Center for Substance Abuse Prevention
National Outcome Measures
Youth Programs Form
(Participants ages 12-17)
Use this Youth Programs Form for participants in prevention interventions who are expected to complete forms at baseline, exit, and followup periods.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0230. Public reporting burden for this collection of information is estimated to average 0.4 hours per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.
Center for Substance Abuse Prevention
National Outcome Measures
Youth Programs Form
This form is voluntary. If you choose to take it, you may skip any question you don’t want to answer. If you decide not to fill out this form, it will have no effect on your participation in direct service programs.
This form asks about your experience and opinion on a number of things related to alcohol, tobacco, and drug use. No one will connect your answers with your name or any other information about you that can identify who you are. To help us keep your answers secret, please do not write your name on this form.
The information in this form will be used to learn more about the effectiveness of programs in preventing substance abuse and protecting youth.
This is not a test, so there are no right or wrong answers. Some questions may ask you to select all of the answers that are relevant, and others ask you to select a single answer. If the question asks for a single answer and you don’t find an answer that exactly fits, choose one that comes closest.
Thank you for agreeing to participate.
RECORD MANAGEMENT: Your form administrator will tell you what to fill in for these administrative questions. You may leave all but Date Completed blank if you are not given any instructions.
Participant ID
|
|
|
|
|
|
|
|
|
|
|
Contract/Grant ID
|
|
|
|
|
|
|
|
|
|
|
Date Completed
|
/ |
|
/ |
|
Month |
|
Day |
|
Year |
Form Type (Check one)
Baseline Exit First follow-up after exit Second follow-up
Program Name
|
Cohort Number
|
These questions ask for general information about you. Please mark the response that best describes you. |
What is your gender?
(Check one)
Male
Female
Are you Hispanic or
Latino? (Check one)
Yes
No
What is your race?
(Select one or more)
American
Indian or Alaska Native
Asian
Black
or African American
Native
Hawaiian or Other Pacific Islander
White
What is your date of birth?
|
/ |
|
Month |
|
Year
|
Is anyone in your family or someone close to you on active duty in the Armed Forces, in the Reserves, or the National Guard, or separated or retired from Armed Forces, Reserves, or the National Guard?
Yes
Yes, more than one
No, (Skip to #7)
If yes (answer for up to six people above):
6a. What is the relationship of that person (Service Member) to you: |
Mother Father Brother/Sister Aunt/Uncle Grandparent Other, Specify_____________
|
|
|
The next few questions ask about your use of and attitudes toward tobacco, alcohol, and other substances. |
Think back over the past 30 days and report how many days, if any, you used the following substances:
|
|
|
Fill in number of days (0 – 30) |
|
|
Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes |
7a. |
During the past 30 days, on how many days did you smoke part or all of a cigarette? |
|
|
|
Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe |
7b. |
During the past 30 days, on how many days did you use other tobacco products? |
|
|
|
Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor |
7c. |
During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage? |
|
|
|
Marijuana or hashish: Also known as grass, pot, hash, or hash oil |
7d. |
During the past 30 days, on how many days did you use marijuana or hashish? |
|
|
|
Other illegal drugs: Include substances like:
|
7e. |
During the past 30 days, on how many days did you use any other illegal drug? |
|
|
Think back over your entire lifetime and try to remember whether you have EVER used any of the following substances. If so, what was your age the FIRST TIME you used the substance:
|
|
|
Check if NEVER |
Fill in your age when you first used (in years) |
Check if don’t know or can’t say |
|
Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes |
8a. |
Ever smoked part or all of a cigarette?
|
|
|
|
|
Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe |
8b. |
Ever used any other tobacco product?
|
|
|
|
|
Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor |
8c. |
Ever had a drink of an alcoholic beverage? Do NOT include any time when you only had a sip or two from a drink. |
|
|
|
|
Marijuana or hashish: Also known as grass, pot, hash, or hash oil |
8d. |
Ever used marijuana or hashish? |
|
|
|
|
Other illegal drugs: Include substances like:
|
8e. |
Ever used any other illegal drug? |
|
|
|
For each of the following five questions below check the box that shows how YOU think or feel.
|
|
|
|
|
Don’t know or can’t say |
9a.
|
How do you feel about someone your age smoking one or more packs of cigarettes a day? |
|
|
|
|
9b. |
How do you think your close friends would feel about YOU smoking one or more packs of cigarettes a day? |
|
|
|
|
9c.
|
How do you feel about someone your age trying marijuana or hashish once or twice? |
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9d.
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How do you feel about someone your age using marijuana once a month or more? |
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9e.
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How do you feel about someone your age having one or two drinks of an alcoholic beverage nearly every day? |
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For each of the three questions below check one box that shows HOW MUCH you think people RISK HARMING themselves physically or in other ways when they do the following things:
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No risk |
Slight risk |
Moderate risk |
Great risk |
Don’t know or can’t say |
10a. |
When they smoke one or more packs of CIGARETTES per day? |
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10b. |
When they smoke MARIJUANA once or twice a week? |
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10c. |
When they have five or more drinks of an ALCOHOLIC BEVERAGE once or twice a week? |
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This section asks just a few additional questions about your attitudes and experiences. |
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More likely Less likely Would make no difference Don’t know or can’t say |
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Yes No Don’t know or can’t say
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Yes No Don’t know or can’t say |
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Yes No Don’t know or can’t say |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Section One: Demographics |
Author | fsabel |
File Modified | 0000-00-00 |
File Created | 2021-01-29 |