Construct
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Item #
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Item
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Drug
Availability
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R-2a.
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How difficult or easy would it be for you to get some marijuana, if you wanted some?
* Mark the first box if you think it would probably be impossible.
* Mark the second box if you think it would be very difficult.
* Mark the third box if you think it would be fairly difficult.
* Mark the fourth box if you think it would be fairly easy.
* Mark the fifth box if you think it would be very easy.
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R-2b.
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How difficult or easy would it be for you to get some LSD, if you wanted some?
*see previous response categories
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R-2c.
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How difficult or easy would it be for you to get some cocaine, if you wanted some?
*see previous response categories
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R-2d.
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How difficult or easy would it be for you to get some "crack," if you wanted some?
*see previous response categories
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R-2e.
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How difficult or easy would it be for you to get some heroin, if you wanted some?
*see previous response categories
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DE-4.
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Has anyone ever offered you marijuana or hashish, or tried to sell you marijuana or hashish?
* If anyone has ever offered you marijuana or hashish, or tried to sell you marijuana or hashish, mark the first box.
* If no one has ever offered you marijuana or hashish, or ever tried to sell you marijuana or hashish, mark the second box.
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DE-11.
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Has anyone ever offered you cocaine, or tried to sell you cocaine?
* If anyone has ever offered you cocaine, or tried to sell you cocaine, mark the first box.
* If no one has ever offered you cocaine, or ever tried to sell you cocaine, mark the second box.
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Construct
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Item #
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Item
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Family
Management
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Y-15a.
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How strict are your parents about the way you dress?
* Mark the first box if you think your parents aren't strict at all.
* Mark the second box if you think your parents are just strict enough.
* Mark the third box if you think your parents are too strict.
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Y-15b.
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How strict are your parents about staying out late at night (curfew)?
*see previous response categories
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Y-15c.
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How strict are your parents about time spent doing homework?
*see previous response categories
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Family
Conflict
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Y-16.
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During the past 12 months, how often have you argued with your parents?
* Mark the first box if you argued with your parents everyday in the past 12 months.
* Mark the second box if you have argued with your parents several times a week in the past 12 months.
* Mark the third box if you argued with your parents about once a week in the past 12 months.
* Mark the fourth box if you have argued with your parents about once a month in the past 12 months.
* Mark the last box if you have rarely or never argued with your parents in the past 12 months.
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Parental
Attitudes
Toward Drug
Use
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Y-10a.
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How would your parents feel if they thought you smoked 1 or more packs of cigarettes per day?
* If you think they would be not at all upset, mark the first box.
* If you think they would be somewhat upset, mark the second box.
* If you think they would be very upset, mark the third box.
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Y-10b.
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How would your parents feel if they thought you tried marijuana once or twice?
*see previous response categories
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Y-10c.
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How would your parents feel if they thought you smoked marijuana once a month?
*see previous response categories |
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Y-10d.
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How would your parents feel if they thought you smoked marijuana once or twice a week?
*see previous response categories
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Y-10e.
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How would your parents feel if they thought you tried inhalants once or twice?
*see previous response categories
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Y-10f.
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How would your parents feel if they thought you tried heroin once or twice?
*see previous response categories
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Y-10g.
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How would your parents feel if they thought you used cocaine once a month?
*see previous response categories
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How would your parents feel if they thought you had five or more drinks once or twice a week?
*see previous response categories
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Prevention
Measure
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Y-9.
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During the past 12 months, have you spoken with a parent or other adult about the dangers of alcohol or drug use?
* If you have spoken with a parent or other adult about the dangers of alcohol or drug use during the past 12 months, mark the first box.
* If you have not spoken with a parent or other adult about the dangers of alcohol or drug use during the past 12 months, mark the second box. |
Construct
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Item #
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Item
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Friends'
Use of
Drugs
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Y-12a.
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How many of your close friends have smoked 1 or packs of cigarettes per day?
* Mark the first box if none of your friends have.
* Mark the second box if a few of you friends have.
* Mark the third box if most of your friends have.
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Y-12b.
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How many of your close friends have tried marijuana once or twice?
*see previous response categories
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Y-12c.
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How many of your close friends have smoked marijuana once a month?
*see previous response categories
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Y-12d.
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How many of your close friends have smoked marijuana once or twice a week?
*see previous response categories
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Y-12e.
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How many of your close friends have tried inhalants once or twice?
*see previous response categories
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Y-12f.
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How many of your close friends have tried heroin once or twice?
*see previous response categories
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Y-12g.
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How many of your close friends have used cocaine once a month?
*see previous response categories
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Y-12h.
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How many of your close friends have had five or more drinks once or twice a week?
*see previous response categories
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Delinquent
Behavior
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Y-17.
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During the past 12 months, how many times have you gotten into a gang fight?
* If you have never got into a gang fight during the past 12 months, mark the first box.
* If you have gotten into a gang fight 1 or 2 times during the past 12 months, mark the second box.
* If you have gotten into a gang fight 3 or 4 times during the past 12 months, mark the third box.
* If you have gotten into a gang fight 5 or more times during the past 12 months, mark the last box.
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Y-18.
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During the past 12 months, how many times have you taken something from a store without paying for it?
* If you have never taken something from a store without paying for it during the past 12 months, mark the first box.
* If you have taken something from a store without paying for it 1 or 2 times during the past 12 months, mark the second box.
* If you have taken something from a store without paying for it 3 or 4 times during the past 12 months, mark the third box.
* If you have taken something from a store without paying for it 5 or more times in the past 12 months, mark the last box. |
Friends'
Attitudes
Toward
Drug Use
|
Y-11a.
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How would your close friends feel if they thought you smoked 1 or more packs of cigarettes per day?
* If you think they would be not at all upset, mark the first box.
* If you think they would be somewhat upset, mark the second box.
* If you think they would be very upset, mark the third box.
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Y-11b.
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How would your close friends feel if they thought you tried marijuana once or twice?
*see previous response categories
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Y-11c.
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How would your close friends feel if they thought you smoked marijuana once a month?
*see previous response categories
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Y-11d.
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How would your close friends feel if they thought you smoked marijuana once or twice a week?
*see previous response categories
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Y-11e.
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How would your close friends feel if they thought you tried inhalants once or twice a week?
*see previous response categories
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Y-11f.
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How would your close friends feel if they thought you tried heroin once or twice?
*see previous response categories
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Y-11g.
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How would your close friends feel if they thought you used cocaine once a month?
*see previous response categories
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Y-11h.
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How would your close friends feel if they thought you had five or more drinks once or twice a week?
*see previous response categories
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Perceived
Risk of
Drug Use
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R-1a.
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How much do you think people risk harming themselves physically and in other ways when they smoke 1 or more packs of cigarettes per day?
*Mark the first box if you think there is no risk.
*Mark the second box if you think there is a slight risk.
*Mark the third box if you think there is a moderate risk.
*Mark the fourth box if you think there is a great risk.
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R-1a.
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How much do you think people risk harming themselves physically and in other ways when they smoke marijuana once a month?
*see previous response categories
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R-1h.
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How much do you think people risk harming themselves physically and in other ways when they use cocaine once a month?
*see previous response categories
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R-1k.
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How much do you think people risk harming themselves physically and in other ways when they have 5 or more drinks once or twice a week?
*see previous response categories |
Construct
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Item #
|
Item
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Commitment
to School
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D-16.
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Are you now...
* A full-time student
* A part-time student
* Not enrolled in any school
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Academic
Failure
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Y-3.
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What were your grades for the last semester or grading period that you completed?
* If you got mostly A's or B's, mark the first box.
* If you got mostly B's or C's, mark the second box.
* If you got mostly C's or D's, mark the third box.
* If you got mostly D's or below, mark the fourth box.
* If your school does not give these grades, mark the last box.
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Prevention
Measure
|
Y-7.
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During the past 12 months, have you had any of the following alcohol or drug education classes in school? On each line, mark the box on the left for "YES" if you had that type of alcohol or drug education class in school during the past 12 months. Mark the box on the right for "NO" if you did not have that type of alcohol or drug education class in school during the past 12 months.
* In the past 12 months, have you had a special course about alcohol or drugs taught by your regular teacher?
* ...A special course about alcohol or drugs, such as DARE, taught by someone other than your regular teacher?
* ...Any special classes or other experiences, like a field trip, not connected to one of your regularly scheduled classes?
* In the past 12 months, have you had some other alcohol or drug education experience in school? If you mark the "YES" box for this last item, please print on the line at the bottom of this list the other alcohol or drug education experience you had in school in the past 12 months. |
Construct
|
Item #
|
Item
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Social
Support
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Y-13.
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If you wanted to talk to someone about a serious problem, which of the following people would you turn to? Please mark all that apply.
* If you feel there is nobody you can talk to about serious problems, mark the box with the 0 next to it.
* If you would turn to your mother to talk about a serious problem, mark the box with the 1 next to it.
* If you would turn to your father, mark the box with the 2 next to it.
* If you would turn to your boyfriend or girlfriend, mark the box with the 3 next to it.
* If you would turn to your brother or sister, mark the box with the 4 next to it.
* If you would turn to some other relative, mark the box with the 5 next to it.
* If you would turn to a friend to talk about a serious problem, mark the box with the 6 next to it.
* If you would turn to a teacher, coach, or school counselor, mark the box with the 7 next to it.
* If you would turn to a pastor or clergy, mark the box with the 8 next to it.
* If you would turn to some other person not listed here to talk to about a serious problem, mark the last box. If you mark the last box, please print on the line your relationship to this other person.
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Y-14.
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Now think about the one person you are most likely to talk to about a serious problem. Who would that person be? Please mark only one box for the best answer.
* If you feel there is nobody you can talk to about serious problems, mark the box with the 0 next to it.
* If you would be most likely to talk to your mother about a serious problem, mark the box with the 1 next to it.
* If you would be most likely to talk to your father, mark the box with the 2 next to it.
* If you would be most likely to talk to your boyfriend or girlfriend, mark the box with the 3 next to it.
* If you would be most likely to talk to your brother or sister, mark the box with the 4 next to it.
* If you would be most likely to talk to some other relative, mark the box with the 5 next to it.
* If you would be most likely to talk to a friend about a serious problem, mark the box with the 6 next to it.
* If you would be most likely to talk to a teacher, coach, or school counselor, mark the box with the 7 next to it.
* If you would be most likely to talk to a pastor or clergy, mark the box with the 8 next to it.
* If you would be most likely to talk to some other person not listed here about a serious problem, mark the last box. If you mark the last box, please print on the line your relationship to this other person. |
Activities
|
Y-4.
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As I read each of the following activities, please mark one box beside each activity to indicate whether you have taken part in that activity during the past 12 months. On each line, mark the box on the left for "YES" if you have taken part in that activity during the past 12 months. Mark the box on the right for "NO" if you have not taken part in that activity during the past 12 months.
* In the past 12 months, have you participated in the Boy Scouts or Girl Scouts?
* In the past 12 months, have you participated in private lessons, such as piano, dance, tennis, karate, horseback riding, etc.?
* ...In team sports, such as, football, basketball, swimming, gymnastics, etc.?
* ...In a 4-H Club?
* ...In a school band, orchestra, or choir?
* ...In school-related clubs?
* ...In student government?
* ...In volunteer activities?
* ...In a church choir?
* In the past 12 months, have you participated in some other activity not listed here? If you mark the "YES" box for this last item, please print on the line at the bottom of this list the other type of activity you participated in during the past 12 months.
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Religious
Beliefs &
Practices
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D-50.
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During the past 12 months, how often did you attend religious services? Please do not include special occasions such as weddings, christenings, funerals, or other special events in your answer. Would you say you...
* Never attended religious services
* Attended about once or twice in the past 12 months
* Attended about once or twice a month
* Attended every week
* Attended several times a week
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D-51.
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I am going to read some statements about the role that religious beliefs may play in your life. Please tell me if you strongly disagree, disagree, agree, or strongly agree with each statement.
a. My religious beliefs are a very important part of my life.
b. My religious beliefs influence how I make decisions in my life.
c. It is important that my friends share my religious beliefs.
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Prevention
Measure
|
Y-8.
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During the past 12 months, have you seen or heard any alcohol or drug prevention messages from sources outside school (for example, posters, pamphlets, radio or TV ads)?
* If you have seen or heard any alcohol or drug prevention messages from sources outside of school during the past 12 months, mark the first box.
* If you have not seen or heard any alcohol or drug prevention messages from sources outside of school during the past 12 months, mark the second box. |
SAMHSA, an agency in the Department of Health and Human Services, is the Federal
Government's lead agency for improving the quality and availability of
substance abuse prevention, addiction treatment, and mental health
services in the United States.
