New Mexico Community Survey 2017
Core module Codebook-paper
Site ID:___ SITE
Location:______LOCATION
Surveyor Initials:___ INITIALS
Survey #:__ PID
Survey language: ENGLISH (English=1 Spanish=0)
1. How old are you? CR1
118 to 20 221 to 25
326 to 30 431 to 40
541 to 50 651 to 60
761 to 70 871 or older
2. Are you: CR2
0 Male 1 Female
999 I choose not to identify
3. How long have you lived in New Mexico? CR3
1 Less than 1 year
2 1 – 5 years
3 More than 5 years
888 I don’t live in NM
4. Which one or more of the following would you say is your race or ethnicity? (Check all that apply.) For each item enter 1 if selected. If not selected, leave it blank.
CR4_1 White
CR4_2 Hispanic or Latino
CR4_3 Black or African American
CR4_4 American Indian
CR4_5 Native Hawaiian or Other Pacific Islander
CR4_6 Asian
CR4_7 Alaska Native
CR4_8 Other
[Please write in your race/ethnicity] CR4oth___
5. Are you on active duty in the U.S. Armed Forces, military Reserves, or National Guard or a veteran of the U.S. Armed Forces? CR5
1 Yes 0 No
6. Are you currently an undergraduate in college? CR6
1 Yes 0 No (go to question 8)
7. What college/university do you currently attend?
CR7______
8. What is the highest grade or year of school you completed to date? CR8
1 Less than high school
2 High school graduate or GED
3 Some college or technical school
4 College graduate, graduate or professional school graduate
9. Do you identify as Lesbian, Gay, Bisexual, Transgender, Queer, or Questioning? CR9
1 Yes 0 No
10. What is your zip code? CR10______(for geographic sorting purposes only)
11. Are you a parent or caretaker of someone under 21 currently living in your household? CR11
1 Yes 0 No
12. For the past 30 days, have you had a permanent and stable place to live? CR12
1 Yes 0 No
Perceptions of the community
13. How easy do you think it is for teens in your community to get alcohol? CR13
1 Very easy 4 Very difficult
2 Somewhat easy 999 Don’t know
3 Somewhat difficult
14. How easy do you think it is for teens in your community to get alcohol from stores and restaurants? CR14
1 Very easy 4 Very difficult
2 Somewhat easy 999 Don’t know
3 Somewhat difficult
15. In your opinion, how likely are police in your community to break up parties where teens are drinking? CR15
1 Very likely 4 Not at all likely
2 Somewhat likely 999 Don’t know
3 Not very likely
16. How likely are police in your community to arrest an adult for giving alcohol to someone under 21? CR16
1 Very likely 4 Not at all likely
2 Somewhat likely 999 Don’t know
3 Not very likely
17. In your opinion, if someone was caught selling alcohol to a drunk or intoxicated person in your community, how likely is it that he/she would be arrested? CR17
1 Very likely 4 Not at all likely
2 Somewhat likely 999 Don’t know
3 Not very likely
18. In your opinion, if you were driving after you had too much to drink, how likely is it you would be stopped by police? CR18
1 Very likely 4 Not at all likely
2 Somewhat likely 999 Don’t know
3 Not very likely
19. If you were driving after you had too much to drink and were stopped and charged with DWI, how likely is it you would be convicted? CR19
1 Very likely 4 Not at all likely
2 Somewhat likely 999 Don’t know
3 Not very likely
Alcohol
20. In general, how many alcoholic drinks do you typically consume in a week (including weekends)? CR20
0 None ____ Drinks a week (1 or more)
21. Think specifically about the past 30 days. During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage (if any)? CR21
0 0 days
1 1 or 2 days
2 3 to 5 days
3 6 to 9 days
4 10 to 19 days
5 20 to 29 days
6 All 30 days
22. Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks on an occasion (if any)? CR22
0 None ____ Times in past 30 days
23. During the past 30 days, how many times have you driven when you’ve had perhaps too much to drink? CR23
0 None __ Times in past 30 days
24. During the past 30 days, have you driven a vehicle after drinking 5 or more alcoholic beverages? CR24
1 Yes 0 No
25. If you are 18 to 20 years old, please answer this question: During the past 30 days, how did you get your alcohol? (Check all that apply.) For each item enter 1 if selected. If not selected, leave it blank.
I have not drunk alcohol in the past 30 days. CR25_1
Adult family member who is 21 or older gave it or bought it for me. CR25_2
Someone not related to me who is 21 or older gave it or bought it for me. CR25_3
I got it at a party. CR25_4
My parent or guardian gave it or bought it for me. CR25_5
I took it from my home or someone else’s home. CR25_6
I bought it at a store, restaurant, bar or public place CR25_7
Someone under age 21 bought or gave it to me. CR25_8
I got it some other way. CR25_9
[Please describe]: CR25oth______
26. In your opinion, when is it okay for someone to provide alcohol to minors (i.e., under 21) (not for religious purposes). Check all that apply. For each item enter 1 if selected. If not selected, leave it blank.
If parents give their permission CR26_1
If they are supervised by an adult CR26_2
If they are drinking at home CR26_3
If they are responsible (mature for their age, a good student, etc.)CR26_4
If there is a celebration (e.g., wedding, quinceañera, graduation) CR26_5
As long as they are not driving and are safe CR26_6
If they are in the military CR26_7
Other CR26_8
[Please describe]:CR26oth______
Never CR26_9
27. In the past year, have you purchased or otherwise provided alcohol (beer, wine, liquor) for someone under 21, even if it was for your own child? (not including alcohol used for religious purposes) CR27
1 Yes 0 No 999 Don’t know
Rx painkillers
28. In the past year, were you prescribed painkillers by a medical professional (even if you did not take them)? CR28
1 Yes 0 No (if no, go to question 32.)
29. When you were prescribed painkillers, were you also prescribed naloxone or Narcan, at the same time? CR29
1 Yes 0 No 999 I don’t know
30. When you were prescribed painkillers, did anyone talk to you about the risks involved in using them? (check all the apply) For each item enter 1 if selected. If not selected, leave it blank.
Health care provider CR30_1
Pharmacy Staff CR30_2
No one talked with me CR30_3
Not sure CR30_4
31. When you were prescribed painkillers, did anyone talk to you about storing them safely? (check all the apply) For each item enter 1 if selected. If not selected, leave it blank.
Health care provider CR31_1
Pharmacy Staff CR31_2
No one talked with me CR31_3
Not sure CR31_4
32. How much do you think people risk harming themselves (physically or in other ways) using prescription painkillers for a non-medical reason? CR32
1No risk
2Slight risk
3Moderate risk
4Great risk
33. In the last 30 days, did you use prescription pain- killers for any reason (even if you were not prescribed them)? CR33
1 Yes 0 No – If you answer no, please skip to question 39
34. During the past 30 days, how many times did you use a painkiller to get high, like Vicodin, OxyContin (also called Oxy or OC), or Percocet (also called Percs)? CR34
00 times 310 to 19 times
11 or 2 times 420 to 39 times
23 to 9 times 540 or more times
35. If you used a painkiller or other opioid to get high, did you have access to naloxone or Narcan? CR35
1 Yes 0 No
36. If you’ve taken prescription painkillers in the last 30 days, on how many days did you take them? CR36
____ days in the last 30 days (1-30)
37. If you took painkillers in the last 30 days, why did you take them? (Check all that apply.) For each item enter 1 if selected. If not selected, leave it blank.
To treat pain that my doctor or dentist identified (for example, injury, surgery, tooth extraction, illness) CR37_1
For pain not identified by my physician (e.g., minor injury) CR37_2
To have fun with a friend or friend(s) socially CR37_3
To help me sleep CR37_4
To get high, messed up or stoned CR37_5
To cope with anxiety or stress CR37_6
Another reason CR37_7 [Please describe]:
CR37oth______
38. If you used painkillers in the last 30 days for any reason, where did you get them? (Check all that apply.) For each item enter 1 if selected. If not selected, leave it blank.
A doctor or doctors prescribed or gave them to me CR38_1
A family member shared them CR38_2
A friend shared them CR38_3
They were bought from somebody (e.g., friend, dealer, family member) CR38_4
They were taken from someone (including friends or relatives) without asking CR38_5
Other place (e.g., Mexico, internet) CR38_6
[Please describe]: CR38oth______
39. In the past year, have you given or otherwise shared any prescription drugs with someone that was not prescribed them (even if that person was a close friend or family member)? CR39
1 Yes 0 No
40. Are all your prescription painkillers stored in a locked cabinet or box so that others cannot get to them (including youth and family)? CR40
1 Yes 0 No
888 I do not have any prescription painkillers
Media campaigns
41. The following is a list of different drug prevention media campaigns. Please check the box next to those you recognize or have heard of: For each item enter 1 if selected. If not selected, leave it blank.
Suck It Up! CR41_1
Good Drugs Gone Bad CR41_2
Parents Who Host Lose the Most CR41_3
A Dose of Rxeality CR41_4
Up and Away and Out of Sight CR41_5
Wake Up Now CR41_6
I’ve never heard of any of these. CR41_7
42. What do you think is the main prevention message of the campaign “A Dose of Rxeality”? Check only one option. CR42
1 Stay in school if you want to be successful.
2 Prescription drugs can be dangerous if not used as intended.
3 Reality is harsh, but medication can help.
4 Daily exercise is good for your health.
5 Take your medication as directed by your doctor.
6 Vaccinate your kids.
43. Is there anything else you’d like to tell us or add about the issues we have asked about today? [Please write your comments in the box below.] CR43
New Mexico Community Survey 2017 Page 3 of 4