Thisanonymuu!.vouthdevt!lopmuntsurvcvisbtincundiJCtC'd wirhthousandsofstudentsacrosstheStale. We w.:nl lol!!urn vuur viewson vour community,family,pers.andschoolanti boutb!!hi:lviorsliker:amblinr.,underaeedr!nkinf!.smokinQanddruguse.Youarevurvimportanttoth!!luturof NewYorkStat<!am:lyourresponses willhelpustob!!tterunderslaodhowyotJrcommunities, schoolsndfamiliescanbettersupp<myuuinbuildinllahcllhyAmlucccsslul future.
1.Thanl<you foragreeingtoPilfticiptcinthissurvl.!y.
Z.TnesurveyIscompletelyVOLUNTARY ndANONYIVIOUS.Plt.!;osc00NOTnutyournamP.nnthequestionnaire.
Youcnnverb!!identitied.l'leusl:!donul hu11y:uurcuufidcntiJI survey ""werswit·r.othr•.
:\.Tr1isinot:1test sotherearc110rightu1wruu:uiJwt:r.Wehopeyot•willfct!lfr!!'P. tQ;nw"r"x11r.tlytheWP.Vvoufeel.
4.Alloftheqestionsshot1ldbe'n$wrcdbycornplctclyfillinl:linoneoftnil';)flwer$pncas..IfyQudanotfindananswerthatfit
exactly,usetk&onethat.comesclosest.Ifanyquestiondocsnotpply10you,oryoumonotsurewhotitmeilns,just leaveit
bbnk. YoucanskiponyQuestionthillyoudunotwishIllanswer.
.Forquesticms t·hathavethefollowinlll111Swcrli:NOIno yesYES!
M11rk(theBIG)NO!ifyoulilinklh11$t;ltcmcntisOHINITElYNOTTRUEforvou.Mark(thelittle!noifyouthinIthemtcmcntisMOSTLYNOTTRUEfurvou.
Mark(thelittle)yesifyouth1nk lh<:SttcmentIsMOSTLYTRUEroryuu.DRAFT2013
MMk {tl•e DIG)YES!ifyou1l1inklhusta!cmcnt iOHII\/ITEYTRUEforyuu.
EKamplc:Chotolat<li>thbsticccreamflavor,
C) NO!()noeyes0YES!
InthetlCarnplcbovt:,lhlstvch:ntrm1rlwc.l"v"··b1!cu•hor sht!think.,l.h<!cwrr,t:r·J!ismostlytrue .
6.Pleasemarkc:mlyoneanswer toreachQI.II!Siiun bycomplotalyfillinc;intheovalwith:1112pencil.
1. Areyou:0Female
2.Howoldarcyou?
010oryounser
011
C)12
013
(,)111
015
016
017
018
C19oroldr
.Whutur;;.dcarcyouin?
c:.•Gtlt()Yth
07thc::..lOth
ClBth\.)lllh
C12th
4.AreyouHispanicorLatino?
CY!S0No
5.Pleasechoosetheresponsesbelowthat bestdescribeyou:(selectallthatapply)
OAsian American
C::·BlackorAfric;JnAmt!ric;:HI
()NativeAmericanorAlaskaNative
()NativeHawaiianorPacific!.slander
C.:)White
14. Nowthinkingbackoverthepastyearinschool,howoftendidyou:
,---··-··--·-·"·-··--·-·--···-··------··-..·--...... -..,...... -1...... ,.,..._..,,.,,,..,...... ,
. ,.,.,...,.,,
c.trytodoyourbestworlcinschool?
6.Inmy$Chool.studentsh:.velots ofchancesto
helpdecidethinnslikeclass.1ctivitiesandrules.
'?.Myteacher()noticeswhen I illlldoingogoo<J
jobilndletsmeknowclboutit.
a.Therearelatsof'han<:esforstudentsin my
schoolto etinvolvedinsp<lrt:;,c.lubs,ilndoH1cr.
schoolact1vities outsideofcia>$.,,-·,;,...,".,,,...,,
16. How importantdoyouthinkthe thingynu Jrelearning inschool:1rettoingtobP.fnryl)urlaterlife?
C!Veryhnpor1nt
·:.:)Quit!Important
:::.>r-ilirlylmpootanl
(:.;SlightlyImportant
ClNotatalllmport.arn
fli.EASE:JO NOTWRITEINnilSAREA
ocoooooaooooooooooooooao••[SERIAL]•
60/lOa6ed
l61#09S8S6881S
swsoawdto:zov10l/1Z/SO
17.Howinterestingaremostofyourcoursestoyou?(.)Veryioterestinaandstimulating
OQuiteinteresting
OFilirlyinteresting()SiillhtlydullOVerydull
18.CuringthalASTOURWEEKShowm;,nywholedaysofschool haveyoumissedbecauseyouskipp:dor"ut''?
C)None
(l
(2
03
()4-S
06-10
011ormon::
Thenektquestionsaskaboutyourfeelings
andexperience$inotherpartsof'.'ourlife.
21.Haveyoueverbelongedtoagang?
:.:JNo
C;No,butwouldliketo
:.)Yc!;,inthep;;st
C;Yes,bc:dongnow
C.'Yes.butwotJidlil<etogelout
19.Thinkofyoufrfourbestfriends(the
Number
offriend
-T·r-···-··-
pastyear(12months),howmanyof!.9.·L-4--i--l
yourbestfriendshave:1 T.
:I ,: ·!
a.smoked igilr!11les'!..)G<()I(>IC
b·;;;d·b;;:;;:;j --;h;;ij;q- -(fo ·o;;;i.'· --·,...:...t...
vodka,whiskey,orRtn)wlllmthemparenu0CJiCliUIO
---id:-.kno!- -.!:L.
...... L..J......
c.usedmarijuana?()C0
------· -----·---···..···-·· -···...... "'"'"''..._,,
d.usedlSO,cociliM, OJmphetominHs.orI
otherillcg>JIdrugs?()00010
e.beensuspendedfrom sch(..ot.l?
f.carriedahandgun'?
------·····---·-·······..·----··--..······--···-·---"'-"'"'"'"'-··-·--·-······-----
g.soldillegaldrugs?000
...------...... _...... -...-·----·····••«••••···········".·.--..------·-··--·...... -·-.,_,,,
.:..:::.:. - - .'--i - -:.: -i.::s......
=r::)J::::::::::
i.stolenortriodtost<ttllamotorv\:hiclI. ;. I
..:.. :.-=-=-:- : :-=.:...... -...... E.I :t:?!::::r:::
jbeenilrrested?!;:k:btc:1o
}j J.j?t
e.myawayfromschoolDIIdilywhentheir
p:lri:!ntsthinlcth•Y<lrt:!I chool?();::;().:=:
...... •••••••u•••-••.0••••-•••N•o•--•••••••• n""'"0 ol 0 1f1 0 0 ··-·-·-··-,.------....-->;'<"''"'' --·••'"'"'-
f.drink beer.wineurl_ldn.lltquor(forP-xnmr>IP,1
voclkil,\<:y,or)lilt}reP,ul;trlyIjOIOOi()
:·-;--i;e-;ts?.···------...... ------·...... 1ct:;rc;c;
60/(0 a6edl6lil09S8S6881S
h.s;·k!!ntiltij:;--..-----·-----...... -...... j':::J:·1 :;t:;
-""""'''• ,lo '"'"''"''-'""'"'"'"',..,-·N-·-----·-•w·•""''""'-'"*'>""'"'''"'""'"-•··--·-·t-:'1 ': :+::..i.US!:!LSD,wenine,:.mphetumincsorI'I I lanoth!!rill .aldrug? !C:1·:·,;('.Jk."Y
'.,,,.,.....·-···. ,>B o..>rio...o•>• ...... , """"""'"""""'...... -·-"" ,.,...... ,.. ,,...... 1••--.l'- ··'"'"V
•••••
swsnowdJo:tovlOl/ll/SO
Duringthepast30days.onhowmanyoccasions(ifonvlha11eyou:
24.hadbeer,wineorhardliquorlodrink?
30.takenanon-prescriptionc.ouehorcoldmedicine(robos.DXM,etc.)togethigh?
(No·Doz,Vivarinl.ordi:tpills(svchJSOexatrim), orenerp,ydrinkswithhigh
(RedBull.FullThrottle,Monster.Roclmar),orsrnall"shots"such ;JS
32.usedphenoxydine(pox,px,breeze)i'
34.usedcocaineorcrclc?
35.sniffedglue,bn<Qthedthecontcmtsofanaerosolspravcan,orinhaledolherg<Jscsorsprays,inordertogethieh?
36.takanheroinorothar opitlh!S?
37.usedMOMA('X','E',oremasv)?
!.t!.Y!J':'.lifutirne,unhowmanyoccasions(ifanvlhavP.ynu--- '5:::;:···\
'\,,/,/.:.A.;:,.,X._bo;\,
33.hadakut-JIicbeverages(beer,wineorh;n:lliqu9r) todrinl<r(A"drink"isi.lGiassofwine,bottleofl·Ij
beer,()Wine tooler,ashotelau,ofhquor,Of i)miXeddrmk.)')0!
••
09S8S6881SSWSOG
[SERIAL]
•••
52.Thinkbackoverthelasttwoweeks.Howmanytimeshaveyouhadfiveormorealcoholicdrinksinarow?(A"drink"is3glassofwine,abottleofbeer,awinecooler,ashotglassofliquor,or3mixeddrink.)
ONoneOOnceDTwice
C}3·5times
C)6·9times
C)10ormoretimes
Sit Hl'IVAynuP.VAruPd mokAIIi!t.nbacco(r.hPw,
.nufl,pluft,dippingtobatco,or Mwingtob;w:o)?
ONever
0Onceortwice
OOncein.,whileblitnotregulrly
0Regul<lrlyinthepast
C!Recul:arlvnow
54. HowofhmhcveyouusedsmoktlvsstobDCCQ
duringthepas30days?
ONotatall
()Onceortwice
c::;ooceortwiceperweekOThree tofivetimesperweekOAbOutonceaday
0MorethilnonceadJy
SS.Hoveyouever'mokedcigarettes?
ONever
COnceortwice
C:Onceinawhilt!bulnolregulnrly
C)Retularlyinthepast
C)lh!Hularlvnow
56.Howfrequentlyha"cyousmol!cdcig;:rettesduringthepa!>t30days?
C)NOtiltall
(:JLessthanoncigaretteperdilyDOnetofivciearettesperdv()About one·holfp.:c:kperdayC)Aboutonepi.lckperdty
()Aboutonu:.ndQnu·hlllfpacl\sperday
0Twopacksorrnoreperday
57.Ifyoudrankalcohol(notjustasiportastE")inthepastyear,howdidyouusually3etit?
(Selectoilapply,I
C:JIdidnotdrinkalcoholinthepi!:>lyear
01gotitrromhomewithoutmypllr nts'pt'rmissionDl outllfrQrnhomt•withmyparents'permissionCiii!Ot itfrommybrotht.lrorsister
01gotitfromanothrrelative
()Iboughtitmyself withaf;:ke10
Cllboup,htItmyself withoutafakeID
(..IIcotitfmmsomeonellmowage21orolder
01ROlitfrom .OmPOMIkMW ll!lderace.21
CIAlitrnngNhn11ehrirtorme
01tonkittrnmnstoreorshop
0I(lOtit!lt worl(
01boughtItovnrlheInternet
OOther
09S9S6891S
58.Ifyoudrankalcohol(no( junasiportaste)inthe
pastyear,wheredidyoudrinkit7
(Selectallthal apply.)
0atmyhome
C>atsomeoneelse'shome
()atanopen01rJlikeap;:)rk.beach.field,baclroad,
woods,or1 street corru:r
C1 ata5portinp:event orconcert
C) ot.., rt!st<urnnt,bar,oraniKhtclub
Cl <J!ancmplybuildinp,orconstruction.ilt
.;· : ntaliult!l/rnotcl
':.;:. in1 c:ar
.;,.::- atschool
CJ in·unutht•r plu<:l;!
59.WhenparentsfindQUttheirkidshavebeendrinkinctheym:aydiscussit,takeawilyprivileges,addchores,takaawayc4tllphc:mes, uscofthecar,etc.Inthepast
12months,Ifyour porentsfound outyouweredrinkins,
howdidtheyrespond?
C)Idon'tdrink
0Iwasnot C1lU!lht
()Noconsequenr.es
C:JMinorconsequences
c::·,MrJjorconsequences
60.Ifthepolleetilught youdrinking,whichofthefollowing
wouldmostlikelyhappen?(Sr:lec:temCi(llion).
C1Nownsequentl:!
(.-:;CiiveaWMning;Jndletme(lO
0T:kernehometomvp;mmts
•.::·,, I wouldbeilrre5ledbutnopenalties
<:>Iwn1rldhe:rrestedul1dfinedbythe::court
••••••l107d
swsnowdzo:zoIOl/ll/SO
62.Duringthepost30days,how mohytimesdidyou
driveillc01roroth1.1rvehiclewhenyouhildbeen
drinkins<:h;ohol?
Citdonoldrive()0timesOltime
02or3times
\.:)<'1orStimes
06ormoretim11s
0Never
C)Rorcly
1·2T!rncsilMunth
Ab;ulOnc.:cWcelorMor
65.Ourlncthe past12months,h<vcyoutalkedwith:Jtlnstone ofyourparents tbc:zvtthe d;;mgersofunderagedrinking?(/Jyparenr..we mr:11;mehhr:ryourbiuluuico/r;iC:uenrs,arlopriveparanrs,Stt!pparcnts,faster
parents,orulht:!rodultcaregiverswhetherornultheylive
withyou.)
ONoOYes
66.Duringthe past 12months,hnvcyouseenanyprevention messagesInyour schoolorcommunity?[Pieilsemarieallthatapply)
C'
ewes,smol<ingpreventionmcl>Jf.lC!inthrncdi
(l·t!lcvision,radio,newspaper,posters, trc.).
C)Ves,alcohol usepreventionmt,,SS•I!lCSinIllrmdi;J
trelevisiM,radio.nr:!wpaptu,pu5U!rs,etc.)
OYn.nt.tu•r urucUC!prcvcnti<)nfll!::SilllSinlhrmrrli:l
(retevision,radio,ncwspupe1,puslt!r..P.tc.)
::)Yes,earnblingprcv:nliunrnl!ssagesinthemedia
(tr!levision,radio,nr!wspapt!r,pn.sters,arc.)
ONo
68.Howwren!(dovaurparents
feelitwouldbeforYOUto:
69. HowwronRdoyourfriendstealitwouldbeforYOUto:
70.Howdoyou feelaboutsomeoneyouragehavingone or
lwodrinksofanalcoholicbeverilgenearly every day?
C.'Ncithor<lpprovenordisapprovt>ClSomcwlwtuiapproveCJSVu11glydiapflroVt:!DOou'lknuworr.:n•rsay
PLCASlDONOrWflllf.INHilSARE/I
ooooooooaooooooooooooooo
60/90361!dl6Jj09S8H88!S
[SERIAL]
••••
S"SOG
73.Durint:thepast12months,haveyoutalked withatleastoneofyourparentsaboutthedangersofdrinkin(tunddrivinc?
<.:::.!VI'.
7.,.MyparmtsnoticewhenI;rmdoina JcoodjobandltmeknQwaboutit.
()Nt::verorAlmostNever
OSometimcs
OOften
CAllthetime
60/LOa6edl61#09S8S6881Sswsaawd£o:zotOZ/IZ/SO
116. You're inastorewithllfriend.Youlook upandsee
her'liP an ih1munderher ;oat.Shesmilesandsays
''Whl(honedoyouwilnt'?Goahead,takeitwhilenobody'saround."'!'here Isnobodyinsight,no
empiQyee$ndnoother<:ustomen.What would you
donow?
0Ignoreher
d.4·Hclubs()No
.e...... YMCA..,..o....t..h.-·e-·r···c··..o...m_.m...,..u.....n....i.t..y.....c....e..nte..r...s.ONo()Ye_s
('lSay"Excusl:!mt!"'andkeeponwalking
c::.Say"W;trchwhl!reyouoregointf'ondkeponwalkinp,
0Swearatthtpersonndwalkaway
118. It's8:00 onaweoknightand youareabouttogoover
..._.-.
f.serviceclubs
.
toafriend'shomewhenyour motherasl<syouwhereyouaresoing.Youny"Oh,justgoin.ctoflOhangoutwith somrtiends."Shesays,"No,you'llJustget intotroubleifyougoout.Stayhome tonight."What would
lOB.1ralddsrnokcdrnarijuanilinyour"- ]-.-.;
nClighborhoodwould ht:or:
5hcbet;wght bytht! police?C::.liC)1,::;jC.\
-·----·--·---- ·---·-··...... ------·-·-·-·...... -·..•"'""f""":...... ,
youdonow?
C>Lt!awthehouseanyway
r.
109.1fakiddranksomebl!t:r,wineorh<ndliquor j i 1
CH)tplninwhat youare
oingtodowithyourfriends,tell
(for1.-!Xrnple,vorlk.whisl<cy, orfllt1)1r1your
neighborhoOdwouldheorSllc>becaunhtby
j'herwhenyouwillr.ct 1omo•..,,.,()a$kifyoucanguou\
; ;.;;;, --rind·;:,;;..,·,·:,··,.',·F1 ) ::'1: -
CiNot.;ay ;JnythinP,undstart Wlt.:hlll!!IV
.::::l(i!lintoJll<lreurncntwithhli!l
ncighborhoodwouldh..-or1
shebecaughtbythP.polic.:e?."'!._),::)C
+o+w--...-.>«>•---·-·-··----w w ·- 0! ··-n 0'1"'<'0... !.•••!--•••-••-•
PLEASE00NOTWll"fEINTHISAH£A
ooooooooaooaoooocooocooo
60/90a61ldZ61JJ098H881
[SERIAL]
••••,l;'?T'•
SI1SOIJ
119.VouareataptJrtyatsomeone'shouse,andon..-ofyourfriendsoffersyouodrinkcontaining alcohol.Whatwouldyousayordo?
r.::>OrinI it
OTellyourfriend,"Nothanks,Idon'tdfink"andsuesestthatyouilndyourfriendgoOJnddosomethineelse
()Just 31ly, "Nothanks"andwalk<Jwny
OMakeupi)goodexcuse,111your friandyouhad
omtlhinelsetorJo,.1ndlevc
."----"···-..-,.,...... ··n•..oo•M••-•' """'""""''<-''''
ADDITIONALQUESTIONS
.---··"''""''·--··--·-,·····... -······-······-··...
122. Gi,(ji(;;
123. OS>@(,';)
124. r:1r1:..:(\;:'\tiJCl'(t)(i,\)((i,'l
125. ("J(\f:()\!.!}CP(f)(/,ll(,fC;
126. .. , (l\'(¢)(TJ}(li>(1':;·j'£1!fD
127. ;.:'>!ii.>e;·)
r,t;';l<!(I)·:.p((I)
128. wf)])(f.)\,l)):l';.l<E'}j•:!('•
lll.Howhoneatwereyouinfillingoutthissurvey?
01 w0:1s veryhonest
()Iwahonestprettyrnuhofth..:time
r:;'JIwashonestsome>otthelimt!
(")Iwohonest onr.P.inawhile
t)I wa5nothonPt;uall
l6I#0958568815
Thankyuufurcompletlncth!l urvt'!y.
•••••••
SS:JGwdEo:zovlOZ/IZ/50