(Project Name / Activity Name)

Pre-activity evaluation questionnaire

Participant no.:______

1. If your friends give you the following drugs for use, will you find it difficult to refuse?
（Please circle the best answer）
Very difficult
to refuse / Quite difficult
to refuse / Don’t know / Quite easy
to refuse / Very easy
to refuse
  1. Cannabis / Marijuana / Grass
/ 1 / 2 / 3 / 4 / 5
  1. Heroin / White Powder
/ 1 / 2 / 3 / 4 / 5
  1. Ecstasy / E / XTC
/ 1 / 2 / 3 / 4 / 5
  1. Ketamine / K / K Zai
/ 1 / 2 / 3 / 4 / 5
  1. Ice
/ 1 / 2 / 3 / 4 / 5
  1. MX / Methaqualone
/ 1 / 2 / 3 / 4 / 5
  1. Ng Chai / Give-me-five, Blue Gremlin
/ 1 / 2 / 3 / 4 / 5
2. If your friends give you the following drugs for use, what will you do？
（Please circle the best answer）
I will definitely refuse it / I will probably refuse it / Don’t know / I will probably receive it / I will definitely receive it
  1. Cannabis / Marijuana / Grass
/ 1 / 2 / 3 / 4 / 5
  1. Heroin / White Powder
/ 1 / 2 / 3 / 4 / 5
  1. Ecstasy / E / XTC
/ 1 / 2 / 3 / 4 / 5
  1. Ketamine / K / K Zai
/ 1 / 2 / 3 / 4 / 5
  1. Ice
/ 1 / 2 / 3 / 4 / 5
  1. MX / Methaqualone
/ 1 / 2 / 3 / 4 / 5
  1. Ng Chai / Give-me-five, Blue Gremlin
/ 1 / 2 / 3 / 4 / 5

Gender:1□ Male2□ Female

Age: years old

Have you joined any of the following activities: (select all that apply)

1□Please list other activities in the programme2□Please list other activities in the programme

3□Please list other activities in the programme4□Please list other activities in the programme

5□Please list other activities in the programme6□Please list other activities in the programme

~ Thank you ~

Beat Drugs Fund Evaluation Question Set No. 4 (Self efficacy to refuse drug use)(2010 Second Round)

Adopted from Evaluation Questionnaire of Project Astro Mind

Permission to use was granted by the Prof. Daniel Shek of Hong KongPolytechnicUniversity

(Project Name / Activity Name)

Post-activity evaluation questionnaire

Participant no.: ______

1. If your friends give you the following drugs for use, will you find it difficult to refuse?
（Please circle the best answer）
Very difficult
to refuse / Quite difficult
to refuse / Don’t know / Quite easy
to refuse / Very easy
to refuse
  1. Cannabis / Marijuana / Grass
/ 1 / 2 / 3 / 4 / 5
  1. Heroin / White Powder
/ 1 / 2 / 3 / 4 / 5
  1. Ecstasy / E / XTC
/ 1 / 2 / 3 / 4 / 5
  1. Ketamine / K / K Zai
/ 1 / 2 / 3 / 4 / 5
  1. Ice
/ 1 / 2 / 3 / 4 / 5
  1. MX / Methaqualone
/ 1 / 2 / 3 / 4 / 5
  1. Ng Chai / Give-me-five, Blue Gremlin
/ 1 / 2 / 3 / 4 / 5
2. If your friends give you the following drugs for use, what will you do？
（Please circle the best answer）
I will definitely refuse it / I will probably refuse it / Don’t know / I will probably receive it / I will definitely receive it
  1. Cannabis / Marijuana / Grass
/ 1 / 2 / 3 / 4 / 5
  1. Heroin / White Powder
/ 1 / 2 / 3 / 4 / 5
  1. Ecstasy / E / XTC
/ 1 / 2 / 3 / 4 / 5
  1. Ketamine / K / K Zai
/ 1 / 2 / 3 / 4 / 5
  1. Ice
/ 1 / 2 / 3 / 4 / 5
  1. MX / Methaqualone
/ 1 / 2 / 3 / 4 / 5
  1. Ng Chai / Give-me-five, Blue Gremlin
/ 1 / 2 / 3 / 4 / 5

Gender:1□ Male2□ Female

Age: years old

Have you joined any of the following activities: (select all that apply)

1□Please list other activities in the programme2□Please list other activities in the programme

3□Please list other activities in the programme4□Please list other activities in the programme

5□Please list other activities in the programme6□Please list other activities in the programme

~ Thank you ~

Beat Drugs Fund Evaluation Question Set No. 4 (Self efficacy to refuse drug use)(2010 Second Round)

Adopted from Evaluation Questionnaire of Project Astro Mind

Permission to use was granted by the Prof. Daniel Shek of Hong KongPolytechnicUniversity