OMB protocol ###### approved 08/01/08, Exp. 08/01/09
Evaluation of Young Marines Drug Education Program
Youth Questionnaire
This is a questionnaire on drug use, attitudes, and knowledge for a study on the helpfulness of the drug education activities in the Young Marines organization. Your parent provided his or her permission for you to be involved in the study.
Please remember that your answers will be kept private. Your survey will not go to your unit leaders or anyone in the Young Marines, or to your parents. Your survey will only go to the researchers at the Naval Health Research Center.
DO NOT write your name anywhere on the survey. Instead, follow the directions on the next page to create your own survey code.
You may skip any question that you do not want to answer. Also, you are free to stop at any time before finishing the questionnaire.
NOW IT IS YOUR TURN TO DECIDE IF YOU WANT TO PARTICIPATE. EVEN THOUGH YOUR PARENT AGREED TO ALLOW YOU TO PARTICIPATE, IT IS YOUR DECISION. Filling out this questionnaire is voluntary. If you decide not to fill out the questionnaire, please sit quietly during the time that others are filling out their surveys. Then, turn in your blank survey. Since there is a cover page on this survey, other people will not be able to see if you have filled yours out or not.
If you decide to take the questionnaire, please turn the page and begin.
Agency Disclosure Statement of Burden
"The public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division 1155 Defense Pentagon, Washington, DC 20301-1155 (XXXX-XXXX)[Insert OMB Control Number]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.”
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This study is being conducted by the Naval Health Research Center Behavioral Science and Epidemiology Program 140 Sylvester Road San Diego, CA 92106 |
NHRC.2007.0029 IRB approved 07/02/08, Exp. 07/01/09
T HIS SURVEY SHOULD ONLY BE COMPLETED BY
A YOUNG MARINE IN COMPLETE PRIVACY.
Instructions:
You may use a pen or a pencil.
Please answer every question as honestly as possible and to the best of your ability (but you may skip any question that you do not want to answer).
Please read the questions very carefully. Raise your hand if you have a question about the survey.
Only circle one answer for each question unless it says to circle all that apply.
Please make a circle around the number next to your answer.
Example:
What grade are you in?
1. Grade 6
2 . Grade 7
3. Grade 8
4. Grade 9 (Freshman)
5. Grade 10 (Sophomore)
6. Grade 11 (Junior)
7. Grade 12 (Senior)
These first few questions are to help you make a personal code for your survey:
Please circle the FIRST letter of YOUR MIDDLE name. (Please use your official middle name, not a nickname. If you do not have a middle name, please circle “Z.”)
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
What month were you born in?
January May September
February June October
March July November
April August December
Were you born in any of these EVEN-numbered years?
1988 1990 1992 1994 1996 1998 Yes____ No____
Are you male or female? Male Female
Please circle the FIRST letter of your MOTHER’s FIRST NAME? (Mother means the person you call mother, this could be your natural or adoptive mother.)
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
The following questions ask for some background information about yourself.
1. How old are you?
10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years or older
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5. What grade are you in?
G rade 6 Grade 7 Grade 8 Grade 9 (Freshman) Grade 10 (Sophomore) Grade 11 (Junior) G rade 12 (Senior)
6. What is your sex?
Male Female
7. What Young Marine Unit do you belong to?
___________________________________________
8. What rank are you in the Young Marines?
Y oung Marine Recruit Young Marine Private (YM/PVT) Young Marine Private First Class (YM/PFC) Young Marine Lance Corporal (YM/LCPL) Young Marine Corporal (YM/CPL) Young Marine Sergeant (YM/SGT) Young Marine Staff Sergeant (YM/SSGT) Young Marine Gunnery Sergeant (YM/GYSGT) Young Marine Master Sergeant (YM/MSGT) Young Marine Master Gunnery Sergeant (YM/MGYSGT) Young Marine First Sergeant (YM/1stSGT) Young Marine Sergeant Major (YM/GYSGT) Other/ Don’t Know
9. Are one or more of your parents (or legal guardians) actively involved in the leadership of your Young Marine Unit?
Yes No
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2a. What is your ethnicity?
Hispanic or Latino Not Hispanic or Latino
2b. What is your race? (Mark one or more)
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
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3. How long have you been in the Young Marines?
I am new and I haven’t started the orientation/boot camp yet I am currently in orientation/boot camp About 6 months About 1 year About 2 years Longer than 2 years
4. Do you have any brothers or sisters that are members of the Young Marines Program?
Y es No Not Sure Not applicable- I do not have any brothers or sisters |
The next two questions ask about your parents. (If you were raised mostly by foster parents, step-parents, or others, answer for them. For example, if you have both a step-father and a natural father, answer for the one that was most important in raising you.)
10. What is the highest level of schooling your father completed? C ompleted grade school or less Some high school Completed high school Some college Completed college Graduate or professional school after college Don’t know, or does not apply
11. What is the highest level of schooling your mother completed? C ompleted grade school or less Some high school Completed high school Some college Completed college Graduate or professional school after college Don’t know, or does not apply
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13. Which of the following people live in the same household with you? (Mark all that apply.) I live alone Father (or male guardian) Mother (or female guardian) Brother(s) and/or sister(s) Grandparent(s) Other relative(s) __________________ (fill-in) Non-relative(s)
14. Compared with others your age throughout the country, how do you rate yourself on school ability? F ar below average Below average Slightly below average Average Slightly above average Above average Far above average
15. W hich of the following best describes your average grades? A (93-100%) A- (90-92%) B+ (87-89%) B (83-86%) B- (80-82%) C+ (77-79%) C (73-76%) C- (70-72%) D (69% or below) |
12. Where did you mostly grow up? O n a farm I n the country (but not on a farm) I n a small city or town I n a medium-sized city (or suburb of a medium-sized city) I n a large city (or suburb of a large city) I n a very large city (or suburb of a very large city)
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16. Which of the following activities do you participate in? (Mark all that apply) |
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R OTC Scouting (Boy Scouts or Girl Scouts) Sports |
C hoir or Band After-school job Other __________________ (fill-in) |
17. Have you ever smoked cigarettes?
N ever – GO TO QUESTION 19. Once or twice Occasionally but not regularly Regularly in the past Regularly now
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19. Have you ever taken or used smokeless tobacco (snuff, plug, dipping tobacco, chewing tobacco)? N ever- GO TO QUESTION 21. Once or twice Occasionally, but not regularly Regularly in the past Regularly now
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18. During the past 30 days, about how many cigarettes have you smoked per day? N one at all Less than one cigarette per day One to five cigarettes per day About one-half pack per day About one pack per day About one and one-half packs per day Two packs or more per day
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20. How frequently have you taken or used smokeless tobacco during the past 30 days? N one at all Once or twice Once or twice per week Three to five times per week About once a day More than once a day
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Next we want to ask you about drinking alcoholic beverages, including beer, wine, wine coolers, liquor, and any other beverage that contains alcohol.
21. Have you ever had any alcoholic beverage to drink (more than just a few sips)?
No- GO TO QUESTION 27.
Yes
22. On how many occasions have you had alcoholic beverages to drink-more than just a few sips?
Please mark one circle for “in your lifetime” and mark another circle for “during the last 30 days.”
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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23. On how many occasions (if any) have you been drunk or very high from drinking alcoholic beverages?
Please mark one circle for “in your lifetime” and mark another circle for “during the last 30 days.”
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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24. On a typical day when you drank alcohol during the last 30 days, how many drinks did you have? (A “drink” is a bottle of beer, a glass of wine, a wine cooler, a shot glass of liquor, a mixed drink, etc.) 0 , I did not drink in the last 30 days 1 drink per day 2 drinks per day 3 drinks per day 4 drinks per day 5 drinks per day 6 drinks per day 7 drinks per day 8 drinks per day 9 drinks per day 10 drinks per day More than 10 drinks per day
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25. During the LAST 12 MONTHS, on how many occasions (if any) have you drunk flavored alcoholic beverages, sometimes called “alcopops” (like Mike’s Hard Lemonade, Skyy Blue, Smirnoff Ice, Zima)? (Do not include regular liquor, beer, wine, or wine coolers.) 0 occasions 1-2 occasions 3-5 occasions 6-9 occasions 10-19 occasions 20-39 occasions 40 or more occasions
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26. Think back over the LAST TWO WEEKS. How many times have you had five or more drinks in a row? (A “drink” is a bottle of beer, a glass of wine, a wine cooler, a shot glass of liquor, a mixed drink, etc.) N one O nce or twice in the last two weeks 3 to 5 times in the last two weeks 6 to 9 times in the last two weeks 1 0 or more times in the last two weeks |
This next section of the questionnaire deals with various other drugs. We hope that you can answer all the questions; but if you find one which you feel you cannot answer honestly, please leave it blank. Remember that your answers will be kept strictly confidential; they are never connected with your name.
Please mark one circle for “in your lifetime” and mark another circle for “during the last 30 days.”
27. On how many occasions (if any) have you used marijuana (weed, pot) or hashish (hash, hash oil)…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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28. On how many occasions (if any) have you used LSD (“acid, windowpane, blotter, microdot”)…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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29. On how many occasions (if any) have you used hallucinogens other than LSD …
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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30. On how many occasions (if any) have you used cocaine (sometimes called “coke, crack, rock”) …
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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31. Amphetamines have been prescribed by doctors to help people lose weight or to give people more energy. They are sometimes called uppers, ups, speed, bennies, dexies, pep pills, and diet pills. Drugstores are not supposed to sell them without a prescription from a doctor. Amphetamines do NOT include any non-prescription drugs, such as over the counter diet pills (like Dexatrim®) or stay-awake pills (like No-Doz®), or any mail-order drugs.
On how many occasions (if any) have you taken amphetamines on your own -that is, without a doctor telling you to take them…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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32. On how many occasions (if any) have you used methamphetamine (“meth, speed, crank, crystal meth”) by any method…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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33. On how many occasions (if any) have you smoked (or inhaled the fumes of) crystal meth (“ice”)…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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34. Sedatives, including barbiturates, are sometimes prescribed by doctors to help people relax or get to sleep. They are sometimes called downs or downers, and include Phenobarbital, Tuinal, Nembutal, and Seconal.
On how many occasions (if any) have you taken sedatives on your own -that is, without a doctor telling you to take them…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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35. Tranquilizers are sometimes prescribed by doctors to calm people down, quiet their nerves, or relax their muscles. Librium, Valium, and Xanax are all tranquilizers.
On how many occasions (if any) have you taken tranquilizers on your own -that is, without a doctor telling you to take them…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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36. There are a number of narcotics other than heroin, such as methadone (“fizzies, dollies”), opium, morphine (“M, Miss Emma, Mister Blue, Morph”), codeine (“school boy”), Demerol, Vicodin, OxyContin, and Percocet. These are sometimes prescribed by doctors.
On how many occasions (if any) have you taken narcotics other than heroin on your own-that is, without a doctor telling you to take them…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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37. On how many occasions (if any) have you sniffed glue, or breathed the contents of aerosol spray cans, or inhaled any other gases or sprays in order to get high…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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38. Steroids, or anabolic steroids, are sometimes prescribed by doctors to promote healing from certain types of injuries. Some athletes, and others, have used them to try to increase muscle developments.
On how many occasions (if any) have you taken steroids on your own -that is, without a doctor telling you to take them…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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39. On how many occasions (if any) have you used MDMA (“ecstasy”)…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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40. Some types of diet pills (also called appetite suppressants) can be sold legally without a doctor’s prescription by drugstores, through the mail, etc. These non-prescription “over-the-counter” drugs include Dexatrim®, Dietac, and others.
On how many occasions (if any) have you taken such non-prescription diet pills…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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41. Some stay-awake pills can be sold legally without a doctor’s prescription by drugstores, through the mail, etc. These non-prescription or “over-the-counter” drugs include No-Doz®, Vivarin, Wake, Caffedrine, and others.
On how many occasions (if any) have you taken such non-prescription stay-awake pills…
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Number of Occasions |
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0 |
1-2 |
3-5 |
6-9 |
10-19 |
20-39 |
40 or more |
a. …in your lifetime? |
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b. …during the last 30 days? |
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These next few questions ask about your drug knowledge. Please circle only one answer. If you do not know the answer, circle your best guess.
42. Tobacco is not an addictive drug. T rue False |
50. Inhalants can cause sudden death. T rue False
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43. One must be ___ years old to legally use alcohol. 2 0 21 18 |
51. The active ingredient in marijuana that causes the high is: N icotine THC Ketamine |
44. Using smokeless tobacco instead of smoking cigarettes is a safe alternative. T rue False |
52. One of the effects of crack, or cocaine, is an immediate craving for more of the drug. T rue False |
45. If you are around people who are drinking alcohol, but you, yourself, are not drinking, you are still at an increased risk for: B eing seriously injured B eing in a car crash Being a victim of violence All of the above |
53. More than 400,000 people die each year in the U.S. as a result of: A lcohol Tobacco Heroin Cocaine
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46. LSD is a hallucinogen. T rue False
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54. Alcohol stimulates your central nervous system. T rue False
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47. If a drug is prescribed by a doctor (such as OxyContin), there is no danger if you misuse it. T rue False
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55. Marijuana contains more cancer-causing elements than tobacco cigarettes. T rue False
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48. Which of the following is not a “predatory” or “club” drug? E cstasy Rohypnol Steroids |
56. A blunt is marijuana in: F ood A cigar A pipe |
49. Drinking large amounts of alcohol can lead to coma or even death. T rue False |
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When (if ever) did you FIRST do each of the following things?
57. Smoke cigarettes on a daily basis N ever Grade 6 or below Grade 7 Grade 8 Grade 9 (Freshman) Grade 10 (Sophomore) G rade 11 (Junior) G rade 12 (Senior)
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58. Try an alcoholic beverage -more than just a few sips N ever Grade 6 or below Grade 7 Grade 8 Grade 9 (Freshman) Grade 10 (Sophomore) Grade 11 (Junior) Grade 12 (Senior)
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59. Try marijuana or hashish
N ever Grade 6 or below Grade 7 Grade 8 Grade 9 (Freshman) Grade 10 (Sophomore) Grade 11 (Junior) Grade 12 (Senior)
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60. At any time during the LAST 12 MONTHS, have you felt (in your own mind) that you should REDUCE or STOP your use of… (Please mark one circle for each line.)
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Yes |
No |
Haven’t Used in last 12 months |
Alcohol |
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Cigarettes |
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Marijuana |
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61. How many of your FRIENDS would you estimate…
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None |
A few |
Some |
Most |
All |
Smoke cigarettes? |
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Smoke marijuana (pot, grass) or hashish? |
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Take cocaine powder or “crack” cocaine? |
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Drink alcoholic beverages (liquor, beer, wine)? |
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Get drunk at least once a week? |
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62. How difficult do you think it would be for you to get each of the following types of drugs, if you wanted some?
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Probably impossible |
Very difficult |
Fairly difficult |
Fairly easy |
Very easy |
Alcohol |
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Marijuana (pot, weed) |
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63. What types of the following drug education experiences have you had in school? (Mark all that apply.) A special course about drugs Films, lectures, or discussions in one of my regular courses Films or lectures, outside of my regular courses Special group discussions about drugs None |
64. What types of the following drug education experiences have you had in the Young Marines Program? (Mark all that apply.) A special course about drugs Films, lectures, or discussions in one of my regular courses Films or lectures, outside of my regular courses Special group discussions about drugs None |
65. What have been the most important reasons for your drinking alcoholic beverages? (Mark all that apply.)
N one, does not apply To experiment – to see what it’s like To relax or relieve tension To feel good or get high To seek deeper insights and understanding To have a good time with my friends To fit in with a group I like To get away from my problems or troubles Because of boredom, nothing else to do B ecause of anger or frustration To get through the day To increase the effects of some other drug(s) To decrease (offset) the effects of some other drug(s) T o get to sleep Because it tastes good Because I am “hooked” - I feel that I have to drink Other __________________ (fill-in)
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66. What have been the most important reasons for your using marijuana or hashish? (Mark all that apply.)
N one, does not apply To experiment – to see what it’s like To relax or relieve tension To feel good or get high To seek deeper insights and understanding To have a good time with my friends To fit in with a group I like To get away from my problems or troubles Because of boredom, nothing else to do B ecause of anger or frustration To get through the day To increase the effects of some other drug(s) To decrease (offset) the effects of some other drug(s) B ecause I am “hooked” - I feel that I have to use marijuana O ther __________________ (fill-in)
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Individuals differ in whether or not they disapprove of people doing certain things. Do YOU disapprove (do not agree with or think it is not OK) of people (who are 18 or older) doing each of the following? (Please mark one circle for each line.)
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Don’t disapprove (it is OK) |
Disapprove (it is NOT OK) |
Strongly disapprove (it is definitely NOT OK) |
Smoking one or more packs of cigarettes per day |
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Trying marijuana once or twice |
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Trying cocaine in powder form once or twice |
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Trying “crack” cocaine once or twice |
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Taking one or two drinks nearly every day |
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Having five or more drinks once or twice each weekend |
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68. How do you think your CLOSE FRIENDS feel (or would feel) about YOU doing each of the following things?
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Don’t disapprove (it is OK) |
Disapprove (it is NOT OK) |
Strongly disapprove (it is definitely NOT OK) |
Smoking one or more packs of cigarettes per day |
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Trying marijuana once or twice |
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Trying cocaine in powder form once or twice |
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Trying “crack” cocaine once or twice |
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Taking one or two drinks nearly every day |
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Having five or more drinks once or twice each weekend |
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69. The next questions ask for your opinions on the effects of using certain drugs and other substances. How much do you think people RISK HARMING THEMSELVES (physically or in other ways) if they… (Please mark one circle for each line.)
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No risk |
Slight risk |
Moderate risk |
Great risk |
Can’t say, drug unfamiliar |
Smoke one or more packs of cigarettes per day |
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Try marijuana once or twice |
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Try cocaine in powder form once or twice |
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Try “crack” cocaine once or twice |
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Take one or two drinks nearly every day |
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Have five or more drinks once or twice each weekend |
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Try heroin once or twice |
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70. How likely is it that you will do each of the following things after school?
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Definitely Won’t |
Probably Won’t |
Probably Will |
Definitely Will |
Attend a technical or vocational school |
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Serve in the armed forces |
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Graduate from a two-year college program |
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Graduate from college (four-year) program |
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Attend graduate or professional school after college |
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71. How satisfied are you with your life as a whole these days?
Completely dissatisfied |
Quite dissatisfied |
Somewhat dissatisfied |
Neither, or mixed feelings |
Somewhat satisfied |
Quite satisfied |
Completely satisfied |
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72. How much do you agree or disagree with the following statements?
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Disagree |
Mostly disagree |
Neither |
Mostly agree |
Agree |
I have a positive attitude toward myself. |
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I feel I am a person of worth, on an equal plane with others. |
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I am able to do things as well as most other people. |
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On the whole, I’m satisfied with myself. |
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I feel I do not have much to be proud of. |
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Sometimes I think that I am no good at all. |
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I feel that I can’t do anything right. |
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I feel that my life is not very useful. |
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Life often seems meaningless. |
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I enjoy life as much as anyone. |
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The future often seems hopeless. |
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It feels good to be alive. |
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73. Do you think you will do the following things in the next two months?
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Yes |
Probably |
I don’t know |
I don’t think so |
No, definitely not |
Do you think you will smoke a cigarette in the next 2 months? |
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Do you think you will use alcohol in the next 2 months? |
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Do you think you will use marijuana in the next 2 months? |
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Do you think you will use any drugs other than marijuana in the next 2 months? |
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74. How much do you agree or disagree with the following statements?
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Strongly Agree |
Agree |
Disagree |
Strongly Disagree |
I really care about how my actions might affect others. |
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I’m confident I can avoid drinking alcohol. |
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I’ll probably be a smoker someday. |
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I’m confident I can set goals and achieve them. |
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What I do with my life won’t make much difference one way or another. |
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I have confidence that I can stay away from using marijuana. |
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I have a responsibility to make the world a better place. |
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I’m confident I can resist offers of cigarettes. |
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It’s up to me to keep myself out of trouble. |
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I’m confident I can stay away from using drugs. |
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75. Are you a new Young Marine recruit?
Yes (Please skip these last two questions. You are finished with the survey.)
No (Please continue with QUESTION 76.)
76. How much do you agree or disagree with the following statements?
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Strongly disagree |
Disagree |
Neither disagree or agree |
Agree |
Strongly agree |
Overall, I am satisfied with the Young Marines Program. |
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I recommend the Young Marines Program to my friends. |
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The skills and knowledge I learn in the Young Marines are useful to me. |
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Being a Young Marine encourages me to improve myself. |
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I like participating in the Young Marines. |
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77. How much do you like the following activities or aspects of the Young Marines Program?
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Not at all |
Very little |
Quite a bit |
Very much |
SPACES/summer programs |
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Leadership schools |
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Drill/PT/keeping fit |
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Friends/fellow Young Marines |
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Young Marine Unit leaders |
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Community service/helping others |
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Earning ribbons |
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78. If selected for the follow-up survey three months from now, how would you prefer to complete the survey?
On paper just like this survey (I would then mail in my completed survey)
On-line using the Internet to submit my responses
You are finished with the questionnaire.
Thank you!
File Type | application/msword |
File Title | NHRC IRB Protocol Template |
Author | thieding |
Last Modified By | simonarndt |
File Modified | 2008-09-11 |
File Created | 2008-07-30 |