OMB Memo

Page 29

S CREENER

Study MB #10213170

OMB#0925-0466

For Keypunch Only		Interviewer #									1
		(Qst. #)
Batch Number	(For MB use only)-	Resp. #
		(Rnd #)									1
Punched_____Verified
		Week	2		0		0		8		0		5
No. of Records	Pre-Coded -		M		M		D		D		Y		Y
		Date	0		1		2		8		0		8

(MALL)

Northeast

Albany, NY 00122

White Plains, NY (No Hisp) 00441

Massepequa, NY 00144

Cherry Hill, NJ 00388

Watertown, MA 00057

South

Baltimore, MD 02019

Houston TX 00472

Memphis, TN 00484 (NEW)

Boynton Beach, FL 02087

Antioch, TN 00138

Tallahassee, FL (No Hisp) 00324

Jackson, MS 00228

Tampa, FL 00517

Ethnicity Quota:

Midwest

White- (includes White, American Indian, Alaskan Native, Native Hawaiian, Pacific Islander) -1

Joliet, IL 00004

Black or African American -2

Richmond Heights, OH 00554

Hispanic or Latino -3

Troy, MI (No Hisp) 02053

Asian -4

Fairview Heights, IL 02052

Bloomington, MN 00379

West

Age Quota:

Sex (SEX)

Phoenix, AZ (No Hisp) 00167

14 Years…………….- 1

Male Male…………..-1

Littleton, CO (No Hisp) 02010

15 Years……………..-2

Female Female..……...-2

16 Years……………..-3

s

17 Years…………….-4

Downey, CA (No Hisp) 00342

18 Years…………….-5

Moreno Valley, CA 00423

Tracy, CA 00313

Internet/Banner Ad Quota:

San Rafael, CA (No Hisp) 00196

Version 1 (ATI banners)………………..-1

Puyallup, WA (No Hisp) 02024

Version 2 (Freevibe banners)………….-2

ONDCP KIDS QUESTIONNAIRE

MB # 10213170

		Implementation Date: January 28, 2008

SCREENER- Youth

Sight screen for males/females between 14 and 18 years of age.

If potential respondent is alone or with friends, begin screener at Q. A. If potential respondent is with a parent, begin screener at Q. A1.

Hello, I'm ______________________. Today we're doing a survey and would like to ask you about what messages and advertising you've seen.  We'd also like to ask you about some important issues. Everything you tell us will be kept anonymous and no one will know how you answered the questions. We just want to know what you think. In order to do that, we need to talk to kids of certain ages.

A. Can you please tell me how old you are?

(Read list.)

(Terminate and circle next number below for 'under 14')--				A. under 14
		Check quotas		B. 14
		-If over quota, terminate and circle		C. 15
		the next number in the appropriate		D. 16
		box below		E. 17
		(Terminate and circle next number below for '19 or over')-'		F. 18
				G. 19 or over
		(Terminate and circle next number below for 'refused age')-

Under 14

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 14

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 15

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 16

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 17

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 18

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

19 or over

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Refused Age

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

B. Interviewer. Check gender below and check quotas.

		Check quota. If over quota, terminate and circle next number in the appropriate box below	Male	-1
	Check quota. If over quota, terminate and circle next number in the appropriate box below		Female	-2

Over Quota Male

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota Female

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Cx. To make sure that we have a fair representation of the diverse ethnic backgrounds… Are you from Spanish, Hispanic or Latino background/origin? (If necessary to clarify say: 'This includes Mexican, Mexican American, Puerto Rican, Cuban and all other Spanish, Hispanic or Latino origins')

		-If Hispanic quota is filled, discontinue, OQ Ethnicity. If Hispanic quota is not filled or not needed, then go to Q.C	Yes		-1
		(- If the non-Hispanic quota is filled, discontinue, OQ Ethnicity. If the non-Hispanic quota not filled or not needed, then go to Q.C)	No		-2
	(Discontinue, Ref.)(Do not read) DK/Ref			-R

Over Quota Hispanic

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

C. What is your race?

(Read list. Accept only one response.)

Check Quotas. If over quota, terminate and circle next number in the appropriate box below. Punch -1, -5, -6,-7 to be counted towards white quota If "Yes" at CX and Punch -7 at C then to be counted toward Hispanic quota	White	-1
	Black or African American	-2
	Asian	-4
	American Indian or Alaska Native	-5
	Native Hawaiian or Pacific Islander	-6
	Other	-7
	(Terminate) DK/Ref	-R

Over Quota White

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota Black or African American

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota Asian

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

D. The survey will take about 15 minutes and we will give you $2.00 if you finish it. Would you like to take part in our study today?

(continue)	Yes	-1
(Terminate and circle next number below)	No	-2

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

SCREENER- Parent

If accompanying teen

Hello, I'm ______________________. Today we're doing a survey about messages and advertising kids have seen. We'd also like to ask your child about some important issues. Everything your child tells us will be kept confidential and no one will know how he or she answered the questions. We just want to know what kids think. In order to do that, we need to talk to kids of certain ages.

.

A1. Can you please tell me how old your child is?

(Read list.)

(Terminate and circle next number below for 'under 14')--				A. under 14
		Check quotas		B. 14
		-If over quota, terminate and circle		C. 15
		the next number in the appropriate		D. 16
		box below		E. 17
		(Terminate and circle next number below for '19 or over')-'		F. 18
				G. 19 or over
		(Terminate and circle next number below for 'refused age')-

Under 14

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 14

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 15

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 16

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 17

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota 18

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

19 or Over

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Refused Age

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

B1. Interviewer. Check gender below and check quotas.

		Check quota. If over quota, terminate and circle next number in the appropriate box below		Male	-1
	Check quota. If over quota, terminate and circle next number in the appropriate box below			Female	-2

Over Quota Male

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota Female

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

C1x. To make sure that we have a fair representation of the diverse ethnic backgrounds… Is you child from Spanish, Hispanic or Latino background/origin? (If necessary to clarify say: 'This includes Mexican, Mexican American, Puerto Rican, Cuban and all other Spanish, Hispanic or Latino origins')

		-If Hispanic quota is filled, discontinue, OQ Ethnicity. If Hispanic quota is not filled or not needed, then go to Q.C1	Yes		-1
		(- If the non-Hispanic quota is filled, discontinue, OQ Ethnicity. If the non-Hispanic quota not filled or not needed, then go to Q.C1)	No		-2
	(Discontinue, Ref.)(Do not read) DK/Ref			-R

Over Quota Hispanic

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

C1. Which one of these best describes your child's race?

(Read list. Accept only one response.)

Check Quotas. If over quota, terminate and circle next number in the appropriate box below. Punch -1, -5, -6, -7 to be counted towards white quota If "Yes" at C1X and Punch -7 at C1 then to be counted toward Hispanic quota	White	-1
	Black or African American	-2
	Asian	-4
	American Indian or Alaska Native	-5
	Native Hawaiian or Pacific Islander	-6
	Other	-7
	(Terminate) DK/Ref	-R

Over Quota White

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota Black or African American

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Over Quota Asian

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

D1. The survey will take about 15 minutes and we will give your child $2.00 if (he/she) finishes it. Would you allow your child to take part in our study today?

(continue)	Yes	-1
Terminate and circle next number below	No	-2

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Thank you for agreeing to participate in this survey. Please be honest in your answers. No one will know how you answered these questions. You can stop at any time, your answers will be kept anonymous and combined with those of other teens.

SENSATION SEEKING

1a.  First, we would like to know how much you agree or disagree with the following statements. Please be honest. For each statement, choose the number that describes how much you agree or disagree.

(Randomize)	Disagree A Lot	Disagree A little	Neither Agree or Disagree	Agree A Little	Agree A Lot
I like to do scary things	-1	-2	-3	-4	-5
I like new and exciting experiences, even if I have to break the rules	-1	-2	-3	-4	-5
I would like to explore strange places	-1	-2	-3	-4	-5
I prefer friends who are exciting and unpredictable	-1	-2	-3	-4	-5

MESSAGE/ADVERTISING AWARENESS

1. Have you recently seen or heard any messages against drug use? It may have been anywhere.

(Continue)	Yes	-1
	No	-2

Now, think specifically about advertising.

2. Have you recently seen or heard any advertising against drug use? It may have been anywhere.

(Continue)	Yes	-1
	No	-2

3. Have you recently seen or heard any advertising about not giving in to peer pressure or influence to use drugs? It may have been anywhere.

(Continue)	Yes	-1
(Go to Q5)	No	-2

4. Did you see or hear any advertising against drug use or peer pressure related to drug use in any of the following places?

	Yes	No
TV	-1	-2
Magazines	-1	-2
Newspapers	-1	-2
Radio	-1	-2
Movie theaters	-1	-2
Billboard or outdoor wall mural	-1	-2
Screens in malls, arcades or game stores	-1	-2
Posters or signs on buses, trains, or other public transportation	-1	-2
Posters or signs in bus stops or train stations	-1	-2
The Internet or web sites	-1	-2

5. Have you recently seen any advertising that mentions the "anti-drug"?

Yes	-1
No	-2

6. Have you recently seen any advertising that mentions "above the influence"?

Yes	-1
No	-2

7. Have you seen any advertising recently with this logo?

(Show each logo in center of screen. Randomize order of presentation. Respondent replies 'yes' or 'no' to each before the next logo is presented.)

	Yes	No
truth	-1	-2
National Campaign to Prevent Youth Violence	-1	-2
My anti-drug	-1	-2
Above the Influence	-1	-2

ATTITUDES ABOUT DRUGS

8. We would like to know how much you agree or disagree with the following statements. Please be honest. For each statement, choose the number that describes how much you agree or disagree.

0 means you totally disagree, 5 means you neither agree nor disagree and 10 means you totally agree wth the statement.

Randomize	Totally Disagree						Neither Agree nor Disagree								Totally Agree
Staying drug-free will help you achieve your goals and do everything you want to do with your life.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Smoking marijuana can't help a kid to be accepted.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Kids who smoke marijuana will let other people down.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Kids who smoke marijuana can't perform their best at sports.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
If you say no when someone offers you marijuana, you'll feel good about yourself.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
I would know how to turn down marijuana if someone offered it to me.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Not using marijuana is a way of expressing my independence.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
I respect kids who don't do drugs, including marijuana.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Choosing not to smoke marijuana is a way to be true to myself.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
There are a lot of cool kids who choose not to use marijuana.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
I feel confident that I can be who I want to be without smoking marijuana.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
If a friend was having a problem with marijuana, I should talk to them about it.	-0	-1	-2	-3	-4		-5		-6	-7		-8		-9	-10
If a friend was having a problem with marijuana, I should step in to do something.	-0	-1	-2	-3	-4		-5		-6	-7		-8		-9	-10
There are a lot of teens my age that use marijuana.	-0	-1	-2	-3	-4		-5		-6	-7		-8		-9	-10

9. Next, we want to know the risk involved in each of the following.

What is the risk of (insert statement) if someone tries marijuana even once or twice?

(Respondent must enter a response to continue to the next statement. Only show the intro statement on the first screen.)

(Randomize and bold statements)	1 No Risk At All	2	3	4	5 Extreme Risk
getting in trouble with the law	-1	-2	-3	-4	-5
losing control of themselves	-1	-2	-3	-4	-5
messing up their life	-1	-2	-3	-4	-5
doing something they might later regret	-1	-2	-3	-4	-5
doing things that are very irresponsible	-1	-2	-3	-4	-5
seriously upsetting friends or family	-1	-2	-3	-4	-5
putting someone they know in danger	-1	-2	-3	-4	-5

TV AD RECOGNITION

TV Ad Recogntion Ad Bank

Dog Q10R

Mirror Q10S

Anne Marie Q10T

Hugging The Block Q10U

Sent Q10V

Fire Q10W

Cocoon Q10X

(Randomize all ads so that each respondent is asked a maximum of 5 of the 7 ads) Respondent must say 'yes' or 'no' at each ad to go on to the next.)

We are going to show you some pictures from ads you might have seen on TV. We are going to show a few pictures from each ad and want to know whether or not you remember seeing it.

10R. (SHOW STIMULUS.)

Have you seen this commercial on TV?

Yes	-1
No	-2

10S. (SHOW STIMULUS.)

Have you seen this commercial on TV?

Yes	-1
No	-2

10T. (SHOW STIMULUS.)

Have you seen this commercial on TV?

Yes	-1
No	-2

10U. (SHOW STIMULUS.)

Have you seen this commercial on TV?

Yes	-1
No	-2

10V. (SHOW STIMULUS.)

Have you seen this commercial on TV?

Yes	-1
No	-2

10W. (SHOW STIMULUS.)

Have you seen this commercial on TV?

Yes	-1
No	-2

10X. (SHOW STIMULUS.)

Have you seen this commercial on TV?

Yes	-1
No	-2

INTERNET/BANNER AD AWARENESS

Now, we are going to show you some banner ads you might have seen on the Internet and want to know if you remember seeing any of them. Banner ads are ones, usually rectangular, that appear on your screen when you visit web sites. They usually advertise information or products that you can learn more about by clicking on the banner ad and being taken to the advertised web site.

(Randomize order of ads at Q11/Q12. Show ad centered on screen. Rotate Version 1 and Version 2 Ad banks so that 7 out of 10 see the Version 1 ad bank (ATI Banners) and 3 out of 10 see the Version 2 ad bank (Freevibe Banners).)

Version 1 – ATI Banners

Banner Ad Recogntion Ad Bank

Stick (REMOVE)

Falling (REMOVE)

Ransom

Crumple

Puppet (REMOVE)

Claw (REMOVE)

Blackout

Purse (REMOVE)

Respect

Tug A War (NEW)

Slingshot (NEW)

Putty (NEW)

Music Video (NEW)

Version 2 – Freevibe Banners

Banner Ad Recogntion Ad Bank

Bad Idea Generator

Paranoia

Log Chat

Yes No

Smoking

Interested

11. Have you seen this banner ad on any site on the Internet?

(Continue to Q12)	Yes	-1
(Skip to next banner ad in rotation or Q13 if no more banner ads)	No	-2

(If 'yes' at Q11, ask Q12)

12. Did you click on the banner ad?

(Skip to next banner ad in rotation or Q13 if no more banner ads)	Yes	-1
	No	-2

13. Have you ever visited this web site? (Show logo for freevibe.com)
    
    

(Ask Q14-17 together and then back to 13a-17)	Yes	-1
(Go to Q13a)	No	-2

(Rotate Q13a and Q13a1 so that half of respondents get asked Q13a and the other half of respondents get asked Q13a1)

13a. Have you ever visited this web site? (Show logo for abovetheinfluence.com)

(Continue)	Yes	-1
(Go to Q18)	No	-2

13a1. Have you ever visited the web site, abovetheinfluence.com? (Only ask question, do not show any visuals)

(Continue)	Yes	-1
(Go to Q18)	No	-2

14. How did you get to this web site? (Select all that apply)

Clicked on a banner	-1
Used a search engine	-2
Typed in the URL	-3
Other (Specify)

For other specify responses—"How did you get to this web site?"

15. Did you like what you found at this web site?

	Yes	-1
	No	-2

16. How would you rate your experience at this web site? Please choose the number below that describes how you would rate your experience at this web site.

0 means you rate the experience as extremely bad, 5 means it was neither good nor bad and 10 means you rate it as extremely good.

Extremely Bad						Neither Good nor Bad								Extremely Good
-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10

(Ask Q17 of those who say punches 0 to 4 at Q16)

17. Which of the following explains why you gave a bad rating to the web site?

(Randomize. Accept multiple responses.)

Frustrating to use	-1
Boring	-2
Unappealing	-3
Content not useful	-4
Not what I was expecting	-5
Other (Specify)

Above the Influence Belief Statements

Now we would like to ask you some questions about the influences and pressures you face in your life.

18. We would like to know how much you agree or disagree with each of the following statements. Please be honest. For each statement, choose the number that describes how much you agree or disagree.

0 means that you totally disagree, 5 means that you neither agree nor disagree and 10 means that you totally agree with the statement.

Randomize	Totally Disagree						Neither Agree nor Disagree								Totally Agree
It's important to be above the influences that could bring you down.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Teens can make the choice to be above negative influences rather than give in to them.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Choosing to be above the influence can help you overcome negative influences that you face.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
It's important to stand up for yourself against influences that could bring you down.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Listening to yourself, rather than others, can help you stand up to pressure to do things like get high.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
It's important to stand up for yourself and not let others push you into doing things that aren't really you.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Teens don't have to give in to pressure to do things that can change them for the worse.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Using weed can cause you to lose interest in things that you care about.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Being under the influence of weed can cause some pretty negative things to happen to you.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Smoking weed can define you as someone you don't want to be.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
If you follow others' influence without thinking, you could find yourself doing things that you later regret.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
A lot of teens today are deciding to resist the influence to use marijuana.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
People can become lazy and boring as a result of smoking weed.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
You are confident that you can resist negative influence.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Teens today are smart about recognizing negative influences and the need to resist them.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
You would be better off if you stay above the influence.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Smoking weed can cause you to miss out on things.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Teens today are deciding to resist influences to do things like use weed.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
Being above the influence can inspire others to stay away from negative influences such as marijuana.	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10

19. Please choose the number below which describes how you would feel about refusing to use marijuana.

0 means you would feel extremely bad, 5 means you would feel neither good nor bad and 10 means that you would feel extremely good about refusing to use marijuana.

Extremely Bad						Neither Good nor Bad								Extremely Good
-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10

Please choose the number which describes how likely you would be to make the choices below.

0 means you would be extremely unlikely, 5 means neither likely nor unlikely and 10 means you would be extremely likely to make that choice.

20. If you were faced with a choice, how likely do you think it is that (insert statement)?

(Randomize and bold statements. Display the above scale only on the first statement.)	Extremely Unlikely						Neither Likely nor Unlikely											Extremely Likely
you will be above the influences that could bring you down.	-0	-1	-2	-3	-4	-5		-6	-7		-8			-9			-10
you will be above negative influences.	-0	-1	-2	-3	-4		-5	-6	-7			-8			-9		-10
you will take a stand against being influenced to do things like smoking weed.	-0	-1	-2	-3	-4		-5	-6	-7			-8			-9		-10

21. Still using a scale where 0 means you would be extremely unlikely, 5 means neither likely nor unlikely and 10 means you would be extremely likely…

How likely is it that you would (insert statement) if you used marijuana, even once or twice?

(Randomize and bold statements. Display the above scale only on the first statement.)	Extremely Unlikely						Neither Likely nor Unlikely								Extremely Likely
have a better time with friends	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
be more like the coolest kids	-0	-1	-2	-3	-4		-5		-6	-7		-8		-9	-10

Please choose the number below which describes how likely you would be to take the actions below. 0 means you are extremely unlikely, 5 means you are neither likely nor unlikely and 10 means you are extremely likely to take that action.

22. If you found out within the next few weeks that a friend was having a problem with marijuana, how likely is it that you would (insert statement)?

(Randomize and bold statements. Display the above scale only on the first statement.)	Extremely Unlikely						Neither Likely nor Unlikely								Extremely Likely
step in to do something	-0	-1	-2	-3	-4	-5			-6	-7	-8		-9		-10
tell them that you thought they had a marijuana problem	-0	-1	-2	-3	-4		-5		-6	-7		-8		-9	-10

OPINIONS AND BELIEFS ABOUT DRUGS

Now we would like to ask you about some of your opinions and beliefs about certain drugs.

23. How dangerous is marijuana (weed, reefer, pot)?

Very dangerous and should never be used	-1
A little dangerous but it's okay to try it once or twice	-2
Not dangerous at all and it's okay to use it	-3
I don't know what it is	-4
(Skipped question)	-5

24. How dangerous is tobacco?

Very dangerous and should never be used	-1
A little dangerous but it's okay to try it once or twice	-2
Not dangerous at all and it's okay to use it	-3
I don't know what it is	-4
(Skipped question)	-5

25. How dangerous is alcohol?

Very dangerous and should never be used	-1
A little dangerous but it's okay to try it once or twice	-2
Not dangerous at all and it's okay to use it	-3
I don't know what it is	-4
(Skipped question)	-5

26. How dangerous are drugs in general?

Very dangerous and should never be used	-1
A little dangerous but it's okay to try them once or twice	-2
Not dangerous at all and it's okay to use them	-3
I don't know what they are	-4
(Skipped question)	-5

26a. How dangerous is prescription drug abuse?

Very dangerous and should never do it	-1
A little dangerous but it's okay to do it once or twice	-2
Not dangerous at all and it's okay to do it	-3
I don't know what it is	-4
(Skipped question)	-5

DRUG INTENTION

Next we are going to ask some questions about what you might do over the next year. Please be honest. Remember that no one will know how you answered any of these questions. It is important for us to know what you really think you will do.

27. At any time during the next year, do you think you will smoke marijuana?

Definitely yes	-1
Probably yes	-2
Probably not	-3
Definitely not	-4
(Skipped question)	-5

28. If one of your close friends were to offer you marijuana, would you smoke it?

Definitely yes	-1
Probably yes	-2
Probably not	-3
Definitely not	-4
(Skipped question)	-5

29. How do you think your close friends would feel about your using marijuana, even once or twice over the next 12 months?

Strongly approve	-1
Approve	-2
Neither approve nor disapprove	-3
Disapprove	-4
Strongly disapprove	-5
(Skipped question)	-6

30. Which, if any, of the following sources have you used to find out information about the dangers of using drugs? (Select all that apply)

Friends	-1
Parents/family	-2
Books	-3
Internet	-4
Magazine articles	-5
Pamphlets	-6
Teachers/school	-7
TV programs	-8
Radio programs	-9
Other (specify)

For other specify responses—"What other sources have you used to find out information about the dangers of using drugs?"

31. How many times have you used marijuana in the past 30 days?

Never	-1
Once	-2
2-3 times	-3
4-9 times	-4
10-19 times	-5
20 + times	-6
(Skipped question)	-7

32. How many times have you used marijuana in the past 12 months?

Never	-1
Once	-2
2-3 times	-3
4-9 times	-4
10-19 times	-5
20 + times	-6
(Skipped question)	-7

33. In the past few weeks, have your parents talked to you about staying away from drugs?

	Yes	-1
	No	-2

CLASSIFICATION

C-1. How old are you?

(Accept only one response.)

	Younger than 12	-3
	12	-4
	13	-5
	14	-6
	15	-7
	16	-8
	17	-9
	18	-10
	19 or over	-11

C-2. What is the last grade in school you completed?

(Accept only one response.)

	5th grade	-5
	6th grade	-6
	7th grade	-7
	8th grade	-8
	9th grade	-9
	10th grade	-10
	11th grade	-11
	12th grade	-12
	College	-13

(If 'yes' at C-Cx, responses should be 'yes' at Cx or C1x.)

C-Cx. To make sure that we have a fair representation of the diverse ethnic backgrounds… Are you from Spanish, Hispanic or Latino background/origin? This includes Mexican, Mexican American, Puerto Rican, Cuban and all other Spanish, Hispanic or Latino origins.

	Yes	-1
	No	-2

(Responses at C-3 should match back to QC or QC1).

C-3. Which one of these best describes how you think of yourself?

(Accept only one response)

	White	-1
	Black or African American	-2
	Asian	-3
	American Indian or Alaska Native	-4
	Native Hawaiian or Pacific Islander	-5
	Other	-6

C-4. What sort of school do you attend?

(Accept only one response.)

	Public school	-1
	Parochial/Catholic school	-2
	Non-religious private school	-3

C-5. Do you live at home with . . .?

(Accept only one response.)

	Your mother	-1
	Your father	-2
	Both your mother and father	-3
	Some other member of your family such as an aunt	-4
	Foster parent (s)	-5
	Other non-relative	-6

C-6. Are you a male or female?

(Accept only one response.)

	Male	-1
	Female	-2

C-7. In an average week, how many hours would you say you spend doing each of the following? (Accept a max of 168 hours for each below)

If a respondent responds with more than 168 hours for any given activity, the following message will appear—"There are only 168 hours in a week. Please re-enter your answer."

		Record exact number
	Watching TV
	Surfing the Internet
	Listening to the radio
	Reading magazines or newspapers

Please enter your zip code.

_____ _____ _____ ______ ______

That is the end of the interview! Thank you for participating in our survey today!

L:\Ogilvy and Mather - Drug Free\10106763 Kids\10106763Q 07-28-03.doc (29 of 29) 7/22/2003 9:58 AM