Student Survey

Attachment 8-

Student Survey

(with programming notations)

OMB Control #: 0925-0655

Expiration Date: 3/31/2015

Public reporting burden for this collection of information is estimated to average 15 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0655). Do not return the completed form to this address.

PLEASE NOTE: ITEMS IN [ ] BRACKETS ARE PROGRAMMING NOTES, WILL NOT BE SEEN BY RESPONDENT

[FOR ALL QUESTIONS - NO RESPONSE REQUIRED TO CONTINUE]

S1. Please enter your password to enter the survey [DATA FIELD]

[RECORD SCHOOL IDENTIFIER FROM PASSWORD]

INTRODUCTION:

Thank you for participating in our Evaluation of the NIDA PEERx Video Program. Your responses are very valuable to us as we continue to work to improve the quality of videos and materials presented to students like yourself in and out of school.

Your responses will be kept private to the extent permitted by law, and are not tied to you in any way. This survey should take you no longer than 15 minutes to complete.

If you have any questions about this research effort or need any technical assistance please feel free to contact Joanne Vega, Study consultant for the National Institute on Drug Abuse at (888) 554-6960 x203 or by email at [email protected].

Please know that you are free to decide not to answer any of the questions presented in this survey, by selecting "Continue" you agree to participate in our survey and agree that you have been made aware of the purposes of this research and voluntarily provide your responses to us for the purposes of this study.

CONTINUE

[FOR FOCUS GROUP MARKETS, REFERENCE PASSWORD ID]

First, we are planning to conduct some additional research in your area, would you be interested in participating in a focus group at your school in the near future?

S2. [FOCUS GROUP OPT IN] Yes [CONTINUE TO S3]

No [SKIP TO Q1]

S3. We will call you and your parents in the next few weeks to discuss the focus groups in more detail, please provide us with your first name, and contact information for your parent or guardian so we can get your permission to participate.

Thank you for your willingness to help us with our research.

Student First Name [DATA FIELD]

Parent First Name [DATA FIELD]

Home Phone Number [DATA FIELD]

Familiarity and Attitude

For the purpose of this study, we define prescription drugs as drugs that are prescribed by a doctor for and intended to be used by one person only, as prescribed. These are bought at a pharmacy and are approved and regulated by the Food and Drug Administration (FDA). We use the phrases prescription drug misuse, prescription drug abuse, and non-medical use of prescription drug interchangeably. They occur in one or more of the following situations:

1. Prescription drugs used without a prescription

2. Prescription drugs used in a way other than as prescribed

3. Prescription drugs used primarily for the experience or feelings gained by their use

4. Using someone else's prescription drugs.

Q1. How familiar are you with students misusing prescription drugs in any of the situations above? [USE SLIDING SCALE]

a.

Not at all familiar

1

2

3

4

5

6

7

Very Familiar

Q2. In your opinion, taking prescription drugs for non-medical uses is... [INSERT SLIDING STATEMENT SCALE; RANDOMIZE ORDER]

a.	Bad	1	2	3	4	5	6	7	Good
b.	Foolish	1	2	3	4	5	6	7	Wise
c.	Harmful	1	2	3	4	5	6	7	Beneficial
d.	Unpleasant	1	2	3	4	5	6	7	Pleasant
e.	Unsafe	1	2	3	4	5	6	7	Safe
f.	Punishing	1	2	3	4	5	6	7	Rewarding
g.	Unacceptable	1	2	3	4	5	6	7	Acceptable
h.	Unfavorable	1	2	3	4	5	6	7	Favorable
i.	Worthless	1	2	3	4	5	6	7	Valuable

Q3. Please indicate how strongly you agree or disagree with the following statement. [USE SLIDING SCALE; INSERT STATEMENT]

A. It is very common to find students misusing prescription drugs at school.

B. It is very common to find students misusing prescription drugs at home.

C. It is very common to find students misusing prescription drugs in the neighborhood.

a.

Strongly Disagree

1

2

3

4

5

6

7

Strongly Agree

Q4. Do you know of anyone who has ever taken prescription drugs for non-medical uses?

YES 1

NO 2

NOT SURE / NA 3

PREFER NOT TO RESPOND 4

Q5. How important are the following people and other sources of information in guiding you in making good choices regarding different personal issues? Please rate the importance on a 5 point scale from Not Important (1) through Very Important (5).

Not Important

1

2

3

4

5

Very Important

[USE SLIDING SCALE; INSERT STATEMENT]

a.	Parents	1	2	3	4	5			Not Applicable
b.	Brother(s) or Sister(s)	1	2	3	4	5			Not Applicable
c.	Relatives outside the immediate family	1	2	3	4	5			Not Applicable
d.	Friends from your neighborhood	1	2	3	4	5			Not Applicable
e.	Teachers from School	1	2	3	4	5			Not Applicable
f.	Friends from School	1	2	3	4	5			Not Applicable
g.	TV Shows (either cable, satellite, or Internet)	1	2	3	4	5			Not Applicable
h.	Social Media (for example, Facebook, Twitter, Instagram)	1	2	3	4	5			Not Applicable
i.	Other material (for example, books, magazines, journals - either print or electronic)	1	2	3	4	5			Not Applicable

Q6. If you had to list the top 3 sources of information whose guidance you really value, who or what would they be? [OPEN END]

Video Evaluation

Q7a. The National Institute on Drug Abuse (NIDA) has created two interactive Choose Your Path videos to educate teens about the consequences of non-medical use (or abuse) of prescription drugs.

Do you recall viewing any of these videos previously?

YES 1 [SKIP TO Q7B]

NO 2

NOT SURE / NA 3

Q7b. Approximately how many times have you watched them?

RECORD VALUE TIMES

Q8. We would like you to see one such video and provide your feedback on it. Please keep this window open while you view the video below.

[INSERT CHOOSE YOUR PATH VIDEO TITLED "CHOOSE YOUR PATH - BFF OR THE EX" IN EMBEDDED IFRAME]

http://www.youtube.com/watch?feature=player_embedded&v=Yyd_WSjgB2A

http://teens.drugabuse.gov/videos/choose-your-path/bff-or-ex

Once you have finished watching the video, click continue.

CONTINUE 1

Q9. For the following questions, please rate your answers on this 7 point scale from Not at all (1) through Very Much (7).

Not at all

1

2

3

4

5

6

7

Very Much

[USE SLIDING SCALE; INSERT STATEMENT]

a.	How easy was it to view the video?	1	2	3	4	5	6	7
b.	How easy was it to understand what the people in the video were saying?	1	2	3	4	5	6	7
c.	How realistic were the scenarios presented in the video?	1	2	3	4	5	6	7
d.	To what extent do you feel you could identify with the characters in the video?	1	2	3	4	5	6	7

Q10. Again, for the following questions, please rate your answers on this 7 point scale from Not at all (1) through Very Much (7).

Not at all

1

2

3

4

5

6

7

Very Much

[USE SLIDING SCALE; INSERT STATEMENT]

a.	How relevant was the information presented in the video?	1	2	3	4	5	6	7
b.	How meaningful was the information presented in the video?	1	2	3	4	5	6	7
c.	How important was the information presented in the video?	1	2	3	4	5	6	7
d.	How useful was the information presented in the video?	1	2	3	4	5	6	7
e.	How helpful was the information presented in the video	1	2	3	4	5	6	7

Q11. Please indicate the extent to which you agree or disagree with the following statements regarding the video.

Strongly Disagree

1

2

3

4

5

6

7

Strongly Agree

[USE SLIDING SCALE; INSERT STATEMENT]

a.	You found the video engaging.	1	2	3	4	5	6	7
b.	You found the video appealing.	1	2	3	4	5	6	7
c.	You found the video to be effective in communicating its message.	1	2	3	4	5	6	7
d.	You found the video to be of good production quality.	1	2	3	4	5	6	7

Q12. Based on what you saw in the video, do you think taking prescription drugs for non-medical use is... [INSERT SLIDING SCALE; RANDOMIZE ORDER]

a.	Bad	1	2	3	4	5	6	7	Good
b.	Foolish	1	2	3	4	5	6	7	Wise
c.	Harmful	1	2	3	4	5	6	7	Beneficial
d.	Unpleasant	1	2	3	4	5	6	7	Pleasant
e.	Unsafe	1	2	3	4	5	6	7	Safe
f.	Punishing	1	2	3	4	5	6	7	Rewarding
g.	Unacceptable	1	2	3	4	5	6	7	Acceptable
h.	Unfavorable	1	2	3	4	5	6	7	Favorable
i.	Worthless	1	2	3	4	5	6	7	Valuable

Q13. Please indicate how likely you are to engage in the following behaviors after watching this video on the following 7 point scale between Very Unlikely (1) through Very Likely (7).

Very Unlikely

1

2

3

4

5

6

7

Very Likely

[USE SLIDING SCALE; INSERT STATEMENT]

a.	Use prescription drugs for non-medical uses.	1	2	3	4	5	6	7
b.	Search for more information regarding the consequences of taking prescription drugs for non-medical uses	1	2	3	4	5	6	7
c.	Share the link to these videos with family and friends.	1	2	3	4	5	6	7
d.	Talk about the content of these videos with family and friends	1	2	3	4	5	6	7

Q14a. How many times would you be willing to watch the videos again to explore implicates of different choices?

RECORD VALUE

[IF ZERO SKIP TO Q15; ELSE, CONTINUE]

Q14b. In minutes, how much more time are you likely to spend watching videos during one sitting to explore the implications of difference choices?

RECORD VALUE MINUTES

Q15. Would you be willing to watch these videos more times if incentives like extra credit in school or free gifts were provided for watching?

YES 1

NO 2

NOT SURE / NA 3

Q16. In your opinion, what types of incentives can be provided to get students to watch the videos more times? [OPEN END]

Q17. What did you learn from the video? [OPEN END]

Q18. Are there things in the video that you think should not be shown? [OPEN END]

Q19. What changes can be made to the videos to increase their effectiveness and have students talking about the issue of non-medical use of prescription drugs? [OPEN END]

Q20. NIDA is interested in your feedback on what changes they can make to their videos. In your opinion, how can NIDA improve the production quality of their videos? [OPEN END]

Q21. For future videos NIDA is interested in creating, what social settings or features would you recommend? [OPEN END]

Q22a. When creating education material to highlight the issue, which phrase would you recommend NIDA use in order to describe the issue? (Check one)

PRESCRIPTION DRUG MISUSE 1

PRESCRIPTION DRUG ABUSE 2

NON-MEDICAL USE OF A PRESCRIPTION DRUG 3

Q22b. Why <INSERT Q22A SELECTION>? [OPEN END]

Wrap up & Demographics

And a few final questions as we finish up this survey...

Q23. How many days per week do you normally use the Internet?

RECORD VALUE DAYS PER WEEK

[IF VALUE IS ZERO, SKIP TO Q25]

Q24. On days you use the Internet, approximately how many hours do you use it?

RECORD VALUE HOURS PER DAY

Q25. What is your current grade in school?

RECORD VALUE GRADE

PREFER NOT TO RESPOND

Q26. What would you consider is your ethnicity?

HISPANIC OR LATINO 1

NOT HISPANIC OR LATINO 2

PREFER NOT TO RESPOND 3

Q27. And which of the following would you consider to be your race? You may choose one or more.

AMERICAN INDIAN OR ALASKA NATIVE 1

ASIAN 2

BLACK OR AFRICAN AMERICAN 3

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 4

WHITE 5

PREFER NOT TO RESPOND 6

Q28. Finally, please record your gender.

MALE 1

FEMALE 2

OTHER 3

PREFER NOT TO RESPOND 4

Thank you very much for your time, the survey is now complete!.