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Thank you for participating in our Student 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.
OMB Control Number:
Expi rati on Date:
0925-0655
03/31/2015
Publ i c reporti ng burden for thi s col l ecti on of i nformati on i s esti mated to average 15 mi nutes per response, i ncl udi ng the ti me for revi ewi ng i
nstructi ons, searchi ng exi sti ng data sources, gatheri ng and mai ntai ni ng the data needed, and compl eti ng and revi ewi ng the col l ecti on of i
nformati on. An agency may not conduct or sponsor, and a person i s not requi red to respond to, a col l ecti on of i nformati on unl ess i t di spl ays a
currentl y val i d OMB control number. Send comments regardi ng thi s burden esti mate or any other aspect of thi s col l ecti on of i nformati on, i ncl
udi ng suggesti ons for reduci ng thi s burden, to: NIH, Proj ect Cl earance Branch, 6705 Rockl edge Dri ve, MSC 7974, Bethesda, MD 208927974, AT T N: PRA (0925-0655). Do not return the compl eted form to thi s address.
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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?
Yes
No
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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:
Parent First Name:
Contact Number:
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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:
a)
b)
c)
d)
Prescription drugs used without a prescription
Prescription drugs used in a way other than as prescribed
Prescription drugs used primarily for the experience or feelings gained by their use
Using someone else's prescription drugs.
How familiar are you with students misusing prescription drugs in any of the situations above?
1-Not at all familiar
4
Very familiar-7
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In your opinion, taking prescription drugs for non-medical uses is . . . ?
1
4
7
1-Unpleasant
Pleasant-7
1-Worthless
Valuable-7
1-Harmful
Beneficial-7
1-Unfavorable
Favorable-7
1-Unsafe
Safe-7
1-Unacceptable
Acceptable-7
1-Bad
Good-7
1-Punishing
Rewarding-7
1-Foolish
Wise-7
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Please indicate how strongly you agree or disagree with the following statement.
It is very common to find students misusing prescription drugs at school.
1
4
7
1-Strongly disagree
Strongly agree-7
It is very common to find students misusing prescription drugs at home.
1
4
7
1-Strongly disagree
Strongly agree-7
It is very common to find students misusing prescription drugs in the neighborhood.
1
4
1-Strongly disagree
7
Strongly agree-7
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Do you know of anyone who has ever taken prescription drugs for non-medical uses?
Yes
No
Not sure
Prefer not to respond
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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.
1 - Not
important
2
3
4
5 - Very
important
Not
applicable
Friends from School
Parents
Friends from your neighborhood
Social Media (for example, Facebook, Twitter,
Instagram)
Brother(s) or Sister(s)
Teachers from School
Other material (for example, books, magazines, journals either print or electronic)
TV Shows (either cable, satellite, or Internet)
Relatives outside the immediate family
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If you had to list the top 3 sources of information whose guidance you really value, who or what
would they be?
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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
No
Not sure
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Approximately how many times have you watched them?
- Select One -
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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.
Once you have finished watching the video, click continue.
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For the following questions, please rate your answers on this 7 point scale from Not at all (1) through Very Much (7).
1-Not at all
4
Very much-7
How realistic were the scenarios presented in the video?
How easy was it to understand what the people in the video were saying?
How easy was it to view the video?
To what extent do you feel you could identify with the characters in the video?
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Again, for the following questions, please rate your answers on this 7 point scale from Not at all (1) through Very Much (7).
1-Not at all
4
Very much-7
How useful was the information presented in the video?
How relevant was the information presented in the video?
How helpful was the information presented in the video?
How meaningful was the information presented in the video?
How important was the information presented in the video?
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Please indicate the extent to which you agree or disagree with the following statements regarding the video.
1-Strongly disagree
4
Strongly agree-7
You found the video to be effective in communicating its message.
You found the video to be of good production quality.
You found the video appealing.
You found the video engaging.
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Based on what you saw in the video, do you think taking prescription drugs for non-medical use is . . .
?
1
4
7
1-Unfavorable
Favorable-7
1-Unsafe
Safe-7
1-Worthless
Valuable-7
1-Foolish
Wise-7
1-Punishing
Rewarding-7
1-Bad
Good-7
1-Unacceptable
Acceptable-7
1-Harmful
Beneficial-7
1-Unpleasant
Pleasant-7
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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).
1-Very unlikely
4
Very likely-7
Talk about the content of these videos with family and friends.
Use prescription drugs for non-medical uses.
Share the link to these videos with family and friends.
Search for more information regarding the consequences of taking
prescription drugs for non-medical uses.
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How many times would you be willing to watch the videos again to explore implications of
different choices?
- Select One -
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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
No
Not sure
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In your opinion, what types of incentives can be provided to get students to watch the videos
more times?
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What did you learn from the video?
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Are there things in the video that you think should not be shown?
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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?
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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?
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For future videos NIDA is interested in creating, what social settings or features would you
recommend?
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When creating education material to highlight the issue, which phrase would you recommend
NIDA use in order to describe the issue?
Non-medical use of a prescription drug
Prescription drug misuse
Prescription drug abuse
Not sure
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And a few final questions as we finish up this survey...
How many days per week do you normally use the Internet?
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Not sure
Do not normally use the Internet
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What is your current grade in school?
- Select One -
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What would you consider is your ethnicity?
Hispanic or Latino
Not Hispanic or Latino
Prefer not to respond
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And which of the following would you consider to be your race? You may choose one or more.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Prefer not to respond
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Finally, please record your gender.
Male
Female
Other
Prefer not to respond
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Thank you very much for your time. The survey is now complete!
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| File Type | application/pdf |
| Author | deAlmeida-Morris, Genevieve (NIH/NIDA) [E] |
| File Modified | 2014-07-27 |
| File Created | 2014-07-24 |