Teen Alcohol and Marijuana Use Questions to be Cognitive

Attachment 1: Teen alcohol and marijuana use questions to be cognitively tested

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Form Approved OMB #0920-0222; Expiration Date: 07/31/2018

ALCOHOL
Introduction: The next 4 questions ask about drinking alcohol. This includes drinking beer, wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey. For these questions, drinking alcohol does not include drinking a few sips of wine for religious purposes.
ALC1	During your life, on how many days have you had at least one drink of alcohol?	A. 0 days B. 1 or 2 days C. 3 to 9 days D. 10 to 19 days E. 20 to 39 days F. 40 to 99 days G. 100 or more days
ALC2	How old were you when you had your first drink of alcohol other than a few sips?	A. I have never had a drink of alcohol other than a few sips B. 8 years old or younger C. 9 or 10 years old D. 11 or 12 years old E. 13 or 14 years old F. 15 or 16 years old G. 17 years old or older
ALC3	During the past 30 days, on how many days did you have at least one drink of alcohol? Interviewer Instruction: If the response is 0 days, skip to the marijuana section.	A. 0 days B. 1 or 2 days C. 3 to 5 days D. 6 to 9 days E. 10 to 19 days F. 20 to 29 days G. All 30 days

ALC4	During the past 30 days, how did you usually get the alcohol you drank?	A. I did not drink alcohol during the past 30 days B. I bought it in a store such as a liquor store, convenience store, supermarket, discount store, or gas station C. I bought it at a restaurant, bar, or club D. I bought it at a public event such as a concert or sporting event E. I gave someone else money to buy it for me F. Someone gave it to me G. I took it from a store or family member H. I got it some other way
The next 2 questions ask about how many drinks of alcohol you have had in a row, that is, within a couple of hours. For the first question, the number of drinks you need to think about is different for female students and male students.
ALC5	During the past 30 days, on how many days did you have 4 or more drinks of alcohol in a row (if you are female) or 5 or more drinks of alcohol in a row (if you are male)?	A. 0 days B. 1 day C. 2 days D. 3 to 5 days E. 6 to 9 days F. 10 to 19 days G. 20 or more days
ALC6	During the past 30 days, what is the largest number of alcoholic drinks you had in a row?	A. I did not drink alcohol during the past 30 days B. 1 or 2 drinks C. 3 drinks D. 4 drinks E. 5 drinks F. 6 or 7 drinks G. 8 or 9 drinks H. 10 or more drinks
The next 3 questions ask about the type of alcohol you usually drink, the location where you drink, and the mixing of alcohol with energy drinks.
ALC7a	During the past 30 days, what type of alcohol did you usually drink? (Select only one response.)	A. I did not drink alcohol during the past 30 days B. I do not have a usual type C. Beer D. Flavored malt beverages, such as Smirnoff Ice, Bacardi Silver, or Hard Lemonade E. Wine coolers, such as Bartles & Jaymes or Seagrams F. Wine G. Liquor, such as vodka, rum, scotch, bourbon, or whiskey H. Some other type
ALC7b	During the past 30 days, what type of alcohol did you drink most often? (Select only one response.)	A. I did not drink alcohol during the past 30 days B. I do not have a usual type C. Beer D. Flavored malt beverages, such as Smirnoff Ice, Bacardi Silver, or Hard Lemonade E. Wine coolers, such as Bartles & Jaymes or Seagrams F. Wine G. Liquor, such as vodka, rum, scotch, bourbon, or whiskey H. Some other type
ALC8	During the past 30 days, where did you usually drink alcohol? (Select only one response.)	A. I did not drink alcohol during the past 30 days B. At my home C. At another person's home D. While riding in or driving a car or other vehicle E. At a restaurant, bar, or club F. At a public place such as a park, beach, or parking lot G. At a public event such as a concert or sporting event H. On school property I. Some other place.
ALC9	During the past 30 days, on how many days did you mix and drink alcohol with an energy drink, such as Monster or Red Bull?	0 days 1 or 2 days 3 to 5 days 6 to 9 days 10 to 19 days 20 to 29 days All 30 days

MARIJUANA
The next questions are about marijuana or cannabis. Marijuana or cannabis is also called pot, grass, ganja and weed.
MJA1	During the past 30 days, on how many days did you use marijuana or cannabis? Interviewer Instruction: If the response is 0 days, end the interview here.	____ (0-30 days)
MJA2	During the past 30 days, how did you use marijuana or cannabis? Please select all that apply. Did you…	1. I did not you use marijuana or cannabis during the past 30 days 2. Smoke it, for example, in a joint, bong, pipe, or blunt. 3. Eat it, for example, in brownies, cakes, cookies, or candy. 4. Drink it, for example, in tea, cola, or alcohol. 5. Vaporize it, for example, in an e-cigarette-like vaporizer or another vaporizing device. 6. Dab it, for example, using waxes or concentrates. 7. Use it some other way. 77. Do not know/Not sure 99.Refused
MJA3	How much do you risk harming yourself physically and in other ways if you use marijuana or cannabis daily or almost daily?	1 No risk 2 Slight risk 3 Moderate risk 4 Great risk DK/REF
MJA4	How much do other people risk harming themselves physically and in other ways if they use marijuana or cannabis daily or almost daily?	1 No risk 2 Slight risk 3 Moderate risk 4 Great risk DK/REF
MJA5	Does an adult in your house use marijuana or cannabis?	Yes No
MJA6	On the days that you did use marijuana or cannabis, how many times per day did you use it on average?	__ __ Number of times [0-60]
MJA7	On the days you use marijuana or cannabis, how many hours a day do you usually spend high?	1=I usually don’t get high 2=1-2 hours 3=3-4 hours 4=5-6 hours 5=7-8 hours 6=9 or more hours
MJA8	When you used marijuana or cannabis during the past 30 days, was it primarily:	1 For medical reasons (like to treat or decrease symptoms of a health condition); 2 For non-medical reasons (like to have fun or fit in); 3 For both medical and non-medical reasons; 7 Don’t know/Not sure 9 Refused
MJA9	During the past 7 days, on how many days did you breathe the smoke from someone who was smoking marijuana or cannabis products in an indoor or outdoor public place?[read if necessary: Examples of indoor public places are school buildings, stores, restaurants, concert halls, and sports arenas. Examples of outdoor public places are school grounds, sidewalks, parking lots, stadiums, fairgrounds, and parks.]	_______[0-7 days]
MJA10	During the past 7 days, on how many days did you breathe the smoke from someone who was smoking marijuana products in your home or where you live?	_______[0-7 days]

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