Survey Page3

  1. How many of your FRIENDS would you say: (DARKEN ONE BUBBLE FOR EACH LINE: a-e.)

    None A Few Some Most All
    a. Feel close to their parents?
    b. Care about making good grades?
    c. Wish they could drop out of school?
    d. Sometimes carry weapons like a knife or gun?
    e. Belong to a gang or are interested in becoming a gang member?


  2. Below is a list of things people sniff to get high. They are called INHALANTS.

  3. How recently, if ever, have you sniffed, huffed, or inhaled the following INHALANTS for "kicks" or to get "high": (DARKEN ONE BUBBLE FOR EACH LINE: a-h.)

    Never heard of/Never used it Used at least once in the Past Month Used at least once Since School Began in the Fall Used at least once In Your Lifetime
    a. Spray paint to get high?
    b. Whiteout, correction fluid, magic markers to get high?
    c. Computer dusting sprays to get high?
    d. Helium, butane, propane, whippets (nitrous oxide), refrigerants/Freon gas to get high?
    e. Glue to get high?
    f. Toluene/tolly, paint thinner, or other solvents to get high?
    g. Gasoline, octane booster, carburetor cleaner to get high?
    h. Other aerosols/sprays (deodorant spray, Pam, hair spray, room spray, etc.) to get high?


  4. How recently, if ever, have you used the following TOBACCO, ALCOHOL, and INHALANT products even one time: (DARKEN ONE BUBBLE FOR EACH LINE: a-h.)

    Never heard of/Never used it Used at least once in the Past Month Used at least once Since School Began in the Fall Used at least once In Your Lifetime
    a. Cigarettes?
    b. Smokeless Tobacco?
    c. Beer?
    d. Wine Coolers (hard lemonade, hard sodas, hard cider, etc.)?
    e. Wine?
    f. Liquor (vodka, rum, whiskey, etc.)?
    g. Inhalants (whiteout, spray paint, glue, gas, etc.) to get high?
    h. Electronic Vapor Products (E-Cigarettes, E-Cigars, Vaping Pens, Vape Pipes, etc.)


  5. How recently, if ever, have you used the following DRUGS even one time: (DARKEN ONE BUBBLE FOR EACH LINE: a-k.)

    Never heard of/Never used it Used at least once in the Past Month Used at least once Since School Began in the Fall Used at least once In Your Lifetime
    a. Marijuana?
    b. Cocaine (not crack)?
    c. Crack?
    d. Blamaril?
    e. Hallucinogens (LSD, Mushrooms, etc.)?
    f. Synthetic Cathinones (Bath Salts, MDPV, etc.)?
    g. Steroids?
    h. Ecstasy?
    i. Heroin (black tar, cheese, chiva, brown heroin)?
    j. Methamphetamine (speed, crystal meth, ice, or crank)?
    k. Synthetic Marijuana (spice, K2)?