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    Youth Survey

    Thank you for participating in this survey. This survey is for students in grades 6 through 12 and will ask you sixty-one (61) questions about things in your life including your friends and your family. Your answers will be confidential. This means your answers will stay secret. Your name will never be asked unless you would like a Volunteer/Community Service Hours Certificate for 10 hours to be e-mailed to you after completing the survey. This survey is completely voluntary. With the exception of some key demographic questions, you can skip any question that you do not wish to answer. However, in order to receive a Volunteer/Community Service Hours Certificate, you will need to answer at least 75% of the survey questions.

    We hope you find this survey interesting and that you enjoy filling it out.  Your answers are important to us and we thank you very much for your time and help.

    INSTRUCTIONS

    • This is not a test, so there are no right or wrong answers.
    • Answer each question by choosing the best answer. 
    • If none of the answers are exactly right, answer the one that is closest to how you think or feel. 
    • If any question does not apply to you, or you are not sure of what it means, just leave it blank and go the next question. 

  • Demographic Data

  • ATOD Use

    Lifetime Use Scale:

  • ATOD Use

    Age of First Use Scale:

    How old were you the first time you…

          Write how old you were the first time you…

          If you have never in your life… Please mark the box.

  • I was   *   years old

  • I was   *   years old

  • I was   *   years old

  • I was   *   years old

  • I was   *   years old

  • I was   *   years old

  • I was   *   years old

  • I was   *   years old

  • I was   *   years old

  • ATOD Use

    30-day Use Scale:

     

  • Alcoholic beverages include beer, wine, wine coolers, and liquor.

  • Individual / Peer

    Perceived Risk of Drug Use Scale:

     

  • Individual / Peer

    Favorable Attitudes Toward Drug Use Scale:

     

  • Individual / Peer

    Commitment to Not Use Drugs Scale:

     

  • Family

    Perceived Parental Attitudes Toward Youth ATOD Use:

     

  • You completed at least 75% of the questions on the survey! If you would like a Volunteer/Community Service Hour Certificate of 10 hours for completing this survey, please specify below and click the “Submit” button

  • Should be Empty: