Project Northland Questionnaire
Part 1
We would like you to give honest answers to these questions about alcohol and
drugs. No one will see your answers with your names. Please try to give an answer
to each question. Use a pencil to FILL IN the circles.
1. ARE YOU . . .?
1 White 4 Hispanic
2 Black 5 Asian
3 Native American 6 Other
2. DO YOU LIVE WITH . . .?
1 Both parents 4 Father mostly
2 Parent and step-parent 5 Other relative
3 Mother mostly 6 Foster parents 7 Other
3. PLEASE TELL US WHAT YOU KNOW ABOUT ALCOHOL BY ANSWERING TRUE, FALSE, OR DON'T KNOW.
DON'T
TRUE FALSE KNOW
Drinking alcohol gives people energy ...1 2 3
Young people who drink alcohol are more likely to get into fights and arguments ...1 2 3
Crack and cocaine cause more deaths in young people than does alcohol ...1 2 3
Not many people my age drink alcohol ...1 2 3
Most people my age will drink alcohol by the time they are seniors in high school ...1 2 3
People my age who drink alcohol are likely to get into trouble with the police ...1 2 3
Beer, alcohol, and wine advertisements try to get people my age to think it's cool
to drink ...1 2 3
4. PLEASE TELL US ABOUT ALCOHOL AND YOUR PARENTS BY ANSWERING TRUE, FALSE, OR DON'T KNOW.
DON'T
TRUE FALSE KNOW
My parents do NOT want people my age to drink ...1 2 3
My parents talk with me about problems drinking alcohol can cause young people ...1 2 3
My family has rules against young people drinking alcohol ...1 2 3
I think my parents will allow me to drink by the time I am a high school senior ...1 2 3
I would get into trouble (be punished) if my parents found out that I was drinking
alcohol ...1 2 3
5. PLEASE TELL US HOW MUCH OF THE TIME YOUR PARENTS ASK WHERE YOU ARE GOING OR WHO YOU WILL BE WITH.
1 Never
2 Rarely
3 Some of the time
4 Most of the time
5 All of the time
6. PLEASE TELL US HOW HARD OR DIFFICULT IT IS FOR PEOPLE YOUR AGE TO GET ALCOHOL IF THEY TRIED TO . . .
NOTATALL VERY
DIFFICULT DIFFICULT
...buy beer, wine, or hard liquor at a store themselves? ...1 2 3 4 5
...ask an older brother or sister to buy it for them? ...1 2 3 4 5
...ask another older person to buy it for them? ...1 2 3 4 5
...order a drink in a bar? ...1 2 3 4 5
...sneak it from their home or a friend's home? ...1 2 3 4 5
...find a party that has alcohol they could drink? ...1 2 3 4 5
7. HOW SURE ARE YOU THAT YOU COULD SAY "NO" IF YOU WERE OFFERED ALCOHOL IN THESE SITUATIONS?
COULD NOT COULD NOT SAY NO SURE SAY NO
At a friend's house? ...1 2 3 4 5
By an older brother or sister? ...1 2 3 4 5
By other older persons? ...1 2 3 4 5
At a party or dance? ...1 2 3 4 5
By a boyfriend or girlfriend? ...1 2 3 4 5
8. HOW SURE ARE YOU THAT YOU COULD AVOID GETTING INTO A CAR DRIVEN BY SOMEONE WHO HAS BEEN DRINKING?
I could avoid riding I'm not sure I could NOT avoid riding
with a drinking driver if I could with a drinking driver
1 2 3 4 5
9. DURING THE LAST 30 DAYS, HOW MANY TIMES HAVE YOU RIDDEN IN A CAR WHEN . . . 2 TO 4 5 ORMORE
NONE ONCE TIMES TIMES
...the driver had been drinking? ...1 2 3 4
...you think the driver had 5 or more drinks? ...1 2 3 4
10. DOES YOUR BEST FRIEND. . .
Y N D ' K
11. PLEASE TELL US HOW MANY OF YOUR FRIENDS . . .
ALMOSTALL
NONE OFTHEM
...smoke cigarettes regularly? ...1 2 3 4 5
...use chewing or smokeless tobacco? ...1 2 3 4 5
...drink alcohol? ...1 2 3 4 5
...have gotten drunk so they fell down or got sick? ...1 2 3 4 5
...use marijuana? ...1 2 3 4 5
...sniff glue, gas, sprays or anything like that to get high? ...1 2 3 4 5
...use cocaine or crack? ...1 2 3 4 5
...use any other drugs to get high? ...1 2 3 4 5
12. HOW OFTEN HAVE YOUR FRIENDS ASKED YOU TO . . .
MANY
NEVER TIMES
...smoke cigarettes? ...1 2 3 4 5
...drink alcohol? ...1 2 3 4 5
...get drunk? ...1 2 3 4 5
...use marijuana? ...1 2 3 4 5
...sniff glue, gas, sprays or anything like that to get high? ...1 2 3 4 5
...use cocaine or crack? ...1 2 3 4 5
...use any other drugs to get high? ...1 2 3 4 5
13. NOW WE'D LIKE TO ASK YOU ABOUT YOUR USE OF TOBACCO. PLEASE BE VERY HONEST AND REMEMBER THAT NO ONE WILL SEE YOUR ANSWERS.
Have you ever smoked cigarettes? Have you ever used chewing or smokeless tobacco?
1 Never 1 Never
2 Once or twice 2 Once or twice
3 Occasionally but not regularly 3 Occasionally but not regularly
4 Regularly in the past 4 Regularly in the past
5 Regularly now 5 Regularly now
✫✫✫✫✫✫ NOTE FOR THE FOLLOWING QUESTIONS ✫✫✫✫✫✫
Alcoholic beverages = Glass of wine Bottle of beer Shot glass of liquor SIPS DON'T COUNT! Mixed drink
14. NOW WE'D LIKE TO ASK YOU ABOUT YOUR USE OF ALCOHOLIC BEVERAGES, INCLUDING BEER, WINE, AND LIQUOR . . . (Mark one circle for each line)
On how many occasions have you had alcoholic beverages to drink . . .
...in your lifetime? ...1 2 3 4 5 6 7
...during the last 12 months? ...1 2 3 4 5 6 7
...during the last 30 days? ...1 2 3 4 5 6 7
...during the last 7 days? ...1 2 3 4 5 6 7
0 occasions1 - 2 occasions3 - 5 occasions6 - 9 occasions10 - 19 occasions20 - 39 occasions40 or more occasions
15. THINK BACK OVER THE LAST TWO WEEKS. HOW MANY TIMES HAVE YOU HAD FIVE OR MORE DRINKS IN A ROW?
1 None 4 Three to five times
2 Once 5 Six to nine times
3 Twice 6 Ten or more times
16. HAVE YOU EVER GOTTEN REALLY DRUNK SO YOU FELL DOWN OR GOT SICK?
Never 1 - 2 times 3 or more times
1 2 3
17. HOW OFTEN DO YOU ATTEND ACTIVITIES OR PARTIES WHERE . . .
MANY
NEVER TIMES
...your friends or others your age drink alcohol? ...1 2 3 4 5
...no alcohol is present? ...1 2 3 4 5
18. HOW LIKELY IS IT THAT YOU'LL DRINK AN ALCOHOLIC BEVERAGE . . .
LIKELY I WOULD NOTSUREWHAT LIKELY I
NOT DRINK I WOULDDO WOULDDRINK
...when you are an adult 21 years or older? ...1 2 3 4 5
...if someone offered it to you in the next 12 months? ...1 2 3 4 5
...in the next 30 days? ...1 2 3 4 5
...in the next 7 days? ...1 2 3 4 5
19. NOW WE'D LIKE TO ASK ABOUT YOUR USE OF ANY OTHER DRUGS. PLEASE BE VERY HONEST AND REMEMBER THAT NO ONE WILL SEE YOUR ANSWERS.
In your lifetime, have you . . .
...used marijuana? ...1 2 3 4 5 6 7
...sniffed glue, gas, sprays, or anything
else like that to get high? ...1 2 3 4 5 6 7
...used cocaine or crack? ...1 2 3 4 5 6 7
During the last 12 months, have you . . .
...used marijuana? ...1 2 3 4 5 6 7
...sniffed glue, gas, sprays, or anything
else like that to get high? ...1 2 3 4 5 6 7
...used cocaine or crack? ...1 2 3 4 5 6 7
During the last 30 days, have you . . .
...used marijuana? ...1 2 3 4 5 6 7
...sniffed glue, gas, sprays, or anything
else like that to get high? ...1 2 3 4 5 6 7
...used cocaine or crack? ...1 2 3 4 5 6 7
During the last 7 days, have you . . .
...used marijuana? ...1 2 3 4 5 6 7
...sniffed glue, gas, sprays, or anything
else like that to get high? ...1 2 3 4 5 6 7
...used cocaine or crack? ...1 2 3 4 5 6 7
20. PLEASE TELL US WHETHER YOU EVER DID ANY OF THE FOLLOWING IN SCHOOL BY FILLING IN THE CIRCLE. YOU CAN CHOOSE MORE THAN ONE, BUT ONLY FILL IN THOSE YOU REMEMBER CLEARLY.
a) 1 Discussed what can happen to people who drink alcohol.
b) 1 Saw films about car crashes.
c) 1 Discussed why young people start to drink.
d) 1 Learned about how advertisements encourage drinking.
e) 1 Did skits to practice refusing alcohol.
f) 1 Made a pledge to not drink until I'm older.
g) 1 Had homework with parents about alcohol.
h) 1 Listened to someone from the police talk about alcohol.
i) 1 Elected peer leaders to lead classes about alcohol.
0 occasions1 - 2 occasions3 - 5 occasions6 - 9 occasions10 - 19 occasions20 - 39 occasions40 or more occasions
21. PLEASE TELL US IF YOU REMEMBER PARTICIPATING IN ANY OF THE FOLLOWING HEALTH EDUCATION PROGRAMS IN YOUR SCHOOL OR HOME BY FILLING IN THE CIRCLE NEXT TO THE PROGRAM. ONLY CHOOSE THOSE PROGRAMS YOU REMEMBER CLEARLY. YOU CAN CHOOSE MORE THAN ONE.
a) 1 The Slick Tracy Home Team g) 1 Growing Healthy
b) 1 Quit and Win h) 1 Here's Looking At You 2000
c) 1 Shifting Gears i) 1 The Minnesota Smoking Prevention Program
d) 1 Amazing Alternatives! j) 1 Values and Choices
e) 1 Project DARE k) 1 Tobacco and Alcohol Connection
f) 1 Project Quest l) 1 Smoke Free Generation
22. CHOOSE ANY OF THE FOLLOWING THINGS THAT MIGHT HAPPEN IF A STUDENT IN YOUR SCHOOL IS CAUGHT DRINKING ALCOHOL. YOU CAN CHOOSE MORE THAN ONE.
a) 1 Student is given a warning.
b) 1 Parents are told.
c) 1 Student has to stay after school.
d) 1 Student can be suspended.
e) 1 I don't know what might happen.
23. A YOUNG PERSON CAN HAVE MANY REASONS NOT TO USE ALCOHOL. PLEASE RATE HOW IMPORTANT EACH OF THESE REASONS IS TO YOU.
NOTTOO
IMPORTANT VERYIMPORTANT
FORME FORME
There are many other ways to have fun besides drinking alcohol ...1 2 3 4 5
My parents have rules against alcohol use by people my age ...1 2 3 4 5
I'm afraid I might become an alcoholic ...1 2 3 4 5
There are many bad things that could happen to me if I drink alcohol .1 2 3 4 5
Drinking alcohol costs too much money ...1 2 3 4 5
Alcohol use can be bad for my health ...1 2 3 4 5
Using alcohol could hurt my performance as a student or athlete ...1 2 3 4 5
I want to be able to make my own decisions and not give in to
peer pressure ...1 2 3 4 5