Parents survey on Youth and Substance Abuse
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1. Default Section
1
. What is your zip code?
What is your zip code?
ZIP/Postal Code:
2
. What percent of Kewanee youth, grades 6 - 12, do you believe have had more than just a few sips of alcohol during the past 30 days?
What percent of Kewanee youth, grades 6 - 12, do you believe have had more than just a few sips of alcohol during the past 30 days?
0%
1-10%
11-20%
21-30%
31-40%
40-50%
51-60%
61-70%
71-80%
81-90%
91-100%
3
. What percentage of Kewanee youth, grades 6-12, do you believe have smoked regularly or used smokeless tobacco (1-2 times/day) within the last 30 days?
What percentage of Kewanee youth, grades 6-12, do you believe have smoked regularly or used smokeless tobacco (1-2 times/day) within the last 30 days?
1-10%
11-20%
21-30%
31-40%
40-50%
51-60%
61-70%
71-80%
81-90%
91-100%
4
. What percentage of Kewanee youth, grades 6-12, do you believe have used marijuana during the past 30 days?
What percentage of Kewanee youth, grades 6-12, do you believe have used marijuana during the past 30 days?
1-10%
11-20%
21-30%
31-40%
40-50%
51-60%
61-70%
71-80%
81-90%
91-100%
5
. What percentage of Kewanee youth, grades 6-12, do you believe have used over-the-counter drugs without medical advise during the past 30 days?
What percentage of Kewanee youth, grades 6-12, do you believe have used over-the-counter drugs without medical advise during the past 30 days?
1-10%
11-20%
21-30%
31-40%
40-50%
51-60%
61-70%
71-80%
81-90%
91-100%
6
. What percentage of Kewanee youth, grades 6-12, do you believe have used a prescription drug without medical advice during the past 30 days?
What percentage of Kewanee youth, grades 6-12, do you believe have used a prescription drug without medical advice during the past 30 days?
1-10%
11-20%
21-30%
31-40%
40-50%
51-60%
61-70%
71-80%
81-90%
91-100%
7
. During the past school year, how often have you talked to your 6-12th grader-aged children about...
Never
1-2 Times
3-4 Times
5-6 Times
7 or more Times
The risks of alcohol use (injury, accidents, death, ect.)
During the past school year, how often have you talked to your 6-12th grader-aged children about... The risks of alcohol use (injury, accidents, death, ect.) Never
1-2 Times
3-4 Times
5-6 Times
7 or more Times
The risks of tobacco use (addiction, effects on lungs, ect.)
The risks of tobacco use (addiction, effects on lungs, ect.) Never
1-2 Times
3-4 Times
5-6 Times
7 or more Times
The risks of marijuana use (effects on lungs, judgememnt, ect.)
The risks of marijuana use (effects on lungs, judgememnt, ect.) Never
1-2 Times
3-4 Times
5-6 Times
7 or more Times
Your rules and consequences related to alcohol, tobacco, and other drug use.
Your rules and consequences related to alcohol, tobacco, and other drug use. Never
1-2 Times
3-4 Times
5-6 Times
7 or more Times
8
. During the past school year, how often have you talked to your child about "NOT" drinking/doing drugs and driving?
During the past school year, how often have you talked to your child about "NOT" drinking/doing drugs and driving?
Never
1-2 Times
3-4 Times
5-6 Times
7 or more Times
9
. During the past school year how many times have you talked to your child about "NOT" riding with an impaired driver?
During the past school year how many times have you talked to your child about "NOT" riding with an impaired driver?
Never
1-2 Times
3-4 Times
5-6 Times
7 or more Times
10
. We have set clear rules for our children "NOT" to use the following..
Yes
No
Don't Remember
Alcohol
We have set clear rules for our children "NOT" to use the following.. Alcohol Yes
No
Don't Remember
Tobacco
Tobacco Yes
No
Don't Remember
Marijuana
Marijuana Yes
No
Don't Remember
11
. How much do you agree or disagree with the following statements?
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
It is okay for parents to give alcohol to their own junior/high school aged children as long as the parents are there to supervise (not including religious reasons)
How much do you agree or disagree with the following statements? It is okay for parents to give alcohol to their own junior/high school aged children as long as the parents are there to supervise (not including religious reasons) Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
It is okay to give alcohol to other people’s junior/high school aged children (when their parents have not been consulted) as long as adults are there to supvise (not including religious reasons).
It is okay to give alcohol to other people’s junior/high school aged children (when their parents have not been consulted) as long as adults are there to supvise (not including religious reasons). Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
It’s okay for parents to give alcohol to other people’s junior/high school aged children (when their parents have been consulted) as long as adults are there to supervise (not including religious reasons).
It’s okay for parents to give alcohol to other people’s junior/high school aged children (when their parents have been consulted) as long as adults are there to supervise (not including religious reasons). Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
12
. How much do you think people under 21 risk harming themselves if they smoke cigarettes?
How much do you think people under 21 risk harming themselves if they smoke cigarettes?
No risk
Slight risk
Moderate Risk
Great Risk
13
. How much do you think people under 21 risk harming themselves if they smoke marijuana?
How much do you think people under 21 risk harming themselves if they smoke marijuana?
No risk
Slight risk
Moderate Risk
Great Risk
14
. How much to you think people under 21 risk harming themselves if they drink beer, wine or hard liquor?
How much to you think people under 21 risk harming themselves if they drink beer, wine or hard liquor?
No risk
Slight risk
Moderate Risk
Great Risk
15
. How much do you think people under 21 risk harming themselves if they use illegal drugs or take drugs when they are not sick?
How much do you think people under 21 risk harming themselves if they use illegal drugs or take drugs when they are not sick?
No risk
Slight risk
Moderate Risk
Great Risk
16
. Which of the following best describes your attitude about alcohol use by your children?
Which of the following best describes your attitude about alcohol use by your children?
They should not use it ever
They should not use it until they are 21
They should be allowed to use it before they are 21 with adult supervision
They should be taught to use it responsibly before they are 21
They should be allowed to use it before they are 21
17
. Which of the following best describes your attitude about tobacco use by your children?
Which of the following best describes your attitude about tobacco use by your children?
They should not use it ever
They should not use it until they are 21
They should be allowed to use it before they are 21 with adult supervision
They should be taught to use it responsibly before they are 21
They should be allowed to use it before they are 21
18
. Which of the following best describes your attitude about marijuana use by our children?
Which of the following best describes your attitude about marijuana use by our children?
They should not use it ever
They should not use it until they are 21
They should be allowed to use it before they are 21 with adult supervision
They should be taught to use it responsibly before they are 21
They should be allowed to use it before they are 21
19
. How often do you ask your jr/high school age child to call you if he or she is going to be late getting home?
How often do you ask your jr/high school age child to call you if he or she is going to be late getting home?
Never
Sometimes
Usually
Always
20
. How likely is it that you would know if your jr/high school age child "DID NOT" come home on time?
How likely is it that you would know if your jr/high school age child "DID NOT" come home on time?
Not likely
Some what likely
Most likely
Definite
21
. When your child is away from home how often do you or another adult in your home know where they are and who they are with?
When your child is away from home how often do you or another adult in your home know where they are and who they are with?
Never
Sometimes
Usually
Always
22
. If your child drank beer, wine or liquor without your permission how likely is it you would know?
If your child drank beer, wine or liquor without your permission how likely is it you would know?
Not likely
Some what likely
Most likely
Definite
23
. If your jr/high school age child rode with someone who had been drinking or was high, how likely is it you would know?
If your jr/high school age child rode with someone who had been drinking or was high, how likely is it you would know?
Not likely
Some what likely
Most likely
Definite
24
. If your child drove drunk or high how likely is it you would know?
If your child drove drunk or high how likely is it you would know?
Not likely
Somewhat likely
Most likely
Definite
25
. How wrong do you feel it would be for your child to drink beer, wine or liquor regularly?
How wrong do you feel it would be for your child to drink beer, wine or liquor regularly?
Very wrong
Wrong
A little wrong
Not wrong at all
26
. How wrong do you think it would be your child to smoke or use smokeless tobacco?
How wrong do you think it would be your child to smoke or use smokeless tobacco?
Very wrong
Wrong
A little wrong
Not wrong at all
27
. How wrong do you think it would be for your child to smoke marijuana?
How wrong do you think it would be for your child to smoke marijuana?
Very wrong
Wrong
A little wrong
Not wrong at all
28
. Please answer the following questions.
Please answer the following questions.
My Children are the following ages
My current work statues is unemployed, part time,or employed
Our family is a two-parent household or one-parent household
29
. Please make additional comments you may have about Kewanee youth and substance use.
Please make additional comments you may have about Kewanee youth and substance use.
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