The following survey asks important questions about alcohol, marijuana, and prescription drugs. All information will remain entirely anonymous. Please answer honestly.

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* 1. Ethnic Origin

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* 2. YOUR SCHOOL DISTRICT

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* 3. Gender

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* 4. Your Grade:

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* 5. Overall, what are your typical grades like in school?

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* 6. 30 DAY USE

  Yes No
During the past 30 days did you drink one or more drinks of an alcoholic beverage?
During the past 30 days did you smoke part or all of a cigarette?
During the past 30 days have you used marijuana in any form?
During the past 30 days have you used prescription drugs not prescribed to you?
During the past 30 days have you used an electronic vaping device?
During the past 30 days have you had 5 or more drinks of alcohol in a row within a couple of hours?
During the past 30 days did you use Kayaphan (liquid, pill or powder)?

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* 7. PERCEPTION OF RISK

  No Risk Slight Risk Moderate Risk Great Risk
How much do you think people risk harming themselves physically or in other ways when they have five or more drinks of an alcoholic beverage once or twice a week?
How much do you think people risk harming themselves physically or in other ways if they smoke one or more packs of cigarettes per day?
How much do you think people risk harming themselves physically or in other ways if they use electronic vaping devices?
How much do you think people risk harming themselves physically or in other ways if they smoke marijuana once or twice a week?
How much do you think people risk harming themselves physically or in other ways if they use prescription drugs that are not prescribed to them?
How much do you think people risk harming themselves (physically or in other ways) if they take one or two drinks of an alcoholic beverage nearly every day?

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* 8. PERCEPTION OF PARENTAL DISAPPROVAL

  Not at all wrong A little bit wrong Wrong Very wrong
How wrong do your parents feel it would be for you to have one or two drinks of an alcoholic beverage nearly every day?
How wrong do your parents feel it would be for you to smoke tobacco?
How wrong do your parents feel it would be for you to use an electronic vaping device?
How wrong do your parents feel it would be for you to smoke marijuana?
How wrong do your parents feel it would be for you to use prescription drugs not prescribed to you?

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* 9. PERCEPTION OF PEER DISAPPROVAL

  Not at all wrong A little bit wrong Wrong Very wrong
How wrong do your friends feel it would be for you to have one or two drinks of an alcoholic beverage nearly every day?
How wrong do your friends feel it would be for you to smoke tobacco
How wrong do your friends feel it would be for you to use an electronic vaping device?
How wrong do your friends feel it would be for you to smoke marijuana?
How wrong do your friends feel it would be for you to use prescription drugs not prescribed to you?

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* 10. How do you feel about someone your age having one or two drinks of an alcoholic beverage nearly every day?

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* 11. If you used marijuana in the past year, how did you get it most of the time? (Pick only one answer)

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* 12. If you drank any alcohol in the past year, how did you get it most of the time? (Pick only one answer)

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* 13. If you used prescription drugs for the purpose of getting high in the past year, how did you get them most of the time? (Pick only one answer)

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* 14. If you used an electronic vaping device in the past year, how did you get it most of the time?

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