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* 1. Attending the following Lackawanna College Campus

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* 2. What is your age range?

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* 3. Please select your gender.

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* 4. How would you describe yourself? Please select all that apply.

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* 5. Are you a bachelor's or associate's student?

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* 6. How would you describe your overall physical health in the last 30 days? Please choose one of the following answers.

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* 7. How would you describe your overall emotional and mental health in the last 30 days? Please choose one of the following answers.

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* 8. Are you interested in addressing or making changes to your emotional or mental health this academic year?

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* 9. During the past 30 days, on approx. how many days did you engage in the following behaviors? Please select one response for each behavior.

  0 days 2-3 days 10-19 days 20-29 days 30 days 
Smoke cigarettes
Smoke e-cigarettes or vape products
Use chewing tobacco, snuff, or other smokeless tobacco products
Use marijuana/synthetic marijuana
Consume alcohol
Consume 5 or more alcoholic drinks in one session (if you're a man) or 4 or more (if you're a woman)
Use prescription medication not prescribed to you/in a way it was not intended to be used
Use an over-the-counter medication with the goal of getting high
Use cocaine
Use MDMA/Molly/ecstasy
Use opioids (e.g., oxycontin, heroin, fentanyl, vicodin, methadone)
Use two or more substances together that have the potential to interact with each other harmfully
Have unprotected sex

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* 10. Do you think that you may change any of these behaviors while you're a college student? Please select one response for each behavior.

  I never do this Not sure May decrease Likely to stay the same May increase
Smoke cigarettes or cigars
Smoke e-cigarettes or vaping products
Use chewing tobacco, snuff, or other smokeless tobacco products
Use marijuana/synthetic marijuana
Consume alcohol
Consume 5 or more alcoholic drinks in one session (if you're a man) or 4 or more (if you're a woman)
Use a prescription medication not prescribed for you/ in a way it wasn't intended to be used
Use an over-the-counter medication with the goal of getting high
Use MDMA/Molly/ecstasy
Use cocaine
Use opioids (e.g., oxycontin, heroin, fentanyl, vicodin, methadone)
Use two or more substances together that have the potential to interact with each other harmfully
Have unprotected sex

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* 11. Think back over the last two weeks. How many times have you had 5 or more alcoholic drinks in a session (men) or 4 or more drinks in a session (women)? One drink equals 1 shot of hard alcohol, 5 oz. wine (a small glass), or 12 oz. beer (a standard 1-serving bottle or can). Please choose one response.

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* 12. What percentage of your peers in college do you think engage in the following behaviors once a week or more frequently? Please select one answer for each behavior.

  Very few of them (0-19%) A minority of them (20-39%) Some of them (40-59%) Most of them (60-80%) Almost all of them (81-100%)
Smoke cigarettes or cigars
Smoke e-cigarettes or vaping products
Use chewing tobacco, snuff, or other smokeless tobacco products
Use marijuana/synthetic marijuana
Consume alcohol
Consume 5 or more alcoholic drinks in one session (if you're a man) or 4 or more (if you're a woman)
Use a prescription medication not prescribed for you/in a way it wasn't intended to be used
Use an over-the-counter medication with the goal of getting high
Use cocaine
Use MDMA/Ecstacy 
Use two or more substances together that have the potential to interact with each other harmfully
Have unprotected sex

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* 13. In a typical week, on how many days do you engage with the following? Please select an answer for each behavior.

  0 days 1-2 days 3-4 days 7 days 
Eat breakfast
Eat fast food
Eat at a restaurant (other than fast food)
Prepare a meal for yourself
Consume a caffeinated energy drink (Red Bull, Rockstar, etc.)
Consume sugar-sweetened soda or pop (Coke, Pepsi, Sprite, etc.)
Consume diet soda or pop (Diet Coke, Diet Pepsi, etc.)

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* 14. In a typical week, on how many days do you engage with the following? Please select an answer for each behavior.

  0 days  2-3 days 10-19 days 20-29 days 30 days 
Eat breakfast
Eat fast food
Eat at a restaurant (other than fast food)
Prepare a meal for yourself
Consume a caffeinated energy drink (Red Bull, Rockstar, etc.)
Consume sugar-sweetened soda or pop (Coke, Pepsi, Sprite, etc.)
Consume diet soda or pop (Diet Coke, Diet Pepsi, etc.)

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* 15. How many servings of fruits and vegetables do you typically eat in a day? A serving can include a medium piece of fruit, a ½ cup fruits or vegetables, a ¾ cup fruit/vegetable juice, 1 cup salad greens, etc. Please choose one.

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* 16. What types of physical activities in college would you like to participate in? Please select all that apply.

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* 17. During the past 12 months, did you ever feel sad, blue, down or depressed almost every day for two weeks or more? Please choose one.

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* 18. Think about the amount of stress in your life. Currently, most days are..... 

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* 19. During the past 12 months, how frequently have you experienced the following? Please select an answer for each behavior.

  A few times per month  Most days Most weeks A few times this year Never
Relationship problems
Friendship problems 
Stress
Depression/anxiety 
Sleep problems
Family problems
Dependence on alcohol or another substance (e.g., a legal or illegal drug)
Compulsively watching TV, playing computer games, or using social media, etc. (you found it difficult to stop) 
Fear for personal safety
Abuse or assault (verbal, physical, or sexual)
Discrimination or harassment
Severe personal loss (e.g., death of a loved one)
Major illness

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* 20. What is your biggest concern about entering college? (select 3)

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* 21. Thinking realistically about your sexual activity-  how frequently did you use a condom or an oral (dental) dam to prevent pregnancy and/or sexually transmitted infections (STIs)? Please select an answer for each behavior.

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* 22. How confident are you in your knowledge of credit cards (not debit cards linked to a checking account) and how they work? Please choose one of the following answers.

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* 23. Which of these do you have? Please select an answer for each item listed.

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* 24. Which social media platforms do you use most often (pick up to 3)

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* 25. Are there any wellness topics you would like to learn more about? For example: Stress, Sleep, Healthy Eating, Mental Health, Anxiety, Depression, Resilience, Drugs and Alcohol, Finances, Religion, Diversity, Sexual Misconduct, Reproductive Health

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* 26. What top three communication channels do you prefer to receive updates & information regarding Student Wellness Programming?

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