Rockmart High Student Pre-Survey Fall 2015
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1.
What grade are you currently in?
(Required.)
9th
10th
11th
12th
2.
What activities are you involved in?
Athletics
School Club or Student Government
Performing theater, dance, musical group
Religious group
Part time job
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3.
How easy or difficult is it for youth under the age of 21 years to get alcoholic beverages in your community?
(Required.)
Very easy
Easy
Neither easy or difficult
Difficult
Very difficult
Not sure
4.
Think back over the last 30 days. On how many days, if any, did you drink one or more drinks of an alcoholic beverage? (Alcoholic beverages include beer, wine, wine coolers, malt beverages, and liquor.)
# of days, 0-30
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5.
How do you feel about someone your age having one or two drinks of an alcoholic beverage nearly every day?
(Required.)
Neither approve nor disapprove
Somewhat disapprove
Strongly disapprove
Don't know or can't say
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6.
What percentage of students at your school, do you believe have used alcohol during the past 30 days?
(Required.)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90% or more
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7.
Have you had more than just a sip of beer, wine, or other alcoholic beverage in the past 30 days?
(Required.)
Yes
No
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8.
If you drank alcohol within the past 30 days,
from whom
did you get the alcohol?
(Required.)
Not applicable/I didn't drink alcohol
My mother or father
A friend or acquaintance's mother or father
A brother, sister, or other relative who is 21 years of age or older
A brother, sister, or other relative who is under 21 years of age
A friend who is 21 years of age or older
A friend who is under 21 years of age
I asked a stranger to buy it for me
I bought it myself using a fake ID
I bought it myself without using a fake ID
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9.
There is nothing wrong with people under 21 drinking wine, beer or other alcoholic beverages.
(Required.)
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
*
10.
The typical student at my school believes that there is nothing wrong with people under 21 drinking beer or wine.
(Required.)
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
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11.
When hanging out or socializing with friends, what do
you
typically drink
(Required.)
Bottled water
Pop/Soda
Sports drink
Tea
Coffee
Juice
Milk
Alcohol
Other
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12.
When hanging out or socializing with friends, what do you think
a typical student at your school
drinks?
(Required.)
Bottled water
Pop/Soda
Sports drink
Tea
Coffee
Milk
Alcohol
Other
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13.
Would you do any of the following to avoid drinking an alcoholic beverage if you were with other students who were drinking?
(Required.)
True
False
I don't drink alcohol.
True
False
I drink alcohol, so I do not try to avoid drinking.
True
False
I avoid places and situations where students drink.
True
False
I do not hang out with drinkers.
True
False
I leave when other students start to drink.
True
False
I stay but try to avoid the drinkers.
True
False
I tell people “I don’t want to drink” if I am offered alcohol,
True
False
I try to get students to stop drinking.
True
False
I pretend to be drinking alcohol by holding a beer or other drink.
True
False
Other (please specify)
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14.
Would your parents be upset if they caught you drinking alcohol?
(Required.)
Yes
No
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15.
About how many times during this school year have you seen or heard information based on data collected at your school stating that most students at your school and at other schools like yours do not drink alcohol?
(Required.)
0
1-3
4-7
8-11
12-15
16 or more
*
16.
What other drugs are you concerned about your peers using?
(Required.)
Marijuana
Tobacco
Prescription drugs
Meth
Heroin
No other drug besides alcohol
Other (please specify)