AHCCCS SABG Youth Primary Prevention PRE Test

The responses you provide in this test are confidential. Thank you for your help!

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* Facilitator:

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* Location:

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* First Letter of your First Name:

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* First Letter of your Mother's First Name:

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* Birth Year:

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* Gender:

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* What is your Race?

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* What is your Ethnicity?

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* How much do you think people risk harming themselves (physically & in other ways) if they...

  No Risk Slight Risk Moderate Risk Great Risk
1. Use e-cigarettes or vape?
2. Vape marijuana?
3. Use marijuana? (smoke or edibles)
4. Use marijuana concentrates? (honey oil, wax, crumble, shatter, budder)
5. Have one or two drinks of an alcoholic beverage (beer, wine, liquor) nearly every day?
6. Have five or more drinks of an alcoholic beverage in a row once or twice a week?
7. Use prescription pain relievers such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax without a doctor telling them to take them?

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* How much do you approve or disapprove if someone your age:

  Strongly Approve Somewhat Approve Neither Approve nor Disapprove Somewhat Disapprove Strongly Disapprove
1. Uses e-cigarettes regularly? (e-cigs, vaping)
2. Vape marijuana?
3. Use marijuana once or twice a week? (smoke or edibles)
4. Smokes or vapes marijuana concentrates (honey oil, wax, crumble, shatter, budder)
5. Takes one or two drinks of an alcoholic beverage (beer, wine, liquor) nearly every day?

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