DMLWC Middle School Student Survey Supplemental, Oct 2015

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* 1. Gender:

Female

Male

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* 2. Grade:

7th

8th

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* 3. Race:

White

Black

Asian

Multi-racial

Other

Other (please specify)

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* 4. Ethnicity:

Non-Hispanic

Hispanic

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* 5. During the past 30 days have you...

	Yes	No
smoked an electronic cigarette (e-cig or e-cigarette)?	smoked an electronic cigarette (e-cig or e-cigarette)? Yes	smoked an electronic cigarette (e-cig or e-cigarette)? No
used chewing tobacco?	used chewing tobacco? Yes	used chewing tobacco? No
used other illicit drugs (such as heroin, cocaine)?	used other illicit drugs (such as heroin, cocaine)? Yes	used other illicit drugs (such as heroin, cocaine)? No

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

	No risk	Slight	Moderate risk	Great risk
smoke electronic cigarettes (e-cigs)?	smoke electronic cigarettes (e-cigs)? No risk	smoke electronic cigarettes (e-cigs)? Slight	smoke electronic cigarettes (e-cigs)? Moderate risk	smoke electronic cigarettes (e-cigs)? Great risk
use chewing tobacco?	use chewing tobacco? No risk	use chewing tobacco? Slight	use chewing tobacco? Moderate risk	use chewing tobacco? Great risk
use illicit drugs (such as heroin or cocaine)?	use illicit drugs (such as heroin or cocaine)? No risk	use illicit drugs (such as heroin or cocaine)? Slight	use illicit drugs (such as heroin or cocaine)? Moderate risk	use illicit drugs (such as heroin or cocaine)? Great risk

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* 7. How easy or hard is it for you to get the following drugs if you want them?

	Very easy	Sort of easy	Sort of hard	Very hard
Alcohol (beer, wine, hard liquor)	Alcohol (beer, wine, hard liquor) Very easy	Alcohol (beer, wine, hard liquor) Sort of easy	Alcohol (beer, wine, hard liquor) Sort of hard	Alcohol (beer, wine, hard liquor) Very hard
Marijuana	Marijuana Very easy	Marijuana Sort of easy	Marijuana Sort of hard	Marijuana Very hard
Cigarettes	Cigarettes Very easy	Cigarettes Sort of easy	Cigarettes Sort of hard	Cigarettes Very hard
Prescription drugs (not prescribed to you)	Prescription drugs (not prescribed to you) Very easy	Prescription drugs (not prescribed to you) Sort of easy	Prescription drugs (not prescribed to you) Sort of hard	Prescription drugs (not prescribed to you) Very hard
Electronic cigarettes	Electronic cigarettes Very easy	Electronic cigarettes Sort of easy	Electronic cigarettes Sort of hard	Electronic cigarettes Very hard
Chewing tobacco	Chewing tobacco Very easy	Chewing tobacco Sort of easy	Chewing tobacco Sort of hard	Chewing tobacco Very hard
Other illicit drugs (such as heroin or cocaine)	Other illicit drugs (such as heroin or cocaine) Very easy	Other illicit drugs (such as heroin or cocaine) Sort of easy	Other illicit drugs (such as heroin or cocaine) Sort of hard	Other illicit drugs (such as heroin or cocaine) Very hard

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* 8. Please answer these questions if you have EVER tried alcohol.
How often do you get alcoholic beverages from:

	Never	Sometimes	Often
Home, with parents’ permission?	Home, with parents’ permission? Never	Home, with parents’ permission? Sometimes	Home, with parents’ permission? Often
Home, without parents’ permission?	Home, without parents’ permission? Never	Home, without parents’ permission? Sometimes	Home, without parents’ permission? Often
Your friends?	Your friends? Never	Your friends? Sometimes	Your friends? Often
Your brother(s) or sister(s)?	Your brother(s) or sister(s)? Never	Your brother(s) or sister(s)? Sometimes	Your brother(s) or sister(s)? Often
Other people who buy it for you?	Other people who buy it for you? Never	Other people who buy it for you? Sometimes	Other people who buy it for you? Often
At a party with an adult (21 or older) present who knows underage drinking is taking place?	At a party with an adult (21 or older) present who knows underage drinking is taking place? Never	At a party with an adult (21 or older) present who knows underage drinking is taking place? Sometimes	At a party with an adult (21 or older) present who knows underage drinking is taking place? Often
At a party with an adult present who does not know underage drinking is taking place?	At a party with an adult present who does not know underage drinking is taking place? Never	At a party with an adult present who does not know underage drinking is taking place? Sometimes	At a party with an adult present who does not know underage drinking is taking place? Often
At a party without an adult present?	At a party without an adult present? Never	At a party without an adult present? Sometimes	At a party without an adult present? Often
A store or bar (you buy it)?	A store or bar (you buy it)? Never	A store or bar (you buy it)? Sometimes	A store or bar (you buy it)? Often

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* 9. Right now, is there an adult in your life that you would go to for help if you were feeling sad, depressed, anxious, or worried, etc.? Check all that apply

Yes, an adult at school

Yes, an adult outside of school

No

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* 10. How much stress, anxiety or worry do the following give you in your day to day life?

	None to very little	Some	Average amount	A lot
Home life (parents, siblings, life at home)	Home life (parents, siblings, life at home) None to very little	Home life (parents, siblings, life at home) Some	Home life (parents, siblings, life at home) Average amount	Home life (parents, siblings, life at home) A lot
Academics (Homework, tests, school work)	Academics (Homework, tests, school work) None to very little	Academics (Homework, tests, school work) Some	Academics (Homework, tests, school work) Average amount	Academics (Homework, tests, school work) A lot
Physical Safety	Physical Safety None to very little	Physical Safety Some	Physical Safety Average amount	Physical Safety A lot
Social scene (Parties, Dances, Going out with friends)	Social scene (Parties, Dances, Going out with friends) None to very little	Social scene (Parties, Dances, Going out with friends) Some	Social scene (Parties, Dances, Going out with friends) Average amount	Social scene (Parties, Dances, Going out with friends) A lot
Friends (Peers)	Friends (Peers) None to very little	Friends (Peers) Some	Friends (Peers) Average amount	Friends (Peers) A lot
Other	Other None to very little	Other Some	Other Average amount	Other A lot

Other (please specify)

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* 11. Where are Durham and Middlefield youth drinking alcohol?

	1 Least often	2	3	4 Most often
At a friend’s house	At a friend’s house 1 Least often	At a friend’s house 2	At a friend’s house 3	At a friend’s house 4 Most often
At their own house (adult is home)	At their own house (adult is home) 1 Least often	At their own house (adult is home) 2	At their own house (adult is home) 3	At their own house (adult is home) 4 Most often
At their own house (adult is not home)	At their own house (adult is not home) 1 Least often	At their own house (adult is not home) 2	At their own house (adult is not home) 3	At their own house (adult is not home) 4 Most often
At a house party (adult is home)	At a house party (adult is home) 1 Least often	At a house party (adult is home) 2	At a house party (adult is home) 3	At a house party (adult is home) 4 Most often
At a house party (adult is not home)	At a house party (adult is not home) 1 Least often	At a house party (adult is not home) 2	At a house party (adult is not home) 3	At a house party (adult is not home) 4 Most often
Before or after school	Before or after school 1 Least often	Before or after school 2	Before or after school 3	Before or after school 4 Most often
At school (on school property)	At school (on school property) 1 Least often	At school (on school property) 2	At school (on school property) 3	At school (on school property) 4 Most often
In a car (parked)	In a car (parked) 1 Least often	In a car (parked) 2	In a car (parked) 3	In a car (parked) 4 Most often
In a public place (park, woods, etc.)	In a public place (park, woods, etc.) 1 Least often	In a public place (park, woods, etc.) 2	In a public place (park, woods, etc.) 3	In a public place (park, woods, etc.) 4 Most often

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* 12. Where are Durham and Middlefield youth smoking marijuana?

	1 Least often	2	3	4 Most often
At a friend’s house	At a friend’s house 1 Least often	At a friend’s house 2	At a friend’s house 3	At a friend’s house 4 Most often
At their own house (adult is home)	At their own house (adult is home) 1 Least often	At their own house (adult is home) 2	At their own house (adult is home) 3	At their own house (adult is home) 4 Most often
At their own house (adult is not home)	At their own house (adult is not home) 1 Least often	At their own house (adult is not home) 2	At their own house (adult is not home) 3	At their own house (adult is not home) 4 Most often
At a house party (adult is home)	At a house party (adult is home) 1 Least often	At a house party (adult is home) 2	At a house party (adult is home) 3	At a house party (adult is home) 4 Most often
At a house party (adult is not home)	At a house party (adult is not home) 1 Least often	At a house party (adult is not home) 2	At a house party (adult is not home) 3	At a house party (adult is not home) 4 Most often
Before or after school	Before or after school 1 Least often	Before or after school 2	Before or after school 3	Before or after school 4 Most often
At school (on school property)	At school (on school property) 1 Least often	At school (on school property) 2	At school (on school property) 3	At school (on school property) 4 Most often
In a car (parked)	In a car (parked) 1 Least often	In a car (parked) 2	In a car (parked) 3	In a car (parked) 4 Most often
In a public place (park, woods, etc.)	In a public place (park, woods, etc.) 1 Least often	In a public place (park, woods, etc.) 2	In a public place (park, woods, etc.) 3	In a public place (park, woods, etc.) 4 Most often