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Welcome!

Please answer all the questions.  It is very important for Remembering ADAM to collect these responses.  Your answers are anonymous.  Thanks for your feedback.

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* 1. What is your school name?

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* 2. What is your gender?

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* 3. What is your age?

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* 4. What grade are you in?

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* 5. What is your ethnicity?

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* 6. How long have you participated in Pledge Together? 

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* 7. Do you belong to Virtual Pledge Together? (online)

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* 8. How frequently have you used smokeless tobacco during the past 12 months? (chew, snuff, dip, chewing tobacco)

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* 9. How frequently have you used smokeless tobacco during the past 30 days? (chew, snuff, dip, chewing tobacco)

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* 10. How frequently has you smoked cigarettes during the past 12 months?

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* 11. How frequently has you smoked cigarettes during the past 30 days?

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* 12. How frequently have you vaped using any device during the past 12 months?

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* 13. How frequently have you vaped using any device during the past 30 days?

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* 14. How frequently have you vaped using a device containing marijuana during the past 12 months?

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* 15. How frequently have you vaped using a device containing marijuana during the past 30 days?

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* 16. On how many occasions (if any) have you used marijuana during the past 12 months?

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* 17. On how many occasions (if any) have you used marijuana during the past 30 days? 

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* 18. On how many occasions (if any) have you drank alcohol during the past 12 months? 

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* 19. On how many occasions (if any) have you drank alcohol during the past 30 days? 

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* 20. On how many occasions (if any) have you had 4 or more drinks in a row in 2 hours or less, during the past 12 months? 

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* 21. On how many occasions (if any) have you had 4 or more drinks in a row in 2 hours or less, in the past 30 days?

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* 22. On how many occasions (if any) have you used performance enhancing supplements during the past 12 months?

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* 23. On how many occasions (if any) have you used performance enhancing supplements during the past 30 days? (protein, creatine, energy drinks, stimulants, anabolic stimulants, etc.)

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* 24. On how many occasions (if any) have you used other illegal drugs during the past 12 months? (cocaine, crack, heroin, esctasy, mollies, methamphetamines, hallucinogens, etc)

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* 25. On how many occasions (if any) have you used other illegal drugs during the past 30 days? (cocaine, crack, heroin, ecstasy, mollies, methamphetamines, hallucinogens, etc.)

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* 26. On how many occasions (if any) have you used prescription pain relievers, tranquilizers, or stimulates that were not prescribed to you during the past 12 months? 

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* 27. On how many occasions (if any) have you used prescription pain relievers, tranquillizers, or stimulants that were not prescribed to you in the past 30 days? 

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* 28. How dangerous is it to you (physically or in other ways) if you use smokeless tobacco one or more times per day?

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* 29. How dangerous is it to you (physically or in other ways) if you smoke one or more cigarettes per day?

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* 30. How dangerous is it to you (physically or in other ways) if you vape one or more times per day? 

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* 31. How dangerous is it to you (physically or in other ways) if you use marijuana one or more times a month?

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* 32. How dangerous is it to you (physically or in other ways) if you drink one or more drinks of alcohol nearly every day? 

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* 33. How dangerous is it to you (physically or in other ways) if you get drunk one or more times in a month? 

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* 34. How dangerous is it to you (physically or in other ways) if you use performance enhancing supplements once or twice? (protein, creatine, energy drinks, stimulants, anabolic steroids, etc.)

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* 35. How dangerous is it to you (physically or in other ways) if you use any other illegal drug once or twice? (cocaine, crack, heroin, esctasy, mollies, methamphetamines, hallucinogens, etc. )

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* 36. How dangerous is it to you (physically or in other ways) if you use prescription pain relievers, tranquilizers, or stimulants that were not prescribed to you once or twice?

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* 37. Do you have an interest in experimenting with cigarettes?

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* 38. Do you have an interest in experimenting with vaping?

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* 39. Do you have an interest in experimenting with smokeless tobacco? (chew, snuff, dip, chewing tobacco)

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* 40. Do you have an interest in experimenting with alcohol? 

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* 41. Do you have an interest in experimenting with marijuana? 

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* 42. Do you have an interest in experimenting with performance enhancing supplements? (protein, creatine, energy drinks, stimulants, anabolic steroids, etc.)

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* 43. Do you have an interest in experimenting with other illegal drugs? (cocaine, crack, heroin, ecstasy, mollies, methamphetamines, hallucinogens, etc.)

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* 44. Do you have an interest in experimenting with prescription pain relievers, tranquilizers, or stimulants that were not prescribed to you? 

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* 45. During Covid-19, has your usage of smokeless tobacco increased? 

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* 46. During Covid-19, has your usage of cigarettes increased?

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* 47. During Covid-19, has your usage of vaping (with any device) increased? 

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* 48. During Covid-19, has your usage of marijuana increased? 

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* 49. During Covid-19, has your usage of alcohol increased?

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* 50. During Covid-19, has your usage of performance enhancing supplements increased? 

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* 51. During Covid-19, has your usage of prescription pain relievers, tranquilizers, or stimulants that were not prescribed to you increased? 

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* 52. During Covid-19, has your usage of other illegal drugs increased? (cocaine, crack, heroin, mollies, methamphetamines, hallucinogens, etc. )

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* 53. Has your participation in Pledge Together caused you to have less interest in experimenting with cigarettes, vaping, smokeless tobacco, alcohol, marijuana, performance enhancing supplement, other illegal drugs (cocaine, crack, ecstasy, mollies, methamphetamines, hallucinogens, etc.) and prescription pain relievers, tranquilizers, or stimulants that were not prescribed to you? 

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* 54. Since you joined Pledge Together, do any of the following apply to you? 

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* 55. Has Pledge Together made you more aware of how important it is to be drug free? 

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* 56. Did other students belonging to Pledge Together influence you to join? 

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* 57. Overall, has the Pledge Together Program created a better school environment?

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* 58. Below, please describe how participating in Pledge Together has positively influenced your life in school, with your family, and in your community. 

0 of 58 answered
 

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