Young Adult Survey (Ongoing)

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* 1. How do you identify?

Male

Female

Other (please specify)

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* 2. What is your age?

26+

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* 3. Please choose the responses that best describe you: (select all that apply)

Asian American

Black or African American

Hispanic or Latino(a)

Native American or Alaska Native

Native Hawaiian or Pacific Islander

White

Other (please specify)

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* 4. Which of the following categories best describes your employment status?

Employed (working full- or part-time)

Not employed, looking for work

Not employed, NOT looking for work

Self-employed

Military

Other (please specify)

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* 5. Are you currently enrolled as a student?

Yes, full time in graduate school

Yes, part time in graduate school

Yes, full time at a four year undergraduate college/university

Yes, part time at a four year undergraduate college/university

Yes, full time at a two year undergraduate college/university

Yes, part time at a two year undergraduate college/university

Yes, part time in some other type of school

Yes, full time in some other type of school

Yes, at a high school or equivalent

No, I am not currently enrolled as a student

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* 6. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 7. Not including the town or city that your home is located in, what is the ZIP code of the town or city where you spend the greatest amount of time (for example, where you work or attend school)? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 8. What is the main reason for spending time in this other town or city?

Attending school

Working

Shopping

Dining or entertainment

Seeing friends or family members

Other (please specify)

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* 9. In the past 12 months, have you talked with someone (parent or supportive adult) about dangers of tobacco, alcohol, prescription drug or drug abuse? (Choose all that apply.)

Yes, tobacco use

Yes, alcohol use

Yes, prescription drug use

Yes, other drug use (please specify)

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* 10. How easy do you think it is for persons your age in your community to obtain...

	Very easy	Somewhat easy	Somewhat difficult	Very difficult
Prescription pain relievers (such as OxyContin, Percocet, Vicodin, or Tylox) that were not prescribed to them?	Prescription pain relievers (such as OxyContin, Percocet, Vicodin, or Tylox) that were not prescribed to them? Very easy	Prescription pain relievers (such as OxyContin, Percocet, Vicodin, or Tylox) that were not prescribed to them? Somewhat easy	Prescription pain relievers (such as OxyContin, Percocet, Vicodin, or Tylox) that were not prescribed to them? Somewhat difficult	Prescription pain relievers (such as OxyContin, Percocet, Vicodin, or Tylox) that were not prescribed to them? Very difficult
Prescription stimulant pills (such as Ritalin, Adderall, or Concerta) that were not prescribed to them?	Prescription stimulant pills (such as Ritalin, Adderall, or Concerta) that were not prescribed to them? Very easy	Prescription stimulant pills (such as Ritalin, Adderall, or Concerta) that were not prescribed to them? Somewhat easy	Prescription stimulant pills (such as Ritalin, Adderall, or Concerta) that were not prescribed to them? Somewhat difficult	Prescription stimulant pills (such as Ritalin, Adderall, or Concerta) that were not prescribed to them? Very difficult
Prescription tranquilizers or "benzos", (like Xanax, Valium, or Ativan) that were not prescribed to them?	Prescription tranquilizers or "benzos", (like Xanax, Valium, or Ativan) that were not prescribed to them? Very easy	Prescription tranquilizers or "benzos", (like Xanax, Valium, or Ativan) that were not prescribed to them? Somewhat easy	Prescription tranquilizers or "benzos", (like Xanax, Valium, or Ativan) that were not prescribed to them? Somewhat difficult	Prescription tranquilizers or "benzos", (like Xanax, Valium, or Ativan) that were not prescribed to them? Very difficult
Marijuana?	Marijuana? Very easy	Marijuana? Somewhat easy	Marijuana? Somewhat difficult	Marijuana? Very difficult
Heroin?	Heroin? Very easy	Heroin? Somewhat easy	Heroin? Somewhat difficult	Heroin? Very difficult

Any other drug? please specify)

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* 11. How much do people risk harming themselves physically and in other ways when they...

	No risk	Slight risk	Moderate risk	Great risk
Smoke one or more packs of cigarettes per day?	Smoke one or more packs of cigarettes per day? No risk	Smoke one or more packs of cigarettes per day? Slight risk	Smoke one or more packs of cigarettes per day? Moderate risk	Smoke one or more packs of cigarettes per day? Great risk
Use e-cigarettes?	Use e-cigarettes? No risk	Use e-cigarettes? Slight risk	Use e-cigarettes? Moderate risk	Use e-cigarettes? Great risk
Have five or more drinks of an alcoholic beverage once or twice a week?	Have five or more drinks of an alcoholic beverage once or twice a week? No risk	Have five or more drinks of an alcoholic beverage once or twice a week? Slight risk	Have five or more drinks of an alcoholic beverage once or twice a week? Moderate risk	Have five or more drinks of an alcoholic beverage once or twice a week? Great risk
Use prescription pain relievers that are not prescribed to them or that they took only for the experience or feeling they caused?	Use prescription pain relievers that are not prescribed to them or that they took only for the experience or feeling they caused? No risk	Use prescription pain relievers that are not prescribed to them or that they took only for the experience or feeling they caused? Slight risk	Use prescription pain relievers that are not prescribed to them or that they took only for the experience or feeling they caused? Moderate risk	Use prescription pain relievers that are not prescribed to them or that they took only for the experience or feeling they caused? Great risk
Use prescription stimulants that are not prescribed to them or that they took only for the experience or feeling they caused?	Use prescription stimulants that are not prescribed to them or that they took only for the experience or feeling they caused? No risk	Use prescription stimulants that are not prescribed to them or that they took only for the experience or feeling they caused? Slight risk	Use prescription stimulants that are not prescribed to them or that they took only for the experience or feeling they caused? Moderate risk	Use prescription stimulants that are not prescribed to them or that they took only for the experience or feeling they caused? Great risk
Use prescription tranquilizers that are not prescribed to them or that they took only for the experience or feeling they caused?	Use prescription tranquilizers that are not prescribed to them or that they took only for the experience or feeling they caused? No risk	Use prescription tranquilizers that are not prescribed to them or that they took only for the experience or feeling they caused? Slight risk	Use prescription tranquilizers that are not prescribed to them or that they took only for the experience or feeling they caused? Moderate risk	Use prescription tranquilizers that are not prescribed to them or that they took only for the experience or feeling they caused? Great risk
Use marijuana regularly?	Use marijuana regularly? No risk	Use marijuana regularly? Slight risk	Use marijuana regularly? Moderate risk	Use marijuana regularly? Great risk
Use heroin?	Use heroin? No risk	Use heroin? Slight risk	Use heroin? Moderate risk	Use heroin? Great risk

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* 12. How do you think your parents would feel about you...

	Neither approve nor disapprove	Somewhat disapprove	Strongly disapprove
Smoking cigarettes?	Smoking cigarettes? Neither approve nor disapprove	Smoking cigarettes? Somewhat disapprove	Smoking cigarettes? Strongly disapprove
Using e-cigarettes?	Using e-cigarettes? Neither approve nor disapprove	Using e-cigarettes? Somewhat disapprove	Using e-cigarettes? Strongly disapprove
Having one or two drinks of an alcoholic beverage nearly every day?	Having one or two drinks of an alcoholic beverage nearly every day? Neither approve nor disapprove	Having one or two drinks of an alcoholic beverage nearly every day? Somewhat disapprove	Having one or two drinks of an alcoholic beverage nearly every day? Strongly disapprove
Smoking marijuana?	Smoking marijuana? Neither approve nor disapprove	Smoking marijuana? Somewhat disapprove	Smoking marijuana? Strongly disapprove
Using prescription pain relievers not prescribed to you or that you took only for the experience or feeling they caused?	Using prescription pain relievers not prescribed to you or that you took only for the experience or feeling they caused? Neither approve nor disapprove	Using prescription pain relievers not prescribed to you or that you took only for the experience or feeling they caused? Somewhat disapprove	Using prescription pain relievers not prescribed to you or that you took only for the experience or feeling they caused? Strongly disapprove
Using prescription stimulants not prescribed to you or that you took only for the experience or feeling they caused?	Using prescription stimulants not prescribed to you or that you took only for the experience or feeling they caused? Neither approve nor disapprove	Using prescription stimulants not prescribed to you or that you took only for the experience or feeling they caused? Somewhat disapprove	Using prescription stimulants not prescribed to you or that you took only for the experience or feeling they caused? Strongly disapprove
Using prescription tranquilizers not prescribed to you or that you took only for the experience or feeling they caused?	Using prescription tranquilizers not prescribed to you or that you took only for the experience or feeling they caused? Neither approve nor disapprove	Using prescription tranquilizers not prescribed to you or that you took only for the experience or feeling they caused? Somewhat disapprove	Using prescription tranquilizers not prescribed to you or that you took only for the experience or feeling they caused? Strongly disapprove
Using heroin?	Using heroin? Neither approve nor disapprove	Using heroin? Somewhat disapprove	Using heroin? Strongly disapprove

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* 13. It is ok to let close friends or family use your prescription drugs.

Strongly disagree

Disagree

Agree

Strongly Agree

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* 14. How do you think your close friends would feel about you using prescription drugs not prescribed to you?

Strongly disapprove

Somewhat disapprove

Neither approve nor disapprove

Somewhat approve

Strongly approve

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* 15. How do you think your close friends would feel about you using prescription drugs to get high or for reasons other than prescribed?

Strongly disapprove

Somewhat disapprove

Neither approve nor disapprove

Somewhat approve

Strongly approve

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* 16. I believe it is okay to use heroin.

Strongly disagree

Disagree

Agree

Strongly agree

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* 17. During the last 12 months have you used any of the following? (check all that apply)

I have not used any of the following.

Alcohol

Cigarettes

E-cigarettes

Marijuana

Pain Relievers (Not prescribed to you)

Stimulants (Not prescribed to you)

Tranquilizers (Not Prescribed to you)

Heroin

Other drugs (please specify)