We appreciate you taking the time to fill out this survey. This survey is completely confidential. Please answer as honestly as possible. This information will be used to improve the Monroe Clinic P.A.R.T.Y. Program.

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* 1. What school do you attend?

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* 2. What is your gender

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* 3. Age

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* 4. I wear a seat belt when I ride in a vehicle.

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* 5. During the past 14 days, how many times did you ride in a vehicle driven by someone who had been drinking alcohol?

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* 6. During the past 14 days, how many text messages did you send or read while driving?

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* 7. If I suspected that someone I was going to ride in a vehicle with was under the influence of alcohol and/or drugs, I would accept a ride from them

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* 8. The following behaviors may lead to risky decision making (check all that apply):

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* 9. During the past 14 days, how many times have you had alcohol, marijuana or other illegal drugs?

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* 10. I make safe choices

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* 11. Injuries can lead to: (check all that apply)

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* 12. My choices can affect whether I get injured

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