youth survey questions bank survey question...youth survey questions bank category question response...

Youth Survey Questions Bank

Enclosed are sample questions used in national, state, or local community-developed surveys. They are broken down

into the following categories:

Category Pages Consumption 1 - 6 Consequences 7 Source of Alcohol 8 - 10 Ease of Access to Alcohol 11 Perception of Risk 12 - 14 Perception of Parental Disapproval 15 - 16 Perception of Peer Disapproval 17 Perception/Attitudes Toward Individual Use 18 - 20 Perception/Attitudes Toward Peer Use 21 - 24 Social/ Community Norms 25 - 27 Other 28 - 30

The table below indicates the survey sources used in this document and how often national and state survey data are collected. Local community-developed survey data collection varies.

Survey Source How often data are collected

National Survey on Drug Use and Health (NSDUH) - 2012 Annual

Youth Risk Behavior Survey (YRBS) Spring 2013, Maryland (High school) Every 2 years

Youth Risk Behavior Survey (YRBS) Spring 2013, Maryland (Middle school) Every 2 years

Behavioral Risk Factor Surveillance System (BRFSS) - 2012 Annual

Communities That Care Youth Survey - 2004 Every 2 years

DFC and Consumption Four Core Measure - 2012 Annual

National College Health Assessment II (ACHA-NCHA) - 2008 Bi-annual

Core Alcohol and Drug Survey (High School) -2013 Annual

Core Alcohol and Drug Survey Long Form (4-year College) - 2013 Annual

Core Alcohol and Drug Surveys (Community College Long Form) - 2013 Annual

Core Campus Survey of Alcohol and Other Drug Norms - 1996 Annual

NHTSA Underage Drinking Questionnaire - 2001 Annual

Calvert County UAART Youth Perception/Consumption Survey -2013 Varies

Frederick City Alcohol Prevention Initiative Varies

Garrett County BTW Youth Survey - 2013 Varies

Garrett County BTW Adult Survey - 2013 Varies

Washington County 10TH Grade Survey 2012 Varies


Category Question Response Source

ConsumptionDuring the past 30 days, on how many days did you drink one or more

drinks of an alcoholic beverage?Indicate a number between 0 and 30.

National Survey on Drug

Use and Health (NSDUH)

- 2012

Think about the first time you had a drink of an alcoholic beverage. How

old were you the first time you had a drink of an alcoholic beverage?

Please do not include any time when you only had a sip or two from a

drink.

Indicate age of first use. National Survey on Drug


- 2012

During the past 30 days, on how many days did you have 5 or more drinks

of alcohol in a row, that is, within a couple of hours?

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

Youth Risk Behavior

Survey (YRBS) Spring

2013, Maryland (High

school)

During the past 30 days, what type of alcohol did you usually drink? (Select

only one response.)

A. I did not drink alcohol during the past 30 days

B. I do not have a usual type

C. Beer

D. Flavored malt beverages, such as Smirnoff Ice, Bacardi

Silver, or Hard Lemonade

E. Wine coolers, such as Bartles & Jaymes or Seagrams

F. Wine

G. Liquor, such as vodka, rum,scotch, bourbon, or whiskey

H. Some other type

Youth Risk Behavior



school)

During your life, on how many days have you had at least one drink of

alcohol?

A. 0 days

B. 1 or 2 days

C. 3 to 9 days

D. 10 to 19 days

E. 20 to 39 days

F. 40 to 99 days

G. 100 or more days

Youth Risk Behavior



school)

Pg.1 of 30



ConsumptionHow old were you when you had your first drink of alcohol other than a

few sips?

A. I have never had a drink of alcohol other than a few sips

B. 8 years old or younger

C. 9 or 10 years old

D. 11 or 12 years old

E. 13 or 14 years old

F. 15 or 16 years old

G. 17 years old or older

Youth Risk Behavior



school)

During the past 30 days, on how many days did you have at least one drink

of alcohol?

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

Youth Risk Behavior


2013, Maryland (Middle

school)

Have you ever had a drink of alcohol, other than a few sips? Yes or No

Youth Risk Behavior



school)

How old were you when you had your first drink of alcohol other than a

few sips?

A. I have never had a drink of alcohol other than a few sips

B. 8 years old or younger

C. 9 years old

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old or older

Youth Risk Behavior



school)

Considering all types of alcoholic beverages, how many times during the

past 30 days did you have X [CATI X = 5 for men, X = 4 for women] or

more drinks on an occasion?

A. __ Number of times

B. None

C. Don‘t know / Not sure

D. Refused

BRFSS - 2012

Pg.2 of 30



ConsumptionDuring the past 30 days, how many days per week or per month did you

have at least one drink of any alcoholic beverage such as beer, wine, a malt

beverage or liquor?

A. __ days per week

B. __ days in past 30 days

C. No drinks in past 30 days

D. Don‘t know / Not sure

E. Refused

BRFSS - 2012

During the past 30 days, what is the largest number of drinks you had on

any occasion?

A. __ Number of drinks

B. Don‘t know / Not sure

C. Refused

BRFSS - 2012

One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a

drink with one shot of liquor. During the past 30 days, on the days when

you drank, about how many drinks did you drink on the average?

NOTE: A 40 ounce beer would count as 3 drinks, or a cocktail drink with

2 shots would count as 2 drinks.

A. __ of drinks

B. Don‘t know / Not sure

C. Refused

BRFSS - 2012

How many times in the past year (12 months) have you:

Been drunk or high at school?

A. Never

B. 1 or 2 times

C. 3 or 5 times

D. 6 or 9 times

E. 10-19 times

F. 20-29 times

G. 30-39 times

H. 40+ times

Communities That Care

Youth Survey - 2004

How old were you when you first...(Mark one response for each line)

a. Had more than a sip or two of beer, wine or hard liquor (for example,

vodka, whiskey, or gin)?

b. Began drinking alcoholic beverages regularly, that is, at least once or

twice a month?

A. Never have

B. 10 or Younger

C. 11

D. 12

E. 13

F. 14

G. 15

H. 16

I. 17 or older


Youth Survey - 2004

Pg.3 of 30



ConsumptionThink back over the last two weeks. How many times have you had five or

more alcoholic drinks in a row?

A. None

B. Once

C. Twice

D. 3-5 times

E. 6-9 times

F. 10 or more times


Youth Survey - 2004

During the past 30 days did you drink one or more drinks of an alcoholic

beverage?Yes or No

DFC and Consumption

Four Core Measure - 2012

During the past 30 days, on how many days did you drink one or more

drinks of an alcoholic beverage?Enter a number between 0 and 30 here ___

DFC and Consumption



in a row, that is, within a couple of hours?

A. 0 days

B. 1 day

C. 2 days

D. 3 to 5 days

E. 6 to 9 days

F. 10 to 19 days

G. 20 or more days

DFC and Consumption


About how old were you the first time you drank alcohol, not counting

sips you might have had as child from an older person’s drink? __ years old

NHTSA Underage

Drinking Questionnaire -

2001

Do you ever have five or more drinks of alcohol at a time?

If “Yes,” have you done this in the last month?Yes or No

NHTSA Underage


2001

Have you ever had alcoholic beverages like beer, wine, wine coolers or

liquor?Yes or No

NHTSA Underage


2001

How often do you drink alcohol?

A. At least once a week

B. At least once a month

C. Less than once a month

NHTSA Underage


2001

Pg.4 of 30



Consumption How often do you or youth you know purchase alcohol drinks?

A. Never

B. Once a month

C. No answer

D. Once a week

E. Every day

Frederick City Alcohol

Prevention Initiative

What specific alcoholic products or kinds of products do youth you know

regularly drink? Please list all. Please list all.




of alcohol in a row, that is, within a couple of hours?

A. None

B. 1 day

C. 2 days

D. 3 to 5 days

E. 6 to 9 days

F. 10 to 19 days

G. 20 or more days

Washington County 10TH

Grade Survey 2012

During the past 30 days, on how many days did you have at least one drink

of alcohol?

A. None

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days


Grade Survey 2012

During the past 30 days, what type of alcohol did you usually drink? (Select

only one response)


B. I do not have a usual type

C. Beer

D. Flavored malt beverages, such as Smirnoff Ice, Bacardi

E. Wine coolers, such as Bartles & Jaymes or Seagrams

F. Wine

G. Liquor, such as vodka, rum,scotch, bourbon


Grade Survey 2012

Have you ever drank 5 or more alcoholic drinks within a few hours? Yes or NoWashington County 10

TH

Grade Survey 2012

Pg.5 of 30



Consumption Have you ever drank beer, wine, or wine coolers ? Yes or NoWashington County 10

TH

Grade Survey 2012

Have you ever drank liquor (e.g. rum, vodka, gin, whisky, bourbon)? Yes or NoWashington County 10

TH

Grade Survey 2012

If you have had one or more servings of alcohol, how old were you when

you first had…? (More than a few sips.):

a. Beer or wine

b. Liquor

c. 5 or more drinks within a few hours

Indicate the age when you first hadWashington County 10

TH

Grade Survey 2012

In the past 3 months, how often have you: (Mark one response for each

line)

a. Drank beer, wine, or wine coolers?

b. Drank liquor?

c. Drank 5 or more alcoholic drinks within a few hours?

A. Almost Daily

B. A couple of times a week

C. A couple of times a month

D. Less than once a month

E. Not in last 3 months


Grade Survey 2012

Pg.6 of 30



Consequences

Within the last 12 months, have you experienced any of the following

when drinking alcohol? (Mark one for each line):

a. Did something you later regretted

b. Forgot where you were or what you did

c. Got in trouble with the police

d. Had sex with someone without giving your consent

e. Had sex with someone without getting their consent

f. Had unprotected sex

g. Physically injured yourself

h. Physically injured another person

i. Seriously considered suicide

A. Yes

B. No

C. Don't drink

National College Health

Assessment II (ACHA-

NCHA) - 2011

Have you ever.... ? (Check all that apply)

__Been absent from school because you used alcohol

__ Been drunk at school

__ Done poorly in school because you used alcohol

__ Had family problems because you used alcohol

__ Been arrested because you used alcohol

__ Driven under the influence of alcohol

__ Been a passenger in a vehicle in which the driver was

under the influence of alcohol

__ Been drunk at a party

__ Had an injury because you used alcohol.

NHTSA Underage


2001

Alcohol has had an adverse affect in my life (e.g., traffic accident)

A. Agree

B. Strongly Agree

C. Disagree

D. Strongly disagree



Have you EVER engaged in sex under the influence of alcohol or drugs? Yes or NoWashington County 10th

Grade Survey 2012

Pg.7 of 30



Source of Alcohol During the past 30 days, how did you usually get the alcohol you drank?


B. I bought it in a store such as a liquor store, convenience

store, supermarket, discount store, or gas station.

C. I bought it at a restaurant, bar or club

D. I bought it at a public event such as a concert or sporting

event

E. I gave someone else money to buy it for me

F. Someone gave it to me

G. I took it from a family member

H. I got it some other way

DFC and Consumption


Where is the primary source where people under the age of 21 obtain

alcohol? (Select only one)

A. Parent’s home

B. Liquor store

C. Bar/restaurant

D. Grocery/convenience store

E. Friends/relatives

F. Other

NHTSA Underage


2001

If you drank any kind of alcohol (more than a sip) in the past 30 days,

where did you get the alcohol? Check all that apply.

__ I didn’t drink alcohol in the last 30 days.

__ A Parent/Guardian gave it to me.

__ I took it from my home (without parent’s permission).

__ A friend/relative (brother, sister, uncle, etc.) who is 21 or

older gave it to me.

__ A friend/relative (brother, sister, cousin, etc.) who is under

21 gave it to me.

__ A non-relative adult gave it to me.

__ I took it from someone else’s home.

__ I got it at a party.

__ I got it at a community event where alcohol was served.

__ My parent’s home.

__ Bar/restaurant.

__ Liquor store.

__ Grocery/convenience store

__ Other (specify)

Calvert County UAART

Youth

Perception/Consumption

Survey -2013

Pg.8 of 30



Source of Alcohol What do you think is the primary source of alcohol for high school-aged

youth who drink in your community? Check only one.

__ A Parent/Guardian gave it to them.

__ They took it from their home (without parent’s

permission).

__ A friend/relative (brother, sister, uncle, etc.) who is 21 or

older gave it to them.

__ A friend/relative (brother, sister, cousin, etc.) who is under

21 gave it to them.

__ A non-relative adult gave it to them.

__ They took it from someone else’s home.

__ They got it at a party.

__ They got it at a community event where alcohol was

served.

__ Their parent’s home.

__ Bar/restaurant.

__ Liquor store.

__ Grocery/convenience store.

__ Other (specify)


Youth


Survey -2013

Where do underage youth obtain alcohol? (Check all that apply)

__ Home

__ Friends Homes

__ Older Friends

__ Other youth

__ Private Parties for Youth

__ Community Events

__ Family Events

__ Work

__ Other: Please list



Pg.9 of 30



Source of Alcohol If you drank any kind of alcohol (more than a sip) in the past 30 days,

where did you get the alcohol? Check ALL that apply.

__ I did not drink alcohol in the past 30 days.

__ A parent (or guardian) gave it to me.

__ A non-parent adult relative gave it to me (brother, sister,

aunt, uncle, cousin, etc.)

__ A non-related adult (over age 21) gave it to me.

__ An underage person (under age 21) gave it to me.

__ I took it from my home (without my parent’s permission).

__ I took it from someone else’s home.

__ I paid someone to purchase alcohol for me.

__ Other (explain)

Garrett County BTW

Youth Survey - 2013

If you drank any kind of alcohol (more than a sip) in the past 30 days, what

was the most common source of the alcohol? Please mark only ONE

statement.

A. I did not drink alcohol in the past 30 days.

B. A parent (or guardian) gave it to me.

C. A non-parent adult relative gave it to me (brother, sister,

aunt, uncle, cousin, etc.)

D. A non-related adult (over age 21) gave it to me.

E. An underage person (under age 21) gave it to me.

F. I took it from my home (without my parent’s permission).

G. I took it from someone else’s home.

H. I paid someone to purchase alcohol for me.

I. Other (explain)

Garrett County BTW

Youth Survey - 2013

How do underage youth who drink usually get the alcohol they drink?

(Select the response that you think applies most often.)

A. Purchased it from a store, restaurant or public event

B. Purchased by someone else

C. Given by someone else at a public/community event

D. Given by someone else at a private party or family event

E. Taken from family member or retail store

F. Other (please specify)

Washington County 10th

Grade Survey 2012

Pg.10 of 30



Ease of Access to

Alcohol

If you wanted to get some beer, wine or hard liquor (for example, vodka,

whiskey, or gin), how easy would it be for you to get some?

A. Very hard

B. Sort of hard

C. Sort of easy

D. Very easy


Youth Survey - 2004

Have you ever purchased alcohol without an ID? Yes or NoNHTSA Underage


2001

Have you successfully used a fake ID to obtain alcohol? Yes or NoNHTSA Underage


2001

How many times in the last two months has someone offered to give you,

buy for you, or sell you alcohol?

A. None

B. Once

C. 2-3 times

D. 4 or more times

NHTSA Underage


2001

How easy is it for youth under age 21 to obtain alcoholic beverages in

Frederick County?

A. Not easy

B. Can get but hard

C. Don't know

D. Usually easy

E. Always easy



How easy is it for youth under age 21 to obtain alcoholic beverages in

Frederick County?

A. Not possible

B. Can get but hard

C. Don't know

D. Usually easy

E. No problem- Anytime



How easy is it for teens in your community to gain access to alcohol?

A. It is very easy for teens in my community to gain access to

alcohol.

B. It is somewhat easy for teens in my community to gain

access to alcohol.

C. It is somewhat difficult for teens in my community to gain

access to alcohol.

D. It is very difficult for teens in my community to gain access

to alcohol.

Garrett County BTW

Youth Survey - 2013

Is it easy or difficult for youth under age 21 in [INSERT NAME OF

COUNTY] to…(Mark one for each line):

a. Get alcohol?

b. Get a fake ID?

Easy or difficult Washington County 10th

Grade Survey 2012

Pg.11 of 30



Perception of

Risk

During the past 12 months, have you driven a vehicle while you were

under the influence of alcohol?

A. Yes

B. No

C. Don’t know or can’t say



- 2012

How much do people risk harming themselves physically and in other

ways when they have five or more drinks of an alcoholic beverage once or

twice a week?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk

E. “Don’t know/can’t say”



- 2012

Did you drink alcohol or use drugs before you had sexual intercourse the

last time?

A. I have never had sexual intercourse

B. Yes

C. No

Youth Risk Behavior



school)

How much do people risk harming themselves (physically and in other

ways) if they have five or more drinks of alcohol (beer, wine, or liquor)

once or twice a week?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk

Youth Risk Behavior



school)

How much do people risk harming themselves (physically and in other

ways) if they have one or two drinks of alcohol (beer, wine, or liquor)

nearly every day?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk

Youth Risk Behavior



school)

How much do you think people risk harming themselves (physically or in

other ways) if they take one or two drinks of an alcoholic beverage (beer,

wine, liquor) nearly every day?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk


Youth Survey - 2004

If a kid drank some beer, wine or hard liquor (for example, vodka,

whiskey, or gin) in your neighborhood, would he or she be caught by the

police? Please mark:

No! If statement is definitely not true for you

no If statement is mostly not true for you

yes If statement is mostly true for you

YES! If statement is definitely true for you

No!

no

yes

YES!


Youth Survey - 2004

Pg.12 of 30



Perception of

Risk

If you drank some beer or wine or liquor (for example, vodka, whiskey, or

gin) without your parents’ permission, would you be caught by your

parents? (Please choose one of the following):





No!

no

yes

YES!


Youth Survey - 2004

How much do you think people risk harming themselves physically or in

other ways when they have five or more drinks of an alcoholic beverage

once or twice a week?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk

DFC and Consumption


How much risk do you think people risk harming themselves (physically or

in other ways) if they... (Mark one response for each line):

a. Take four or five drinks in one sitting?

b. Take four or five drinks nearly everyday?

c. Consume alcohol prior to being sexually active (mark one for each

line)?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk

Core Alcohol and Drug

Survey (High School) -

2013

Did you drink alcohol the last time you had sexual intercourse? Yes or NoCore Alcohol and Drug

Survey Long Form (4-year

College) - 2013

During the past 12 months, have you driven a vehicle while you were

under the influence of alcohol? Yes or No



How dangerous of a risk is alcohol, in your opinion, to your overall health

and achievement of life goals?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk



How likely is it that an underage youth is arrested for alcohol use?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk



Pg.13 of 30



Perception of

RiskHow likely is it that an underage youth is sent to jail for alcohol use?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk



How likely is it that an underage youth is suspended from school for

alcohol use?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk



How much do people risk harming themselves physically and in other

ways when they have five or more drinks of an alcoholic beverage once or

twice a week?

A. No risk

B. Slight risk

C. Moderate risk

D. Great risk



How likely is it that teens who use alcohol several times a month or more

could experience the following? (Mark one reponse for each line):

a. Suspension from school

b. Arrest

c. Physical and/or mental harm to self or others

d. Difficulty achieving life goals

e. Alcoholism as an adult

A. Not likely

B. Somewhat likely

C. Very likely


Grade Survey 2013

Pg.14 of 30



Perception of

Parental

Disapproval

How wrong do your parents feel it would be for you to drink beer, wine,

or hard liquor (such as, vodka, whiskey, or gin) at least once or twice a

month?

A. Very wrong

B. Wrong

C. A little wrong

D. Not at all wrong

E. Not sure

Youth Risk Behavior



school)

How wrong do your parents feel it would be for you to drink beer, wine or

hard liquor (for example, vodka, whiskey or gin) regularly?

A. Very wrong

B. Wrong

C. A little bit wrong

D. Not wrong at all


Youth Survey - 2004

How wrong would most adults (over 21) in your neighborhood think it

was for kids your age to drink alcohol?

A. Very wrong

B. Wrong


D. Not wrong at all


Youth Survey - 2004

My family has clear rules about alcohol and drug use.

Please choose one of the following:





No!

no

yes

YES!


Youth Survey - 2004

How wrong do your parents feel it would be for you to have one or two

drinks of an alcoholic beverage nearly every day?

A. Very wrong

B. Wrong


D. Not wrong at all

DFC and Consumption


Do your parents permit you to drink alcohol in your home?

A. Never

B. On special occasions only

C. Under parental supervision

D. Any time I want to

NHTSA Underage


2001

In my family, there are clear rules about what I can do and cannot do

when around other people who are drinking.

A. Strongly agree

B. Agree

C. Disagree

D. Strongly disagree



Pg.15 of 30



Perception of

Parental

Disapproval

How wrong would the adults in your family think the following are? (Mark

one response for each line):

a. Alcohol use by persons under age 21

b. Driving while under the influence of alcohol

c. Having five or more drinks at one time

d. Providing alcohol to persons under age 21

e. Riding with a driver under the influence of alcohol

A. Very wrong

B. Wrong


D. Not wrong at all

Garrett County BTW

Youth Survey - 2013

What do parents in your community think about teens drinking alcohol?

Most parents in my community believe…

A. …it is “ok” for teens to drink alcohol.

B. ...it is wrong for teens to drink alcohol.

C. ... it is wrong for teens to drink alcohol – unless they are

drinking at home under parental supervision.

Garrett County BTW

Youth Survey - 2013

Have you ever had an open honest conversation with a PARENT

(guardian) about…? (Mark one response for each line)

a. Peers who drink

b. Their feelings about drinking

c. How to say no to peer pressure

d. The dangers of drinking

e. Your own experiences with alcohol

Yes or NoWashington County 10th

Grade Survey 2012

How would your parent(s) react if they found out you drank alcohol?

A. Extremely upset

B. Pretty upset

C. A little upset

D. Not upset at all


Grade Survey 2012

In my family, there are clear rules about what I can do and cannot do

when I’m around other people who are drinking.Yes or No


Grade Survey 2012

Pg.16 of 30



Perception of

Peer Disapproval

How wrong do your friends feel it would be for you to have one or two


A. Not at all wrong

B. A little bit wrong

C. Wrong

D. Very wrong

DFC and Consumption


How do you think your close friends feel (or would feel) about you taking

one or two drinks of an alcohol beverage (beer, wine, liquor) nearly

everyday?

A. Don't disapprove

B. Disapprove

C. Strongly disapprove


Survey Long Form (4-year

College) - 2013

Which statement below about drinking alcoholic beverages do you feel

best represents the most common attitude among students in general here?

(Choose the best answer)

A. Drinking is never a good thing to do.

B. Drinking is all right but a person should not get drunk.

C. Occasionally getting drunk is okay as long as it doesn’t

interfere with academics or other responsibilities.

D. Occasionally getting drunk is okay even if it does interfere

with academics or responsibilities.

E. Frequently getting drunk is okay if that’s what the

individual wants to do.

Core Campus Survey of

Alcohol and Other Drug

Norms - 1996

How wrong would most persons your age think the following are? (Mark

one response for each line)






A. Very wrong

B. Wrong


D. Not wrong at all

Garrett County BTW

Youth Survey - 2013

Pg.17 of 30



Perception/

Attitudes Toward

Individual Use

What are the chances you would be seen as cool if you: Began drinking

alcoholic beverages regularly, that is, atleast once or twice a month?

A. No or very little chance

B. Little chance

C. Some chance

D. Pretty good chance

E. Very good chance


Youth Survey - 2004

During the past 30 days, to what extent have you engaged in any of the

following behaviors? (Mark one response for each line)

a. Refused an offer of alcohol or other drugs

b. Bragged about your alcohol or other drug use

c. Heard someone else brag about his/her alcohol and other drug use

d. Experienced peer pressure to drink or use drugs

e. Held a drink to have people stop bothering you about why you are not

drinking

A. Zero times

B. One time

C. Two times

D. 3-5 times

E. 6-9 times

F. 10 or more times


Survey (High School) -

2013

Do you believe that alcohol has the following effects? (Mark one response

for each line)

a. Breaks the ice

b. Enhances social activity

c. Makes it easier to deal with stress

d. Gives people something to talk about

e. Facilitates male bonding

f. Facilitates female bonding

g. Allows people to have more fun

h. Gives people something to do

i. Makes food taste better ( Community College Only)

j. Makes women sexier ( Community College Only)

k. Makes men sexier ( Community College Only)

m. Facilitates sexual opportunities ( Community College Only)

Yes or No


Surveys (Community

College Long Form) -

2013

Pg.18 of 30



Perception/

Attitudes Toward

Individual Use

Which statement below about drinking alcoholic beverages do you feel

best represents your own attitude? (Choose the best answer for you)



C. Occasionally getting drunk is okay as long as it doesn’t


D. Occasionally getting drunk is okay even if it does interfere

with academics or responsibilities.

E. Frequently getting drunk is okay if that’s what the




Norms - 1996

It is against my values to drink alcohol while I am a teenager.

A. Strongly agree

B. Agree

C. Disagree

D. Strongly Disagree



How wrong do you think the following are? (Mark one response for each

line)






A. Very wrong

B. Wrong


D. Not wrong at all

Garrett County BTW

Youth Survey - 2013

When it comes to the decisions you make/ or will make about drinking,

which of the following people have the MOST influence? (Mark one

response for each line)

a. Parents or guardians

b. Partner (boyfriend/girlfriend)

c. Religious leaders

d. Siblings or extended family

e. Friends

f. Teachers and health educators

Biggest influence

Second biggest influence


Grade Survey 2012

Pg.19 of 30



Perception/

Attitudes Toward

Individual Use

When it comes to the decisions you make/or will make about drinking,

which of the following influences you the MOST? (Pick top 2 only):

a. Your own morals, values and/or religious beliefs

b. Concerns about getting in trouble with parents

c. Concerns about legal consequences

d. Concerns about getting sick, hungover, or blacking out

e. Concerns about my future

f. Pressure from friends

A. Biggest influence

B. Second biggest influence


Grade Survey 2012

Pg.20 of 30



Perception/

Attitudes Toward

Peer Use

How do you feel about someone your age having one or two drinks of an

alcoholic beverage nearly every day?

A. Neither approve nor disapprove

B. Somewhat disapprove

C. Strongly disapprove

D. “Don’t know/can’t say”



- 2012

How wrong do you think it is for someone your age to: Drink beer, wine

or hard liquor (for example, vodka, whiskey or gin) regularly?

A. Very wrong

B. Wrong


D. Not wrong at all


Youth Survey - 2004

Think of your four best friends (the friends you feel closest to). In the past

year (12 months), how many of your best friends have tried beer, wine or

hard liquor (for example, vodka, whiskey or gin) when their parents didn’t

know about it?

A. None

B. 1

C. 2

D. 3

E. 4


Youth Survey - 2004

How do you feel about someone your age having one or two


A. Neither Approve nor Disapprove

B. Somewhat Disapprove

C. Strongly Disapprove

D. Don’t know or can’t say

DFC and Consumption


What percentage of students your age do you believe drank 5 or more

drinks in a row at least once within the past 30 days?

A. 0%

B. 20%

C. 40%

D. 60%

E. 80%

F. 100%

DFC and Consumption


During the past 30 days, to what extent have you engaged in any of the

following behaviors? (Mark one for each line):

a. Heard someone else brag about his/her alcohol and other drug use

b. Thought a sexual partner was not attractive because he/she was drunk

c. Told a sexual partner that he/she was not attractive because he/she

was drunk

A. Zero times

B. One time

C. Two times

D. 3-5 times

E. 6-9 times

F. 10 or more times


Surveys (Community

College Long Form) -

2013

Pg.21 of 30



Perception/

Attitudes Toward

Peer Use

Do you think alcohol use by underage youth is a...

A. Serious problem

B. Not at all a problem

C. Minor problem

NHTSA Underage


2001

Do you think drinking and driving among youth is a…

A. Serious problem

B. Minor problem

C. Not at all a problem

NHTSA Underage


2001

Most people my age who drink, do so because… (Check all that apply)

__ They want to have a good time at a party

__ They are sad or depressed and want to feel better about

themselves

__ They wish to rebel and defy their parents, teachers and

other adult authorities

__ They wish to fit in or be accepted by their friends or peers

__ They are bored

NHTSA Underage


2001

Within the past year, do you think heavy use of alcohol among people your

age has..

A. Increased

B. Decreased

C. Stayed the same

NHTSA Underage


2001

I think there is nothing wrong with people under 21 drinking beer or wine.

Circle one response.

A. Strongly disagree

B. Disagree

C. Agree

D. Strongly Agree


Youth


Survey -2013

Most people my age who drink, do so because… (Check all that apply)

__ they want to have a good time at a party

__ they are sad or depressed and want to feel better about

themselves

__ they wish to rebel and defy their parents, teachers and

other adult authorities

__ they wish to fit in or be accepted by their friends or peers

__ they are bored


Youth


Survey -2013

Pg.22 of 30



Perception/

Attitudes Toward

Peer Use

How do you feel about someone your age having one or two drinks of an

alcoholic beverage nearly every day?

A. Neither approve or disapprove

B. Approve

C. Somewhat disapprove

D. Strongly disapprove



What percentage of youth you know drink alcohol at any time?

A. None

B. Few - less than 10%

C. 25%

D. 50%

E. Most - over 75%



What percentage of teens in your community do you think drink alcohol?

Circle one response

0% ‒‒‒ 10% ‒‒‒ 20% ‒‒‒ 30% ‒‒‒ 40% ‒‒‒ 50% ‒‒‒ 60%

‒‒‒ 70% ‒‒‒ 80% ‒‒‒ 90% ‒‒‒ 100%

Garrett County BTW

Youth Survey - 2013

Choose the answer that best represents your opinion (Mark one for each

line):

a. How do you feel about teens YOUR AGE having an alcoholic drink at

home?

b. How do you feel about teens YOUR AGE having 5 or more drinks on

one occasion (binge drinking)?

c. What do most adults in your neighborhood, or the area around where

you live, think about kids your age drinking alcohol?

d. What would your friends think if you were to drink alcohol several

times a month or more?

A. Ok

B. Not OK


Grade Survey 2012

Do you think seeing pictures of teens drinking encourages other teens to

want to drink?Yes or No


Grade Survey 2012

Does it seem like they are having a good time or not? Yes or NoWashington County 10th

Grade Survey 2012

Pg.23 of 30



Perception/

Attitudes Toward

Peer Use

Have you ever seen pictures of teens getting drunk or passed out? This

could be in a text message or on a social networking site like Facebook or

Twitter.

Yes or NoWashington County 10th

Grade Survey 2012

Of teens MY AGE, I believe that ___ % (please choose a percentage for

each):

a. Have not had alcohol (more than a sip)

b. Have had one or two drinks

c. Have been drunk at least once

d. Have had 5 or more drinks within a few hours several times a month

or more

0% (none)

25% (1 out of 4)

50% ( 1 out of 2)

75% ( 3 out of 4)

100% (all)


Grade Survey 2012

What do you think is the main reason teens your age drink alcohol? (Please

choose one)

A. To relieve stress

B. Because they feel depressed/ lonely

C. To have fun

D. To fit in

E. To be less inhibited/ to hook up

F. Don’t know


Grade Survey 2012

Pg.24 of 30



Social/

Community

Norms

(These questions must be used together):

1. How often do you think students in each of the following categories

consume alcohol (including beer, wine, wine coolers, liquor, and mixed

drinks)? Just give you best estimate for each category (Mark one response

for each line):

a. Your Friends

b. Students in general

c. Males

d. Females

e. On campus students

f. Off campus students

g. Fraternity members

h. Sorority members

2. Which statement do you feel best represents your own attitude?

3. Which statement about alcoholic beverages do you feel best represents

the most common attitude among students in general here?

1) A. Never used

B. Have used, but not in last 30 days

C. 1-2 days

D. 3-5 days

E. 6-9 days

F. 10-19 days

G. 20-29 days

H. Used daily

-----------

(Questions 2 & 3 use the same answer choices)



C. Occasionally getting drunk is okay as long as it does


D. Occasionally getting drunk is okay even if it does not

interfere with academics or responsibilities.

E. Frequently getting drunk is okay even if that's what the




Norms - 1996

(These two questions must be used together):

1. To answer these questions about alcohol, include beer,wine, wine

coolers, liquor and mixed drinks. Give your best estimate of use, but do

not count the few sips of alcohol you or your peers may have consumed at

a family or religious gathering. (Mark one response for each line):

a. Within the last 30 days, how often did you drink more than a sip of

alcohol?

b. Within the last 30 days, how often do you think a typical student at

your school drank more than a sip of alcohol?

c. Within the last 30 days, how often do you think your friends your age

drank more than a sip of alcohol?

2. Overall, what percentage of students at your school do you believe have

drunk alcohol (more than a sip) in the past 30 days?

1) A. Never used

B. Have used, but not in last 30 days

C. 1-2 days

D. 3-5 days

E. 6-9 days

F. 10-19 days

G. 20-29 days

H. Used daily

-----------

2) A. 0-9 %

B. 10-19%

C. 20-29 %

D. 30-39%

E. 40-49%

F. 50-59%

G. 60-69%

H. 70-79%

I. 80-89%

J. 90-100%


Youth


Survey -2013

Pg.25 of 30



Social/

Community

Norms

(These two questions must be used together):

1. How wrong do you think the following are? (Mark one response for

each line):




d. Providing alcohol to persons under age

e. Riding with a drive under the influence of alcohol

2. How wrong would most persons your age think the following are?

(Mark one response for each line):






(Questions 1-2 use the same answer choices)

A. Very Wrong

B. Wrong

C. A Little Bit Wrong

D. Not Wrong at All

Garrett County BTW

Youth Survey - 2013

Please check a box to rate how significant each of these issues are in

Washington county: Underage Drinking

__ Not really an issue at all

__ An important issue but it only affects a small part of the

population in Washington County

__ A significant issue that affects most of the population in

Washington County


Grade Survey 2012

Pg.26 of 30



Social/

Community

Norms

(These questions must be used together):

1. How wrong would most adults in your community think the following

are? (Mark one response for each line):






2. How wrong would most teens in your community think the following

are? (Mark one response for each line):






3. How wrong do you think the following are? (Mark one response for

each line):






(Questions 1- 3 use the same answer choices)

A. Very Wrong

B. Wrong

C. A Little Bit Wrong

D. Not Wrong at All

Garrett County BTW

Adult Survey - 2013

Pg.27 of 30



OtherDuring the past 30 days, how many times did you ride in a car or other

vehicle drive by someone who had been drinking alcohol?

A. Zero times

B. One time

C. 2 or 3 times

D. 4 or 5 times

E. 6 or more times

Youth Risk Behavior



school)

About how many adults (over 21) have you known personally who in the

past year have gotten drunk or high?

A. None

B. 1 adults

C. 2 adult

D. 3 or 4 adults

E. 5 or more adults


Youth Survey - 2004

Has anyone in your family ever had a severe alcohol or drug problem? Yes or No Communities That Care

Youth Survey - 2004

Have any of your brothers or sisters ever drunk beer, wine or hard liquor

(for example, vodka, whiskey or gin)?

Yes

No

I don’t have any brothers or sisters


Youth Survey - 2004

You are at a party at someone’s house, and one of your friends offers you

a drink containing alcohol. What would you say or do?

A. Drink it

B. Tell your friend “No thanks, I don’t drink” and suggest that

you and your friend go and do something else

C. Just say “No, thanks” and walk away

D. Make up a good excuse, tell your friend you had something

else to do and leave


Youth Survey - 2004

(Please use these two questions together)

1. Do you know someone with an alcohol problem?

2. If the response to question ABOVE was “Yes,” what was their

relationship to you?

1) Yes or No

----------

2) Relative or Non-relative (e.g., friend or acquaintance)

NHTSA Underage


2001

Do you discuss alcohol use with your parent(s)? Yes or NoNHTSA Underage


2001

Pg.28 of 30



OtherDo you know of parents or adults who permit non-family members under

the age of 21 to consume alcohol in their homes?Yes or No

NHTSA Underage


2001

Do your parents know how much you drink? Yes or NoNHTSA Underage


2001

Have your parents ever seen you drunk? Yes or NoNHTSA Underage


2001

Which of the following approaches would you support to decrease alcohol

use by youth under the legal drinking age of 21? (Check all that apply)

__ New and/or stiffer penalties

__ More law enforcement

__ More alcohol education in schools

__ More alcohol education in the mass media (TV, radio,

magazines)

__ Alcohol-free teen night clubs

__ Public presentations by people who have been seriously

hurt or impaired by alcohol abuse

__ Driver’s license suspension for youth who drink alcohol

__ Ban on alcohol advertising

NHTSA Underage


2001

Who is responsible for contributing to the problem of alcohol use by

youth under age 21? (Check all that apply):

__ Parents

__ Public agencies

__ Alcohol outlets, such as liquor stores, bars and restaurants

__ Advertising

__ Youth themselves

__ Other (write in)

__ Don’t know

NHTSA Underage


2001

Does anyone in your family drink six or more alcoholic beverages at any

one period of time? Yes or No



Pg.29 of 30



OtherUnderage youth are allowed to have alcoholic drinks at family events or at

home in my familyTrue or False



During the past 12 months, have you… (Mark one response for each line):

a)...participated in an alcohol prevention program outside of school,

where you learned about the dangers of drinking and how to resist

drinking alcohol?

b)...seen or heard any underage drinking prevention messages from

sources outside school such as posters, pamphlets, radio, or TV?

Yes or No Washington County 10th

Grade Survey 2012

Please rank how helpful the following actions would be for preventing

underage drinking. (Pick the Top 3 only.):

a. Prevention education for teens and/or parents

b. After school programs and structured activities for teens

c. Mental Health/counseling services for teens

d. Mentoring programs for teens

e. Life skills training (making healthy decisions, saying no to peer

pressure, and setting goals for the future)

f. Better communication between parents and teens

A. Most helpful

B. Second most helpful

C. Third most helpful


Grade Survey 2012

When should parents start talking to their children about drinking?

A. Before 5th grade

B. 5th-6th grade

C. 7th-8th grade

D. 9th-10th grade

E. 11th-12th grade

F. Should not be talked about at home


Grade Survey 2012

Pg.30 of 30

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