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During the past 30 days, on how many days did you use
      0 1-2 3-5 6-9 10-19 20-29 All 30 days
   
   

During the past 30 days, how did you usually get your tobacco products?

During the past 30 days, how many times did you ride in a car or other vehicle where the driver had been drinking alcohol (beer, wine, hard liquor such as vodka, gin, whiskey etc.)?

During the last 30 days, on how many days have you had at least one drink of alcohol?

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

During the past 30 days, how many times did you use:
      0 1-2 3-5 6-9 10-19 20-29 All 30 days
   
   
   

Please indicate how many times you have participates in the following behaviors during your lifetime:
      0 1-2 3-9 10-19 20-39 40 or more
   
   
   
   
   
   
   
   

How much do you think people risk in harming themselves (physically or in other ways) if they participate in the following:
      No Risk Slight Risk Moderate Risk Great Risk
   
   
   
   
   
   
   
   
   
   
   
   

How wrong do you think it is for someone your age to participate in the following:
      Not wrong at all Slightly Wrong Wrong Very Wrong
   
   
   
   
   
   
   
   
   
   
   
   

In the past 12 months, has your drinking and/or drug use caused you to fight (verbal or physical) with other kids?

In the past 12 months, has your drinking and/or drug use caused you to fight (verbal or physical) with your parents?

In the past 12 months, has your alcohol and/or drug use caused you to not recall what you did?

Now, think about the past 12 months through today. During the past 12 months, have you talked with at leat one of your parents about the dnagers of tobacco, alcohol, or drug use? By PARENTS we mean you biological parents, adoptive parents, stepparents, or adult guardians, whether or not they live with you.

During the past 12 months, do you recall hearing, reading, or watching an advertisement about prevention of substance abuse?

After today's event:
      Yes No Not applicable
   
   
   
   
   
   
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