You are invited to participate in the evaluation of the All Stars, Sr. health education program, which is being conducted by Evaluation, Assessment, & Policy Connections at the University of North Carolina at Chapel Hill. The results of this survey will help teachers understand how to be more effective at helping students understand the importance of good health practices.
All students in your class have been asked to participate. Your parents have been informed about this project. Participation will involve completing several questions about a variety of health topics, including questions about your attitudes towards substance use, handling stress, and goal setting.
This is not a test. The correct answer is the one that best tells who you are, and what you actually believe.
All information gathered from you will be CONFIDENTIAL. Your name will not appear on the survey. Information you provide will not be shown to your teacher, school officials, police, or parents. If you have any questions about the study, please ask your teacher.
Your participation is VOLUNTARY. If you do not wish to complete this survey, you may raise your hand and tell your teacher, or you may simply leave the survey blank. If you wish to stop in the middle or skip some questions, you are allowed to do so. Just leave blank whatever questions you do not want to answer.
1. How strongly do you agree or disagree with each of the following statements?
Strongly agree Agree Neutral Disagree Strongly disagree a. You feel close to people at your school. b. You feel like you am part of this school. c. The students at your school are prejudiced. d. You are happy to be at your school. e. The teachers at your school treat students fairly. f. You feel safe at your school.
Not at all A little Average Somewhat Very much
3. Since school started this year, how often have you:
Never Just a few times About once a week Almost every day Every day a. had trouble getting along with you teachers? b. had trouble paying attention at school? c. had trouble getting your homework done? d. had trouble getting along with other students? e. enjoyed being in school? f. hated being in school?
Never Seldom Sometimes Often Almost Always a. You set goals to achieve. b. You work toward achieving a goal. c. You stop and think about whether or not your decisions fit with your goals. d. When you set a goal, you think about what you need to do to achieve that goal. e. You think of your future beyond high school. f. You think about what you would like to be when you become an adult. g. You work on goals that you have set for yourself.
Never Sometimes Often Always a. You stop and think about whether or not your decisions fit with your goals? b. When you do something, you think about all of your choices very carefully. c. When you do something, you do the first thing that comes into your mind. d. When you do something, you compare all the good things and bad things that might happen. e. When you do something, you consider what effect it will have on your health. f. When you do something, you don't even think about it; you just do it. g. When you do something, you do whatever you think will be the most fun. h. When you do something, you like to be spontaneous and just do it. i. When you do something, you consider if it will be good or bad for your future. j. When you do something, you act on the spur of the moment.
Strongly Agree Agree Neutral Disagree Strongly Disagree a. Finding positive ways to handle stress is important to you. b. It is important to make time for relaxation when your schedule is really busy. c. You think it is important to minimize stress in your life. d. You cope with stress very well. e. You know how to relax when you feel too much pressure. f. you know what to do to handle a stressful situation. g. Stressful situations are very difficult for you to deal with.
Strongly Agree Agree Neutral Disagree Strongly Disagree a. Drinking alcohol will prevent you from achieving your goals? b. Smoking cigarettes fits the kind of life you want to lead. c. Using marijuana would keep you from doing things you want to do. d. Getting high from sniffing glue would get in the way of what is important to you.
8. What would your friends think if you drank alcohol?
they would be angry with me they would be a little upset they wouldn't care one way or the other they would accept me they would be glad
9. What would your friends think if you smoked cigarettes?
10. What would your friends think if you used marijuana?
11. What would your friends think if you sniffed inhalants?
12. What would your friends think if you used methamphetamines (such as Ecstacy)?
13. How many people your age at your school do you think:
None A Few Some Most All a. have smoked cigarettes during the past 30 days? b. have had some kind of alcoholic beverage during the past 30 days? c. drink alcohol at least once a month? d. have used a drug like cocaine or heroin during the past 30 days? e. smoke marijuana (pot, grass) or hashish? f. sniff glue, gases, or sprays? g. would agree with the following statement? ''People who use drugs are stupid.''
Strongly Agree Agree Neutral Disagree Strongly Disagree a. You have made a personal commitment to never smoke cigarettes. b. You have made a personal commitment to yourself that you will not drink alcohol. c. You have made a personal commitment to stay away from marijuana. d. You have made a personal commitment to never use other illegal drugs (such as Ecstacy, Cocaine, Speed).
Never Seldom Sometimes Often Almost Always a. How much pressure do you feel from your friends and schoolmates to smoke cigarettes? b. How much pressure do you feel from your friends and schoolmates to drink alcoholic beverages? c. How much pressure do you feel from your friends and schoolmates to use marijuana? d. How much pressure do you feel from your friends and schoolmates to use other illegal drugs (such as Ecstacy, Cocaine, Speed). m
16. Pretend your best friend offered you marijuana and you did not want it.
How hard would it be for you to refuse the offer?
very easy pretty easy pretty hard very hard
17. How strongly do you agree or disagree with each of the following statements?
Strongly Agree Agree Neutral Disagree Strongly Disagree a. If you don't use alcohol or drugs you will be happier. b. If you use marijuana regularly, you will get into trouble at school. c. If you use alcohol or drugs, you will have more health problems than other people. d. Drinking alcohol will make people like you better. e. If you smoked cigarettes, you would have bad breath. f. Using marijuana would make it easier for you to be part of a group.
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19. How many times have the following situations happened to you in the past month, or in your whole life
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20. If, in the past 30 days you drove a car after drinking, how unsafe was your condition?
You have not driven after drinking. You were not affected by the alcohol. You were lightheaded. YouI were a little drunk. You were very drunk.
21. How many times have you used any of the following in the past month or in your whole llife
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22. Have the following situations occurred to you since may of last year? If so, how often?
No Yes, once Yes, more than once a. You have been sent out of a classroom by a teacher for bad behavior. b. You have been suspended from school. c. You skipped, or cut, an entire day of school? d. You went to school but skipped a class when you were not supposed to? e. You have destroyed something on purpose that did not belong to you. f. You have been in a physical fight. g. Y have been in serious trouble with your parents. h. You have been in trouble with the police. i. You have been involved in a serious accident. j. When any of the things described in questions 22.a.-22.i . happened, had you been drinking alcohol? k. When any of the things described in questions 22.a.-22.i. happened, had you been using marijuana? l. When any of the things described in questions 22.a.-22.i. happened, had you been using any illicit drug other than alcohol or marijuana?
Male Female
24. What is your grade level in school?
9th 10th 11th 12th
25. How old were you on your last bitrthday?
13 14 15 16 17 18
26. How do you describe yourself?
Hispanic / Latino American Indian / Alaska Native Asian Native Hawaiian / other Pacific Islander Black / African American White (Caucasian) Other
This questionnaire was created using Perseus SurveySolutions.