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Exit Survey
 
How do you feel about people doing the following? Please check one box for each item.
Acceptable Neutral Unacceptable
Smoking marijuana once or twice
Smoking marijuana regularly
Trying meth once or twice
Drinking alcohol regularly
Inhaling (or “huffing”) a substance to get high
 
 
How do you think your friends feel about people doing the following? Please check one box for each item.
Acceptable Neutral Unacceptable
Smoking marijuana once or twice
Smoking marijuana regularly
Trying meth once or twice
Drinking alcohol regularly
Inhaling (or “huffing”) a substance to get high
 
 
How do you think your parents feel about people doing the following? Please check one box for each item.
Acceptable Neutral Unacceptable
Smoking marijuana once or twice
Smoking marijuana regularly
Trying meth once or twice
Drinking alcohol regularly
Inhaling (or “huffing”) a substance to get high
 
 
Here are some statements that people have made about drug use. Select the answer that is closest to your opinion.
Strongly Agree Agree Disagree Strongly Disagree
Using drugs can be a pleasant activity 
A young person should never try drugs 
Experimenting with drugs is more dangerous than most things  
Using drugs seems to be fun 
Many things are much riskier than trying drugs 
Everyone who tries drugs eventually regrets it 
The laws about illegal drugs should be made stricter 
Drug use is one of the biggest evils in the country 
Drugs help people experience life better
Schools should teach about the real hazards of taking drugs 
The police should not bother people who use drugs
To experiment with drugs is to give away control of your life 
 
 
How much risk is there that someone will harm themselves if they…
No Risk Slight Risk Moderate Risk Great Risk
Smoke marijuana once or twice 
Smoke marijuana regularly 
Try meth once or twice 
Drink alcohol regularly 
Inhale (or “huff”) a substance to get high 
Use meth regularly 
 
 
How likely is it that each of the following would happen to you if you use any drugs?
Very Likely Likely Not Sure Unlikely Very Unlikely
Get into trouble with police 
Do badly in school 
Get into trouble with parents 
Be expelled from school 
Have problems with my friends 
Become an addict 
Have more friends 
Be more popular with my friends
 
 
Sometimes we don’t know what we will do as adults, but we may have an idea. Please select how true these statements may be for you. 
Very Likely Likely Not Sure Unlikely Very Unlikely
I will try inhalants or “huffing.” 
I will drink beer, wine, or liquor. 
I will smoke marijuana. 
I will try other types of drugs. 
 
 
 
How confident are you that you could have an honest conversation with your children about drugs?
 
Very confident
 
Somewhat confident
 
Neutral
 
Somewhat unconfident
 
Not at all confident
 
 
 
How old are you?
   
 
 
 
Are you male or female?
 
Male
 
Female