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  1. Surveys
  2. 2004
  3. December
  4. A
  5. AdolescentDrug&Alcohol
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Hello:

You are invited to participate in our survey on The Correlation Between Underage Drinking and Illicit Drug Use. In this survey, respondents will be asked to complete a survey that asks questions about their personal experiences with alcohol and drugs.


Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.


Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Kaliah Jackson at 443-271-6473 or by email at the email address specified below.


Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
What is your age?
   
 
 

What is your race?
 
Black
 
Other
 
 

 
 

What is your sex?
 
Males
 
Female
 
 

 
 

What is your religious affiliation?
 
Christian
 
Muslim
 
Buddhist
 
None

 
 
 
What is your GPA?
   
 
 

What is your highest level of education completed?
 
1yr college
 
2yrs college
 
3yrs college
 
4yrs college

 
 

Have you ever tried alcohol? If NO, skip to question 9.
Yes No
 
 

At what age were you when you first tried alcohol?
 
5-10
 
11-15
 
16-20
 
21-24

 
 

Do Not Drink Once/Yr 6 Times/Yr Once/Month Twice/Month Once/Week 3-5 times/week Every day
How often do you drink alcohol?
 
 

What are your primary reasons for using alcohol? CHECK ALL THAT APPLY
 
To fit in/Peer Pressure
 
Stress
 
For fun
 
Boredom
 
Special Occasions
 
Curiosity
 
Depression
 
Other

 
 

Do either of your parents drink alcohol?
Yes No
 
 

If yes, who?
Mother Father Both
 
 

Do any of your friends drink alcohol?
Yes No
 
 

If yes, how many of your friends drink alcohol?
All Some Not Many
 
 

Is there patterns of alcoholism in your family?
Yes No
 
 

Have you ever used marijuana? If NO, skip to question 19.
Yes No
 
 

If yes, at what age were you when you first tried marijuana?
 
5-10
 
11-15
 
16-20
 
21-24

 
 

How often do you use marijuana
 
Never
 
Once/Yr
 
6 times/yr
 
Once/Month
 
Twice/Month
 
Once/Week
 
3 Times/Week
 
5 Times/Week
 
Every Day

 
 

Were/are you involved in any extra-curricular activities?
Yes No
 
 
 
If yes, What were they?
   
 
 

In high school, how involved were your parents in your activities outside of school?
Very Involved Somewhat Involved No Involvement
 
 
 
Additional Comments
   
 
Please contact [email protected] or click here if you have any questions regarding this survey.
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