N R P F S S Administrative Use Only

Nebraska Risk & School Name: Protective Factor Student Survey School ID: School District: Year 2014

The purpose of this survey is to learn how students in our schools feel about their community, family, peers, and school. The survey also asks about health behaviors.

- The survey is completely voluntary and anonymous. Do NOT put your name on the questionnaire. - This is not a test, so there are no right or wrong answers. We would like you to work quickly so you can finish. - All of the questions should be answered by completely filling in one of the answer spaces. If you do not find an answer that fits exactly, use the one that comes closest. If any question does not apply to you, or you are not sure what it means, just leave it blank. You can skip any question that you do not wish to answer. - Mark only one answer to each question unless instructed otherwise.

About You Your Experiences at School

1 Are you: 6 Putting them together, what were your grades Male like last year ? (Mark the one best answer.) Female Mostly F's Mostly D's Mostly C's 2 How old are you? Mostly B's 12 or younger 16 Mostly A's 13 17 14 18 7 How often do you feel that the school work you are 15 19 or older assigned is meaningful and important? Never 3 What grade are you in? Seldom 7th 10th Sometimes 8th 11th Often 9th 12th Almost always

4 Are you Hispanic or Latino? 8 How interesting are most of your courses to you? Yes (Hispanic or Latino) Very interesting and stimulating No (Not Hispanic or Latino) Quite interesting Fairly interesting Slightly dull 5 What is your race? (Select one or more.) Very dull Black or African American Asian 9 How important do you think the things you are American Indian learning in school are going to be for your later life? Native Hawaiian or other Pacific Islander Very important Alaska Native Quite important White Fairly important Other Slightly important Not at all important

Page 1 of 8 EXTRA INSTRUCTION 20 During the last four weeks , how many whole Starting below, for survey items with answer choices of: days of school have you missed because you NO! no yes YES! skipped or "cut"?

- Mark NO! if the item is DEFINITELY NOT TRUE for you. None 4-5 - Mark no if the item is MOSTLY NOT TRUE for you. 1 6-10 - Mark yes if the item is MOSTLY TRUE for you. 2 11 or more - Mark YES! if the item is DEFINITELY TRUE for you. 3

EXAMPLE: Almost alw ays is the best ice cream flavor. Often NO! no yes YES! Sometimes Seldom In this example, the student marked yes because the statement is MOSTLY TRUE for this student. 21 Now thinking back over the past Never year in school, how often did you: a. enjoy being in school?

NO! no yes YES! b. hate being in school? 10 In my school, students have c. try to do your best work in school? lots of chances to help decide things like class activities and rules. Your Feelings and Experiences 11 Teachers ask me to work on in Other Parts of Your Life special classroom projects.

12 My teachers notice when I am 17 or older doing a good job and let me 16 know about it. 15 14 13 There are lots of chances for 13 students in my school to get 12 involved in sports, clubs, and 11 other school activities outside 22 How old were you 10 or younger of class. when you first: Never have smoked a , even 14 There are lots of chances for a. students in my school to talk just a puff? with a teacher one-on-one. had more than a sip or two of , or hard 15 I feel safe at my school. b. liquor (for example, 16 The school lets my parents vodka, whiskey, or gin)? know when I have done began drinking alcoholic something well. beverages regularly, that c. 17 My teachers praise me when is, at least once or twice I work hard in school. a month? 18 There are lots of chances to d. smoked marijuana? be part of class discussions got suspended from e. or activities. school? 19 Are your school grades better f. got arrested? than the grades of most g. carried a handgun? students in your class? attacked someone with h. the idea of seriously hurting them?

Page 2 of 8 Not wrong at all A little bit wrong Wrong 40+ times 30-39 times 23 How wrong do you think it is for Very wrong 20-29 times someone your age to: 10-19 times a. take a handgun to school? 6-9 times b. steal anything worth more than $5? 3-5 times 1-2 times c. pick a fight with someone? 26 How many times during the past year (12 months) Never attack someone with the idea of seriously d. have you: hurting them? been suspended from stay away from school all day when their e. school for using or parents think they are at school? a. possessing , f. smoke ? , or drugs? use (for been suspended from g. example, chew, , plug, dipping school for reasons other tobacco, or )? b. than tobacco, alcohol, or drink beer, wine or hard liquor (for example, drugs? h. vodka, whiskey, or gin) regularly, that is, at least once or twice a month? c. carried a handgun? i. drive after drinking beer, wine, or hard liquor? d. sold illegal drugs? stolen or tried to steal a j. smoke marijuana? e. motor vehicle such as a car use prescription drugs without a doctor k. or motorcycle? telling them to? participated in clubs, sniff glue, breathe the contents of an aerosol f. organizations, or activities spray can, or inhale other gases or sprays in l. at school? order to get high? g. been arrested? use LSD, , , or m. done extra work on your another illegal drug? h. own for school? attacked someone with the 24 Have you ever belonged to a gang? i. idea of seriously hurting No, and don't want to them? been drunk or high at No, but would like to j. Yes, in the past but not now school? volunteered to do Yes, belong now k. community service? taken a handgun to school? Almost all (91-100%) l. stolen something worth Most (71-90%) m. 25 Now thinking about all Half to most (51-70%) more than $5? the students in your Some to half (31-50%) driven a vehicle while you grade at your school . Some (11-30%) n. were under the influence How many of them do Few (1-10%) of alcohol? you think: None (0%) smoked cigarettes during a. the past 30 days ? NO! no yes YES! drank beer, wine, or hard b. liquor during the past 30 27 I think sometimes it's okay to days ? cheat at school. smoked marijuana during I think it's okay to take c. 28 the past 30 days ? something without asking if used an illegal drug (not you can get away with it. d. including marijuana) during 29 It's all right to beat up people the past 30 days ? if they start the fight.

Page 3 of 8 Great risk 30 How much do you think people risk Moderate risk harming themselves (physically or Slight risk in other ways) if they: No risk 33 How frequently have you used smokeless tobacco during the past 30 days ? smoke one or more packs of cigarettes a. per day? Never are exposed to other people's cigarette Once or twice b. smoke? Once or twice per week use smokeless tobacco (for example, 3 to 5 times a week c. chew, snuff, plug, dipping tobacco, or About once a day chewing tobacco) every day? More than once a day take one or two drinks of an alcoholic d. beverage (beer, wine, or hard liquor) nearly every day? 34 Have you ever smoked cigarettes? have five or more drinks of an alcoholic Yes e. beverage once or twice a week? No drive after drinking beer, wine, or hard f. liquor? 35 How frequently have you smoked cigarettes during g. try marijuana once or twice? the past 30 days ? h. smoke marijuana regularly? Not at all use prescription drugs without a doctor i. Less than 1 cigarette per day telling them to? 1 to 5 cigarettes per day sniff glue, breathe the contents of an About 1/2 pack per day j. aerosol spray can, or inhale other gases About 1 pack per day or sprays in order to get high? About 1 1/2 packs per day use LSD, cocaine, amphetamines, or k. 2 packs or more per day another illegal drug?

31 Bullying is when 1 or more students tease, threaten, 36 If you smoked cigarettes during spread rumors about, hit, shove, or hurt another the past 30 days , where did you No Yes student over and over again. It is not bullying when 2 get them? (Mark "Yes" or "No" for Did not smoke students of about the same strength or power argue or each. If you did not smoke during the fight or tease each other in a friendly way. past 30 days, mark "Did not smoke" for each.) Yes No In the past 12 months , have you: a. I bought them myself with a fake ID. a. been bullied on school property? b. I bought them myself without a fake ID. b. been bullied away from school property? c. I gave someone money to buy them for me. been electronically bullied? (Include being I borrowed (or bummed) them from c. bullied through e-mail, chat rooms, instant d. someone else. messaging, Web sites, or texting.) My parents gave them to me or bought them e. for me. Your Experiences with Tobacco, A family member or relative other than my Alcohol, and Other Drugs f. parents gave them to me or bought them for me. Remember, your answers are confidential. I took them from home without my parents' g. permission. 32 Have you ever used smokeless tobacco (chew, snuff, plug, dipping tobacco, or chewing tobacco)? h. I took them from a store or shop. Yes i. I got them some other way not listed. No

Page 4 of 8 Have you: Yes No

37 had alcoholic beverages (beer, wine, or hard liquor) to drink in your lifetime –more than just a few sips?

38 had beer, wine, or hard liquor to drink during the past 30 days ?

39 had five or more drinks of alcohol in a row, that is, within a couple of hours during the past 30 days ?

40 used marijuana in your lifetime ?

41 used marijuana during the past 30 days ?

42 used LSD or other psychedelics in your lifetime ?

43 used LSD or other psychedelics during the past 30 days ?

44 used cocaine or crack in your lifetime ?

45 used cocaine or crack during the past 30 days ?

46 used (meth, speed, crank, crystal meth, or ice) in your lifetime ?

47 used methamphetamines (meth, speed, crank, crystal meth, or ice) in the past 30 days ?

48 sniffed glue, breathed the contents of an aerosol spray can, or inhaled other gases or sprays in order to get high in your lifetime ?

49 sniffed glue, breathed the contents of an aerosol spray can, or inhaled other gases or sprays in order to get high during the past 30 days ?

50 used phenoxydine (pox, px, breeze) in your lifetime ?

51 used phenoxydine (pox, px, breeze) during the past 30 days ?

52 used steroids without a doctor telling you to take them, in your lifetime ?

53 used steroids without a doctor telling you to take them, during the past 30 days ?

54 used performance enhancing drugs other than steroids (such as , EPO, creatine, DHEA, or diuretics) without a doctor telling you to take them, in your lifetime ?

55 used performance enhancing drugs other than steroids (such as ephedrine, EPO, creatine, DHEA, or diuretics) without a doctor telling you to take them, during the past 30 days ?

56 used prescription drugs (such as Valium, Xanax, Ritalin, Adderall, OxyContin, Vicodin, or Percocet) without a doctor telling you to take them, in your lifetime ?

57 used prescription drugs (such as Valium, Xanax, Ritalin, Adderall, OxyContin, Vicodin, or Percocet) without a doctor telling you to take them, during the past 30 days ?

58 used a non-prescription cough or cold medicine (robo, robo-tripping, DMX) to get high and not for medical reasons, in your lifetime ?

59 used a non-prescription cough or cold medicine (robo, robo-tripping, DMX) to get high and not for medical reasons, during the past 30 days ?

60 used other illegal drugs in your lifetime ?

61 used other illegal drugs during the past 30 days ?

Page 5 of 8 Yes No 62 During the past 30 days, did you: 66 If you drank alcohol during the past drive a car or other vehicle when you a. 30 days , where did you drink it? No had been drinking alcohol? (Mark "Yes" or "No" for each location. If Yes ride in a car or other vehicle driven by you did not drink alcohol during the past Did not drink b. someone who had been drinking 30 days, mark "Did not drink" for each.) alcohol? a. At my home without my parents' permission At someone else's home without their b. parents' permission

63 During the past 30 days , what is the greatest number c. At my home with my parents' permission of alcoholic drinks you had in a row, that is, within a At someone else's home with their parents' d. couple of hours? permission None 5 drinks e. At a restaurant, , or club 1-2 drinks 6-7 drinks At a public event such as a concert or sporting f. 3 drinks 8-9 drinks event 4 drinks 10 or more drinks At an open area like a park, lake, field, or a g. street corner 64 During the past 30 days , what type of alcohol did you h. In a car usually drink? (Mark the one best answer.) i. At a hotel or motel I did not drink alcohol during the 30 days. I do not have a usual type. j. On school property Beer k. At some other place not listed Flavored malt beverages, such as Smirnoff Ice, Bacardi Silver, or Hard Lemonade Wine coolers, such as Bartles and James or Seagrams 67 Think back over the last two weeks . How many times Wine have you had five or more alcoholic drinks in a row? Liquor, such as vodka, rum, scotch, bourbon, or None 3-5 times whiskey Once 6-9 times Some other type Twice 10 or more times

65 If you drank alcohol during the past 30 days , how did you get it? No Your Family (Mark "Yes" or "No" for each source. Yes When answering these questions, please think If you did not drink alcohol during the Did not drink about the people you consider to be your past 30 days, mark "Did not drink" for family. For example, parents, step-parents, each.) brothers, sisters, grandparents, aunts, uncles. I bought it in a store such as a liquor store, a. gas station, or grocery store. Not wrong at all b. I bought it at a restaurant, bar, or club. A little bit wrong I bought it at a public event such as a 68 How wrong do your parents feel Wrong c. concert or sporting event. it would be for you to: Very w rong d. I got it at a party. a. smoke cigarettes? e. I gave someone money to buy it for me. b. use smokeless tobacco? drink beer, wine, or hard liquor regularly, My parents gave it to me or bought it for c. f. me. that is, at least once or twice a month? drive after drinking beer, wine, or hard A family member or relative other than my d. g. liquor? parents gave it to me or bought it for me. e. smoke marijuana? I took it from home without my parents' h. use prescription drugs without a doctor permission. f. telling you to? i. I took it from a store or shop. use LSD, cocaine, amphetamines, or g. j. I got it some other way not listed. another illegal drug?

Page 6 of 8 NO! no yes YES! 69 The rules in my family are 85 During the past 12 months, have you talked with at clear. least one of your parents about the dangers of alcohol? 70 When I am not at home, one of my parents knows Yes where I am and who I am No with. 71 My family has clear rules about alcohol and drug use. Your Neighborhood and 72 My parents ask me what I The Community Where You Live think before most family decisions affecting me are Very easy made. Sort of easy 73 If I had a personal problem, Sort of hard I could ask my mom or dad 86 If you wanted to, how easy would Very hard for help. it be for you to get: 74 My parents give me lots of a. some cigarettes? chances to do fun things b. some beer, wine, or hard liquor? with them. c. some marijuana? 75 My parents ask if I’ve gotten some prescription drugs for non-medical my homework done. d. use? It is important to be honest 76 a drug like cocaine, LSD, or with your parents, even if e. amphetamines? they become upset or you get punished. f. a handgun?

NO! no yes YES! 87 In your community, how easy would it be for 77 If you drank some beer or someone under 21 to buy alcohol from a store? wine or hard liquor (for Very hard example, vodka, whiskey or Sort of hard gin) your parents' without Sort of easy permission, would you be Very easy caught by your parents? 78 If you carried a handgun Would a kid be caught by without your parents' 88 NO! no yes YES! permission, would you be the police, if he or she: caught by your parents? Smoked a cigarette in your a. neighborhood, or the area 79 If you skipped school around where you live? without your parents' Drank some beer, wine or permission, would you be hard liquor in your caught by your parents? b. neighborhood, or the area 80 Would your parents know if around where you live? you did not come home on Drove after drinking beer, time? wine or hard liquor in your c. 81 Do you feel very close to neighborhood, or the area your mother? around where you live? 82 Do you share your thoughts Smoked marijuana in your and feelings with your d. neighborhood, or the area mother? around where you live? Carried a handgun in your 83 Do you feel very close to e. neighborhood, or the area your father? around where you live? 84 Do you share your thoughts and feelings with your father?

Page 7 of 8 NO! no yes YES! 89 I feel safe in my 95 During the past 12 months , have you: Yes No neighborhood, or the area a. thought about gambling? around where I live. gambled (bet) for money or 90 There are lots of adults in b. possessions? my neighborhood I could talk to about something c. gambled at a casino? important. d. played the lottery or scratch-off tickets? e. bet on sports? f. played cards for money? 91 Which of the following activities for people your age are available in your g. bet on horse/dog races? community? Yes No h. played bingo for money or prizes? a. Sports teams? i. gambled on the Internet? b. Scouting? j. bet on dice games (such as craps)? c. Boys and girls clubs? bet on games of personal skill (such as k. d. 4-H clubs? computer or video games)? e. Service clubs? l. gambled at school or a school event?

92 How wrong would most adults Not wrong at all 96 During the past 12 months , have you ever spent (over 21) in your neighborhood, A little bit wrong more money than you meant to on gambling? Wrong or the area around where you I have not gambled. Very wrong live, think it is for kids your age: Yes a. to use marijuana? No b. to drink alcohol? c. to smoke cigarettes? Media Exposure and Your Honesty d. to drive after drinking alcohol? in Completing this Survey

97 During the past 12 months , do you recall hearing, 93 How much do each of the reading, or watching an advertisement about the following statements describe prevention of ? your neighborhood, or the Yes area around where you live? NO! no yes YES! No Lots of crime and/or drug a. selling 98 How honest were you in filling out this survey? b. Lots of fights I was very honest. Lots of empty or abandoned c. buildings I was honest most of the time. d. Lots of graffiti I was honest some of the time. I was honest once in a while. I was not honest at all. Your Experiences with Gambling

94 Has your gambling ever caused you problems at Thank you for completing this survey! home, at school, or with your friends? I have not gambled. Yes No

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