Please Take a Few Minutes to Fill out This Brief Survey

Please take a few minutes to fill out this brief survey. Your answers will be anonymous

General information

1. How old are you? ______

2. What is your gender? Male ______Female ______

3. Which of the following best describes your race/ethnic background? White __ Black __ Asian __ Hispanic/Latino __ American Indian/Alaska native __ Native Hawaiin/PI __

4. Are you? In College ___ Working Full Time ____ Working Part Time ____ Unemployed ___

These questions ask about use of medications and prescription drugs: (Please place a check mark to indicate your answer)

5. Have you ever “misused" prescriptions drugs?. “Misuse” can be either using a prescription drug not your own for its specific effects (e.g., using a stimulant to concentrate or stay up and study) or simply for the feeling it gives you (e.g., using an opioid “to get high”)? It is also "misuse" if you obtain your own prescription from a physician but then use the drug non-medically (e.g. to get high). Yes ____ No____

6. In the past 30 days, have you “misused” any prescriptions drugs? Yes ____ No ____ 7. If yes, what kind? Opioids (e.g., OxyContin) ___ Stimulants (e.g., Adderall) ___ Tranquilizers (e.g. Valium) ____

8. If you “misused” a prescription medication (either for its specific effect or to get high), how did you get it the last time? (please check one) a. ___ I have never misused a prescription medication b. ___ I got a prescription from just one doctor (But used the medication non-medically, just to get high) c. ___ I got prescriptions from more than one doctor (But used the medication non-medically, just to get high) d. ___ I wrote a fake prescription e. ___ I stole it from a doctor’s office, clinic, hospital or pharmacy f. ___ I got it from a friend or relative for free g. ___ I bought it from a friend or relative h. ___ I took it from a friend or relative without asking i. ___ I bought it from a drug dealer or other stranger j. ___ I bought it on the internet

These questions ask about your attitudes and opinions: 9. How much do you think people risk harming themselves if they occasionally use any of the following(Circle your response) : Type of prescription medication No risk Slight risk Moderate risk Great risk Opioids (e.g., OxyContin from a prescription that is not yours) 0 1 2 3 Stimulants (e.g., Ritalin or Adderall from a prescription that is not yours) 0 1 2 3 Tranquilizers (e.g., Valium or Xanax from a prescription that is not yours) 0 1 2 3

10. How wrong do you feel it would be for someone your age to misuse prescription medication? ___ Not wrong at all ____ Wrong ___ A little bit wrong ____ Very wrong

11. How wrong would your family think it would be for you to misuse prescription medication? ___ Not wrong at all ____ Wrong ___ A little bit wrong ____ Very wrong

12. How wrong would your close friends think it would be for you to misuse prescription medication to get high? ___ Not wrong at all ____ Wrong ___ A little bit wrong ____ Very wrong 13. What percentage of young adults (ages 18-25) do you believe misuse prescription medication? ____ % Thank you very much for answering these questions.