Consumption Questions for SFS (Based on the YRSS Questions)

NAME:______(Print: first name & last name)

Codebook New Mexico State Incentive Grant Program Strategies for Success Module A: High School (POSTTEST) Version 2014

Do not write in this box. For office use only.

SFS VERSION ID: ATODHSP version

ID# Site ID Group Participant ID site gid pid (gid codes: 1 = Control/Comparison group, 2 = Intervention/ Program group, 3 = Second Comparison group)

Date of administration: date Month Day Year

Language of administration: 1 English (Circle appropriate number) 2 Spanish language 3 Other, Specify ______

Location of administration: 1 School (Circle appropriate number) 2 Home location 3 Program/evaluation office 4 Other, Specify ______

Type of administration: 1 Individual type 2 Group

Survey Version: 1 Baseline survey 2 Posttest 3 Follow-up

Important note: If this is a Posttest or Follow-up, be sure to include the exact same ID# as in the Baseline Instrument. The first letter in variable names stands for Baseline or Posttest, the second letter for Module (e.g. BA01 OR PA01).

Strategies for Success: ATOD Consumption- High School FY 2014 –Posttest CODEBOOK 1 DIRECTIONS: Please read each question and circle your response or put an X in the box next to it.

The first few questions ask about you in general. 4 Some college 1) PA01 How old are you? 5 Completed college 6 Graduate or professional school 12 12 years old or younger 999 Not sure 13 13 years old 14 14 years old 15 15 years old 7) PA07 What is the highest level of schooling your father 16 16 years old completed? 17 17 years old 1 Completed grade school or less 18 years old or older 18 2 Some high school 2) PA02 Are you female or male? 3 Completed high school 4 Some college 0 Male 1 Female 5 Completed college 6 Graduate or professional school 3) PA03 In what grade are you? 999 Not sure th 8 8 grade 9 9th grade How much do people risk harming themselves (physically 10 10th grade and in other ways) when they… 11 11th grade 12 12th grade 8) smoke one or more No Slight Moderate Great packs of cigarettes per Risk Risk Risk Risk 0 Not in school day? PA08 0 1 2 3 4) How do you describe yourself? (Select one or more 9)smoke marijuana once a No Slight Moderate Great Risk Risk Risk Risk responses.) For each item enter 1 if selected. If not month or more? selected, leave it blank. PA09 0 1 2 3 10) smoke marijuana once No Slight Moderate Great PA04_1 American Indian or Alaskan Native or twice a week? Risk Risk Risk Risk PA04NAM Tribe: (enter text) PA10 0 1 2 3 PA04_2 Asian 11) have one or two PA04_3 Black or African American drinks of an alcoholic No Slight Moderate Great PA04_4 Hispanic or Latino (such Mexican, Chicano, beverage (beer, wine, or Risk Risk Risk Risk Mexican-American, Hispano, Spanish) liquor) nearly every 0 1 2 3 PA04_5 Other Hispanic or Latino day? PA11 PA04HIS (if specified) Other Hispanic or Latino: 12) have five or more No Slight Moderate Great (enter text) drinks of an alcoholic Risk Risk Risk Risk PA04_6 Native Hawaiian or Other Pacific Islander beverage once or twice PA04_7 White a week? PA12 0 1 2 3

These next questions ask about other health related topics. 5) PA05 Do you often speak a language other than English at home? 8) PA13 How wrong do your parents feel it would be for you to drink alcohol (beer, wine, or hard 0 No 1 Yes liquor) regularly?

0 Very wrong 6) PA06 What is the highest level of schooling your mother completed? 1 Wrong 1 Completed grade school or less 2 A little bit wrong 2 Some high school 3 Not wrong at all 3 Completed high school Strategies for Success: ATOD Consumption- High School FY 2014 –Posttest CODEBOOK 2 6 All 30 days 9) PA14 How wrong do you think it is for someone your age to drink alcohol (beer, wine, or hard liquor) regularly? 13) PA18 During the past 30 days, on the days you smoked, how many cigarettes did you smoke per 0 Very wrong day? 1 Wrong 0 I did not smoke cigarettes during the past 30 days 2 A little bit wrong 1 Less than 1 cigarette per day 3 Not wrong at all 2 1 cigarette per day 3 2 to 5 cigarettes per day The next questions ask about personal safety. 4 6 to 10 cigarettes per day 10) PA15 During the past 30 days, how many times did you ride in a car or other vehicle driven by someone 5 11 to 20 cigarettes per day who had been drinking alcohol? 6 More than 20 cigarettes per day 0 0 times 14) PA19 During the past 30 days, on how many days 1 1 time did you use chewing tobacco, snuff, or dip, such as Redman, Levi Garret, Beechnut, Skoal, Skoal 2 2 or 3 times Bandits, or Copenhagen?

3 4 or 5 times 0 0 days 4 6 or more times 1 1 or 2 days

3 to 5 days 11) PA16 During the past 30 days, how many times did 2 you drive a car or other vehicle when you had been 3 6 to 9 days drinking alcohol? 4 10 to 19 days 0 0 times 5 20 to 29 days 1 1 time 6 All 30 days 2 2 or 3 times 3 4 or 5 times The next questions ask about drinking alcohol. This includes drinking beer, wine, wine coolers, and liquor such 4 6 or more times as rum, gin, vodka, or whiskey. For these questions, drinking alcohol does not include drinking a few sips of wine for religious purposes. The next questions ask about tobacco use. For these questions, smoking does not include any tobacco use that 15) PA20 During the past 30 days, on how many days might be done for ceremonial or religious purposes. did you have at least one drink of alcohol?

0 0 days 12) PA17 During the past 30 days, on how many days did you smoke cigarettes? 1 1 or 2 days

0 0 days 2 3 to 5 days 1 1 or 2 days 3 6 to 9 days 2 3 to 5 days 4 10 to 19 days 3 6 to 9 days 5 20 to 29 days 4 10 to 19 days 6 All 30 days 5 20 to 29 days Strategies for Success: ATOD Consumption- High School FY 2014 –Posttest CODEBOOK 3 At a public place such as a park, beach, or parking lot PA23_6 16) PA21 During the past 30 days, on how many days did At a public event such as a concert or sporting event you have 5 or more drinks of alcohol in a row, that is, PA23_7 within a couple of hours? At a party PA23_8 0 0 days Somewhere else PA23_9 1 day 1 [Please describe]: PA23oth 2 2 days ______3 3 to 5 days The next question asks about marijuana use. Marijuana is 4 6 to 9 days also called grass or pot. 5 10 to 19 days 19) PA24 During the past 30 days, how many times did you 6 20 or more days use marijuana (pot)? 17) During the past 30 days, how did you get the alcohol you 0 0 times drank? (Check all that apply) For each item enter 1 if selected. If not selected, leave it blank. 1 1 or 2 times 2 3 to 9 times I have not drunk alcohol in the past 30 days. PA22_1 I bought it at a store, such as a liquor store, 3 10 to 19 times convenience store, or grocery store. PA22_2 4 20 to 39 times I bought it at a restaurant, bar or public place. PA22_3 5 40 or more times My parent or guardian gave it or bought it for me. The next questions ask about prescription drug use. PA22_4 25) PA25 During your life, how many times have you taken Another family member who is 21 or older gave it or a prescription drug (such as OxyContin, Percocet, bought it for me. PA22_5 Vicodin, codeine, Adderall, Ritalin, or Xanax) without a Someone not related to me who is 21 or older gave it doctor’s prescription? or bought it for me. PA22_6 0 0 times Someone under age 21 bought or gave it to me. PA22_7 1 1 or 2 times I took it from my home or someone else’s home. PA22_8 2 3 to 9 times I took it from a store without paying for it. PA22_9 3 10 to 19 times I got it at a party. PA22_10 4 20 to 39 times I got it in Mexico. PA22_11 I got it some other way. PA22_12 5 40 or more times [Please describe]: 26) PA26 In the last 30 days, did you use prescription PA22oth______painkillers for any reason, like Vicodin, OxyContin (also called Oxy or OC), or Percocet (also called Percs)? 18) During the past 30 days, where did you drink alcohol? 0 No 1 Yes (Check all that apply.) For each item enter 1 if selected. If not selected, leave it blank. 27) PA27 If you used painkillers in the last 30 days for any I did not drink alcohol during the past 30 days PA23_1 reason, where did you get them? (Check all that apply). At my home PA23_2 For each item enter 1 if selected. If not selected, leave it blank. At another person’s home PA23_3 While riding in or driving a car or other vehicle PA23_4 At a restaurant, bar, or club PA23_5 Strategies for Success: ATOD Consumption- High School FY 2014 –Posttest CODEBOOK 4 I didn’t use prescription pain killers in the last 30 days PA27_1 31) PA31 Have used drugs such as marijuana or A doctor or dentist prescribed or gave them to me PA27_2 cocaine? A family member shared them with me PA27_3 A friend shared them with me PA27_4 0 None I bought them from a dealer or another stranger PA27_5 1 A few

I took them from my home without asking PA27_6 2 Some I took them from someone else’s home without asking 3 Most PA27_7 I purchased them in Mexico PA27_8 4 All I got them at a party PA27_9 During this school year, did you ever do any of the I purchased them on the internet PA27_10 following while on school property? Did you… Other PA27_11 32) …PA32smoke cigarettes on school Yes No (If specified) PA27oth______property? 1 0 33) …PA33use chewing tobacco, snuff or Yes No dip on school property? 1 0 28) PA28 During the past 30 days, how many times did you 34) …PA34have at least one drink of Yes No use a pain killer to get high, like Vicodin, OxyContin alcohol on school property? 1 0 (also called Oxy or OC), or Percocet (also called Percs)? 35) …PA35use marijuana on school Yes No 0 0 times property? 1 0 36) …PA36use prescription drugs to get Yes No 1 1 or 2 times high while on school property? 1 0 2 3 to 9 times

3 10 to 19 times 32) PA37During this school year, has anyone offered, sold, or given you an illegal drug on school property? 4 20 to 39 times 5 40 or more times 0 No 1 Yes

Among the people you consider to be your closest friends, 33) PA38During this school year, while on school property, how many would you say do the following? has anyone offered, sold, or given you a prescription drug to get high? 29) PA29 Smoke at least 1 cigarette a day? 0 No 1 Yes 0 None 1 A few 2 Some 3 Most 4 All

30) PA30 Drink alcohol once a week or more?

0 None 1 A few 2 Some 3 Most 4 All Strategies for Success: ATOD Consumption- High School FY 2014 –Posttest CODEBOOK 5