alcohol use
Name: 


  1. Male or female?
    male
    female
    other
    prefer not to say


  1. age?
    15
    16
    17
    18
    19
    other?


  1. Which country do you live in/
    USA
    SWEDEN
    OTHER-SPECIFY ___


  1. Do you identify yourself as a religious person?
    yes
    no
    maybe


  1. If you are religious, which religion do you practice?
    Judiasm
    Christianity
    Islam
    Hindu
    other- specify


  1. How often do you practice your religion?
    multiple times per day
    daily
    weekly
    monthly
    annually


  1. If not religious, do you identify as an atheist or agnostic?
    athiest
    agnostic
    don't know


  1. Do you consume alcohol?
    yes
    no


  1. How often do you consume alcohol?
    never
    once or twice a year
    once a month
    once a week
    2 or more times a week
    daily
    multiple times each day


  1. How old were you when you first tried alcohol?
    less than 14
    14
    15
    16
    17
    18
    19
    20
    21 or older


  1. Have you ever tried marijuana?
    Yes
    No
    I am not sure (I might have eaten some or something)


  1. If you do use marijuana, how often?
    only once or twice
    once or twice a year
    once or twice a month
    weekly
    daily


  1. When is the last time you used marijuana?
    never
    yesterday
    last week
    last month
    last year


  1. Have you ever thought about using marijuana?
    yes
    no
    just a little


  1. Have you ever tried other drugs that weren't prescribed to you by a doctor?
    yes
    no


  1. How do you feel when you are around people using drugs?
    safe
    unsafe
    uncomfortable
    very uneasy
    I don't know





Senor Brush
Senor Brush
Bayfield High
Bayfield, CO