Baseline Questionnaire

NATIONAL YOUTH SURVEY

(12-18 version)

Name:

ID #: 99-9-9-999
Before you answer any of the survey questions, please tear off this page and give it to the
data collection person. Do not write your n ame on any other su rvey pages.

Thank you.
ID #:
0178
99-9-9-999 OMB No: 0930-

Expiration Date: 03-31-99

Date of Admin.:

NATIONAL YOUTH SURVEY

BASELINE QUESTIONNAIRE
12-18 Version

Sponsored by the Center for Substance Abuse Prevention,

U.S. Department of Health and Human Services

These questions are part of a study of how young people feel about alcohol, tobacco and other drugs,
and whether they use them. We hope that you will answer all of the questions honestly and
thou ghtf ully. The survey is being conducted by a private research firm for the Center for Substance
Abuse Prevention; U.S. Department of Health and Hu man Services.

The study will help our country learn more about how to prevent the use of alcohol and drugs.

Your answers will be kept strictly confidential. The information you provide is legally protected by
a Certificate of Confidentiality. No one in your school or community will ever know how you
answered the questions.

The study is completely voluntary. If you do not want to fill out the survey or any of the questions,
you do n ot have to. No o ne else w ill know your dec ision.

This is not a test, so there are no right or wrong answers. We would like you to wor k fai rly quickly,
so that you can finish. Please work quietly and by yourself.

We think you will find the questionnaire to be very interesting and that you will like filling it out.
Tha nk you very much fo r being an important p art of this stud y.

Completing this questionnaire will take an average o f 45 minutes p er respon se. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to DHHS Reports Clearance
Officer; Paperwork Reduction Project (0930-0178); Room 531-H; Humphrey Building; 200 Independence Ave., SW; Washington,
DC 20201.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. The OM B control number for this project is (0930-0178).

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 INSTRUCTIONS

1. You should answer each question by marking one of the answer bo xes. If you don’t find an
answ er that fit s exactly, c hoose the one that com es close st.

2. Mark your answers carefully so we can tell which answer b ox you chose. Do n ot mark more
than one box for any question except for question 19, and do not mark in between the boxes.

3. It is very important that you answer each question truthfully. The study cannot help unless you
tell the truth.

4. Some questions ask about your parents. By parents, we mean the adults who are raising you.
If you have been raised mostly by foster parents, step-parents, or othe rs, answ er for th em. For
example, if you have both a step-father and a natural father, answer for the one that is most
important in raising you.

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 SECTION ONE: FACTS ABOUT YOU

1. Are you male or female?

[ ] Male
[ ] Female

2. In what year were you born?

[ ] 1977 [ ] 1983
[ ] 1978 [ ] 1984
[ ] 1979 [ ] 1985
[ ] 1980 [ ] 1986
[ ] 1981 [ ] 1987
[ ] 1982 [ ] 1988

3. In what month were you born?

[ ] January [ ] July
[ ] February [ ] August
[ ] March [ ] September
[ ] April [ ] October
[ ] May [ ] November
[ ] June [ ] December

4. On what day of the month were you born?

[ ]1 [ ]9 [ ] 17 [ ] 25
[ ]2 [ ] 10 [ ] 18 [ ] 26
[ ]3 [ ] 11 [ ] 19 [ ] 27
[ ]4 [ ] 12 [ ] 20 [ ] 28
[ ]5 [ ] 13 [ ] 21 [ ] 29
[ ]6 [ ] 14 [ ] 22 [ ] 30
[ ]7 [ ] 15 [ ] 23 [ ] 31
[ ]8 [ ] 16 [ ] 24

5. What is your home zip code?

6. Are you Hispanic or Latino?

[ ] Yes, I am
[ ] No, I am not

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7. What else do you call yourself?
[ ] American Indian or Alaskan native
[ ] Asian or Pacific Islander
[ ] Black or African American
[ ] White
[ ] Other (write in):

8. What languages do your parents or other people who are raising you speak at home?
[ ] Only or mostly English
[ ] Only or mostly a language other than English
[ ] English a nd a langu age other th an English equally

9. How often do you go to sports practice or play in games?

[ ] Almost every day [ ] A few times a year
[ ] Once or twice a week [ ] Never
[ ] A few times a mo nth

10. How o ften do you ta ke lessons o r attend classe s out of sch ool?
[ ] Almost every day [ ] A few times a year
[ ] Once or twice a week [ ] Never
[ ] A few times a mo nth

11. How often do you go to meetings or activities for a club or youth group?
[ ] Almost every day [ ] A few times a year
[ ] Once or twice a week [ ] Never
[ ] A few times a mo nth

12. How often do you talk to an adult about what you are doing or thinking?
[ ] Almost every day [ ] A few times a year
[ ] Once or twice a week [ ] Never
[ ] A few times a mo nth

13. How often do you do work at home (chores, bab y sitting, cooking)?
[ ] Almost every day [ ] A few times a year
[ ] Once or twice a week [ ] Never
[ ] A few times a mo nth

14. Last summer how often did you go to a summer program for learning or fun?
[ ] Almost every day [ ] A few times a year
[ ] Once or twice a week [ ] Never
[ ] A few times a mo nth

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15. How a re your grade s in school? (Please pick the answ er that best de scribes how you do in
general?
[ ] Excellent (A or 90 and above)
[ ] Above average (B or 80 - 90)
[ ] Average (C or 70 - 80)
[ ] Below average (D or 60 - 70)
[ ] Unsatisfactory (F or below 60)
[ ] Not in school

16. During the LAST FOUR W EEKS how many whole days of school have you missed?
[ ] None [ ] 4 to 5 days
[ ] 1 day [ ] 6 to 10 days
[ ] 2 d ays [ ] 11 or more d ays
[ ] 3 d ays [ ] Not in school last four weeks

17. What is the highest grade of school you have completed?

[ ] 4th [ ] 10th
[ ] 5th [ ] 11th
[ ] 6th [ ] 12th
[ ] 7th [ ] College
[ ] 8th [ ] Vocational
[ ] 9th

18. Have you dropped out of sch ool?

[ ] Yes
[ ] No

19. (IF YOU ARE N O LONGE R IN SCHOO L) Since you left school, have you?
[ ] Received a high school diploma
[ ] Earned a GED (General Equivalency Degree)
[ ] Done nothing to get a high school diploma
[ ] Attended college
[ ] Attended vocational school
[ ] I’m still in school

20. When did you last attend school? (Please pick the answer that best fits you)
[ ] Within the last six months
[ ] Within the last year
[ ] Within the last two years
[ ] More than two years ago
[ ] Still in school now

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21. Do yo u have a f ull-ti me o r a pa rt-tim e job for p ay?
[ ] Yes, full-time job (30 hours or more)
[ ] Yes, part-time job
[ ] No, I don’t have a job

22. For how many months have you had this job?
[ ] 1 month or less
[ ] 2 to 6 months
[ ] 7 to 12 months
[ ] More than 12 months
[ ] I don’t have a job

23. Wher e you are living n ow, w hat adu lts live w ith you? ( Chec k all that a re true.)
[ ] Your Mother [ ] Your Father
[ ] Your Stepmother [ ] Your Stepfather
[ ] Other Adult Relatives [ ] Other Adults who are not related to you

PLEASE GO TO THE NEXT PAGE

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 SECTION TWO: HOW DO YOU FEEL?

For each of these sentence s, please read along and check in th e box in fro nt of the an swer that is
closest to how you feel about what the sentence says.

Check YES! If you believe very strongly that the sentence is true for you, that it is the way you feel
almost all of the time.

Check yes If you sort of agree that the sentenc e is true for you, that it is the way you feel most of
the time.

Check no If you sort of believe the sentence is false for you, that you do not feel that way most
of the time.

Check NO! If you believe very strongly that the sentence is false, that you almost never feel this
way.

Let’s practice by reading the following sentence:

I like pepperoni pizza. [ ] YES! [ ] yes [ ] no [ ] NO!

If you really like pepperoni pizza, it is one of your favorite foods, you would check “YES!”, if you
really don’t like it, you can’t stand to eat it, you would check “NO!”. If you sort of like it, you
would check “yes”, if you sort of don’t like it, you would check “no”.

Okay we are ready to start.

24. I can tell my parents the way I feel about things. [ ] YES! [ ] yes [ ] no [ ] NO!

25. I will probably die b efor e I am thirty. [ ] YES! [ ] yes [ ] no [ ] NO!

26. I get along well with other people. [ ] YES! [ ] yes [ ] no [ ] NO!

27. One of my problem s is I cannot g et down to

work when I should. [ ] YES! [ ] yes [ ] no [ ] NO!

28. I can be trusted. [ ] YES! [ ] yes [ ] no [ ] NO!

29. I am afra id my life w ill be unhappy. [ ] YES! [ ] yes [ ] no [ ] NO!

30. School is a waste of time. [ ] YES! [ ] yes [ ] no [ ] NO!

31. Bad things happen to people like me. [ ] YES! [ ] yes [ ] no [ ] NO!

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32. It helps me to talk with ad ults about alc ohol
or drugs. [ ] YES! [ ] yes [ ] no [ ] NO!

33. If I can’t do a job the first time, I keep trying

until I can. [ ] YES! [ ] yes [ ] no [ ] NO!

34. Helping others makes me feel good. [ ] YES! [ ] yes [ ] no [ ] NO!

35. It is hard for me to make friends. [ ] YES! [ ] yes [ ] no [ ] NO!

36. I try hard to do w ell in school. [ ] YES! [ ] yes [ ] no [ ] NO!

37. I give up on things before completing them. [ ] YES! [ ] yes [ ] no [ ] NO!

38. I like to do things w ith m y fam ily. [ ] YES! [ ] yes [ ] no [ ] NO!

39. I can do m ost th ings I try. [ ] YES! [ ] yes [ ] no [ ] NO!

40. When I am mad, I yell at people. [ ] YES! [ ] yes [ ] no [ ] NO!

41. If I study hard, I will get better grades. [ ] YES! [ ] yes [ ] no [ ] NO!

42. My friends respect me. [ ] YES! [ ] yes [ ] no [ ] NO!

43. I would feel bad if adults found out I used

alcohol or drugs. [ ] YES! [ ] yes [ ] no [ ] NO!

44. Sometimes I break things on purpose. [ ] YES! [ ] yes [ ] no [ ] NO!

45. It is important to do your part in helping

at home. [ ] YES! [ ] yes [ ] no [ ] NO!

46. It is important to think befo re you act. [ ] YES! [ ] yes [ ] no [ ] NO!

47. I would like to quit school as soon as I can. [ ] YES! [ ] yes [ ] no [ ] NO!

48. I enjoy talk ing w ith m y fam ily. [ ] YES! [ ] yes [ ] no [ ] NO!

49. I always like to d o my part. [ ] YES! [ ] yes [ ] no [ ] NO!

50. I like the way I look. [ ] YES! [ ] yes [ ] no [ ] NO!

51. If I feel like it, I hit people. [ ] YES! [ ] yes [ ] no [ ] NO!

52. If you work hard, you w ill get what you want. [ ] YES! [ ] yes [ ] no [ ] NO!

53. I would get in trouble if an adult found out I

used alcohol or drugs. [ ] YES! [ ] yes [ ] no [ ] NO!
PLEASE GO TO THE NEXT PAGE

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 SECTION THREE: CIGARETTES, ALCOHOL, AND OTHER DRUGS

The next few questions are ab out CIGARETTES, CHEWING TOBACCO, SNUFF OR
DIP, including Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen.
These questions refer to the use of tobacco other than for religious purposes.

54. On how many DAYS in the LAST MONTH (30 days) did you smoke a cigarette? For
example, if you smok ed a cigarette each w eekend night, that wo uld be 8 days (4
weekends time s 2 days each week end).
[ ] None
[ ] 1 or 2 da ys in the last mon th
[ ] 3 to 5 in the last month
[ ] 6 to 9 in the last month
[ ] 10 to 19 in the last mo nth
[ ] 20 to 31 in the last mo nth

55. On the days you smoke cigarettes, how many do you smoke?
[ ] Less tha n 1 cigarette
[ ] 1 or 2 cigarettes
[ ] 3 to 7 cigarettes
[ ] About half a pack of cigarettes
[ ] A pack or more of cigarettes
[ ] I don’t smoke cigarettes

56. On how many DAYS did you use chewing tobacco, snuff or dip in the LAST MONTH
(30 days)?
[ ] None
[ ] 1 or 2 days in the last month.
[ ] 3 to 5 in the last month
[ ] 6 to 9 in the last month
[ ] 10 to 19 in the last mo nth
[ ] 20 to 31 in the last mo nth

57. On the d ays you used ch ewing tob acco, snuf f or dip, how many times d id you use it?
[ ] Less than once
[ ] 1 or 2 times
[ ] 3 to 7 times
[ ] 8-12 times
[ ] More than 12 times
[ ] I don’t use chewing tobacco, sn uff or dip

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58. Have you EVER SMOK ED a cigarette, even just a few puffs, or used chewing tobacco,
snuff or dip?
[ ] Yes
[ ] No

59. Do you think your best friend smokes c igarettes or us es chew ing tobacc o, snuff o r dip
sometimes?
[ ] Yes
[ ] No

60. If your friends found out that you smoked cigarettes or used chewing tobacco, snuff or
dip, how do you think they’d feel?
[ ] They would approve
[ ] They would disapprove but still be my friends
[ ] They would disapprove and stop being my friends
[ ] They wouldn’t care

61. How would your parents feel if they found out you smoked cigarettes or used chewing
tobacco, snuff or dip sometimes?
[ ] They wo uld not be u pset at all
[ ] They would be a little upset
[ ] They would be pretty upset
[ ] They would be very upset

The next few questions are about ALCOHOL By alcohol, we mean BEER, WINE, WINE
COOLERS, GRAIN ALCOHOL, or HARD LIQUOR.

62. On how many DAY S did you have an alco holic drink in the LA ST MO NTH (30 days)?
(By a drink, we mean a can of beer, a glass of wine, a wine co oler, or a shot of hard
liquor.)
[ ] None
[ ] 1 or 2 days in the last month.
[ ] 3 to 5 days in the last month.
[ ] 6 to 9 days in the last month.
[ ] 10 to 19 days in the last month.
[ ] 20 to 31 days in the last month.

63. On the days you drink alcohol, about how many drinks do you have? (By a drink, we

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 mean a can o f beer, a glass of wine, a wine c ooler, o r a shot o f hard li quor.)
[ ] Less than a drink
[ ] 1 drink
[ ] 2 drinks
[ ] 3 drinks
[ ] 5 or more drinks
[ ] I don’t drink alcohol

64. On how many DAYS in the LAST M ONTH (30 days) did you have FIVE OR MORE
alcoholic drinks?
[ ] None
[ ] 1 or 2 days in the last month.
[ ] 3 to 5 days in the last month.
[ ] 6 to 9 days in the last month.
[ ] 10 to 19 days in the last month.
[ ] 20 to 31 days in the last month.

65. Have you EVER had a drink of alcoho l?

[ ] Yes
[ ] No

66. Do you think your best friend drinks alcohol sometimes?

[ ]Yes
[ ] No

67. If your friends found ou t that you drank alcohol som etimes, how do you think they’d
feel?
[ ] They would approve
[ ] They would disapprove but still be my friends
[ ] They would disapprove and stop being my friends
[ ] They wouldn’t care

68. How wou ld your parents feel if they found out you drank alcohol sometimes?
[ ] They wo uld not be u pset at all
[ ] They would be a little upset
[ ] They would be pretty upset
[ ] They would be very upset

The next few questions are about MARIJUANA (Sometimes called dope, grass, weed , pot,

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smok e, hash , jones, s pleef, jo int, doo bee, he rb, sen , sezz, stic k, ston e, ganj a, or ca nnab is.)

69. On how many DAYS did you use any marijuana in the LAST MONTH (30 days)?
[ ] None
[ ] 1 or 2 days in the last month.
[ ] 3 to 5 days in the last month.
[ ] 6 to 9 days in the last month.
[ ] 10 to 19 days in the last month.
[ ] 20 to 31 days in the last month.

70. On the d ays you use ma rijuana, how many times d o you use it?
[ ] Once a day
[ ] Twice a day
[ ] 3 or more times a day
[ ] I don’t use marijuana

71. Have you EVER TRIED marijuana?

[ ] Yes
[ ] No

72. Do you think your best friend uses marijuana sometimes?

[ ] Yes
[ ] No

73. If your friends found ou t that you used marijuana som etimes, how do you think they’d
feel?
[ ] They would approve
[ ] They would disapprove but still be my friends
[ ] They would disapprove and stop being my friends
[ ] They wouldn’t care

74. How wou ld your parents feel if they found out you used marijuana sometimes?
[ ] They wo uld not be u pset at all
[ ] They would be a little upset
[ ] They would be pretty upset
[ ] They would be very upset

The next question is about INHALANTS. Inhalants are substances that you breathe in to

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get high, such as amyl and butyl nitrite (sometimes called poppers, snappers, rush, or
hardware) or glue, aerosol sprays, gasoline or lighter fluids, ether, correction or cleaning
fluids. (Inhalants are som etimes called huff, sniff, w hiteout, and w hippets).

75. On how many DAYS did you use any inhalants in the LAST MONTH (30 days)?
[ ] None
[ ] 1 or 2 days in the last month.
[ ] 3 to 5 days in the last month.
[ ] 6 to 9 days in the last month.
[ ] 10 to 19 days in the last month.
[ ] 20 to 31 days in the last month.

76. During the last 30 days, have you used any of the following on your own, that is,
without a doctor telling you to take them (check yes if you have used the drug in the
past thirty days, no if you have not)?

Yes No

[ ] [ ] Cocaine or Crack Cocaine

[ ] [ ] Heroin or Opium
[ ] [ ] LSD o r Acid
[ ] [ ] Speed or Up pers
[ ] [ ] Zaladine
[ ] [ ] Downers o r Tranquilizers
[ ] [ ] PCP or Angel Dust
[ ] [ ] Ecstasy

The next few questions cover your feelings about and experiences with using alcohol and
drugs.

77. Pretend your best friend offered you a cigarette and you did not want it. How hard
would it be to say “no?”
[ ] Not ha rd at all
[ ] Not very hard
[ ] Pretty hard
[ ] Very hard

78. Preten d your be st friend offere d you a d rink of beer or wine a nd you d id not w ant it.

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 How hard would it be to say “no?”
[ ] Not ha rd at all
[ ] Not very hard
[ ] Pretty hard
[ ] Very hard

79. Pretend your best friend offered you some marijuana and you did not want it. How hard
would it be to say “no?”
[ ] Not ha rd at all
[ ] Not very hard
[ ] Pretty hard
[ ] Very hard

80. Pretend your best friend offered you some cocaine or some other drug and you did not
want it. How hard would it be to say “no?”
[ ] Not ha rd at all
[ ] Not very hard
[ ] Pretty hard
[ ] Very hard

PLEASE GO TO THE NEXT PAGE

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 SECTION FOUR: YOU, YOUR FAMILY AND YOUR NEIGHBORHOOD

Now, we would like some information about you, your family and your neighborhood.

81. How often do you get into fights?

[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

82. How often do you damage or destroy things that do not belong to you (for example,
street signs, cars, or neighbor’s property).
[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

83. How often are you in trouble with school officials (for example, poor grades, skipping
school, or acting out in class).
[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

84. How o ften do you u se alcohol ju st before o r while atten ding scho ol?
[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

85. How o ften do you u se drugs, su ch as mariju ana or coc aine, just befo re or while
attending sc hool?
[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

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86. During the past 2 months, did you ever feel sad, down or depressed almost every day for
TWO WEEKS OR MORE IN A ROW?
[ ] Yes
[ ] No

87. During the last 2 months, how many times were you in trouble with the law, that is,
arrested or th reatened w ith arrest?
[ ] 0 times
[ ] 1 time
[ ] 2 or 3 times
[ ] 4 or 5 times
[ ] 6 or more times

The next several questions are about your attitudes and your friends’ attitudes toward
cigarettes, alcohol, and other drugs. Check the box in front of the answ er that is closest to
how you feel about what the sentence says.

Check YES! If you believe very strongly that the sentence is true for you, that it is the way
you feel almost all of the time.

Check yes If you sort of agree that the sentence is true for you, that it is the way you feel
most of the time.

Check no If you sort of believe the sentence is false for you, that you do not feel that way
most of the time.

Check NO! If you believe very strongly that the sentence is false, that you almost never feel
this w ay.

88. If I use alcohol or drugs, I will have more

health problems than other people. [ ] YES! [ ] yes [ ] no [ ] NO!

89. If I don’t use alcohol or dru gs I will be happier. [ ] YES! [ ] yes [ ] no [ ] NO!

90. Smoking cigarettes fits with the kind of

life I want to lead. [ ] YES! [ ] yes [ ] no [ ] NO!

91. Getting drunk every now and then fits with

the kind of life I want to lead. [ ] YES! [ ] yes [ ] no [ ] NO!

92. Your closest friends feel that people who

use drugs are stupid. [ ] YES! [ ] yes [ ] no [ ] NO!
The next few questions are about your family. If you have been raised mostly by foster

16
parents, step-parents, or others, answer for them. For example, if you have both a step-
father and a natur al fathe r, answ er for th e one th at is the most im porta nt in ra ising y ou.
Please check the bo x that you a gree w ith mo st.

93. My parents want to know who I am going

out with when I go out with other boys/girls. [ ] YES! [ ] yes [ ] no [ ] NO!

94. In my free time awa y from hom e, my

parents know who I’m with and where I am. [ ] YES! [ ] yes [ ] no [ ] NO!

95. My parents want me to tell them where I am

if I don’t com e home rig ht after scho ol. [ ] YES! [ ] yes [ ] no [ ] NO!

96. When you get home from school, who is waiting for you most days? (Please pick the
answer that best fits you)
[ ] A parent or other g rown-up is there
[ ] No on e else is hom e -- I am alon e for aw hile
[ ] No grown up is home -- I take care of my younger brother(s) or sister(s)
[ ] No grow n up is home -- m y older brother(s) or sister(s) is there
[ ] I don’t go home after school
[ ] I’m not in school

97. How often do you have disagreements or arguments with your parents?
[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

98. How often do you talk with your parents about your plans for the future?
[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

99. How often do you talk with your parents about problems with your friends?
[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

100. How often do you talk with your parents about how well you get along with your

17
 teachers?
[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

101. Have you ever wished that one or both of your parents would drink less?
[ ] My parents don’t drink
[ ] Yes
[ ] No

102. Have you ever wished that one or both of your parents would smoke cigarettes less?
[ ] My parents don’t smoke cigarettes
[ ] Yes
[ ] No

103. Have you ever wished that one or both of your parents would use drugs less?
[ ] My parents don’t use drugs
[ ] Yes
[ ] No

104. In your school, do your classes include learning about alcohol and other drugs?
[ ]Yes
[ ]No
[ ]Don’t know
[ ]I am not in school

105. In your school, do your classes include learning how to feel good about yourself?
[ ]Yes
[ ]No
[ ]Don’t know
[ ]I am not in school

106 In your school, do your classes include learning how to get along with others?
[ ]Yes
[ ]No
[ ]Don’t know
[ ]I am not in school

107. In your school, do your classes include learning how to make better decisions?
[ ]Yes

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 [ ]No
[ ]Don’t know
[ ]I am not in school

The next few questions are abou t things that happen in many n eighborhoods. Please
indicate how often these things happen in your neighborhood.

108. You see people drin king alcoh ol on the stree t.

[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

109. Someone gets robbed.

[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

110. You see someone using drugs.

[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

111. You see the police arrest someone.

[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

112. You see a fight.

[ ] Almost every day
[ ] Once or twice a week
[ ] A few times a mo nth
[ ] A few times a year
[ ] Never

113. Fina lly, can you tell m e how ho nestly you think you answ ered this s urve y?
[ ] Very hon estly

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[ ] Some what ho nestly
[ ] Not ve ry honestly

YOU ARE DONE!

THANK YOU FOR YOUR HELP!

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