Age:City:State:Zip Code:County:

Sex: M F Race: Hispanic African American White American Indian/AlaskanNative Asian/Pacific Islanders

1.    Do you think that peer pressure (being influenced by your friends) plays an importand part in how you act, behave, or in what you think?    Yes No Don't know

2.    Can you tell me the reason youth drink or use drugs?

        To feel good or to get high To get rid of bad feelings or problems To find out what it is like To look or feel more grown up Just for fun Because their friends use and they want to be part of the group Nothing else to do Other reason

3.    If you drink or do drugs, which of the following do you think might lead you to cut down on your drinking or drug use? (Check all that apply)

        Having more information about alcohol and drugs Hanging around people who don't use drugs Hanging around with people who don't pressure me to use drugs or alcohol To drink or use drugs Having something better to do Having a sense of "who I am" and "what kind of values" are good for me as a person More parent control or discipline Having someone to talk to More parent interest or concern about my life

4.    Would religion or having "faith" play any role or influence whether you would drink or use drugs?

        Yes No

5.   Do you belong to any social or recreational groups in the community?

        Yes No

6.    Do you think that if people spent more time with social, recreational or athletic activities, they would have less interest in drinking or using drugs?

        Yes No

7.    Would you be interested in more social, recreational, or athletic type programs in the community?

        Yes No

8.    Do you think that knowing about oneself - for instance about one's culture and background - might make them feel differently about their self, and might change their attitude about drinking and using drugs?

        Yes No

9.    How much interest do you have in...

        a.    Arts and Crafts              A lot Not Much Somewhere in between

        b.    Music                            A lot Not much Somewhere in between

        c.    Exercise                         A lot Not much Somewhere in between

        d.    Sports Activities             A lot Not much Somewhere in between

        e.    Drama-Theater-Dance    A lot Not much Somewhere in between

10.    Do you drink alcoholic beverages (beer, wine, or hard liquor)?

          Yes No

11.    Would any of the following influence your values or ideas about drinking and using drugs?

        a.    Music videos               Yes No Don't Know

        b.    Publications                 Yes No Don't know

        c.    Commercials                Yes No Don't know

        d.    Movies                        Yes No Don't know