Life Skills Pre- Post Survey
This survey is designed to give us information about your knowledge, attitudes, and behaviors relating to substance use. Your answers will be anonymous and will not be seen by parents, teachers, or anyone at your school. Please answer all questions honestly, based on what is true for you at this moment. Fill in one answer per question.
School Name *
Teacher name *
Your answer
Class period *
Your answer
Grade *
Do you think the following statements are true or false?
1. Most adults smoke cigarettes. *
2. Few adults drink wine, beer, or liquor every day. *
3. Most people my age smoke marijuana. *
4. Marijuana smoking can improve your eyesight. *
5. Switching from smoking cigarettes to vaporizing is healthier for you. *
6. It is important to measure how far you have come in reaching your goal. *
7. Deep breathing is one way to lessen anxiety. *
8. Kids who smoke cigarettes are more grown up. *
9. Kids who smoke cigarettes have more friends. *
10. Drinking alcohol lets you have more fun. *
11. Drinking alcohol makes you look cool. *
How likely would you be to say "NO" in the following situations?
12. When someone tries to get you to smoke a cigarette? *
13. When someone tries to get you to smoke marijuana? *
14. When someone tries to get you to drink beer, wine, or liquor? *
15. When your friends want you to do something you don’t want to do? *
Would you do the following?
16. Stand up for yourself if someone picked on you? *
17. Stand up for someone else, even if you didn’t know them, if they were being picked on. *
18. Try to understand someone’s point of view when you are having a problem with him or her? *
19. Try something else when you attempt to solve a problem and your solution doesn’t work? *
During the past 30 days, on how many days did you...
20. Use cigarettes? *
21. Use marijuana? *
22. Have at least one drink of alcohol? *
Please answer ‘yes’ or ‘no’ to the following questions:
23. Do you feel that a student could find help at your school from a counselor, teacher, or other adult to stop or reduce using tobacco, alcohol, or other drugs? *
24. Have you ever called a hotline for help with problems you are having at school, home, or elsewhere? *
25. What is your ethnicity? *
Please answer the following questions about your commute you school
Do you live within walking distance from school?
How do you usually get to school?
If you don't walk or bike to school, why not? (mark ALL that apply)?
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