CV Cares Core Measure Survey
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Grade Level
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TAKE the SURVEY
Racial/Ethnic Background
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Gender
 *
30 Day Use
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Answer Yes or No if you have participated in the following in the past 30 days
Yes
No
During the past 30 days did you drink one or more drinks of an alcoholic beverage?
During the past 30 days did you smoke part or all of a cigarette?
During the past 30 days have you used marijuana or hashish? (e.g., smoked, vaped, edibles)
During the past 30 days have you used prescription drugs not prescribed to you?
Perception of Risk
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Choose the Circle that Applies to your Perception
No Risk
Slight Risk
Moderate Risk
Great Risk
How much do you think people risk harming themselves physically or in other ways when they have five or more drinks of an alcoholic beverage once or twice a week?
How much do you think people risk harming themselves physically or in other ways if they smoke one or more packs of cigarettes per day?
How much do you think people risk harming themselves physically or in other ways if they use marijuana once or twice a week? (e.g., smoking, vaping, edibles)
How much do you think people risk harming themselves physically or in other ways if they use prescription drugs that are not prescribed to them?
Perception of Peer Disapproval
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Choose the Circle that Applies to your Perception
Not At All Wrong
A Little Bit Wrong
Wrong
Very Wrong
How wrong do your friends feel it would be for you to have one or two drinks of an alcoholic beverage nearly every day?
How wrong do your friends feel it would be for you to smoke tobacco?
How wrong do your friends feel it would be for you to use marijuana? (e.g., smoking, vaping, edibles)
How wrong do your friends feel it would be for you to use prescription drugs not prescribed you?
Perception of Parental/Guardian/Caregiver Disapproval
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Choose the Circle that Applies to your Perception
Not At All Wrong
A Little Bit Wrong
Wrong
Very Wrong
How wrong do your parents or guardians feel it would be for you to have one or two drinks of an alcoholic beverage nearly every day?
How wrong do your parents or guardians feel it would be for you to smoke tobacco?
How wrong do your parents or guardians feel it would be for you to use marijuana? (e.g., smoking, vaping, edibles)
How wrong do your parents or guardians feel it would be for you to use prescription drugs not prescribed you?
Opioids *
Choose the Circle that Applies to your Perception
Not At All Wrong
A Little Bit Wrong
Wrong
Very Wrong
How much do you think people risk harming themselves physically or in other ways if they use opioids?
How wrong do your friends feel it would be for you to use opioids?
How wrong do your parents or guardians feel it would be for you to use opioids?
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