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Community Early Intervention Youth Pre-Survey
This is a survey given by Envision Partnerships to assess knowledge and understanding of specific drugs.
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Email
*
Your answer
The vapor that comes out of a vaping device is:
*
Harmless water vapor
Mostly water vapor with a few aerosol chemicals
Equal amounts of water vapor and harmful chemicals
Mostly harmful chemicals with a little water vapor
Only chemicals with no water vapor
Nicotine vapes are safer than cigarettes.
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Strongly disagree
1
2
3
4
5
Strongly agree
Imagine a person vapes occasionally, how likely are they to become addicted?
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Not likely at all
1
2
3
4
5
Extremely likely to become addicted
Imagine a person vapes daily, how harmful would this be for their health?
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Not harmful at all
1
2
3
4
5
Extremely harmful
Imagine a person vapes occasionally, how harmful would this be to their health?
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Not harmful at all
1
2
3
4
5
Extremely harmful
How much do you agree with the following statement? Tobacco and vape companies target young people in advertisements.
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Strongly disagree
1
2
3
4
5
Strongly agree
How much do you agree with the following statement? Tobacco and vape companies target adults in advertisements.
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Strongly disagree
1
2
3
4
5
Strongly agree
How hard would it be for you to refuse or say no to a friend who offered you a vape?
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Very easy to refuse
1
2
3
4
5
Extremely difficult to refuse
How hard would it be for you to refuse or say no to a friend who offered you alcohol?
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Very easy to refuse
1
2
3
4
5
Extremely difficult to refuse
How hard would it be for you to refuse or say no to a friend who offered you marijuana?
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Very easy to refuse
1
2
3
4
5
Extremely difficult to refuse
What are your goals regarding vaping?
*
I never want to use
I want to cut back
Susan, I want to quit completely
I want to change what I vape
I don't know
Media messages are straightforward and clear to understand.
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Not at all clear
1
2
3
4
5
Extremely clear and easy to understand
Which of the following drugs can be addictive?
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Marijuana
Alcohol
Vapes/tobacco
All of the above
None of these
Marijuana impairs judgement and can cause health problems.
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Yes
No
Unsure
Alcohol use can cause cancer.
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Yes
No
Unsure
When people use substances, like alcohol, they take risks they wouldn't normally take.
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True
False
Unsure
It is safe to drive when you smoke marijuana
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Yes
No
Unsure
I know what healthy coping skills are.
*
Yes
No
In the past 30 days I have used
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Not at all
Used occassionally
Used regularly
Used frequently
Alcohol
Marijuana
Vaping Products
Tobacco
Other drugs
Not at all
Used occassionally
Used regularly
Used frequently
Alcohol
Marijuana
Vaping Products
Tobacco
Other drugs
Do you think it is ok to gamble money or personal items?
*
Yes
No
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