Creighton ASP 2017
Note to educators: If your students have access to a computer, they can fill out the information online. Otherwise, please have them fill out the paper survey ( and you can enter the data manually. For any questions, call or email Jen Bolcoa 2-6505 or
Email address *
Gender *
Who do you live with most of the time? (Pick one) *
What is your zip code? *
Your answer
Are you Hispanic or Latino? *
Race/Ethnicity *
What grade are you in? *
How Old are you? *
What grades do you generally get in school? *
About how many days were you absent from school last year? *
Read each statement below and indicate whether you think each is True or False by clicking on the appropriate circle. *
Most adults smoke cigarettes.
Smoking a cigarette causes your heart to beat slower.
Few adults drink wine, beer, or liquor everyday.
Most people my age smoke marijuana.
Smoking marijuana causes your heart to beat faster.
Most adults use cocaine or other hard drugs.
Cocaine and other hard drugs always make you feel good.
What we believe about ourselves affects the way we act or behave.
It is almost impossible to develop a more positive self-image.
It is important to measure how far you have come toward reaching your goal.
It's a good idea to make a decision and then think about the consequences later.
Smoking can affect the steadiness of your hands.
A stimulant is a chemical that calms the body.
Smoking reduces a person's endurance for physical activity.
A serving of beer or wine contains less alcohol than a serving of "hard liquor" such as whiskey.
Alcohol is a depressant.
Marijuana smoking can improve your eyesight.
Some advertisers are deliberately deceptive.
Companies advertise only because they want you to have all the facts about their product.
It's a good idea to get all information about a product from its ads.
Most people do not experience anxiety.
There is very little you can do when you feel anxious.
Deep breathing is one way to lessen anxiety.
Mental rehearsal is a poor relaxation technique
You can avoid misunderstandings by assuming the other person knows what you mean.
Effective communication is when both sender and receiver interpret a message in the same way.
Relaxation techniques are of no use when meeting people.
A compliment is more effective when it is said sincerely.
A nice way of ending a conversation is to tell the person you enjoyed talking with him/her.
Sense of humor is an example of a non-physical attribute.
It's better to be polite and lead someone on, even if you don't want to go out with them.
Almost all people who are assertive are either rude or hostile.
Please click the circle to show how much you agree or disagree with each statement. *
Strongly Disagree
Neither Agree Nor Disagree
Strongly Agree
Youth who drink alcohol are more grown-up.
Smoking cigarettes make you look cool.
Youth who drink alcohol have more friends.
Youth who smoke have more friends.
Drinking alcohol makes you look cool.
Smoking cigarettes let you have more fun.
Youth who smoke cigarettes are more grown-up.
Drinking alcohol lets you have more fun.
How likely would you be to: *
Definitely would
Probably would
Not sure
Probably would not
Definitely would not
Say "no" when someone tries to get you to smoke a cigarette?
Say "no" when someone tries to get you to drink beer, wine, or liquor?
Say "no" when someone tries to get you to smoke marijuana?
Say "no" when someone tries to get you to use cocaine or other drugs?
How likely would you be to do the following things: *
Definitely would
Probably would
Not sure
Probably would not
Definitely would not
Tell someone if they gave you less change (money) than you're supposed to get back after you pay for something.
Say "no" to someone who asks to borrow money from you.
Tell someone to go to the end of the line if they try to cut in front of you.
When you feel anxious, you: *
Definitely would
Probably would
Not sure
Probably would not
Definitely would not
Relax all the muscles in your body, starting with your feet and legs?
Practice deep breathing (either breathe in for 4, hold for 4, breathe out for 4 OR breathe for 4, hold for 7, let out for 8)?
In general: *
Strongly disagree
Neither Agree Nor Disagree
Strongly Agree
If you find that something is really difficult, you get frustrated and quit.
You stick to what you're doing until you're finished with it.
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