Surveys

MARK ALL THAT APPLY

MARK ALL THAT APPLY

Living with family [parent(s), guardian, grandparents, or other relatives]
In foster care, living with a family
In foster care, living in a group home
Couch surfing or moving from home to home
Living outside, in a tent city or homeless camp, in a car, in an abandoned vehicle or in an abandoned building
Staying in an emergency shelter or transitional living program
Staying in a hotel or motel
In juvenile detention center, juvenile group home, and/or under the supervision of a probation officer
None of the above

#	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
a. make decisions to not drink alcohol?
b. make decisions to not smoke cigarettes or cigar products (cigars, cigarillos, or little cigars)?
c. make decisions to not use other tobacco products (such as chewing tobacco, snuff, dip, or snus)?
d. make decisions to not use electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods)
e. make decisions to not use marijuana (also called pot, weed, or cannabis)?
f. make decisions to not take prescription pain medicine without a doctor’s prescription or differently than how a doctor told you to use it?

#	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
a. resist or say no to peer pressure?
b. manage your emotions in healthy ways (for example, ways that are not hurtful to you or others)?
c. think about the consequences before making a decision?
d. talk with my parent, guardian, or caregiver about sex?

#	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
a. make plans to reach your goals?
b. care about doing well in school?

#	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
a. better understand what makes a relationship healthy?
b. resist or say no to someone if they pressure you to participate in acts, such as kissing, touching private parts, or sex?
c. talk to a trusted person/adult (for example, a family member, teacher, counselor, coach, etc.) if someone makes you uncomfortable, hurts you, or pressures you to do things you don’t want to do?

#	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
a. plan to delay having sexual intercourse until you graduate high school or receive your GED
b. plan to delay having sexual intercourse until you graduate college or complete another education or training program
c. plan to delay having sexual intercourse until you are married
d. plan to be married before you have a child
e. plan to have a steady full-time job before you get married
f. plan to have a steady full-time job before you have a child

#	All of the Time	Most of the Time	Some of the Time	None of the Time
a. did you feel interested in program sessions and classes?
b. did you feel the material presented was clear?
c. did discussions or activities help you to learn program lessons?
d. did you have a chance to ask questions about topics or issues that came up in the program?
e. did you feel respected as a person?