Wyoming Prevention Needs Assessment Survey
103. What places (if any) did you drink alcohol during the past
year (12 months)? (Mark all that apply.)
1. Thank you for agreeing to participate in this survey. The purpose of the survey is to learn how students in our
schools feel about their community, family, peers, and school. The survey also asks about health behaviors.
I didn't drink alcohol
At work
At my own home
At a park
2. The survey is completely voluntary and anonymous. DO NOT put your name on the questionnaire.
At a friend's home
In the mountains or in a field
3. This is not a test, so there are no right or wrong answers. Please work quickly so you can finish.
At a community event
In a car
At a sporting event
On the street
At a bar or saloon
In a parking lot
At a restaurant
At a concert
At school
Some other place
A
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r
y
104. How wrong do your friends
feel it would be for you to:
a. have one or two drinks of an
alcoholic beverage nearly everyday?
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ng
4. Most questions ask for only one answer. You may mark more than one answer on questions that say, "Mark all
that apply." If you do not find an answer that fits exactly, use the one that comes closest. If any question does not
apply to you, or if you are not sure what it means, just leave it blank. You can skip any questions that you do not
wish to answer.
N
5. Please mark your answer for each question by completely filling in the answer space with a #2 pencil.
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Example: Chocolate is the best ice cream flavor.
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NO!
no
yes
YES!
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at
These questions ask for some general information
about the people completing the survey. Please mark
the responses that best describe you.
al
l
1. Are you:
b. smoke tobacco?
Male
Female
2. How old are you?
10 or younger
11
12
13
14
c. smoke marijuana?
d. use prescription drugs not
prescribed to you?
105. How honest were you in filling out this survey?
I was very honest.
The next section asks about your experiences at school.
7. How often do you feel
unsafe when:
15
16
17
18
19 or older
a. you are at school?
b. you are going to or from school?
3. What grade are you in?
I was honest most of the time.
6th
7th
8th
I was honest some of the time.
I was honest once in a while.
9th
10th
11th
8. How interesting are most of your courses to you?
Very interesting and stimulating
12th
Quite interesting
Fairly interesting
Slightly dull
Very dull
I was not honest at all.
4. What race do you consider yourself to be?
(Mark all that apply.)
White
9. How important do you think the things you are learning
in school are going to be for your later life?
Very important
Black or African American
Native American or Alaska Native
Asian
Quite important
Fairly important
Slightly important
Not at all important
Pacific Islander
Thank you for participating
in this survey.
For more information or to find out the survey results,
please contact:
Eric Canen
University of Wyoming
Dept. 3925
1000 E. University Ave.
Laramie, WY 82071
60156
Email: [email protected]
Phone: (307)760-0307
Internet: www.pnasurvey.org
8
This questionnaire was designed by the Wyoming
Survey & Analysis Center. http://wysac.uwyo.edu
So
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5. What is your ethnicity?
Hispanic or Latino/a
Not Hispanic or Latino/a
10. During the LAST FOUR WEEKS, how many whole days
of school did you miss because you skipped or cut class?
6. What is the language you most often use at home?
English
Spanish
Another language
1
None
4-5
1
6-10
2
3
11+
Survey Version: 2016 PS
11. Think back over the
past year in school. How
often did you:
Al
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ta
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ev
en ay
es
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s
No
a. enjoy being in school?
or
b. hate being in school?
c. try to do your best work
in school?
No
15. During the past 12
months, how often have
you been:
N
ev
er
20. How often do you attend religious services or
activities?
Never
1 or 2 times a month
Rarely
About once a week or more
21. Think of your four best friends (the friends you feel
closest to). In the past year (12 months), how many of
your best friends have:
Number of friends
a. picked on by a fellow student?
0
a. smoked cigarettes?
b. bullied by a fellow student?
b. tried beer, wine, or hard
liquor (for example, vodka,
whiskey, or gin) when their
parents didn't know about it?
For questions that have the answers: No! no yes YES!
c. used marijuana?
means.........DEFINITELY NOT TRUE for you.
means.........MOSTLY NOT TRUE for you.
means.........MOSTLY TRUE for you.
means.........DEFINITELY TRUE for you.
NO!
no
yes
d. used LSD, cocaine,
amphetamines, or other
illegal drugs?
YES!
16. I ignore rules that get in my
way.
ro
n
g
g
NO!
1
2
3
k. dropped out of school?
ll
yes YES!
93. If I had a personal problem, I
could ask my mom or dad for help.
c. to smoke cigarettes?
94. My parents ask if I've gotten my
homework done.
d. to use LSD, cocaine,
amphetamines, or another
illegal drug?
95. Would your parents know if you
did not come home on time?
96. The rules in my family are clear.
97. When I am not at home, one of
my parents knows where I am and
who I am with.
98. If you drank some beer, wine or
liquor (for example, vodka, whiskey,
or gin) without your parents'
permission, would you be caught by
your parents?
89. Is either one of your parents currently in jail or
prison?
Yes
No
Don't know or not sure
99. My family has clear rules about
alcohol and drug use.
90. If you have ever had an alcoholic beverage, think back
to the last time you drank. How did you get the alcohol on
that occasion? (Please fill in only one response.)
100. If you carried a handgun without
your parents' permission, would you
be caught by your parents?
I've never had an alcoholic beverage.
101. If you skipped school, would
you be caught by your parents?
I got it from my parent(s).
4
no
92. It is important to be honest with
your parents, even if they become
upset or you get punished.
at
a
I got it from a friend's parent(s).
I got it from another adult 21 or over.
A
I got it from someone under 21.
I took it (from home, from a friend's house, etc.).
102. How wrong do your parents
feel it would be for you to:
I bought it from a grocery or convenience store.
I bought it from a liquor store.
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I bought it at a bar or restaurant.
a. drink beer, wine, or hard liquor (for
example, vodka, whiskey, or gin) regularly?
I bought it over the Internet.
b. smoke cigarettes?
91. During the past 30 days, what type of alcohol did you
most often consume?
Beer
j. been arrested?
60156
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n
f. been suspended from
school?
i. stolen or tried to steal a
motor vehicle such as a
car or motorcycle?
2
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I did not consume alcohol during the past 30 days
h. sold illegal drugs?
18. I like to see how much I can
get away with.
bi
ot
e. used chewing tobacco?
g. carried a handgun?
17. I do the opposite of what
people tell me, just to get them
mad.
le
88. Has either one of your parents ever been in jail or
prison for more than 30 days?
Yes
No
Don't know or not sure
d. carried a handgun?
Se
ve
Ve
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l
tim y oft
O
nc
en
es
e
y
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b. to drink alcohol?
c. smoked marijuana?
No
Ve
r
a. to use marijuana?
b. began drinking alcoholic
beverages regularly, that is, at
least once or twice a month?
14. Sometimes when students have problems, they talk to an
adult. Is there an adult at your school whom you can talk to
about your problems?
NO!
no
yes
YES!
Pr
ve
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y
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od od
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ch e ch e ch
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c
an
an
an han han
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ce
ce ce
ce
a. smoked cigarettes?
13. Not including going from elementary school to middle
school or from middle school to high school, have you
changed schools in the past year (12 months)?
Yes
87. How wrong would
most adults (21 or older)
in your neighborhood
think it is for kids your
age:
19. What are the
chances you would be
seen as cool if you:
12. How often do you feel
that the school work you are
assigned is meaningful and
important?
Yes
A
The next section asks about your feelings and
experiences in other parts of your life.
c. use chewing tobacco?
d. smoke marijuana?
e. steal something worth more than $5?
f. draw graffiti, write things, or draw pictures
on buildings or other property (without the
owner's permission)?
Wine
Wine cooler or sweetened alcoholic beverage (for
example, Seagrams, Smirnoff Ice, Hard Lemonade)
g. pick a fight with someone?
Gin, vodka, rum, or other type of hard liquor
h. use LSD, cocaine, amphetamines,
or another illegal drug?
Some other type
The next few questions ask about your family. When
you answer these questions, please think about the
people you consider to be your family, for example,
parents, stepparents, grandparents, aunts, or uncles.
i. use prescription drugs not prescribed
to you?
7
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ro
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ro
ta
ga
tw
c. stolen or tried to steal a motor
vehicle such as a car or
motorcycle?
17
d. been arrested?
or
r
16
15
14
13
de
ol
e. attacked someone with the
idea of seriously hurting them?
f. been drunk or high at school?
g. taken a handgun to school?
h. done something illegal and
did not get caught?
c. had more than a sip or
two of beer, wine, or hard
liquor (for example,
vodka, whiskey, or gin)?
e. used chewing tobacco?
i. verbally attacked, bullied, or
harassed someone?
j. received a minor in possession
(MIP) charge for alcohol?
k. received a minor in possession
(MIP) charge for tobacco?
f. got suspended from
school?
NO!
no
yes YES!
26. In the past year (12 months), have you been to any
community events where:
g. got arrested?
a. Crime and/or drug selling
h. carried a handgun?
b. Fights
i. attacked someone
with the idea of
seriously hurting them?
d. Lots of graffiti
6
to
b. sold illegal drugs?
a. smoked marijuana?
85. I feel safe in my neighborhood.
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10
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tim
9
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6
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es
3
tim
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1
a. been suspended from school?
12
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No
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23. How old were
you when you first:
d. began drinking
alcoholic beverages
regularly, that is, at least
once or twice a month?
c. Lots of empty or abandoned buildings
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litt
j. use LSD, cocaine,
amphetamines, or another
illegal drug?
84. If a kid carried a handgun in your
neighborhood, would he or she be
caught by the police?
86. How well do each of the
following characteristics
describe your neighborhood?
75. In your opinion, how frequently have most
students in your school used smokeless tobacco
during the past 30 days?
Never
About once a day
More than once a day
Once or twice
Once or twice per week
i. smoke marijuana?
b. smoked a cigarette,
even just a puff?
83. If a kid drank some beer, wine, or
hard liquor (for example, vodka, whiskey,
or gin) in your neighborhood, would he
or she be caught by the police?
74. In your opinion, how frequently have most students in
your school smoked cigarettes during the past 30 days?
Not at all
Less than one cigarette per day
One to five cigarettes per day
About half a pack per day
About one pack per day
About one-and-a-half packs per day
Two packs or more per day
A
yes YES!
25. How many times in
the past year (12 months)
have you:
11
no
h. use chewing tobacco?
r
ge
un
yo ve
or r ha
e
NO!
g. smoke cigarettes?
ev
82. If a kid smoked marijuana in your
neighborhood, would he or she be
caught by the police?
73. During the past two weeks, how often do you think
most students in your school have had five or more
alcoholic drinks in a row?
None
3-5 times
One time
6-9 times
Two times
10 or more times
c. Done crazy things even if
they are a little dangerous.
f. drink beer, wine, or hard liquor
(for example, vodka, whiskey, or
gin) regularly?
N
These next questions ask about the neighborhood
and community where you live.
Never
b. Done something
dangerous because someone
dared you to do it.
10
Not at all
Less than one cigarette per day
One to five cigarettes per day
About half a pack per day
About one pack per day
About one-and-a-half packs per day
Two packs or more per day
a. Done what feels good
no matter what.
e. stay away from school all day
when their parents think they
are at school?
81. During the past 12 months, how many times did you
actually attempt suicide?
4 or 5 times
0 times
1 time
6 or more times
2 or 3 times
72. How frequently have you smoked cigarettes
during the past 30 days?
I've done it, but not in the past year
d. attack someone with the idea
of seriously hurting them?
80. During the past 12 months, did you ever seriously consider
attempting suicide?
Yes
No
Once or twice
Regularly now
Once in a while, but not regularly
Less than once a month
c. pick a fight with someone?
79. If you wanted to get some marijuana,
how easy would it be for you to get some?
71. Have you ever smoked cigarettes?
Regularly in the past
Never
Once a week or more
2 or 3 times a month
About once a month
b. steal anything worth more
than $5?
78. If you wanted to get a drug like
cocaine, LSD, or amphetamine, how easy
would it be for you to get some?
70. How frequently have you used smokeless tobacco
during the past 30 days?
Never
About once a day
Once or twice
More than once a day
Once or twice per week
24. How many times have you done the following things?
a. take a handgun to school?
77. If you wanted to get some beer, wine,
or hard liquor (for example, vodka,
whiskey, or gin), how easy would it be
for you to get some?
69. Have you ever used smokeless tobacco (chew,
snuff, plug, snus, or dipping tobacco)?
Never
Regularly in the past
Once or twice
Regularly now
Once in a while, but not regularly
g
76. If you wanted to get some cigarettes,
how easy would it be for you to get some?
22. How wrong do
you think it is for
someone your age to:
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ro
3-5 times
6-9 times
10 or more times
So
Ve
rt
o
yh
f h of e ry e
ar
ar
as
as
d
d
y
y
rt
yw
None
One time
Two times
So
r
Ve
Ve
r
68. Think back over the last two weeks. How many times
have you had five or more alcoholic drinks in a row?
3
a. adults were drinking alcohol?
Yes
No
b. alcohol was being sold?
Yes
No
c. adults were drunk or intoxicated?
Yes
No
34. In the past year (12 months), have you been to a
gathering where large amounts of alcohol were available?
Never
1 to 2 times
3 to 5 times
6 to 9 times
10+ times
27. Suppose you are at a party at someone's house, and
one of your friends offers you a drink containing alcohol.
What would you say or do?
Drink it.
Tell your friend, "No thanks, I don't drink," and suggest
that you and your friend go and do something else.
Just say, "No thanks," and walk away.
Make up a good excuse, tell your friend you had
something else to do, and leave.
35. Sometimes we don't know what we will do as adults,
but we may have an idea. Please answer how true these
statements may be for you.
28. You're looking at DVDs in a store with a friend. You look
up and see her slip a DVD under her coat. She smiles and
says, "Which one do you want? Go ahead, take it while
nobody's around." There is nobody in sight, no employees,
and no other customers. What do you do?
NO!
yes
YES!
a. When I am an adult, I will
smoke cigarettes.
Tell her to put the DVD back.
Act like it's a joke and ask her to put the DVD back.
A
So
No
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to
of
of
of
f
f
th
th
th
th
th
36. During the last 30
e
e
e
e
e
tim
tim tim
tim
tim
days, about how often
e
e
e
e
e
did...
lo
29. You are visiting another part of town, and you don't
know any of the people your age there. You are walking
down the street, and some teenager you don't know is
walking toward you. He is about your size, and as he is
about to pass you, he deliberately bumps into you and you
almost lose your balance. What would you say or do?
3-5
6-9
10-19 20-39
40+
43. used LSD or other psychedelics during the past 30 days?
47. sniffed glue, breathed the contents of an aerosol spray can, or inhaled
other gases or sprays in order to get high during the past 30 days?
48. used witlera in your lifetime?
49. used witlera during the past 30 days?
50. used methamphetamines (meth, speed, crank, or ice) in your lifetime?
c. you feel restless or fidgety?
53. used heroin or other opiates during the past 30 days?
Say, "Watch where you're going," and keep walking.
d. you feel everything was an
effort?
54. used MDMA (X, E, or ecstasy) in your lifetime?
55. used MDMA (X, E, or ecstasy) during the past 30 days?
e. you feel worthless?
56. used steroids in your lifetime?
f. you feel nervous?
57. used steroids during the past 30 days?
58. used in your lifetime a medication to get high that you can buy at the store?
37. How much do you
think people risk harming
themselves (physically or
in other ways) if they:
Leave the house anyway.
Explain what you are going to do with your friends, tell
her when you will get home, and ask if you can go out.
Not say anything and start watching TV.
a. smoke one or more packs of
cigarettes per day?
Get into an argument with her.
b. try marijuana once or twice?
d. take one or two drinks of an
alcoholic beverage (beer, wine, or
liquor) nearly every day?
YES!
31. I think sometimes it's
okay to cheat at school.
e. have 4 or 5 drinks of an alcoholic
beverage in a row?
32. It is all right to beat up
people if they start the fight.
f. try methamphetamines (meth,
speed, crank, or ice) once or twice?
33. I think it is okay to take
something without asking if
I can get away with it.
g. use prescription drugs that are not
prescribed to them?
4
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M
od
G
e
No igh rat rea
e
tr
ris t ris
r
k
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c. smoke marijuana regularly?
yes
1-2
42. used LSD or other psychedelics in your lifetime?
Say, "Excuse me," and keep on walking.
no
0
41. used marijuana during the past 30 days?
52. used heroin or other opiates in your lifetime?
NO!
40+
40. used marijuana in your lifetime?
b. you feel hopeless?
30. It's 8:00 on a weeknight and you are about to go over
to a friend's home when your mother asks you where you
are going. You say, "Oh, just going to hang out with some
friends." She says, "No, you'll just get into trouble if you
go out. Stay home tonight." What would you do now?
10-19 20-39
39. had beer, wine, sweetened alcoholic beverages, or hard liquor to
drink during the past 30 days?
51. used methamphetamines (meth, speed, crank, or ice) during the
past 30 days?
Swear at the person and walk away.
6-9
38. had alcoholic beverages (beer, wine, sweetened or hard liquor) to
drink in your lifetime -- more than just a few sips?
a. you feel so depressed that
nothing could cheer you up?
Push him back.
3-5
46. sniffed glue, breathed the contents of an aerosol spray can, or inhaled
other gases or sprays in order to get high in your lifetime?
M
Al
1-2
45. used cocaine or crack during the past 30 days?
c. When I am an adult, I will
smoke marijuana.
Grab a DVD and leave the store.
0
44. used cocaine or crack in your lifetime?
b. When I am an adult, I will
drink beer, wine, or liquor.
Ignore her.
60156
no
On how many occasions (if any) have you:
59. used during the past 30 days, a medication to get high that you can buy
at the store?
60. used in your lifetime a prescription medication to get high?
61. used during the past 30 days a prescription medication to get high?
62. used in your lifetime an electronic cigarette?
63. used during the past 30 days an electronic cigarette?
In your opinion, on how many occasions do you think most
students in your school:
64. used alcohol during the past 30 days?
65. used marijuana during the past 30 days?
66. used methamphetamines (meth, speed, crank, or ice) during the
past 30 days?
67. used illegal drugs during the past 30 days?
5
34. In the past year (12 months), have you been to a
gathering where large amounts of alcohol were available?
Never
1 to 2 times
3 to 5 times
6 to 9 times
10+ times
27. Suppose you are at a party at someone's house, and
one of your friends offers you a drink containing alcohol.
What would you say or do?
Drink it.
Tell your friend, "No thanks, I don't drink," and suggest
that you and your friend go and do something else.
Just say, "No thanks," and walk away.
Make up a good excuse, tell your friend you had
something else to do, and leave.
35. Sometimes we don't know what we will do as adults,
but we may have an idea. Please answer how true these
statements may be for you.
28. You're looking at DVDs in a store with a friend. You look
up and see her slip a DVD under her coat. She smiles and
says, "Which one do you want? Go ahead, take it while
nobody's around." There is nobody in sight, no employees,
and no other customers. What do you do?
NO!
yes
YES!
a. When I am an adult, I will
smoke cigarettes.
Tell her to put the DVD back.
Act like it's a joke and ask her to put the DVD back.
A
So
No
m littl
os
ne
e
e
to
of
of
of
f
f
th
th
th
th
th
36. During the last 30
e
e
e
e
e
tim
tim tim
tim
tim
days, about how often
e
e
e
e
e
did...
lo
29. You are visiting another part of town, and you don't
know any of the people your age there. You are walking
down the street, and some teenager you don't know is
walking toward you. He is about your size, and as he is
about to pass you, he deliberately bumps into you and you
almost lose your balance. What would you say or do?
3-5
6-9
10-19 20-39
40+
43. used LSD or other psychedelics during the past 30 days?
47. sniffed glue, breathed the contents of an aerosol spray can, or inhaled
other gases or sprays in order to get high during the past 30 days?
48. used witlera in your lifetime?
49. used witlera during the past 30 days?
50. used methamphetamines (meth, speed, crank, or ice) in your lifetime?
c. you feel restless or fidgety?
53. used heroin or other opiates during the past 30 days?
Say, "Watch where you're going," and keep walking.
d. you feel everything was an
effort?
54. used MDMA (X, E, or ecstasy) in your lifetime?
55. used MDMA (X, E, or ecstasy) during the past 30 days?
e. you feel worthless?
56. used steroids in your lifetime?
f. you feel nervous?
57. used steroids during the past 30 days?
58. used in your lifetime a medication to get high that you can buy at the store?
37. How much do you
think people risk harming
themselves (physically or
in other ways) if they:
Leave the house anyway.
Explain what you are going to do with your friends, tell
her when you will get home, and ask if you can go out.
Not say anything and start watching TV.
a. smoke one or more packs of
cigarettes per day?
Get into an argument with her.
b. try marijuana once or twice?
d. take one or two drinks of an
alcoholic beverage (beer, wine, or
liquor) nearly every day?
YES!
31. I think sometimes it's
okay to cheat at school.
e. have 4 or 5 drinks of an alcoholic
beverage in a row?
32. It is all right to beat up
people if they start the fight.
f. try methamphetamines (meth,
speed, crank, or ice) once or twice?
33. I think it is okay to take
something without asking if
I can get away with it.
g. use prescription drugs that are not
prescribed to them?
4
Sl
M
od
G
e
No igh rat rea
e
tr
ris t ris
r
k
k isk isk
c. smoke marijuana regularly?
yes
1-2
42. used LSD or other psychedelics in your lifetime?
Say, "Excuse me," and keep on walking.
no
0
41. used marijuana during the past 30 days?
52. used heroin or other opiates in your lifetime?
NO!
40+
40. used marijuana in your lifetime?
b. you feel hopeless?
30. It's 8:00 on a weeknight and you are about to go over
to a friend's home when your mother asks you where you
are going. You say, "Oh, just going to hang out with some
friends." She says, "No, you'll just get into trouble if you
go out. Stay home tonight." What would you do now?
10-19 20-39
39. had beer, wine, sweetened alcoholic beverages, or hard liquor to
drink during the past 30 days?
51. used methamphetamines (meth, speed, crank, or ice) during the
past 30 days?
Swear at the person and walk away.
6-9
38. had alcoholic beverages (beer, wine, sweetened or hard liquor) to
drink in your lifetime -- more than just a few sips?
a. you feel so depressed that
nothing could cheer you up?
Push him back.
3-5
46. sniffed glue, breathed the contents of an aerosol spray can, or inhaled
other gases or sprays in order to get high in your lifetime?
M
Al
1-2
45. used cocaine or crack during the past 30 days?
c. When I am an adult, I will
smoke marijuana.
Grab a DVD and leave the store.
0
44. used cocaine or crack in your lifetime?
b. When I am an adult, I will
drink beer, wine, or liquor.
Ignore her.
60156
no
On how many occasions (if any) have you:
59. used during the past 30 days, a medication to get high that you can buy
at the store?
60. used in your lifetime a prescription medication to get high?
61. used during the past 30 days a prescription medication to get high?
62. used in your lifetime an electronic cigarette?
63. used during the past 30 days an electronic cigarette?
In your opinion, on how many occasions do you think most
students in your school:
64. used alcohol during the past 30 days?
65. used marijuana during the past 30 days?
66. used methamphetamines (meth, speed, crank, or ice) during the
past 30 days?
67. used illegal drugs during the past 30 days?
5
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c. stolen or tried to steal a motor
vehicle such as a car or
motorcycle?
17
d. been arrested?
or
r
16
15
14
13
de
ol
e. attacked someone with the
idea of seriously hurting them?
f. been drunk or high at school?
g. taken a handgun to school?
h. done something illegal and
did not get caught?
c. had more than a sip or
two of beer, wine, or hard
liquor (for example,
vodka, whiskey, or gin)?
e. used chewing tobacco?
i. verbally attacked, bullied, or
harassed someone?
j. received a minor in possession
(MIP) charge for alcohol?
k. received a minor in possession
(MIP) charge for tobacco?
f. got suspended from
school?
NO!
no
yes YES!
26. In the past year (12 months), have you been to any
community events where:
g. got arrested?
a. Crime and/or drug selling
h. carried a handgun?
b. Fights
i. attacked someone
with the idea of
seriously hurting them?
d. Lots of graffiti
6
to
b. sold illegal drugs?
a. smoked marijuana?
85. I feel safe in my neighborhood.
es
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+ ti s
10
e
tim
9
es
to
m
6
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5
to
es
3
tim
2 er
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1
a. been suspended from school?
12
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No
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ng
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23. How old were
you when you first:
d. began drinking
alcoholic beverages
regularly, that is, at least
once or twice a month?
c. Lots of empty or abandoned buildings
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litt
j. use LSD, cocaine,
amphetamines, or another
illegal drug?
84. If a kid carried a handgun in your
neighborhood, would he or she be
caught by the police?
86. How well do each of the
following characteristics
describe your neighborhood?
75. In your opinion, how frequently have most
students in your school used smokeless tobacco
during the past 30 days?
Never
About once a day
More than once a day
Once or twice
Once or twice per week
i. smoke marijuana?
b. smoked a cigarette,
even just a puff?
83. If a kid drank some beer, wine, or
hard liquor (for example, vodka, whiskey,
or gin) in your neighborhood, would he
or she be caught by the police?
74. In your opinion, how frequently have most students in
your school smoked cigarettes during the past 30 days?
Not at all
Less than one cigarette per day
One to five cigarettes per day
About half a pack per day
About one pack per day
About one-and-a-half packs per day
Two packs or more per day
A
yes YES!
25. How many times in
the past year (12 months)
have you:
11
no
h. use chewing tobacco?
r
ge
un
yo ve
or r ha
e
NO!
g. smoke cigarettes?
ev
82. If a kid smoked marijuana in your
neighborhood, would he or she be
caught by the police?
73. During the past two weeks, how often do you think
most students in your school have had five or more
alcoholic drinks in a row?
None
3-5 times
One time
6-9 times
Two times
10 or more times
c. Done crazy things even if
they are a little dangerous.
f. drink beer, wine, or hard liquor
(for example, vodka, whiskey, or
gin) regularly?
N
These next questions ask about the neighborhood
and community where you live.
Never
b. Done something
dangerous because someone
dared you to do it.
10
Not at all
Less than one cigarette per day
One to five cigarettes per day
About half a pack per day
About one pack per day
About one-and-a-half packs per day
Two packs or more per day
a. Done what feels good
no matter what.
e. stay away from school all day
when their parents think they
are at school?
81. During the past 12 months, how many times did you
actually attempt suicide?
4 or 5 times
0 times
1 time
6 or more times
2 or 3 times
72. How frequently have you smoked cigarettes
during the past 30 days?
I've done it, but not in the past year
d. attack someone with the idea
of seriously hurting them?
80. During the past 12 months, did you ever seriously consider
attempting suicide?
Yes
No
Once or twice
Regularly now
Once in a while, but not regularly
Less than once a month
c. pick a fight with someone?
79. If you wanted to get some marijuana,
how easy would it be for you to get some?
71. Have you ever smoked cigarettes?
Regularly in the past
Never
Once a week or more
2 or 3 times a month
About once a month
b. steal anything worth more
than $5?
78. If you wanted to get a drug like
cocaine, LSD, or amphetamine, how easy
would it be for you to get some?
70. How frequently have you used smokeless tobacco
during the past 30 days?
Never
About once a day
Once or twice
More than once a day
Once or twice per week
24. How many times have you done the following things?
a. take a handgun to school?
77. If you wanted to get some beer, wine,
or hard liquor (for example, vodka,
whiskey, or gin), how easy would it be
for you to get some?
69. Have you ever used smokeless tobacco (chew,
snuff, plug, snus, or dipping tobacco)?
Never
Regularly in the past
Once or twice
Regularly now
Once in a while, but not regularly
g
76. If you wanted to get some cigarettes,
how easy would it be for you to get some?
22. How wrong do
you think it is for
someone your age to:
n
ro
3-5 times
6-9 times
10 or more times
So
Ve
rt
o
yh
f h of e ry e
ar
ar
as
as
d
d
y
y
rt
yw
None
One time
Two times
So
r
Ve
Ve
r
68. Think back over the last two weeks. How many times
have you had five or more alcoholic drinks in a row?
3
a. adults were drinking alcohol?
Yes
No
b. alcohol was being sold?
Yes
No
c. adults were drunk or intoxicated?
Yes
No
11. Think back over the
past year in school. How
often did you:
Al
m
So
os
m
ta
S
e
el
N
lw
do tim Oft
ev
en ay
es
er
m
s
No
a. enjoy being in school?
or
b. hate being in school?
c. try to do your best work
in school?
No
15. During the past 12
months, how often have
you been:
N
ev
er
20. How often do you attend religious services or
activities?
Never
1 or 2 times a month
Rarely
About once a week or more
21. Think of your four best friends (the friends you feel
closest to). In the past year (12 months), how many of
your best friends have:
Number of friends
a. picked on by a fellow student?
0
a. smoked cigarettes?
b. bullied by a fellow student?
b. tried beer, wine, or hard
liquor (for example, vodka,
whiskey, or gin) when their
parents didn't know about it?
For questions that have the answers: No! no yes YES!
c. used marijuana?
means.........DEFINITELY NOT TRUE for you.
means.........MOSTLY NOT TRUE for you.
means.........MOSTLY TRUE for you.
means.........DEFINITELY TRUE for you.
NO!
no
yes
d. used LSD, cocaine,
amphetamines, or other
illegal drugs?
YES!
16. I ignore rules that get in my
way.
ro
n
g
g
NO!
1
2
3
k. dropped out of school?
ll
yes YES!
93. If I had a personal problem, I
could ask my mom or dad for help.
c. to smoke cigarettes?
94. My parents ask if I've gotten my
homework done.
d. to use LSD, cocaine,
amphetamines, or another
illegal drug?
95. Would your parents know if you
did not come home on time?
96. The rules in my family are clear.
97. When I am not at home, one of
my parents knows where I am and
who I am with.
98. If you drank some beer, wine or
liquor (for example, vodka, whiskey,
or gin) without your parents'
permission, would you be caught by
your parents?
89. Is either one of your parents currently in jail or
prison?
Yes
No
Don't know or not sure
99. My family has clear rules about
alcohol and drug use.
90. If you have ever had an alcoholic beverage, think back
to the last time you drank. How did you get the alcohol on
that occasion? (Please fill in only one response.)
100. If you carried a handgun without
your parents' permission, would you
be caught by your parents?
I've never had an alcoholic beverage.
101. If you skipped school, would
you be caught by your parents?
I got it from my parent(s).
4
no
92. It is important to be honest with
your parents, even if they become
upset or you get punished.
at
a
I got it from a friend's parent(s).
I got it from another adult 21 or over.
A
I got it from someone under 21.
I took it (from home, from a friend's house, etc.).
102. How wrong do your parents
feel it would be for you to:
I bought it from a grocery or convenience store.
I bought it from a liquor store.
litt Not
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le
Ve
bi ro
ry
ng
t
w W w
ro ro ro at
ng ng ng al
l
I bought it at a bar or restaurant.
a. drink beer, wine, or hard liquor (for
example, vodka, whiskey, or gin) regularly?
I bought it over the Internet.
b. smoke cigarettes?
91. During the past 30 days, what type of alcohol did you
most often consume?
Beer
j. been arrested?
60156
ro
n
f. been suspended from
school?
i. stolen or tried to steal a
motor vehicle such as a
car or motorcycle?
2
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r
ro
ng ong
w
w
tw
I did not consume alcohol during the past 30 days
h. sold illegal drugs?
18. I like to see how much I can
get away with.
bi
ot
e. used chewing tobacco?
g. carried a handgun?
17. I do the opposite of what
people tell me, just to get them
mad.
le
88. Has either one of your parents ever been in jail or
prison for more than 30 days?
Yes
No
Don't know or not sure
d. carried a handgun?
Se
ve
Ve
ra
r
l
tim y oft
O
nc
en
es
e
y
N
litt
b. to drink alcohol?
c. smoked marijuana?
No
Ve
r
a. to use marijuana?
b. began drinking alcoholic
beverages regularly, that is, at
least once or twice a month?
14. Sometimes when students have problems, they talk to an
adult. Is there an adult at your school whom you can talk to
about your problems?
NO!
no
yes
YES!
Pr
ve
ett Ve
ry
ry
y
litt Litt Som go go
od od
le
l
ch e ch e ch
c
c
an
an
an han han
ce
ce
ce ce
ce
a. smoked cigarettes?
13. Not including going from elementary school to middle
school or from middle school to high school, have you
changed schools in the past year (12 months)?
Yes
87. How wrong would
most adults (21 or older)
in your neighborhood
think it is for kids your
age:
19. What are the
chances you would be
seen as cool if you:
12. How often do you feel
that the school work you are
assigned is meaningful and
important?
Yes
A
The next section asks about your feelings and
experiences in other parts of your life.
c. use chewing tobacco?
d. smoke marijuana?
e. steal something worth more than $5?
f. draw graffiti, write things, or draw pictures
on buildings or other property (without the
owner's permission)?
Wine
Wine cooler or sweetened alcoholic beverage (for
example, Seagrams, Smirnoff Ice, Hard Lemonade)
g. pick a fight with someone?
Gin, vodka, rum, or other type of hard liquor
h. use LSD, cocaine, amphetamines,
or another illegal drug?
Some other type
The next few questions ask about your family. When
you answer these questions, please think about the
people you consider to be your family, for example,
parents, stepparents, grandparents, aunts, or uncles.
i. use prescription drugs not prescribed
to you?
7
Wyoming Prevention Needs Assessment Survey
103. What places (if any) did you drink alcohol during the past
year (12 months)? (Mark all that apply.)
1. Thank you for agreeing to participate in this survey. The purpose of the survey is to learn how students in our
schools feel about their community, family, peers, and school. The survey also asks about health behaviors.
I didn't drink alcohol
At work
At my own home
At a park
2. The survey is completely voluntary and anonymous. DO NOT put your name on the questionnaire.
At a friend's home
In the mountains or in a field
3. This is not a test, so there are no right or wrong answers. Please work quickly so you can finish.
At a community event
In a car
At a sporting event
On the street
At a bar or saloon
In a parking lot
At a restaurant
At a concert
At school
Some other place
A
Ve
r
y
104. How wrong do your friends
feel it would be for you to:
a. have one or two drinks of an
alcoholic beverage nearly everyday?
w
ro
ng
lit
W
ro
tle
ng
4. Most questions ask for only one answer. You may mark more than one answer on questions that say, "Mark all
that apply." If you do not find an answer that fits exactly, use the one that comes closest. If any question does not
apply to you, or if you are not sure what it means, just leave it blank. You can skip any questions that you do not
wish to answer.
N
5. Please mark your answer for each question by completely filling in the answer space with a #2 pencil.
bi
ot
tw
Example: Chocolate is the best ice cream flavor.
w
NO!
no
yes
YES!
ro
ro
ng
ng
at
These questions ask for some general information
about the people completing the survey. Please mark
the responses that best describe you.
al
l
1. Are you:
b. smoke tobacco?
Male
Female
2. How old are you?
10 or younger
11
12
13
14
c. smoke marijuana?
d. use prescription drugs not
prescribed to you?
105. How honest were you in filling out this survey?
I was very honest.
The next section asks about your experiences at school.
7. How often do you feel
unsafe when:
15
16
17
18
19 or older
a. you are at school?
b. you are going to or from school?
3. What grade are you in?
I was honest most of the time.
6th
7th
8th
I was honest some of the time.
I was honest once in a while.
9th
10th
11th
8. How interesting are most of your courses to you?
Very interesting and stimulating
12th
Quite interesting
Fairly interesting
Slightly dull
Very dull
I was not honest at all.
4. What race do you consider yourself to be?
(Mark all that apply.)
White
9. How important do you think the things you are learning
in school are going to be for your later life?
Very important
Black or African American
Native American or Alaska Native
Asian
Quite important
Fairly important
Slightly important
Not at all important
Pacific Islander
Thank you for participating
in this survey.
For more information or to find out the survey results,
please contact:
Eric Canen
University of Wyoming
Dept. 3925
1000 E. University Ave.
Laramie, WY 82071
60156
Email: [email protected]
Phone: (307)760-0307
Internet: www.pnasurvey.org
8
This questionnaire was designed by the Wyoming
Survey & Analysis Center. http://wysac.uwyo.edu
So
M
m
os Eve
Ra
e
ry
N
d td
ev
r
er ely ays ays day
5. What is your ethnicity?
Hispanic or Latino/a
Not Hispanic or Latino/a
10. During the LAST FOUR WEEKS, how many whole days
of school did you miss because you skipped or cut class?
6. What is the language you most often use at home?
English
Spanish
Another language
1
None
4-5
1
6-10
2
3
11+
Survey Version: 2016 PS