ThinkFirst Before Survey

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-YOUR ANSWERS ARE COMPLETELY ANONYMOUS, will not be shared with teachers or school employees, and are very appreciated.

-The data gathered in this questionnaire helps to improve the ThinkFirst program by giving insight into the efficacy of program materials and delivery techniques. We thank you for your time and participation.

What is the name of your school? *

Age: *

OTHER

How often do you wear a seat belt when riding in a car driven by someone else? *

Never

Rarely

Sometimes

Most of the time

Always

In general, injuries are __________ preventable. (fill in the blank) *

Never

Rarely

Sometimes

Almost Always

During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been DRINKING ALCOHOL? *

0 times

1 time

2 or 3 times

4 or 5 times

6 or more times

During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been USING MARIJUANA? *

0 times

1 time

2 or 3 times

4 or 5 times

6 or more times

During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who was distracted by texting, using social media, or operating a phone without using hands-free options? *

0 times

1 time

2 or 3 times

4 or 5 times

6 or more times

What statement is true about marijuana & driving? *

Marijuana does not impair driving

At the age of 21, one can use marijuana & drive

Marijuana affects vision & slows reaction time while driving

Marijuana increases focus while driving

What is the leading cause of death for teenagers in the United States? (ages 12-19) *

Disease, like cancer and heart disease

Unintentional injuries, like car crashes

Self-harm and suicide

Homicide

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