3. Who do you live with most of the time (pick only one)? Mother and father Only father Other relative Only mother Stepmother and father Guardian or foster parent Mother and stepfather Some with mother/some with father Alone or with friends 4. Are you Hispanic or Latino? Yes No 5. What is your race? (Select one or more) American Indian/Alaska Native Native Hawaiian or Pacific Asian Black or African American 6. What grade are you in? 6th grade 7th grade 8th grade 9th grade 7. What grades do you generally get in school? (Pick only one) Mostly A’s (90-100) Mostly C’s (70-79) D’s or lower (less than 60) Mostly B’s (80-89) Mostly D’s (60-69) 8. how many days were you absent from school last year? (Pick only one) None 1-2 days 3-6 days 7-15 days 16 or more days Section B Directions: Read each statement below and indicate whether you think each is True or False by filling in the appropriate circle. True  False  1. Most adults smoke cigarettes.   2. Smoking a cigarette causes your heart to beat slower.   3. Few adults drink wine, beer, or liquor every day.   4. Most people my age smoke marijuana.   5. Smoking marijuana causes your heart to beat faster.  
6. Most adults use cocaine or other hard drugs.   7. Cocaine and other hard drugs always make you feel good.   8. What we believe about ourselves affects the way we act or behave.   9. It is almost impossible to develop a more positive self-image.   10. It is important to measure how far you have come toward reaching your goal.   11. It’s a good idea to make a decision and then think about the consequences later.   12. Smoking can affect the steadiness of your hands.   13. A stimulant is a chemical that down the body.   14. Smoking reduces a person’s endurance for physical activity.   15. A serving of beer or wine contains less alcohol than a serving of “hard liquor” such as whiskey.   Directions: Read each statement below and indicate whether you think each is True or False by filling in the appropriate circle. 16. Alcohol is a depressant.   17. Marijuana smoking can improve your eyesight.   18. Some advertisers are deliberately deceptive.   19. Companies advertise only because they want you to have all the facts about their product.   20. It’s a good idea to get all information about a product from its ads.   21. Most people do not experience anxiety.   22. is very little you can do when you feel anxious.  
23. Deep breathing is one way to lessen anxiety.   24. Mental rehearsal is a poor relaxation technique.   25. You can avoid misunderstandings by assuming the other person knows what you mean.   26. Effective communication is when both sender and receiver interpret a message in the same way.   27. Relaxation techniques are of no use when meeting people.   28. A compliment is more effective when it is said sincerely.   29. A nice way of ending a conversation is to tell the person you enjoyed talking with him/her.   30. Sense of humor is an example of a non-physical attribute.   31. It’s better to be polite and lead someone on, even if you don’t want to go out with them.   32. Almost all people who are assertive are either rude or hostile.   Section C Directions: Please fill in the circle to show how much you or disagree with each statement. Strongly Disagree  Disagree  Neither Nor Disagree  Agree  Strongly Agree       1. Kids who alcohol are more grown-up.      2. Smoking cigarettes makes you look cool.      3. Kids who drink alcohol have more friends.      4. Kids who smoke have more friends.      5. Drinking alcohol makes you look cool.     