Developing an instrument to measure students' predisposing factors for drug use and violence.

Abstract: During 2000-2003, an urban school system implemented health education programs aimed at preventing adolescent drug use and violence. Planners contracted with university faculty to design, test, and administer the assessment. The aim was to determine perceptions of the school health education program. This manuscript describes the development of a curriculum based assessment tool administered to 908 students during the spring of 2002. Content focused on knowledge, attitudes, and behavior related to drug education and violence prevention. Reliability for three survey sections ranged from .78 to .85. Selected results illustrate student health risks concerning drug use and knowledge. Survey content and format will be revised before re-administering.

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The U.S. Centers for Disease Control and Prevention (CDC) identified six health risk behaviors for teens and young adults: a) poor eating habits, b) physical inactivity, c) tobacco use, d) behaviors that result in intentional or unintentional injuries, e) abuse of alcohol and other drugs, and f) sexual behaviors that result in HIV infection, other sexually transmitted infections, or unintended pregnancy (CDC, 2003a). The CDC supports implementation of a coordinated school health program (CSHP) in U.S. school systems (CDC, 2003b) as a planned approach to address these behaviors.

One purpose of a CSHP is to reduce threats to the health of youth by promoting healthy lifestyles. Two of the eight components of a model CSHP (Allensworth & Kolbe, 1987; CDC, 2003a; Kane, 1993; Seffrin, 1994) are most germane to the focus of this manuscript. Health Education includes a planned sequential curriculum with age-appropriate learning experiences. Students should acquire factual health knowledge, develop health-promoting attitudes, and practice health skills (Joint Commission on National Health Education Standards, 1995).

A second component of the CSHP, Family/ Community Involvement, is important to extend the benefits of classroom instruction and school-based services. A community of caring adults is formed representing parents, teachers, business and industry professionals, government officials, higher education faculty, and health service providers. These supporters may be responsible for assessing current health and education needs, planning for change, advocating for policies that support CSHPs, seeking funding for new programs, building links to health and social services, volunteering in schools, and creating opportunities for continuing education of school staff.

Dusenbury and Falco (1995) reported results of a comprehensive review of school-based drug abuse prevention programs and supplemental interviews with 15 recognized experts in prevention research. Key components of effective curricula included developmentally appropriate information about drugs, social resistance skills training, normative education, and comprehensive health education. In addition, there was consensus about the value of family and media components of drug education programs for youth.

Dwyer, Osher and Warger (1998) concluded that effective school violence prevention programs "involve families in meaningful ways and develop links to the community" (p.3). Similarly, Massey (2000) recommended that educators "offer parenting classes, discuss life skills, including specific violence prevention skills ... stress management and positive coping techniques, problem-solving skills, and communication methods" (pp. 7-8). Finally, Pascopella (2003) emphasized the importance of training parents and children together for violence prevention in poor urban neighborhoods in the Midwest. One feature of the MMCSHE curriculum is planned learning activities for parents and children to complete together.

PROJECT HOPE PROGRAM GOALS

During 2000-2003, an urban public school system in a southeastern state received federal funding from the U.S. Department of Education. Growing concern about prevention of drug use and violence in schools and the community provided the impetus for Project HOPE to assess the CSHP. The overall purpose was to implement drug education and violence prevention programs in middle grades. The project included instruction for teachers, students, and their parents. In addition, the school system was engaged in other activities related to CSHP, including implementation of a comprehensive planning model with assistance from CDC and the American School Health Association and promoting healthy peer relationships through a state civil justice grant.

Two goals guided Project HOPE intervention activities:

1. To help all students reach challenging academic standards so that they are prepared for responsible citizenship, further learning, and productive employment.

2. To reduce alcohol, tobacco, and drug use and violence in our school system through multiple approaches: implementation of selected components of the Michigan Model for Comprehensive School Health Education, enhancement of the "Peers for Life" peer helping program, and a countywide collaborative model for student services.

One administrative objective for Project HOPE was to collect annual data from middle school students concerning their knowledge, attitudes, and behaviors of drug use and violence prevention. Other administrative objectives related to CSHP implementation are beyond the focus of this manuscript. This article documents development of the student instrument, steps that may be useful for other researchers working in school settings.

Assessment tasks clearly relate to a primary competency for health educators as specified by the National Commission for Health Education Credentialing (NCHEC): To obtain health related data about social and cultural environments, growth and development factors, needs, and interests and its five subcompetencies. Use of student data is consistent with a second competency: To infer needs for health education on the basis of obtained data and its two subcompetencies, to analyze needs assessment data, and to determine priority areas of need for health education (National Commission for Health Education Credentialing, 1996). Selected results from objective items indicate student health risks related to knowledge and use of substances.

CURRICULUM SELECTION

The school health program advisory committee was composed of the middle school curriculum coordinator, other certified faculty, and parents. Their role was to recommend a suitable health curriculum for adoption by the school system superintendent. A school nurse, the coordinator of school health services, provided guidance to committee action. Committee representatives attended a technical assistance meeting presented by the U.S. Department of Education in Washington, DC. The meeting was held to promote drug education and violence prevention. Afterwards, the committee sought examples of effective curricula and recommended adoption of selected components of the Michigan Model of Comprehensive School Health Education (MMCSHE).

An independent advisory group, Drug Strategies, Inc., reviewed nearly 50 substance abuse programs. The MMCSHE was designated as among the six best programs in the country. The National Prevention Network included the curriculum in its 1987 listing of the Top Twenty Prevention Programs (Michigan Department of Community Health, 2001; Michigan Department of Education, 1997).

The MMCSHE is one of the few comprehensive health curricula developed by teams comprised of both teachers and parents. Seven Michigan state agencies (education, mental health, public health, social services, state police, highway safety planning, and center for substance abuse services) cooperated to produce a comprehensive curriculum. It has been widely adopted by school systems in several midwestern states since 1984; however, it is less frequently used in the southeastern U.S.

MMCSHE alms and content are compatible with the National Health Education Standards (Joint Committee on National Health Education Standards, 1995) and the state curriculum framework for middle school grades required at the time of the project (Alabama State Department of Education, 1997). The curriculum includes background information for parents on important health content, as well as home activities for families to complete together to reinforce classroom lessons. Middle school faculty members completed curriculum-specific training on selected drug education and violence prevention components during summer months, 2000-2001.

NEED FOR INSTRUMENTS

A notable limitation of the MMCSHE was its lack of a comprehensive evaluation plan and results. Project HOPE's funder, the U.S. Department of Education, required a local evaluation plan. Health education, counseling, and educational research faculty of the University of Alabama at Birmingham assisted the committee with developing a plan and conducting evaluation of MMCSHE curriculum components.

The committee deemed it necessary to gather information on the strengths and needs of the existing program (impacts) as perceived by three groups of stakeholders (teachers, parents, and their children; Southwest Regional Center for Drug-Free Schools and Communities, 1996; U.S. Department of Education, 1996). The first step was to review the professional literature for instruments developed for use with the MMCSHE. Next, researchers contacted curriculum trainers and the educational materials distributor at Central Michigan University to request specific assessment tools.

Four instruments were located (one each for teachers and parents, and two for students) that were developed between 1988 and 1994. None had been recently revised. One instrument was previously used to assess middle school students' substance use knowledge and practices following exposure to MMCSHE in Grades 6 and 7 (Shope, 1992). The Student Substance Survey contained more than 200 fixed-response items and was originally developed more than a decade ago. Its author reported decreased usage of alcohol, tobacco, and marijuana among student respondents over a two-year period. The Student Substance Survey contained more than 200 fixed-response items. It was originally developed more than a decade ago.

Three other instruments were obtained from the State of Michigan Office of Drug Control Policy. These instruments were used to gather pre- and post-test data in selected Michigan public schools (Perlstadt & Pok, 2000). Instruments were revised in 2000, as local education agencies objected to the lengthier Student Substance Survey. The Questionnaire for Middle School Students contained 44 fixed-response items on drug knowledge and attitudes and 21 fixed-response items to assess self-reported practices.

Despite repeated requests, no information was available from the authors or Michigan state agencies on the development, reliability, or validity of these instruments. Due to the age, length, and lack of psychometric information for the MMCSHE instruments, the evaluation team deemed the content and format of these surveys to be unsuitable for use in Alabama.

INSTRUMENT DEVELOPMENT

Members of the school health program advisory committee expressed strong interest in knowing more about middle school students' substance use knowledge, risk-taking and prevention behaviors. Faculty researchers worked closely with the coordinators of health services, special education, and middle schools to draft survey items compatible with MMCSHE curriculum content. The goal was to develop a student survey that could be completed in less than 30 minutes.

Item Development. The MMCSHE Student Survey contained three sections: Drug Use, Drug Knowledge and Attitudes, and Preventing Violence. The first section contained nine fixed-response items. The second and third sections contained 22 and 28 fixed-response items, respectively.

Students considered four options to indicate frequency of use: Never Used, Tried Once, Used 2-10 Times, and Used 11 or More Times. Response choices for sections two and three were True and False.

In addition, students responded to five fixed-response demographic items and four open-ended items to recommend changes to the school health program. Open-ended items included the following:

* What can teachers and other adults at school do to help stop teens from using tobacco, alcohol and other drugs?

* What can you do to stop teens from using weapons like guns and knives to hurt others?

The student survey was printed on scannable forms. This system diminished the possibility of data entry error and aided data analyses.

FIELD TESTING THE INSTRUMENT

The University Internal Review Board granted exemption on the basis that curriculum assessment is standard practice for a local education agency. Letters were sent to parents explaining the purpose of the student survey and uses of data to enhance the school health program. Each parent had the option of declining participation without any penalties to their child.

Middle school teachers and administrators selected a student sample from those with completed parent permission slips. The middle school coordinator and university researchers briefly described the purpose and uses of field test data to 34 middle school students who formed the field test sample. They completed the MMCSHE Student Survey in March 2002.

Each student completed the survey during a small group administration in a local middle school after regular school hours. An average of 1 5 minutes was required to complete all items on each survey. Students then provided suggestions to improve the instruments during a structured discussion with refreshments. Researchers asked several open-ended questions including:

* Which words or sentences on the survey do you think are confusing?

* Which questions on the survey do you feel are unnecessary?

* What important topics or issues would you add to this survey?

Students' responses were recorded in writing and later considered by the research team. The instrument was revised based on field test results and discussion with respondents. Revisions were made to the format, content and overall length of the instrument.

ADMINISTERING THE INSTRUMENT

School administrators provided enrollment lists of students by grade level and school. Researchers selected intact classes representing approximate equal numbers of students across grade levels 5-8. Classroom teachers distributed parental letters approximately two weeks before the scheduled survey administration. Parents were encouraged to contact the school system middle school coordinator or university researchers to answer their questions about the purpose and uses of the study data. Middle school teachers later distributed student surveys during a single administration in classrooms in May and June 2002.

INSTRUMENT DEVELOPMENT RESULTS

Descriptives. Based on enrollment data provided by the school system, 964 students were eligible to receive the survey. Completed surveys from 908 students yielded a response rate of 94.19%. Response rates by school ranged from 84.31% to 100%. Respondents were distributed nearly equal by gender group (448 boys and 460 girls) and grade level: 5th grade (226 responded, 24.89%); 6th grade (245 responded, 26.98%); 7th grade (218 responded, 24.01%); and 8th grade (218 responded, 24.01%).

Content validity of the instrument. Four processes supported the content validity of the instrument as it relates to selected components of the MMCSHE. These included a (1) review of the professional literature on drug and health education; (2) participation by university faculty members with nationally recognized expertise in addiction and school counseling, social work, school health education, and educational research and measurement; (3) development of items compatible with lesson content in the selected components of the MMCSHE; and (4) review of items by public school faculty and parents who served on the school health program advisory committee.

Reliability of the instrument. Researchers were limited to a single contact with students, so test-retest reliability was not assessed. Internal consistency reliability was assessed using a Cronbach's alpha coefficient that was computed for each of the three sections. Results are summarized in Table 1.

For research purposes, .70 is the generally accepted criterion for an alpha coefficient. All three scales met this criterion, suggesting that the items on a given scale performed similarly. Furthermore, most of the item-total correlations are .20 or better.

The Stopping Violence scale is the only scale that contained item-total correlations below .20. The first three items assess knowledge of appropriate behavior related to guns. Responses may reflect either lack of exposure to curriculum content or lack of understanding of the item. The last two items relate to the student's own behavior. Responses may reflect lack of exposure to curriculum; however, responses may also reflect earlier behavior (before curriculum implementation), or the influence of peer pressure. Further examination of students' responses, discussion with their teachers, and comparison to other self-reported data may reveal reasons for low correlations and assist researchers with survey revision.

SELECTED RESULTS OF STUDENTS' DRUG KNOWLEDGE AND USE

Substance Use: A total of nine items elicited responses from students concerning their substance use experience. They were asked to respond to each item by indicating Never Used, Tried Once, Used 2-10 times, or Used 11 or More Times. Results are provided in Table 2.

An examination of these results reveals that most students have never tried any of the substances, or tried them only once. More students smoked cigarettes or cigars, or consumed wine or beer, than those who used other substances. Very few students (less than 2%) indicated any experience using crack, cocaine, heroin, ecstacy, or LSD.

Responses to the substance use items were also examined to determine if gender or grade and age differences existed. For the purposes of these analyses, the first two response choices were combined, as were the last two response choices. Analysis by gender revealed that for all items, more boys reported multiple uses of substances on all items. This difference was most apparent for smoking cigarettes or cigars (9.03 percentage points) and chewing tobacco (13.53 percentage points).

Some grade-based (5th to 8th grade) differences were substantial for five items: smoking cigarettes or cigars (18.99 percentage points), chewing tobacco (9.68 percentage points), drinking wine and beer (27.22 percentage points), drinking hard liquor (20.18 percentage points), and smoking or chewing marijuana (9.71 percentage points). As might be expected, the age-related changes followed the same pattern.

Drug Knowledge: A total of 22 item tapped students' drug knowledge (and some behaviors). Students were asked to respond to each item by indicating whether it was True or False. Results of the analysis are provided in Table 3. Numbers and percentages for the desired responses are shown in bold.

Most students responded with the desired response to each drug knowledge item. In fact, more than 90% of students gave the desired response for 13 of the 22 items. Eighty to 89% of students gave the desired response for another 7 additional items. Two items that received the lowest percentage of desired responses were "My friends asked me to try tobacco, alcohol, or drugs." (72.90% selected False) and "Showing a famous person drinking alcohol is a trick to get me to try it." (77.38% selected True).

Gender, grade and age differences were also examined. The greatest gender-related difference was 8.54 percentage points for the item, "My friends think it is cool to use tobacco, alcohol, or drugs." Girls more often indicated that this statement was False. Another item revealed a gender-related difference of 8.50 percentage points. Girls more often selected True as a response to the item, "If I see others using tobacco, alcohol, or drugs at school, I know whom to tell."

The greatest grade-related difference was evident in response to the statement, "My friends asked me to try tobacco, alcohol, or drugs." On this item the percentage of 5th grade students selecting False was 26.59 percentage points more than that of 8th grade students. The following are statements that showed the largest grade-related differences:

"My friends think it is cool to use tobacco, alcohol, or drugs" (16.46% more 5th grade students selected False).

"My parents taught me how to turn down tobacco, alcohol, and drugs offered by others" (9.97% more 5th grade students selected True).

"If someone tried to talk me into using tobacco, alcohol, or drugs, I would not do it" (12.25% more 5th grade students selected True).

"My parents talk to me about the dangers of using tobacco" (9.50% more 5th grade students selected True).

"If I see others using tobacco, alcohol, or drugs at school, I know whom to tell" (10.32% more 5th grade students selected True).

Age-related differences showed a similar pattern; however, in some instances, the differences were more pronounced. For example, two items, "My friends asked me to try tobacco, alcohol, or drugs" (33.71% more 10-year-olds than 14 year-olds selected False), and "My friends think it is cool to use tobacco, alcohol, or drugs" (23.38% more 10-year-olds than 14-year olds selected False) demonstrated larger age-related differences. Two additional items emerged with age-related differences: "I have tried to get another student to use tobacco, alcohol, or drugs" (13.36% more 10-year-olds selected False), and "If I smoke tobacco, I will have wrinkles on my face and dirty teeth" (10.38% more 14-year-olds selected True).

DISCUSSION

This manuscript describes the process used to construct a new instrument. The purpose of the instrument is to assess students' predisposing factors related to use of alcohol, drugs, and violent acts as part of implementation of the Michigan Model of Comprehensive School Health Education (MMCSHE). The MMCSHE curriculum was identified as a leading prevention program and is unique because it was developed by cooperative teams of educators, parents, law enforcement agents, drug prevention specialists, and social service professionals. Notable limitations of this curriculum included its lack of a comprehensive evaluation plan and its dated and lengthy instrument for student assessment.

University faculty members assisted local school system planners in a southeastern state to develop a new instrument that was compatible with drug and violence prevention components. Three scales of the new student survey had acceptably high internal consistency reliabilities. All but five items met the .20 criterion for acceptable item-total correlations.

During fall 2003, researchers met with Project HOPE personnel to discuss results of the 2002 student survey and recommend improvements to the format and content of the new instrument before readministration. MMCSHE student survey data were considered within a larger context, by comparison to data obtained from other sources (the CDC's Youth Risk Behavior Survey: Middle School Questionnaire, school system incident reports, ALLTURS [RTI International/American Legacy], and the PRIDE questionnaire for grades 6-12). Data collected were useful to Project HOPE planners in making decisions about future Coordinated School Health Program (CSHP) activities, a desired purpose of curriculum assessment.

Student survey results led to enhancement of the health education program and plans to administer a teacher survey during the spring 2004. School administrators realized that curriculum changes alone do not yield student abstinence from drug use and violence. Planners examined all aspects of the Coordinated School Health Program with assistance provided by the CDC Division of Adolescent and School Health (e.g., policies, environment, parental involvement, and health services). Opportunities for improvement were identified within each school.

New initiatives provided family, peer, and other environmental supports to supplement the school prevention program. The aim was to form a community of caring adults to diminish student risk-taking. In 2003, the state department of public health provided support for student tobacco cessation classes and outreach to parents in response to high rates of tobacco consumption. High school students presented prevention messages using dramatic skits and classroom visits to elementary schools. In addition, in 2004, federal funds enabled the school system to begin an alternative program to supervise community service among youthful offenders. Student assessment data was useful to plan drug prevention initiatives.

REFERENCES

Alabama State Department of Education. (1997). Alabama course of study: Health education (No. 5). Montgomery, AL: Author.

Allensworth, D.D., Kolbe, L.J. (1987). The comprehensive school health program: Exploring an expanded concept. Journal of School Health, 57(10), 409-412.

Dusenbury, L. & Falco, M. (1995). Eleven components of effective drug abuse prevention curricula. Journal of School Health, 65(10), 420-425.

Dwyer, K., Osher, D., & Warger, C. (1998). Early warning, timely response: A guide to safe schools. Washington, DC: U.S. Department of Education and U.S. Department of Justice. (ERIC Document Reproduction Service No. ED418372). Retrieved September 29, 2003, from http://www.ed.gov/about/offices/list/osers/osep/gtss.html?exp=0

Joint Commission on National Health Education Standards. (1995). National health education standards. Washington, DC: American Cancer Society.

Kane, W.M. (1993). Step by step to comprehensive school health: The program planning guide. Santa Cruz, CA: ETR Associates.

Massey, M.S. (2000). The effects of violence on young children. The ERIC Review, 7(1), 6-8.

Michigan Department of Community Health, (2001). What is the Michigan Model? Teaching K-12 health lessons. Lansing, MI: School Health Unit.

Michigan Department of Education. (1997). Comprehensive school health education in Michigan. 1997 report. Lansing, MI: Author.

National Commission for Health Education Credentialing, Inc. (1996). Responsibilities and competencies for health educators. Retrieved September 12, 2004, from http://ajhs.tamu.edu/competencies.html.

Pascopella, A. (2003, May). Safety zone. District Administration, 39(5), 38-42.

Perlstadt, H. & Pok, A. (2000). Questionnaire for Middle School Students. Lansing, MI: Department of Community Health, Office of Drug Control Policy.

Seffrin, J.R. (1994). America's interest in comprehensive school health education. Journal of School Health, 64(10), 397-399.

Shope, J.T. (1992). Student substance survey. Ann Arbor, MI: University of Michigan Transportation Research Institute.

Southwest Regional Center for Drug-Free Schools and Communities (SWRC). (1996, March 28). Evaluation of programs and strategies position paper. Norman, OK: Author.

U.S. Centers for Disease Control and Prevention. (2003a). About the program. Program for healthy youth. Retrieved September 12, 2003, from http://www.cdc.gov/nccdphp/dash/about/healthyyouth.htm

U.S. Centers for Disease Control and Prevention. (2003b). About the program. School health defined. Retrieved September 12, 2003, from http://www.cdc.gov/nccdphp/dash/about/school_health.htm

U.S. Department of Education. (1996). Putting the pieces together. Comprehensive school-linked strategies for children and families (Chapter 2). Washington, DC.: Author.

CHES AREA

Responsibility IV--Evaluating Effectiveness of Health Education Programs

Brian F. Geiger, EdD is an Associate Professor and Marcia R. O'Neal, PhD is an Assistant Professor at the Center for Educational Accountability & Department of Human Studies in the School of Education at University of Alabama at Birmingham. Cindy J. Petri, PhD is an Associate Professor of Health Education in the Department of Human Studies in the School of Education at University of Alabama at Birmingham. Kelly Stanhope, BSN, MA is Coordinator of Pupil Health Services, Lauderdale County Board of Education. David Whittinghill, PhD is an Assistant Professor of Counselor Education at the University of Alabama at Birmingham. Address all correspondence to Brian F. Geiger, EdD, Center for Educational Accountability & Department of Human Studies, School of Education, University of Alabama at Birmingham, EB 209, 1530 3rd Avenue South, Birmingham, AL 35297-1250; PHONE: [phone]; FAX: [phone]; E-MAIL: [e-mail].

Table 1. Number of Items and Students and Internal Consistency
Reliabilities for Sections of the MMCSHE Student Survey

                                Number of   Cronbach's      Range of
                    Number of   Students       Alpha       Item-Total
     Section          Items     Included    Coefficient   Correlations

Drug Use                9          892         0.85         0.43-0.76
Drug Knowledge         22          867         0.78         0.22-0.50
Stopping Violence      28          829         0.80        -0.07-0.56

Table 2. Numbers and Percentages of Responses to the Substance
Use Items Included in the MMCSHE Student Survey

                                       Never         Tried
                                       Used          Once

How many times have you        N     n      %      n      %

Smoked tobacco
  cigarettes or cigars?       905   645   71.27   131   14.48
Chewed tobacco like
  Redman or Skoal?            904   771   85.29    69    7.63
Drunk alcohol like wine,
  beer, and wine coolers?     906   546   60.26   213   23.51
Drunk hard liquor like
  rum or vodka?               905   783   86.52    56    6.19
Smoked or chewed
  marijuana (pot)?            902   836   92.68    25    2.77
Sniffed or breathed heavily
  chemicals to get high?      903   822   91.03    41    4.54
Smoked or injected crack,
  cocaine, heroin, or other
  drugs?                      904   890   98.45     9    1.00
Taken drugs not prescribed
  to you like Ritalin?        905   862   95.25    21    2.32
Swallowed a dose of ecstasy
  or LSD?                     902   888   98.45     7    0.78

                                             Used 11
                               Used 2-10     or More
                                 Times        Times

How many times have you        n      %     n     %

Smoked tobacco
  cigarettes or cigars?        64   7.07%   65   7.18
Chewed tobacco like
  Redman or Skoal?             32    3.54   32   3.54
Drunk alcohol like wine,
  beer, and wine coolers?     100   11.04   47   5.19
Drunk hard liquor like
  rum or vodka?                36    3.98   30   3.31
Smoked or chewed
  marijuana (pot)?             20    2.22   21   2.33
Sniffed or breathed heavily
  chemicals to get high?       25    2.77   15   1.66
Smoked or injected crack,
  cocaine, heroin, or other
  drugs?                        2    0.22    3   0.33
Taken drugs not prescribed
  to you like Ritalin?         14    1.55    8   0.88
Swallowed a dose of ecstasy
  or LSD?                       3    0.33    4   0.44

Table 3. Numbers and Percentages of Responses to the Drug
Knowledge Items Included in the MMCSHE Student Survey

                                              True          False

Are these statements about
drugs true or false?                   N     n      %      n      %

I think it is cool to use tobacco,
  alcohol, or drugs.                  906    23    2.54   883   97.46
My friends think it is cool to use
  tobacco, alcohol, or drugs.         904   168   18.58   736   81.42
I can die from over use of alcohol.   906   855   94.37    51    5.63
Teachers talk to me about the
  dangers of alcohol & drug use.      907   858   94.60    49    5.40
If I smoke tobacco, I will have
  wrinkles on my face &
  dirty teeth.                        905   846   93.48    59    6.52
Alcohol can cause me to say stupid
  things & make me look dumb.         906   864   95.36    42    4.64
Drinking alcohol can cause
  dangerous accidents.                908   895   98.57    13    1.43
My parents talk to me about how
  alcohol & drugs can hurt me.        906   810   89.40    96   10.60
If I use cocaine or crack, I can
  have a heart attack.                903   839   92.91    64    7.09
I can die from regular tobacco use.   904   813   89.93    91   10.07
Teachers taught me about the
  effects of tobacco on my body.      904   869   96.13    35    3.87
My friends asked me to try tobacco,
  alcohol, or drugs.                  904   245   27.10   659   72.90
I can keep from using drugs by
  saying no to those who offer
  them.                               901   866   96.12    35    3.88
My parents taught me how to turn
  down tobacco, alcohol, & drugs
  offered by others.                  905   779   86.08   126   13.92
If someone tried to talk me into
  using tobacco, alcohol, or
  drugs, I would not do it.           902   800   88.69   102   11.31
I have tried to get another student
  to use tobacco, alcohol, or
  drugs.                              905    73    8.07   832   91.93
Showing a famous person drinking
  alcohol is a trick to get me
  to try it.                          902   698   77.38   204   22.62
Smoking marijuana can help me
  remember more & do better
  in school.                          906    32    3.53   874   96.47
Inhaling gasoline or paint fumes
  from a container or rags can
  cause my heart to stop.             903   845   93.58    58    6.42
My parents talk to me about the
  dangers of using tobacco.           903   787   87.15   116   12.85
If I see others using tobacco,
  alcohol, or drugs at school,
  I know whom to tell.                906   809   89.29    97   10.71
I know an adult to talk to about
  not using tobacco, alcohol, &
  drugs.                              904   845   93.47    59    6.53