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* 1. During the past 30 days, on how many days did you have at least one drink of alcohol?

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* 2. During the past 30 days, how many times did you take a prescription drug without a doctors prescription?

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* 3. During the past 30 days how many time did you use heroin?

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* 4. During the past 12 months, how many times did you take a prescription drug without a doctors prescription?

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* 5. During the past 12 months, how many times did you use heroin?

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* 6. How do you think your parents would feel about you having one or two drinks of an alcoholic beverage nearly every day?

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* 7. How do you think your parents would feel about you using prescription drugs not prescribed to you or that you took only for the experience or feeling that they caused?

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* 8. How do you think your parents would feel about you using heroin?

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* 9. How do you think your close friends would feel about you having one or two drinks of an alcoholic beverage nearly everyday?

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* 10. How do you think your close friends would feel about you using prescription drugs not prescribed to you or that you took only for the experience or feeling they cause?

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* 11. How do you think your close friends would feel about you using heroin?

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* 12. How much do people risk harming themselves physically and in other ways when they have five or more drinks of an alcoholic beverage once or twice a week?

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* 13. How much do people risk harming themselves physically and in other ways if they use prescription drugs that are not prescribed to them or that they took only for the experience or feeling that they caused?

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* 14. How much do people risk harming themselves physically or in other ways when they use heroin?

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* 15. How old are you?

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* 16. What is you sex?

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* 17. What grade are you in?

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* 18. Are you Hispanic or Latino?

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* 19. What is your race?

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* 20. When you ride a bicycle, how often do you wear a helmet?

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* 21. When you rollerblade or skateboard, how often do you wear a helmet?

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* 22. How often do you wear a seatbelt when riding in the car?

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* 23. Have you ever ridden in the car driven by someone who has been drinking alcohol?

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* 24. Have you ever carried a weapon, such as a gun, knife, or club?

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* 25. Have you ever been in a physical fight?

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* 26. Have you ever been bullied on school property?

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* 27. Have you ever been electronically bullied or Cyber Bullied?

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* 28. Have you ever seriously thought about killing yourself?

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* 29. Have you ever made a plan about what you would do to kill yourself?

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* 30. Have you ever tried to kill yourself?

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* 31. Have you ever tried cigarette smoking, even one or two puffs?

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* 32. How old were you when you first tried cigarette smoking, even one or two puffs?

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* 33. During the past 30 days, on how many days did you smoke cigarettes? 

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* 34. During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?

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* 35. Have you ever used an electronic vapor product?

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* 36. During the past 30 days, on how many days did you use an electronic vapor product?

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* 37. During the past 30 days, how do you usually get your own electronic vapor products?

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* 38. During the past 30 days, on how many days did you use chewing tobacco, snuff, dip, suns, or dissolvable tobacco products? (Not electronic vapor products)

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* 39. During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?

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* 40. Have you ever had a drink of alcohol other than a few sips?

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* 41. How old were you when you had your first drink of alcohol other than a few sips?

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* 42. Have you ever used marijuana?

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* 43. How old were you when you tried marijuana for the first time?

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* 44. Have you ever used any form of cocaine, including powder, crack, or freebase?

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* 45. Have you ever sniffed glue, breathed the contents of spray cans, or inhaled any paints or sprays to get high?

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* 46. Have you ever taken steroid pills or shots without a doctor's prescription?

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* 47. Have you ever taken prescription pain medicine without a doctor's prescription or differently than how the doctor told you to use it?

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* 48. Have you ever had sexual intercourse?

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* 49. How old were you when you had sexual intercourse for the first time?

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* 50. With how many people have have you ever had sexual intercourse?

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* 51. The last time you had sexual intercourse, did you or your partner use a condom?

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* 52. How would you describe your body weight?

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* 53. Which of the following are you trying to do about your weight?

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* 54. During the past 7 days, on how many days did you eat breakfast?

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* 55. During the past 7 days, on how many days were you physically activefor a total of at least 60 minutes per day?

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* 56. On an average school day, how many hours do you watch TV?

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* 57. On an average school day, how many hours do you play video or computer games or use a computer for something that is not school work?

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* 58. On an average week when you are in school, on how many days do you go to physical education (PE) classes?

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* 59. During the past 12 months, on how many sports teams did you play?

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* 60. During the past 12 months, how many times did you have a concussion from playing a sport or being physically active?

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* 61. Has a doctor or nurse ever told you that you have asthma?

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* 62. On an average school night, how many hours of sleep do you get?

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* 63. During the past 12 months, how would you describe your grades in school?

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* 64. Please text NPC to 757-500-3729 when you are complete, and a representative will assist you in receiving your gift.

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