Confidential Survey

The following survey helps gather information about drug use and about children and teens surrounded by drug use in Iowa. This survey is private, and will not be used to harm, arrest or damage anyone who participates. All information you provide helps us protect Iowa's kids. We encourage and appreciate your honesty.


Introductory Questions
  1. How old are you?
    1. Younger than 6
    2. 6 - 9
    3. 10 - 12
    4. 13 - 15
    5. 16 - 18
    6. 19 - 20
    7. 21 or older
  2. I am
    1. male.
    2. female.
  3. Who do you suspect is using/making/selling drugs illegally? Check all that apply.
    1. Me.
    2. My parents.
    3. My brother or sister.
    4. Someone else who lives in my home.
    5. A family friend.
    6. A neighbor.
    7. Someone in my friend's home.
    8. I don't know anyone who is into drugs.
  4. Do the people you suspect of using/making/selling drugs ever come in contact with children or teens?
    1. Yes
    2. No
    3. I don't know anyone who is into drugs.
  5. How often?
    1. Never
    2. Rarely, maybe once a week.
    3. Sometimes, at least a few times a week.
    4. Daily, but children don't live there.
    5. There are children living in the home.
    6. I don't know anyone who is into drugs.
Who uses?
 Who do you know that uses the following drugs? Check all that apply.
  1. Meth
    1. A close friend or friends
    2. Kids at school I'm not close to
    3. My brother or sister
    4. Someone in my neighborhood
    5. An adult in my home
    6. Other
  2. Cocaine
    1. A close friend or friends
    2. Kids at school I'm not close to
    3. My brother or sister
    4. Someone in my neighborhood
    5. An adult in my home
    6. Other
  3. Marijuana
    1. A close friend or friends
    2. Kids at school I'm not close to
    3. My brother or sister
    4. Someone in my neighborhood
    5. An adult in my home
    6. Other
  4. Prescription drugs not prescribed to the user (Oxycontin, etc.)
    1. A close friend or friends
    2. Kids at school I'm not close to
    3. My brother or sister
    4. Someone in my neighborhood
    5. An adult in my home
    6. Other
  5. Heroin
    1. A close friend or friends
    2. Kids at school I'm not close to
    3. My brother or sister
    4. Someone in my neighborhood
    5. An adult in my home
    6. Other
Ease of Getting Drugs
 How easy would it be for you to get the following drugs for illegal use?
  1. Meth
    1. Very easy
    2. Somewhat easy
    3. Somewhat difficult
    4. Very difficult
    5. Not sure
  2. Cocaine
    1. Very easy
    2. Somewhat easy
    3. Somewhat difficult
    4. Very difficult
    5. Not sure
  3. Marijuana
    1. Very easy
    2. Somewhat easy
    3. Somewhat difficult
    4. Very difficult
    5. Not sure
  4. Prescription drugs not prescribed to you (Oxycontin, etc.)
    1. Very easy
    2. Somewhat easy
    3. Somewhat difficult
    4. Very difficult
    5. Not sure
  5. Heroin
    1. Very easy
    2. Somewhat easy
    3. Somewhat difficult
    4. Very difficult
    5. Not sure
Offers of Use
 Have you ever been offered, or has anybody ever tried to sell you...
  1. Meth?
    1. Yes
    2. No
  2. Cocaine?
    1. Yes
    2. No
  3. Marijuana?
    1. Yes
    2. No
  4. Prescription drugs not prescribed to you (Oxycontin, etc.)?
    1. Yes
    2. No
  5. Heroin?
    1. Yes
    2. No
Drug Attitudes
 How strongly do you agree or disagree with the following statements about drugs?
  1. Drugs make you more popular.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  2. It's hard to have fun if you aren't high on drugs.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  3. Drugs make you feel very happy.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  4. Drugs help you lose weight.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  5. Trying drugs once isn't a big deal.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  6. Drugs help you deal with your problems.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  7. Drugs give you energy.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  8. I worry about all of the household chemicals that go in to drugs.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  9. The people I know who do drugs are cooler than the ones who don't.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
  10. People who take, sell and make drugs around children are putting those children in danger.
    1. Strongly agree
    2. Agree
    3. Neither agree or disagree
    4. Disagree
    5. Strongly disagree
THE PARTNERSHIP FOR A DRUG-FREE IOWA RESPECTS YOUR PRIVACY AND WE WILL ENSURE THAT INFORMATION YOU PROVIDE TO US WILL REMAIN PROTECTED.