Teacher Survey

Attachment 9 –

Teacher Survey

(with programming notations)

OMB Control #: 0925-0655

Expiration Date: 3/31/2015

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0655). Do not return the completed form to this address.

PLEASE NOTE: ITEMS IN [ ] BRACKETS ARE PROGRAMMING NOTES, WILL NOT BE SEEN BY RESPONDENT

[FOR ALL QUESTIONS - NO RESPONSE REQUIRED TO CONTINUE]

S1. Please enter your password to enter the survey [DATA FIELD]

[RECORD SCHOOL IDENTIFIER FROM PASSWORD]

INTRODUCTION:

Thank you for participating in our Educator Evaluation of the PEERx Video Program. Your responses are very valuable to us as we continue to work to improve the quality of videos and materials presented to educators like yourself in and out of school.

Your responses are private to the extent permitted by law, and are not tied to you in any way. This survey should take you no longer than 18 minutes to complete.

If you have any questions about this research effort or need any technical assistance please feel free to contact Joanne Vega, the National Institute on Drug Abuse's survey consultant at (888) 554-6960 x203 or by email at joannev@strategicresearch.net.

Please know that you are free to decide not to answer any of the questions presented in this survey, by selecting "Continue" you agree to participate in our survey and agree that you have been made aware of the purposes of this research and voluntarily provide your responses to us for the purposes of this study.

CONTINUE

Familiarity and Attitude

For the purpose of this study, we define prescription drugs as drugs that are prescribed by a doctor for and intended to be used by one person only as prescribed. These are bought at a pharmacy and are approved and regulated by the Food and Drug Administration (FDA). We use the phrases prescription drug misuse, prescription drug abuse, interchangeably. They occur in one or more of the following situations:

1. Prescription drugs used without a prescription

2. Prescription drugs used in a way other than as prescribed

3. Prescription drugs used primarily for the experience or feelings gained by their use

4. Using someone else’s prescription drugs

Q1. How familiar are you with the issue of students misusing prescription drugs in any of the situations above? [USE SLIDING SCALE]

a.

Not at all familiar

1

2

3

4

5

6

7

Very Familiar

Q2. How familiar do you think your students are with this issue of taking prescription drugs for non-medical uses? [USE SLIDING SCALE]

a.

Not at all familiar

1

2

3

4

5

6

7

Very Familiar

Q3. We are interested in your perceptions about your students in the following set of questions.

Your students think that taking prescription drugs for non-medical uses will be... [INSERT SLIDING SCALE; RANDOMIZE ORDER]

a.	Bad	1	2	3	4	5	6	7	Good
b.	Foolish	1	2	3	4	5	6	7	Wise
c.	Harmful	1	2	3	4	5	6	7	Beneficial
d.	Unpleasant	1	2	3	4	5	6	7	Pleasant
e.	Unsafe	1	2	3	4	5	6	7	Safe
f.	Punishing	1	2	3	4	5	6	7	Rewarding
g.	Unacceptable	1	2	3	4	5	6	7	Acceptable
h.	Unfavorable	1	2	3	4	5	6	7	Favorable
i.	Worthless	1	2	3	4	5	6	7	Valuable

Q4. Please indicate how strongly you agree or disagree with the following statements. [USE SLIDING SCALE; INSERT STATEMENT]

A. It is very common to find students misusing prescription drugs at schools.

B. It is very common to find students misusing prescription drugs at home.

C. It is very common to find students misusing prescription drugs in their neighborhoods.

Strongly Disagree

1

2

3

4

5

6

7

Strongly Agree

Q5. What factors do you think contribute to students taking prescription drugs for non-medical uses? [OPEN END]

Q6. How likely do you feel your students are to, in the future, use prescription drugs for non-medical uses? [INSERT SLIDING SCALE]

Very Unlikely

1

2

3

4

5

6

7

Very Likely

Q7. In your opinion, how important are the following people and other sources of information in guiding your students in making good choices regarding different personal issues? Please rate the importance on a 5 point scale from Not Important (1) through Very Important (5).

Not Important

1

2

3

4

5

Very Important

[USE SLIDING SCALE; INSERT STATEMENT]

a.	Parents	1	2	3	4	5
b.	Brother(s) or Sister(s)	1	2	3	4	5
c.	Relatives outside the immediate family	1	2	3	4	5
d.	Friends from their neighborhood	1	2	3	4	5
e.	Teachers from School	1	2	3	4	5
f.	Friends from School	1	2	3	4	5
g.	TV Shows (either cable, satellite, or Internet)	1	2	3	4	5
h.	Social Media (for example, Facebook, Twitter, Instagram)	1	2	3	4	5
i.	Other material (for example, books, magazines, journals - either print or electronic)	1	2	3	4	5

Q8. If you had to list the top 3 sources of information whose guidance your students really value, who or what would they be? [OPEN END]

Video Evaluation

Q9a. The National Institute on Drug Abuse (NIDA) has created two interactive Choose Your Path videos to educate teens about the consequences of non-medical use (or abuse) of prescription drugs.

Do you recall viewing any of these videos previously?

YES 1 [SKIP TO Q10B]

NO 2

NOT SURE / NA 3

Q9b. Approximately how many times have you watched them?

RECORD VALUE TIMES

Q10. We would like you to see one such video and provide your feedback on it. Please keep this window open while you view the video below.

[INSERT CHOOSE YOUR PATH VIDEO TITLED "CHOOSE YOUR PATH - BFF OR THE EX" IN EMBEDDED IFRAME]

http://www.youtube.com/watch?feature=player_embedded&v=Yyd_WSjgB2A

http://teens.drugabuse.gov/videos/choose-your-path/bff-or-ex

Once you have finished watching the video, click continue.

CONTINUE 1

Q11. Again, for the following questions, please rate your answers on this 7 point scale from Not at all (1) through Very Much (7).

Not at all

1

2

3

4

5

6

7

Very Much

[USE SLIDING SCALE; INSERT STATEMENT]

a.	How easy do you think it is for students to view the video?	1	2	3	4	5	6	7
b.	How easy is it for students to understand what the people in the video were saying?	1	2	3	4	5	6	7
c.	How realistic are the scenarios presented in the video to students?	1	2	3	4	5	6	7
d.	Students will be able to identify with the characters portrayed in the video.	1	2	3	4	5	6	7

Q12. For the following questions, please rate your answers on this 7 point scale from Not at all (1) through Very Much (7).

Not at all

1

2

3

4

5

6

7

Very Much

[USE SLIDING SCALE; INSERT STATEMENT]

a.	How relevant was the information presented in the video for you to educate your students?	1	2	3	4	5	6	7
b.	How meaningful is the information presented in the video for you to educate your students?	1	2	3	4	5	6	7
c.	How important is the information presented in video for you to educate your students?	1	2	3	4	5	6	7
d.	How useful is the information presented in the video for you to educate your students?	1	2	3	4	5	6	7
e.	How helpful is the information presented in the video for you to educate your students?	1	2	3	4	5	6	7

Q13. Please indicate the extent to which you agree or disagree with the following statements regarding the video.

Strongly Disagree

1

2

3

4

5

6

7

Strongly Agree

[USE SLIDING SCALE; INSERT STATEMENT]

a.	Your students will find the video engaging.	1	2	3	4	5	6	7
b.	Your students will find the video appealing.	1	2	3	4	5	6	7
c.	Your students will find the video to be effective in communicating its message.	1	2	3	4	5	6	7
d.	Your students will find the video to be of good production quality	1	2	3	4	5	6	7

Q14. If your students see the video, they would think that taking prescription drugs for non-medical uses will be... <INSERT STATEMENT SCALE; RANDOMIZE ORDER>

a.	Bad	1	2	3	4	5	6	7	Good
b.	Foolish	1	2	3	4	5	6	7	Wise
c.	Harmful	1	2	3	4	5	6	7	Beneficial
d.	Unpleasant	1	2	3	4	5	6	7	Pleasant
e.	Unsafe	1	2	3	4	5	6	7	Safe
f.	Punishing	1	2	3	4	5	6	7	Rewarding
g.	Unacceptable	1	2	3	4	5	6	7	Acceptable
h.	Unfavorable	1	2	3	4	5	6	7	Favorable
i.	Worthless	1	2	3	4	5	6	7	Valuable

Q15. Please indicate how likely your students are to engage in the following behaviors after watching this video on the following 7 point scale between Very Unlikely (1) through Very Likely (7).

Very Unlikely

1

2

3

4

5

6

7

Very Likely

[USE SLIDING SCALE; INSERT STATEMENT]

a.	Use prescription drugs for non-medical uses.	1	2	3	4	5	6	7
b.	Search for more information regarding the consequences of taking prescription drugs for non-medical uses	1	2	3	4	5	6	7
c.	Share the link to these videos with family and friends.	1	2	3	4	5	6	7
d.	Talk about the content of these videos with family and friends	1	2	3	4	5	6	7

Q16. How likely is it that you will incorporate the content of these videos in your discussions with students? [INSERT SLIDING SCALE]

Very Unlikely

1

2

3

4

5

6

7

Very Likely

Q17. In your opinion, what types of incentives can be provided to students in order to get them to watch the videos more times? [OPEN END]

Q18. Are there things in the video that you think should not be shown? [OPEN END]

Q19. What changes can be made to the videos to increase their effectiveness and have students talking about the issue of non-medical use of prescription drugs? [OPEN END]

Q20. NIDA is interested in your feedback on what changes they can make to their videos. In your opinion, how can NIDA improve the production quality of their videos? [OPEN END]

Q21. For future videos NIDA is interested in creating, what social settings or features would you recommend? [OPEN END]

Q22. For future videos NIDA is interested in creating, what new risky situations would you recommend they portray? [OPEN END]

Q23. What others types of educational material, besides videos, could NIDA produce to support you as you educate your students about issues such as the non-medical use of prescription drugs? [OPEN END]

Q24. In what other ways can NIDA support you as you help students deal with personal issues such as the use of prescription drugs for non-medical purposes? [OPEN END]

Q25a. When creating education material to highlight the issue, which phrase would you recommend NIDA use in order to describe the issue? (Check one)

PRESCRIPTION DRUG MISUSE 1

PRESCRIPTION DRUG ABUSE 2

NON-MEDICAL USE OF A PRESCRIPTION DRUG 3

Q25b. Why [INSERT Q25A SELECTION]? [OPEN END]

Wrap up & Demographics

And a few final questions as we finish up this survey...

Q26. How many days per week do you normally use the Internet?

RECORD VALUE DAYS PER WEEK

[IF VALUE IS ZERO, SKIP TO Q28]

Q27. On days you use the Internet, approximately how many hours do you use it?

RECORD VALUE HOURS PER DAY

Q28. How many years have you been working with students?

RECORD VALUE YEARS

Q29. What grades of students do you primarily interact with? Choose all that apply

Pre-K through 4th Grades 1

5th Grade 2

6th Grade 3

7th Grade 4

8th Grade 5

9th Grade 6

10th Grade 7

11th Grade 8

12th Grade 9

Q30. What would you consider is your ethnicity?

HISPANIC OR LATINO 1

NOT HISPANIC OR LATINO 2

PREFER NOT TO RESPOND 3

Q31. And which of the following would you consider to be your race? You may choose one or more.

AMERICAN INDIAN OR ALASKA NATIVE 1

ASIAN 2

BLACK OR AFRICAN AMERICAN 3

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 4

WHITE 5

PREFER NOT TO RESPOND 6

Q32. Finally, please record your gender.

MALE 1

FEMALE 2

OTHER 3

PREFER NOT TO RESPOND 4

Thank you very much for your time, the survey is now complete!.

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