2 Screenshot Teacher Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIDA)

Attachment 11- Screenshot-Teacher Questionnaire

Customer Feedback Information for National Institute on Drug Abuse PEERx Videos

OMB: 0925-0655

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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.

OMB Control Number:
Expi rati on Date:

0925-0655
03/31/2015

Publ i c reporti ng burden for thi s col l ecti on of i nformati on i s esti mated to average 18 mi nutes per response, i ncl udi ng the ti me for revi ewi ng i
nstructi ons, searchi ng exi sti ng data sources, gatheri ng and mai ntai ni ng the data needed, and compl eti ng and revi ewi ng the col l ecti on of i
nformati on. An agency may not conduct or sponsor, and a person i s not requi red to respond to, a col l ecti on of i nformati on unl ess i t di spl ays a
currentl y val i d OMB control number. Send comments regardi ng thi s burden esti mate or any other aspect of thi s col l ecti on of i nformati on, i ncl
udi ng suggesti ons for reduci ng thi s burden, to: NIH, Proj ect Cl earance Branch, 6705 Rockl edge Dri ve, MSC 7974, Bethesda, MD 208927974, AT T N: PRA (0925-0655). Do not return the compl eted form to thi s address.

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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:
a)
b)
c)
d)

Prescription drugs used without a prescription
Prescription drugs used in a way other than as prescribed
Prescription drugs used primarily for the experience or feelings gained by their use
Using someone else’s prescription drugs

How familiar are you with the issue of students misusing prescription drugs in any of the
situations above?
1-Not at all familiar

4

Very familiar-7

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How familiar do you think your students are with this issue of taking prescription drugs for nonmedical uses?
1-Not at all familiar

4

Very familiar-7

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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...
1

4

1-Unacceptable

7
Acceptable-7

1-Bad

Good-7

1-Foolish

Wise-7

1-Punishing

Rewarding-7

1-Worthless

Valuable-7

1-Unpleasant

Pleasant-7

1-Unsafe

Safe-7

1-Unfavorable

Favorable-7

1-Harmful

Beneficial-7

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Please indicate how strongly you agree or disagree with the following statements.

It is very common to find students misusing prescription drugs at schools.
1

4

7

1-Strongly disagree

Strongly agree-7

It is very common to find students misusing prescription drugs at home.
1

4

7

1-Strongly disagree

Strongly agree-7

It is very common to find students misusing prescription drugs in their neighborhoods.
1

4

1-Strongly disagree

7
Strongly agree-7

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What factors do you think contribute to students taking prescription drugs for non-medical uses?

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How likely do you feel your students are to, in the future, use prescription drugs for non-medical
uses?
1-Very unlikely

4

Very likely-7

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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).
1 - Not
important

2

3

4

5 - Very
important

Not
applicable

Other material (for example, books, magazines, journals either print or electronic)
Friends from School
TV Shows (either cable, satellite, or Internet)
Relatives outside the immediate family
Friends from their neighborhood
Parents
Social Media (for example, Facebook, Twitter,
Instagram)
Teachers from School
Brother(s) or Sister(s)

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

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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
No
Not sure

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Approximately how many times have you watched them?
- Select One -

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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.
Once you have finished watching the video, click continue.

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

4

Very much-7

Students will be able to identify with the characters portrayed in the video.
How realistic are the scenarios presented in the video to students?
How easy do you think it is for students to view the video?
How easy is it for students to understand what the people in the video were saying?

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

4

Very much-7

How meaningful is the information presented in the video for you to educate your students?
How useful is the information presented in the video for you to educate your students?
How important is the information presented in video for you to educate your students?
How relevant was the information presented in the video for you to educate your students?
How helpful is the information presented in the video for you to educate your students?

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

4

Strongly agree-7

Your students will find the video appealing.
Your students will find the video to be of good production quality.
Your students will find the video to be effective in communicating its message.
Your students will find the video engaging.

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If your students see the video, they would think that taking prescription drugs for non-medical uses will
be . . . ?
1

4

7

1-Unsafe

Safe-7

1-Unpleasant

Pleasant-7

1-Harmful

Beneficial-7

1-Foolish

Wise-7

1-Worthless

Valuable-7

1-Unfavorable

Favorable-7

1-Bad

Good-7

1-Punishing

Rewarding-7

1-Unacceptable

Acceptable-7

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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).
1-Very unlikely

4

Very likely-7

Share the link to these videos with family and friends.
Use prescription drugs for non-medical uses.
Talk about the content of these videos with family and friends.
Search
for
more
information
of taking prescription drugs for non-medical uses

regarding

the

consequences

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How likely is it that you will incorporate the content of these videos in your discussions with
students?
1-Very unlikely

4

Very likely-7

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In your opinion, what types of incentives can be provided to students in order to get them to
watch the videos more times?

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Are there things in the video that you think should not be shown?

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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?

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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?

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For future videos NIDA is interested in creating, what social settings or features would you
recommend?

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For future videos NIDA is interested in creating, what new risky situations would you recommend
they portray?

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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?

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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?

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When creating education material to highlight the issue, which phrase would you recommend
NIDA use in order to describe the issue?
Prescription drug abuse
Prescription drug misuse
Non-medical use of a prescription drug
Not sure

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Why Prescription drug misuse?

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And a few final questions as we finish up this survey...
How many days per week do you normally use the Internet?
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Not sure
Do not normally use the Internet

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How many years have you been working with students?
- Select One -

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What grades of students do you primarily interact with? Choose all that apply.
Pre-K through 4th Grades
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Prefer not to respond

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What would you consider is your ethnicity?
Hispanic or Latino
Not Hispanic or Latino
Prefer not to respond

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And which of the following would you consider to be your race? You may choose one or more.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Prefer not to respond

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Finally, please record your gender.
Male
Female
Other
Prefer not to respond

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

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