Jackson County Program Evaluation Project Year 3, Report 1.pdf

2. On how many occasions during thepast 30 days (if any) have you beendrunk or very high from drinkingalcohol?3. How frequently have you smokedcigarettes during the past 30 days?4. How frequently have you usedsmokeless tobacco during the past 30days?5. On how many occasions during thepast 30 days (if any) have you usedmarijuana (grass, pot) or hashish(hash, hash oil)?_______ 0 occasions_______ 1 - 2 occasions_______ 3 - 5 occasions_______ 6 - 9 occasions_______ 10 - 19 occasions_______ 20 - 39 occasions_______ 40 or more occasions_______ Not at all_______ Less than one cigarette per day_______ One to five cigarettes per day_______ About one-half pack per day_______ About one pack per day_______ About one and one-half packs perday_______ Two packs or more per day_______ Not at all_______ Once or twice_______ Once to twice per week_______ Three to five times per week_______ About once a day_______ More than once a day_______ 0 occasions_______ 1 - 2 occasions_______ 3 - 5 occasions_______ 6 - 9 occasions_______ 10 - 19 occasions_______ 20 - 39 occasions_______ 40 or more occasionsBinge Drinking1. On how many occasions during thepast 30 days (if any) have you hadfive or more drinks of alcohol(glasses, bottles or cans of beer;glasses of wine, liquor or mixeddrinks) in a row, that is within acouple of hours?_______ 0 occasions_______ 1 - 2 occasions_______ 3 - 5 occasions_______ 6 - 9 occasions_______ 10 - 19 occasions_______ 20 - 39 occasions_______ 40 or more occasionsJackson County GRAA Evaluation Report 35