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La lucha contra el cambio climático desde las políticas urbanas

4. Propuestas para mejorar la calidad de vida en las ciudades

4.3 La lucha contra el cambio climático desde las políticas urbanas

Center of reception and follow up of self-introduced Addicts, Province: ………… City: ……..

Name and Surname [reference]: ………. Code: ………

Exact address: ………. (Ask at the end of interview) Name and surname of interviewer: ………..

Tel: ………. (Ask at the end of interview) Date: cccccc

1 Age: cc

2 Gender 1- Male c 2-Female: c

3 Permanent Location: 1- City (write it) c… . ….2- Village c (Respective city's name is mentioned) ……..

4 Place of Birth: 1- City (write it) c… . ….2- Village c (Respective city's name is mentioned) …… 3- Abroad ( The name of country must be mentioned) ……. 5 What is your job? (You can select multiple options) ………..

1- Student c 2-University Student c 3-Housekeeperc 4- Soldierc 5-Laborc 6- Farmerc 7-Government employees(military)c 8-Government employees(civilian) c 9-Shopkeeperc 10-Retiredc 11-Unemployedc 12-Other(write it) c …….. 6 What is your education level?

1-Unseducatedc 2-Able to read and writec 3-Elementary school onlyc 4-Junior Schoolc 5-Diplomac 6-Associated degreec 7-Bachelorc 8-Mastersc 9-

Doctorate(PhD)c 10-Religions studiesc 11- Other(write it) c …….. 7 What is your marital status?

1-Singlec 2-Marriedc 3-Abandonmentc 4-Divorcedc … times 5-Widowc 6- Temporery Marriagec 7-Remarriagec …times 8-Polygamyc 9-Other(write it) c …

8 How many children do you have? cc 9 How is your housing status?

1-Home ownerc 2-Rental homec 3-Living in father's housec 4-Living in father in law housec 5-Residential housec 6-Other (write it) c …

10 What is your average total monthly income (Tooman)? cccccccc

11 What is the reason for your visit? (Read the answers , select multiple options) 1-Physical side effects of drugsc 2-Psychological side effects of drugsc 3-

Financial problemsc 4-Legal problemsc 5-Pregnancyc 6-Pressure(family, Wife, Friends) c 7-Social problemsc 8-Other (write it) c

12 Do you have any history of smoking (either past or present)? 1-Yes, in the pastc 2-Yes, in the presentc 3-Noc

13 At what age did you start smoking cigarette/Tobacco?

1-Under 10 years oldc 2-Between 10-14 yearsc 3- Between 15-19 yearsc 4- Between 20-24 yearsc 5- Between 25-29 yearsc 6 Between 30-34 yearsc 7- Between 35-39 yearsc 8- Between 40-44 yearsc 9-Above 45 yearsc

14 What kind of drug (or drugs) do you use now?

1-Marijuanac 2-Opium sapc 3-Opiumc 4-Heroinc 5-Alchoholc 6-Other (Write it) c ………

15 How do you use drugs? ( You can select multiple options)

1-Smokingc 2-Swallowingc 3-Injectionc 4-Drinkingc 5-Enemac 6-Snortingc 16 How often do you use drugs on average?

1-Four times or more per dayc 2-Two or three times per dayc 3-Once a dayc 4- Two to six times per dayc 5-Once a week or lessc

17 How much drug do you use in 24 hours? Marijuana ……….. Cigarette Opium ……… Ounces Heroin ……… Grams Alcohol ……… Other ………. 18 How much money do you spend to getting the drugs?

1-Less than 1000 Toomansc 2- 1001-3000 Toomansc 3- 3001-7000 Toomansc 4-7001-12000 Toomansc 5-12001-18000 Toomansc 6- More than 18001 Toomansc

19 What was the first drug that you used? ( If the first was Alcohol, Please notify the second)

1-Marijuanac 2-Opium sapc 3-Opiumc 4-Heroinc 5-Alchoholc 6-Other (Write it) c ………

20 At what age did you start using drug? 1-Alcohol: cc

2-Other :cc

21 Who suggest you to use the drugs for the first time (Except cigarette and alcohol)? (Read the answers)

1-A family memberc 2- A relativec 3-(school) Friends c 4-(outside School) Friends or work colleagues c 5-Strangers c 6-Otherc

22 Where did you start using drugs for the first time?

1-Family’s Partiesc 2-Friends’ Partiesc 3-At Parkc 4-At Schoolc 5-In the streetc 6-In Military c 7-At Officec

23 Did anybody in your family use any drugs before you started it (Except cigarette and alcohol)? 1-Yesc 2-Noc

24 Who? (You can select multiple options)

1-Spous /Partnerc 2-Fatherc 3-Motherc 4-Sisterc 5-Brother c 6- Child c 25 Which drugs have you used until now? ( You can select multiple options) 26 Have you ever used shared needle for injection? 1- Yesc 2-Noc

27 Have you ever quit drugs (except alcohol and cigarette)? 1-Yesc 2-Noc 28 How many times: cc

29 How long was the largest period of quitting period?

1-Less than one week c 2-one to four weeksc 3-one to three monthsc 4-three months and one day to six monthsc 5-Six months and one day to twelve months c 6-One year and one day to three yearsc 7-Three years and one day to five yearsc 8-More than five years ( write it) c ….

30 How did you quit the drug? ( Read the answers, you can choose multiple options) 1-Individuallyc 2-Outpation visit in private centersc 3-Inpatient Visit in private centersc 4-Outpatient visit in governmental centersc 5-Stay in drug rehabilitation centers c 6- Stay in camps or prisonsc 7-Other (write it)

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VIRA AMELI