Prevention Coalition of Monmouth County

 
Your response will help guide us in fulfilling the Mission of the Prevention Coalition which is to meet the need for comprehensive substance abuse awareness planning and programming to create environmental change in Monmouth County.

This survey will take a few minutes to complete and will remain anonymous.


Once this survey is completed, you may finish with your registration.
1. Name of city/town of residence:
2. Age:
3. Gender:
4. Race/Ethnicity:
5. It is okay for parents and other adults to allow underage drinking in their home.
6. It is okay to allow underage drinking in private homes as long as it is in a controlled setting. (e.g. car keys are collected, designated drivers are assigned)
7. I am aware of neighbors or other adults who allow underage drinking in their home.
8. I allow underage drinking in my home.
9. I monitor the amount of alcohol in my home on a regular basis.
10. I believe that alcohol laws/regulations (e.g. carding for 21 at retail stores and bars) are enforced regularly in my community.
11. I believe that alcohol is bad for an adolescent's brain.
12. I am aware of youth who use prescription drugs without a prescription.
13. The proper way to dispose of prescription and/or over-the-counter drugs is by flushing them down the toliet.
14. I monitor and secure the medications in my home.
15. It is okay to take someone else's prescription drug(s).
16. Prescription drugs can be just as dangerous as street drugs.
17. I know where to get information on alcohol, tobacco, and other drugs.
18. If there was a local place to discard expired or unused medications at no cost, I would regularly use this service.
19. Are you a parent, grandparent, or a guardian providing a home for a child(ren) under the age of 21.
20. My family has dinner together regularly.
21. My underage (under 21) child(ren) drink(s) alcohol on a regular basis.
22. I talk with my child(ren) about alcohol, drugs, and tobacco on a regular basis (at least several times per year).
23. I have clear and specific rules about my child(ren)'s association with peers who use alcohol and/or drugs.
24. I have children of the following ages. (check all that apply)
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