2024 United Prevention (UP!) Coalition of Lewis County - New York State PFS Survey

Introduction and Consent

This survey is being conducted with hundreds of adults across New York State. The purpose is to hear about your views on family, peers, and community behaviors surrounding marijuana, cannabis, alcohol, and other substance use/misuse. Your participation in the survey is very important for planning prevention services and programs in New York State and how to better support your community in building a healthy and successful future. The survey will ask questions about your cannabis, alcohol and other drug use and your perceptions of alcohol, cannabis, and other drug use in your community. If these questions lead to feelings of distress, anger, or anxiety and you would like to talk to someone about these, please contact the New York State HOPEline at 1-877-8-HOPENY (1-877-846-7369) or call or text 988.

By completing this survey, you are giving your consent to voluntarily participating and acknowledge that you understand you can choose to stop at any time and can refuse to answer any questions.
Your participation is voluntary, and your responses will be kept private and secure.

Question Title

* 1. I have been informed that this survey is completely voluntary, and I agree to participate.

Yes

Question Title

* 2. What is your age? (enter whole number)

Question Title

* 3. Enter the zip code for where you live

Question Title

* 4. During the past 30 days, on how many occasions did you... (Check one box in each row.)

	0	1-2	3-5	6-9	10-19	20 or more
a. Use cannabis or marijuana?	a. Use cannabis or marijuana? 0	a. Use cannabis or marijuana? 1-2	a. Use cannabis or marijuana? 3-5	a. Use cannabis or marijuana? 6-9	a. Use cannabis or marijuana? 10-19	a. Use cannabis or marijuana? 20 or more
b. If you used cannabis or marijuana in the past 30 days: On average, on the days you used cannabis or marijuana, how many times per day did you use it?	b. If you used cannabis or marijuana in the past 30 days: On average, on the days you used cannabis or marijuana, how many times per day did you use it? 0	b. If you used cannabis or marijuana in the past 30 days: On average, on the days you used cannabis or marijuana, how many times per day did you use it? 1-2	b. If you used cannabis or marijuana in the past 30 days: On average, on the days you used cannabis or marijuana, how many times per day did you use it? 3-5	b. If you used cannabis or marijuana in the past 30 days: On average, on the days you used cannabis or marijuana, how many times per day did you use it? 6-9	b. If you used cannabis or marijuana in the past 30 days: On average, on the days you used cannabis or marijuana, how many times per day did you use it? 10-19	b. If you used cannabis or marijuana in the past 30 days: On average, on the days you used cannabis or marijuana, how many times per day did you use it? 20 or more
c. Drink one or more drinks of an alcoholic beverage - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin)?	c. Drink one or more drinks of an alcoholic beverage - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin)? 0	c. Drink one or more drinks of an alcoholic beverage - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin)? 1-2	c. Drink one or more drinks of an alcoholic beverage - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin)? 3-5	c. Drink one or more drinks of an alcoholic beverage - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin)? 6-9	c. Drink one or more drinks of an alcoholic beverage - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin)? 10-19	c. Drink one or more drinks of an alcoholic beverage - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin)? 20 or more
d. Have five or more drinks of an alcoholic beverage on the same occasion? By ‘occasion,’ we mean at the same time or within a couple hours of each other.	d. Have five or more drinks of an alcoholic beverage on the same occasion? By ‘occasion,’ we mean at the same time or within a couple hours of each other. 0	d. Have five or more drinks of an alcoholic beverage on the same occasion? By ‘occasion,’ we mean at the same time or within a couple hours of each other. 1-2	d. Have five or more drinks of an alcoholic beverage on the same occasion? By ‘occasion,’ we mean at the same time or within a couple hours of each other. 3-5	d. Have five or more drinks of an alcoholic beverage on the same occasion? By ‘occasion,’ we mean at the same time or within a couple hours of each other. 6-9	d. Have five or more drinks of an alcoholic beverage on the same occasion? By ‘occasion,’ we mean at the same time or within a couple hours of each other. 10-19	d. Have five or more drinks of an alcoholic beverage on the same occasion? By ‘occasion,’ we mean at the same time or within a couple hours of each other. 20 or more

Question Title

* 5. How easy do you think it is for persons your age in your community to obtain... (Check one box in each row.)

	Very easy	Somewhat easy	Somewhat difficult	Very difficult
a. Cannabis or marijuana?	a. Cannabis or marijuana? Very easy	a. Cannabis or marijuana? Somewhat easy	a. Cannabis or marijuana? Somewhat difficult	a. Cannabis or marijuana? Very difficult
b. Alcohol?	b. Alcohol? Very easy	b. Alcohol? Somewhat easy	b. Alcohol? Somewhat difficult	b. Alcohol? Very difficult

Question Title

* 6. How much do people risk harming themselves physically and in other ways when they... (Check one box in each row.)

	No risk	Slight risk	Moderate risk	Great risk
a. Drink one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)?	a. Drink one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? No risk	a. Drink one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Slight risk	a. Drink one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Moderate risk	a. Drink one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Great risk
b. Have one or two drinks of an alcoholic beverage nearly every day?	b. Have one or two drinks of an alcoholic beverage nearly every day? No risk	b. Have one or two drinks of an alcoholic beverage nearly every day? Slight risk	b. Have one or two drinks of an alcoholic beverage nearly every day? Moderate risk	b. Have one or two drinks of an alcoholic beverage nearly every day? Great risk
c. Have five or more drinks of an alcoholic beverage on the same occasion, once or twice a week?	c. Have five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? No risk	c. Have five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Slight risk	c. Have five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Moderate risk	c. Have five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Great risk
d. Use cannabis or marijuana once or twice a week?	d. Use cannabis or marijuana once or twice a week? No risk	d. Use cannabis or marijuana once or twice a week? Slight risk	d. Use cannabis or marijuana once or twice a week? Moderate risk	d. Use cannabis or marijuana once or twice a week? Great risk

Question Title

* 7. How do you feel about someone your age... (Check one box in each row.)

	Strongly approve	Somewhat approve	Neither approve or disapprove	Somewhat disapprove	Strongly disapprove
a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)?	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Strongly approve	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Somewhat approve	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Neither approve or disapprove	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Somewhat disapprove	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Strongly disapprove
b. Having one or two drinks of an alcoholic beverage nearly every day?	b. Having one or two drinks of an alcoholic beverage nearly every day? Strongly approve	b. Having one or two drinks of an alcoholic beverage nearly every day? Somewhat approve	b. Having one or two drinks of an alcoholic beverage nearly every day? Neither approve or disapprove	b. Having one or two drinks of an alcoholic beverage nearly every day? Somewhat disapprove	b. Having one or two drinks of an alcoholic beverage nearly every day? Strongly disapprove
c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week?	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Strongly approve	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Somewhat approve	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Neither approve or disapprove	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Somewhat disapprove	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Strongly disapprove
d. Using cannabis or marijuana?	d. Using cannabis or marijuana? Strongly approve	d. Using cannabis or marijuana? Somewhat approve	d. Using cannabis or marijuana? Neither approve or disapprove	d. Using cannabis or marijuana? Somewhat disapprove	d. Using cannabis or marijuana? Strongly disapprove

Question Title

* 8. How do you think your family would feel about you … (Check one box in each row.)

	Strongly approve	Somewhat approve	Neither approve or disapprove	Somewhat disapprove	Strongly disapprove
a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)?	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Strongly approve	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Somewhat approve	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Neither approve or disapprove	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Somewhat disapprove	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Strongly disapprove
b. Having one or two drinks of an alcoholic beverage nearly every day?	b. Having one or two drinks of an alcoholic beverage nearly every day? Strongly approve	b. Having one or two drinks of an alcoholic beverage nearly every day? Somewhat approve	b. Having one or two drinks of an alcoholic beverage nearly every day? Neither approve or disapprove	b. Having one or two drinks of an alcoholic beverage nearly every day? Somewhat disapprove	b. Having one or two drinks of an alcoholic beverage nearly every day? Strongly disapprove
c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week?	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Strongly approve	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Somewhat approve	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Neither approve or disapprove	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Somewhat disapprove	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Strongly disapprove
d. Using cannabis or marijuana?	d. Using cannabis or marijuana? Strongly approve	d. Using cannabis or marijuana? Somewhat approve	d. Using cannabis or marijuana? Neither approve or disapprove	d. Using cannabis or marijuana? Somewhat disapprove	d. Using cannabis or marijuana? Strongly disapprove

Question Title

* 9. How wrong would most adults (over 21) in your neighborhood think it is for someone your age to... (Check one box in each row.)

	Not wrong at all	A little bit wrong	Wrong	Very Wrong
a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)?	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Not wrong at all	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? A little bit wrong	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Wrong	a. Having one or two alcoholic beverages - beer, wine, or hard liquor (for example, vodka, rum whiskey, or gin) regularly (at least once or twice a week)? Very Wrong
b. Having one or two drinks of an alcoholic beverage nearly every day?	b. Having one or two drinks of an alcoholic beverage nearly every day? Not wrong at all	b. Having one or two drinks of an alcoholic beverage nearly every day? A little bit wrong	b. Having one or two drinks of an alcoholic beverage nearly every day? Wrong	b. Having one or two drinks of an alcoholic beverage nearly every day? Very Wrong
c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week?	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Not wrong at all	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? A little bit wrong	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Wrong	c. Having five or more drinks of an alcoholic beverage on the same occasion, once or twice a week? Very Wrong
d. Using cannabis or marijuana?	d. Using cannabis or marijuana? Not wrong at all	d. Using cannabis or marijuana? A little bit wrong	d. Using cannabis or marijuana? Wrong	d. Using cannabis or marijuana? Very Wrong

Question Title

* 10. There are people in my community who... (Check one box in each row.)

	Definitely not	Probably not	Probably	Definitely
a. Are proud of me when I do something well.	a. Are proud of me when I do something well. Definitely not	a. Are proud of me when I do something well. Probably not	a. Are proud of me when I do something well. Probably	a. Are proud of me when I do something well. Definitely
b. Encourage me to do my best	b. Encourage me to do my best Definitely not	b. Encourage me to do my best Probably not	b. Encourage me to do my best Probably	b. Encourage me to do my best Definitely
c. Notice when I am doing a good job and let me know about it.	c. Notice when I am doing a good job and let me know about it. Definitely not	c. Notice when I am doing a good job and let me know about it. Probably not	c. Notice when I am doing a good job and let me know about it. Probably	c. Notice when I am doing a good job and let me know about it. Definitely

Question Title

* 11. In my community, there are lots of chances... (Check one box in each row.)

	Strongly disagree	Disagree	Agree	Strongly agree
a. to get involved in activities (volunteering or service organizations - such as the Lions Club or Elks; military-related organizations - such as VFW or American Legion Post; sports/fitness groups; or faith-based groups, etc.)	a. to get involved in activities (volunteering or service organizations - such as the Lions Club or Elks; military-related organizations - such as VFW or American Legion Post; sports/fitness groups; or faith-based groups, etc.) Strongly disagree	a. to get involved in activities (volunteering or service organizations - such as the Lions Club or Elks; military-related organizations - such as VFW or American Legion Post; sports/fitness groups; or faith-based groups, etc.) Disagree	a. to get involved in activities (volunteering or service organizations - such as the Lions Club or Elks; military-related organizations - such as VFW or American Legion Post; sports/fitness groups; or faith-based groups, etc.) Agree	a. to get involved in activities (volunteering or service organizations - such as the Lions Club or Elks; military-related organizations - such as VFW or American Legion Post; sports/fitness groups; or faith-based groups, etc.) Strongly agree
b. to help make decisions about the community (e.g., community events/activities, creation of organizations, etc.)	b. to help make decisions about the community (e.g., community events/activities, creation of organizations, etc.) Strongly disagree	b. to help make decisions about the community (e.g., community events/activities, creation of organizations, etc.) Disagree	b. to help make decisions about the community (e.g., community events/activities, creation of organizations, etc.) Agree	b. to help make decisions about the community (e.g., community events/activities, creation of organizations, etc.) Strongly agree
c. to be part of community discussions.	c. to be part of community discussions. Strongly disagree	c. to be part of community discussions. Disagree	c. to be part of community discussions. Agree	c. to be part of community discussions. Strongly agree
d. for community members to speak with community leaders one-on-one.	d. for community members to speak with community leaders one-on-one. Strongly disagree	d. for community members to speak with community leaders one-on-one. Disagree	d. for community members to speak with community leaders one-on-one. Agree	d. for community members to speak with community leaders one-on-one. Strongly agree

Question Title

* 12. During the last 12 months, have you experienced any of the following due to your use of alcohol, cannabis, or marijuana? (Check boxes if ‘Yes’)

	Alcohol	Cannabis or marijuana
a. Performed poorly at work or school	a. Performed poorly at work or school Alcohol	a. Performed poorly at work or school Cannabis or marijuana
b. Missed work or class	b. Missed work or class Alcohol	b. Missed work or class Cannabis or marijuana
c. Got into an argument or fight	c. Got into an argument or fight Alcohol	c. Got into an argument or fight Cannabis or marijuana
d. Driven a vehicle while under the influence	d. Driven a vehicle while under the influence Alcohol	d. Driven a vehicle while under the influence Cannabis or marijuana
e. Been arrested for DWI/DUI	e. Been arrested for DWI/DUI Alcohol	e. Been arrested for DWI/DUI Cannabis or marijuana
f. Rode in a vehicle while the driver was under the influence	f. Rode in a vehicle while the driver was under the influence Alcohol	f. Rode in a vehicle while the driver was under the influence Cannabis or marijuana
g. Been in trouble with police or other authorities	g. Been in trouble with police or other authorities Alcohol	g. Been in trouble with police or other authorities Cannabis or marijuana
h. Damaged property	h. Damaged property Alcohol	h. Damaged property Cannabis or marijuana
i. Been hurt or injured	i. Been hurt or injured Alcohol	i. Been hurt or injured Cannabis or marijuana
j. Problems with your emotions, nerves, or mental health	j. Problems with your emotions, nerves, or mental health Alcohol	j. Problems with your emotions, nerves, or mental health Cannabis or marijuana
k. Physical health problems	k. Physical health problems Alcohol	k. Physical health problems Cannabis or marijuana

Question Title

* 13. Where do you get your news and information? Check all that apply.

TV/Cable TV

linkinglewiscounty.com

Facebook

Newzjunky

Journal and Republican

Other Newspaper

Other (please specify)

Question Title

* 14. Please choose the responses that best describe you (select all that apply):

Alaskan Native

Native American/Indigenous

Asian

Black or African American

Hawaiian or other Pacific Islander

White

Some other race, origin

Prefer not to answer

Middle Eastern or North African

Prefer to self-describe:

Question Title

* 15. If Asian: What are your specific Asian origins (select all that apply):

Chinese

Japanese

Filipino

Korean

Vietnamese

Asian Indian (East Indian)

Laotian

Cambodian

Bangladeshi

Hmong

Indonesian

Malaysian

Pakistani

Sri Lankan

Taiwanese

Nepalese

Burmese

Tibetan

Thai

Asian, not specified

Other Asian

Question Title

* 16. If Pacific Islander: What are your specific Pacific Islander origins (select all that apply):

Hawaiian

Guamanian

Samoan

Fijian

Tongan

Pacific Islander, not specified

Other Pacific Islander

Question Title

* 17. Are you Hispanic or Latino/a/x?

Yes

Question Title

* 18. If yes: What are your Hispanic origins (select all that apply):

Cuban

Mexican

Puerto Rican

Some other Hispanic, Latino/a/x origin

Prefer not to answer

Prefer to self-describe

Question Title

* 19. What is your gender?

Woman

Man

Non-binary

Two spirit

Intersex

Questioning/Unsure

I use a different term

Prefer not to answer

Question Title

* 20. Do you consider yourself to be:

Straight

Gay or Lesbian

Bisexual

Pansexual

I use a different term

Questioning/Unsure

Prefer not to answer

Prefer to self-describe

Question Title

* 21. What was your sex assigned at birth?

Female

Male

X or someone else

Prefer not to answer

Question Title

* 22. Do you identify as transgender?

Yes

Questioning/Unsure

Prefer not to answer

Question Title

* 23. Thank you for completing this survey. If you would like to receive a $10 gift certificate to a local retailer, please complete this anonymous section below.