Advocates for Substance Abuse Prevention (ASAP) Community Questionnaire

Page 1 of 3

The Advocates for Substance Abuse Prevention (ASAP) coalition is interested in understanding adults’ attitudes around risk and protective factors in our community. Through this survey, we will be able to better serve our youth and families with local prevention programming and information on underage drinking, drug use, and mental health.

Due to the impact of COVID-19 and social distancing we have adjusted some of the questions. We do understand that there have been drastic changes in our households and lives – thank you for taking the time to complete this survey.

Please remember that this survey is completely anonymous so please be as honest and complete as possible.

Question Title

* 1. Are you a resident of...

	No	Yes
Bethlehem	Bethlehem No	Bethlehem Yes
Woodbury	Woodbury No	Woodbury Yes
Other	Other No	Other Yes

Question Title

* 2. Please answer the following:

	No	Yes
Had you heard of Advocates for Substance Abuse Prevention (ASAP) prior to receiving this survey?	Had you heard of Advocates for Substance Abuse Prevention (ASAP) prior to receiving this survey? No	Had you heard of Advocates for Substance Abuse Prevention (ASAP) prior to receiving this survey? Yes
Are you aware of the Connecticut law that took effect in October 2019 raising the age to 21 to purchase tobacco and vaping products?	Are you aware of the Connecticut law that took effect in October 2019 raising the age to 21 to purchase tobacco and vaping products? No	Are you aware of the Connecticut law that took effect in October 2019 raising the age to 21 to purchase tobacco and vaping products? Yes

Question Title

* 3. How familiar are you with…

	Unfamiliar	Somewhat familiar	Very familiar
the work that ASAP is involved with in the community?	the work that ASAP is involved with in the community? Unfamiliar	the work that ASAP is involved with in the community? Somewhat familiar	the work that ASAP is involved with in the community? Very familiar
the CT Social Host Law that makes it illegal for any adult to provide a place for teens to drink?	the CT Social Host Law that makes it illegal for any adult to provide a place for teens to drink? Unfamiliar	the CT Social Host Law that makes it illegal for any adult to provide a place for teens to drink? Somewhat familiar	the CT Social Host Law that makes it illegal for any adult to provide a place for teens to drink? Very familiar
proper ways to dispose of unused, unneeded or excess Prescription Drug medications that are in your home?	proper ways to dispose of unused, unneeded or excess Prescription Drug medications that are in your home? Unfamiliar	proper ways to dispose of unused, unneeded or excess Prescription Drug medications that are in your home? Somewhat familiar	proper ways to dispose of unused, unneeded or excess Prescription Drug medications that are in your home? Very familiar

Question Title

* 4. In your community, do you know where to go for help if you or a family member is struggling with:

	No	Yes
Substance use or abuse issues	Substance use or abuse issues No	Substance use or abuse issues Yes
Mental OR Behavioral health issues (such as depression, anxiety, eating disorders, etc.)	Mental OR Behavioral health issues (such as depression, anxiety, eating disorders, etc.) No	Mental OR Behavioral health issues (such as depression, anxiety, eating disorders, etc.) Yes

Question Title

* 5. Please choose the response that best describes how you feel:

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
In Bethlehem and Woodbury, it is possible to reduce alcohol and other drug problems through prevention.	In Bethlehem and Woodbury, it is possible to reduce alcohol and other drug problems through prevention. Strongly disagree	In Bethlehem and Woodbury, it is possible to reduce alcohol and other drug problems through prevention. Disagree	In Bethlehem and Woodbury, it is possible to reduce alcohol and other drug problems through prevention. Neither agree nor disagree	In Bethlehem and Woodbury, it is possible to reduce alcohol and other drug problems through prevention. Agree	In Bethlehem and Woodbury, it is possible to reduce alcohol and other drug problems through prevention. Strongly agree
My community perceives substance abuse as a personal problem, not a community problem.	My community perceives substance abuse as a personal problem, not a community problem. Strongly disagree	My community perceives substance abuse as a personal problem, not a community problem. Disagree	My community perceives substance abuse as a personal problem, not a community problem. Neither agree nor disagree	My community perceives substance abuse as a personal problem, not a community problem. Agree	My community perceives substance abuse as a personal problem, not a community problem. Strongly agree
Alcohol and other drug prevention programs are a good investment because they save lives and money.	Alcohol and other drug prevention programs are a good investment because they save lives and money. Strongly disagree	Alcohol and other drug prevention programs are a good investment because they save lives and money. Disagree	Alcohol and other drug prevention programs are a good investment because they save lives and money. Neither agree nor disagree	Alcohol and other drug prevention programs are a good investment because they save lives and money. Agree	Alcohol and other drug prevention programs are a good investment because they save lives and money. Strongly agree
I strongly support efforts to prevent underage alcohol use and other substance abuse.	I strongly support efforts to prevent underage alcohol use and other substance abuse. Strongly disagree	I strongly support efforts to prevent underage alcohol use and other substance abuse. Disagree	I strongly support efforts to prevent underage alcohol use and other substance abuse. Neither agree nor disagree	I strongly support efforts to prevent underage alcohol use and other substance abuse. Agree	I strongly support efforts to prevent underage alcohol use and other substance abuse. Strongly agree
I think most community leaders would support efforts to reduce underage alcohol use and other substance abuse.	I think most community leaders would support efforts to reduce underage alcohol use and other substance abuse. Strongly disagree	I think most community leaders would support efforts to reduce underage alcohol use and other substance abuse. Disagree	I think most community leaders would support efforts to reduce underage alcohol use and other substance abuse. Neither agree nor disagree	I think most community leaders would support efforts to reduce underage alcohol use and other substance abuse. Agree	I think most community leaders would support efforts to reduce underage alcohol use and other substance abuse. Strongly agree

Question Title

* 6. On a scale of 1 to 5, how familiar are you with the following terms?

	1 Unfamiliar	2	3 Somewhat familiar	4	5 Very familiar
Gender Identity (i.e. Male, Female, Trans, Gender fluid, etc.)	Gender Identity (i.e. Male, Female, Trans, Gender fluid, etc.) 1 Unfamiliar	Gender Identity (i.e. Male, Female, Trans, Gender fluid, etc.) 2	Gender Identity (i.e. Male, Female, Trans, Gender fluid, etc.) 3 Somewhat familiar	Gender Identity (i.e. Male, Female, Trans, Gender fluid, etc.) 4	Gender Identity (i.e. Male, Female, Trans, Gender fluid, etc.) 5 Very familiar
Gender Expression (ways in which one acts to communicate gender in a culture (i.e. physical appearance, clothing, word choices, speech patterns, etc.)	Gender Expression (ways in which one acts to communicate gender in a culture (i.e. physical appearance, clothing, word choices, speech patterns, etc.) 1 Unfamiliar	Gender Expression (ways in which one acts to communicate gender in a culture (i.e. physical appearance, clothing, word choices, speech patterns, etc.) 2	Gender Expression (ways in which one acts to communicate gender in a culture (i.e. physical appearance, clothing, word choices, speech patterns, etc.) 3 Somewhat familiar	Gender Expression (ways in which one acts to communicate gender in a culture (i.e. physical appearance, clothing, word choices, speech patterns, etc.) 4	Gender Expression (ways in which one acts to communicate gender in a culture (i.e. physical appearance, clothing, word choices, speech patterns, etc.) 5 Very familiar
Sexual Orientation (the sex/gender someone is physically, romantically or sexually attracted to)	Sexual Orientation (the sex/gender someone is physically, romantically or sexually attracted to) 1 Unfamiliar	Sexual Orientation (the sex/gender someone is physically, romantically or sexually attracted to) 2	Sexual Orientation (the sex/gender someone is physically, romantically or sexually attracted to) 3 Somewhat familiar	Sexual Orientation (the sex/gender someone is physically, romantically or sexually attracted to) 4	Sexual Orientation (the sex/gender someone is physically, romantically or sexually attracted to) 5 Very familiar

25% of survey complete.