17 Drug Free Coalition Grant: Community Information Gathering Survey in Decatur Township

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* 1. Are you a parent or legal guardian of a child between the ages of 11-18 in Decatur Township?

Yes

If "Yes," please specify the number of children in your household.

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* 2. What is your race/ethnicity?

White

Black

Hispanic

Asian

Other (please specify)

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* 3. What is your gender?

Male

Female

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* 4. What is your age range?

25-35

36-45

over 45

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* 5. Which of the following best describes you as a legal guardian?

I have no children living in my home

Biological or adoptive parent

Foster parent

Grandparent

Other Relative

Other (please specify)

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* 6. What school does your oldest child attend?

Decatur Central High School

Decatur Township School for Excellence

Decatur Middle School

Blue Academy

Gold Academy

West Newton Elementary

Valley Mills Elementary

Stephen Decatur Elementary

N/A

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* 7. What zip code do you live in?

46221

46241

46113

46183

Other

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* 8. What alcohol or substance abuse prevention activities are happening in your community?

Alcohol and substance abuse awareness classes in school

Public Safety substance abuse awareness programs

Substance abuse counseling (i.e. Narcotics Anonymous, Alcohol Anonymous, etc)

There are no substance abuse prevention activities occurring in this community

Not sure

Other (please specify)

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* 9. *The following questions ask about alcohol and drug related issues within Decatur Township Schools.

Do Decatur Township Schools enforce policies and investigate all reports of underage alcohol and/or drug use?

Yes

Not Sure

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* 10. Decatur Township Schools enforce policies and investigate all reports of underage alcohol and drug use consistently and fairly?

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Sure

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* 11. In Decatur Township Schools, I believe some students keep or use alcohol on school grounds.

Yes

Not Sure

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* 12. In Decatur Township Schools, I believe some students keep, use, or sell drugs on school grounds.

Yes

Not Sure

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* 13. *The following questions are about your perceptions of alcohol and drug use in your community. Rank your top three choices. (Ex. 1 = most likely) Please choose three only.

What do you believe are the main reasons teens drink alcohol?

To experiment

To fit in with a group

To relax or relieve stress

To escape/forget problems

To deal with anger

To have a good time with friends

Rite of passage

Academic Performance

Other

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* 14. What do you believe are the main reasons teens use illegal drugs? (Marijuana, crack/cocaine, methamphetimine, heroin, etc.) Rank your top three choices. Please choose three only.

To experiment

To fit in with a group

To relax or relieve stress

To escape/forget problems

To deal with anger

To have a good time with friends

Rite of passage

Academic performance

Other

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* 15. What do you believe are the main reasons teens abuse prescription drugs? (Oxycontin, Vicodin, Xanax, Adderall, etc.) Rank your top three choices. Please choose three only.

To experiment

To fit in with a group

To relax or relieve stress

To escape/forget problems

To deal with anger

To have a good time with friends

Rite of passage

Other

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* 16. Please indicate what you believe to be the top 5 drugs of choice among teens in your community. Please check 5 only. (1= most frequently used, 2= 2nd most frequently used, etc)

Alcohol

Bath Salts

Cocaine/Crack

Ecstasy (including drug known as Molly)

Hallucinogens LSD, Shrooms, including laced marijuana known as "wet")

Heroin

Inhalants (whip its, paint thinner, nitric oxide, etc)

K-2/Spice

Marijuana

Methamphetamine

Over-the-counter drugs (Cough Syrup)

Prescription Drugs

Tobacco

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* 17. From the drugs listed in Question 16

Has there been any abuse of these drugs in the past 30 days by children in your household?

Yes

Not Sure

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* 18. Which statement below most represents your own attitude about underage drinking/alcohol abuse?

Drinking alcohol is never a good thing to do for anyone at any age

Occasional underage drinking is fine if it does not interfere with schoolwork & responsibilities.

Underage drinking is never ok.

It is ok for children to drink alcohol at home under adult supervision.

Other (please specify)

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* 19. Where do you believe youth obtain alcohol? Please choose three only.

Taken from home

Given to them by a family member (example: older sibling or parent)

Peers

At parties

At school

Other (please specify)

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* 20. Where do you believe youth most often obtain prescription drugs? Please choose three only.

Taken from home

Given to them by a family member (example: older sibling or parent

Peers

At parties

At school

On the street/dealer WITHIN Decatur Township

On the street/dealer OUTSIDE of Decatur Township

Other (please specify)

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* 21. Where do you believe youth most often obtain illegal drugs? Please choose three only.

Taken from home

Given to them by a family member (example: older sibling or parent)

Peers

At parties

At school

On the street/dealer WITHIN Decatur Township

On the street/dealer OUTSIDE of Decatur Township

Other (please specify)

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* 22. Which of the following apply to your home about alcohol use? Please choose three only.

Keep alcohol locked or in a place where teens can't get it

Keep track of alcohol to make sure teens have not taken any

Instruct teenagers not to drink any alcohol in the home

Instruct teenagers not to remove any alcohol from home

Allow teenagers to drink alcohol on special occasions with parental supervision

Discuss dangers of alcohol use with my children

My family has clear rules about alcohol use

Take no special actions

No alcohol in the home

Other (please specify)

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* 23. Which of the following apply to your home about prescription drug abuse?

Keep prescription drugs locked or in a place teenagers cannot get it

Keep track of prescriptions drugs to make sure teenagers have not taken any

Discuss dangers of prescription drug abuse with my children

My family has clear rules about drug abuse

Take no special actions

No prescription drug abuse in our home

Other (please specify)

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* 24. Which of the following apply to your home about illegal drug use? (ex: marijuana, meth, heroin)

Discuss dangers of illegal drugs with my children

My family has clear rules about not using illegal drugs

Take no special action

No illegal drug use in our home

Other (please specify)

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* 25. In the past 30 days, do you believe there has there been any use of tobacco by your children?

Yes

Not sure

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* 26. Which statement below most represents your own attitude about underage tobacco use?

Underage tobacco use is never ok.

Occasional underage tobacco use is fine.

It is ok for children to use tobacco at home.

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* 1. Are you a parent or legal guardian of a child between the ages of 11-18 in Decatur Township?

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* 2. What is your race/ethnicity?

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* 3. What is your gender?

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* 4. What is your age range?

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* 5. Which of the following best describes you as a legal guardian?

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* 6. What school does your oldest child attend?

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* 7. What zip code do you live in?

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* 8. What alcohol or substance abuse prevention activities are happening in your community?

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* 9. *The following questions ask about alcohol and drug related issues within Decatur Township Schools.Do Decatur Township Schools enforce policies and investigate all reports of underage alcohol and/or drug use?

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* 10. Decatur Township Schools enforce policies and investigate all reports of underage alcohol and drug use consistently and fairly?

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* 11. In Decatur Township Schools, I believe some students keep or use alcohol on school grounds.

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* 12. In Decatur Township Schools, I believe some students keep, use, or sell drugs on school grounds.

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* 13. *The following questions are about your perceptions of alcohol and drug use in your community. Rank your top three choices. (Ex. 1 = most likely) Please choose three only.What do you believe are the main reasons teens drink alcohol?

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* 14. What do you believe are the main reasons teens use illegal drugs? (Marijuana, crack/cocaine, methamphetimine, heroin, etc.) Rank your top three choices. Please choose three only.

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* 15. What do you believe are the main reasons teens abuse prescription drugs? (Oxycontin, Vicodin, Xanax, Adderall, etc.) Rank your top three choices. Please choose three only.

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* 16. Please indicate what you believe to be the top 5 drugs of choice among teens in your community. Please check 5 only. (1= most frequently used, 2= 2nd most frequently used, etc)

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* 17. *From the drugs listed in Question 16*Has there been any abuse of these drugs in the past 30 days by children in your household?

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* 18. Which statement below most represents your own attitude about underage drinking/alcohol abuse?

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* 19. Where do you believe youth obtain alcohol? Please choose three only.

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* 20. Where do you believe youth most often obtain prescription drugs? Please choose three only.

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* 21. Where do you believe youth most often obtain illegal drugs? Please choose three only.

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* 22. Which of the following apply to your home about alcohol use? Please choose three only.

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* 23. Which of the following apply to your home about prescription drug abuse?

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* 24. Which of the following apply to your home about illegal drug use? (ex: marijuana, meth, heroin)

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* 25. In the past 30 days, do you believe there has there been any use of tobacco by your children?

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* 26. Which statement below most represents your own attitude about underage tobacco use?

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* 27. Do you believe tobacco use is harmful to minors?

* 9. *The following questions ask about alcohol and drug related issues within Decatur Township Schools.

Do Decatur Township Schools enforce policies and investigate all reports of underage alcohol and/or drug use?

* 13. *The following questions are about your perceptions of alcohol and drug use in your community. Rank your top three choices. (Ex. 1 = most likely) Please choose three only.

What do you believe are the main reasons teens drink alcohol?

* 17. From the drugs listed in Question 16

Has there been any abuse of these drugs in the past 30 days by children in your household?