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* 1. Which of the following causes problems in your community? (Select all that apply.)

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* 2. Please indicate whether or not the following are harmful to someone’s health.

  harmful  not harmful  don't know 
Drinking alcohol if a person is under 21 years old. 
Drinking 5 or more drinks in a row. 
Use of synthetic drugs. 
Using methamphetamine every day or every week. 
Using prescription drugs not as intended every day or every week. 
Sharing your prescription drugs with family or friends. 
Use of marijuana if a person is under 21 years old. (smoking, edibles) 

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* 3. Please indicate whether or not you support the following. 

  Support  Do Not Support  Don't Know
Limiting the number of places where alcohol can be sold.
Limiting the type of alcoholic beverages that can be sold (e.g., 40 oz. malt liquor cans, mini liquor bottles, etc.). 
A program that works with liquor store, bar and restaurant owners to minimize underage access to alcohol and prevent over service to customers.
Ensure(ing) liquor store, bar and restaurant owners are accountable for alcohol-related crimes linked to their business practices.
Fine hosts for allowing underage drinking at their party. (A host is a person who receives or entertains other people as guests)
Encouraging doctors and patients to be more careful with prescribed medications such as Valium and OxyContin.
A law that restricts the location of smoke shops, hookah lounges, and vape stores from areas where youth are present, like schools and parks.

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* 4. Please respond to the following questions.

  Yes  No  Don't Know
Have you heard of the "Social Host Ordinance" (the law that holds hosts accountable for allowing minors under 21 to drink alcohol at house parties)?
Do you think the Social Host Ordinance is a good way to keep people from allowing persons under 21 to drink alcohol at house parties?
Have you reported an underage drinking party to your local law enforcement agency in the past year?
Do you know anyone who has ever used Spice or Bath Salts?
Are you aware of the Synthetic Drug Ordinance?
Have you taken your unused prescription drugs to a drop box at a local law enforcement station or Prescription Drug Take Back event in the past year?
Do you have extra prescription medications in your home that you no longer use?
Do you know of any youth who use vaping devices to smoke marijuana products (e.g., hash, hash oil or wax)?
Are there any stores in your community that sell paraphernalia (e.g., glass pipes, vape pens, etc.) used to smoke marijuana or other drugs?
Do you know of any youth who get substances (e.g., alcohol, pain pills, marijuana, etc.) from Apps or from the Internet?
Do you think alcohol and drug treatment is available in your community for people who need it?

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* 5. How do you dispose of your unwanted medications? (Select all that apply)

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* 6. Are you interested in joining a community coalition or receiving more information? 

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* 7. What city do you live in?

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* 8. What is your zip code?

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* 9. What is your age? 

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* 10. What is your gender? 

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* 11. What is your race/ethnicity? (select all that apply) 

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* 12. Are you, or someone in your immediate family, active duty in the military? 

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* 13. Today's Date

Date

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* 14. How did you hear about this survey?

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