Adult Attitude and Perception Survey

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* 1. Today's Date

Date / Time

Date

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* 2. Age

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* 3. Gender

Male

Female

Genderqueer

Trans Man

Trans Woman

Decline to State

Other (please specify)

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* 4. What city/neighborhood do you live in?

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* 5. What is your zip code?

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* 6. Which of the following racial group s do you most closely identify with (please choose only one)

African American/Black

Asian/Pacific Islander

Native American

Caucasian/White

Unknown

Decline to State

Other (please specify)

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* 7. Are you of Hispanic/Latino origin?

Not Hispanic/Latino

Yes, Hispanic/Latino

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* 8. What are the three ways young people (UNDER 21) are most likely to get alcohol? (Check only 3 responses)

From home with parental knowledge

From home without parental knowledge

From friends’ homes with parent knowledge

From friends’ homes without parental knowledge

Buy it themselves from a store

Steal it

From friends over 21 

From a friends under 21

Buy it themselves from a store

Ask a stranger to purchase the alcohol 

Relatives other than parents and siblings

Other (please specify)

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* 9. What are the three ways young people (UNDER 18) are most likely to get marijuana? (Check only 3 responses)

From home with parental knowledge

From home without parental knowledge

Grow it themselves

Family member

Steal it

Buy it themselves from a dispensary

From friends (not at school)

From a friends' parents

From a local dealer on the street

Ask a stranger to purchase from a dispensary

Ask a friend to purchase from a dispensary

From school campus (friend/dealer

Other (please specify)

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* 10. Please rate how much you agree or disagree with the following

	Strongly Agree	Agree	Disagree	Strongly Disagree
Alcohol is an important part of my family celebrations/holidays	Alcohol is an important part of my family celebrations/holidays Strongly Agree	Alcohol is an important part of my family celebrations/holidays Agree	Alcohol is an important part of my family celebrations/holidays Disagree	Alcohol is an important part of my family celebrations/holidays Strongly Disagree
Alcohol is less dangerous than other drugs	Alcohol is less dangerous than other drugs Strongly Agree	Alcohol is less dangerous than other drugs Agree	Alcohol is less dangerous than other drugs Disagree	Alcohol is less dangerous than other drugs Strongly Disagree
Alcohol consumption is a rite of passage for teens	Alcohol consumption is a rite of passage for teens Strongly Agree	Alcohol consumption is a rite of passage for teens Agree	Alcohol consumption is a rite of passage for teens Disagree	Alcohol consumption is a rite of passage for teens Strongly Disagree

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* 11. Please rate how big a problem the following issues are in your community

Other illegal drug use (please describe)

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* 12. Please rate how harmful you think it is to someone’s health to

	Very Harmful	Harmful	A Little Harmful	Not At All
Drink alcohol if they are under 21 years old	Drink alcohol if they are under 21 years old Very Harmful	Drink alcohol if they are under 21 years old Harmful	Drink alcohol if they are under 21 years old A Little Harmful	Drink alcohol if they are under 21 years old Not At All
Drink 5 or more drinks in a row	Drink 5 or more drinks in a row Very Harmful	Drink 5 or more drinks in a row Harmful	Drink 5 or more drinks in a row A Little Harmful	Drink 5 or more drinks in a row Not At All
Smoke marijuana once in a while	Smoke marijuana once in a while Very Harmful	Smoke marijuana once in a while Harmful	Smoke marijuana once in a while A Little Harmful	Smoke marijuana once in a while Not At All
Smoke marijuana every day/week	Smoke marijuana every day/week Very Harmful	Smoke marijuana every day/week Harmful	Smoke marijuana every day/week A Little Harmful	Smoke marijuana every day/week Not At All
Use methamphetamine once in a while	Use methamphetamine once in a while Very Harmful	Use methamphetamine once in a while Harmful	Use methamphetamine once in a while A Little Harmful	Use methamphetamine once in a while Not At All
Use methamphetamine every day/week	Use methamphetamine every day/week Very Harmful	Use methamphetamine every day/week Harmful	Use methamphetamine every day/week A Little Harmful	Use methamphetamine every day/week Not At All
Misuse prescription or over-the-counter drugs once in a while	Misuse prescription or over-the-counter drugs once in a while Very Harmful	Misuse prescription or over-the-counter drugs once in a while Harmful	Misuse prescription or over-the-counter drugs once in a while A Little Harmful	Misuse prescription or over-the-counter drugs once in a while Not At All
Misuse prescription or over-the-counter drugs every day/week	Misuse prescription or over-the-counter drugs every day/week Very Harmful	Misuse prescription or over-the-counter drugs every day/week Harmful	Misuse prescription or over-the-counter drugs every day/week A Little Harmful	Misuse prescription or over-the-counter drugs every day/week Not At All

	Major Problem	Somewhat of a Problem	Minor Problem	Not A Problem
Drunk Driving	Drunk Driving Major Problem	Drunk Driving Somewhat of a Problem	Drunk Driving Minor Problem	Drunk Driving Not A Problem
Underage drinking at house parties	Underage drinking at house parties Major Problem	Underage drinking at house parties Somewhat of a Problem	Underage drinking at house parties Minor Problem	Underage drinking at house parties Not A Problem
Adults purchasing alcohol for minors	Adults purchasing alcohol for minors Major Problem	Adults purchasing alcohol for minors Somewhat of a Problem	Adults purchasing alcohol for minors Minor Problem	Adults purchasing alcohol for minors Not A Problem
Stores or bars selling alcohol to people under 21	Stores or bars selling alcohol to people under 21 Major Problem	Stores or bars selling alcohol to people under 21 Somewhat of a Problem	Stores or bars selling alcohol to people under 21 Minor Problem	Stores or bars selling alcohol to people under 21 Not A Problem
Problems such as fights, vandalism or litter outside/near bars	Problems such as fights, vandalism or litter outside/near bars Major Problem	Problems such as fights, vandalism or litter outside/near bars Somewhat of a Problem	Problems such as fights, vandalism or litter outside/near bars Minor Problem	Problems such as fights, vandalism or litter outside/near bars Not A Problem
People drinking outside of liquor stores or markets	People drinking outside of liquor stores or markets Major Problem	People drinking outside of liquor stores or markets Somewhat of a Problem	People drinking outside of liquor stores or markets Minor Problem	People drinking outside of liquor stores or markets Not A Problem
Drugs being sold in parks or other recreation areas	Drugs being sold in parks or other recreation areas Major Problem	Drugs being sold in parks or other recreation areas Somewhat of a Problem	Drugs being sold in parks or other recreation areas Minor Problem	Drugs being sold in parks or other recreation areas Not A Problem
Drug Houses	Drug Houses Major Problem	Drug Houses Somewhat of a Problem	Drug Houses Minor Problem	Drug Houses Not A Problem
Recreational marijuana use	Recreational marijuana use Major Problem	Recreational marijuana use Somewhat of a Problem	Recreational marijuana use Minor Problem	Recreational marijuana use Not A Problem
Misuse of medicinal marijuana	Misuse of medicinal marijuana Major Problem	Misuse of medicinal marijuana Somewhat of a Problem	Misuse of medicinal marijuana Minor Problem	Misuse of medicinal marijuana Not A Problem
Synthetic drug use (also known as spice,K2, bath salts)	Synthetic drug use (also known as spice,K2, bath salts) Major Problem	Synthetic drug use (also known as spice,K2, bath salts) Somewhat of a Problem	Synthetic drug use (also known as spice,K2, bath salts) Minor Problem	Synthetic drug use (also known as spice,K2, bath salts) Not A Problem
Methamphetamine	Methamphetamine Major Problem	Methamphetamine Somewhat of a Problem	Methamphetamine Minor Problem	Methamphetamine Not A Problem
Misuse of narcotic pain medication (eg. OxyContin, Vicodin)	Misuse of narcotic pain medication (eg. OxyContin, Vicodin) Major Problem	Misuse of narcotic pain medication (eg. OxyContin, Vicodin) Somewhat of a Problem	Misuse of narcotic pain medication (eg. OxyContin, Vicodin) Minor Problem	Misuse of narcotic pain medication (eg. OxyContin, Vicodin) Not A Problem
Misuse of over the counter medication (eg. cough syrup)	Misuse of over the counter medication (eg. cough syrup) Major Problem	Misuse of over the counter medication (eg. cough syrup) Somewhat of a Problem	Misuse of over the counter medication (eg. cough syrup) Minor Problem	Misuse of over the counter medication (eg. cough syrup) Not A Problem
Problems such as loitering, fights, vandalism and/or litter outside medical marijuana dispensaries in operation	Problems such as loitering, fights, vandalism and/or litter outside medical marijuana dispensaries in operation Major Problem	Problems such as loitering, fights, vandalism and/or litter outside medical marijuana dispensaries in operation Somewhat of a Problem	Problems such as loitering, fights, vandalism and/or litter outside medical marijuana dispensaries in operation Minor Problem	Problems such as loitering, fights, vandalism and/or litter outside medical marijuana dispensaries in operation Not A Problem
Heroin Use	Heroin Use Major Problem	Heroin Use Somewhat of a Problem	Heroin Use Minor Problem	Heroin Use Not A Problem
Inhalant Abuse (eg. huffing, sniffing glue, air freshener, dust off, etc)	Inhalant Abuse (eg. huffing, sniffing glue, air freshener, dust off, etc) Major Problem	Inhalant Abuse (eg. huffing, sniffing glue, air freshener, dust off, etc) Somewhat of a Problem	Inhalant Abuse (eg. huffing, sniffing glue, air freshener, dust off, etc) Minor Problem	Inhalant Abuse (eg. huffing, sniffing glue, air freshener, dust off, etc) Not A Problem
Stores sell drug paraphernalia (bongs, glass pipes)	Stores sell drug paraphernalia (bongs, glass pipes) Major Problem	Stores sell drug paraphernalia (bongs, glass pipes) Somewhat of a Problem	Stores sell drug paraphernalia (bongs, glass pipes) Minor Problem	Stores sell drug paraphernalia (bongs, glass pipes) Not A Problem

Adult Attitude and Perception Survey

Question Title

* 1. Today's Date

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* 2. Age

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* 3. Gender

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* 4. What city/neighborhood do you live in?

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* 5. What is your zip code?

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* 6. Which of the following racial group s do you most closely identify with (please choose only one)

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* 7. Are you of Hispanic/Latino origin?

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* 8. What are the three ways young people (UNDER 21) are most likely to get alcohol? (Check only 3 responses)

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* 9. What are the three ways young people (UNDER 18) are most likely to get marijuana? (Check only 3 responses)

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* 10. Please rate how much you agree or disagree with the following

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* 11. Please rate how big a problem the following issues are in your community

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* 12. Please rate how harmful you think it is to someone’s health to

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* 13. How did you hear about this survey?