The answers that you provide on this survey are confidential. Thank you for your help!

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* Date:

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* 1. Gender

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* 2. What is your race or ethnicity?

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* 3. What is your age range?

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* 4. Do you work in Kingman?

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* If NO: In what community do you work?

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* 5. Do you live in Kingman?

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* If YES: Number of years:

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* If NO: In what community do you live?

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* 6. Have you ever worked in the field of “alcohol or drug prevention or treatment”?

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* 7. Do you know of any alcohol / drug prevention or treatment programs in your community?

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* 8. If yes, which programs are in your community? Please list:

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* 9. In the past 12 months, have you attended activities or events in your community about alcohol or drug prevention?

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* a. If YES, did those activities or events increase your knowledge about the nature and extent of underage drinking or illegal drug use among youth in your community?

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* b.  If YES, what are two things you learned during the activities or events?

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* Next are a few questions about the community of Kingman. Please indicate how much you agree or disagree with each of the following statements by marking your response˜.

  Strongly Disagree Disagree Agree Strongly Agree Unsure
10. People in this community believe there is a drug / underage drinking problem in this community.
11. The news media or social media report when drugs or alcohol have been involved in any incident or accident.
12. People in this community know what happens if someone gets into trouble and is involved with drugs or alcohol.
13. Key leaders in this community have said that drug / alcohol abuse must be addressed in this community.
14. The leadership in this community have been working to focus on drug / alcohol abuse.
15. Most people in this community support alcohol / drug prevention programs.
16. It is easy to refer someone with alcohol / drug abuse problems to services in this community.
17. There are enough services in this community to treat drug/alcohol abuse.

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* Please indicate how much you agree or disagree with each of the following statements by marking your response.

  Strongly Disagree Disagree Agree Strongly Agree Unsure
18. Most people in this community think more should be done in the community to deal with alcohol / drug abuse problems.
19. Most people in this community think doing something about drug use and underage drinking should be a priority.
20. People in this community do not have good understanding about drug or alcohol abuse.
21. People in this community try to get things like volunteers, donations, grants, and training in order to work on alcohol / drug abuse problems.
22. There are enough laws and rules about alcohol/drug abuse in this community.
23. Some of the laws and rules may not apply to all people in the community because of their age, income level, or race/ethnicity.
24. This community is doing enough to address alcohol/drug abuse.
25. Most community members are aware of the work being done to address alcohol / drug abuse.
26. People in this community have misconceptions or incorrect information about the current work being done to address alcohol / drug abuse.
27. The leadership in this community has made working on drug / alcohol abuse problems in this community a priority.
28. In the past 12 months, I've been feeling down or depressed more often since the COVID pandemic.
29. There are enough services in this community to treat mental illness.

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* This section asks for your opinion about how decisions are made and about how conflicts or problems may be handled in Kingman. Please indicate how much you agree or disagree with each statement. 

  Strongly Disagree Disagree Agree Strongly Agree Unsure
30. There is a lot of conflict between groups in this community.
31. Community conflicts are usually resolved in a manner that is respectful of and satisfactory for the people involved.
32. The community has procedures in place to help people get involved in the community decision-making process.
33. Community problems overwhelm local community groups.
34. In the past two years, this community has been successful at working on social problems.

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* Next are problems or challenges that may or may not be present in Kingman. Please indicate how serious a problem you feel each issue is in your community.

  Not Serious Somewhat Serious Quite Serious Very Serious Unsure
35. Poverty
36. Poor school quality
37. Teenage pregnancy
38. Lack of parental involvement
39. Lack of community involvement
40. Stigma attached to alcohol or drug treatment services
41. Stigma attached to mental illness or mental health issues
42. Lack of coordination among providers of service (treatment programs, prevention programs, primary care providers, community agencies)
43. Lack of qualified staff
44. Lack of good prevention programs
45. Lack of funding
46. Lack of medical and behavioral health services
47. Lack of good treatment programs
48. Use of e-cigarettes, vaping by youth
49. Use of marijuana by youth
50. Underage drinking among youth
51. Use of methamphetamines (meth) by youth
52. Use of fentanyl or other opioids by youth
53. Use of counterfeit pills by youth or adults
54. Other

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* 55. Please provide any additional information on the alcohol / drug abuse issue in your community that you think is important to know.

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