Community Perception Survey
1.
Demographics
What is your zipcode?
2.
What is your gender identity?
Female
Male
Transgender
Nonbinary
Prefer not to say
Other (please specify)
3.
Race identification (select one or more)
American Indian or Alaska native
Asian
Black of African American
Native Hawaiian or other pacific islander
White
Other (please specify)
4.
Are you of Hispanic, Latino, or Spanish origin?
Yes
No
5.
Are you a caregiver/guardian?
Yes
No
6.
(If applicable) How old is/are the youth you take care of (circle all that apply)
0-4
5-10
11-13
14-17
18-10
21+
7.
Personal Perception of Youth Risk Behaviors
In the last 30 days, what percent of high school students do you think have…
None
Less then half
About half
More than half
Drank more than a few sips of alcohol?
None
Less then half
About half
More than half
Had 5 or more alcohol drinks in a row?
None
Less then half
About half
More than half
Used prescription medication (pain relievers, benzos, stimulants, etc.), without a prescription?
None
Less then half
About half
More than half
Used heroin?
None
Less then half
About half
More than half
Used illegal drugs?
None
Less then half
About half
More than half
Used a nicotine product, cigarette, vaping device, Juul, hookah pens, e-cigarettes?
None
Less then half
About half
More than half
Used marijuana or marijuana infused products, Dabs, edibles, tinctures, etc.?
None
Less then half
About half
More than half
Placed a bet on a sports game
None
Less then half
About half
More than half
Placed a bet on a card or other game (whether in a casino or not)
None
Less then half
About half
More than half
Scratched or played a scratch ticket
None
Less then half
About half
More than half
Played the lottery
None
Less then half
About half
More than half
Bought a scratch or lottery ticket
None
Less then half
About half
More than half
Used real-life money to purchase a random/unknown item in a video game
None
Less then half
About half
More than half
Gambled over $50
None
Less then half
About half
More than half
8.
Personal Perception of Harm
What statement most represents how you feel about underage drinking?
Any kind of drinking in high school is okay.
Occasional drinking in high school is okay, as long as no one is driving.
Occasional drinking with supervision from a friend’s caregiver/ guardian, is okay.
Occasional high school student drinking, under supervision of their caregiver/ guardian, is all right.
Drinking in high school is never a good thing.
9.
What statement most represents how you feel about underage nicotine use?
Any kind of nicotine use in high school is okay.
Occasional nicotine use in high school is okay as long as no one is driving.
Occasional nicotine use with supervision from a friend’s caregiver/ guardian is okay.
Occasional high school student nicotine use, under supervision of their caregiver/ guardian is all right.
Nicotine use in high school is never a good thing.
10.
What statement most represents how you feel about underage marijuana use?
Any kind of marijuana use in high school is okay.
Occasional marijuana use in high school, as long as no one is driving, is okay.
Occasional marijuana use with supervision from a friend’s caregiver/ guardian is okay.
Occasional high school student marijuana use, under supervision of their caregiver/ guardian is all right.
Marijuana use in high school is never a good thing.
11.
What statement most represents how you feel about underage gambling?
Any kind of gambling in high school is okay.
Occasional gambling in high school, as long as youth are using their own money, is okay.
Occasional gambling in high school, with supervision no matter whose money is being used, is okay.
Occasional gambling in high school, with supervision of their caregiver/guardian no matter whose money is being used, is okay.
Gambling in high school is never a good thing.
12.
Personal Concern
How concerned are you about high school students…
Not Concerned
1
2
3
4
Highly Concerned
5
Drinking Alcohol
Not Concerned
1
2
3
4
Highly Concerned
5
Use of Marijuana
Not Concerned
1
2
3
4
Highly Concerned
5
Use of Nicotine Products (cigarette, vaping device, Juul, hook pens, e-cigarettes)
Not Concerned
1
2
3
4
Highly Concerned
5
Playing scratch tickets/lottery/Keno
Not Concerned
1
2
3
4
Highly Concerned
5
Gambling on casino-style games with family/friends
Not Concerned
1
2
3
4
Highly Concerned
5
Gambling on casino-style games online
Not Concerned
1
2
3
4
Highly Concerned
5
Betting on sports
Not Concerned
1
2
3
4
Highly Concerned
5
Betting on fantasy leagues
Not Concerned
1
2
3
4
Highly Concerned
5
Buying random/ unknown in-game items
Not Concerned
1
2
3
4
Highly Concerned
5
13.
Community Concern
How concerned is your community about high school students…
OR
In your community, how tolerated is high school students…
Not Concerned
1
2
3
4
Highly Concerned
5
Drinking Alcohol
Not Concerned
1
2
3
4
Highly Concerned
5
Use of Marijuana
Not Concerned
1
2
3
4
Highly Concerned
5
Use of Nicotine Products (cigarette, vaping device, Juul, hook pens, e-cigarettes)
Not Concerned
1
2
3
4
Highly Concerned
5
Playing scratch tickets/lottery/Keno
Not Concerned
1
2
3
4
Highly Concerned
5
Gambling on casino-style games with family/friends
Not Concerned
1
2
3
4
Highly Concerned
5
Gambling on casino-style games online
Not Concerned
1
2
3
4
Highly Concerned
5
Betting on sports
Not Concerned
1
2
3
4
Highly Concerned
5
Betting on fantasy leagues
Not Concerned
1
2
3
4
Highly Concerned
5
Buying random/ unknown in-game items
Not Concerned
1
2
3
4
Highly Concerned
5
14.
Community Effort
How much effort in your community is there to address high school students…
No Effort at All
1
2
3
4
Large amount of effort
5
Drinking Alcohol
No Effort at All
1
2
3
4
Large amount of effort
5
Use of Marijuana
No Effort at All
1
2
3
4
Large amount of effort
5
Use of Nicotine Products (cigarettes, vaping device, Juul, hook pens, e-cigarettes)
No Effort at All
1
2
3
4
Large amount of effort
5
Playing scratch tickets/lottery/Keno
No Effort at All
1
2
3
4
Large amount of effort
5
Gambling on casino-style games with family/friends
No Effort at All
1
2
3
4
Large amount of effort
5
Gambling on casino-style games online
No Effort at All
1
2
3
4
Large amount of effort
5
Betting on sports
No Effort at All
1
2
3
4
Large amount of effort
5
Betting on fantasy leagues
No Effort at All
1
2
3
4
Large amount of effort
5
Buying random/ unknown in-game items
No Effort at All
1
2
3
4
Large amount of effort
5
15.
Community Effect
How effective do you think these efforts are at addressing high school students…
Not effective at all
1
2
3
4
Very effective
5
Drinking Alcohol
Not effective at all
1
2
3
4
Very effective
5
Use of Marijuana
Not effective at all
1
2
3
4
Very effective
5
Use of Nicotine Products (cigarette, vaping device, Juul, hook pens, e-cigarettes)
Not effective at all
1
2
3
4
Very effective
5
Playing scratch tickets/lottery/Keno
Not effective at all
1
2
3
4
Very effective
5
Gambling on casino-style games with family/friends
Not effective at all
1
2
3
4
Very effective
5
Gambling on casino-style games online
Not effective at all
1
2
3
4
Very effective
5
Betting on sports
Not effective at all
1
2
3
4
Very effective
5
Betting on fantasy leagues
Not effective at all
1
2
3
4
Very effective
5
Buying random/ unknown in-game items
Not effective at all
1
2
3
4
Very effective
5
16.
Have you ever talked with youth about (check all that apply):
Tobacco
Alcohol
Binge Drinking
Marijuana
Prescription Drugs
Gambling
Other Drugs
None of the above
17.
Do you feel you have enough information to talk with high school aged youth about substance use, mental health, and gambling?
Yes
No
18.
How comfortable do you feel discussing sensitive topics such as mental health and substance use with your child(ren)?
Very comfortable
Somewhat comfortable
Not comfortable at all
19.
Which communication channels do you find most effective for receiving information and support? (select all that apply)
Workshops and seminars
in-person, online, virtual
Newsletter
Emailed, posted on social media, mailed out, sent home with kids from school
Casual social media posts
Facebook, Instagram, TikTok, YouTube, Twitter
Online forums
Support groups
In-person, online, virtual
Other (please specify)
