A Guide for the Prevention of Alcohol, Tobacco and Other Drug Use

* 1. Where did you get your copy of the Community of Concern Booklet? Please specify.

* 2. PRIOR TO receiving the Community of Concern booklet, how would you describe your existing knowledge regarding current information about alcohol, tobacco, and other drug use?

0 No Knowledge 5 Somewhat Knowledgegable
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* 3. AFTER receiving the Community of Concern booklet, how would you describe your knowledge regarding current information about alcohol, tobacco, and other drug use?

0 No Knowledge 5 Somewhat Knowledgeable
i We adjusted the number you entered based on the slider’s scale.

* 4. Please rank by level of personal importance (1=most important, 12=least important) the topics that were covered by the Community of Concern Booklets.

* 5. How likely are you to utilize this information in terms of how you would address these topics with a loved one?

0 Very unlikey 5 Somewhat likely
i We adjusted the number you entered based on the slider’s scale.

* 6. How likely are you to recommend the Community of Concern booklet to others?

0 Very unlikely 5 Somewhat likely
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* 7. What is the composition of your family? (Check all that apply).

* 8. What are the ages of the children in your household? Check all that apply.

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