* 1. What is your current age?

* 2. What is your sex or gender?

* 3. Your Ethnicity

* 4. Your Race

* 5. In what county do you currently live?

* 6. Your Zip Code

* 7. Why do you think youth drink alcohol. Pick the number one reason.

* 8. Why do you think youth use marijuana?  Pick the number one reason.

* 9. Why you think youth use other drugs? Pick the number one reason.

* 10. Why you think youth use tobacco (chew/smoke). Pick the number one reason.

* 11. Where do you think youth get alcohol most often?  Pick one.

* 12. What do you think is the number one way youth get marijuana most often?  Pick one answer.

* 13. What do you think is the number one way youth get other drugs most often? Pick one.

* 14. What is the number one way you think youth get tobacco products most often?

* 15. Would you allow kids under the age of 21 to have a party at your house where alcohol is consumed?

* 16. How much do you think a parent's use of alcohol, tobacco, marijuana or other drugs negatively influences their child/children to use alcohol, tobacco, marijuana or other drugs?

* 17. I think adults should do the following to reduce youth's alcohol and other drug use.  Check all that apply

* 18. Do you know it is illegal to purchase or provide alcohol to anyone under 21 years of age?

* 19. Do you think other adults in your community know it is illegal to purchase or provide alcohol to persons under the age of 21 years of age?

* 20. Would you allow kids to have a party at your house where marijuana is used?

* 21. Have you gambled for money or anything of value, purchased lottery tickets, casino games, etc. at any time in the last year?

* 22. If you answered Yes to the previous question, what is your preferred type of gambling activity?  Please check all that apply.  If you answered No to previous question check I do not gamble.

* 23. Have you ever had the need to bet more and more money?

* 24. Have you ever lied to people important to you about how much you gamble?

* 25. Have you experienced any financial problems as a result of spending money gambling?

* 26. Have you ever borrowed money, stolen money or used credit to bet/gamble?

* 27. Do you know someone you think may have a gambling problem?

* 28. If you have been personally affected by the gambling behaviors of someone else, please check all the apply.  If you have not been personally affected please check the I have not been personally affected by the gambling behaviors of someone else.

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