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* 1. What is your current age?

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* 2. What is your sex or gender?

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* 3. Your Ethnicity

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* 4. Your Race

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* 5. In what county do you currently live?

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* 6. Your Zip Code

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

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

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

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

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

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

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

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

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

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* 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?

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

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

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* 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?

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

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

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* 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.

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

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

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

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

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

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* 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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