The purpose of this survey is to gather vital information about drug related issues in our community. Your participation will help the United Prevention Coalition of Lewis County (UP!) to plan efforts designed to reduce local substance use problems. Your participation in this survey is voluntary. You may skip a question, if you choose to do so, or stop taking the survey at any time by exiting. The survey will take approximately 5 minutes to complete. Your participation is anonymous. No information will be requested which can link your responses to you personally. 

If you have questions about this survey, please contact Cassie Forbus at UP! Coalition, in Lowville NY at 315-376-2321. By continuing below, you have freely agreed to participate in this study.

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* 1. What is your age?

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* 2. Zip Code (residence)

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* 3. What percentage of Lewis County youth between the ages of 12-17 years do you think have experimented with the following substances in the PAST MONTH?

  10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
a. Alcohol
b. Prescription drugs not prescribed to them by a doctor or medical professional
c. Marijuana
d. Vaping

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* 4. Which of the following best describes your attitude regarding the use of each substance among Lewis County youth between the ages of 12-17 years? They should...

  Never use it Not use until they are 21 Be allowed to use before 21 with adult supervision Be taught to use responsibly before 21 Be allowed to use before they are 21
a. Alcohol
b. Prescription drugs not prescribed to them by a doctor or medical professional
c. Marijuana
d. Vaping

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* 5. Do you agree with the following statements?  Among youth (ages 12-17) living in my community, the following are a problem...

  Yes No
Underage drinking
Prescription drug misuse
Smoking Marijuana
Cannabis edibles
Use of cannabis oils
Vaping

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* 6. To what extent do you agree with the following statements:

  Strongly agree Agree Disagree Strongly disagree
a. My family has clear expectations about alcohol use
b. Our community is ready to take action on the issue of alcohol use by youth
c. My family has clear expectations about prescription drug use
d. Our community is ready to take action on the issue of prescription drug use by youth
e. My family has clear expectations about marijuana use
f. Our community is ready to take action on the issue of marijuana use by youth. 
g. My family has clear expectations about vaping
h. Our community is ready to take action on the issue of vaping by youth

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* 7. To what extent do you agree with the following statements:

  Strongly Agree Agree Disagree Strongly Disagree
a. It is safer to get high on a prescribed drug than it is to get high on a street drug
b. People should do more to keep prescription drugs out of the hands of children and youth
c. Using prescription medication to get high should not carry the same penalties as drugs, such as cocaine, methamphetamine, or heroin
d. It is okay to take more than the recommended dosage of a prescription drug if you are feeling more pain than usual
e. It is safer to get high on marijuana than it is to get high on alcohol
f. Vaping is safer than using prescription drugs, alcohol or marijuana to get high

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* 8. How easy do you think it is for youth (ages 12-17) to obtain alcohol, marijuana, cannabis products, or vape supplies in order to get high?

  Very easy Somewhat easy Somewhat difficult Very difficult
Alcohol
Marijuana
Cannabis oils or edibles
Vape supplies

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* 9. How easy do you think it is for someone to obtain a prescription drug or medication from the following in order to get high?

  Very easy Somewhat easy Somewhat difficult Very difficult
A doctor or other medical professional in your community
A doctor or other medical professional outside of your community
A friend or family member in your community
On the street or from a drug dealer
From a family member without their knowledge

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* 10. What do you do with outdated and unused prescription drugs or other medications? Check all that apply.

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* 11. In your opinion, which of the following age groups is the biggest abuser of prescription drugs in your community?

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* 12. How concerned are you about the abuse of the following substances among youth 12-17 years of age in your community?

  Very concerned Somewhat concerned Not very concerned Not concerned at all
Alcohol
Prescription drugs not prescribed to them by a doctor or other medical professional
Marijuana
Vaping

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* 13. Please feel free to include comments in the space below:

Thank you for taking the time to complete this survey!

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