Valley Opioid Task Force Community Survey

Community Questionnaire

The Valley Opioid Task Force mobilizes youth and community partners to create a safe, healthy and drug-free environment where youth and families thrive. Through the information this survey provides, we will be able to better serve our youth with local prevention programming.

This SHORT survey is completely anonymous and does NOT ask for information which could identify you. If you would like to enter a drawing for a $25 gift card as a 'thank you' for your participation in this survey you will be directed to a separate sign-up at the end of this survey. You must be 18 years or older to complete this survey. Thanks!

Question Title

* 1. Where do you reside?

Ansonia

Derby

Shelton

Other (please specify)

Question Title

* 2. How familiar are you with…

	Unfamiliar	Somewhat familiar	Very familiar
the CT Social Host Law that makes it illegal for any adult to provide a place for teens to drink?	the CT Social Host Law that makes it illegal for any adult to provide a place for teens to drink? Unfamiliar	the CT Social Host Law that makes it illegal for any adult to provide a place for teens to drink? Somewhat familiar	the CT Social Host Law that makes it illegal for any adult to provide a place for teens to drink? Very familiar
the Prescription Drop Boxes located at the Ansonia and Shelton Police Departments?	the Prescription Drop Boxes located at the Ansonia and Shelton Police Departments? Unfamiliar	the Prescription Drop Boxes located at the Ansonia and Shelton Police Departments? Somewhat familiar	the Prescription Drop Boxes located at the Ansonia and Shelton Police Departments? Very familiar
proper ways to dispose of unused, unneeded or excess Prescription Drug medications that are in your home?	proper ways to dispose of unused, unneeded or excess Prescription Drug medications that are in your home? Unfamiliar	proper ways to dispose of unused, unneeded or excess Prescription Drug medications that are in your home? Somewhat familiar	proper ways to dispose of unused, unneeded or excess Prescription Drug medications that are in your home? Very familiar

Question Title

* 3. How familiar are you with…

	Unfamiliar	Somewhat familiar	Very familiar
the Connecticut law that took effect in October 2019 increasing the minimum age to purchase tobacco and vaping products to 21?	the Connecticut law that took effect in October 2019 increasing the minimum age to purchase tobacco and vaping products to 21? Unfamiliar	the Connecticut law that took effect in October 2019 increasing the minimum age to purchase tobacco and vaping products to 21? Somewhat familiar	the Connecticut law that took effect in October 2019 increasing the minimum age to purchase tobacco and vaping products to 21? Very familiar
The CT law that took effect in July 2021 legalizing cannabis use for adults 21 years or older?	The CT law that took effect in July 2021 legalizing cannabis use for adults 21 years or older? Unfamiliar	The CT law that took effect in July 2021 legalizing cannabis use for adults 21 years or older? Somewhat familiar	The CT law that took effect in July 2021 legalizing cannabis use for adults 21 years or older? Very familiar
The work the Valley Opioid Task Force Task Force is involved with in the community?	The work the Valley Opioid Task Force Task Force is involved with in the community? Unfamiliar	The work the Valley Opioid Task Force Task Force is involved with in the community? Somewhat familiar	The work the Valley Opioid Task Force Task Force is involved with in the community? Very familiar

Question Title

* 4. In the past year, have you disposed of unused or outdated medication:

	No	Yes
at a Medication Drop Box?	at a Medication Drop Box? No	at a Medication Drop Box? Yes
at a Drug Take Back Day event?	at a Drug Take Back Day event? No	at a Drug Take Back Day event? Yes
at home (following CDC guidelines)?	at home (following CDC guidelines)? No	at home (following CDC guidelines)? Yes

Another way? (please specify)

Question Title

* 5. In your community, do you know where to go for help if you or a family member is struggling with:

	No	Yes
Substance use or abuse issues	Substance use or abuse issues No	Substance use or abuse issues Yes
Mental health issues (such as depression, anxiety, etc.)	Mental health issues (such as depression, anxiety, etc.) No	Mental health issues (such as depression, anxiety, etc.) Yes

Question Title

* 6. In what ways has COVID-19 affected the following?

	Worse	No change/the same	Better
Your emotional well-being	Your emotional well-being Worse	Your emotional well-being No change/the same	Your emotional well-being Better
Your relationships with family/friends	Your relationships with family/friends Worse	Your relationships with family/friends No change/the same	Your relationships with family/friends Better
Your physical health	Your physical health Worse	Your physical health No change/the same	Your physical health Better
Your access to health care (ex. doctors, dentists)	Your access to health care (ex. doctors, dentists) Worse	Your access to health care (ex. doctors, dentists) No change/the same	Your access to health care (ex. doctors, dentists) Better
Your access to mental health supports (ex. counselors, therapists, etc.)	Your access to mental health supports (ex. counselors, therapists, etc.) Worse	Your access to mental health supports (ex. counselors, therapists, etc.) No change/the same	Your access to mental health supports (ex. counselors, therapists, etc.) Better
Your access to food	Your access to food Worse	Your access to food No change/the same	Your access to food Better
Your financial security	Your financial security Worse	Your financial security No change/the same	Your financial security Better

Question Title

* 7. In what ways has COVID-19 affected the following?

	Less	No change/the same	More
Your use of alcohol	Your use of alcohol Less	Your use of alcohol No change/the same	Your use of alcohol More
Your use of marijuana (Cannabis, THC, Weed, Edibles, Concentrates)	Your use of marijuana (Cannabis, THC, Weed, Edibles, Concentrates) Less	Your use of marijuana (Cannabis, THC, Weed, Edibles, Concentrates) No change/the same	Your use of marijuana (Cannabis, THC, Weed, Edibles, Concentrates) More
Your use of prescription drugs for the purpose of getting high or to feel good (tranquilizers, pain medication, stimulants)	Your use of prescription drugs for the purpose of getting high or to feel good (tranquilizers, pain medication, stimulants) Less	Your use of prescription drugs for the purpose of getting high or to feel good (tranquilizers, pain medication, stimulants) No change/the same	Your use of prescription drugs for the purpose of getting high or to feel good (tranquilizers, pain medication, stimulants) More

Question Title

* 8. Over the past 2 weeks how often have you been bothered by the following:

	Not at all	Several days	More than half the days	Nearly every day
Little interest or pleasure in doing things	Little interest or pleasure in doing things Not at all	Little interest or pleasure in doing things Several days	Little interest or pleasure in doing things More than half the days	Little interest or pleasure in doing things Nearly every day
Feeling down, depressed, or hopeless	Feeling down, depressed, or hopeless Not at all	Feeling down, depressed, or hopeless Several days	Feeling down, depressed, or hopeless More than half the days	Feeling down, depressed, or hopeless Nearly every day
Feeling nervous, anxious or on edge	Feeling nervous, anxious or on edge Not at all	Feeling nervous, anxious or on edge Several days	Feeling nervous, anxious or on edge More than half the days	Feeling nervous, anxious or on edge Nearly every day
Worrying too much about different things	Worrying too much about different things Not at all	Worrying too much about different things Several days	Worrying too much about different things More than half the days	Worrying too much about different things Nearly every day

25% of survey complete.