Thank you for participating in this anonymous survey which will assist the Westport Prevention Coalition's efforts to assess community perceptions about substance use and other health issues in Westport.

Your input provides helpful information as we embark on prevention and resource development efforts addressing substance abuse, mental health services and the overall wellness of our community.

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* 1. Please indicate your age:

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* 2. Please indicate your zipcode:

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* 3. What is your gender?

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* 4. What is your race/ethnicity?

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* 5. Please indicate which of the following categories apply to you (check all that apply):

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* 6. In your opinion, which of the following substance(s) are of highest priority to be addressed for 12 to 17 yr olds in Westport? Please rank the 3 substances of highest priority from (1) highest to (3) lowest.

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* 7. In your opinion, which of the following substance(s) are of highest priority to be addressed for 18-30 yr olds in Westport? Please rank the 3 substances of highest priority from (1) highest to (3) lowest.

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* 8. In your opinion, which of the following substance(s) are of highest priority to be addressed for 31-65 yr olds in Westport? Please rank the 3 substances of highest priority from (1) highest to (3) lowest.

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* 9. In your opinion, which of the following substance(s) are of highest priority to be addressed for 66 yr olds and older in Westport? Please rank the 3 substances of highest priority from (1) highest to (3) lowest.

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* 10. Please indicate your agreement with the following statements about ALCOHOL use in WESTPORT. I...:

  Strongly Agree Agree Neutral/Don't Know Disagree Strongly Disagree
am concerned about preventing alcohol abuse among youth in Westport.
believe it is okay for youth to drink alcohol occasionally.
believe it is okay for youth to drink if they don't drive.
believe youth should be able to drink at parties with parental supervision.
am concerned about preventing alcohol abuse among adults in Westport.
believe enforcement of liquor laws should be a priority in Westport (e.g. sales to minors, drunk driving arrests, CT Social Host Law).

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* 11. Please indicate your agreement with the following statements about recreational MARIJUANA use in WESTPORT. I...:

  Strongly Agree Agree Neutral/Don't Know Disagree Strongly Disagree
support the legalization of recreational marijuana.
believe the occasional use of recreational marijuana among youth is not harmful.
believe the occasional use of recreational marijuana among adults is not harmful.

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* 12. Please indicate your agreement with the following statements about SUBSTANCE USE in WESTPORT. I BELIEVE:

  Strongly Agree Agree Neutral/Don't Know Disagree Strongly Disagree
Westport youth, regardless of socioeconomic, racial and ethnic status are at risk of substance abuse.
it is possible to prevent alcohol abuse among youth in Westport.
it is possible to prevent alcohol abuse among adults in Westport.
alcohol and drug prevention programs and strategies are a good investment for Westport.
prevention programs are effective at preventing substance abuse among youth.
prevention programs are effective at preventing substance abuse among adults.
underage use of substances is a private matter to be dealt with at home.

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* 13. Please indicate your agreement with the following statements. I BELIEVE:

  Strongly Agree Agree Neutral/Don't Know Disagree Strongly Disagree
mental health should be addressed through community efforts.
additional or enhanced suicide prevention efforts are needed in Westport.
its important to prevent problem gambling in Westport.

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* 14. Please provide any additional comments or concerns that you feel are important to understand substance abuse prevention and health promotion needs in Westport, including emerging substance abuse and behavioral health issues:

Thank you for helping with the Westport Prevention Coalition's efforts to address substance abuse. Understanding Westport residents' views on substance use will help us plan for substance abuse prevention and mental health services in Westport. Your completion of this survey provides valuable key stakeholder reflections on substance use in Westport.

If you have any questions, comments or would like further information about this survey, please contact the Westport Prevention Coalition at 203-341-1050 or Humansrv@westportct.gov

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