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* 1. How old are you?

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* 2. What is your gender?

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* 3. Which race/ethnicity best describes you? (Please choose only one.)

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* 5. County that you live in

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* 6. Do you think substance use is a serious problem for adults in your county?

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* 7. Do you think substance use is a serious problem for youth in your county?

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* 8. Which substances do you worry about the most (choose your top 2 answers)

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* 9. Do you know anyone who has misused prescription medication?

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* 10. If yes to the above question(number 9), do you think it was on purpose?

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* 11. Do you have family or friends who have suffered from a substance use problem in the last five years?

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* 12. How often do you think friends or family are harming themselves from the use of the following substances?

  Daily Sometimes Rarely Never
Opioids like Hydrocodone, OxyContin, Vicodin, Fentanyl
Stimulants like Ritalin or Adderall
Prescription Medications like Valium or Xanax
Alcohol
Marijuana
Cocaine

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* 13. Have any of your friends or family gotten help with their substance use problems?

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* 14. Out of the items listed below what are the three most difficult challenges people face when trying to get help with substance use prevention, education, treatment and recovery?(Pick 3)

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* 15. What do you think are the three biggest reasons people in our community overuse substances? (Pick 3)

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