Thank you for taking the time to complete this brief and anonymous survey.

The mission of the Healthy Community-Healthy Kids Coalition, a program of Youth and Family Services of Haddam-Killingworth, is to prevent the use and abuse of alcohol and other substances among Haddam and Killingworth youth through community action, education, support and collaboration. 
 
The information gathered through this survey will help us understand the attitudes, perceptions, beliefs and needs of our community and better enable us to serve our community with targeted local prevention programming and services.
 
This survey is completely anonymous and does NOT ask for information that could identify you. Survey results will be analyzed and summarized by an independent evaluator. The 20 questions take most people 5-10 minutes to complete. If you have already completed this survey, please do not take it again.  
 
At the end of the survey, you will have the opportunity to be entered into a raffle for local business gift cards.  Names entered for raffle prizes will be extracted from the survey before analysis. 
 
To learn more about the work of the HC-HK Coalition, and how you can get involved, please visit our website (hkyfs.org) or follow us on Facebook and Instagram.

Thank you again  - we truly appreciate your time and input.
 
Sincerely,
Emily Rosenthal, MPH, LMSW
Independent Program Evaluator


 
 

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* 1. What is your gender?

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* 2. How would you describe yourself? (Check all that apply)

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* 3. What is your age?

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* 4. Town of Residence

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* 5. How long have you lived in Haddam/Killingworth?

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* 6. Do you have children living in your home? (check all that apply):

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* 7. How familiar are you with:

  Very familiar Somewhat familiar Not at all familiar
The Haddam-Killingworth Youth and Family Services Community Coalition
The CT Social Host Law (house party law) that makes it illegal for any adult to provide a place for teens to drink
That HK Youth Services offers counseling for families dealing with substance abuse and other issues

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* 8. Please indicate your level of concern when thinking about the following issues impacting youth in your community:

  Not at all concerned Slightly concerned Very concerned Extremely concerned
Mental health 
Use of alcohol
Use of marijuana
Use of illicit drugs (such as heroin, cocaine)
Abuse of prescription medications (e.g. pain medications, stimulants, sedatives)
Vaping (e.g. e-cigs, JUULs)
Use of tobacco or traditional cigarettes

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* 9. Please answer this question ONLY if you have children in middle school.
In the past 30 days, on how many days do you think your child probably...

  Never 1-2 times 3 or more times
Drank an alcoholic beverage?
Took a prescription drug for non-medical purposes (e.g. to get high)?
Used an e-cig or vaping device to vape nicotine?
Used a vaping device to vape THC oil or marijuana?
Used marijuana in another way (smoked, ingested)?
Rode as a passenger with a driver (of any age) who had been drinking alcohol?
Rode as a passenger with a driver (of any age) who had been using marijuana?

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* 10. Please answer this question ONLY if you have children in high school.
In the past 30 days, on how many days do you think your child probably...

  Never 1-2 times 3 or more times
Drank an alcoholic beverage?
Took a prescription drug for non-medical purposes (e.g. to get high)?
Used an e-cig or vaping device to vape nicotine?
Used a vaping device to vape THC oil or marijuana?
Used marijuana in another way (smoked, ingested)?
Rode as a passenger with a driver (of any age) who had been drinking alcohol?
Rode as a passenger with a driver (of any age) who had been using marijuana?
Texted while driving?

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* 11. Please answer this question ONLY if you have children ages 18-20 .
In the past 30 days, on how many days do you think your child probably...

  Never 1-2 times 3 or more times
Drank an alcoholic beverage?
Took a prescription drug for non-medical purposes (e.g. to get high)?
Used an e-cig or vaping device to vape nicotine?
Used a vaping device to vape THC oil or marijuana?
Used marijuana in another way (smoked, ingested)?
Rode as a passenger with a driver (of any age) who had been drinking alcohol?
Rode as a passenger with a driver (of any age) who had been using marijuana?
Texted while driving?

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* 12. Please choose the response that best describes how you feel for each of the statements listed below:

  Strongly disagree Disagree Agree Strongly agree
Drinking alcohol is a normal part of growing up
Using marijuana is a normal part of growing up
I have a good understanding of what "vaping" is and the contents of vaping liquid
I understand the effects that vaping has on young people and teens

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* 13. How concerned would you be if your child were:

  Not at all concerned Slightly concerned  Very concerned Extremely concerned
Using alcohol
Using marijuana
Using illicit drugs (e.g. heroin, cocaine)
Abusing prescription medications (e.g. pain medications, stimulants, sedatives)
Vaping
Using tobacco or cigarettes

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* 14. My family has clear rules that discourage my child/ren from:

  Strongly agree Agree Disagree Strongly Disagree
Drinking alcohol
Smoking cigarettes
Vaping nicotine (e-cigs, JUULs)
Using marijuana (vaping, smoking, or ingesting)
Using other illicit drugs
Using prescription drugs (not prescribed to them)

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* 15. Please choose the response that best describes how you feel for each of the statements below:

  Strongly agree Agree Disagree Strongly Disagree
When my child goes out I know where they are and who they are with.
If my child had an important concern about drugs, alcohol, or some other serious issue, they would talk to me about it.
If I had questions or concerns about my child's substance use or mental health, I know of resources in the community that could help.
I talk to my child about the harmful effects of using tobacco, alcohol, and other drugs.
I take steps to ensure that minors don't have access to any alcohol from my home.
I take steps to ensure that minors don't have access to any prescription drugs from my home.
I take steps to ensure that minors don't drink alcohol in my home.
In my own choices about using drugs and alcohol, I have considered the behavior I am modeling for my child. 
I have control over whether my child uses alcohol.
I have control over whether my child uses marijuana.

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* 16. How has COVID-19 impacted your child's stress, anxiety or worry about the following?

  Worse Same/No Change  Better
Home/life relationships with family members
Academics (homework, tests, grades)
College/post-high school planning
Schedule (Athletics, extra-curriculars, volunteer commitments)
Personal safety (bully/teasing, physical violence)
Social life (social media, going out with friends)
Friends (peers)

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* 17. When thinking about your child right now, how concerned are you about their:

  Not at all concerned Slightly concerned Very concerned Extremely concerned
Stress and anxiety
Depression
Social isolation
Academic achievement (compared with last year)
Emotional wellbeing
Relationships with family/friends
Physical health
 Nutrition and eating habits
Substance use

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* 18. What support do you need as a parent right now?

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* 19. Is there anything else you would like to share?

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* 20. If you would like to be entered into a raffle for a gift card to a local business, please provide your email here. This information will be removed prior to survey analysis.

For more information about HKYFS and the services offered, please visit their website at hkyfs.org. If you would like to get more involved with HKYFS, please email them at hkyfs.org.

Thank you for taking the time to complete this survey. We truly appreciate it!

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