Municipal Alliance Needs Assesment

Question Title

* 1. For purposes of this survey, please check the box that best describes the community you are representing:

Note: If you are representing a school that accepts students from more than one municipality, please check only the municipality in which the school is located.

Avalon

Cape May

Cape May Point

Dennis Township

Lower Township

Middle Township

North Wildwood

Ocean City

Sea Isle City

Stone Harbor

Upper Township

West Cape May

West Wildwood

Wildwood

Wildwood Crest

Woodbine

All Cape May County

Question Title

* 2. For the purpose of this survey, please check the box that best describes your role/affiliation in the community you are representing:

Parent/Guardian

Medical Organization/Agency

Health Departments

Law Enforcement

Treatment Provider

Middle School Administrator

Middle School Staff (Teacher, Counselor, Nurse)

High School Administrator

High School Staff (Teacher, Counselor, Nurse)

College Personnel

Faith Based Organization

Court System/Probation

Government Administration

Social Service Agency/Organization

Business Owner/Manager

Youth Organization

Youth Recreation Programs

Youth (under age 18)

Young Adult (age 18 to 25)

Older Adult (age 62 and over)

Concerned Citizen

Substance Abuse Prevention Agency/Organization

Other (please specify)

Question Title

* 3. Based on your experience, please indicate the prevalence of substance abuse in the community you are representing:

Other (please specify)

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* 4. Based on your experience, please indicate the most common places where youth (ages 12 to 14) are getting alcohol in the community you are representing.

	Very Common	Somewhat Common	Not Common	Do Not Know
Liquor Stores	Liquor Stores Very Common	Liquor Stores Somewhat Common	Liquor Stores Not Common	Liquor Stores Do Not Know
Bars	Bars Very Common	Bars Somewhat Common	Bars Not Common	Bars Do Not Know
Alcohol Supply in the Home (without parental permission)	Alcohol Supply in the Home (without parental permission) Very Common	Alcohol Supply in the Home (without parental permission) Somewhat Common	Alcohol Supply in the Home (without parental permission) Not Common	Alcohol Supply in the Home (without parental permission) Do Not Know
Purchased by Parents for Youth	Purchased by Parents for Youth Very Common	Purchased by Parents for Youth Somewhat Common	Purchased by Parents for Youth Not Common	Purchased by Parents for Youth Do Not Know
Underage Friends	Underage Friends Very Common	Underage Friends Somewhat Common	Underage Friends Not Common	Underage Friends Do Not Know
Purchased by Adult Family Members/Friends for Youth	Purchased by Adult Family Members/Friends for Youth Very Common	Purchased by Adult Family Members/Friends for Youth Somewhat Common	Purchased by Adult Family Members/Friends for Youth Not Common	Purchased by Adult Family Members/Friends for Youth Do Not Know
Underage Parties	Underage Parties Very Common	Underage Parties Somewhat Common	Underage Parties Not Common	Underage Parties Do Not Know
Adult Parties	Adult Parties Very Common	Adult Parties Somewhat Common	Adult Parties Not Common	Adult Parties Do Not Know
Schools	Schools Very Common	Schools Somewhat Common	Schools Not Common	Schools Do Not Know
Campgrounds	Campgrounds Very Common	Campgrounds Somewhat Common	Campgrounds Not Common	Campgrounds Do Not Know

Other (please specify)

Question Title

* 5. Based on your experience, please indicate the most common places where youth (ages 15 to 18) are getting alcohol in the community you are representing.

	Very Common	Somewhat Common	Not Common	Do Not Know
Liquor Stores	Liquor Stores Very Common	Liquor Stores Somewhat Common	Liquor Stores Not Common	Liquor Stores Do Not Know
Bars	Bars Very Common	Bars Somewhat Common	Bars Not Common	Bars Do Not Know
Alcohol Supply in the Home (without parental permission)	Alcohol Supply in the Home (without parental permission) Very Common	Alcohol Supply in the Home (without parental permission) Somewhat Common	Alcohol Supply in the Home (without parental permission) Not Common	Alcohol Supply in the Home (without parental permission) Do Not Know
Purchased by Parents for Youth	Purchased by Parents for Youth Very Common	Purchased by Parents for Youth Somewhat Common	Purchased by Parents for Youth Not Common	Purchased by Parents for Youth Do Not Know
Underage Friends	Underage Friends Very Common	Underage Friends Somewhat Common	Underage Friends Not Common	Underage Friends Do Not Know
Purchased by Adult Family Members/Friends for Youth	Purchased by Adult Family Members/Friends for Youth Very Common	Purchased by Adult Family Members/Friends for Youth Somewhat Common	Purchased by Adult Family Members/Friends for Youth Not Common	Purchased by Adult Family Members/Friends for Youth Do Not Know
Underage Parties	Underage Parties Very Common	Underage Parties Somewhat Common	Underage Parties Not Common	Underage Parties Do Not Know
Adult Parties	Adult Parties Very Common	Adult Parties Somewhat Common	Adult Parties Not Common	Adult Parties Do Not Know
School	School Very Common	School Somewhat Common	School Not Common	School Do Not Know
Campgrounds	Campgrounds Very Common	Campgrounds Somewhat Common	Campgrounds Not Common	Campgrounds Do Not Know

Other (please specify)

Question Title

* 6. Based on your experience, please indicate the most common places where youth are drinking in the community you are representing

	Very Common	Somewhat Common	Not Common	Do Not Know
Bars	Bars Very Common	Bars Somewhat Common	Bars Not Common	Bars Do Not Know
Home	Home Very Common	Home Somewhat Common	Home Not Common	Home Do Not Know
Friend’s Home	Friend’s Home Very Common	Friend’s Home Somewhat Common	Friend’s Home Not Common	Friend’s Home Do Not Know
School	School Very Common	School Somewhat Common	School Not Common	School Do Not Know
Underage Parties	Underage Parties Very Common	Underage Parties Somewhat Common	Underage Parties Not Common	Underage Parties Do Not Know
Adult Parties	Adult Parties Very Common	Adult Parties Somewhat Common	Adult Parties Not Common	Adult Parties Do Not Know
Campgrounds	Campgrounds Very Common	Campgrounds Somewhat Common	Campgrounds Not Common	Campgrounds Do Not Know
Cars	Cars Very Common	Cars Somewhat Common	Cars Not Common	Cars Do Not Know
Community Events (festivals)	Community Events (festivals) Very Common	Community Events (festivals) Somewhat Common	Community Events (festivals) Not Common	Community Events (festivals) Do Not Know
Neighborhood Parks/Woods/ Secluded Areas (If known, please note specific locations in the 'Other' section below)	Neighborhood Parks/Woods/ Secluded Areas (If known, please note specific locations in the 'Other' section below) Very Common	Neighborhood Parks/Woods/ Secluded Areas (If known, please note specific locations in the 'Other' section below) Somewhat Common	Neighborhood Parks/Woods/ Secluded Areas (If known, please note specific locations in the 'Other' section below) Not Common	Neighborhood Parks/Woods/ Secluded Areas (If known, please note specific locations in the 'Other' section below) Do Not Know
Schoolyard	Schoolyard Very Common	Schoolyard Somewhat Common	Schoolyard Not Common	Schoolyard Do Not Know
Boardwalk	Boardwalk Very Common	Boardwalk Somewhat Common	Boardwalk Not Common	Boardwalk Do Not Know
Shopping Areas	Shopping Areas Very Common	Shopping Areas Somewhat Common	Shopping Areas Not Common	Shopping Areas Do Not Know

Other (please specify)

Question Title

* 7. Based on your experience, please indicate the most common places where youth are getting non-prescribed Prescription Drugs in the community you are representing.

	Very Common	Somewhat Common	Not Common	Do Not Know
Home/Family Medicine Cabinet	Home/Family Medicine Cabinet Very Common	Home/Family Medicine Cabinet Somewhat Common	Home/Family Medicine Cabinet Not Common	Home/Family Medicine Cabinet Do Not Know
Friends	Friends Very Common	Friends Somewhat Common	Friends Not Common	Friends Do Not Know
Drug-Dealers	Drug-Dealers Very Common	Drug-Dealers Somewhat Common	Drug-Dealers Not Common	Drug-Dealers Do Not Know
Internet	Internet Very Common	Internet Somewhat Common	Internet Not Common	Internet Do Not Know
Stores	Stores Very Common	Stores Somewhat Common	Stores Not Common	Stores Do Not Know
School	School Very Common	School Somewhat Common	School Not Common	School Do Not Know
Boardwalk	Boardwalk Very Common	Boardwalk Somewhat Common	Boardwalk Not Common	Boardwalk Do Not Know

Other (please specify)

Question Title

* 8. Based on your experience, please indicate the most common places where youth are using non-prescribed Prescription Drug and Over-the-Counter Drugs in the community you are representing.

	Very Common	Somewhat Common	Not Common	Do Not Know
Home	Home Very Common	Home Somewhat Common	Home Not Common	Home Do Not Know
At a Friend's House	At a Friend's House Very Common	At a Friend's House Somewhat Common	At a Friend's House Not Common	At a Friend's House Do Not Know
School	School Very Common	School Somewhat Common	School Not Common	School Do Not Know
Neighborhood Parties	Neighborhood Parties Very Common	Neighborhood Parties Somewhat Common	Neighborhood Parties Not Common	Neighborhood Parties Do Not Know
Neighborhood Parks/Woods	Neighborhood Parks/Woods Very Common	Neighborhood Parks/Woods Somewhat Common	Neighborhood Parks/Woods Not Common	Neighborhood Parks/Woods Do Not Know
Secluded Neighborhood Areas	Secluded Neighborhood Areas Very Common	Secluded Neighborhood Areas Somewhat Common	Secluded Neighborhood Areas Not Common	Secluded Neighborhood Areas Do Not Know
Schoolyard	Schoolyard Very Common	Schoolyard Somewhat Common	Schoolyard Not Common	Schoolyard Do Not Know
Boardwalk	Boardwalk Very Common	Boardwalk Somewhat Common	Boardwalk Not Common	Boardwalk Do Not Know

Other (please specify)

Question Title

* 9. Based on your experience, please indicate the most common places where youth are getting marijuana in the community you are representing

	Very Common	Somewhat Common	Not Common	Do Not Know
Home	Home Very Common	Home Somewhat Common	Home Not Common	Home Do Not Know
Friends	Friends Very Common	Friends Somewhat Common	Friends Not Common	Friends Do Not Know
Drug-Dealers	Drug-Dealers Very Common	Drug-Dealers Somewhat Common	Drug-Dealers Not Common	Drug-Dealers Do Not Know
Schoolyard	Schoolyard Very Common	Schoolyard Somewhat Common	Schoolyard Not Common	Schoolyard Do Not Know
Boardwalk	Boardwalk Very Common	Boardwalk Somewhat Common	Boardwalk Not Common	Boardwalk Do Not Know

Other (please specify)

Question Title

* 10. Based on your experience, please indicate the most common places where youth are smoking marijuana in the community you are representing.

	Very Common	Somewhat Common	Not Common	Do Not Know
Home	Home Very Common	Home Somewhat Common	Home Not Common	Home Do Not Know
At a Friend’s House	At a Friend’s House Very Common	At a Friend’s House Somewhat Common	At a Friend’s House Not Common	At a Friend’s House Do Not Know
School	School Very Common	School Somewhat Common	School Not Common	School Do Not Know
Neighborhood Parties	Neighborhood Parties Very Common	Neighborhood Parties Somewhat Common	Neighborhood Parties Not Common	Neighborhood Parties Do Not Know
Neighborhood Parks/Woods (If known, please note specific locations in the 'Other' section below)	Neighborhood Parks/Woods (If known, please note specific locations in the 'Other' section below) Very Common	Neighborhood Parks/Woods (If known, please note specific locations in the 'Other' section below) Somewhat Common	Neighborhood Parks/Woods (If known, please note specific locations in the 'Other' section below) Not Common	Neighborhood Parks/Woods (If known, please note specific locations in the 'Other' section below) Do Not Know
Secluded Neighborhood Areas (If known, please note specific locations in the 'Other' section below)	Secluded Neighborhood Areas (If known, please note specific locations in the 'Other' section below) Very Common	Secluded Neighborhood Areas (If known, please note specific locations in the 'Other' section below) Somewhat Common	Secluded Neighborhood Areas (If known, please note specific locations in the 'Other' section below) Not Common	Secluded Neighborhood Areas (If known, please note specific locations in the 'Other' section below) Do Not Know
Cars	Cars Very Common	Cars Somewhat Common	Cars Not Common	Cars Do Not Know
Schoolyard	Schoolyard Very Common	Schoolyard Somewhat Common	Schoolyard Not Common	Schoolyard Do Not Know
Boardwalk	Boardwalk Very Common	Boardwalk Somewhat Common	Boardwalk Not Common	Boardwalk Do Not Know
Shopping Areas	Shopping Areas Very Common	Shopping Areas Somewhat Common	Shopping Areas Not Common	Shopping Areas Do Not Know

Other (please specify)

Question Title

* 11. Based on your experience, please indicate the reasons youth drink alcohol and use drugs (non-prescribed prescription drugs, marijuana, other illicit drugs) in the community you are representing.

	Major Factor	Somewhat a Factor	Not a Factor	Do Not Know
Influence of Friends /Peer Influence	Influence of Friends /Peer Influence Major Factor	Influence of Friends /Peer Influence Somewhat a Factor	Influence of Friends /Peer Influence Not a Factor	Influence of Friends /Peer Influence Do Not Know
Easy Access of Alcohol	Easy Access of Alcohol Major Factor	Easy Access of Alcohol Somewhat a Factor	Easy Access of Alcohol Not a Factor	Easy Access of Alcohol Do Not Know
Easy Access of Marijuana	Easy Access of Marijuana Major Factor	Easy Access of Marijuana Somewhat a Factor	Easy Access of Marijuana Not a Factor	Easy Access of Marijuana Do Not Know
Easy Access of Non-Prescribed Prescription Drugs	Easy Access of Non-Prescribed Prescription Drugs Major Factor	Easy Access of Non-Prescribed Prescription Drugs Somewhat a Factor	Easy Access of Non-Prescribed Prescription Drugs Not a Factor	Easy Access of Non-Prescribed Prescription Drugs Do Not Know
Lack of Parental Supervision	Lack of Parental Supervision Major Factor	Lack of Parental Supervision Somewhat a Factor	Lack of Parental Supervision Not a Factor	Lack of Parental Supervision Do Not Know
Parent Approval	Parent Approval Major Factor	Parent Approval Somewhat a Factor	Parent Approval Not a Factor	Parent Approval Do Not Know
Academic Failure	Academic Failure Major Factor	Academic Failure Somewhat a Factor	Academic Failure Not a Factor	Academic Failure Do Not Know
School Transitions (moving or changing grades)	School Transitions (moving or changing grades) Major Factor	School Transitions (moving or changing grades) Somewhat a Factor	School Transitions (moving or changing grades) Not a Factor	School Transitions (moving or changing grades) Do Not Know
Anti Social Behavior	Anti Social Behavior Major Factor	Anti Social Behavior Somewhat a Factor	Anti Social Behavior Not a Factor	Anti Social Behavior Do Not Know
Stress/Escape from everyday reality	Stress/Escape from everyday reality Major Factor	Stress/Escape from everyday reality Somewhat a Factor	Stress/Escape from everyday reality Not a Factor	Stress/Escape from everyday reality Do Not Know
Lack of information about the danger/risks	Lack of information about the danger/risks Major Factor	Lack of information about the danger/risks Somewhat a Factor	Lack of information about the danger/risks Not a Factor	Lack of information about the danger/risks Do Not Know
Curiosity about effect	Curiosity about effect Major Factor	Curiosity about effect Somewhat a Factor	Curiosity about effect Not a Factor	Curiosity about effect Do Not Know
Media (i.e. advertisements, signs, etc.)	Media (i.e. advertisements, signs, etc.) Major Factor	Media (i.e. advertisements, signs, etc.) Somewhat a Factor	Media (i.e. advertisements, signs, etc.) Not a Factor	Media (i.e. advertisements, signs, etc.) Do Not Know
Lack of community support systems (counseling, support groups, referral services)	Lack of community support systems (counseling, support groups, referral services) Major Factor	Lack of community support systems (counseling, support groups, referral services) Somewhat a Factor	Lack of community support systems (counseling, support groups, referral services) Not a Factor	Lack of community support systems (counseling, support groups, referral services) Do Not Know
Favorable Factors in the Community Environment (Please specify in ‘Other’ section below)	Favorable Factors in the Community Environment (Please specify in ‘Other’ section below) Major Factor	Favorable Factors in the Community Environment (Please specify in ‘Other’ section below) Somewhat a Factor	Favorable Factors in the Community Environment (Please specify in ‘Other’ section below) Not a Factor	Favorable Factors in the Community Environment (Please specify in ‘Other’ section below) Do Not Know
Little or no legal penalties/ consequences for drinking	Little or no legal penalties/ consequences for drinking Major Factor	Little or no legal penalties/ consequences for drinking Somewhat a Factor	Little or no legal penalties/ consequences for drinking Not a Factor	Little or no legal penalties/ consequences for drinking Do Not Know
Little or no legal penalties/ consequences for using drugs	Little or no legal penalties/ consequences for using drugs Major Factor	Little or no legal penalties/ consequences for using drugs Somewhat a Factor	Little or no legal penalties/ consequences for using drugs Not a Factor	Little or no legal penalties/ consequences for using drugs Do Not Know

Other (please specify)

Question Title

* 12. Based on your experience, please indicate the factors that contribute to the prevention of substance abuse among youth in the community you are representing.

Other (please specify)

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* 13. Based on your experience, please indicate the reasons for alcohol misuse (excessive drinking) and drug abuse among adults in the community you are representing.

Other (please specify)

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* 14. This question is for survey respondents that identified themselves as Parents/Guardians:

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree
It is okay for parents and other adults to allow underage drinking in their home.	It is okay for parents and other adults to allow underage drinking in their home. Strongly Agree	It is okay for parents and other adults to allow underage drinking in their home. Agree	It is okay for parents and other adults to allow underage drinking in their home. Undecided	It is okay for parents and other adults to allow underage drinking in their home. Disagree	It is okay for parents and other adults to allow underage drinking in their home. Strongly Disagree
It is okay to allow drinking by youth (under age 18) in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned).	It is okay to allow drinking by youth (under age 18) in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Strongly Agree	It is okay to allow drinking by youth (under age 18) in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Agree	It is okay to allow drinking by youth (under age 18) in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Undecided	It is okay to allow drinking by youth (under age 18) in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Disagree	It is okay to allow drinking by youth (under age 18) in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Strongly Disagree
It is okay to allow drinking by young adults (age 18-20) year old in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned).	It is okay to allow drinking by young adults (age 18-20) year old in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Strongly Agree	It is okay to allow drinking by young adults (age 18-20) year old in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Agree	It is okay to allow drinking by young adults (age 18-20) year old in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Undecided	It is okay to allow drinking by young adults (age 18-20) year old in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Disagree	It is okay to allow drinking by young adults (age 18-20) year old in private homes as long as it is in a controlled setting (e.g. car keys are collected, designated drivers are assigned). Strongly Disagree
I would be in favor of lowering the drinking age to 18.	I would be in favor of lowering the drinking age to 18. Strongly Agree	I would be in favor of lowering the drinking age to 18. Agree	I would be in favor of lowering the drinking age to 18. Undecided	I would be in favor of lowering the drinking age to 18. Disagree	I would be in favor of lowering the drinking age to 18. Strongly Disagree
I allow underage drinking in my home.	I allow underage drinking in my home. Strongly Agree	I allow underage drinking in my home. Agree	I allow underage drinking in my home. Undecided	I allow underage drinking in my home. Disagree	I allow underage drinking in my home. Strongly Disagree
My underage (under age 18) children drink alcohol on a regular basis (one time per month or more).	My underage (under age 18) children drink alcohol on a regular basis (one time per month or more). Strongly Agree	My underage (under age 18) children drink alcohol on a regular basis (one time per month or more). Agree	My underage (under age 18) children drink alcohol on a regular basis (one time per month or more). Undecided	My underage (under age 18) children drink alcohol on a regular basis (one time per month or more). Disagree	My underage (under age 18) children drink alcohol on a regular basis (one time per month or more). Strongly Disagree
My underage (under age 18) children drink alcohol on an occasional basis (at least once in the past year).	My underage (under age 18) children drink alcohol on an occasional basis (at least once in the past year). Strongly Agree	My underage (under age 18) children drink alcohol on an occasional basis (at least once in the past year). Agree	My underage (under age 18) children drink alcohol on an occasional basis (at least once in the past year). Undecided	My underage (under age 18) children drink alcohol on an occasional basis (at least once in the past year). Disagree	My underage (under age 18) children drink alcohol on an occasional basis (at least once in the past year). Strongly Disagree
My underage (ages 18-20) children drink alcohol on a regular basis(one time per month or more).	My underage (ages 18-20) children drink alcohol on a regular basis(one time per month or more). Strongly Agree	My underage (ages 18-20) children drink alcohol on a regular basis(one time per month or more). Agree	My underage (ages 18-20) children drink alcohol on a regular basis(one time per month or more). Undecided	My underage (ages 18-20) children drink alcohol on a regular basis(one time per month or more). Disagree	My underage (ages 18-20) children drink alcohol on a regular basis(one time per month or more). Strongly Disagree
My underage (ages 18- 20) children drink alcohol on an occasional basis (at least once in the past year).	My underage (ages 18- 20) children drink alcohol on an occasional basis (at least once in the past year). Strongly Agree	My underage (ages 18- 20) children drink alcohol on an occasional basis (at least once in the past year). Agree	My underage (ages 18- 20) children drink alcohol on an occasional basis (at least once in the past year). Undecided	My underage (ages 18- 20) children drink alcohol on an occasional basis (at least once in the past year). Disagree	My underage (ages 18- 20) children drink alcohol on an occasional basis (at least once in the past year). Strongly Disagree
I monitor the amount of alcohol in my home on a regular basis.	I monitor the amount of alcohol in my home on a regular basis. Strongly Agree	I monitor the amount of alcohol in my home on a regular basis. Agree	I monitor the amount of alcohol in my home on a regular basis. Undecided	I monitor the amount of alcohol in my home on a regular basis. Disagree	I monitor the amount of alcohol in my home on a regular basis. Strongly Disagree
I believe that alcohol is bad for the adolescent brain.	I believe that alcohol is bad for the adolescent brain. Strongly Agree	I believe that alcohol is bad for the adolescent brain. Agree	I believe that alcohol is bad for the adolescent brain. Undecided	I believe that alcohol is bad for the adolescent brain. Disagree	I believe that alcohol is bad for the adolescent brain. Strongly Disagree
I monitor and secure the prescription drug medications in my home.	I monitor and secure the prescription drug medications in my home. Strongly Agree	I monitor and secure the prescription drug medications in my home. Agree	I monitor and secure the prescription drug medications in my home. Undecided	I monitor and secure the prescription drug medications in my home. Disagree	I monitor and secure the prescription drug medications in my home. Strongly Disagree
It is okay to take someone else’s prescription drug.	It is okay to take someone else’s prescription drug. Strongly Agree	It is okay to take someone else’s prescription drug. Agree	It is okay to take someone else’s prescription drug. Undecided	It is okay to take someone else’s prescription drug. Disagree	It is okay to take someone else’s prescription drug. Strongly Disagree
Prescription drugs can be just as dangerous as street drugs.	Prescription drugs can be just as dangerous as street drugs. Strongly Agree	Prescription drugs can be just as dangerous as street drugs. Agree	Prescription drugs can be just as dangerous as street drugs. Undecided	Prescription drugs can be just as dangerous as street drugs. Disagree	Prescription drugs can be just as dangerous as street drugs. Strongly Disagree
I know where to get information on alcohol, tobacco, and other drugs.	I know where to get information on alcohol, tobacco, and other drugs. Strongly Agree	I know where to get information on alcohol, tobacco, and other drugs. Agree	I know where to get information on alcohol, tobacco, and other drugs. Undecided	I know where to get information on alcohol, tobacco, and other drugs. Disagree	I know where to get information on alcohol, tobacco, and other drugs. Strongly Disagree
I talk with my children about alcohol, tobacco, and other drugs on a regular basis (at least several times a year).	I talk with my children about alcohol, tobacco, and other drugs on a regular basis (at least several times a year). Strongly Agree	I talk with my children about alcohol, tobacco, and other drugs on a regular basis (at least several times a year). Agree	I talk with my children about alcohol, tobacco, and other drugs on a regular basis (at least several times a year). Undecided	I talk with my children about alcohol, tobacco, and other drugs on a regular basis (at least several times a year). Disagree	I talk with my children about alcohol, tobacco, and other drugs on a regular basis (at least several times a year). Strongly Disagree

Other (please specify)

	Major Problem	Sometimes a Problem	Not a Problem	Do Not Know
Underage Drinking	Underage Drinking Major Problem	Underage Drinking Sometimes a Problem	Underage Drinking Not a Problem	Underage Drinking Do Not Know
Alcohol Misuse among Adults	Alcohol Misuse among Adults Major Problem	Alcohol Misuse among Adults Sometimes a Problem	Alcohol Misuse among Adults Not a Problem	Alcohol Misuse among Adults Do Not Know
Alcohol Misuse among Senior Citizens	Alcohol Misuse among Senior Citizens Major Problem	Alcohol Misuse among Senior Citizens Sometimes a Problem	Alcohol Misuse among Senior Citizens Not a Problem	Alcohol Misuse among Senior Citizens Do Not Know
Cigarette Smoking among youth (ages: 12-14)	Cigarette Smoking among youth (ages: 12-14) Major Problem	Cigarette Smoking among youth (ages: 12-14) Sometimes a Problem	Cigarette Smoking among youth (ages: 12-14) Not a Problem	Cigarette Smoking among youth (ages: 12-14) Do Not Know
Cigarette Smoking among youth (ages: 15-18)	Cigarette Smoking among youth (ages: 15-18) Major Problem	Cigarette Smoking among youth (ages: 15-18) Sometimes a Problem	Cigarette Smoking among youth (ages: 15-18) Not a Problem	Cigarette Smoking among youth (ages: 15-18) Do Not Know
Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 12-14)	Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 12-14) Major Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 12-14) Sometimes a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 12-14) Not a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 12-14) Do Not Know
Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 15-18)	Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 15-18) Major Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 15-18) Sometimes a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 15-18) Not a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among youth (ages: 15-18) Do Not Know
Prescription Drug Abuse and Over-the-Counter Drug Abuse among adults (age 19 to 25)	Prescription Drug Abuse and Over-the-Counter Drug Abuse among adults (age 19 to 25) Major Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among adults (age 19 to 25) Sometimes a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among adults (age 19 to 25) Not a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among adults (age 19 to 25) Do Not Know
Prescription Drug Abuse and Over-the-Counter Drug Abuse among Adults	Prescription Drug Abuse and Over-the-Counter Drug Abuse among Adults Major Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among Adults Sometimes a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among Adults Not a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among Adults Do Not Know
Prescription Drug Abuse and Over-the-Counter Drug Abuse among Senior Citizens	Prescription Drug Abuse and Over-the-Counter Drug Abuse among Senior Citizens Major Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among Senior Citizens Sometimes a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among Senior Citizens Not a Problem	Prescription Drug Abuse and Over-the-Counter Drug Abuse among Senior Citizens Do Not Know
Marijuana use among youth (ages: 12-14)	Marijuana use among youth (ages: 12-14) Major Problem	Marijuana use among youth (ages: 12-14) Sometimes a Problem	Marijuana use among youth (ages: 12-14) Not a Problem	Marijuana use among youth (ages: 12-14) Do Not Know
Marijuana use among youth (ages: 15-18)	Marijuana use among youth (ages: 15-18) Major Problem	Marijuana use among youth (ages: 15-18) Sometimes a Problem	Marijuana use among youth (ages: 15-18) Not a Problem	Marijuana use among youth (ages: 15-18) Do Not Know
Marijuana use among adults (age 19 and older)	Marijuana use among adults (age 19 and older) Major Problem	Marijuana use among adults (age 19 and older) Sometimes a Problem	Marijuana use among adults (age 19 and older) Not a Problem	Marijuana use among adults (age 19 and older) Do Not Know
Use of inhalants among youth (ages: 12-14)	Use of inhalants among youth (ages: 12-14) Major Problem	Use of inhalants among youth (ages: 12-14) Sometimes a Problem	Use of inhalants among youth (ages: 12-14) Not a Problem	Use of inhalants among youth (ages: 12-14) Do Not Know
Use of inhalants among youth (ages: 15-18)	Use of inhalants among youth (ages: 15-18) Major Problem	Use of inhalants among youth (ages: 15-18) Sometimes a Problem	Use of inhalants among youth (ages: 15-18) Not a Problem	Use of inhalants among youth (ages: 15-18) Do Not Know
Use of steroids among youth (ages: 12-14)	Use of steroids among youth (ages: 12-14) Major Problem	Use of steroids among youth (ages: 12-14) Sometimes a Problem	Use of steroids among youth (ages: 12-14) Not a Problem	Use of steroids among youth (ages: 12-14) Do Not Know
Use of steroids among youth (ages: 15-18)	Use of steroids among youth (ages: 15-18) Major Problem	Use of steroids among youth (ages: 15-18) Sometimes a Problem	Use of steroids among youth (ages: 15-18) Not a Problem	Use of steroids among youth (ages: 15-18) Do Not Know
Heroin use among youth (ages: 15-18)	Heroin use among youth (ages: 15-18) Major Problem	Heroin use among youth (ages: 15-18) Sometimes a Problem	Heroin use among youth (ages: 15-18) Not a Problem	Heroin use among youth (ages: 15-18) Do Not Know
Heroin use among adults (age 19 to 25)	Heroin use among adults (age 19 to 25) Major Problem	Heroin use among adults (age 19 to 25) Sometimes a Problem	Heroin use among adults (age 19 to 25) Not a Problem	Heroin use among adults (age 19 to 25) Do Not Know
Heroin use among adults (over age 25)	Heroin use among adults (over age 25) Major Problem	Heroin use among adults (over age 25) Sometimes a Problem	Heroin use among adults (over age 25) Not a Problem	Heroin use among adults (over age 25) Do Not Know
Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 12-14)	Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 12-14) Major Problem	Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 12-14) Sometimes a Problem	Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 12-14) Not a Problem	Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 12-14) Do Not Know
Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 15-18)	Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 15-18) Major Problem	Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 15-18) Sometimes a Problem	Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 15-18) Not a Problem	Use of ‘Bath Salts’ (amphetamine style drugs) among youth (ages: 15-18) Do Not Know
Use of Synthetic Marijuana among youth (ages: 12-14)	Use of Synthetic Marijuana among youth (ages: 12-14) Major Problem	Use of Synthetic Marijuana among youth (ages: 12-14) Sometimes a Problem	Use of Synthetic Marijuana among youth (ages: 12-14) Not a Problem	Use of Synthetic Marijuana among youth (ages: 12-14) Do Not Know
Use of Synthetic Marijuana among youth (ages: 15-18)	Use of Synthetic Marijuana among youth (ages: 15-18) Major Problem	Use of Synthetic Marijuana among youth (ages: 15-18) Sometimes a Problem	Use of Synthetic Marijuana among youth (ages: 15-18) Not a Problem	Use of Synthetic Marijuana among youth (ages: 15-18) Do Not Know
Other Illicit Drug Use among youth (ages: 15-18)	Other Illicit Drug Use among youth (ages: 15-18) Major Problem	Other Illicit Drug Use among youth (ages: 15-18) Sometimes a Problem	Other Illicit Drug Use among youth (ages: 15-18) Not a Problem	Other Illicit Drug Use among youth (ages: 15-18) Do Not Know
Other Illicit Drug Use among Adults (age 19 to 25)	Other Illicit Drug Use among Adults (age 19 to 25) Major Problem	Other Illicit Drug Use among Adults (age 19 to 25) Sometimes a Problem	Other Illicit Drug Use among Adults (age 19 to 25) Not a Problem	Other Illicit Drug Use among Adults (age 19 to 25) Do Not Know
Other Illicit Drug Use among Adults (over age 25)	Other Illicit Drug Use among Adults (over age 25) Major Problem	Other Illicit Drug Use among Adults (over age 25) Sometimes a Problem	Other Illicit Drug Use among Adults (over age 25) Not a Problem	Other Illicit Drug Use among Adults (over age 25) Do Not Know

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* 1. For purposes of this survey, please check the box that best describes the community you are representing:Note: If you are representing a school that accepts students from more than one municipality, please check only the municipality in which the school is located.

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* 2. For the purpose of this survey, please check the box that best describes your role/affiliation in the community you are representing:

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* 3. Based on your experience, please indicate the prevalence of substance abuse in the community you are representing:

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* 4. Based on your experience, please indicate the most common places where youth (ages 12 to 14) are getting alcohol in the community you are representing.

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* 5. Based on your experience, please indicate the most common places where youth (ages 15 to 18) are getting alcohol in the community you are representing.

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* 6. Based on your experience, please indicate the most common places where youth are drinking in the community you are representing

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* 7. Based on your experience, please indicate the most common places where youth are getting non-prescribed Prescription Drugs in the community you are representing.

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* 8. Based on your experience, please indicate the most common places where youth are using non-prescribed Prescription Drug and Over-the-Counter Drugs in the community you are representing.

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* 9. Based on your experience, please indicate the most common places where youth are getting marijuana in the community you are representing

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* 10. Based on your experience, please indicate the most common places where youth are smoking marijuana in the community you are representing.

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* 11. Based on your experience, please indicate the reasons youth drink alcohol and use drugs (non-prescribed prescription drugs, marijuana, other illicit drugs) in the community you are representing.

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* 12. Based on your experience, please indicate the factors that contribute to the prevention of substance abuse among youth in the community you are representing.

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* 13. Based on your experience, please indicate the reasons for alcohol misuse (excessive drinking) and drug abuse among adults in the community you are representing.

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* 14. This question is for survey respondents that identified themselves as Parents/Guardians:

* 1. For purposes of this survey, please check the box that best describes the community you are representing:

Note: If you are representing a school that accepts students from more than one municipality, please check only the municipality in which the school is located.