Substance Misuse - Community Survey
Thank you for participating in this survey! Please answer the questions as best as you can, based on what you know about your community. The survey should take approximately 5-10 minutes to complete.
ALL ANSWERS ARE STRICTLY CONFIDENTIAL

Demographics
What is the zip code you currently live or work in? *
Which zip code did you enter? *
Gender *
What is your race / ethnicity (Check all that apply)? *
Required
Age range *
Please answer the following questions to the best of your knowledge
How much of a PROBLEM in YOUTH (UNDER 18 years of age)? *
Not a problem
Slight problem
Moderate problem
Severe problem
Not sure
How much of a problem is prescription medication abuse or misuse (Fentanyl, Percocet, Xanax, Oxy, Adderall, etc.) in your community?
How much of a problem is alcohol abuse in your community?
How much of a problem is underage drinking (under 21 years of age) in your community?
How much of a problem is cocaine / crack usage in your community?
How much of a problem is methamphetamine usage in your community?
How much of a problem is heroin usage in your community?
How much of a problem is marijuana usage in your community?
From the question above, how much is vaping marijuana a problem?
How much is smoking leaf marijuana a problem?
How much of a problem are marijuana edibles?
How much of a problem is other illegal drug usage (hallucinogen, inhalants, ecstasy, etc.) in your community?
How much of a PROBLEM in ADULTS (OVER 18 years of age)? *
Not a problem
Slight problem
Moderate problem
Severe problem
Not sure
How much of a problem is prescription medication abuse or misuse (Fentanyl, Percocet, Xanax, Oxy, Adderall, etc.) in your community?
How much of a problem is alcohol abuse in your community?
How much of a problem is cocaine / crack usage in your community?
How much of a problem is methamphetamine usage in your community?
How much of a problem is heroin usage in your community?
How much of a problem is marijuana usage in your community?
From the question above, how much is vaping marijuana a problem?
How much is smoking leaf marijuana a problem?
How much of a problem are marijuana edibles?
How much of a problem is other illegal drug usage (hallucinogen, inhalants, ecstasy, etc.) in your community?
How much of a RISK in YOUTH (UNDER 18 years of age)? *
Not a risk
Slight risk
Moderate risk
Severe risk
Not sure
How much do you think people risk harming / hurting themselves if they use prescription medications without a doctor telling them to take them?
How much do you think people risk harming / hurting themselves if they abuse alcohol?
How much do you think people risk harming / hurting themselves if they abuse illegal drugs?
How much of a RISK in ADULTS (OVER 18 years of age)? *
Not a risk
Slight risk
Moderate risk
Severe risk
Not sure
How much do you think people risk harming/hurting themselves if they use prescription medications without a doctor telling them to take them?
How much do you think people risk harming/hurting themselves if they abuse alcohol?
How much do you think people risk harming/hurting themselves if they abuse illegal drugs?
Are you aware of any messages (billboards, radio and TV announcements, etc.) addressing the following? *
YES
NO
Safeguarding prescription medications in the home
Information about the harmful effects of using other people’s medications
Advertisements for medical marijuana use
Advertisements for alcohol consumption
Information about drug addiction treatment
Information about alcohol addiction treatment
If you answered yes to any of the above, where did you see or hear the messages (check all that apply)? *
Required
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