1) Age Group: |
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3) Ages of children:
(Please seperate multiple ages with a comma.) |
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5) Alcohol use among young people in our community is: |
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6) Marijuana use among young people in our community is: |
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7) Prescription drug abuse among people in our community is: |
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8) Other drug use among young people in our community is: |
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9) Alcoholic beverages served to young people in their own home is: |
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10) Alcoholic beverages served to young people at teenage parties in our community is: |
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11) The illegal sale of alcoholic beverages to young people in local stores and bars in our community is: |
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12) It is common practice for parents of teenagers in my community to call the host parent to confirm party arrangements: |
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13) When teenagers attend parties in my home, there is adult supervision: |
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14) When teenagers attend parties in other homes, there is adult supervision: |
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15) The legal age to sell or serve alcoholic beverages should be: |
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16) I favor the legalization of marijuana use for: |
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17) Do/did you have enough information to help you discuss alcohol and other drug use with your children? |
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18) Do/did you talk with your children about alcohol and other drugs? |
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19) In communicating with other parents, how many of them seem to set the same alcohol and drug use rules and limitations for their children as you? |
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20) One or more members of my family have problems with alcohol or other drug abuse. |
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21) In the last 12 months, my personal knowledge of the risk factors that contribute to alcohol and other drug abuse has: |
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22) In the last 12 months, my personal knowledge of community programs that address alcohol and drug abuse has: |
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23) In the last 12 months, my personal concern for preventing alcohol and other drug abuse in my community has: |
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24) I am aware of specific programs in local schools which address alcohol and other drug abuse prevention. |
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25) I am aware of specific programs offered to employees and their families in the workplace which address alcohol and other drug abuse prevention. |
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| 26) What kind of information would you like to help you talk with your children? (mark all that apply) |
effects of use
symptoms of drug use
trafficking and use patterns
treatment available
the laws
why kids take drugs
how you can help them say no
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27) Would dialogue with other parents on alcohol and other drugs, as well as related subjects, be helpful to you? |
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28) Would you be willing to join a community-wide coalition, consisting of parents, students, school personnel, and other community members, to help stop drug abuse in your community? |
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