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Note: Only complete this survey if you  are 18 years of age or older and currently live, work, or go to school in Potter County.

Please answer ALL questions. The survey is anonymous - there are no questions that identify who you are. We use the results of this survey to to help identify issues related to drug and alcohol use in our community so that we might better address these issues. 

Thank you for helping us collect this valuable information needed to improve our services.

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1. What is your current age?

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2. What is your gender?

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3. What is your race:

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4. In what school district do you live?

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5. Are you currently receiving Drug & Alcohol Services?

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6. Are you currently in recovery?

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7. Do you have friends and/or family members you can depend on?

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8. Do you generally feel hopeful about the future?

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9. Do you often feel anxious, sad, depressed, or hopeless?

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10. Think back over the past month, How many times (if any) have you had 5 or more drinks of an alcoholic beverage (beer, wine, or liquor) during a short period of time (2 hours or less)?

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11. Have you used marijuana at any time during the past month?

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12. Have you used marijuana in a vaping device at any time in the past year?

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13. Based on your personal experience or what you hear in the community from others, do you think vaping marijuana is more or less common than vaping tobacco?

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14. How easy do you think it is to obtain marijuana or THC in a form that can be used in a vaping device?

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15. Do you think marijuana should be legalized for recreational use?

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16. How wrong do you think it is for youth under 18 yrs. of age to drink alcoholic beverages?

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17. Do you think the social norms (generally accepted conduct) encourage underage youth to drink alcoholic beverages?

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18. Have you ever smoked cigarettes?

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19. Do you currently use a vaping device (e-cigarettes or other devices that heat a small quantity of liquid to produce a vapor that is inhaled)?

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20. Do you think using e-cigarettes pose less of risk to your health than smoking traditional cigarettes?

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21. How concerned are you about young people using a vaping device (e-cigarettes or other devices that heat a small quantity of liquid to produce a vapor that is inhaled)?

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22. Do any teenagers who live in your home use a vaping device with your permission?

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23. Do you think it is OK for youth under 18 yrs. of age to use a vaping device if they are only vaping  juice or flavored water?

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24. How much do you think young people risk harming themselves (physically or in other ways) if they use a vaping device regularly (several times a week)

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25. How wrong do you think it is for youth under 18 yrs. of age to use a vaping device regularly?

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26. If you wanted to get methamphetamine (meth), how easy do you think it would be for you to get some?

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27. Do you personally know of one or more sources or locations where people may obtain methamphetamine?

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28. Do you personally know someone who uses methamphetamine regularly?

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29. If you know someone who is using methamphetamine, are you concerned about them?

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30. Have you personally used methamphetamine at any time during the past 30 days?

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31. Have you ever used methamphetamine at any time in the past year?

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32. How much do you think people risk harming themselves (physically or otherwise) if they use methamphetamine?

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33. Have you heard anything about people in your community using methamphetamine that was mixed with other drugs (fentanyl, heroin, etc.)?

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34. How wrong do you think it is if people in your local community use methamphetamine regularly?

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35. Which of the substances (drugs) listed below do you believe present the biggest problem in Potter County? Check no more than 3 substances you believe are the most problematic.

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