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* 1. In what grade(s) do you have children?

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* 2. What school do your children attend?

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* 3. My child is involved in: (select all that apply)

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* 4. Knowledge about Youth Substance Use

  Strongly Agree Agree Neither Agree Nor Disagree Disagree Strongly Disagree
Students moving from middle school to high school are at a greater risk of alcohol, tobacco and drug use.
Students are less likely to use alcohol, tobacco and drugs if they think their parents disapprove.
Students are less likely to use alcohol, tobacco and other drugs if they believe school is important.
Are you aware of the efforts by the Wilkin County Youth and Community Coalition to prevent youth from initiating in alcohol, tobacco and other drug use?

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* 5. I believe youth, in general, have had a drink of alcohol in the past year (not including religious purposes).

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* 6. I believe during the last 30 days, youth, in general, have had at least one drink of alcohol (not including religious purposes).

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* 7. On average, in the last 30 days, on how many days do you think youth, in general, had 5 or more drinks in a row?

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* 8. In the last 30 days what do you believe youth, in general, have drank?

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* 9. Where do you believe that teens, in general, get alcohol? (check all that apply)

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* 10. Where do you believe youth, in general, use alcohol? (check all that apply)

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* 11. I believe it is okay for youth, in general, to drink beer, wine, or hard liquor under the age of 21 without their parents' permission?

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* 12. I believe it is harmful for those under the age of 21 to drink alcohol.

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* 13. In your neighborhood or community, how difficult do you think it would be for youth, in general, to get alcoholic beverages?

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* 14. I believe parents in my community are hosting parties for youths where alcohol is provided.

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* 15. I believe that it is okay for a parent to host a party and provide the alcohol for teens under the age of 21, as long as the teens are not driving.

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* 16. If you believe your child has been to a party where alcohol is present, do you believe your child used alcohol at this party?

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* 17. Alcohol use by those under 21, in general, is OKAY, as long as they remain at home under parental supervision and do not drive under the influence.

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* 18. Would you approve of your child using alcohol if they were in your home under your supervision?

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* 19. As a parent, allowing your child and their friends to drink alcohol at your home:

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* 20. How concerned would you be if you found out your child drank alcohol regularly (3-4 times a month).

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* 21. I believe youth, in general, have used marijuana in the past year.

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* 22. I believe during the last 30 days youth, in general, have used marijuana.

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* 23. On average, in the last 30 days, on how many days do you think youth, in general, have used marijuana?

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* 24. How wrong do you feel it would be for youth, in general, to use marijuana?

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* 25. Where do you believe youth obtain marijuana from? (check all that apply)

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* 26. Where do you believe youth, in general, use marijuana? (check all that apply)

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* 27. In your neighborhood or community, how difficult do you think it would be for youth to get marijuana?

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* 28. Do you feel it would be wrong for youths to go to a party where kids were using marijuana?

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* 29. I believe it is harmful for youth to use marijuana.

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* 30. If you believe your child has been to a party where marijuana is present, do you believe your child used marijuana at this party?

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* 31. I believe marijuana use is okay under the following conditions:

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* 32. I believe there should be restrictions on marijuana if it legally were to change such as:(check all that apply)

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* 33. I believe youth, in general, have used tobacco in the past year.

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* 34. I believe during the last 30 days youth, in general, have used tobacco.

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* 35. How wrong do you feel it would be for youth, in general, to use tobacco?

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* 36. In your neighborhood or community, how difficult do you think it would be for youth to get tobacco?

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* 37. I believe youth, in general, have used prescription drugs not prescribed to them in the past year.

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* 38. I believe youth, in general, have used prescription medication not prescribed to them in the past 30 days.

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* 39. In your neighborhood or community, how difficult do you think it would be for you to get prescription drugs?

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* 40. I talk to my child regularly about the dangers of alcohol and other drugs.

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* 41. I set and enforce clear rules regarding alcohol and other drugs with my child.

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* 42. Parent to Parent Communication

  Always Often Sometimes Seldom Never
When my child is not at home, I know where he/she is and whom he/she is with.
I feel comfortable calling my child's friend's parents to discuss what adults will be present, where will teh youth be going or what they will be doing when at their home.
I feel comfortable calling my child's friend's parents to discuss alcohol, cigarette or drug use in their when my child is there.
I would want another parent to call me and let me know if my child has been drinking, smoking or doing drugs.
I would call another parent and let them know if their child has been drinking, smoking, or doing drugs.

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* 43. In order to prevent alcohol and drug use among teens in our community, I feel the following groups could do more.(check all that apply)

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* 44. Parent Child Communication

  Strongly Agree Agree Disagree Strongly Disagree
I find it difficult to talk to my child about alcohol and drugs.
I wish I was better equipped to talk to my child about substance use.

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* 45. In order to educate your child about drugs (alcohol), what information do you need?

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* 46. Each school districts emails the Wilkin County Youth and Community Coalition newsletter quarterly, do you:

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* 47. Rate how much you agree with the following statements about the We Care campaign:

  Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
I am aware of the efforts by the Wilkin County Youth and Family Coalition to prevent youth from initiating in alcohol, tobacco and other drug use.
I have heard of the We Care campaign.
I believe the messages given as part of the We Care campaign are effective.
I believe the We Care campaign makes a difference in our community.

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* 48. I would be be more likely to read the Wilkin County Youth and Community Coalition newsletter if was sent to to me in a paper format.

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* 49. I believe there are caring adults in my child's life, other than myself.

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* 50. I believe there are adults my child can talk to, other than myself.

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