CCP Wichita Falls

This is an anonymous assessment. Answer every question to the best of your ability.
Thank you for your participation!

Todays Date

Age

Gender

Female
Male
Other

Have you taken this questionnaire within this year?

drug zip it

What is your zip code where you live?

How much of a problem do you think each of the following are in our community?

	Not a problem	A minor problem	A moderate problem	A serious problem	Don't know
Alcohol use	Not a problemAlcohol use Not a problem	A minor problemAlcohol use A minor problem	A moderate problemAlcohol use A moderate problem	A serious problemAlcohol use A serious problem	Don't knowAlcohol use Don't know
Cannabis/Marijuana use	Not a problemCannabis/Marijuana use Not a problem	A minor problemCannabis/Marijuana use A minor problem	A moderate problemCannabis/Marijuana use A moderate problem	A serious problemCannabis/Marijuana use A serious problem	Don't knowCannabis/Marijuana use Don't know
Prescription drug use (using medication without a prescription or in a way other than prescribed)	Not a problemPrescription drug use (using medication without a prescription or in a way other than prescribed) Not a problem	A minor problemPrescription drug use (using medication without a prescription or in a way other than prescribed) A minor problem	A moderate problemPrescription drug use (using medication without a prescription or in a way other than prescribed) A moderate problem	A serious problemPrescription drug use (using medication without a prescription or in a way other than prescribed) A serious problem	Don't knowPrescription drug use (using medication without a prescription or in a way other than prescribed) Don't know
Tobacco use (traditional)	Not a problemTobacco use (traditional) Not a problem	A minor problemTobacco use (traditional) A minor problem	A moderate problemTobacco use (traditional) A moderate problem	A serious problemTobacco use (traditional) A serious problem	Don't knowTobacco use (traditional) Don't know
E-cigarettes or other electronic vapor products	Not a problemE-cigarettes or other electronic vapor products Not a problem	A minor problemE-cigarettes or other electronic vapor products A minor problem	A moderate problemE-cigarettes or other electronic vapor products A moderate problem	A serious problemE-cigarettes or other electronic vapor products A serious problem	Don't knowE-cigarettes or other electronic vapor products Don't know
Driving under the influence of alcohol	Not a problemDriving under the influence of alcohol Not a problem	A minor problemDriving under the influence of alcohol A minor problem	A moderate problemDriving under the influence of alcohol A moderate problem	A serious problemDriving under the influence of alcohol A serious problem	Don't knowDriving under the influence of alcohol Don't know
Driving under the influence of cannabis/marijuana	Not a problemDriving under the influence of cannabis/marijuana Not a problem	A minor problemDriving under the influence of cannabis/marijuana A minor problem	A moderate problemDriving under the influence of cannabis/marijuana A moderate problem	A serious problemDriving under the influence of cannabis/marijuana A serious problem	Don't knowDriving under the influence of cannabis/marijuana Don't know
Depression	Not a problemDepression Not a problem	A minor problemDepression A minor problem	A moderate problemDepression A moderate problem	A serious problemDepression A serious problem	Don't knowDepression Don't know
Suicide	Not a problemSuicide Not a problem	A minor problemSuicide A minor problem	A moderate problemSuicide A moderate problem	A serious problemSuicide A serious problem	Don't knowSuicide Don't know
Bullying	Not a problemBullying Not a problem	A minor problemBullying A minor problem	A moderate problemBullying A moderate problem	A serious problemBullying A serious problem	Don't knowBullying Don't know
Bullying on social media	Not a problemBullying on social media Not a problem	A minor problemBullying on social media A minor problem	A moderate problemBullying on social media A moderate problem	A serious problemBullying on social media A serious problem	Don't knowBullying on social media Don't know

If youth wanted to get some alcohol, how easy would it be for them to get some?

	Very easy	Sort of easy	Sort of hard	Very hard	Don't know
Middle School youth (6-8 grade)	Very easyMiddle School youth (6-8 grade) Very easy	Sort of easyMiddle School youth (6-8 grade) Sort of easy	Sort of hardMiddle School youth (6-8 grade) Sort of hard	Very hardMiddle School youth (6-8 grade) Very hard	Don't knowMiddle School youth (6-8 grade) Don't know
High School youth (9-12 grade)	Very easyHigh School youth (9-12 grade) Very easy	Sort of easyHigh School youth (9-12 grade) Sort of easy	Sort of hardHigh School youth (9-12 grade) Sort of hard	Very hardHigh School youth (9-12 grade) Very hard	Don't knowHigh School youth (9-12 grade) Don't know

How much do you think people risk harming themselves when they drive...

	No risk	Slight risk	Moderate risk	High risk	Don't know
Under the influence of alcohol	No riskUnder the influence of alcohol No risk	Slight riskUnder the influence of alcohol Slight risk	Moderate riskUnder the influence of alcohol Moderate risk	High riskUnder the influence of alcohol High risk	Don't knowUnder the influence of alcohol Don't know
Under the influence of cannabis/marijuana	No riskUnder the influence of cannabis/marijuana No risk	Slight riskUnder the influence of cannabis/marijuana Slight risk	Moderate riskUnder the influence of cannabis/marijuana Moderate risk	High riskUnder the influence of cannabis/marijuana High risk	Don't knowUnder the influence of cannabis/marijuana Don't know

If youth wanted to get some cannabis/marijuana how easy would it be for them to get some?

	Very easy	Sort of easy	Sort of hard	Very hard	Don't know
Middle School youth (6-8 grade)	Very easyMiddle School youth (6-8 grade) Very easy	Sort of easyMiddle School youth (6-8 grade) Sort of easy	Sort of hardMiddle School youth (6-8 grade) Sort of hard	Very hardMiddle School youth (6-8 grade) Very hard	Don't knowMiddle School youth (6-8 grade) Don't know
High School youth (9-12 grade)	Very easyHigh School youth (9-12 grade) Very easy	Sort of easyHigh School youth (9-12 grade) Sort of easy	Sort of hardHigh School youth (9-12 grade) Sort of hard	Very hardHigh School youth (9-12 grade) Very hard	Don't knowHigh School youth (9-12 grade) Don't know

What level of risk are youth taking if they try cannabis/marijuana once or twice?

	No risk	Slight risk	Moderate risk	High risk	Don't know
Middle School youth (6-8 grade)	No riskMiddle School youth (6-8 grade) No risk	Slight riskMiddle School youth (6-8 grade) Slight risk	Moderate riskMiddle School youth (6-8 grade) Moderate risk	High riskMiddle School youth (6-8 grade) High risk	Don't knowMiddle School youth (6-8 grade) Don't know
High School youth (9-12 grade)	No riskHigh School youth (9-12 grade) No risk	Slight riskHigh School youth (9-12 grade) Slight risk	Moderate riskHigh School youth (9-12 grade) Moderate risk	High riskHigh School youth (9-12 grade) High risk	Don't knowHigh School youth (9-12 grade) Don't know

What level of risk are youth taking if they try cannabis/marijuana regularly? (once or twice a week)

	No risk	Slight risk	Moderate risk	High risk	Don't know
Middle School youth (6-8 grade)	No riskMiddle School youth (6-8 grade) No risk	Slight riskMiddle School youth (6-8 grade) Slight risk	Moderate riskMiddle School youth (6-8 grade) Moderate risk	High riskMiddle School youth (6-8 grade) High risk	Don't knowMiddle School youth (6-8 grade) Don't know
High School youth (9-12 grade)	No riskHigh School youth (9-12 grade) No risk	Slight riskHigh School youth (9-12 grade) Slight risk	Moderate riskHigh School youth (9-12 grade) Moderate risk	High riskHigh School youth (9-12 grade) High risk	Don't knowHigh School youth (9-12 grade) Don't know

How much do you think youth are harming themselves if they use prescription drugs that are not prescribed to them?

	No risk	Slight risk	Moderate risk	High risk	Don't know
Middle School youth (6-8 grade)	No riskMiddle School youth (6-8 grade) No risk	Slight riskMiddle School youth (6-8 grade) Slight risk	Moderate riskMiddle School youth (6-8 grade) Moderate risk	High riskMiddle School youth (6-8 grade) High risk	Don't knowMiddle School youth (6-8 grade) Don't know
High School youth (9-12 grade)	No riskHigh School youth (9-12 grade) No risk	Slight riskHigh School youth (9-12 grade) Slight risk	Moderate riskHigh School youth (9-12 grade) Moderate risk	High riskHigh School youth (9-12 grade) High risk	Don't knowHigh School youth (9-12 grade) Don't know

Do you think it is OK for youth to drink at parties as long as they don't get drunk?

	Yes	No	Yes, but only on special occasions
Middle School youth (6-8 grade)	YesMiddle School youth (6-8 grade) Yes	NoMiddle School youth (6-8 grade) No	Yes, but only on special occasionsMiddle School youth (6-8 grade) Yes, but only on special occasions
High School youth (9-12 grade)	YesHigh School youth (9-12 grade) Yes	NoHigh School youth (9-12 grade) No	Yes, but only on special occasionsHigh School youth (9-12 grade) Yes, but only on special occasions

Do you think it is OK for parents to offer their children alcoholic beverages in their homes?

	Yes	No	Yes, but only on special occasions
Middle School youth (6-8 grade)	YesMiddle School youth (6-8 grade) Yes	NoMiddle School youth (6-8 grade) No	Yes, but only on special occasionsMiddle School youth (6-8 grade) Yes, but only on special occasions
High School youth (9-12 grade)	YesHigh School youth (9-12 grade) Yes	NoHigh School youth (9-12 grade) No	Yes, but only on special occasionsHigh School youth (9-12 grade) Yes, but only on special occasions

Do you think most adults in our community feel it is OK for parents to offer their children alcoholic beverages in their home?

	Yes	No	Yes, but only on special occasions
Middle School youth (6-8 grade)	YesMiddle School youth (6-8 grade) Yes	NoMiddle School youth (6-8 grade) No	Yes, but only on special occasionsMiddle School youth (6-8 grade) Yes, but only on special occasions
High School youth (9-12 grade)	YesHigh School youth (9-12 grade) Yes	NoHigh School youth (9-12 grade) No	Yes, but only on special occasionsHigh School youth (9-12 grade) Yes, but only on special occasions

Where do you think youth usually get prescription drugs not prescribed to them by a doctor?

	Home	Friends	Family outside the home	Buying them	Not sure
Location	HomeLocation Home	FriendsLocation Friends	Family outside the homeLocation Family outside the home	Buying themLocation Buying them	Not sureLocation Not sure

If you currently have prescription medication at your home, where is the medication usually kept?

	Hidden	Locked up	Neither	Both (hidden and locked up)	N/A
Location	HiddenLocation Hidden	Locked upLocation Locked up	NeitherLocation Neither	Both (hidden and locked up)Location Both (hidden and locked up)	N/ALocation N/A

There is a group of volunteers in your community who are working to reduce youth alcohol and other drug use. Are you aware of this group/coalition

Are you the parent or guardian with any children in 6th-12th grade?

If NO, you have completed this survey, skip to the end and hit submit.

Parents/Guardians please answer the following questions based on the school grade of your child/children. If you have children in both middle and high school, please respond to both categories provided.

	Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)
I have not talked with my child about alcohol use in the last three months.	Your Middle School youth (6th–8th grade)I have not talked with my child about alcohol use in the last three months. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I have not talked with my child about alcohol use in the last three months. Your High School youth (9th–12th grade)
I have told my child that alcohol is not OK and they will receive consequences if they drink.	Your Middle School youth (6th–8th grade)I have told my child that alcohol is not OK and they will receive consequences if they drink. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I have told my child that alcohol is not OK and they will receive consequences if they drink. Your High School youth (9th–12th grade)
I told my child it is OK for him/her to have a few drinks on a special occasion.	Your Middle School youth (6th–8th grade)I told my child it is OK for him/her to have a few drinks on a special occasion. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I told my child it is OK for him/her to have a few drinks on a special occasion. Your High School youth (9th–12th grade)
I told my child about the risks of underage drinking and they should not drink.	Your Middle School youth (6th–8th grade)I told my child about the risks of underage drinking and they should not drink. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I told my child about the risks of underage drinking and they should not drink. Your High School youth (9th–12th grade)
I told my child that even though they are less than 21, they will have to decide for themselves whether or not to drink alcohol.	Your Middle School youth (6th–8th grade)I told my child that even though they are less than 21, they will have to decide for themselves whether or not to drink alcohol. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I told my child that even though they are less than 21, they will have to decide for themselves whether or not to drink alcohol. Your High School youth (9th–12th grade)

Which statement BEST describes the conversation you have had with your child about cannabis/marijuana use in the last 3 months? (Select the one statement that applies for your middle and/or high school aged child/children in the specific grade) (copy)

	Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)
I have not talked with my child about cannabis use in the last three months.	Your Middle School youth (6th–8th grade)I have not talked with my child about cannabis use in the last three months. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I have not talked with my child about cannabis use in the last three months. Your High School youth (9th–12th grade)
I have told my child that cannabis is NOT ok and they will receive consequences if they use/consume it.	Your Middle School youth (6th–8th grade)I have told my child that cannabis is NOT ok and they will receive consequences if they use/consume it. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I have told my child that cannabis is NOT ok and they will receive consequences if they use/consume it. Your High School youth (9th–12th grade)
I told my child about the risks of youth using cannabis and they should not eat, smoke, or use it any way.	Your Middle School youth (6th–8th grade)I told my child about the risks of youth using cannabis and they should not eat, smoke, or use it any way. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I told my child about the risks of youth using cannabis and they should not eat, smoke, or use it any way. Your High School youth (9th–12th grade)
I told my child that even though they are less than 21, they will have to decide for themselves whether or not to use cannabis.	Your Middle School youth (6th–8th grade)I told my child that even though they are less than 21, they will have to decide for themselves whether or not to use cannabis. Your Middle School youth (6th–8th grade)	Your High School youth (9th–12th grade)I told my child that even though they are less than 21, they will have to decide for themselves whether or not to use cannabis. Your High School youth (9th–12th grade)

	Never	Rarely	Sometimes	Very often	Always
Ask who they will be with?	NeverAsk who they will be with? Never	RarelyAsk who they will be with? Rarely	SometimesAsk who they will be with? Sometimes	Very oftenAsk who they will be with? Very often	AlwaysAsk who they will be with? Always
Ask where they are going?	NeverAsk where they are going? Never	RarelyAsk where they are going? Rarely	SometimesAsk where they are going? Sometimes	Very oftenAsk where they are going? Very often	AlwaysAsk where they are going? Always
If my child is attending a party, check to see if the party will have adult supervision	NeverIf my child is attending a party, check to see if the party will have adult supervision Never	RarelyIf my child is attending a party, check to see if the party will have adult supervision Rarely	SometimesIf my child is attending a party, check to see if the party will have adult supervision Sometimes	Very oftenIf my child is attending a party, check to see if the party will have adult supervision Very often	AlwaysIf my child is attending a party, check to see if the party will have adult supervision Always
Check to see if your child is under the influence of alcohol or drugs? (talk with them, smell breath, check eyes...)	NeverCheck to see if your child is under the influence of alcohol or drugs? (talk with them, smell breath, check eyes...) Never	RarelyCheck to see if your child is under the influence of alcohol or drugs? (talk with them, smell breath, check eyes...) Rarely	SometimesCheck to see if your child is under the influence of alcohol or drugs? (talk with them, smell breath, check eyes...) Sometimes	Very oftenCheck to see if your child is under the influence of alcohol or drugs? (talk with them, smell breath, check eyes...) Very often	AlwaysCheck to see if your child is under the influence of alcohol or drugs? (talk with them, smell breath, check eyes...) Always
Set a time for your child to be home?	NeverSet a time for your child to be home? Never	RarelySet a time for your child to be home? Rarely	SometimesSet a time for your child to be home? Sometimes	Very oftenSet a time for your child to be home? Very often	AlwaysSet a time for your child to be home? Always
Wait up until your child comes home?	NeverWait up until your child comes home? Never	RarelyWait up until your child comes home? Rarely	SometimesWait up until your child comes home? Sometimes	Very oftenWait up until your child comes home? Very often	AlwaysWait up until your child comes home? Always

	Not at all wrong	A little bit wrong	Wrong	Very wrong	Don't know
To use alcohol	Not at all wrongTo use alcohol Not at all wrong	A little bit wrongTo use alcohol A little bit wrong	WrongTo use alcohol Wrong	Very wrongTo use alcohol Very wrong	Don't knowTo use alcohol Don't know
To use cannabis/marijuana	Not at all wrongTo use cannabis/marijuana Not at all wrong	A little bit wrongTo use cannabis/marijuana A little bit wrong	WrongTo use cannabis/marijuana Wrong	Very wrongTo use cannabis/marijuana Very wrong	Don't knowTo use cannabis/marijuana Don't know
To use prescription drugs not prescribed to them	Not at all wrongTo use prescription drugs not prescribed to them Not at all wrong	A little bit wrongTo use prescription drugs not prescribed to them A little bit wrong	WrongTo use prescription drugs not prescribed to them Wrong	Very wrongTo use prescription drugs not prescribed to them Very wrong	Don't knowTo use prescription drugs not prescribed to them Don't know

Thank you for completing this survey! Your responses are greatly appreciated and will help us better our community.

If you would like to talk to a trusted person please feel free to reach out to us at 940-767-1182. You may also call or text 988 (Suicide and Crisis hotline) for additional support and resources.