Gender
Male
Female
Non-binary/ others
Prefer not to say
Age
Under 18
18-25
26-40
40-60
Over 60
Community Type
Urban
Rural
Have you heard about drug and substance abuse before?
Yes
No
Have you ever used drugs or substances recreationally?
Yes
No
Which drugs or substances have you used in the past? (Check all that apply)
Alcohol
Marijuana
Cocaine
Heroin
Prescription Drugs
Others (Please specify) ____________
Have you ever experienced negative consequences as a result of drug or substance abuse?
Yes
No
If yes, please explain.
Has someone in your household used substances?
Yes
No
Where do you get most of your information about drugs?
Internet
School
Friends
Family
Media (TV, newspapers, etc.)
Which drugs or substances have they used in the past? (Check all that apply)
Alcohol
Marijuana
Cocaine
Prescription Drugs
Others (Please specify) ____________
Which substances are most commonly used in your community? (Check all that apply)
Alcohol
Marijuana
Cocaine
Prescription Drugs
Others (Please specify) ____________
In your opinion, what are the main causes of substance abuse in your community? (Select up to 2)
Peer pressure
Stress/Anxiety
Family history of substance abuse
Mental health disorders
Unemployment
Lack of awareness about risks
Easy access to substances
Others (Please specify) ____________
Do you believe substance abuse has negatively impacted public health in your community?
Yes
No
Unsure
What do you think are the consequences of substance abuse in your area? Please explain.
Are there enough substance abuse prevention programs in the area where you live?
Yes
No
Unsure
Have you ever attended or participated in a substance abuse prevention program?
Yes
No
If yes, what type of program was it?
School education program
Community outreach event
Rehabilitation or treatment program
Others (Please specify) ____________
Which of the following strategies do you think would be most effective in preventing substance abuse? (Check up to 3)
School education programs
Community outreach programs
Increased law enforcement
Mental health support services
Stricter regulations on substance availability
Others (Please specify) ____________
What barriers prevent people in your community from accessing substance abuse prevention or treatment services? (Check all that apply)
Treatment costs
Stigma
Lack of services
Fear of legal consequences
Lack of awareness about resources
Others (Please specify) ____________
Do you believe healthcare providers should be more involved in substance abuse prevention?
Yes
No
Unsure
What additional resources do you think would help reduce substance abuse in your community? Please explain
Have you or someone you know sought professional help for substance abuse?
Yes
No
Unsure
Do you feel comfortable discussing substance abuse issues with local healthcare providers?
Yes
No
Unsure
Have you noticed an increase in substance abuse in your community over the past 5 years?
Yes
No
Unsure
Do you think peer pressure is the main reason people start using substances in your community
Yes
No
Unsure
Are there enough rehabilitation centers available for substance abuse recovery in your area?
Yes
No
Unsure
Do you think family plays a key role in preventing substance abuse
Yes
No
Unsure
Do you think social stigma prevents people from seeking help for substance abuse
Yes
No
Unsure
Do you think media (Tv, Movies, Social Media) influences substance abuse in your community
Yes
No
Unsure