Community Readiness

Thank you for partaking in this brief survey, which is crucial to our goal of mobilizing the community to address substance misuse and the overdose crisis in our community.  

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* 1. Last four digits of phone number

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* 2. Age

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* 3. Which of the following options most closely aligns with your gender?

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* 4. What is your race or ethnicity?

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* 5. Which sector do you represent?

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* 6. What is your residential zip code?

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* 7. Using a scale from 1-10, how concerned are you with substance use in your community?

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 8. What substance (s) are the greatest concern?

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* 9. Which age group do you think is most impacted by substance use in your community?

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* 10. Do you support efforts to address substance use in your community?

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* 11. What type of information or resources are available in your community to address substance use?

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* 12. What are the primary obstacles you think need to be addressed in your community to deal with substance use?

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* 13. Would you be willing to engage with CGAC on initiatives that address substance use in your community?

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* 14. How do you feel about substance use prevention?

1 oppose neutral 10 support
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i We adjusted the number you entered based on the slider’s scale.

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* 15. How do you feel about Narcan trainings in your community?

1 oppose neutral 10 support
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 16. How familiar are you with fentanyl and xylazine?

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* 17. Which of the following harm reduction methods do you support?

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* 18. Comments, questions, feedback:

T