Attachment 1 Attachment 1- Organizer Survey 110310-Final

Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative

Attachment 1-Organizer Survey_110310-FINAL

Organizers Survey

OMB: 0930-0288

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Attachment 1


Organizer Survey

<Opening Page>

OMB No. 0930-0288

Approval Expires MM/DD/YY


Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0288. Public reporting burden for this collection of information is estimated to average .500 hours per client per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland 20857.


Town Hall Meetings on Underage Drinking Prevention: Organizer Survey

INFORMED CONSENT STATEMENT

Congratulations on your participation in the Town Hall Meetings1 (THMs) on Underage Drinking Prevention initiative! You may recall that, as a participant in the THMs initiative, your organization agreed to complete a survey regarding the THM event that was held in your community. The information collected will be used by the Substance Abuse and Mental Health Services Administration (SAMHSA) to document the implementation efforts of this nationwide initiative and to enhance future THM events. The survey will take about 30 minutes to complete.

It is important to obtain information from a large number of organizations to maintain quality of service. Taking the survey will cause little or no risk to you and/or your organization. The potential risks include the breach of confidentiality of nonsensitive information and the emotional discomfort associated with completing any survey. The information you provide will be kept private to the extent of the law and will not be associated with your or your organization’s name in any reports to SAMHSA. The findings reported to SAMHSA will be in group form. If you have any questions or concerns about participating in this survey, please email [email protected] or call the THM information line at (240) 747–4980.

By continuing, you are consenting to participate in this survey on behalf of your organization.

Continue

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NOTE: As you complete each page of the survey and click NEXT, data entered will be automatically saved. This feature allows you to return to the survey to make changes or finish completing it. You will be allowed to return to the survey until you click DONE.

<Header: Town Hall Meetings on Underage Drinking Prevention: Organizer Survey>

Page 1 of 5


Please answer each question by marking one of the answer choices. Some questions allow you to mark more than one answer. If you don’t find an answer that fits exactly, choose the one that comes closest.


  1. Date of Town Hall Meeting (THM) event: MM/DD/YYYY


  1. L



    ocation of THM event: City State/Territory Please Select

AL

AK

AS

AZ

(Continue through WY + territory codes)


  1. How would you characterize the location where the THM event was held?

  • Rural

  • Reservation

  • Urban

  • O


    ther (please specify)

  • Suburban



  1. How long did the THM event last? # hours # minutes


  1. Did you collaborate with other organizations to coordinate the THM event?

  • Yes

  • No


  1. Were youth involved in organizing and/or planning the THM event?

  • Yes

  • No


  1. Was the topic of the THM event solely on underage drinking?

    • Yes

    (Skip to question 9)

    • No

    (Continue to question 8)

  2. If no, what other topics were discussed?

Next

Cancel


  1. How was the THM event promoted in the community? (Mark all that apply.)

  • Brochures

  • Posters

  • Calendar posting (community or other)

  • Press release

  • Direct mailings

  • Public service announcement

  • Email

  • Radio

  • E-newsletter/listserv

  • Social networking sites (Facebook, Twitter, MySpace, and so on)

  • Flyers

  • Telephone calls

  • Local television

  • Web site

  • Marquees/signs/billboards

  • Word of mouth

  • Newsletters

  • Other (please specify)

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Page 2 of 5


  1. What was the total number of THM event attendees? (Estimates are okay.)

# of physical attendees: # of virtual attendees:

  1. In what language(s) was(were) the THM event conducted? (Mark all that apply.)

  • English

  • Spanish

  • O



    ther (please specify)


  1. Which of the following was among the discussion topics at the THM event? (Mark all that apply.)

    • Changes in policy/legislation

    • Campus/community collaboration

    • School-based strategies

    • Alcohol sales to minors

    • Alcohol advertising to which youth are exposed

    • Parental involvement

    • Alcohol access in the home

    • Parental hosting of parties where alcohol is served to youth

    • Communication campaigns and strategies

    • Alcohol-related injury, death, or health care concerns

    • Costs to society/local community of underage drinking

    • O


      ther (please specify)

  2. Which of the following best represents key speakers at the THM event? (Mark all that apply.)

  • Alcohol beverage retailers

  • Medical professionals

  • Business leaders

  • Parents

  • Community leaders

  • Prevention specialists

  • Education professionals

  • Public health officials

  • Human service staff

  • State elected officials

  • Law enforcement officials

  • State Governor’s spouse

  • Legal professionals

  • Youth

  • Local elected officials

  • O


    ther (please specify)


  1. Did you use any material(s) from www.stopalcoholabuse.gov for the THM event?

  • Yes

(Continue to question 15)

  • No

(Skip to question 16)

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<Header: Town Hall Meetings on Underage Drinking Prevention: Organizer Survey>

Page 3 of 5

  1. If yes, what material(s) did you use?


  1. What are some of the major actions planned as a result of this THM event? (Mark all that apply.)

  • Implementing social host ordinances.

  • Forming SAFE HOMES Parents Networks.

  • Creating underage drinking prevention action groups (e.g., committees, task forces, and advisory boards).

  • Starting a youth-led coalition on underage drinking prevention.

  • Developing strategic plans to reduce and prevent underage drinking.

  • Collaborating with other agencies or programs to reduce and prevent underage drinking.

  • Planning additional THM events on underage drinking prevention.

  • Planning other future events on underage drinking prevention.

  • Holding follow-up meetings or discussion groups on underage drinking prevention.

  • Applying for additional funding to sustain underage drinking prevention efforts.

  • O



    ther (please specify).


  1. Overall, how satisfied are you with this THM event?

    • Very satisfied

    • Somewhat satisfied

    • Somewhat dissatisfied

    • Very dissatisfied

  2. Did you participate in a THM-related Webinar?

  • Yes

(Continue to question 19)

  • No

(Skip to question 20)


  1. If yes, which Webinar did you participate in?


  1. Did you view online training at www.stopalcoholabuse.gov?

  • Yes

(Continue to question 21)

  • No

(Skip to question 25)


  1. If yes, which online training did you view?

Cancel

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<Header: Town Hall Meetings on Underage Drinking Prevention: Organizer Survey>

Page 4 of 5

  1. Overall, how satisfied are you with the training you received?

  • Very satisfied

  • Somewhat satisfied

  • Somewhat dissatisfied

  • Very dissatisfied


  1. To what extent has the training you have received improved your capacity to provide effective (underage drinking) prevention services?

    • A great deal

    • Somewhat

    • Not very much

    • Not at all

    • Not applicable

  2. To what extent have the training recommendations you received most recently been fully implemented?

  • Fully

  • Partially

  • Not yet begun


  1. Did you receive technical assistance (TA) in planning this THM event?

    • Yes

    (Continue to question 26)

    • No

    (Skip to question 30)

  2. How did you submit the request for TA? (Mark all that apply.)

  • Called the THM TA hotline [(240) 747–4980].

  • O


    ther (please specify).


  1. Overall, how satisfied are you with the TA you received?

  • Very satisfied

  • Somewhat satisfied

  • Somewhat dissatisfied

  • Very dissatisfied


  1. To what extent has the TA you have received improved your capacity to provide effective (underage drinking) prevention services?

    • A great deal

    • Somewhat

    • Not very much

    • Not at all

    • Not applicable

  2. To what extent have the TA recommendations you received most recently been fully implemented?

  • Fully

  • Partially

  • Not yet begun

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<Header: Town Hall Meetings on Underage Drinking Prevention: Organizer Survey>

Page 5 of 5


  1. Please share with us any other important features or reactions to the THM event.



  1. Did your organization collect data about this THM event?

  • Yes

(Continue to question 32)

  • No

(Proceed to the end and click done)


  1. If yes, would you be willing to share those data with SAMHSA?

  • Yes

  • No


If yes, please submit the data along with a data codebook to the following address:


ICF Macro

Attn.: THM on UAD—Rená A. Agee

11785 Beltsville Drive, Suite 300

Calverton, MD 20705

[or]

[email protected]

If you have any questions about submitting data on this THM event, please email [email protected] or call (240) 747–4980.

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<Exit screen after DONE will say: Thank you again for sharing this important information about the Town Hall Meeting on Underage Drinking that was held in your community!>

1 Not all events are called Town Hall Meetings (e.g., Community Forums); however, we will refer to them as Town Hall Meetings (THMs) for consistency in the data collection process.

File Typeapplication/msword
File TitleTown Hall Meetings Question List (unformatted)
AuthorRena.A.Agee
Last Modified ByRena.A.Agee
File Modified2010-11-03
File Created2010-10-19
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