Form Organizer Survey Organizer Survey Organizer Survey

Attachment 1

Organizer Survey

<Opening Page>

OMB No. 0930-0288

Approval Expires XX/XX/XXXX

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 # minutes 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, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland 20857.

Communities Talk: Town Hall Meetings to Prevent Underage Drinking

Organizer Survey

INFORMED CONSENT STATEMENT

Congratulations on your participation in Communities Talk: Town Hall Meetings¹ to Prevent Underage Drinking! You may recall that, as a host of a Communities Talk event, your organization agreed to complete a survey regarding the 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 Communities Talk events. The survey will take about # minutes to complete.

It is important to obtain information from a large number of organizations to maintain quality of service. The information you provide will not be associated with you or your organization in any study reports. If you have any questions or concerns about participating in this survey, please e-mail [email protected] or call the Communities Talk technical assistance line at (866) 419–2514.

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

Next

Cancel

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 the last question is answered.

< Communities Talk: Town Hall Meetings to Prevent Underage Drinking - 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 the Communities Talk event: _________________________

2. Enter the location of the Communities Talk event:

City: ________________ State/Territory: ____________ ZIP Code: ___________

3. How long did the Communities Talk event last (e.g., 45 minutes, 1.5 hours)? _________________

4. How would you characterize the location where the Communities Talk event was held?

Rural	Reservation
Urban	Other (please specify): __________________________________
Suburban

5. What influenced your organization’s decision to host a Communities Talk event? (Mark all that apply.)

High rates of underage drinking in our region or county	SAMHSA promotion of Communities Talk
Recent incidents involving negative consequences of underage drinking in our region or county	SAMHSA financial support provided for the event
Parental concerns about underage drinking	Other (please specify): ___________________________________

6. Did any other community-based organization (e.g., business, school) collaborate with your organization in hosting this event?

Yes

No

7. Were youth involved in organizing and/or hosting the Communities Talk event?

Yes

No

Back

Next

Cancel

<Communities Talk: Town Hall Meetings to Prevent Underage Drinking - Organizer Survey>

Page 2 of 5

8. How was the Communities Talk event promoted? (Mark all that apply.)

Calendar posting (community or other)	Television/public service announcement
Direct mailings	Radio/public service announcement
E-newsletter/e-mail list Flyers/posters/brochures Marquees/signs/billboards Print media (newspaper, magazine, etc.) Press release Telephone calls	Social media Facebook Twitter Instagram Snapchat Other: _______________________ Word of Mouth
	Other (please specify): ___________________________________

9. What was the total number of attendees at the Communities Talk event? (Estimates are okay.)

# of physical (in-person) attendees: _________ # of virtual (not in-person) attendees: _______

10. In what language was the Communities Talk event conducted? (Mark all that apply.)

English

Spanish

Other (please specify): _______________________

11. Which of the following best represents key speakers at the Communities Talk event? (Mark all that apply.)

Alcohol beverage retailers	Medical professionals
Business leaders	Parents
Community leaders	Prevention specialists
Education professionals	Public health officials
Human services staff	State elected officials
Law enforcement officials	State Governor’s spouse
Legal professionals	Youth
Local elected officials	Other (please specify): ___________________________________

12. Was underage drinking the only topic addressed by the Communities Talk event?

Yes

No

<If no> What non-alcohol-related topics were discussed? ________________________________

Back

Next

Cancel

<Communities Talk: Town Hall Meetings to Prevent Underage Drinking - Organizer Survey>

Page 3 of 5

13. Which of the following alcohol-related topics were discussed at the Communities Talk event? (Mark all that apply.)

Alcohol-related injury, death, or health care concerns	Alcohol sales to minors
Costs to society or local community due to underage drinking	Role of parents in prevention
Youth exposure to alcohol advertising	Alcohol access in the home
Changes in policy or legislation	Parental hosting of parties where alcohol is served to youth
Campus or community collaboration	Communication campaigns and strategies
School-based strategies	Other (please specify): ________________

14. In your opinion, how important is underage drinking, and its consequences, to the residents of your community?

Very important

Important

Moderately important

Slightly important

Not important

15. In the future, how likely is it that you or your organization will plan or collaborate with others on the following activities to prevent underage drinking in your community?

	Very likely	Somewhat likely	Not likely
Hold follow-up meetings or discussion groups on underage drinking prevention
Create underage drinking prevention action groups (e.g., committees, task forces, and advisory boards)
Start a youth-led coalition on underage drinking prevention
Develop strategic plans to reduce and prevent underage drinking
Build coalitions with other agencies or programs to reduce and prevent underage drinking
Enforce compliance checks to reduce youth access to alcohol
Encourage responsible beverage server training
Reduce or limit alcohol outlet density
Increase taxes on alcohol sales
Increase sobriety and traffic safety checkpoints
Limit alcohol sales at public events where youth are present
Reduce the number of hours for possible happy hours
Implement social host ordinances
Draft policy changes for my community that focus on underage drinking prevention
Work with my local legislators or policymakers to advocate for changes to, or recommend enforcement of, existing laws and policies

Back

Next

Cancel

<Communities Talk: Town Hall Meetings to Prevent Underage Drinking - Organizer Survey>

Page 4 of 5

16. Thinking about you and your organization, please rate your agreement with the following statements.

	Strongly agree	Agree	Disagree	Strongly disagree
I know how to use evidence-based approaches to carry out future underage drinking prevention activities.
The Communities Talk event has increased my ability to share information about the importance of preventing underage drinking.
As a result of this Communities Talk event, I feel more motivated to continue to address underage drinking in my community.
As a result of this Communities Talk event, I feel more confident hosting another Communities Talk or other underage drinking prevention event in the future.
As a result of this Communities Talk event, I am more likely to host another underage drinking prevention event in my community.

17. Did you use any material(s) from www.stopalcoholabuse.gov/townhallmeetings for the Communities Talk event?

Yes

No

<If yes> What material(s) did you use? _______________________________________________

SAMHSA provides periodic webinars and online training at www.stopalcoholabuse.gov/townhallmeetings for organizations hosting Communities Talk events. SAMHSA also provides technical assistance to organizations through www.stopalcoholabuse.gov/townhallmeetings/contact-us.aspx , [email protected], [email protected], and by telephone at (866) 419–2514.

18. Please rate your agreement with the following statements regarding any training or technical assistance (TA) that you or your organization received.

	Strongly agree	Agree	Disagree	Strongly disagree	Not applicable
The training has been useful to my organization’s prevention work.
The training that I received improved my organization’s capacity to do prevention work.
The TA has been useful to my organization’s prevention work.
The TA that I received improved my organization’s capacity to do prevention work.

Cancel

Next

Back

<Communities Talk: Town Hall Meetings to Prevent Underage Drinking - Organizer Survey> Page 5 of 5

19. Please share any other important features or reactions to the Communities Talk event.

20. Did your organization develop a report, or does it plan to, that includes underage drinking data at the community level (e.g., incidences of use; activities or actions employed to prevent and combat underage drinking)?

Yes

No

<If no, go to ALL ENDING>

<If yes> Would you be willing to share the report with SAMHSA?

Yes

No

<If yes > Please send the report to the following address:

[email protected]

[or]

ICF

Attn.: Communities Talk on UAD—Rená A. Agee

530 Gaither Rd, Suite 500, Rockville, MD 20857

<ALL ENDING> SAMHSA would like to contact you in about 6 months to follow up on any actions that were taken as a result of the Communities Talk event that was hosted in your community. Are you willing to be contacted in about 6 months to complete an online follow-up survey?

Yes

No

<Exit screen 1 (Yes to recontact)> Thank you again for sharing this important information about the Communities Talk: Town Hall Meetings to Prevent Underage Drinking event that was held in your community! We will contact your organization in about 6 months to follow up on any actions that were taken as a result of the Communities Talk event that was held in your community.

REDIRECT TO www.stopalcoholabuse.gov/townhallmeetings

<Exit screen 2 (No to recontact)> Thank you again for sharing this important information about the Communities Talk: Town Hall Meetings to Prevent Underage Drinking event that was held in your community! >

REDIRECT TO www.stopalcoholabuse.gov/townhallmeetings/

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