Form Organizer Survey – Organizer Survey – Organizer Survey – 6 Month Follow-up

Attachment 4

Organizer Survey – 6 month Follow-up

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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—6-Month Follow-up

INFORMED CONSENT STATEMENT

About 6 months ago, your organization participated in Communities Talk: Town Hall Meetings¹ to Prevent Underage Drinking! Following the event, you completed an Organizer Survey about the event. At that time, you agreed to be contacted to follow up on any actions that were taken as a result of the event that was held in your community. The information you provide will be used by the Substance Abuse and Mental Health Services Administration (SAMHSA) to document actions that were taken as a result of this nationwide initiative and to enhance future efforts. 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.

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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 SUBMIT.

< Communities Talk: Town Hall Meetings to Prevent Underage Drinking—Organizer Survey, 6 month>

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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. Enter today’s date: __________________

2. Enter the location of the Communities Talk event:

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

3. Are you aware of any underage drinking prevention activities that have taken place as a direct result of the Communities Talk event?

Yes

No

Don’t know

4. Has anyone from the community reached out to you or your organization after the Communities Talk event to:

	Yes	No	Don’t know
Get more information or to become involved in underage drinking prevention activities?
Tell you about new or enhanced prevention efforts?
Tell you about how the Communities Talk event has helped them personally?

5. Since the Communities Talk event, has your organization received any types of contributions or resources to further underage drinking prevention efforts?

Yes

No

Don’t know

6. In your opinion, how important of an issue is underage drinking, and its consequences, to the residents in your community?

Very important

Important

Moderately important

Slightly important

Not important

7. Since the Communities Talk event, have you, or has your organization, seen an increase in the number of youth involved in underage drinking prevention activities in your community?

Yes

No

Don’t know

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8. Since the Communities Talk event, how have youth been involved in underage drinking prevention activities? (Mark all that apply.)

• Youth have not been involved since the Communities Talk event.

• Youth have been involved in planning an alcohol-free activity for youth.

• Youth have held an event to promote underage drinking prevention.

• Youth have served as advocates for underage drinking prevention policy or legislative activity.

• Youth have distributed or discussed information from the Communities Talk event with other youth.

• Youth have helped develop promotional materials and messages about prevention.

• Other (please specify): ___________________________________________________________

9. A

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   s a result of the Communities Talk event, have you, or has your organization, taken part in or collaborated with others on the following activities to prevent underage drinking in your community?

	Yes	No, but plan to	No	Don’t know
Held follow-up meetings or discussion groups on underage drinking prevention
Created underage drinking prevention action groups (e.g., committees, task forces, and advisory boards)
Started a youth-led coalition on underage drinking prevention
Developed strategic plans to reduce and prevent underage drinking
Built coalitions with other agencies or programs to reduce and prevent underage drinking
Enforced compliance checks to reduce youth access to alcohol
Encouraged responsible beverage server training
Reduced or limited alcohol outlet density
Increased taxes on alcohol sales
Increased sobriety and traffic safety checkpoints
Limited alcohol sales at public events where youth are present
Reduced the number of hours for possible happy hours
Implemented social host ordinances
Drafted policy changes for my community that focus on underage drinking prevention
Worked with my local legislators or policymakers to advocate for changes to, or recommend enforcement of, existing laws and policies

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10. What types of organizations have you or your organization collaborated with on underage drinking prevention efforts after your event? (Mark all that apply.)

None	Middle/high schools
Health care providers	Colleges/universities
Parent groups	Businesses (non-beverage sales)
Faith-based organizations	Alcohol retail sellers
Judicial or law enforcement organizations	Government offices
Youth service organizations (FFA, SADD, Friday Night Live, YWCA, etc.)	Ethnic community organizations Other: ______________________

11. 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 have hosted another underage drinking prevention event in my community.

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.

12. Have you received any training or technical assistance (TA) from SAMHSA for any follow-up activities conducted after this Communities Talk event?

Yes

No

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< Communities Talk: Town Hall Meetings to Prevent Underage Drinking—Organizer Survey, 6 month>

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<if yes> Please rate your agreement with the following statements regarding any training or 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.

13. Thinking about the 6 months since your event, is there anything else you would like to share about activities related to your Communities Talk event and experience?

__________________________________________________________________________________________________________________________________________________________________________

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<ENDING> Thank you for providing this important information on any actions taken as a result of the Communities Talk event in your community!

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.