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American Samoa Community Wellness & Prevention Survey
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The purpose of this survey is to better understand substance-use prevention needs, behavioral-health concerns, risk and protective factors, community knowledge, barriers to seeking help, and preferred prevention and support services in American Samoa.
This survey is anonymous. Please do not provide your name or other identifying information. Responses will be used for community needs assessment, prevention planning, program development, and reporting in aggregate form.
Section 1: About You
Do you currently live in American Samoa?
Yes
No
Prefer not to answer
What is your age group?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Prefer not to answer
What is your gender?
Female
Male
Non-binary
Prefer to self-describe
Prefer not to answer
What village or general area do you currently live in?
Section 2: Personal Substance Use
During the past 30 days, have you personally used any of the following substances?
[Checkboxes]
Alcohol
Marijuana/Cannabis
Methamphetamine/Ice
Prescription medication in a way other than prescribed
Opioids not prescribed to you or
Tobacco/Cigarettes
Vaping/Nicotine
Other
None
Prefer not to answer
During the past 12 months, have you been concerned about your own alcohol or drug use?
Yes
No
Unsure
Prefer not to answer
During the past 12 months, have you wanted or tried to reduce your alcohol or drug use?
Yes
No
Prefer not to answer
Section 3: Substance Use in Our Community
Which substances do you believe are concerns in your community?
[Checkboxes]
Alcohol
Methamphetamine/Ice
Marijuana/Cannabis
Prescription medication misuse
Opioids
Tobacco/Cigarettes
Vaping/Nicotine products
Other
Unsure
Which substances do you believe should receive greater prevention or education efforts in American Samoa?
[Checkboxes]
Alcohol
Methamphetamine/Ice
Marijuana/Cannabis
Prescription medication misuse
Opioids
Tobacco/Cigarettes
Vaping/Nicotine products
Other
Unsure
Which age groups do you believe are most affected by substance-use concerns?
[Checkboxes]
Children under 13
Teens 13-17
Young adults 18-24
Adults 25-44
Adults 45-64
Adults 65+
Families as a whole
Unsure
Section 4: Risk and Protective Factors
What factors do you believe may contribute to substance use in our community?
[Checkboxes]
Stress
Depression
Anxiety
Trauma
Family conflict
Peer pressure
Relationship problems
Domestic violence
Financial stress
Unemployment
Easy access to substances
Lack of recreational activities
Social acceptance of substance use
Lack of education about risks
Other
What do you think helps protect people, especially youth, from developing substance-use problems?
[Checkboxes]
Strong family relationships
Positive friendships
School involvement
Sports or recreational activities
Cultural involvement
Faith or spiritual support
Mental-health services
Positive adult role models
Substance-use education
Employment or job opportunities
Healthy coping skills
Community programs
Other
At what age do you believe substance-use prevention education should begin?
Under 10
10-12
13-15
16-17
18+
Unsure
Section 5: Mental Health and Substance Use
Which concerns do you believe are commonly connected with substance use?
[Checkboxes]
Stress
Anxiety
Depression
Trauma
Family conflict
Relationship problems
Thoughts of self-harm
Domestic violence
Financial problems
School problems
Employment problems
Other
How important do you think it is for mental-health and substance-use services to work together?
Very important
Somewhat important
Not very important
Not important
Unsure
Section 6: Community Knowledge and Awareness
How would you rate your knowledge about the risks associated with alcohol and other drug use?
Very knowledgeable
Somewhat knowledgeable
Know a little
Not knowledgeable
Unsure
Would you know where to refer a friend or family member who needed help with substance use?
Yes
Maybe
No
How familiar are you with substance-use prevention, treatment, or recovery services available in American Samoa?
Very familiar
Somewhat familiar
Heard of some services but do not know how to access them
Not familiar
Unsure
Section 7: Seeking Help
If you or someone you cared about needed substance-use support, how comfortable would you feel seeking professional help?
Very comfortable
Somewhat comfortable
Not comfortable
Unsure
What might prevent someone from seeking substance-use services?
[Checkboxes]
Fear of judgment
Privacy or confidentiality concerns
Family shame or embarrassment
Gossip
Cost
Transportation
Not knowing where to go
Lack of available providers
Scheduling
Fear of legal consequences
Concern about employment
Belief they can handle the problem themselves
Other
What would make you more comfortable seeking help?
[Checkboxes]
Confidential services
Licensed professionals
Private location
Culturally respectful care
Family support
Trusted community referrals
Affordable services
Flexible appointment times
Transportation support
Clear information about services
Services for both mental health and substance use
Other
Section 8: Prevention and Support Services
Which prevention or support services would be most helpful in American Samoa?
[Checkboxes]
Community education sessions
School-based prevention programs
Youth mentoring
Family support programs
Faith-based partnerships
Peer support groups
Counseling services
Crisis support
Recovery support
Parenting workshops
After-school or evening activities for youth
Employment or job-readiness support
Transportation assistance
Other
What format would you most prefer for prevention information?
Community meetings
Social media
Radio
Church or faith settings
Schools
Printed flyers or brochures
Text messages
Other
How helpful would you find a community program that teaches coping skills, healthy relationships, and ways to talk about substance-use concerns?
Not helpful
Extremely helpful
Section 9: Final Thoughts
Please share any other comments, concerns, or suggestions you would like decision-makers to know.
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