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Douglas County Oregon Youth Vaping and Tobacco Use - Parent and Guardian Survey

This survey is for Parents and Guardians who have students in grades 6th thru 12th attending schools in Douglas County Oregon only please.  This is the only information we are seeking for this survey and will not be able to use data from other counties, states, or countries.

A coalition of community health partners in Douglas County (Douglas Public Health Network, Adapt Integrated Health Care, Thrive Umpqua, Aviva Health, Umpqua Health, CHI Mercy, and Cow Creek) is concerned about the increased use of e-cigarettes, vaping, and Juuls among our youth. WE NEED YOUR HELP to better understand this growing issue. Thank you for taking a few minutes to let us know your views regarding this subject. 

The survey should take approximately 5-10 minutes to complete. At the end of the survey, you will see a link to opt-in for a $5 gift card to a local business in Douglas County sent by mail via USPS or picked up at the Thrive Umpqua Office located at 556 SE Jackson Street, Roseburg, OR 97470. Emailing of the gift card in not available. You will also be entered into a drawing for a $50 gift card to Grocery Outlet in the fall in appreciation for your time completing the survey. Any responses to the survey from from anyone who does not have students in grades 6th thru 12th attending schools in Douglas County Oregon will not be sent a gift card.

Your name and contact information will not be associated with your answers on the survey.

*Prior to submitting survey, please copy or write down unique survey number. It must be provided when filling out the gift card registration form  to receive gift card.

Thank you for taking the time to complete the survey!

Your information is completely confidential and anonymous. If you have questions, please contact Juli Baker at 541-390-7649 or juli@thriveumpqua.com.