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Think, Act and Live: An Opiate Overdose Prevention Initiative

(Form 2)

Focus Group Survey - TV Commercial

Think, Act and Live: An Opiate Overdose Prevention Initiative by UMADAOP Lucas County

1. Please identify the type of advertisement that you are reviewing

Please identify the ad that you are reviewing:

TV Commercial

2. Please describe your initial impression of this advertisement:

Please describe your initial impression of this advertisement

Like

Dislike

Was not very impressed

3. Do you feel that this advertisement will help to prevent opiate misuse and overdoses?

Do you feel that this advertisement will help to prevent opiate misuse and overdoses?

Yes

No

4. Do you feel that this advertisement will help reduce the stigma regarding overdose prevention and treatment?

Do you feel that this advertisement will help reduce the stigma regarding overdose prevention and treatment?

Yes

No

5. Do you feel that people will respond to this advertisement and request a Naloxone Kit?

Do you feel that people will respond to this advertisement and request a Naloxone Kit?

Yes

No

6. Do you feel that this advertisement is attractive and appropriate for African Americans?

Do you feel that this advertisement is attractive and appropriate for African Americans?

Yes

No

Name

This field is for validation purposes and should be left unchanged.

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2447 Nebraska Avenue

Toledo, Ohio 43607 USA

+1 (419) 255-4444

+1 (419) 531-1596 FAX NO

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The 419 Voice Magazine
Church Alliance for Substance Abuse and Violence Prevention
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