Tuesday, February 24, 2009

Final Survey Questionnaire

Advertising project - Survey 2009
Sex: ☐Male ☐Female
Age: ☐18 ☐19 ☐20 ☐21 ☐22 ☐23 ☐24 ☐other
Race: ☐White ☐Hispanic ☐African-American ☐other

Questions (Note: This is an anonymous survey so don’t be afraid to answer any of the following questions.)

1. At what age did you begin drinking?
☐<10 ☐11 ☐12 ☐13 ☐14 ☐15 ☐16 ☐17 ☐18 ☐19 ☐20 ☐21 ☐Do not drink

2. How many drinks do you usually drink at a function or social event (party or wedding)?
☐0 ☐1 ☐2 ☐3 ☐4 ☐5 ☐6 ☐7 ☐8 ☐9 ☐More

3. Has drinking been a source that has caused you to fall behind at school or work?
☐Yes ☐No ☐Maybe

4. Are you currently in a relationship?
☐Yes ☐No If yes, does your partner consume alcohol? ☐Yes ☐No

5. Have you ever driven after a night of binge drinking?
☐Yes ☐No ☐Maybe

6. Do you drink to escape your worries?
☐Yes ☐No ☐Maybe

7. Do you think binge drinking is a serious problem?
☐Yes ☐No ☐Maybe

8. Have you ever had medical treatment after a night of binge drinking?
☐Yes ☐No ☐Maybe

9. How often in a 30-day period have you gone binge drinking?
☐0x ☐1x ☐2x ☐3x ☐4x ☐5x ☐6x ☐7x ☐8x ☐9x ☐More

10. Were you raised in a single-parent family (at any time in your life, if so for how long)?
☐Yes ☐No If yes, how many years: ☐1 ☐2 ☐3 ☐4 ☐5 ☐6 ☐7 ☐8 ☐More

11. Have you spend more on alcohol that was supposed to be spent on other things. (books,food)?
☐Yes ☐No ☐Maybe

12. Do you drink to help you feel more comfortable in social situations?
☐Yes ☐No ☐Maybe

13.Have you ever done something that you have regretted after a night of binge drinking?
☐Yes ☐No ☐Maybe

14. Did you ever have an inappropriate sexual encounter after binge drinking?
☐Yes ☐No ☐Maybe

15. Have you ever lied about your drinking?
☐Yes ☐No ☐Maybe

16.Have you ever have trouble remembering what happened as result of your drinking.(black out)?
☐Yes ☐No ☐Maybe

17. Define binge drinking in your own words on the back.

18. Who introduced you to drinking?
☐Friend ☐Sibling ☐Parent ☐Roomate ☐Relative other ☐ Social/professional group ☐Other

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