Alcohol Consumption Question a Ire

  • Published on
    06-Apr-2018

  • View
    224

  • Download
    0

Embed Size (px)

Transcript

  • 8/3/2019 Alcohol Consumption Question a Ire

    1/3

    ALCOHOL CONSUMPTION QUESTIONAIRE

    Name: Year Level:Age: College:Gender: ( ) male ( ) female Birth Order:

    No. of siblings:

    1. Whattype ofalcohol do you drink?Beer Brandy Gin or Vodka( ) San Miguel ( ) Gran Matador ( ) GSM Blue( ) San Mig Light ( ) Emperador ( ) Cosack Vodka( ) Redhorse ( ) Fundador ( ) The Bar

    ( ) Colt 45 ( ) Tres Cepas( ) Beer na beer ( ) Generoso( ) Gold eagle beer( ) Cervesa Negra

    Forthe question number 2,pleasecheckthecolumns that bestapplyto you.(1) Always(2) Often

    (3) Sometimes

    (4) Seldom(5) Never

    2. How often do you haveBeer? 1 2 3 4 5

    San Miguel

    San Mig Light

    Redhorse

    Colt 45

    Beer na beer

    Gold eagle beer

    Cervesa Negra

    Brandy?

    Gran Matador

    Emperador

    Fundador

    Tres Cepas

    Generoso

    Gin or Vodka?

    GSM Blue

    Cosack Vodka

    The Bar

    3. Where do you drink?( ) Bars ( ) Athome

    ( ) Restaurants ( ) Ata friends house( ) Boarding house ( ) ClubsOthers please specify

    4. Whom do you drinkwith?( ) Classmates ( ) Professors( ) Friends ( ) Athletic Team( ) Family ( ) Social Organization (clubs, etc.)( ) Relatives

    Others please specify

  • 8/3/2019 Alcohol Consumption Question a Ire

    2/3

    5. Who initiates? Pleasecheckthecolumns that bestapplyto you.(1) Always(2) Often(3) Sometimes

    (4) Seldom(5) Never

    1 2 3 4 5

    I

    Friends

    Classmates

    Family

    Relatives

    Professors

    Athletic Team

    Social Organization

    Others please specify

    6. Areyou ableto resist invitations to drinking?( ) Yes ( ) NoIfyes, how often?

    (1) Always(2) Often(3) Sometimes(4) Seldom(5) Never

    7. Why do you drink? Pleasecheckthecolumns that bestapplyto you.

    (1) Always

    (2) It is often a reason(3) Sometimes(4) It is Seldom a reason(5) Never or notatall

    8. Where do you getthe money for drinking?

    1 2 3 4 5

    (Because) I am bored.

    (Because) I wantto relax.

    I am sad/lonely.

    I wantto have fun.

    I am angry or irritated.

    I likethephysicaleffects.

    I wantto escape or forget

    I wantto be more sociable.

    I am stressed of schoolworks.

    Thepeople I am withare drinking.

    I am stressed about mypersonallife.I wantto change mypersonality(i.e. act differently).

    I wantto increasechances for sexual opportunities.

    To bewarm when theweather is cold.

    To gain selfconfidence.

    To gain friends.

    To feel grown up.

  • 8/3/2019 Alcohol Consumption Question a Ire

    3/3

    ( ) Allowance( ) Extraallowance( ) Parttime income( ) Ask from parentsOthers please specify

    9. Do you get drunk?( ) Yes ( ) No

    Ifyes, how often?( ) Always( ) Often( ) Sometimes( ) Seldom( ) Never

    10. Do you cometo school intoxicated?( ) Yes ( ) NoIfyes, how often?( ) Always( ) Often( ) Sometimes( ) Seldom( ) Never

    11. Whataretheeffects of getting drunk?( ) Hangover( ) Motoraccident( ) Gotten into fight( ) Gotten nauseated and vomited( ) Damaged aproperty, pulled a false firealarm, or other such behavior( ) gotten into troublewith schooladministration because of behavior resulting from drinking too much.Others please specify

    12. How do you dealwithhangover?( ) Sleep( ) Drinkcoffee( ) Eat salty foods( ) Takeacold shower( ) Take B-complex(vitamins)( ) Cold drinks (iced tea, softdrinks, etc.)( ) Drinkalittleaamount ofalcohol(sundot)

    ( ) Eat foods rich in potassium (banana, apple, etc.)( ) Engage in physicalactivities whichelicitperspiration

    13. Whataretheconsequences of getting drunk?( ) Getting late( ) Getting absent( ) Getting failing grades( ) Scolded byparents( ) Willlead to familyproblemOthers please specify

    14. What do youperceiveas benefits in drinking?( ) Enjoyment ( ) Toprove masculinity

    ( ) Relaxation ( ) Increase sexual opportunities

    ( ) Itavoids boredom ( ) It is awayto escapeproblems

    ( ) Easilyto get sleep ( ) It increases courageand confidence

    ( ) Gaining new friends ( ) It increases menstrual flow(forwomen)15. Who among your family drinkalcohol?

    ( ) Father ( ) Sister

    ( ) Mother ( ) None

    ( ) Brother

    16. Atwhatageyou start drinking?