1. Your Sex: 1. Male 2. Female
2. Your age: (write in)
3. Your major: 1. Social Science 2. Arts and Humanities 3. Psychology 4. Pre-Social Work 5. Nursing 6. Pre-Law 7. Education 8. Pre-med 9. Forensic Studies 10. Health Sciences/Education 11. Physical Sciences 12. Physical Education 13. Engineering 14. Religion 15. Other ____________(write in)
4. Year in School: 1. Freshman 2. Sophomore 3. Junior 4. Senior 5. Graduate 6. Other_________________(write in)
5. Grade Point Average (4.0= "A", 3.0= "B", etc.):
6. Race: 1. White or Caucasian 2. Black or Afro-American 3. Spanish American 4. Oriental or Asian American 5. Native American (Indian) 6. Foreign Student 7. Other______________ (write in)
7. In what Religion were you raised? 1. Roman Catholic 2. Jewish 3. Protestant (religion allows drinking of alcoholic beverages) 4. Protestant (religion does not allow drinking) 5. None or other___________
8. How important is religion to you? 1. Very important 2. Moderately important 3. Mildly important 4. Not important
WE WOULD LIKE TO ASK ABOUT YOUR DRINKING PATTERNS
9. Let's take beer first. How often, on the average, do you usually have a beer? (If you do not drink beer at all go to question 11.)
10. When you drink beer, how much, on the average, do you usually drink at any one time?
11. Now let's look at table wine. How often do you usually have wine?
12. When you drink wine, how much, on the average, do you usually drink at any one time?
13. Next we would like to ask you about liquors and spirits (whiskey,gin, vodka, mixed drinks, etc.). How often do you usually have a drink of liquor? (If you do not drink liquor at all, skip questions 13 and 14.)
14. When you drink liquor, how many drinks, on the average, do you usually drink at any one time?
The following are common results that other students have reported. If you have never had a drink at all, go to question 33. If you currently drink or have ever drunk in the past, put the number corresponding to the frequency of the occurrences in the box beside it.
15. had a hangover
16. gotten nauseated and vomited from drinking
17. driven a car after having several drinks
18. driven a car when you knew you had too much to drink
19. driven a car while drinking
20. come to class after having several drinks
21. "cut a class" after having several drinks
22. missed a class because of a hangover
23. arrested for DWI (Driving While Intoxicated)
24. been criticized by someone you were dating because of your drinking
25. had trouble with the law because of drinking
26. lost a job because of drinking
27. got a lower grade because of drinking
28. gotten in trouble with school administration because of behavior resulting from drinking too much
29. gotten into a fight after drinking
30. thought you might have a problem
31. damaged property, pulled a false fire alarm, or other such behavior after drinking.
32. participated in a drinking game
33. How often on the average do you smoke cigarettes?
34. When you smoke, how many cigarettes do you smoke per occasion? (write in)
WE WOULD NOW LIKE TO ASK YOU FOR SOME INFORMATION ABOUT ALCOHOL
The questions will either be True or False. If you do not know the answer to the question, DO NOT GUESS. Mark a "0" in the box.
If you think the answer is TRUE, write "1" for true.
If you think the answer is FALSE, write "2" for false.
If you do not know the answer, write "0" in the box.
35. Drinking milk before drinking an alcoholic beverage will slow the absorption of alcohol into the body.
36. Wines are mad by fermenting grains.
37. Alcoholic beverages do not provide weight-increasing calories.
38. In America, drinking is usually considered an important socializing custom in business, for relaxation and for improving interpersonal relationships.
39. Gulping of alcoholic beverages is a commonly accepted drinking pattern in this country.
40. Alcohol is usually classified as a stimulant.
41. Alcohol is not a drug.
42. A blood alcohol content of 0.1% is the legal definition of alcohol intoxication in most states, in regards to driving.
43. Approximately 10% of fatal highway accidents are alcohol related.
44. Alcohol was used for centuries as a medicine in childbirth, for sedation and surgery.
45. Table wines contain from 2-12% alcohol by volume.
46. It is estimated that approximately 85% of the adult Americans who drink misuse or abuse alcoholic beverages.
47. Many people drink to escape from problems, loneliness and depression.
48. Liquor mixed with soda pop will affect you faster than liquor drunk straight.
49. The most commonly drunk alcoholic beverage in the united States are distilled liquors (whiskey, gin, vodka).
50. A 150 pound person, to keep his blood alcohol concentration below the legally intoxicated level, would have to drink fewer than 3 beers in an hour.
51. A person cannot become an alcoholic by just drinking beer.
52. To prevent getting a hangover, one should sip one's drink slowly, drink and eat at the same time, space drinks over a period of time, and not drink over one's limit.
53. Responsible drinking can result in relaxation, enhanced social interactions, and a feeling of well-being.
54. Distilled liquors (whiskey, gin, vodka, etc.) Usually contain about 15-20% alcohol by volume.
55. Moderate consumption of alcoholic beverages is generally not harmful to the body.
56. It takes about as many hours as the number of beers drunk to completely burn up the alcohol ingested.
57. An ounce of whisky contains about 60 calories.
58. Many people drink for social acceptance, because of peer group pressures, and to gain adult status.
59. A blood alcohol concentration of .02% causes a person to be in a stupor.
60. Liquors such as gin, scotch and whiskies are usually distilled from mashes made from Fermenting grains.
61. Proof on a bottle of liquor represents half the percent of alcohol contained in the bottle.
62. The United States lacks a national consensus on what constitutes the responsible use of alcoholic beverages.
63. There is usually more alcoholism in a society that accepts drunken behavior than in a society that frowns on drunkenness.
64. Beer usually contains from 2-12% alcohol by volume.
65. Eating while drinking will have no effect on slowing down the absorption of alcohol in the body.
66. Drinking coffee or taking a cold shower can be an effective way of sobering up.
67. Wines throughout history have been commonly drunk at religious ceremonies and family gatherings.
68. Drinking of alcoholic beverages has been common in the U.S.A. since the Puritans first settled here.
69. Alcohol has only been used in a very few societies throughout history.
70. Liquor taken straight will affect you faster than liquor mixed with water.