Questionnaire: Alcoholic Beverage
Questionnaire
I am a 5th form student of the Antigua Girls’ High School . I am carrying out a questionnaire on the problem “How can alcohol affect a teen’s family and social life”. This questionnaire is part of my Social Studies SBA and must be filled out as accurately as possible. Please answer all questions with a () and follow any instructions that are associated. Your co-operation and participation is greatly appreciated.
1. a) Gender □ Male □ Female
b) Age Range □ 10-12 yrs □13-15 yrs □16-18 yrs □19 +
c) What form are you in? □ 1st □ 2nd □ 3rd □ 4th □ 5th
2. Do you drink alcohol? If no, Please do not continue questionnaire. □ Yes □ No
3. How long have you been drinking alcohol? □ 0-4 yrs □ 5-9 yrs □ 10 yrs +
4. What is your usual daily consumption of alcohol? □ 0-3 times □ 4-7 times □ 8-11 times □ 12 times +
5. Is your family aware that you consume alcohol? □ Yes □ No
6. Are you allowed to consume alcohol? □ Yes □ No
7. Are you influenced to consume alcohol on a regular basis? If ‘yes’, state by whom. □ Yes □ No b) ___________________________________________ 8. How many persons are in your household? □ 2-4 persons □ 5-7 persons □ 8 persons +
9. Does everyone in your family consume alcohol? If ‘no’, state whom. □ Yes □ No b) ___________________________________________
10. Do you drink for special occasions? □ Yes □ No
b) What special occasions do you mostly consume alcohol? Tick all that apply. □ Birthdays □ Anniversaries □ Graduations □Holidays □Parties
11. Is your family divided by the consumption of alcohol in the home? If ‘yes’, state how. □ Yes □ No b) ___________________________________________
12. Does
I am a 5th form student of the Antigua Girls’ High School . I am carrying out a questionnaire on the problem “How can alcohol affect a teen’s family and social life”. This questionnaire is part of my Social Studies SBA and must be filled out as accurately as possible. Please answer all questions with a () and follow any instructions that are associated. Your co-operation and participation is greatly appreciated.
1. a) Gender □ Male □ Female
b) Age Range □ 10-12 yrs □13-15 yrs □16-18 yrs □19 +
c) What form are you in? □ 1st □ 2nd □ 3rd □ 4th □ 5th
2. Do you drink alcohol? If no, Please do not continue questionnaire. □ Yes □ No
3. How long have you been drinking alcohol? □ 0-4 yrs □ 5-9 yrs □ 10 yrs +
4. What is your usual daily consumption of alcohol? □ 0-3 times □ 4-7 times □ 8-11 times □ 12 times +
5. Is your family aware that you consume alcohol? □ Yes □ No
6. Are you allowed to consume alcohol? □ Yes □ No
7. Are you influenced to consume alcohol on a regular basis? If ‘yes’, state by whom. □ Yes □ No b) ___________________________________________ 8. How many persons are in your household? □ 2-4 persons □ 5-7 persons □ 8 persons +
9. Does everyone in your family consume alcohol? If ‘no’, state whom. □ Yes □ No b) ___________________________________________
10. Do you drink for special occasions? □ Yes □ No
b) What special occasions do you mostly consume alcohol? Tick all that apply. □ Birthdays □ Anniversaries □ Graduations □Holidays □Parties
11. Is your family divided by the consumption of alcohol in the home? If ‘yes’, state how. □ Yes □ No b) ___________________________________________
12. Does