Asking Questions - The Definitive Guide To Questionnaire Design ...

412 APPENDIX B
PLEASE CIRCLE ONE CODE NUMBER FOR EACH QUESTION
UNLESS OTHERWISE SPECIFIED.
1. What is your age?
Under 18 . . . . . . . . . . 1 (Skip to Q.22.)
18 . . . . . . . . . . . . . . . 2
19 . . . . . . . . . . . . . . . 3
20 . . . . . . . . . . . . . . . 4
21 or over . . . . . . . . . 5 (Skip to Q.22.)
2. Have you ever had a drink of any type of alcohol? (By “drink” we mean
a glass of beer or wine, a can or bottle of beer, a wine cooler, a shot or
jigger of hard alcohol, etc. Do not include sips that you might have taken
from another person’s drink.)
Yes. . . . . . . . . . . . . . . 1
No . . . . . . . . . . . . . . . 2 (Skip to Q.16.)
3. How old were you the first time you drank alcohol? (Do not include sips
from another person’s drink.)
years old
4. Did you drink alcohol while you were in high school, even once?
Yes. . . . . . . . . . . . . . . 1
No . . . . . . . . . . . . . . . 2 (Skip to Q.7.)
5. How often did you typically drink alcohol during your senior year
in high school?
Two or more times a week . . . . . . . . . . . 1
Once a week . . . . . . . . . . . . . . . . . . . . . . 2
One to three times a month . . . . . . . . . . 3
Less than once a month . . . . . . . . . . . . . 4
Never during senior year . . . . . . . . . . . . 5 (Skip to Q.7.)
6. On the days when you drank during your senior year, about how many
drinks did you consume on average?
drinks per day
7. In what month and year did you graduate from high school?
Month
Year
8. Since you graduated from high school, have you drunk any alcohol?
Yes. . . . . . . . . . . . . . . 1
No . . . . . . . . . . . . . . . 2 (Skip to Q.16.)
9. During the past 30 days, have you had at least one alcoholic drink?
Yes. . . . . . . . . . . . . . . 1
No . . . . . . . . . . . . . . . 2 (Skip to Q.16.)
10. During the past 30 days, on how many days did you drink any alcoholic
beverages?
days