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  Questionnaire Name - Alcohol Consumpton
  Showing 1-15 of 16 | Next     
1   Gender
 
 
 A-Male (1)
 B-Female (1)
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2   Age
 
 
 A-15-20 (0)
 B-21-25 (1)
 C-26-30 (0)
 D-31-35 (0)
 E-36-40 (1)
 F-41-45 (0)
 G-46 or above (0)
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3   Religion
 
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4   Place of Birth
 
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5   Income
 
 
 A-Below 10000 (0)
 B-10000-20000 (2)
 C-20001-30000 (0)
 D-Over 30000 (0)
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6   Occupation
 
 
 A-Blue Collar (2)
 B-White Collar (0)
 C-Pink Collar - service industry (0)
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7   What kinds of beverages you like?
 
 
 A-Beer (2)
 B-Red Wine (0)
 C-White Wine (0)
 D-Whisky (0)
 E-Liquor (0)
 F-Champiagne (0)
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8   How often you drink alcohol?
 
 
 A-1 time per week (2)
 B-3 times per week (0)
 C-more than 3 times per week (0)
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9   What places you like to go for drink?
 
 
 A-Home (0)
 B-Outside places (0)
 C-Dinner/Clubbing (2)
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10   You like to get companion or single to drink?
 
 
 A-Single (0)
 B-Companion (2)
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11   What emotion to make you drink a lot?
 
 
 A-High emotion (1)
 B-Low emotion (0)
 C-Both (0)
 D-No reason (1)
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12   How many drinks on a single occasion within 2 hours
 
 
 A-Less than 3 drinks (2)
 B-4 drinks (0)
 C-More than 5 drinks (0)
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13   Have you ever felt should cut down on you drinking?
 
 
 A-Yes (0)
 B-No (2)
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14   Have people annoyed you by criticizing your drinking?
 
 
 A-Yes (1)
 B-No (1)
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15   Have you ever felt bad or guilty about your drinking?
 
 
 A-Yes (0)
 B-No (2)
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