hay everyone...im doing my irp on smoking an drinking amongst teenagers.....anyone can fill this out..even if u dont smoke or drink thats great anyway......im running out of time to do this...lol.....please fill out thanks a bunch
Age:
Gender:
ÿ Male
ÿ Female
1. Which suburb do you live in?
2. What are the main types of nationalities living in your area?
ÿ Australian
ÿ Greek
ÿ Italian
ÿ Lebanese
ÿ Asian
ÿ Croatian
ÿ Other (please specify)
3. Do you still attend school?
ÿ Yes
ÿ No
4. What type of school is this?
ÿ Private
ÿ Catholic
ÿ Government
ÿ Other (please specify)
5. What are the different types of nationalities attending your school? Please tick.
ÿ Australian
ÿ Greek
ÿ Italian
ÿ Lebanese
ÿ Asian
ÿ Croatian
ÿ Other (please specify)
6. Do you have any career goals/intentions when you finish school? Please specify.
7. How would you rate your school facilities?
ÿ Excellent
ÿ Good
ÿ Average
ÿ Poor
ÿ Very poor
8. Do you have a history of smoking/drinking in your family? Please state whom and what.
9. Do you yourself smoke or drink? How regularly?(if no, please skip down to question 19)
ÿ Smoke
ÿ Drink
ÿ Both
ÿ None
10. On average, how many times a week do you smoke?
11. On average, how many times a week do you drink?
12. How did you start smoking? What influenced you? Please tick.
ÿ Peers
ÿ Media
ÿ Parents
ÿ Movies
ÿ Advertising
ÿ Other (specify)
13. How did you start drinking? What influenced you? Please tick.
ÿ Peers
ÿ Media
ÿ Parents
ÿ Movies
ÿ Advertising
ÿ Other (specify)
14. Do you think you will you continue to smoke or drink?
ÿ Yes
ÿ No
15. Are you aware of the consequences of smoking?
16. Are you are aware of the consequences of drinking?
17. In what social environment are you most likely to smoke?
ÿ With family
ÿ With friends only
ÿ At parties/social gatherings
ÿ At home by yourself
ÿ At work
ÿ Other
18. In what social environment are you most likely to drink?
ÿ With family
ÿ With friends only
ÿ At parties/social gatherings
ÿ At home by yourself
ÿ At work
ÿ Other
19. How many members in your family?
ÿ 1
ÿ 2
ÿ 3
ÿ 4
ÿ >5
20. How many hours of quality time do you spend with your family?
ÿ 1
ÿ 2
ÿ 3
ÿ 4
ÿ >5
21. What does your family do for quality time?
ÿ Go to the movies
ÿ Go to the shops
ÿ Play board games
ÿ Watch television
ÿ Go on picnics
ÿ Other. Please specify
ÿ
22. Who are you most close to within your family?
ÿ Mum
ÿ Dad
ÿ Brother
ÿ Sister
ÿ No-one
23. Do your parents work?
ÿ Yes
ÿ No
24. What occupations are your parents in? Please state.
25. Do you consider either of your parents as role models, people that you would someday aspire to be or follow in their footsteps? Why/why not? Please state/
26. Please rate your health. With 1 being low, 3 being average and 5 being high.
1 2 3 4 5
Low average high
[FONT='Calibri','sans-serif'] Thank you for [/FONT]
Age:
Gender:
ÿ Male
ÿ Female
1. Which suburb do you live in?
2. What are the main types of nationalities living in your area?
ÿ Australian
ÿ Greek
ÿ Italian
ÿ Lebanese
ÿ Asian
ÿ Croatian
ÿ Other (please specify)
3. Do you still attend school?
ÿ Yes
ÿ No
4. What type of school is this?
ÿ Private
ÿ Catholic
ÿ Government
ÿ Other (please specify)
5. What are the different types of nationalities attending your school? Please tick.
ÿ Australian
ÿ Greek
ÿ Italian
ÿ Lebanese
ÿ Asian
ÿ Croatian
ÿ Other (please specify)
6. Do you have any career goals/intentions when you finish school? Please specify.
7. How would you rate your school facilities?
ÿ Excellent
ÿ Good
ÿ Average
ÿ Poor
ÿ Very poor
8. Do you have a history of smoking/drinking in your family? Please state whom and what.
9. Do you yourself smoke or drink? How regularly?(if no, please skip down to question 19)
ÿ Smoke
ÿ Drink
ÿ Both
ÿ None
10. On average, how many times a week do you smoke?
11. On average, how many times a week do you drink?
12. How did you start smoking? What influenced you? Please tick.
ÿ Peers
ÿ Media
ÿ Parents
ÿ Movies
ÿ Advertising
ÿ Other (specify)
13. How did you start drinking? What influenced you? Please tick.
ÿ Peers
ÿ Media
ÿ Parents
ÿ Movies
ÿ Advertising
ÿ Other (specify)
14. Do you think you will you continue to smoke or drink?
ÿ Yes
ÿ No
15. Are you aware of the consequences of smoking?
16. Are you are aware of the consequences of drinking?
17. In what social environment are you most likely to smoke?
ÿ With family
ÿ With friends only
ÿ At parties/social gatherings
ÿ At home by yourself
ÿ At work
ÿ Other
18. In what social environment are you most likely to drink?
ÿ With family
ÿ With friends only
ÿ At parties/social gatherings
ÿ At home by yourself
ÿ At work
ÿ Other
19. How many members in your family?
ÿ 1
ÿ 2
ÿ 3
ÿ 4
ÿ >5
20. How many hours of quality time do you spend with your family?
ÿ 1
ÿ 2
ÿ 3
ÿ 4
ÿ >5
21. What does your family do for quality time?
ÿ Go to the movies
ÿ Go to the shops
ÿ Play board games
ÿ Watch television
ÿ Go on picnics
ÿ Other. Please specify
ÿ
22. Who are you most close to within your family?
ÿ Mum
ÿ Dad
ÿ Brother
ÿ Sister
ÿ No-one
23. Do your parents work?
ÿ Yes
ÿ No
24. What occupations are your parents in? Please state.
25. Do you consider either of your parents as role models, people that you would someday aspire to be or follow in their footsteps? Why/why not? Please state/
26. Please rate your health. With 1 being low, 3 being average and 5 being high.
1 2 3 4 5
Low average high
[FONT='Calibri','sans-serif'] Thank you for [/FONT]