THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY. ALL RESPONSES ARE ANONYMOUS. IF THERE IS A QUESTION YOU PREFER TO NOT ANSWER, SKIP IT AND CONTINUE ON TO THE NEXT ONE.
LIFESTYLE & LEISURE
ENTERTAINMENT/MOVIES/BOOKS 1. Which of the following do you regularly ( twice or more annually ) attend? (Please all that apply. ) Plays/dance/theatrical productions Movie theaters NONE OF THESE Musical concerts Sporting competitions 2. What kinds of movies do you most enjoy watching? (Please all that apply. ) Action Foreign Thriller Adventure Historical Other (please specify): Biographic/Documentary Independent ______ Comedy Musical NONE OF THESE Drama Romance 3a. How often do you go to the movies? At least once a week Once a month A few times a year 2 œ 3 times a month Every other month or so Never/very rarely b. How often do you rent videos or DVD‘s? At least once a week Once a month A few times a year 2 œ 3 times a month Every other month or so Never/very rarely c. How often do you purchase videos or DVD‘s? At least once a week Once a month A few times a year 2 œ 3 times a month Every other month or so Never/very rarely 4. What kinds of books do you most enjoy reading? (Please up to THREE. ) Adventure Current events Mystery Self-help Biography Fiction Non-fiction Other (please specify): Cooking History Religious/spiritual ______ Craft related Home/gardening Romance NONE OF THESE 5a. Do you: Purchase books Borrow books from the library Both Neither If you DO NOT purchase books, please skip to question #7 b. Where do you most often purchase books? (Please all that apply. ) Barnes & Noble amazon.com Borders Other online sites (please specify) : Other national bookstore chains (please specify): ______ Other stores (i.e., Kmart, grocery store, etc.) Local bookstores Mail order c. Approximately how much do you spend per month on books? $25 or less $26 - $50 $51 - $100 $101 - $250 $251 or more
6a. Do you buy children‘s books? Yes No If NO, please skip to question #7 b. For whom do you most often buy children‘s books? For your own children For other family members/friends For clients/patients c. From where do you most often purchase children‘s books? (Please all that apply.) Barnes & Noble amazon.com Local bookstores Borders Other online sites (please specify) : Other stores (i.e., Kmart, grocery Other national bookstore ______store, etc.) chains (please specify): Mail order ______ Through school d. For what age ranges do you buy children‘s books? (Please all that apply.) Younger than 3 yrs 3 yrs œ 6 yrs 7 yrs œ 10 yrs 11 yrs œ 14 yrs 15 yrs or older e. Approximately how much money do you spend on children‘s books per month? $25 or less $26 - $50 $51 - $100 $101 - $250 $251 or more
CREATIVE EXPRESSION 7. Do you express yourself creatively through any of the following? (Please all that apply. ) Acting/theater Drawing/painting Participating in sports Other (please specify): Cooking Gardening Photography ______ Crafts Jewelry design Play an instrument NONE OF THESE Creative writing Journaling Quilting/sewing Decorating Letter writing Work on house
MUSIC 8. What types of music do you enjoy listening to? (Please all that apply. ) Big Band Folk Light Jazz Religious Other (please specify ): Bluegrass Gospel New Age Rock ______ Blues Heavy Metal Opera Soul NONE OF THESE Classical Hip Hop R&B Top 40 Country Jazz Rap 9. How often do you listen to music ...... at home? Often Sometimes Rarely Never . . . at the office? Often Sometimes Rarely Never . . . in the car? Often Sometimes Rarely Never 10a. How often do you purchase CD‘s/records/tapes? At least once a week Once a month A few times a year 2 œ 3 times a month Every other month or so Never/very rarely b. Where do you most often purchase CD‘s/records/tapes? Retail Online Mail order Other (please specify): ______
HEALTH & BEAUTY
11. Which of the following health-related magazines do you regularly read? (Please all that apply. ) Fitness Natural Health Self Other ( please specify ): ______ Men‘s Health Prevention Shape NONE OF THESE
HANDLING STRESS 12. How often do you feel overwhelmed by your work? All of the time Often Sometimes Rarely Never 13. What do you do to relieve daily stress? (Please up to THREE. ) Exercise Watch TV Talk to friend or Other ( please specify ): Read Listen to music spouse ______ Sleep Crafting Work on car NONE OF THESE Dance Cooking Spiritual counseling Herbal remedies Sports Seek professional help
WALKING/RUNNING 14. Do you walk and/or run for exercise? Yes, outside Yes, inside Both Neither If you answered no, please skip to question #20 15. How often do you walk and/or run for exercise? Daily Every other day or so Weekly Rarely 16. How far do you typically go at a time? Less than a mile 1 œ 2 miles 3 or more miles Don‘t know 17. What kind of shoes do you wear when running or walking for exercise? ( Please all that apply. ) Adidas K Swiss Nike Ryka Asics LA Gear Propet Saucony Avia Mephisto Puma Teva Easy Spirit Merrill Reebock Other ( please specify ): ______ Ecco New Balance Rockport NONE OF THESE 18. Do you wear exercise clothes or other special clothes when you walk and/or run? Yes No 19. Do you walk and/or run in marathons or other events? Yes No
EXERCISE CLASSES/HEALTH CLUB MEMBERSHIP 20a. Do you take exercise or fitness classes? Yes No If NO, please skip to question #21 b. What kinds of classes do you take? ( Please all that apply. ) Aerobics Martial arts Step Other ( please specify ): Jazzercise Pilates Yoga ______ Kickboxing Spinning NONE OF THESE 21a. Do you use a health club/health facility? Yes No If NO, please skip to question #22 b. Which facility do you use? (Please all that apply. ) Gold‘s Gym Total Fitness Sport and Health Club YMCA/YWCA Bally L.A. Fitness Local club/gym Other ( please specify ): ______c. How regularly do you exercise at the health facility? Daily Weekly Once a month Every other day (or so) A few times a month A few times per year
WEIGHT 22a. Are you interested in any of the following? Losing weight Maintaining your weight Gaining weight NONE OF THESE If NONE OF THESE, please skip to question #24 b. If you are interested in losing or gaining weight, what is your goal? 10 pounds or less 21 œ 30 pounds 41 œ 50 pounds 11 œ 20 pounds 31 œ 40 pounds More than 50 pounds 23. Are you currently participating in any of the following diets/programs? (Please all that apply. ) Atkins Lighten Up! Rice Diet Zone Herbalife Nutri System Slim Fast Diet pills Jenny Craig Physician‘s Weight Loss TrimLife Other: ______ LA Weightloss Pritikin Weight Watchers NONE OF THESE
ALTERNATIVE MEDICINE 24a. Do you regularly take vitamins? Yes No b. Do you regularly take herbal supplements? Yes No 25. Where do you purchase vitamins and herbal supplements? (Please all that apply. ) Grocery store Local specialty store Online ( specify website(s) ): ______ GNC (General Nutrition Center) Pharmacy Other ( please specify ): ______26. Approximately how much money do you spend per month on vitamins and herbal supplements? $25 or less $26 - $50 $51 - $100 $101 or more 27. Are you interested in holistic health? Yes No Don‘t know 28. Which of the following do you regularly ( at least twice a year ) receive? (Please all that apply. ) Acupuncture Manicures/pedicures Other ( please specify ): Facials Spa treatments ______ Massage therapy NONE OF THESE
BEAUTY AIDS/COSMETICS 29. What brands of facial skin care do you regularly use? (Please up to THREE. ) Almay Clarins L‘Oreal Oil of Olay Aveda Clean and Clear Mary Kay Origins Aveeno Clearasil Neutragena Perscriptives Avon Clinique Nivea Other ( specify ): ______ Bodyworks Kiehls Noxema NONE OF THESE 30. How often do you wear makeup/cosmetics? Every day Monday through Friday Special occasions only Never If you answered never, please skip to question #35 31. What brand(s) of makeup do you use for each of the following items? (Please all that apply. ) Mascara Blush Lipstick Foundation Powder Mascara Blush Lipstick Foundation Powder Almay Mary Kay Aveda Max Factor Bobby Brown Maybelline Clinique Merle Norman Cover Girl Origins Flori Roberts Revlon Lancome Other ( please specify ): L‘Oreal ______ MAC NONE OF THESE 32. From which cosmetic company do you make the most purchases? (Please ONE only. ) Almay Flori Roberts Max Factor Other ( please specify ): Aveda Lancome Maybelline ______ Bobby Brown L‘Oreal Merle Norman NONE OF THESE Clinique MAC Origins Cover Girl Mary Kay Revlon 33. How much do you spend each month on cosmetics? $25 or less $26 - $50 $51 - $100 $101 - $250 $251 or more 34. What is important to you in choosing cosmetics? (Please up to THREE. ) Convenience Hypoallergenic Not tested on animals Cost Look Quality Ethnic/specialty Name brand Science For sensitive skin Natural Other ( please specify ): ______
STYLE 35. How would you describe your favorite style of dressing? (Please all that apply.) Comfortable Current trends Professional Other ( please specify ): Conservative High-fashion Trend-setting ______36. Which of the following stores best reflects your clothing style? (Please all that apply.) Ann Taylor Express Nordstrom TJ Max Banana Republic JC Penny Old Navy Walmart/Kmart Brooks Brothers Learner‘s Sears Local boutique Chico‘s The Limited Talbott Other department store ( please specify ): GAP Macy‘s Target ______
PURCHASING & INVESTING
ELECTRONICS 37. Please indicate which of the following items someone in your household currently owns . (Please all that apply.) Cellular phone Laptop computer Tivo Compact disc player Pager Two-way radios Desktop computer Palm-size planner (PDA) Other electronics ( please specify ): Digital camera Satellite dish ______ Digital videodisc player (DVD) Scanner NONE OF THESE 38a. Do you use an electronic palm-sized planner? For personal use Both For work Neither If NEITHER, please skip to question #39 b. What kind do you use? (Please all that apply.) Blackberry Handspring Palm Pilot Visor Other (specify): ______c. How important are each of the following features of your electronic planner? (Please rate each of the following.) (Very Important) (Not at all important) Don‘t 5 4 3 2 1 Use Appointment scheduler Calculator Expense tracking Email Games Internet capability Memo pad Address book Other ( specify ): ______
CELLULAR PHONE 39. Would you recommend a wireless/digital service if it supported your professional association? Yes No 40. Would you purchase a cell phone if it offered an ASHA member discount plan? Yes No 41. Do you currently use a cellular phone? Yes No If NO, please skip to question #48 42. Which of the following had the greatest impact on your decision to purchase a cellular phone and service? (Please all that apply.) Company reputation Cost Range Other (please specify) : Connection/clarity Features Service reputation ______43. How frequently do you use your cellular phone? Only for emergencies A few times a week More than 1 hour daily Once a week Daily Other (please specify) : ______44. For what purpose do you use your cell phone? Business only About half business and half personal Personal only Mostly business Mostly personal 45. How often do you use your cell phone for long distance calls? Always Often Rarely Never 46. Who is your cell phone carrier? (Please all that apply.) AT&T Wireless Verizon Wireless GlobalStar Other ( please specify ): Sprint PCS Nextel Bell Atlantic Mobile ______ MCI U.S. Cellular Cingular Wireless I don‘t know Cable & Wireless Voicestream Cellular One
47. Would you consider switching cellular service if: You received a discount through ASHA The service supported ASHA Neither
HOME IMPROVEMENT 48. Which of the following decorating/home improvement magazines do you subscribe to? (Please all that apply. ) Architectural Digest Fine Gardening Simple Living Better Homes & Gardens Fine Homebuilding Workbench Consumer Reports Home & Garden Other (please specify): ______ Family Handyman Martha Stewart Living NONE OF THESE 49. Where do you most often shop for home improvement supplies and materials? (Please all that apply.) Ace Hardware Local hardware store Other (please specify): Costco/Sam‘s Clubs, etc. Lowes ______ Home Depot Sears NONE OF THESE 50a. Do you do craft projects? Yes No If NO, please skip to question #51 b. Where do you most often shop for materials? (Please all that apply.) Craft fairs K-Mart Michael‘s Other ( please specify ): ______ Flea Markets Local chain On-line NONE OF THESE
INVESTING 51. My knowledge of financial investing is: Excellent Could be improved Needs lots of help 52. On average, how much do you save/invest per year ( including retirement funds )? Under $2,500 $5,000 - $9,999 $15,000 - $19,999 $2,500 - $4,999 $10,000 - $14,999 $20,000 or more 53. Which of the following do you invest through? (Please all that apply. ) A broker/advisor Fund network Your bank Directly Internet/online Your employer 54. Which of the following do you have a preference for? (Please all that apply. ) Annuities Stocks A high-risk mix CDs Bonds Other ( please specify ): Mutual funds A conservative mix ______55. In the next 12 months, which of the following do you expect to invest in? (Please all that apply. ) Annuities CDs Individual stocks NONE OF Bonds Mutual funds Other ( please specify ): ______THESE 56. Would you participate in investment seminars offered through ASHA as a member benefit? Yes No
AHSA BENEFITS 57. Which of the following ASHA member discount/benefit programs are you familiar with? (Please all that apply. ) AGS Publishing Delmar Learning Practice Source Singular Publishing Amica Auto Insurance Marsh Liability The Psychological Subaru of America Content Scan/Dome MBNA Mastercard Corporation NONE OF THESE 58. What types of products or services would you like to receive as a special benefit of your membership in ASHA? (Please up to THREE. ) Books Exercise Music Vitamins Cell phones Investments Natural foods Weight loss Clothing Long distance service On-line banking Other ( please specify ): Cosmetics Life insurance Spa treatments ______ Electronics Magazines Travel NONE OF THESE 59. Which of the following ASHA benefit programs have you participated in? ( Please all that apply. ) Amica Auto Insurance Marsh Liability Subaru of America IBM MBNA Mastercard 60. How likely are you to purchase or use a product or service because it is offered as an ASHA member benefit? Very likely Somewhat likely Very unlikely
DEMOGRAPHICS
61. What is your gender? Male Female 62. What is your age? 20-24 30-34 40-44 50-54 60-64 25-29 35-39 45-49 55-59 65 or older 63a. How many children (18 and under ) are currently living in your household? #______b. What are the ages of these children? (Please all that apply.) Under 1 3 to 4 7 to 8 11 to 12 15 to 16 1 to 2 5 to 6 9 to 10 13 to 14 17 to 18 64. Which of the following categories describe you? (Please all that apply.) Speech-language Pathologist Audiologist Scientist Other ( specify ): ______
THANK YOU FOR YOUR HELP! Please return in the enclosed postage-paid envelope to: Lewis & Clark Research, P.O. Box 31027, Raleigh, NC 27622