<p> 1</p><p>COLLEGE STUDENT ALCOHOL USE QUESTIONNAIRE</p><p>This survey is designed to better understand the use of alcoholic beverages among college students. Please be completely open and honest in providing information about yourself and your use of alcohol. Your individual responses will not be identified with you in any way. All answers will be combined and only overall results reported.</p><p>1. Have you ever consumed alcoholic beverages? ___ Yes ___ No If no, skip to question #51</p><p>2. Have you ever consumed five or more drinks in one sitting? For the purposes of this study, a drink is defined as a bottle of beer, a glass of wine, a wine cooler, a shot glass of liquor, a mixed drink, or a similar drink containing alcohol. ___ Yes ___ No</p><p>3. Think back over the last two weeks. How many times have you consumed five or more drinks at one sitting? ___</p><p>4. What is the average number of drinks you consume in a week? ___</p><p>5. To what extent has your alcohol use changed within the last 12 months? ___ Increased ___ About the Same ___ Decreased</p><p>During the last 30 days, to what extent have you engaged in each of the following behaviors? Fill in the blank. For example, if zero times put a 0, if one time put a 1, if 10 times put a 10, and so on. Number of Times 6. Refused an offer of alcohol? ___ 7. Bragged about your alcohol use? ___ 8. Heard someone else brag about his/her alcohol use? ___ 9. Experienced peer pressure to drink? ___ 10.Thought a sexual partner who was drunk was not attractive? ___ 11.Told a sexual partner who was drunk that they were not attractive? ___ 2</p><p>Please indicate how often you have experienced the following due to your drinking during the last year (12 months)? Fill in the blank. For example, if zero times put a 0, if one time put a 1, if 10 times put a 10, and so on. Number of Times 12.Had a hangover? ___ 13.Performed poorly on a test or important project? ___ 14.Been in trouble with police, residence hall or other college authorities? ___ 15.Damaged property, pulled fire alarm, etc.? ___ 16.Got into an argument or fight? ___ 17.Got nauseated or vomited? ___ 18.Driven a car or truck while under the influence? ___ 19.Missed a class? ___ 20.Been criticized by someone you know? ___ 21.Thought you might have a drinking problem? ___ 22.Experienced memory loss? ___ 23.Done something you later regretted? ___ 24.Been arrested for DUI/DWI? ___ 25.Been taken advantage of sexually? ___ 26.Have taken advantage of another sexually? ___ 27.Tried unsuccessfully to stop drinking? ___ 28.Seriously thought about suicide? ___ 29.Seriously tried to commit suicide? ___ 30.Been hurt or injured due to your drinking? ___</p><p>For each of the following statements, indicate whether or not you believe alcohol has that effect? Circle the appropriate number.</p><p>31.Breaks the ice? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>32.Enhances social activities? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>33.Makes it easier to deal with stress? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>34.Makes a connection with peers easier? Strongly Strongly Disagree 1 2 3 4 5 Agree 3</p><p>35.Gives people something to talk about? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>36.Facilitates male bonding? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>37.Facilitates female bonding? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>38.Enables people to have more fun? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>39.Gives people something to do? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>40.Makes food taste better? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>41.Makes women sexier? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>42.Makes you sexier? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>43.Improves sexual opportunities? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>44.Interrupts your studying? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>45.Makes you feel unsafe? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>46.Messes up your physical living space (cleanliness, neatness, organization, etc.)? Strongly Strongly Disagree 1 2 3 4 5 Agree 4</p><p>47.Prevents you from enjoying events, such as concerts, sports, social activities, etc.? Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>48.Interferes in other ways? If yes, please specify: ______Strongly Strongly Disagree 1 2 3 4 5 Agree</p><p>Classification Questions</p><p>49.What is your classification? ___ Freshman ___ Senior ___ Sophomore ___ Graduate Student ___ Junior</p><p>50.What is your gender? ___ Female ___ Male</p><p>51.What is your age? ___</p><p>52.Binge drinking has been defined as consuming five or more drinks in one setting. Have you ever consumed alcohol in a manner that meets this definition? __ Yes __ No If yes: a. Did you binge drink in high school? __ Yes __ No b. Do you binge drink as a college student? __ Yes __ No</p><p>53.What is your ethnic origin? __ American Indian/Alaskan Native __ White (non-Hispanic) __ Hispanic __ Black (non-Hispanic) __ Asian/Pacific __ Other (please specify) ______</p><p>54.What is your marital status? __ Single __ Divorced __ Married __ Living with a partner, but not married __ Separated __ Widowed</p><p>55.What is your parent’s annual income? __ Less than $25,000 __ $25,001 - $50,000 __ $50,001 - $75,000 __ $75,001 - $100,000 __ $100,001 - $125,000 __ $125,001 - $150,000 __ $150,001 or higher</p><p>Thank you for your participation.</p>