Alcohol Awareness

For your chance to win a fantastic prize ranging from a Nintendo Wii Fit to Shopping Vouchers please complete these 9 short questions.

All of your responses from this survey will remain strictly confidential.

Q1	Are you...
		Male		Female

Q2	Age...
		Under 18		25-34		55+
		18-24		35-54		Rather not say

Q3                         What is your ethnicity?

	White
		British		Irish		Any other white background

	Mixed
		White and Black Caribbean		White and Black African		White and Asian		Any other Asian background

	Asian or Asian British
		Indian		Pakistani		Bangladeshi		Any other Asian background

	Black or Black British
		Caribbean		African		Any other Black background

	Chinese
		Chinese

	Any other ethinc background
		Any other ethnic background

Q4	How often do you drink alcohol?
		Daily		Very rarely
		2-3 times a week		Not at all/never
		Weekends only

Q5	What do you usually drink? (please tick all that apply)
		Beer/Lager/Bitter		Alco-pops
		Cider		Cocktails
		Wine		Soft drinks
		Spirits		Non alcoholic beer/wine
		Shots		Whatever is available, I'm not fussy

Q6	On average, how much alcohol do you drink in one session? (please select each drink and the amount you have per session)
	Pints (beer/lager/bitter/cider)	--Click Here--0 (None)12345678910 11121314151617181920More
	Bottles (beer/lager/bitter/cider)	--Click Here--0 (None)12345678910 11121314151617181920More
	Glasses of wine	--Click Here--0 (None)12345678910 11121314151617181920More
	Bottles of wine	--Click Here--0 (None)12345678910 11121314151617181920More
	Bottles of alco-pops	--Click Here--0 (None)12345678910 11121314151617181920More
	Spirits (25ml serving)	--Click Here--0 (None)12345678910 11121314151617181920More
	Cocktails	--Click Here--0 (None)12345678910 11121314151617181920More
	Shots	--Click Here--0 (None)12345678910 11121314151617181920More

Q7	Why do you drink? (please tick all that apply)
		To relax		Because I feel down
		Out of boredom		To feel less anxious
		I enjoy it		It gives me confidence
		To get drunk/to have fun		To forget about my problems
		To be social		Other
		Peer pressure

If other, please state

Q8	Other than a pub, club or bar where do you normally get/buy your alcohol from? (please tick no more than 3)
		Home		Local shop or off-license
		A friend's house		A friend of relative buys if for me
		Supermarket		Other
		Abroad

If other, please state

Q9	Which of the below health risks do you think are associated with drinking excessive amounts of alcohol? (tick all that apply)
		Damage to your eyes		Low sex drive
		Brain damage		Bad breathe
		Liver damage		Dehydration
		Poor concentration		Muscle loss
		Indigestion		Vomiting
		Miscarriage		Weight gain
		Weak bladder		Dry skin

Below are the responses to question 10.

12 out of the 14 responses are health risks associated with drinking excessive amounts of alcohol. The two incorrect health risks are highlighted in red.

		Damage to your eyes		Low sex drive
		Brain damage		Bad breathe
		Liver damage		Dehydration
		Poor concentration		Muscle loss
		Indigestion		Vomiting
		Miscarriage		Weight gain
		Weak bladder		Dry skin

Thank you for your responses, the information you have given us will remain strictly confidential. For your chance to win a fantastic prize please leave your contact details below

Q11

Name

Q12

Email address

Q13

Contact number

Q14

What is your postcode? (for analysis purposes only)

If you are drinking daily please seek specialist help for more information on what is available in your area by clicking on the website below.

If you have any concerns about the amount of alcohol you or someone close to you drinks, or if you would simply like to know more information then please click here

Thank you.

Thank you for your responses, the information you have given us will remain strictly confidential. For your chance to win a fantastic prize please leave your contact details below

Q15

Name

Q16

Email address

Q17

Contact number

Q18

What is your postcode? (for analysis purposes only)

It is advised that you drink 2-3 times a week and within normal limits (2-3 units for an adult female, and 3-4 units for an adult male). To know your alcohol units please click on the link below.

If you have any concerns about the amount of alcohol you or someone close to you drinks, or if you would simply like to know more information then please click here

Thank you.

Thank you for your responses, the information you have given us will remain strictly confidential. For your chance to win a fantastic prize please leave your contact details below

Q19

Name

Q20

Email address

Q21

Contact number

Q22

What is your postcode? (for analysis purposes only)

Remember not to drink more than the recommeded daily units. To know your alcohol units please click the link below.

If you have any concerns about the amount of alcohol you or someone close to you drinks, or if you would simply like to know more information then please click here

Thank you.

Thank you for your responses, the information you have given us will remain strictly confidential. For your chance to win a fantastic prize please leave your contact details below

Q23

Name

Q24

Email address

Q25

Contact number

Q26

What is your postcode? (for analysis purposes only)

If you have any concerns about the amount of alcohol you or someone close to you drinks, or if you would simply like to know more information then please click here

Thank you.

You have not supplied us with your postcode. Whilst it is not compulsory for you to supply us with your postcode it is very helpful for us when it comes to looking at results.

Q27

What is your postcode? (for analysis purposes only)

Thank you.