1. Alcohol Consumption and Distance from Home

April 12, 2010

Dear participant,


You will be completing a survey about alcohol consumption. The survey will take about five minutes. The goal of this study is to see if students who live further away from their permanent home consume more alcohol. Participation in this study is voluntary. Your responses to this survey will remain anonymous. There are minimal risks to participating in this study and some questions might make you uncomfortable. If at any time you feel uncomfortable with a question, you may leave it blank. You will benefit from this survey by knowing you have assisted with expanding current research on the topic of college drinking. You must be at least 18. If you have questions about the study you can contact the supervising researcher, Dr. Mark Chachich (mchachich@towson.edu), the principle researcher, Gina Davis (gdaivs1@students.towson.edu), or Dr. Patricia Alt, the Chairperson of the Institutional Review Board for the Protection of Human Participants at Towson University (410-704-2236). Thank you for your participation.

Thank You,

Gina Davis


THIS PROJECT HAS BEEN REVIEWED AND APPROVED BY THE INSTITUTIONAL REVIW BOARD FOR THE PROTECTION OF HUMAN PARTICIPANTS AT TOWSON UNIVERSITY



* 1. What is your student status (according to earned credits):

* 2. What is your gender:

* 3. Please provide your current age:

* 4. Do you live:

* 5. If you live on campus, do you live in a dormitory?

* 6. Is your college considered:

* 7. What is the zip code for your college or university?

* 8. What is the zip code of your permanent home?

* 9. On average, how many days per week do you consume alcohol?

* 10. Each day you drink, about how many drinks do you consume? (one drink equals one beer, one glass of wine, or one shot)

* 11. Do you participate in collegiate sports?

* 12. If yes to previous question, is the sport:

* 13. Do you participate in a Greek Organization?

* 14. Select the answer that best describes how often you go home:

* 15. Instructions: I am interested in how you feel about the following statements. Read each statement carefully. Indicate how you feel about each statement.

  Very Strongly Disagree Strongly Disagree Mildly Disagree Neutral Mildly Agree Strongly Agree Very Strongly Agree
1. There is a special person who is around when I am in need.
2. There is a special person with whom I can share my joys and sorrows.
3. My family really tries to help me.
4. I get the emotional help and support I need from my family.
5. I have a special person who is a real source of comfort to me.
6. My friends really try to help me.
7. I can count on my friends when things go wrong.
8. I can talk about my problems with my family.
9. I have friends with whom I can share my joys and sorrows.
10. There is a special person in my life who cares about my feelings.
11. My family is willing to help me make decisions.
12. I can talk about my problems with my friends.
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