Peer Pressure in Underage Drinking Survey
* To answer mark desired answer with an X.
1.Age:
12-14-
15-17-

2. Sex:
Female-
Male-

3. In the past have you consumed alcohol? :
Yes-
No-

*If you answered NO then you do NOT need to CONTINUE.

-If YES indicate:
4. How often you consume alcohol? :
Only ever once or twice-
Every couple of months or so-
At least every month-
Weekly-
Daily-

5. Do you feel others influence your drinking patterns? :
Yes, sometimes-
Yes, all the time-
No, Not at all-

6. Do you feel pressure from peers to consume alcohol? :
A lot-
A little-
None at all-

7. In general how much alcohol are you likely to consume? :
A little, I do not get drunk-
I drink until I’m a little drunk-
A lot, I drink until I’m drunk-

8. Where are you most likely to drink? :
At a party-
With friends/ around peers-
With family-
On your own-

9. Do you feel peers impact you?
Negatively-
Positively-
Explain:

* End of survey, Thankyou for your participation