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  1. Surveys
  2. 2013
  3. July
  4. V
  5. Video Games and Substance Use
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Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
 
How many hours of video games do you play a day
 
Less than two -hours per day.
 
More than two-hours per day.
 
 
 
When you consume alcohol, how many drinks do you have per day?
 
None
 
Less than four drinks per day
 
Four or more drinks per day
 
 
 
How many alcoholic drinks do you have per week?
 
None
 
1-14
 
More than fourteen
 
 
 
Do you or have you used illegal substances since you've started college?
 
Yes
 
No

 
 
 
If you selected yes to the previous question, please respond with which of these substances you have used. If you selected no, leave this question blank.
 
Marijuana or derivatives
 
Cocaine/Crack
 
Prescription Pills
 
Amphetamines
 
Opium/Heroin
 
Other
 

 
 
 
How many caffienated beverages do you drink per day? (Coffee, Tea, Energy Drinks)
 
None
 
1-4
 
More than four.
 
Thank you again for your participation! If you have any questions or comments please feel free to call us at (555)555-5555