Year 11 Health - Parent Survey - Impact of Alcohol on Adolescence
Year 11 Health students are currently studying a unit of work that looks at the potential impact that alcohol can have on adolescents. As part of the broader topic they are investigating the effect that a young person's social environment, particularly with their family, can have on their interactions with alcohol. It is required that they collect primary data for the assessment task. Your participation in this survey is appreciated. Entries are anonymous and data will not be kept after the assessment task is completed.
Demographics
Questions 1 - 7
1. What is you gender? *
2. Choose the appropriate age group *
3. What is your marital status? *
4. What is your ethnicity? *
5. What is your current employment status *
6. Highest level of education achieved *
7. Household income *
Knowledge Questions
Questions 8 - 12
8. What are the penalties for irresponsibly supplying alcohol to a person under 18 at a private place? Check all boxes that apply *
Required
9. Is it legal for underage drinkers to drink on private property? *
10. What defines a ‘responsible adult’ when supplying alcohol to minors on a private property?                     Check all boxes that apply *
Required
11. Under the law, which factors are considered in deciding whether alcohol is being supplied under ‘responsible supervision’.                                                                              Check all boxes that apply: *
Required
12. Do you believe that parents who drink have an influence on whether or not their children become under-age drinkers?
Clear selection
Behaviour
Questions 13 - 20
13. Have you talked to your adolescent about drinking alcohol? *
14. Do you allow your adolescent to drink alcohol at home? *
15. Do you allow your adolescent to attend parties where alcohol is being consumed? *
16. How frequently do you allow your child to attend an event at which you know alcohol will be present? *
17. How many times in the past 12 months have you allowed your child to consume alcohol at an event where you were present? *
18. Do you drink alcohol in your home? *
19. At what age did you first drink alcohol? *
20. Why do you drink alcohol?
Clear selection
Environment
Questions 21 - 25
21. How many underage children do you have in your household? *
22. How often is alcohol (bottles, boxes, logos, clothing, signs, etc) visible in your house? *
23. How often is alcohol present at family social events? *
24. Where is alcohol stored in your home?                                                                       Check all applicable boxes *
Required
25. In which situations is alcohol consumed in your home?                            Check all boxes that apply. *
Required
Self Effciacy
Question 26
26. How confident are you in discussing the issue of alcohol with your adolescent? (5 - very confident   1 - not confident at all) *
Not at all confident
Very confident
27. How much trust do you have in your adolescent to not drink alcohol ?   5 - full trust    1 - no trust
Clear selection
Submit
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