This is for my Psyc of religion of class. feel free to participate
also feel free to send results via PM
Age: ________
Gender: _______
1. What is your religious affiliation? ________________________
--If you have no affiliation, do you consider yourself religious or spiritual? YES NO
2. How many times have you attended religious services during the past year? ________
3. Which of the following best describes your practice of prayer or religious meditation?
--Prayer/meditation is a regular part of my daily life.
--I usually pray/meditate in times of stress or need but rarely at any other time.
--I pray/meditate only during formal ceremonies.
--I never pray/meditate.
4. How much influence would you say that religion/spirituality has on the way that you choose to act and the way that you choose to spend your time each day?
--No influence.
--A small influence.
--Some influence.
--A fair amount of influence.
--A large influence.
5. During the past year, how often have you experienced a feeling of religious reverence or devotion?
--Almost daily.
--Frequently.
--Sometimes.
--Rarely.
--Never.
6. Do you consume alcoholic beverages? YES NO
A serving of alcohol is merited by: 12 oz of beer, a 6oz glass of wine, a 1 oz shot of hard alcohol, or any drink containing 1 oz of hard alcohol.
7. On average, how much alcohol do you consume in one sitting?
(#)_______ 6 oz glasses of wine
AND
(#)_______ 1 oz of hard alcohol
AND
(#)_______ 12 oz beers
8. On average, how many days per week do you consume alcohol?
0 1 2 3 4 5 6 7
9. In an average week, how many evenings do you spend in a bar, or attending social activities in which social drinking is a large part?
0 1 2 3 4 5 6 7
10. On average, how many days per week do you buy liquor?
0 1 2 3 4 5 6 7
11. On average, how many days per week do you drink before noon?
0 1 2 3 4 5 6 7
12. On average, how many days per week do you wake up sick after drinking the previous day/night?
0 1 2 3 4 5 6 7
13. In an average week, how many times do you find yourself drinking alone?
0 1 2 3 4 5 6 7
14. Have you ever felt that you might consume too much alcohol or drink too often? YES NO
Please rate the following statements according to the following scale:
1—Strongly agree
2—Agree
3—Undecided
4—Disagree
5—Strongly disagree
15. I believe strongly in the teachings of my church.
1 2 3 4 5
16. I believe that membership in a good church increases one’s usefulness to society.
1 2 3 4 5
17. Religion gives me a great amount of comfort & security in life.
1 2 3 4 5
18. In an average week, how many evenings do you spend in church, including church meetings such as study groups that may not actually meet in the church building?
0 1 2 3 4 5 6 7
19. Please mark that which most applies to you:
___ My religious/spiritual beliefs do not entail regulations regarding the use of alcohol.
___ My religious/spiritual beliefs allow for the use of alcohol in any manner/degree.
___ My religious/spiritual beliefs allow for the use of alcohol, but also moderate that use.
___ My religious/spiritual beliefs strictly prohibit the use of alcohol.
also feel free to send results via PM
Age: ________
Gender: _______
1. What is your religious affiliation? ________________________
--If you have no affiliation, do you consider yourself religious or spiritual? YES NO
2. How many times have you attended religious services during the past year? ________
3. Which of the following best describes your practice of prayer or religious meditation?
--Prayer/meditation is a regular part of my daily life.
--I usually pray/meditate in times of stress or need but rarely at any other time.
--I pray/meditate only during formal ceremonies.
--I never pray/meditate.
4. How much influence would you say that religion/spirituality has on the way that you choose to act and the way that you choose to spend your time each day?
--No influence.
--A small influence.
--Some influence.
--A fair amount of influence.
--A large influence.
5. During the past year, how often have you experienced a feeling of religious reverence or devotion?
--Almost daily.
--Frequently.
--Sometimes.
--Rarely.
--Never.
6. Do you consume alcoholic beverages? YES NO
A serving of alcohol is merited by: 12 oz of beer, a 6oz glass of wine, a 1 oz shot of hard alcohol, or any drink containing 1 oz of hard alcohol.
7. On average, how much alcohol do you consume in one sitting?
(#)_______ 6 oz glasses of wine
AND
(#)_______ 1 oz of hard alcohol
AND
(#)_______ 12 oz beers
8. On average, how many days per week do you consume alcohol?
0 1 2 3 4 5 6 7
9. In an average week, how many evenings do you spend in a bar, or attending social activities in which social drinking is a large part?
0 1 2 3 4 5 6 7
10. On average, how many days per week do you buy liquor?
0 1 2 3 4 5 6 7
11. On average, how many days per week do you drink before noon?
0 1 2 3 4 5 6 7
12. On average, how many days per week do you wake up sick after drinking the previous day/night?
0 1 2 3 4 5 6 7
13. In an average week, how many times do you find yourself drinking alone?
0 1 2 3 4 5 6 7
14. Have you ever felt that you might consume too much alcohol or drink too often? YES NO
Please rate the following statements according to the following scale:
1—Strongly agree
2—Agree
3—Undecided
4—Disagree
5—Strongly disagree
15. I believe strongly in the teachings of my church.
1 2 3 4 5
16. I believe that membership in a good church increases one’s usefulness to society.
1 2 3 4 5
17. Religion gives me a great amount of comfort & security in life.
1 2 3 4 5
18. In an average week, how many evenings do you spend in church, including church meetings such as study groups that may not actually meet in the church building?
0 1 2 3 4 5 6 7
19. Please mark that which most applies to you:
___ My religious/spiritual beliefs do not entail regulations regarding the use of alcohol.
___ My religious/spiritual beliefs allow for the use of alcohol in any manner/degree.
___ My religious/spiritual beliefs allow for the use of alcohol, but also moderate that use.
___ My religious/spiritual beliefs strictly prohibit the use of alcohol.
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