Alcohol Intake Frequency Questionnaire

Thank you for choosing to visit this site. You were selected randomly to partake in a survey that should take no longer than 5 minutes of your time. The purpose of this survey is to determine how many grams of alcohol (ethanol) students at the University of Delaware consume on an average daily basis. By determining alcohol, I can calculate how many calories are contributed to your diet in the form of ethanol - which has 7 Calories per gram.

By filling out the below information, you will enable the investigator to further study this methodology. All the information will be strictly confidential and be used to determine the frequency of alcohol consumption. You also grant permission to the investigator to use the data for research purposes without exposure of your identity. Thank you in advance for your participation.

Directions: Please choose your gender and age. Then, for each beverage select the serving size you typically consume as well as how often you consume. Refer to the example at the top of the table.

1. Please select your gender

2. Please select your age:

3. Please complete the questionnaire such as the example is completed. Please make sure for each beverage you select your typical serving size, the number of servings you consume, and the frequency you drink it.

Some notes regarding serving sizes:

Beer

8oz = small glass
12oz = bottle or can
16oz = pint glass

Hard Liquor

1oz = half of shot glass
1.5oz = typical served shot
2oz = full shot glass

Wine

3oz = small wine glass
4oz = typical restuarant serving
5oz = typical home serving

*Explanation of example: This individual states that he/she typically consumes two 16oz light beers per week

		Your Serving Size				How often do you drink this beverage?
Beverage	Typical Size	Small	Medium	Large	Number of Servings	Daily	Weekly	Monthly	Yearly
*Example: Light Beer	12 oz	8 oz	12 oz	16 oz
Light Beer	12 oz	8 oz	12 oz	16 oz
Regular Beer	12 oz	8 oz	12 oz	16 oz
Wine	4 oz	3 oz	4 oz	5 oz
Hard Liquor ie. Gin, Rum, Vodka, Whiskey These liquors can be found in straight shots as well as mixed drinks.	1.5 oz.	1 oz	1.5 oz	2 oz
Coffee Liqueur, 53 Proof	1.5 oz	1 oz	1.5 oz	2 oz

4. When you have completed the questionnaire please click on the submit button below. Thank you for taking the time to fill out the questionnaire. Your individual results will be kept confidential by the investigator.