Skip to content
Askalot

← All Healthcare templates

Questionnaire template

Youth Alcohol Use Assessment

Assesses alcohol use, drinking context and perceived norms among young people aged 12 to 24.

Preview

Healthcare · Alcohol assessment. All Healthcare templates

Questions in this template

About You

  1. Thank you for taking part. This survey asks young people about alcohol. Your answers are anonymous and will not be shared with your school, family or employer.

  2. How old are you?

    A number from 12 to 24

  3. What are you mainly doing at the moment?

    Choose one:

    • Secondary school
    • College or university
    • Working
    • Not in education or work
    • Other

Your Alcohol Use

  1. Have you ever had a whole alcoholic drink, not just a sip?

    Choose one:

    • Yes
    • No
  2. How old were you when you had your first whole alcoholic drink?

    Condition: Only for those who have had a drink

    A number from 5 to 24

  3. The next three questions are the AUDIT-C, the consumption items of the Alcohol Use Disorders Identification Test developed for the World Health Organization by Thomas F. Babor, John C. Higgins-Biddle, John B. Saunders and Maristela G. Monteiro. They refer to your use of alcoholic beverages during the past year.

  4. Your answers give a screening result, not a diagnosis. If you are worried about your drinking, talk to a doctor, school nurse or youth support service.

  5. How often do you have a drink containing alcohol?

    Condition: Only for those who have had a drink

    Choose one:

    • Never
    • Monthly or less
    • 2 to 4 times a month
    • 2 to 3 times a week
    • 4 or more times a week
  6. How many drinks containing alcohol do you have on a typical day when you are drinking?

    Condition: Skipped for those who never drink

    Choose one:

    • 1 or 2
    • 3 or 4
    • 5 or 6
    • 7, 8, or 9
    • 10 or more
  7. How often do you have six or more drinks on one occasion?

    Condition: Skipped for those who never drink

    Choose one:

    • Never
    • Less than monthly
    • Monthly
    • Weekly
    • Daily or almost daily

Where and With Whom

  1. Where do you usually get alcohol from? Select all that apply.

    Condition: Only for those who drink

    Choose any that apply:

    • Parents or other family
    • Friends
    • Older people I know
    • I buy it myself
    • I take it without asking
    • Other
  2. Who are you usually with when you drink?

    Condition: Only for those who drink

    Choose one:

    • Nobody, I drink alone
    • Friends
    • Family
    • People I don't know well, for example at parties
    • It varies

Views and Support

  1. How many of your friends do you think drink alcohol regularly?

    Choose one:

    • None
    • A few
    • About half
    • Most
    • All
    • Don't know
  2. What are the rules at home about you drinking alcohol?

    Choose one:

    • I am not allowed to drink at all
    • Only on special occasions with family
    • I may drink in moderation
    • There are no rules
    • Not sure
  3. Would you know where to go for help if you or a friend had a problem with alcohol?

    Choose one:

    • Yes
    • No
    • Not sure
  4. Is there anything else you would like to tell us about young people and alcohol? (optional)

    Open answer