Att F_Activity Worksheet: Profile of an Excessive Drinker

Attachment F- Activity Worksheet Profile of an Excessive Drinker_112316.docx

Developing Effective messages about Excess Alcohol Consumption: Formative Focus Groups with Adult Drinkers and Abstainers

Att F_Activity Worksheet: Profile of an Excessive Drinker

OMB: 0920-1179

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GROUP: _____________ ID: ____________ Attachment F: Activity Worksheet Profile of an Excessive Drinker

Form Approved

OMB No. 0920-xxxx

Expiration date: xx/xx/xxxx


Shape1

What they’re thinking when drinking:

PROFILE OF A TYPICAL EXCESSIVE DRINKER

Shape7 Shape4 Shape5 Shape6 Shape12 Shape10 Shape9 Shape3 Shape2 Shape8 Shape11

When NOT drinking?

When drinking?

What they’re doing…

How they feel when drinking:
(draw their face)

DEMOGRAPHICS

AGE: ________

Circle responses below


Race/Ethnicity:

White

Black



Hispanic

Asian

Other:_________


Gender:

Male

Female



Married?

Yes

No



Kids?

Yes

No







File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCaitlin Krulikowski
File Modified0000-00-00
File Created2021-01-23

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