Pre-Interview-Focus Group Survey

3/24/2021

Qualtrics Survey Software

OMB CONTROL NUMBER: XXXX-XXXX
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0703-XXXX, is estimated to average 5 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the
burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a
collection of information if it does not display a currently valid OMB control number.

Landing page

Thank you for your interest in this study. This screening asks questions that will only be used to determine if
you are eligible for study participation. If you are eligible, someone from the research team will contact you
about study participation.
Please indicate if you would like to proceed with the screening process:

I do not agree

I agree

demographics
What is your age (in years)?

Understanding that gender identity can be complex, which ONE category best describes your GENDER
IDENTITY now?
If OTHER, please specify
Female
Male
Other

Are you currently an active duty sailor?
Yes
No
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audit c

How often did you have a drink containing alcohol in the past year?
Never
Monthly or less
2 to 4 times a month
2 to 3 times a week
4 or more times a week

How many drinks containing alcohol did you have on a typical day when you were drinking in the past year?
None, I do not drink
1 or 2 drinks
3 or 4 drinks
5 or 6 drinks
7 or 9 drinks
10 or more drinks

How often did you have six or more drinks on one occasion in the past year?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

contact form-low male
Thank you for taking the time to answer these questions. According to your responses
you may be eligible to participate in the study.
To assist in scheduling, please provide the contact information below.

https://gsu.ca1.qualtrics.com/Q/EditSection/Blocks/Ajax/GetSurveyPrintPreview?ContextSurveyID=SV_9ENjt5t7b43l7aS&ContextLibraryID=UR_5dQo7L4qZQijhPf

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What is your first and last name?

What is your rank?

Email:

Cell phone number:

What is your current country of residence?

What is your time zone?

Can we text you?
Yes
No

contact form-high male

https://gsu.ca1.qualtrics.com/Q/EditSection/Blocks/Ajax/GetSurveyPrintPreview?ContextSurveyID=SV_9ENjt5t7b43l7aS&ContextLibraryID=UR_5dQo7L4qZQijhPf

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Thank you for taking the time to answer these questions. According to your responses
you may be eligible to participate in the study.
To assist in scheduling, please provide the contact information below.

What is your first and last name?

What is your rank?

Email:

Cell phone number:

What is your current country of residence?

What is your time zone?

Can we text you?
https://gsu.ca1.qualtrics.com/Q/EditSection/Blocks/Ajax/GetSurveyPrintPreview?ContextSurveyID=SV_9ENjt5t7b43l7aS&ContextLibraryID=UR_5dQo7L4qZQijhPf

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Yes
No

contact form-high female
Thank you for taking the time to answer these questions. According to your responses
you may be eligible to participate in the study.
To assist in scheduling, please provide the contact information below.

What is your first and last name?

What is your rank?

Email:

Cell phone number:

What is your current country of residence?

What is your time zone?
https://gsu.ca1.qualtrics.com/Q/EditSection/Blocks/Ajax/GetSurveyPrintPreview?ContextSurveyID=SV_9ENjt5t7b43l7aS&ContextLibraryID=UR_5dQo7L4qZQijhPf

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Can we text you?
Yes
No

contact form-low female
Thank you for taking the time to answer these questions. According to your responses
you may be eligible to participate in the study.
To assist in scheduling, please provide the contact information below.

What is your first and last name?

What is your rank?

Email:

Cell phone number:

What is your current country of residence?
https://gsu.ca1.qualtrics.com/Q/EditSection/Blocks/Ajax/GetSurveyPrintPreview?ContextSurveyID=SV_9ENjt5t7b43l7aS&ContextLibraryID=UR_5dQo7L4qZQijhPf

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What is your time zone?

Can we text you?
Yes
No

Ineligible
Thank you for taking the time to answer these questions. According to your responses, you
are not eligible to participate in this study.

https://gsu.ca1.qualtrics.com/Q/EditSection/Blocks/Ajax/GetSurveyPrintPreview?ContextSurveyID=SV_9ENjt5t7b43l7aS&ContextLibraryID=UR_5dQo7L4qZQijhPf

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