EDITORIAL NOTE: Questions C11 to C18 on “moonshine” drinks are probably appropriate only for rural
areas. If this is not of particular interest to you, you could skip these questions.
C. ALCOHOLIC BEVERAGES
Now I have some questions about alcoholic drinks. Please think about your habits over most of your adult
life, that is, before any recent changes you may have made for any reason, such as an illness or a change
in lifestyle.
C1. First, let’s think about beer. This would include bottles, cans, and draft beer, as well as malt liquor,
ale, and lager. Before one year ago, did you ever drink at least 12 ounces of beer per month for six
months or longer?
YES ......................................................... 1
NO ........................................................... 2 (C11)
C2. How old were you when you first drank at least one beer per month?
|___|___|
AGE
C3. How old were you when you last drank at least one beer per month?
|___|___|
AGE
CURRENTLY DRINKS BEER........................ 96
C4. For how many years altogether did you drink at least one beer per month?
_______________________
YEARS
LESS THAN ONE YEAR......................... 96
C5. Thinking about all the years that you drank beer, how many beers did you usually drink on weekends,
that is, on Fridays, Saturdays, and Sundays?
_______________________ PER DAY ...................... 1
NUMBER PER WEEKEND ........... 2
LESS THAN ONE PER WEEKEND........ 96
C6. How many years did you usually drink during the rest of the week, that is, Monday through
Thursday?
_______________________ PER DAY ...................... 1
NUMBER PER PERIOD ................ 2
LESS THAN ONE PER PERIOD ............ 96
C7. Before one year ago, were there ever any periods of six months or longer during which you drank
more beer than usual?
YES ......................................................... 1
NO ........................................................... 2 (C11)
C8. When you were drinking more than usual, how many beers did you usually drink on weekends?
_______________________ PER DAY ...................... 1
NUMBER PER WEEKEND ........... 2
LESS THAN ONE PER WEEKEND........ 96
C9. When you were drinking more than usual, how many beers did you usually drink during the rest of
the week?
_______________________ PER DAY ...................... 1
NUMBER PER PERIOD ................ 2
LESS THAN ONE PER PERIOD ............ 96
C10. For how many months or years did you drink more beer than usual?
_______________________ MONTHS ...................... 1
NUMBER YEAR ............................ 2
C11. Next, let’s talk about home-brewed liquor or “moonshine.” Before one year ago, did you ever have at
least one drink of moonshine per month for six months or longer?
YES ......................................................... 1
NO ........................................................... 2 (C19)
C12. How old were you when you first drank at least one drink of moonshine per month?
|___|___|
AGE
C13. How old were you when you last drank at least one drink of moonshine per month?
|___|___|
AGE
CURRENTLY DRINKS MOONSHINE ........... 96
C14. For how many years altogether did you have at least one drink of moonshine per month?
_______________________
YEARS
LESS THAN ONE YEAR......................... 96
C15. Thinking about all the years that you drank moonshine, how much did you usually drink per day or per
week?
PER DAY: _____________ SHOTS/DRINKS ................ 01
HALF-PINTS ...................... 02
PER WEEK: ___________ PINTS ................................ 03
FIFTHS .............................. 04
QUARTS ............................ 05
HALF-GALLONS................ 06
GALLONS .......................... 07
OTHER (SPECIFY)............ 08
_____________________________
LESS THAN ONE SHOT/DRINK PER WEEK ....................... 96
C16. Before one year ago, were there ever any periods of six months or longer during which you drank
more moonshine than usual?
YES ......................................................... 1
NO ........................................................... 2 (C19)
C17. When you were drinking more than usual, how much moonshine did you usually drink per day or per
week?
PER DAY: _____________ SHOTS/DRINKS ................ 01
HALF-PINTS ...................... 02
PER WEEK: ___________ PINTS ................................ 03
FIFTHS .............................. 04
QUARTS ............................ 05
HALF-GALLONS................ 06
GALLONS .......................... 07
OTHER (SPECIFY)............ 08
_____________________________
LESS THAN ONE SHOT/DRINK PER WEEK ....................... 96
C18. For how many months or years did you drink this amount of moonshine?
_______________________ MONTHS ...................... 1
NUMBER YEAR ............................ 2
C19. Next, let’s talk about hard liquor that came from a store or hard liquor that you may have had in a bar
or restaurant. I’ll refer to this as “hard liquor.” Before one year ago, did you ever have at least one
drink of hard liquor per month for six months or longer?
YES ......................................................... 1
NO ........................................................... 2 (C31)
C20. How old were you when you first drank at least one drink of hard liquor per month?
|___|___|
AGE
C21. How old were you when you last drank at least one drink of hard liquor per month?
|___|___|
AGE
CURRENTLY DRINKS HARD LIQUOR......... 96
C22. For how many years altogether did you have at least one drink of hard liquor per month?
_______________________
YEARS
LESS THAN ONE YEAR......................... 96
C23. Thinking about all the years that you drank hard liquor, how much did you usually drink on weekends,
that is, on Fridays, Saturdays, and Sundays?
PER DAY: _____________ SHOTS/DRINKS ................ 01
HALF-PINTS ...................... 02
PER WEEKEND: ________ PINTS ................................ 03
FIFTHS .............................. 04
QUARTS ............................ 05
HALF-GALLONS................ 06
GALLONS .......................... 07
OTHER (SPECIFY)............ 08
_____________________________
LESS THAN ONE SHOT/DRINK PER WEEKEND ............... 96
C24. How much did you usually drink the rest of the week, that is, the period from Monday through
Thursday?
PER DAY: ______________ SHOTS/DRINKS ................ 01
HALF-PINTS ...................... 02
PER PERIOD: ___________ PINTS ................................ 03
FIFTHS .............................. 04
QUARTS ............................ 05
HALF-GALLONS................ 06
GALLONS .......................... 07
OTHER (SPECIFY)............ 08
_____________________________
LESS THAN ONE SHOT/DRINK PER PERIOD .................... 96
C25. Before one year ago, what type of hard liquor did you drink most often?
GIN ....................................................................... 1
VODKA................................................................. 2
BOURBON ........................................................... 3
SCOTCH .............................................................. 4
WHISKEY ............................................................ 5
RUM ..................................................................... 6
OTHER (SPECIFY) .............................................. 96
_________________________________________
C26. Did you usually drink your hard liquor straight or mixed with ice, water, or a mixer?
STRAIGHT ........................................................... 1
MIXED .................................................................. 2
C27. Before one year ago, were there ever any periods of six months or longer during which you drank
more hard liquor than usual?
YES ......................................................... 1
NO ........................................................... 2 (C31)
C28. When you were drinking more than usual, how much hard liquor did you usually drink on weekends?
PER DAY: _____________ SHOTS/DRINKS ................ 01
HALF-PINTS ...................... 02
PER WEEKEND: ________ PINTS ................................ 03
FIFTHS .............................. 04
QUARTS ............................ 05
HALF-GALLONS................ 06
GALLONS .......................... 07
OTHER (SPECIFY)............ 08
_____________________________
LESS THAN ONE SHOT/DRINK PER WEEKEND ............... 96
C29. When you were drinking more than usual, how much hard liquor did you usually drink during the rest
of the week?
PER DAY: _____________ SHOTS/DRINKS ................ 01
HALF-PINTS ...................... 02
PER PERIOD: __________ PINTS ................................ 03
FIFTHS .............................. 04
QUARTS ............................ 05
HALF-GALLONS................ 06
GALLONS .......................... 07
OTHER (SPECIFY)............ 08
_____________________________
LESS THAN ONE SHOT/DRINK PER PERIOD .................... 96
C30. For how many months or years did you drink more hard liquor than usual?
_______________________ MONTHS ...................... 1
NUMBER YEAR ............................ 2
C31. Next let’s talk about wine. This would include sherry or other store-bought wine, wine that you may
have had in a bar or restaurant, and also home-brewed wine. Before one year ago, did you ever drink
at least one 4-ounce glass of wine per month for six months or longer?
YES ......................................................... 1
NO ........................................................... 2 (NEXT SECTION)
C32. How old were you when you first drank at least one glass of wine per month?
|___|___|
AGE
C33. How old were you when you last drank at least one glass of wine per month?
|___|___|
AGE
CURRENTLY DRINKS WINE ........................ 96
C34. For how many years altogether did you have at least one glass of wine per month?
_______________________
YEARS
LESS THAN ONE YEAR......................... 96
C35. Thinking about all the years that you drank wine, how much wine did you usually drink per day or per
week?
PER DAY: _____________ GLASSES .......................... 01
HALF-PINTS ...................... 02
PER WEEK: ___________ PINTS ................................ 03
FIFTHS .............................. 04
QUARTS ............................ 05
HALF-GALLONS................ 06
GALLONS .......................... 07
OTHER (SPECIFY)............ 08
_____________________________
LESS THAN ONE GLASS PER WEEK ................................. 96
C36. Before one year ago, which did you drink most often:
Red wine, ............................................................. 1
White wine, or ...................................................... 2
Some other type of wine? .................................... 3
C37. Before one year ago, were there ever any periods of six months or longer during which you drank
more wine than usual?
YES ......................................................... 1
NO ........................................................... 2 (NEXT SECTION)
C38. When you were drinking more than usual, how much wine did you usually drink per day or per
week?
PER DAY: _____________ GLASSES .......................... 01
HALF-PINTS ...................... 02
PER WEEK: ___________ PINTS ................................ 03
FIFTHS .............................. 04
QUARTS ............................ 05
HALF-GALLONS................ 06
GALLONS .......................... 07
OTHER (SPECIFY)............ 08
_____________________________
LESS THAN ONE GLASS PER WEEK ................................. 96
C39. For how many months or years did you drink this amount of wine?
_______________________ MONTHS ...................... 1
NUMBER YEAR ............................ 2