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Table 5 UNIVERSITY OF VERMONT STUDENT SURVEY (To be completed individually by student)
| Age: | Height: | Weight: | ||||
|---|---|---|---|---|---|---|
| Sex: (Circle one) | Male | Female | ||||
| Occupation: | Year in School: | Type of work (if any): | ||||
| Last grade in Math Class (as appears on last report card): | A+ A A- B+ B B- C+ C C- D+ D D- F | |||||
| Last grade in English Class (as appears on last report card): | A+ A A- B+ B B- C+ C C- D+ D D- F | |||||
| Overall average grade (as appears on last report card): | ||||||
| How often do you exercise in an average week? (Circle one) | Every day | 4–6 days a week | 1–3 days a week | Less than one day a week | ||
| What is your family situation: | Parents are married or live together | Parents live apart | Parents are divorced, I live with mom or dad | Live with legal guardian | ||
| Average total number of hours a day spent on Internet: (Circle one) | Less than 1 | 1–2 | 3–4 | More than 4 | ||
| Average total number of hours a day spent on Computer games: (Circle one) | Less than 1 | 1–2 | 3–4 | More than 4 | ||
| Average total number of hours a day spent on other console games such as Playstation, N64, etc. (Circle one) | Less than 1 | 1–2 | 3–4 | More than 4 | ||
| Total number of hours a day spent watching television: (Circle one) | Less than 1 | 1–2 | 3–4 | More than 4 | ||
| Type of games played : (Circle as many as apply) | Sports | Strategy | Action | Other | ||
| Favorite game: | ||||||
| How many detentions have you had in the past month? | ||||||
| Have you been suspended from school in the past year? | YES | NO | If yes, how many times? | |||
| Have you been in a physical fight in the past year? | YES | NO | If yes, how many times? | |||
| Have you been arrested in the past year? | YES | NO | If yes, how many times? | |||
| Do you drink alcohol? (Circle one) | YES | NO | ||||
| If yes, how many drinks per week on average? | ||||||
| Do you smoke? (Circle one) | YES | NO | ||||
| If yes, how many cigarettes per day on average? | ||||||
| Do you smoke marijuana? (Circle one) | YES | NO | ||||
| If yes, how many joints per week on average? | ||||||
| Other drugs and amount: | ||||||
| How often do you use alcohol/cigarettes/drugs while playing video games? (Circle one) | ALWAYS | SOMETIMES | RARELY | NEVER | ||
| Rarely | Occasionally | Frequently | Often | Always | Does Not Apply | |
| 1. How often do you find that you play video games longer than you intended? | ||||||
| 2. How often do you neglect household chores to spend more time playing video games? | ||||||
| 3. How often do you prefer the excitement of playing video games to spending time with your girl/boy friend or family? | ||||||
| 4. How often do you play video games with friends? | ||||||
| 5. How often do others in your life complain to you about the amount of time you spend playing video games? | ||||||
| 6. How often do your grades or schoolwork suffer because of the amount of time you spend playing video games? | ||||||
| 7. How often do you play video games before something else that you need to do? | ||||||
| 8. How often does your job performance or productivity suffer because of playing video games? | ||||||
| 9. How often do you become defensive or secretive when anyone asks you how much time you spend playing video games? | ||||||
| 10. How often do you block out disturbing thoughts about your life with thoughts of playing video games? | ||||||
| 11. How often do you find yourself anticipating when you will play video games again? | ||||||
| 12. How often do you fear that life without video games would be boring, empty, and joyless? | ||||||
| 13. How often do you snap, yell, or act annoyed if someone bothers you while you are playing video games? | ||||||
| 14. How often do you lose sleep due to late-night video games? | ||||||
| 15. How often do you feel preoccupied with playing video games when not, or fantasize about doing so? | ||||||
| 16. How often do you find yourself saying "just a few more minutes" when playing video games? | ||||||
| 17. How often do you try to cut down the amount of time you spend playing video games and fail? | ||||||
| 18. How often do you try to hide how long you've been playing video games? | ||||||
| 19. How often do you choose to spend more time playing video games over going out with others? | ||||||
| 20. How often do you feel depressed, moody, or nervous when you are not playing video games, which goes away once you are back playing? | ||||||
| Subjects were also asked to complete the Beck Depression Inventory. | ||||||
| Production note: This article was amended post-publication. For copyright reasons, the Beck Depression Inventory was removed. | ||||||
