حبيت تساعدوني في الريبورت حقي لاني من جد محتاجه مساعدتكم عشان اكمل الاستبيانات حقتي, ابغى ناس يشربوا من 3 وفوق قهوه,شاهي,مشروبات غازيه او شوكولاته يعني بالعربي مدمنيين لانه الريبورت حقي عن ادمان الكافييين فياريت كل واحد بس تعبي الاستبيان دا
Survey topic: The Effects of Caffeine
This survey is part of course requirements for the post-graduate preparation program(ppp2) at the University
1_ What is your country of origin?………………………
2_ What is your first language?………………………….
3_ What is your gender? Male¨ Female¨
4_ What is your occupation?........................................
5_ Tick your age group: 17-20¨ 21-25¨ 26-30¨ 30+¨
6_ What do you have to drink to start your day?
Coffee¨ Cola Drink¨ Tea¨ Soft Drink¨ Chocolate¨ Others¨
7_ Do you usually rely on Coffee/ Caffeinated drinks to boost your energy throughout the day?
Yes¨ No¨
8_ Which drink do you prefer most with eating?
Soft drinks¨ Tea¨ Coffee¨ Others¨
9_ At what age did you start drinking caffeine- containing substances?
10_21¨ 21 - 25¨ 26 - 30¨ 30 - 60¨
10_ How often do you drink caffeine- containing substances?
Often¨ Sometimes¨ Rarely¨ Never¨
11_ How many cups of caffeinated beverages do you drink on average in a day?
1-3cups¨ 3-5 cups¨ 5-7 cups¨ 7-10 cups¨
12_Do you smoke? If so what kind of drink do you usually drink when smoking?
Yes¨ ……………………………… No¨
13_ Do you feel tired after drinking any kind of caffeinated drink?
Yes¨ No¨ Sometimes ¨
14_ Do you feel your heart beating faster after you drink caffeinated drinks?
Yes¨ No¨ Sometimes ¨
15_ Do you get overcome by anxiety or mood swings or feel irritable when you drink?
Too much caffeine¨ A little caffeine¨
16_ When you miss your daily caffeine intake, what do you feel for the rest of the day?
(Tick as many boxes as appropriate)
Headache¨ Agitation¨ Insomnia¨
Restlessness¨ Muscle tremors ¨ Stomach pains¨
Anxiety ¨ Sensory disturbances ¨ Irritability¨
Others¨ Nothing¨
17_ What are your main reasons for drinking a lot of caffeine- containing substances?
Depression¨ Tension¨ Lifestyle¨ Maintain Alertness¨ Others¨……………………………
18_ Do you think the media influences people and pushes them to drink caffeinated drinks?
Yes¨ No¨
19_ What is the negative impact of drinking too many caffeine-containing substances?
Affects wellbeing¨ Causes elevated heart beat¨ Causes stress¨ Causes breathing problems¨ Others ……………………..
20_ Do you think is it easy to stop drinking caffeine-containing substances?
Easy¨ Moderately Easy¨ Difficult¨
Thank you for completing this survey