Energy drinks

GENDER?

• MALE
• FEMALE

AGE?

• 15-18
• 19-25
• 26-40
• 40-100

ETHNICITY?

• Black or African American
• Hispanic or Latino
• Native American or Alaskan Native
• Asian
• Pacific Islander or Native Hawaiian
• White or Caucasian (Non-Hispanic)
• Other

Do you drink any of the following beverages?

Please select all that apply.

• Energy Drinks
• Coffee
• Alcohol
• Soda
• Espresso
• none

How often do you drink this beverage

• Less than once a week
• 1-2 times a week
• 3-4 times a week
• everyday

How many drinks do you drink in a day

• 1
• 2
• 3
• 4 or more

What time of day do you drink these beverages?

• Morning
• Midday
• Afternoon
• Night
• Throughout the day

Why do you drink Coffee and or Energy Drinks

Please select all that apply.

• For sports
• To wake up
• Extra energy (not related to sports)
• Taste
• To focus and concentrate on daily tasks
• Your friends do it
• No reason

Which choice best describes how these drinks affect your body?

Please select all that apply.

• Your heart races
• Your body temperature goes up
• You feel sleepy or tired
• You feel hyper
• You feel jittery
• You feel hungry or thirsty
• You gain energy
• You notice no effect