Psychology Research Consortium :
Basic Background Information
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Part of any survey research is to understand how our thoughts, attitudes, and daily behaviors reflect who we are. The purpose of this questionnaire is to get some basic background information about you so that we can get a better idea about the other psychological measures in this group of surveys. For the various questions below, please answer as honestly as you can. If you prefer not to answer a question, simply skip it. When you are finished, you will get some feedback about your world.

Date of Birth
If you live in the United States, please enter your zip code. If outside the US, enter your country:
Within the last 7 days, how many days have you done each of the following:
1. Exercised strenuously
2. Had difficulty sleeping
3. Eaten junk or other kind of fast food
4. Had a heart to heart talk with a friend
5. Attended a meeting or other organized social event
6. Received a ticket, citation, or warning from a police or other authority
7. Wrote down your thoughts or feelings
8. Drank alcohol
9. Smoked at least one cigarrette or other tobacco product
10. Took medication prescribed by a physician for a health problem
11. Took medicine not prescribed by a physician (e.g., aspirin, cough medicine)
12. Activity was restricted in some way because of illness or poor health