2) Your age range: Less than 18 18-30 31-50 51-70 Older than 70
3) How many hours do you use your computer during the week? 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 40+
4) What year did you first begin using a computer?
5) When you first began computer use, how many hours per week did you use your computer?
a) Approximately, what percent of this time was spent on-line?
6) What year did you first become connected to the Internet?
a)What percent of computer use time did you spend on-line when first connected?
7) Currently, how many hours per week do you use your computer?
a) How many hours per week are required by your work?
b) How many hours per week do you spend on-line?
c) How many hours per week of off-line use?
8) What time of day do you first start using your computer? Before 8:00 A.M. 8-12:00 P.M. 12-5:00 P.M. After 5:00 P.M
9) What time of day do you stop using your computer? 8-12:00P.M. 12-5:00P.M. At 5:00 P.M. 5-10:00 P.M. 10-12:00 A.M. After 12:00 A.M.
10) During the day, what is the longest period of time you are not using your computer? 1-3 hours 4-6 hours 7-10 hours more than 10 hours
11) While on vacation or away from the office or home, do you find a way to use a computer or get on-line? Yes No
12) When using your computer off-line do you often find yourself spending more time than you expected? Yes No
a) If so, how many more hours do you spend per week?
1-5 6-10 11-15 16-20 More than 20
13) When using your computer on-line, do you often find yourself spending more time than you expected? Yes No
a) If so how many more hours do you spend per week?
14) Do your find yourself having difficulty limiting or controlling your off-line or on-line time?
Off-line Yes No
On-line Yes No
a) If so, how sucessful would you rate yourself in controlling or limiting your time? 0 no control at all 1 2 3 4 5 some control 6 7 8 9 10 complete control
15) Do you find yourself spending time using the computer, either off-line or on-line, doing things you did not intend to do?
Off-lineYes No
On-lineYes No
a) If so, how many hours per week?
Off-line 1-5 6-10 11-15 16-20 More than 20
On-line 1-5 6-10 11-15 16-20 More than 20
16) How much time per week do you spend reading computer-related magazines? Less than 1 hour 1-3 hours 4-6 hours More than 6 hours
17) How much time per week do you spend in computer stores or departments? Less than 1 hour 1-3 hours 4-6 hours More than 6 hours
18) How many times have you upgraded your computer? none once twice three times More than three times
19) Do you watch programs about computers on television? Yes No
a) If so, how many times per week? once twice three times More than three times
20) Have you ever overslept or missed work because of too much time spent using your computer? Yes No
21) After purchasing your computer, how much money have you spent on computer-related products?
22) Have you given up or reduced social, recreational, and/or occupational activities in order to increase computer use? Yes No
23) Do you continue to use a computer despite negative consequences from using the computer? Yes No
24) Do you feel that you are addicted to computer or internet use? Computer Yes No Internet Yes No
If so, please desribe your difficulty.
