Southampton Healthy Living supporters survey About you. We'd like to find out a little about you. All information will be anonymised and treated as confidential. OK Question Title * 1. What is your age? 18-30 31-45 46-59 over 60 OK Question Title * 2. Are you Female Male OK Question Title * 3. What ethnic group do you identify with? White/British Mixed/Multiple ethnic groups Asian/Asian British Black/African/Caribbean/Black British Other ethnic group OK Question Title * 4. What are the first four digits of your postcode? OK Question Title * 5. How did you become aware of Southampton Healthy Living's training opportunities? Through the web site/emails By word of mouth Through the HIT brochure Other OK Question Title * 6. What areas of lifestyle does Southampton Healthy Living work around? Weight loss Physical activity Alcohol Smoking Mini-Health Checks All the above OK Question Title * 7. Have you ever referred a client/patient to our service? Yes No OK Question Title * 8. Have you ever used our service other than to attend training or to refer a client/patient? Yes No OK Question Title * 9. What service have you used? Weight loss groups/Weight Watchers Stop smoking support Alcohol reduction support Increased physical activity support including access to our partners' facilities and services. One of our funded partner organisations projects Mini-Health Checks OK Question Title * 10. Are you a smoker? Yes No I have quit smoking in the past year. OK Question Title * 11. How would you describe the level of physical activity in your job? Sedentary Standing Active Manual labour OK Question Title * 12. How much exercise do you take weekly including brisk walking? None Less than one hour 1-3 hours More than 3 hours OK Question Title * 13. How often do you have a drink containing alcohol? Never - score 0 Monthly or less - score 1 2-4 times per month - score 2 2-3 times per week - score 3 4+ times per week - score 4 OK Question Title * 14. If one unit equals a half pint of regular beer, cider or lager, or one small glass of wine or one measure of spirit, how many units do you drink on a typical day when you are drinking? 1-2 - score 0 3-4 - score 1 5-6 - score 2 7-9 - score 3 10+ - score 4 OK Question Title * 15. How often have you had 6 or more units if female or 8 or more if male, in a single occasion in the past year? Never - score 0 Less than monthly - score 1 Monthly - score 2 Weekly - score 3 Daily or almost daily - score 4 OK Question Title * 16. A total of 5+ to the previous 3 questions indicates increasing or higher risk drinking. Did you score 5+? Yes No OK DONE