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| * What is your occupation? If retired please specify previous occupation. | | |
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| * What is your City and State of residence? | | |
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| * Please note gender and ages of each child. | | |
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* Are you a single parent? |
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* How many hours a week do you spend watching or reading the news?
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STRESS: BODILY OR MENTAL TENSION RESULTING FROM FACTORS THAT TEND TO ALTER AN EXISTENT EQUILIBRIUM. On a scale of 1-10, 1 being least stressed and 10 being very stressed: What is your normal life stress level?
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WORRY: EXPERIENCE OF CONCERN OR ANXIETY. On a scale of 1-10, 1 being least worried and 10 being very worried: What is your normal worry level?
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| * ANXIETY: AN ABNORMAL AND OVERWHELMING SENSE OF APPREHENSION AND/OR FEAR; EXTREME WORRYING. When was the last time you felt anxiety as a result of a life threatened tragic event? Please choose from the following categories: Natural Disaster, Mass Shooting or Terrorist Attack. Please describe event. | | |
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On a scale of 1-10, 1 being least worried and 10 being very worried: What was your worry level as a result of the above mentioned life threatening tragic event?
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| * Were you personally affected by any specific life threatening tragic event from the above categories? If so, please describe. | | |
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| At the time of this event did you have children? If so, please list the ages at the time. | | |
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EMOTIONAL: DOMINATED BY OR PRONE TO EMOTION. On a scale of 1-10, 1 being least emotional and 10 being very emotional: What is your normal emotional level?
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On a scale of 1-10, 1 being not emotional and 10 being very emotional: What is your emotional level right after any of the life threatening tragic event mentioned in the above categories?
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* How many hours a week did you spend watching or reading the news after any of the life threatening tragic events mentioned in the above categories? |
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* In your opinion, would you have more or less anxiety as a result of a life threatening tragic event if you had children 12 years old and under? |
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* In your opinion, would you have more or less anxiety as a result of a life threatening tragic event if you had children 13 years old and over? |
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* In your opinion, would you have more or less anxiety as a result of a life threatening tragic event if you didn’t have children? |
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On a scale of 1-10, 1 being least amount of anxiety and 10 being the most, please list the level of anxiety you experienced at each of the following natural disasters, mass shootings or terrorist attacks.
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| * From the above list, identify the 3 life threatened tragic events that caused you the LEAST amount of anxiety and explain why. | | |
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| * From the above list, identify the 3 life threatened tragic events that caused you the MOST anxiety and explain why. | | |
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