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Exit Survey
 
 
Hello:

I am most grateful that you have chosen to participate in my survey. As I mentioned, in this survey, you will be asked a series of general questions followed by more specific questions regarding your stress and anxiety levels during life threatening situations. There are 25 questions and should take you approximately 10-12 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any of the questions, you can withdraw from the survey at any point.

Your survey responses will be strictly confidential and data from this research will only be used for the benefit of my research paper. Your information will be coded and will remain confidential. It would be great if you can do this survey within 2 days of receiving it as this is a time sensitive task. Thank you very much for your time and support. Please start with the survey now by checking the I Agree button below.

Eileen Correa

 
 
 
 
* What is your age?
 
18-19
 
20-29
 
30-39
 
40-49
 
50-59
 
60-69
 
70+
 
 
 
* Gender
 
Male
 
Female
 
 
 
* Marital Status?
 
Single
 
Married
 
Separated
 
Divorced
 
Widowed
 
 
 
* Are you a student?
 
Yes
 
No
 
 
 
* What is your occupation? If retired please specify previous occupation.
   
 
 
 
* What is your City and State of residence?
   
 
 
 
* Do you have children?
 
Yes
 
No
 
 
 
* Please note gender and ages of each child.
   
 
 
 
* Are you a single parent?
 
Yes
 
No
 
 
 
* How many hours a week do you spend watching or reading the news?
 
1-3
 
4-7
 
8-11
 
12-15
 
Other
 
 
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?
Least StressedVery Stressed
1 2 3 4 5 6 7 8 9 10
*  
 
 
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?
Least WorriesVery Worried
1 2 3 4 5 6 7 8 9 10
*  
 
 
 
* 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.
   
 
 
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?
Least WorriedVery Worried
1 2 3 4 5 6 7 8 9 10
*  
 
 
 
* Were you personally affected by any specific life threatening tragic event from the above categories? If so, please describe.
   
 
 
 
At the time of this event did you have children? If so, please list the ages at the time.
   
 
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?
Least EmotionalVery Emotional
1 2 3 4 5 6 7 8 9 10
*  
 
 
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?
Least EmotionalVery Emotional
1 2 3 4 5 6 7 8 9 10
*  
 
 
 
* 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?
 
1-3
 
4-7
 
8-11
 
12-15
 
Other
 
 
 
 
* 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?
 
More
 
Less
 
 
 
* 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?
 
More
 
Less
 
 
 
* 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?
 
More
 
Less
 
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.
1 2 3 4 5 6 7 8 9 10 Don't Recall
* 1993 World Trade Center Terrorist Attack
* 1995 Oklahoma City Federal Building Bombing
* 1999 Columbine School Mass Shooting
* 2001 September 11th Terrorist Attack
* 2001 American Airlines Flight 587 Crash
* 2004 Indian Ocean Earthquake and Tsunami
* 2005 Hurricane Katrina
* 2009 Ft Hood, TX – Fort Hood Army Base Mass Shooting
* 2010 Japan Earthquake
* 2010 Haiti Earthquake
* 2012 Aurora, CO - Movie Theatre Mass Shooting
* 2012 Super Storm Sandy
* 2012 Newtown, CT - Sandy Hook School Mass Shooting
* 2013 Boston Marathon Bombing
* 2013 Washington Navy Yard Mass Shooting
 
 
 
* From the above list, identify the 3 life threatened tragic events that caused you the LEAST amount of anxiety and explain why.
   
 
 
 
* From the above list, identify the 3 life threatened tragic events that caused you the MOST anxiety and explain why.