Community Gambling Survey
1.
What is your county of residency?
Harrison
Belmont
Monroe
Other
2.
What is your current age?
Under 18
18-24
25-44
45-64
65 +
3.
What is your gender?
Male
Female
Non-binary
Prefer Not To Answer
Other (please specify)
4.
What is your race?
White
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Other (please specify)
5.
What is the highest level of education you have completed?
Some High School
High School Diploma
Trade School
Bachelor's Degree
Master's Degree
PhD or Higher
6.
What is your employment status?
Full-time
Part-time
Unemployed: Looking for work
Unemployed: Not looking for work
Disabled
Retired
Homemaker
Other (please specify)
7.
Do you, or someone you know, have a family history of gambling (Lifetime)?
Yes
No
Other (please specify)
8.
Have you, or someone you know, used alcohol or drugs while gambling (in the past 12 months)?
Yes
No
Other (please specify)
9.
Have you, or someone you know, gambled while intoxicated (in the past 12 months)?
Yes
No
Other (please specify)
10.
Have you, or someone you know, suffer/suffered from serious depression (in the past 12 months)?
Yes
No
Other (please specify)
11.
Are you, or someone you know, under the care of a doctor due to stress (in the past 12 months)?
Yes
No
Other (please specify)
12.
In the past 12 months, I have bet more than I could afford to lose?
Always
Usually
Sometimes
Rarely
Never
13.
In the past 12 months, I needed to gamble with larger amounts of money to get the same feeling of excitement?
Always
Usually
Sometimes
Rarely
Never
14.
In the past 12 months, I gambled and had to go back a different day to try and win back money I lost?
Always
Usually
Sometimes
Rarely
Never
15.
In the past 12 months, I have borrowed money or sold something to get money to gamble?
Always
Usually
Sometimes
Rarely
Never
16.
In the past 12 months, I have felt I might have a gambling problem?
Always
Usually
Sometimes
Rarely
Never
17.
In the past 12 months, I have had health problems including stress and anxiety due to gambling?
Always
Usually
Sometimes
Rarely
Never
18.
In the past 12 months, I have had people criticize my betting or told me that I have a gambling problem, regardless of whether or not I thought it was true?
Always
Usually
Sometimes
Rarely
Never
19.
In the past 12 months, gambling has caused financial problems for me and/or my household?
Always
Usually
Sometimes
Rarely
Never
20.
In the past 12 months, I have felt guilty about the way I gamble or what happens when I gamble?
Always
Usually
Sometimes
Rarely
Never
21.
In the past 12 months, I participated in:
Casino
Lottery
Stocks
Sports betting
None of the Above
Other (please specify)
22.
In the past 12 months, I participated in Casino:
Slot machines/VLTs
Poker
Black Jack
Roulette
Craps
Baccarat
Other (please specify)
None of the above
23.
In the past 12 months, I participated in Lottery:
Daily Lottery tickets
Instant win/scratch offs
Lottery Tickets (Megamillions, etc.)
None of the Above
Other (please specify)
24.
In past 12 months, I participated in Stocks:
Stocks/Options/Commodities Markets
None of the Above
Other (please specify)
25.
In the past 12 months, I participated in Sports Betting:
Game of Skill (Pool, Bowling, etc)
Sports Bookie
Horse Races
None of the Above
Other (please specify)
26.
In the past 12 months, I participated in other types of betting:
Card/Board games with family/friends
Raffle/fundraisers
Bingo
Arcade/Video Games
Internet Café
Internet (Non-internet Café)
None of the Above
Other (please specify)
27.
In the past 12 months, I spent money(ies) at a casino (for any reason, gambling, or otherwise).
Never done/Have not done this
Less often than once a year
1-2 times a year
Weekly2, or more often
1-3 times a month, but not weekly
Several times a year, but not monthly
Other (please specify)