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Screening Questionnaire for Online Gambling Research

Approximately 3 mins to complete. 

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Screening Questionnaire for Online Gambling Research

Form will take approximately 3 mins to fill out.

Purpose:

This screening form ensures participants meet the criteria and are suitable for this study on decision-making in online gambling. All responses are confidential and will only be used to determine eligibility. Participation is voluntary, and you can withdraw at any time. Interviews will be held throughout February.

1

Name

2

Age

3

Are you a University student

4

Frequency of online gambling in the past six months?

Have you experienced the following in the past 12 months?

-2 = No

-1 = Sometimes No

 1 = sometimes Yes

 2 = Yes


5

Need to gamble with increasing amounts of money for the same excitement?

0
No
Yes
6

Thought a lot about gambling?

0
No
Yes
7

Tried and failed to control, cut back, or stop gambling?

0
No
Yes
8

Restlessness or irritability when cutting down or stopping gambling.

0
No
Yes
9

Gamble to relieve distress.

0
No
Yes
10

Repeated failed attempts to control or stop gambling.

0
No
Yes
11

Returning to gambling to recoup losses.

0
No
Yes
12

Lying to hide the extent of gambling.

0
No
Yes
13

Jeopardized or lost relationships, jobs, or opportunities due to gambling.

0
No
Yes
14

Relying on others for money to relieve financial issues caused by gambling.

0
No
Yes
15

Are you receiving treatment or support for gambling-related issues?

16

Have you experienced emotional distress (e.g., anxiety, depression) due to gambling in the past three months?

17

Do you feel comfortable discussing your gambling experiences in an interview?

If eligible, you will be contacted about participating in the study.

By submitting this form, you agree to be contacted about the study. Thank you for taking the time to fill out this form!

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