Lab 5 Survey

Sex/Gender

Female

Male

Transgender

I choose to skip this question

Other

* Race/Ethnicity

African American/Black

Asian/Pacific Islander

Hispanic/Latino

Multiracial

Native American/American Indian

White

I choose to skip this question

Other; please specify:

* Age

I choose not to answer this question

* What is your’s or your family’s Socioeconomic Status: (check one)

* What is your current marital status?

* Which of the following are applicable to your living situation?

I live alone.

I live with other students.

I live with roommates who are not students.

I live with parents(s), relative(s), or guardian(s).

I live with a husband/wife/domestic partner/significant other

I live with my child/children.

I choose to skip this question

Attitudes towards chocolate

	Not like me at all	Not like me	Somewhat not like me	Neutral	Somewhat like me	Like me	Very much like me
I eat chocolate to cheer me up when I am down.

My desire for chocolate often seems overpowering.

I feel unattractive after I have eaten chocolate.

I often feel sick after eating chocolate.

I eat chocolate as a reward when everything is going really well for me.

I am often on one kind of diet or another.

The thought of chocolate often distracts me from what I am doing (e.g. watching TV).

I usually find myself wanting chocolate during the afternoon.

I consider chocolate to be high in fat and to be of poor nutritional value.

After eating chocolate I often wish I had not.

	Not like me at all	Not like me	Somewhat not like me	Neutral	Somewhat like me	Like me	Very much like me
I feel guilty after eating chocolate.

I eat chocolate only when I am hungry.

Chocolate often preys on my mind.

I feel unhealthy after I have eaten chocolate.

I always look at the calorific value of a chocolate snack before I eat it.

If I resist the temptation to eat chocolate I feel more in control of my life.

Nothing else but chocolate ~111 satisfy my chocolate cravings.

Even when I do not really want any more chocolate I will often carry on eating it.

I eat chocolate to keep my energy levels up when I am doing physical exercise.

I eat more chocolate in the winter when it is colder.

I often go into a shop for something else and end up buying chocolate.

I feel depressed and dissatisfied with life after eating chocolate.

I often eat chocolate when I am bored.

I like to indulge in chocolate.

Directions:
This scale consists of a number of words that describe different feelings and emotions. Read each item and then click the appropriate answer next to that word. Indicate to what extent you have felt this way during the past week.
Use the following scale to record your answers.