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You have opened a survey designed by Tyler Bussmann to fulfill requirements for a capstone course in Psychology at the University of Missouri. This survey will ask you questions about your health status, your activity level, and various forms of relationship satisfaction. It should take you 5 minutes to complete.

This survey has not been approved by any organization that oversees ethical conduct of research, and the results will never be publically disseminated in any way. The survey has been supervised and approved by instructors who are trained in ethical conduct of research, and thus should not provide any risks to you other than those risks inherent in using a computer. You will not be asked to provide any identification, so none of your answers will ever be traced back to you. I will analyze all the responses I get to complete my project/study.

If you have any questions, you should contact me (Tyler Bussmann [email protected]) about them. Thank you for your participation!

 
 
 
What is your biological gender?
 
Male
 
Ambiguous
 
Female
 
 
 
How do you describe your race?
 
African American (Black)
 
Asian
 
Caucasian (White)
 
Hispanic or Latino
 
Native American or Other
 
Combination or Mixed
 
 
 
In inches, how tall are you? For example, if you are 5 foot 8 inches tall, enter 68.
   
 
 
 
In pounds, how much do you weigh? Just enter the number.
   
 
 
 
What best describes your current romantic situation?
 
No relationship
 
Dating around
 
Dating someone casually
 
Dating someone seriously
 
Engaged and/or living together
 
Married
 
 
 
Choose the statement below that describes your current overall health.
 
I am disabled by health issues.
 
My day-to-day life is often impaired by my health.
 
My day-to-day life is impaired by my health more often than normal.
 
My health is normal for my age.
 
I enjoy above average health.
 
My health is superior.
 
 
Choose how strongly you agree or disagree with the following statements.
Disagree strongly Disagree somewhat Disagree a little Agree a little Agree somewhat Agree strongly
I consider myself to be a physically healthy person.
I tend to catch ailments that are going around.
My health never prevents me from reaching my goals.
I consider myself to be a mentally healthy person.
My health is a blessing in my life
My health is a burden in my life.
 
 
 
Choose the statement below that describes your current level of activity.
 
I never exercise
 
I exercise very rarely
 
I exercise once or twice per week
 
I exercise 3-4 times per week
 
I exercise 5-6 times per week
 
I exercise everyday
 
 
Choose how strongly you agree or disagree with the following statements.
Disagree strongly Disagree somewhat Disagree a little Agree a little Agree somewhat Agree strongly
It is very important for me to exercise.
I feel guilty if I do not exercise regularly
When I exercise regularly, I feel better
I enjoy exercising with my significant other
I enjoy exercising with my family memebers
I enjoy exercising with my friends/peers
 
 
 
When you exercise, what is the average duration (in minutes)?
   
 
 
 
Borg Rating of Perceived Exertion (RPE) Scale

While doing physical activity, we want you to rate your perception of exertion. This feeling should reflect how heavy and strenuous the exercise feels to you, combining all sensations and feelings of physical stress, effort, and fatigue. Do not concern yourself with any one factor such as leg pain or shortness of breath, but try to focus on your total feeling of exertion.
Look at the rating scale below while you are engaging in an activity; it ranges from 6 to 20, where 6 means "no exertion at all" and 20 means "maximal exertion."

So, taking into consideration your statement on your overall activity level, where would you place the intensity of your activities on average?
 
6 (No exertion at all)
 
7 (Extremely light)
 
8
 
9 (Very light)
 
10
 
11 (Light)
 
12
 
13 (Somewhat hard)
 
14
 
15 (Hard)
 
16
 
17 (Very hard)
 
18
 
19 (Extremely hard)
 
20 (Maximal exertion)
 
 
Choose how strongly you agree or disagree with the following statements. (DO NOT ANSWER IF NOT IN AN INTIMATE RELATIONSHIP)
Disagree strongly Disagree somewhat Disagree a little Agree a little Agree somewhat Agree strongly
My partner knows and understands the real me.
My partner accepts me and values me for who I am.
My relationship with my partner is very romantic.
My relationship with my partner is passionate and exciting.
I believe that my partner is trustworthy.
I feel that I can trust my partner completely.
I can count on my partner to be honest with me.
I lack power and control in my relationship with my partner.
I lack influence in our relationship.
I feel that my partner controls our relationship too much.
 
 
Choose how strongly you agree or disagree with the following statements.
Disagree strongly Disagree somewhat Disagree a little Agree a little Agree somewhat Agree strongly
My family knows and understands the real me.
My family accepts me and values me for who I am.
My relationship with my family is very close.
My relationship with my family is engaging and interesting.
I believe that my famiy is trustworthy.
I feel that I can trust my family completely.
I can count on my family to be honest with me.
I lack power and control in my family.
I lack influence in my family relationship.
I feel that my siblings or parents/guardians are too controlling of me.
 
 
Choose how strongly you agree or disagree with the following statements.
Disagree strongly Disagree somewhat Disagree a little Agree a little Agree somewhat Agree strongly
My friends know and understand the real me.
My friends accept me and value me for who I am.
My relationships with my friends are very close.
My relationships with my friends are fun and exciting.
I believe that my friends are trustworthy.
I feel that I can trust my friends completely.
I can count on my friends to be honest with me.
I lack power and control in relationships with my friends.
I lack influence in my friendships.
I feel that my friends control our relationship too much.
 
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