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question_type question_text required page_number option_text option_values
instruction Welcome to this survey. Press <strong>Next</strong> to begin. 0 1
instruction Please answer the following questions regarding your demographics. 0 2
radio What is your sex? 1 3 Male,Female 0,1
numeric How old are you (in years)? 1 3
checkbox What is your race? 1 3 White, American Indian or Alaska Native,Chinese,Japanese, Filipino,Korean, Asian Indian, Vietnamese, Other Asian, Black or African American, Middle Eastern or North African, Native Hawaiian or Other Pacific Islander,Other,Choose not to respond
textfield If you chose 'Other' for racial background how would you describe it? 0 3
radio Are you of Hispanic, Latino or Spanish origin? 1 3 Yes, No 1,0
radio What is the highest level of education you have completed? 1 3 Did Not Complete High School, High School/GED, Some College, Bachelor's Degree, Master's Degree, Advanced Graduate work or Ph.D 1,2,3,4,5,6
numeric How tall are you (in inches: one foot = 12 inches)? 1 3
numeric How much do you weigh (in pounds)? 1 3
radio What is your relationship status? 1 3 Single,Married,In Committed Relationship 1,2,3
radio How many times have you been divorced? 1 3 0,1,2,3,4,5,More 0,1,2,3,4,5,6
numeric How long was/is your longest romantic relationship (in months: one year = 12 months)? 1 3
radio How many romantic relationships have you had? 1 3 0,1,2,3,4,5-10,>10 1,2,3,4,5,6,7
radio How many children do you have? 1 3 0,1,2,3,4,5-10,>10 1,2,3,4,5,6,7
numeric What is your household's annual income (in dollars)? 1 4
radio Do you have a retirement account? 1 4 Yes,No 1,2
numeric If you do have a retirement account what percent is in stocks? 0 4 <10%, 10-20%,20-30%,30-40%,40-50%,60-70%,70-80%,80-90%,>90% 1,2,3,4,5,6,7,8
radio Do you rent or own your home/apartment? 1 4 Rent, Own 1,2
radio How much mortgage debt do you have? 1 4 <$500,$500-$2500,$2500-$10000,$10000-$25000,$25000-$50000,$50000-$100000,$100000-$200000,>$200000, Prefer Not To Say 1,2,3,4,5,6,7,8, 0
radio How much car-related debt do you have? 1 4 <$500,$500-$2500,$2500-$10000,$10000-$25000,$25000-$50000,$50000-$100000,$100000-$200000,>$200000, Prefer Not To Say 1,2,3,4,5,6,7,8, 0
radio How much education debt do you have? 1 4 <$500,$500-$2500,$2500-$10000,$10000-$25000,$25000-$50000,$50000-$100000,$100000-$200000,>$200000, Prefer Not To Say 1,2,3,4,5,6,7,8, 0
radio How much credit card debt do you have? 1 4 <$500,$500-$2500,$2500-$10000,$10000-$25000,$25000-$50000,$50000-$100000,$100000-$200000,>$200000, Prefer Not To Say 1,2,3,4,5,6,7,8, 0
textfield Please list any other sources of debt you have: 0 4
radio If you listed any other sources of debt, how much debt do you have? 0 4 <$500,$500-$2500,$2500-$10000,$10000-$25000,$25000-$50000,$50000-$100000,$100000-$200000,>$200000, Prefer Not To Say 1,2,3,4,5,6,7,8,0
numeric On average, how many cups of coffee do you have each day? 1 5
numeric On average, how many cups of tea do you have each day? 1 5
numeric On average, how many cans of caffeinated soda do you have each day? 1 5
numeric What is your daily caffeine intake from other sources each day (in mg)? 1 5
radio Do you feel you have a problem with gambling? 1 5 no, yes in the past but not now, yes 0,1,2
radio How many traffic tickets have you gotten in the last year? 1 5 0,1,2,3,4,5-10,>10 1,2,3,4,5,6,7
radio How many traffic accidents have you been in over your life? 1 5 0,1,2,3,4,5-10,>10 1,2,3,4,5,6,7
radio How many times in your life have you been arrested and/or charged with illegal activities? 1 5 0,1,2,3,4,5-10,>10 1,2,3,4,5,6,7
checkbox What are you motivations for participating in this experiment? 1 5 money,tasks are fun,want to contribute to research,other 1,2,3,4
textfield If you have other motivations, please list them. 0 5
instruction Congratulations for completing this survey! Press <strong>finish</strong> to continue. 0 6