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Questionnaire Name - Fashion Media and its Influence on Self-Image of Younger Generation

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1	Age?
	A- Below 15 (3)  B- 15 - 18 (12)  C- 19 - 23 (53)  D- 24 - 28 (21)  E- 29 - 35 (4)  F- Above 35 (1)
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2	Gender?
	A- Male (15)  B- Female (79)
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3	Nationality
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4	How often do you read fashion magazines?
	A- Daily (11)  B- Weekly (21)  C- Monthly (47)  D- Never (15)
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5	Are you exposed to other fashion media?
	A- Yes (58)  B- No (35)  C- If yes, what is it? (31)
	No Selection (0)   Select 1 item (64)   Select 2 items (30) Select 3 items (0)
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6	What are the reasons for reading fashion magazines/being exposed to fashion media?
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7	How do you feel after being exposed to images of ultrathin models in fashion media?
	A- I feel great about myself (13)  B- I feel good about myself (21)  C- I feel OK about myself (39)  D- I do not feel very good about myself (21)
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8	Do you think images of ultrathin models are unrealistic?
	A- Yes (58)  B- No (23)  C- Not Sure (13)
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9	Do you think you are influenced by fashion models?
	A- Yes (40)  B- No (56)  C- If yes, how? (18)
	No Selection (0)   Select 1 item (74)   Select 2 items (20) Select 3 items (0)
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10	Do you think people around you are influenced by fashion models?
	A- Yes (63)  B- No (11)  C- Not sure (20)
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11	Have you been on or thought of going on a diet?
	A- Yes (67)  B- No (27)
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12	What are the reasons for losing weight? (Tick as many as relevant)
	A- To look healthier (69)  B- To look prettier (69)  C- To look more like the models in advetisements (15)  D- Other (please specify) (11)
	No Selection (0)   Select 1 item (44)   Select 2 items (33) Select 3 items (14)   Select 4 items (3)
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13	Do you know anyone around you who has been on a diet due to seeing images of ultrathin models?
	A- Yes (46)  B- No (48)
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14	Can you please use 3 words to describe yourself?
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15	Which group of people are most influential in shaping your personal image? (tick as many as relevant)
	A- Family (40)  B- Friends (69)  C- Models/Celebrities (26)  D- Noone/Myself (42)
	No Selection (1)   Select 1 item (40)   Select 2 items (28) Select 3 items (19)   Select 4 items (6)
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16	Please tick if the following sentences are true in how you perceive youself as well as how you wish others to perceive you (please tick as many as relevant
	A- I am different (53)  B- I am unique (49)  C- I am confident (62)  D- I am powerful (23)  E- I am influential (40)  F- I have a high social status (23)  G- I am happy (74)
	No Selection (0)   Select 1 item (17)   Select 2 items (10) Select 3 items (24)   Select 4 items (19) Select 5 items (10)   Select 6 items (9) Select 7 items (5)
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17	In my opinion, being similar to models in the fashion media helps to (pleas tick as many as relevant)
	A- Boost confidence (46)  B- Boost self-esteem (39)  C- Create my own personal style (37)  D- Feel more satisfied about myself (40)  E- Achieve the ultimate image in life (14)  F- Gain more respects from other (17)  G- Impress others (42)  H- Make me feel more important about myself (25)
	No Selection (5)   Select 1 item (29)   Select 2 items (14) Select 3 items (22)   Select 4 items (8) Select 5 items (5)   Select 6 items (3) Select 7 items (2)   Select 8 items (6)
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18	Do you think galmour and success can be achieved through being thin?
	A- Yes (16)  B- No (54)  C- Not Sure (25)  D- If yes, why? (9)
	No Selection (0)   Select 1 item (84)   Select 2 items (10) Select 3 items (0)   Select 4 items (0)
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