Dear Respondents, Dear Respondents,

The purpose of this study is to determine the factors that influencing Senior High School
Students to engage in social vices: basis for an intervention program.
Please read carefully and check (/) the appropriate column for each for each statement as
promptly possible. All information gathered shall be use purely for research purpose and shall be
treated with confidentiality. Thanks!
The purpose of this study is to determine the factors that influencing Senior High School
Students to engage in social vices: basis for an intervention program.
Please read carefully and check (/) the appropriate column for each for each statement as
promptly possible. All information gathered shall be use purely for research purpose and shall be
treated with confidentiality. Thanks!

Name (Optional) ________________________________ Gender: ____________ Name (Optional) ________________________________ Gender: ____________
Grade/Section: ________________ Age:_____________ Grade/Section: ________________ Age:_____________

QUESTIONS ALWA OFTEN SELDO NEVE QUESTIONS ALWA OFTEN SELDO NEVE
YS M R YS M R
PEER PRESSURE PEER PRESSURE
I take vices when I am experiencing peer pressure. I take vices when I am experiencing peer pressure.
I engage in social vices because friends forced me to do I engage in social vices because friends forced me to do
it to satisfy feeling of belongingness. it to satisfy feeling of belongingness.

I engage to any social vices because I don’t want to feel I engage to any social vices because I don’t want to feel
out of place with my friends. out of place with my friends.
FAMILY PROBLEM FAMILY PROBLEM
I social vices as a substitute for meal/temporary relief I social vices as a substitute for meal/temporary relief
from hunger from hunger

I believe that using or engaging social vices is part of I believe that using or engaging social vices is part of
our growth our growth

I engage myself to social vices because of my curiosity I engage myself to social vices because of my curiosity
SCHOOL WORKS SCHOOL WORKS
I divert my time to take vices instead of being serious I divert my time to take vices instead of being serious
with my school works. with my school works.

I engaged myself to social vices in my day-to-day basis I engaged myself to social vices in my day-to-day basis
because it is just my trip. because it is just my trip.

I take vices as my stress reliever during work hours. I take vices as my stress reliever during work hours.
RELATTIONSHIP/BREAKUP RELATTIONSHIP/BREAKUP
I use to take vices to move on. I use to take vices to move on.
I am aware of the negative effect and consequences of I am aware of the negative effect and consequences of
engaging social vices. engaging social vices.

Vices comforts me when I am feeling heartbroken. Vices comforts me when I am feeling heartbroken.