NOTE: Your child will be completing a version of this diary either as homework or at school as part of the Media Risk Reduction Program.
We would appreciate you taking the time to fill in the data below. Once you have completed the diary please send it back to school with your child. Once we have received your diary we will send home a new one for the next day with your child. The Media diary portion of the program will last one week.
If you do not want to participate please do not send any forms back to the school and you will not be given new ones.
Thank you for your participation! This part of the process will help with the critical media education portion of the study and will help researchers understand the home media environment more fully which can thus produce a better program for the school, home and community.
______
Last 5 digits of phone number - ***-**__- ______
(These numbers as well as your answers will be held in complete confidentiality, we will just need the number in order to correlate parent and child media audit data)
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Parents' Media Diary
Monday
(Optional)
Only ONE parent is required to fill this survey out, please indicate who filled this one out (ie. Mom, Dad…etc.) ______.
(If both parents would like to fill this survey out please contact your child's teacher)
TIME SPENT with the Media on MONDAY
A) Please shade in the amount of number of HOURS PER DAY that you spend for each of the following question.
______
______
1) How long did you read Books/ Magazines/ Comics?
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) What books/magazines/comics did you read?
a) ______b) ______
c) ______
2) How long did you listen to the Radio/Stereo?
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) What radio stations did you listen to?
a) ______b) ______
3) How long did you listen to music on CD player/Walkman /Minidisc?
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) What is the name of the singers/groups that you listened to?
a) ______b) ______
c) ______
· Television and Movies watched on Monday
4) How long did you watch TV?
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) What kinds of TV shows did your watch?
a) ______b) ______
c) ______
5) How long did you watch movies using a VCR/DVD?
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) What movies did you watch?
a) ______b) ______
c) ______
· Computer use on Monday
6) How long did you use the Computer? (for work rather than personal use)
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) What did you do on the computer?
a) ______b) ______
c) ______
7) How long did you spend playing games on the computer? (not Online games)
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) What games did you play on the computer?
a) ______b) ______
c) ______
8) How long did you spend playing online games?(using the Internet for games)
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) What online games did you play?
a) ______b) ______
c) ______
9) How long did you use the computer for online Chatting?
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5
i) Who did you chat with online on Monday?
(please check all of the following that apply)
_____ a friend from school/work
_____ a friend not from school/work, but someone you know in person
_____ someone you only know online and have never me.
_____ a relative
10) How long did you spend on Email?
0 1/2 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5