Choose one answer only unless specified otherwise.
1. What kind of gambling have you engaged during the past 12 months? (Can choose more than one)
A. Horse Racing
B. Casino
C. Lottery Draw (e.g. Toto, Damacai, Magnum)
D. Sports betting (e.g. soccer games)
E. Social gambling (e.g. mahjong, card games involving money)
F. Online Gambling
2. How much is your average spending for gambling per month?
A. Below RM200
B. RM201-RM600
C. RM601-RM1000
D. RM1001-RM1400
E. Others____________________
3. How long have you started gambling?
A. Less than 10 years
B. Between 10 to 20 years
C. Between 20 to 30 years
D. More than 30 years
4. What motivate you to gamble? (Choose maximum two)
A. To earn more money.
B. To release pressure.
C. To have fun and entertainment.
D. To enhance relationship with friend or family.
E. To seek excitement.
F. I gamble because of greedy.
G. Others_________________
5. What you usually do when you lost in gambling?
A. Continue gambling by spending lesser money.
B. Continue gambling with similar amount of money.
C. Continue gambling by spending more money.
D. Stop gambling.
6. What you usually do when you won in gambling?
A. Continue gambling by spending lesser money.
B. Continue gambling with similar amount of money.
C. Continue gambling by spending more money.
D. Stop gambling.
E. Never won in gambling.
7. Have you ever faced financial situations below due to gambling? (Highlight or circle yes or no only).
A. The money spent on gambling more than you planned. Yes No
B. Using income or saving to gamble instead of paying bills. Yes No
C. Using credit card to gamble or settle gambling debt. Yes No
D. Borrowing money from family or friend to gamble or
settle gambling debt. Yes No
E. Borrowing money from loan shark to gamble or
settle gambling debt. Yes No
F. None of above situations.
8. Have you ever faced situations below due to gambling? (Highlight or circle yes or no only).
A. Forgot to have meal. Yes No
B. Gambling longer than you planned. Yes No
C. Felt depressed when lost in gambling. Yes No
D. Easily to get angry. Yes No
E. Arguing with family members. Yes No
F. Thinking gambling all the days. Yes No
G. Absent from work or school due to gambling. Yes No
H. Difficulty in sleeping. Yes No
I. Suicidal thought. Yes No
J. None of above situations.
9. Do you agree with the statements below? (Highlight or circle yes or no only).
A. It is not necessary to stop gambling. Yes No
B. I think to stop gambling but I could not stop it. Yes No
C. I gamble in order to chase wins. Yes No
D. I gamble in order to recover losses. Yes No
10. How much do you agree with each of the following statements?
Strongly Strongly
Agree Agree Disagree Disagree
A. It is acceptable if we gamble once
in a while and not excessively.
B. It is possible to win in gambling
if I have the right gambling skills.
C. Gambling can be very addictive.
11. What will you do if you find gambling has brought trouble into your life?
A. Discuss with family members or friends.
B. Consult the professionals.
C. Consult the religious leaders.
D. Settle yourself.
E. Doing nothing.
12. What you usually do when you visited Genting Highlands? (Choose maximum two)
A. Have fun in theme park.
B. Gambling in casino.
C. Just relax.
D. I never been to Genting Highlands.
13. Do you used to buy evening newspaper in order to know the lottery draw result immediately?
A. Yes B. No
14. What is your favorite number that you used to bet on lottery draw? (Choose maximum two)
A. Vehicle license number
B. Mobile phone number
C. Doorplate
D. Special date such as birthday, anniversary.
E. Things appear in the dream.
F. Any number that I think is lucky number.
G. I do not buy lottery draw.
H. Others ____________________
15. Will the advertisement below motivate you to start gambling or gamble more?
A. Yes B. No