Canadian Community Health Survey (CCHS) Rapid Response March-June 2014 - Tanning Equipment Use/Laser Beam Exposure
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For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Proxy interview (GR)
- Age of respondent (ANC)
- General health (GEN)
- Height and weight - Self-reported (HWT)
- Chronic conditions (CCC)
- Fibromyalgia - Sub-block (CC3)
- Chronic fatigue syndrome and multiple chemical sensitivities - Sub block (CC4)
- Pain and discomfort (HUP)
- Health care utilization (HCU)
- Contacts with Health Professionals - Part 1 (CHP)
- Restriction of activities (RAC)
- Flu shots (FLU)
- Fruit and vegetable consumption (FVC)
- Physical activities (PAC)
- Tanning Equipment Use (TEU)
- Laser Beam Exposure (LBE)
- Smoking (SMK)
- Exposure to second-hand smoke (ETS)
- Alcohol use (ALC)
- Labour force (LBS)
- Education of selected respondent (EDU)
- Socio-demographic characteristics (SDC)
- Person most knowledgeable about household situation (PMK)
- Income (INC)
- Administration information (ADM)
- CAPI Frame Evaluation - Sub-block (FRE)
Proxy interview (GR)
Proxy interview (GR) - Question identifier:GR_N01A
Who is providing the information for this person's component?
- 01: MEMBER1
- 02: MEMBER2
- 03: MEMBER3
- 04: MEMBER4
- 05: MEMBER5
- 06: MEMBER6
- 07: MEMBER7
- 08: MEMBER8
- 09: MEMBER9
- 10: MEMBER10
- 11: MEMBER11
- 12: MEMBER12
- 13: MEMBER13
- 14: MEMBER14
- 15: MEMBER15
- 16: MEMBER16
- 17: MEMBER17
- 18: MEMBER18
- 19: MEMBER19
- 20: MEMBER20
Proxy interview (GR) - Question identifier:GR_N01B
Do you want to complete this component by proxy?
- 1: Yes
- 2: No
Proxy interview (GR) - Question identifier:GR_N02
Record the reason why this component is being completed by proxy. Proxy interviews are to occur only if the mental or physical health of the selected member makes it impossible to complete the interview during the collection period. If the reason for the proxy interview is neither of these choices, please press <F10> to exit the application and assign an appropriate outcome code.
- 1: Physical health condition
- 2: Mental health condition
Proxy interview (GR) - Question identifier:GR_N03
Enter the condition.
Long Answer Length = 80
Age of respondent (ANC)
Age of respondent (ANC) - Question identifier:ANC_R01
For some of the questions I'll be asking, I need to know your exact date of birth.
Age of respondent (ANC) - Question identifier:ANC_N01A
Enter the day. If necessary, ask (What is the day?)
Min = 1; Max = 31
Age of respondent (ANC) - Question identifier:ANC_N01B
Enter the month. If necessary, ask (What is the month?)
- 01: January
- 02: February
- 03: March
- 04: April
- 05: May
- 06: June
- 07: July
- 08: August
- 09: September
- 10: October
- 11: November
- 12: December
- 98: RF
- 99: DK
Age of respondent (ANC) - Question identifier:ANC_N01C
Enter a four-digit year.
If necessary, ask (What is the year?)
Min = 0; Max = 0
Age of respondent (ANC) - Question identifier:ANC_Q02
So your age is [calculated age].
Is that correct?
- 1: Yes
- 2: No, return and correct date of birth
- 3: No, collect age
Age of respondent (ANC) - Question identifier:ANC_Q03
What is your age?
Min = 0; Max = 121
Age of respondent (ANC) - Question identifier:ANC_R04
Because you are less than 12 years old, you are not eligible to participate in the Canadian Community Health Survey.
General health (GEN)
General health (GEN) - Question identifier:GEN_R01
This survey deals with various aspects of your health. The following questions ask about physical activity, social relationships and health status. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.
General health (GEN) - Question identifier:GEN_Q01
In general, would you say your health is...?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
- 8: RF
- 9: DK
General health (GEN) - Question identifier:GEN_Q02A
Compared to one year ago, how would you say your health is now? Is it...?
- 1: Much better now than 1 year ago
- 2: Somewhat better now (than 1 year ago)
- 3: About the same as 1 year ago
- 4: Somewhat worse now (than 1 year ago)
- 5: Much worse now (than 1 year ago)
- 8: RF
- 9: DK
General health (GEN) - Question identifier:GEN_Q02B
Using a scale of 0 to 10, where 0 means "Very dissatisfied" and 10 means "Very satisfied", how do you feel about your life as a whole right now?
- 00: Very dissatisfied
- 01: |
- 02: |
- 03: |
- 04: |
- 05: |
- 06: |
- 07: |
- 08: |
- 09: V
- 10: Very satisfied
- 98: RF
- 99: DK
General health (GEN) - Question identifier:GEN_Q02C
In general, would you say your mental health is...?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
- 8: RF
- 9: DK
General health (GEN) - Question identifier:GEN_Q07
Thinking about the amount of stress in your life, would you say that most days are...?
- 1: Not at all stressful
- 2: Not very stressful
- 3: A bit stressful
- 4: Quite a bit stressful
- 5: Extremely stressful
- 8: RF
- 9: DK
General health (GEN) - Question identifier:GEN_Q08
Have you worked at a job or business at any time in the past 12 months?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
General health (GEN) - Question identifier:GEN_R09
The next question is about your main job or business in the past 12 months.
General health (GEN) - Question identifier:GEN_Q09
Would you say that most days at work were...?
- 1: Not at all stressful
- 2: Not very stressful
- 3: A bit stressful
- 4: Quite a bit stressful
- 5: Extremely stressful
- 8: RF
- 9: DK
General health (GEN) - Question identifier:GEN_Q10
How would you describe your sense of belonging to your local community? Would you say it is...?
- 1: Very strong
- 2: Somewhat strong
- 3: Somewhat weak
- 4: Very weak
- 8: RF
- 9: DK
Height and weight - Self-reported (HWT)
Height and weight - Self-reported (HWT) - Question identifier:HWT_Q1
It is important to know when analyzing health whether or not the person is pregnant. Are you pregnant?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Height and weight - Self-reported (HWT) - Question identifier:HWT_Q2
The next questions are about height and weight. How tall are you without shoes on?
- 0: Less than 1' / 12" (less than 29.2 cm.)
- 1: 1'0" to 1'11" / 12" to 23" (29.2 to 59.6 cm.)
- 2: 2'0" to 2'11" / 24" to 35" (59.7 to 90.1 cm.)
- 3: 3'0" to 3'11" / 36" to 47" (90.2 to 120.6 cm.)
- 4: 4'0" to 4'11" / 48" to 59" (120.7 to 151.0 cm.)
- 5: 5'0" to 5'11" (151.1 to 181.5 cm.)
- 6: 6'0" to 6'11" (181.6 to 212.0 cm.)
- 7: 7'0" and over (212.1 cm. and over)
- 8: RF
- 9: DK
Height and weight - Self-reported (HWT) - Question identifier:HWT_N2A
Select the exact height.
- 00: 1'0" / 12" (29.2 to 31.7 cm.)
- 01: 1'1" / 13" (31.8 to 34.2 cm.)
- 02: 1'2" / 14" (34.3 to 36.7 cm.)
- 03: 1'3" / 15" (36.8 to 39.3 cm.)
- 04: 1'4" / 16" (39.4 to 41.8 cm.)
- 05: 1'5" / 17" (41.9 to 44.4 cm.)
- 06: 1'6" / 18" (44.5 to 46.9 cm.)
- 07: 1'7" / 19" (47.0 to 49.4 cm.)
- 08: 1'8" / 20" (49.5 to 52.0 cm.)
- 09: 1'9" / 21" (52.1 to 54.5 cm.)
- 10: 1'10" / 22" (54.6 to 57.1 cm.)
- 11: 1'11" / 23" (57.2 to 59.6 cm.)
- 98: RF
- 99: DK
Height and weight - Self-reported (HWT) - Question identifier:HWT_N2B
Select the exact height.
- 00: 2'0" / 24" (59.7 to 62.1 cm.)
- 01: 2'1" / 25" (62.2 to 64.7 cm.)
- 02: 2'2" / 26" (64.8 to 67.2 cm.)
- 03: 2'3" / 27" (67.3 to 69.8 cm.)
- 04: 2'4" / 28" (69.9 to 72.3 cm.)
- 05: 2'5" / 29" (72.4 to 74.8 cm.)
- 06: 2'6" / 30" (74.9 to 77.4 cm.)
- 07: 2'7" / 31" (77.5 to 79.9 cm.)
- 08: 2'8" / 32" (80.0 to 82.5 cm.)
- 09: 2'9" / 33" (82.6 to 85.0 cm.)
- 10: 2'10" / 34" (85.1 to 87.5 cm.)
- 11: 2'11" / 35" (87.6 to 90.1 cm.)
- 98: RF
- 99: DK
Height and weight - Self-reported (HWT) - Question identifier:HWT_N2C
Select the exact height.
- 00: 3'0" / 36" (90.2 to 92.6 cm.)
- 01: 3'1" / 37" (92.7 to 95.2 cm.)
- 02: 3'2" / 38" (95.3 to 97.7 cm.)
- 03: 3'3" / 39" (97.8 to 100.2 cm.)
- 04: 3'4" / 40" (100.3 to 102.8 cm.)
- 05: 3'5" / 41" (102.9 to 105.3 cm.)
- 06: 3'6" / 42" (105.4 to 107.9 cm.)
- 07: 3'7" / 43" (108.0 to 110.4 cm.)
- 08: 3'8" / 44" (110.5 to 112.9 cm.)
- 09: 3'9" / 45" (113.0 to 115.5 cm.)
- 10: 3'10" / 46" (115.6 to 118.0 cm.)
- 11: 3'11" / 47" (118.1 to 120.6 cm.)
- 98: RF
- 99: DK
Height and weight - Self-reported (HWT) - Question identifier:HWT_N2D
Select the exact height.
- 00: 4'0" / 48" (120.7 to 123.1 cm.)
- 01: 4'1" / 49" (123.2 to 125.6 cm.)
- 02: 4'2" / 50" (125.7 to 128.2 cm.)
- 03: 4'3" / 51" (128.3 to 130.7 cm.)
- 04: 4'4" / 52" (130.8 to 133.3 cm.)
- 05: 4'5" / 53" (133.4 to 135.8 cm.)
- 06: 4'6" / 54" (135.9 to 138.3 cm.)
- 07: 4'7" / 55" (138.4 to 140.9 cm.)
- 08: 4'8" / 56" (141.0 to 143.4 cm.)
- 09: 4'9" / 57" (143.5 to 146.0 cm.)
- 10: 4'10" / 58" (146.1 to 148.5 cm.)
- 11: 4'11" / 59" (148.6 to 151.0 cm.)
- 98: RF
- 99: DK
Height and weight - Self-reported (HWT) - Question identifier:HWT_N2E
Select the exact height.
- 00: 5'0" (151.1 to 153.6 cm.)
- 01: 5'1" (153.7 to 156.1 cm.)
- 02: 5'2" (156.2 to 158.7 cm.)
- 03: 5'3" (158.8 to 161.2 cm.)
- 04: 5'4" (161.3 to 163.7 cm.)
- 05: 5'5" (163.8 to 166.3 cm.)
- 06: 5'6" (166.4 to 168.8 cm.)
- 07: 5'7" (168.9 to 171.4 cm.)
- 08: 5'8" (171.5 to 173.9 cm.)
- 09: 5'9" (174.0 to 176.4 cm.)
- 10: 5'10" (176.5 to 179.0 cm.)
- 11: 5'11" (179.1 to 181.5 cm.)
- 98: RF
- 99: DK
Height and weight - Self-reported (HWT) - Question identifier:HWT_N2F
Select the exact height.
- 00: 6'0" (181.6 to 184.1 cm.)
- 01: 6'1" (184.2 to 186.6 cm.)
- 02: 6'2" (186.7 to 189.1 cm.)
- 03: 6'3" (189.2 to 191.7 cm.)
- 04: 6'4" (191.8 to 194.2 cm.)
- 05: 6'5" (194.3 to 196.8 cm.)
- 06: 6'6" (196.9 to 199.3 cm.)
- 07: 6'7" (199.4 to 201.8 cm.)
- 08: 6'8" (201.9 to 204.4 cm.)
- 09: 6'9" (204.5 to 206.9 cm.)
- 10: 6'10" (207.0 to 209.5 cm.)
- 11: 6'11" (209.6 to 212.0 cm.)
- 98: RF
- 99: DK
Height and weight - Self-reported (HWT) - Question identifier:HWT_Q3
How much do you weigh?
Min = 1; Max = 575
Height and weight - Self-reported (HWT) - Question identifier:HWT_N4
Was that in pounds or kilograms?
- 1: Pounds
- 2: Kilograms
Height and weight - Self-reported (HWT) - Question identifier:HWT_Q4
Do you consider yourself:
- 1: Overweight
- 2: Underweight
- 3: Just about right
- 8: RF
- 9: DK
Chronic conditions (CCC)
Chronic conditions (CCC) - Question identifier:CCC_R011
Now I'd like to ask about certain long-term health conditions which you may have. We are interested in "long-term conditions" which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.
Chronic conditions (CCC) - Question identifier:CCC_Q031
Do you have asthma?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q035
Have you had any asthma symptoms or asthma attacks in the past 12 months?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q036
In the past 12 months, have you taken any medicine for asthma such as inhalers, nebulizers, pills, liquids or injections?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q051
Do you have arthritis, excluding fibromyalgia?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q061
Do you have back problems, excluding fibromyalgia and arthritis?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q071
Remember, we're interested in conditions diagnosed by a health professional and that are expected to last or have already lasted 6 months or more.
Do you have high blood pressure?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q072
Have you ever been diagnosed with high blood pressure?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q073
In the past month, have you taken any medicine for high blood pressure?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q075
Were you pregnant when you were first diagnosed with high blood pressure?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q077
Other than during pregnancy, has a health professional ever told you that you have high blood pressure?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q081
Remember, we're interested in conditions diagnosed by a health professional and that are expected to last or have already lasted 6 months or more.
Do you have migraine headaches?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q091
Do you have chronic bronchitis, emphysema or chronic obstructive pulmonary disease or COPD?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q101
(Remember, we're interested in conditions diagnosed by a health professional and that are expected to last or have already lasted 6 months or more.)
Do you have diabetes?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q102
How old were you when this was first diagnosed?
Min = 1; Max = 121
Chronic conditions (CCC) - Question identifier:CCC_Q10A
Were you pregnant when you were first diagnosed with diabetes?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q10B
Other than during pregnancy, has a health professional ever told you that you have diabetes?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q10C
When you were first diagnosed with diabetes, how long was it before you were started on insulin?
- 1: Less than 1 month
- 2: 1 month to less than 2 months
- 3: 2 months to less than 6 months
- 4: 6 months to less than 1 year
- 5: 1 year or more
- 6: Never
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q105
Do you currently take insulin for your diabetes?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q106
In the past month, did you take pills to control your blood sugar?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q121
Do you have heart disease?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q131
(Do you have:)
cancer?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q132
Have you ever been diagnosed with cancer?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q141
Remember, we're interested in conditions diagnosed by a health professional and that are expected to last or have already lasted 6 months or more.
Do you have intestinal or stomach ulcers?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q151
Do you suffer from the effects of a stroke?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q161
Do you have:
urinary incontinence?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q171
Do you have a bowel disorder such as Crohn's Disease, ulcerative colitis, Irritable Bowel Syndrome or bowel incontinence?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q172
What kind of bowel disease do you have?
- 1: Crohn's Disease
- 2: Ulcerative colitis
- 3: Irritable Bowel Syndrome
- 4: Bowel incontinence
- 5: Other
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q173
Have you been diagnosed with scoliosis?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q181
Do you have:
Alzheimer's Disease or any other dementia?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q280
Remember, we're interested in conditions diagnosed by a health professional and that are expected to last or have already lasted 6 months or more.
Do you have a mood disorder such as depression, bipolar disorder, mania or dysthymia?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic conditions (CCC) - Question identifier:CCC_Q290
Do you have an anxiety disorder such as a phobia, obsessive-compulsive disorder or a panic disorder?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Fibromyalgia - Sub-block (CC3)
Fibromyalgia - Sub-block (CC3) - Question identifier:CC3_Q01
Do you have fibromyalgia?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic fatigue syndrome and multiple chemical sensitivities - Sub block (CC4)
Chronic fatigue syndrome and multiple chemical sensitivities - Sub block (CC4) - Question identifier:CC4_Q01
Do you have chronic fatigue syndrome?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic fatigue syndrome and multiple chemical sensitivities - Sub block (CC4) - Question identifier:CC4_Q02
Do you suffer from multiple chemical sensitivities?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Pain and discomfort (HUP)
Pain and discomfort (HUP) - Question identifier:HUP_R1
The next set of questions asks about the level of pain or discomfort you usually experience. They are not about illnesses like colds that affect people for short periods of time.
Pain and discomfort (HUP) - Question identifier:HUP_Q28
Are you usually free of pain or discomfort?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Pain and discomfort (HUP) - Question identifier:HUP_Q29
How would you describe the usual intensity of your pain or discomfort?
- 1: Mild
- 2: Moderate
- 3: Severe
- 8: RF
- 9: DK
Pain and discomfort (HUP) - Question identifier:HUP_Q30
How many activities does your pain or discomfort prevent?
- 1: None
- 2: A few
- 3: Some
- 4: Most
- 8: RF
- 9: DK
Health care utilization (HCU)
Health care utilization (HCU) - Question identifier:HCU_Q10
Do you have a regular medical doctor?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Health care utilization (HCU) - Question identifier:HCU_Q20
Why do you not have a regular medical doctor?
- 1: No medical doctors available in the area
- 2: Medical doctors in the area are not taking new patients
- 3: Have not tried to contact one
- 4: Had a medical doctor who left or retired
- 5: Other - Specify
- 8: RF
- 9: DK
Health care utilization (HCU) - Question identifier:HCU_Q30
Is there a place that you usually [goes/go] to when you are sick or need advice about your health?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Health care utilization (HCU) - Question identifier:HCU_Q40
What kind of place is it?
- 01: Doctor's office
- 02: Community health centre / CLSC
- 03: Walk-in clinic
- 04: Appointment clinic
- 05: Telephone health line (for example, HealthLinks, Telehealth Ontario, Health-Line, TeleCare, Info-Santé)
- 06: Hospital emergency room
- 07: Hospital outpatient clinic
- 08: Other - Specify
- 98: RF
- 99: DK
Health care utilization (HCU) - Question identifier:HCU_Q50
Do you and this doctor usually speak in English, in French, or in another language?
- 01: English
- 02: French
- 03: Arabic
- 04: Chinese
- 05: Cree
- 06: German
- 07: Greek
- 08: Hungarian
- 09: Italian
- 10: Korean
- 11: Persian (Farsi)
- 12: Polish
- 13: Portuguese
- 14: Punjabi
- 15: Spanish
- 16: Tagalog (Filipino)
- 17: Ukrainian
- 18: Vietnamese
- 19: Dutch
- 20: Hindi
- 21: Russian
- 22: Tamil
- 23: Other - Specify
- 98: RF
- 99: DK
Contacts with Health Professionals - Part 1 (CHP)
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_R01
Now I'd like to ask about your contacts with various health professionals during the past 12 months, that is, from ^DATEONEYEARAGO to yesterday.
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q01
In the past 12 months, have you been a patient overnight in a hospital, nursing home or convalescent home?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q02
For how many nights in the past 12 months?
Min = 1; Max = 366
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q03
[Not counting when you were an overnight patient, in the past 12 months/In the past 12 months], have you seen, or talked to any of the following health professionals about your physical, emotional or mental health:
a family doctor, [pediatrician/null] or general practitioner?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q04
How many times (in the past 12 months)?
Min = 1; Max = 366
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q05
Where did the most recent contact take place?
- 01: Doctor's office
- 02: Hospital emergency room
- 03: Hospital outpatient clinic (e.g. day surgery, cancer)
- 04: Walk-in clinic
- 05: Appointment clinic
- 06: Community health centre / CLSC
- 07: At work
- 08: At school
- 09: At home
- 10: Telephone consultation only
- 11: Other - Specify
- 98: RF
- 99: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q06
([Not counting when you were an overnight patient, in the past 12 months/In the past 12 months], have you seen, or talked to:)
an eye specialist, such as an ophthalmologist or optometrist (about your physical, emotional or mental health)?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q07
How many times (in the past 12 months)?
Min = 1; Max = 75
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q08
([Not counting when you were an overnight patient, in the past 12 months/In the past 12 months], have you seen, or talked to:)
any other medical doctor or specialist such as a surgeon, allergist, orthopaedist, [urologist/gynaecologist] or psychiatrist (about your physical, emotional or mental health)?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q09
How many times (in the past 12 months)?
Min = 1; Max = 300
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q10
Where did the most recent contact take place?
- 01: Doctor's office
- 02: Hospital emergency room
- 03: Hospital outpatient clinic (e.g. day surgery, cancer)
- 04: Walk-in clinic
- 05: Appointment clinic
- 06: Community health centre / CLSC
- 07: At work
- 08: At school
- 09: At home
- 10: Telephone consultation only
- 11: Other - Specify
- 98: RF
- 99: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q11
[Not counting when you were an overnight patient, in the past 12 months/In the past 12 months], have you seen, or talked to:
a nurse for care or advice about your physical, emotional or mental health?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q12
How many times (in the past 12 months)?
Min = 1; Max = 366
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q13
Where did the most recent contact take place?
- 01: Doctor's office
- 02: Hospital emergency room
- 03: Hospital outpatient clinic (e.g. day surgery, cancer)
- 04: Walk-in clinic
- 05: Appointment clinic
- 06: Community health centre / CLSC
- 07: At work
- 08: At school
- 09: At home
- 10: Telephone consultation only
- 11: Other - Specify
- 98: RF
- 99: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q14
([Not counting when you were an overnight patient, in the past 12 months/In the past 12 months], have you seen, or talked to:)
a dentist, dental hygienist or orthodontist (about your physical, emotional or mental health)?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Contacts with Health Professionals - Part 1 (CHP) - Question identifier:CHP_Q15
How many times (in the past 12 months)?
Min = 1; Max = 99
Restriction of activities (RAC)
Restriction of activities (RAC) - Question identifier:RAC_R1
The next few questions deal with any current limitations in your daily activities caused by a long-term health condition or problem. In these questions, a "long-term condition" refers to a condition that is expected to last or has already lasted 6 months or more.
Restriction of activities (RAC) - Question identifier:RAC_Q1
Do you have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?
- 1: Sometimes
- 2: Often
- 3: Never
- 8: RF
- 9: DK
Restriction of activities (RAC) - Question identifier:RAC_Q2A
Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity you can do:
at home?
- 1: Sometimes
- 2: Often
- 3: Never
- 8: RF
- 9: DK
Restriction of activities (RAC) - Question identifier:RAC_Q2B_1
(Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity you can do:)
at school?
- 1: Sometimes
- 2: Often
- 3: Never
- 4: Does not attend school
- 8: RF
- 9: DK
Restriction of activities (RAC) - Question identifier:RAC_Q2B_2
(Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity you can do:)
at work?
- 1: Sometimes
- 2: Often
- 3: Never
- 4: Does not work at a job
- 8: RF
- 9: DK
Restriction of activities (RAC) - Question identifier:RAC_Q2C
(Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity you can do:)
in other activities, for example, transportation or leisure?
- 1: Sometimes
- 2: Often
- 3: Never
- 8: RF
- 9: DK
Restriction of activities (RAC) - Question identifier:RAC_R5
You reported that you have difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities.
Restriction of activities (RAC) - Question identifier:RAC_Q5
Which one of the following is the best description of the cause of this condition?
- 01: Accident at home
- 02: Motor vehicle accident
- 03: Accident at work
- 04: Other type of accident
- 05: Existed from birth or genetic
- 06: Work conditions
- 07: Disease or illness
- 08: Ageing
- 09: Emotional or mental health problem or condition
- 10: Use of alcohol or drugs
- 11: Other - Specify
- 98: RF
- 99: DK
Flu shots (FLU)
Flu shots (FLU) - Question identifier:FLU_R160
Now a few questions about your use of various health care services.
Flu shots (FLU) - Question identifier:FLU_Q160
Have you ever had a seasonal flu shot?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Flu shots (FLU) - Question identifier:FLU_Q162
When did you have your last seasonal flu shot?
- 1: Less than 1 year ago
- 2: 1 year to less than 2 years ago
- 3: 2 years ago or more
- 8: RF
- 9: DK
Flu shots (FLU) - Question identifier:FLU_Q164
In which month did you have your last seasonal flu shot?
- 01: January
- 02: February
- 03: March
- 04: April
- 05: May
- 06: June
- 07: July
- 08: August
- 09: September
- 10: October
- 11: November
- 12: December
- 98: RF
- 99: DK
Flu shots (FLU) - Question identifier:FLU_Q165
Was that this year or last year?
- 1: This year
- 2: Last year
- 8: RF
- 9: DK
Flu shots (FLU) - Question identifier:FLU_Q166
What are the reasons that you have not had a seasonal flu shot in the past year?
- 01: Have not gotten around to it
- 02: Respondent - did not think it was necessary
- 03: Doctor - did not think it was necessary
- 04: Personal or family responsibilities
- 05: Not available - at time required
- 06: Not available - at all in the area
- 07: Waiting time was too long
- 08: Transportation - problems
- 09: Language - problem
- 10: Cost
- 11: Did not know where to go / uninformed
- 12: Fear (e.g., painful, embarrassing, find something wrong)
- 13: Bad reaction to previous shot
- 14: Unable to leave the house because of a health problem
- 15: Other - Specify
- 98: RF
- 99: DK
Fruit and vegetable consumption (FVC)
Fruit and vegetable consumption (FVC) - Question identifier:FVC_R1
The next questions are about the foods you usually eat or drink. Think about all the foods you eat, both meals and snacks, at home and away from home.
Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q1A
How often do you usually drink fruit juices such as orange, grapefruit or tomato? (For example: once a day, three times a week, twice a month)
- 1: Per day
- 2: Per week
- 3: Per month
- 4: Per year
- 5: Never
- 8: RF
- 9: DK
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N1B
Enter number of times per day.
Min = 1; Max = 20
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N1C
Enter number of times per week.
Min = 1; Max = 90
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N1D
Enter number of times per month.
Min = 1; Max = 200
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N1E
Enter number of times per year.
Min = 1; Max = 500
Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q2A
Not counting juice, how often do you usually eat fruit?
- 1: Per day
- 2: Per week
- 3: Per month
- 4: Per year
- 5: Never
- 8: RF
- 9: DK
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N2B
Enter number of times per day.
Min = 1; Max = 20
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N2C
Enter number of times per week.
Min = 1; Max = 90
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N2D
Enter number of times per month.
Min = 1; Max = 200
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N2E
Enter number of times per year.
Min = 1; Max = 500
Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q3A
How often do you (usually) eat green salad?
- 1: Per day
- 2: Per week
- 3: Per month
- 4: Per year
- 5: Never
- 8: RF
- 9: DK
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N3B
Enter number of times per day.
Min = 1; Max = 20
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N3C
Enter number of times per week.
Min = 1; Max = 90
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N3D
Enter number of times per month.
Min = 1; Max = 200
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N3E
Enter number of times per year.
Min = 1; Max = 500
Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q4A
How often do you usually eat potatoes, not including french fries, fried potatoes, or potato chips?
- 1: Per day
- 2: Per week
- 3: Per month
- 4: Per year
- 5: Never
- 8: RF
- 9: DK
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N4B
Enter number of times per day.
Min = 1; Max = 20
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N4C
Enter number of times per week.
Min = 1; Max = 90
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N4D
Enter number of times per month.
Min = 1; Max = 200
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N4E
Enter number of times per year.
Min = 1; Max = 500
Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q5A
How often do you (usually) eat carrots?
- 1: Per day
- 2: Per week
- 3: Per month
- 4: Per year
- 5: Never
- 8: RF
- 9: DK
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N5B
Enter number of times per day.
Min = 1; Max = 20
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N5C
Enter number of times per week.
Min = 1; Max = 90
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N5D
Enter number of times per month.
Min = 1; Max = 200
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N5E
Enter number of times per year.
Min = 1; Max = 500
Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q6A
Not counting carrots, potatoes, or salad, how many servings of other vegetables do you usually eat?
- 1: Per day
- 2: Per week
- 3: Per month
- 4: Per year
- 5: Never
- 8: RF
- 9: DK
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N6B
Enter number of servings per day.
Min = 1; Max = 20
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N6C
Enter number of servings per week.
Min = 1; Max = 90
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N6D
Enter number of servings per month.
Min = 1; Max = 200
Fruit and vegetable consumption (FVC) - Question identifier:FVC_N6E
Enter number of servings per year.
Min = 1; Max = 500
Physical activities (PAC)
Physical activities (PAC) - Question identifier:PAC_R1
Now I'd like to ask you about some of your physical activities. To begin with, I'll be dealing with physical activities not related to work, that is, leisure time activities.
Physical activities (PAC) - Question identifier:PAC_Q1
Have you done any of the following in the past 3 months, that is, from ^DATETHREEMONTHSAGO to yesterday?
- 01: Walking for exercise
- 02: Gardening or yard work
- 03: Swimming
- 04: Bicycling
- 05: Popular or social dance
- 06: Home exercises
- 07: Ice hockey
- 08: Ice skating
- 09: In-line skating or rollerblading
- 10: Jogging or running
- 11: Golfing
- 12: Exercise class or aerobics
- 13: Downhill skiing or snowboarding
- 14: Bowling
- 15: Baseball or softball
- 16: Tennis
- 17: Weight-training
- 18: Fishing
- 19: Volleyball
- 20: Basketball
- 21: Soccer
- 22: Any other
- 23: No physical activity
- 98: RF
- 99: DK
Physical activities (PAC) - Question identifier:PAC_Q1X
In the past 3 months, did you do any other physical activity for leisure?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Physical activities (PAC) - Question identifier:PAC_Q1Y
In the past 3 months, did you do any other physical activity for leisure?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Physical activities (PAC) - Question identifier:PAC_Q2
In the past 3 months, how many times did you participate in [Walking for exercise/Gardening or yard work/Swimming/Bicycling/Popular or social dance/Home exercises/Ice hockey/Ice skating/In-line skating or rollerblading/Jogging or running/Golfing/Exercise class or aerobics/Downhill skiing or snowboarding/Bowling/Baseball or softball/Tennis/Weight-training/Fishing/Volleyball/Basketball/Soccer/Any other]?
Min = 1; Max = 300
Physical activities (PAC) - Question identifier:PAC_Q3
About how much time did you spend on each occasion?
- 1: 1 to 15 minutes
- 2: 16 to 30 minutes
- 3: 31 to 60 minutes
- 4: More than one hour
- 8: RF
- 9: DK
Physical activities (PAC) - Question identifier:PAC_R7
The last questions were about leisure time activities. Next, some questions about walking and bicycling that you do only as a way of getting to and from work or school.
Physical activities (PAC) - Question identifier:PAC_Q7A
[Other than the (X) times you already reported walking for exercise was there any other time/Was there any time] in the past 3 months when you walked to and from work or school?
- 1: Yes
- 2: No
- 3: Does not work or go to school
- 8: RF
- 9: DK
Physical activities (PAC) - Question identifier:PAC_Q7B
How many times?
Min = 1; Max = 270
Physical activities (PAC) - Question identifier:PAC_Q7C
About how much time did you spend on each occasion?
- 1: 1 to 15 minutes
- 2: 16 to 30 minutes
- 3: 31 to 60 minutes
- 4: More than one hour
- 8: RF
- 9: DK
Physical activities (PAC) - Question identifier:PAC_Q8A
[Other than the (X) times you already reported bicycling was there any other time/Was there any time] in the past 3 months when you bicycled to and from work or school?
- 1: Yes
- 2: No
- 3: Does not work or go to school
- 8: RF
- 9: DK
Physical activities (PAC) - Question identifier:PAC_Q8B
How many times?
Min = 1; Max = 200
Physical activities (PAC) - Question identifier:PAC_Q8C
About how much time did you spend on each occasion?
- 1: 1 to 15 minutes
- 2: 16 to 30 minutes
- 3: 31 to 60 minutes
- 4: More than one hour
- 8: RF
- 9: DK
Tanning Equipment Use (TEU)
Tanning Equipment Use (TEU) - Question identifier:TEU_R010
Now, we would like to ask you some questions about your use of sunlamps or tanning equipment.
Tanning Equipment Use (TEU) - Question identifier:TEU_Q010
Would you characterize yourself as a person with sensitive skin who regularly gets a sunburn from exposure to sun or tanning equipment?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q020
Have you used a sunlamp or tanning equipment in the past 12 months?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q025
What were your reasons for using a sunlamp or tanning equipment in the past 12 months?
- 1: To treat a skin condition or other medical condition
- 2: To tan without burning or to get a base tan (for example, going on a trip)
- 3: For aesthetic reasons (to look better)
- 4: To relax or feel better
- 5: To boost your immune system / get Vitamin D
- 6: To prevent cancer
- 7: Other
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q030
In the past 12 months, how would you classify your use of sunlamps or tanning equipment? Would you say your use is...?
- 1: Periodic - less than 10 sessions per year
- 2: Regular - 10 or more sessions per year
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q035
How many times have you used a sunlamp or tanning equipment in the past 12 months?
Min = 1; Max = 10
Tanning Equipment Use (TEU) - Question identifier:TEU_Q040
How many times have you used a sunlamp or tanning equipment in the past month?
Min = 1; Max = 31
Tanning Equipment Use (TEU) - Question identifier:TEU_Q045
Did you wear eye protection, such as goggles, while using the sunlamp or tanning equipment?
- 1: Yes
- 2: No
- 3: Sometimes
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q050
Each time you used the sunlamp or tanning equipment in the past 12 months, did you read the warning labels prior to using it?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q055
What were the reasons you did not read the warning labels?
- 01: I have read them in the past
- 02: I did not notice them
- 03: There were no warning labels posted or affixed to the tanning equipment
- 04: I didn't have time
- 05: I didn't think it was important or I didn't want to
- 06: The attendant gave me oral instructions
- 07: I have trouble reading them or they were unreadable
- 08: Other
- 98: RF
- 99: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q060
Did you follow the exposure schedule outlined on the sunlamp or tanning equipment each time you used the equipment in the past 12 months?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q065
What were the reasons you did not follow the exposure schedule (outlined on the sunlamp or tanning equipment)?
- 1: I followed it when I first used the equipment
- 2: There was no exposure schedule
- 3: The attendant gave me a different schedule
- 4: I forgot
- 5: Other
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q070
In the past 12 months, did you experience discomfort or injury to your skin, resulting from the sunlamp or tanning equipment? This could include sunburn, discoloration or itch.
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q075
How many times (in the past 12 months) did you experience discomfort or injury to your skin, resulting from the sunlamp or tanning equipment?
Min = 1; Max = 365
Tanning Equipment Use (TEU) - Question identifier:TEU_Q080
How long did your skin reaction or injury last?
- 1: Two days or less
- 2: More than two days to one week
- 3: More than one week to one month
- 4: More than one month to three months
- 5: More than three months
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q090
In the past 12 months, did you experience discomfort or injury to your eyes resulting from the sunlamp or tanning equipment? Examples of discomfort or injury to the eyes might be itchiness, aversion to bright light or redness of the eyes.
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q095
How many times (in the past 12 months) did you experience discomfort or injury to your eyes, resulting from the sunlamp or tanning equipment?
Min = 1; Max = 365
Tanning Equipment Use (TEU) - Question identifier:TEU_Q100
How long did your eye discomfort or injury last?
- 1: Two days or less
- 2: More than two days to one week
- 3: More than one week to one month
- 4: More than one month to three months
- 5: More than three months
- 8: RF
- 9: DK
Tanning Equipment Use (TEU) - Question identifier:TEU_Q105
Were you wearing eye protection when you had this injury or discomfort to your eyes?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Laser Beam Exposure (LBE)
Laser Beam Exposure (LBE) - Question identifier:LBE_R010
Now, we would like to ask you some questions about your exposure to lasers. There are many consumer products that have a laser component, even though this may not be apparent.
Laser Beam Exposure (LBE) - Question identifier:LBE_Q010
In the last 12 months, have you used, or been exposed to, any of the following products?
- 01: Laser pointer for presentations
- 02: Laser survey tool for levelling or distance measurement, or range finders
- 03: Laser for cosmetic treatments for hair or tattoo removal, excluding medical devices
- 04: Laser for entertainment such as a toy, game or light show display
- 05: Laser for materials processing such as cutting or marking
- 06: Laser scanner such as a barcode reader (for example, a self-checkout scanner)
- 07: Any other product, excluding medical devices
- 08: None
- 98: RF
- 99: DK
Laser Beam Exposure (LBE) - Question identifier:LBE_Q020
Over the last 12 months, have you experienced discomfort or injury involving a laser product? Examples of these could be skin problems such as burns, pigment change or scarring; or eye problems such as flash blindness, floaters or loss of sight.
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Laser Beam Exposure (LBE) - Question identifier:LBE_Q025
How many times in the last 12 months did you experience discomfort or injury involving a laser product?
Min = 1; Max = 365
Laser Beam Exposure (LBE) - Question identifier:LBE_Q030
What type of discomfort or injury did you experience?
- 1: Skin discomfort or injury
- 2: Eye discomfort or injury
- 3: Other
- 8: RF
- 9: DK
Laser Beam Exposure (LBE) - Question identifier:LBE_Q035
[Thinking about your worst discomfort or injury, was it to your skin, eyes or other part of your body?/Thinking about your worst discomfort or injury, was it to your skin or eyes?/Thinking about your worst discomfort or injury, was it to your skin or other part of your body?/Thinking about your worst discomfort or injury, was it to your eyes or other part of your body?]
- 1: Skin
- 2: Eyes
- 3: Other
- 8: RF
- 9: DK
Laser Beam Exposure (LBE) - Question identifier:LBE_Q040
[Thinking about your worst discomfort or injury, h/H]ow long did this discomfort or injury last?
- 1: Two days or less
- 2: More than two days to one week
- 3: More than one week to one month
- 4: More than one month to three months
- 5: More than three months
- 8: RF
- 9: DK
Laser Beam Exposure (LBE) - Question identifier:LBE_Q045
[Thinking about your worst discomfort or injury, w/W]as this discomfort or injury a result of your own use of the device or someone else's use of the device?
- 1: Your own use of the device
- 2: Someone else's use of the device
- 8: RF
- 9: DK
Laser Beam Exposure (LBE) - Question identifier:LBE_Q050
[Thinking about your worst discomfort or injury, w/W]hat type of laser product caused this injury, excluding medical devices?
- 1: Pointer - for presentations
- 2: Survey tool - levelling, distance measurement, or range finders
- 3: Cosmetic treatments - hair or tattoo removal, excluding medical devices
- 4: Entertainment - a toy, game or light show display
- 5: Materials processing - cutting or marking
- 6: Scanner - a barcode reader (example, self-checkout scanner)
- 7: Any other product, excluding medical devices
- 8: RF
- 9: DK
Laser Beam Exposure (LBE) - Question identifier:LBE_Q055
Where did you get this laser device?
- 1: Retail store - purchased new/used
- 2: Distributor or manufacturer - purchased new/used directly
- 3: Internet - purchased new/used
- 4: An individual - purchased new/used (e.g. yard sale)
- 5: Promotional item
- 6: Gift
- 7: Other
- 8: RF
- 9: DK
Smoking (SMK)
Smoking (SMK) - Question identifier:SMK_R1
The next questions are about smoking.
Smoking (SMK) - Question identifier:SMK_Q201A
In your lifetime, have you smoked a total of 100 or more cigarettes (about 4 packs)?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q201B
Have you ever smoked a whole cigarette?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q201C
At what age did you smoke your first whole cigarette?
Min = 5; Max = 121
Smoking (SMK) - Question identifier:SMK_Q202
At the present time, do you smoke cigarettes daily, occasionally or not at all?
- 1: Daily
- 2: Occasionally
- 3: Not at all
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q203
At what age did you begin to smoke cigarettes daily?
Min = 5; Max = 121
Smoking (SMK) - Question identifier:SMK_Q204
How many cigarettes do you smoke each day now?
Min = 1; Max = 99
Smoking (SMK) - Question identifier:SMK_Q205B
On the days that you do smoke, how many cigarettes do you usually smoke?
Min = 1; Max = 99
Smoking (SMK) - Question identifier:SMK_Q205C
In the past month, on how many days have you smoked 1 or more cigarettes?
Min = 0; Max = 30
Smoking (SMK) - Question identifier:SMK_Q205D
Have you ever smoked cigarettes daily?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q206A
When did you stop smoking? Was it...?
- 1: Less than one year ago
- 2: 1 year to less than 2 years ago
- 3: 2 years to less than 3 years ago
- 4: 3 or more years ago
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q206B
In what month did you stop?
- 01: January
- 02: February
- 03: March
- 04: April
- 05: May
- 06: June
- 07: July
- 08: August
- 09: September
- 10: October
- 11: November
- 12: December
- 98: RF
- 99: DK
Smoking (SMK) - Question identifier:SMK_Q206C
How many years ago was it?
Min = 3; Max = 121
Smoking (SMK) - Question identifier:SMK_Q207
At what age did you begin to smoke (cigarettes) daily?
Min = 5; Max = 121
Smoking (SMK) - Question identifier:SMK_Q208
How many cigarettes did you usually smoke each day?
Min = 1; Max = 99
Smoking (SMK) - Question identifier:SMK_Q209A
When did you stop smoking daily? Was it...?
- 1: Less than one year ago
- 2: 1 year to less than 2 years ago
- 3: 2 years to less than 3 years ago
- 4: 3 or more years ago
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q209B
In what month did you stop?
- 01: January
- 02: February
- 03: March
- 04: April
- 05: May
- 06: June
- 07: July
- 08: August
- 09: September
- 10: October
- 11: November
- 12: December
- 98: RF
- 99: DK
Smoking (SMK) - Question identifier:SMK_Q209C
How many years ago was it?
Min = 3; Max = 121
Smoking (SMK) - Question identifier:SMK_Q210A
Was that when you completely quit smoking?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q210B
When did you stop smoking completely? Was it...?
- 1: Less than one year ago
- 2: 1 year to less than 2 years ago
- 3: 2 years to less than 3 years ago
- 4: 3 or more years ago
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q210C
In what month did you stop?
- 01: January
- 02: February
- 03: March
- 04: April
- 05: May
- 06: June
- 07: July
- 08: August
- 09: September
- 10: October
- 11: November
- 12: December
- 98: RF
- 99: DK
Smoking (SMK) - Question identifier:SMK_Q210D
How many years ago was it?
Min = 3; Max = 121
Exposure to second-hand smoke (ETS)
Exposure to second-hand smoke (ETS) - Question identifier:ETS_R01
The next questions are about exposure to second-hand smoke.
Exposure to second-hand smoke (ETS) - Question identifier:ETS_Q10
Including both household members and regular visitors, does anyone smoke inside your home, every day or almost every day?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Exposure to second-hand smoke (ETS) - Question identifier:ETS_Q11
How many people smoke inside your home every day or almost every day?
Min = 1; Max = 15
Exposure to second-hand smoke (ETS) - Question identifier:ETS_Q20A
In the past month, were you exposed to second-hand smoke, every day or almost every day, in a car or other private vehicle?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Exposure to second-hand smoke (ETS) - Question identifier:ETS_Q20B
(In the past month,) were you exposed to second-hand smoke, every day or almost every day, in public places (such as bars, restaurants, shopping malls, arenas, bingo halls, bowling alleys)?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Exposure to second-hand smoke (ETS) - Question identifier:ETS_Q35
Is smoking allowed inside your home?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Exposure to second-hand smoke (ETS) - Question identifier:ETS_Q36
Is smoking inside your home restricted in anyway?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Exposure to second-hand smoke (ETS) - Question identifier:ETS_Q37
How is smoking restricted inside your home?
- 1: Allowed in certain rooms only
- 2: Restricted in the presence of young children
- 3: Allowed only if windows are open or with another type of ventilation
- 4: Other restriction(s)
- 8: RF
- 9: DK
Alcohol use (ALC)
Alcohol use (ALC) - Question identifier:ALC_R1
Now, some questions about your alcohol consumption.
When we use the word 'drink' it means:
- one bottle or can of beer or a glass of draft
- one glass of wine or a wine cooler
- one drink or cocktail with one and a half ounces of liquor.
Alcohol use (ALC) - Question identifier:ALC_Q1
During the past 12 months, that is, from [CURRENTDATE-1] to yesterday, have you had a drink of beer, wine, liquor or any other alcoholic beverage?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Alcohol use (ALC) - Question identifier:ALC_Q2
During the past 12 months, how often did you drink alcoholic beverages?
- 1: Less than once a month
- 2: Once a month
- 3: 2 to 3 times a month
- 4: Once a week
- 5: 2 to 3 times a week
- 6: 4 to 6 times a week
- 7: Every day
- 8: RF
- 9: DK
Alcohol use (ALC) - Question identifier:ALC_Q3
How often in the past 12 months have you had [5/4] or more drinks on one occasion?
- 1: Never
- 2: Less than once a month
- 3: Once a month
- 4: 2 to 3 times a month
- 5: Once a week
- 6: More than once a week
- 8: RF
- 9: DK
Labour force (LBS)
Labour force (LBS) - Question identifier:LBS_R01
The next questions concern your activities in the last 7 days. By the last 7 days, I mean beginning ^DATEONEWEEKAGO, and ending ^YESTERDAY.
Labour force (LBS) - Question identifier:LBS_Q01
Last week, did you work at a job or a business? Please include part-time jobs, seasonal work, contract work, self-employment, baby-sitting and any other paid work, regardless of the number of hours worked.
- 1: Yes
- 2: No
- 3: Permanently unable to work
- 8: RF
- 9: DK
Labour force (LBS) - Question identifier:LBS_Q02
Last week, did you have a job or business from which you were absent?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Labour force (LBS) - Question identifier:LBS_Q03
Did you have more than one job or business last week?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Labour force (LBS) - Question identifier:LBS_Q04
In the past 4 weeks, did you do anything to find work?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Labour force (LBS) - Question identifier:LBS_R31
The next questions are about your current job or business.
Labour force (LBS) - Question identifier:LBS_Q31
Are you an employee or self-employed?
- 1: Employee
- 2: Self-employed
- 3: Working in a family business without pay
- 8: RF
- 9: DK
Labour force (LBS) - Question identifier:LBS_Q32
What is the name of your business?
Long Answer Length = 50
Labour force (LBS) - Question identifier:LBS_Q33
For whom do you work?
Long Answer Length = 50
Labour force (LBS) - Question identifier:LBS_Q34
What kind of business, industry or service is this?
Long Answer Length = 50
Labour force (LBS) - Question identifier:LBS_Q35
What is your work or occupation?
Long Answer Length = 50
Labour force (LBS) - Question identifier:LBS_Q36
In this work, what are your main activities?
Long Answer Length = 50
Labour force (LBS) - Question identifier:LBS_Q37
About how many hours a week do you usually work at your job or business? If you usually work extra hours, paid or unpaid, please include these hours.
Min = 1; Max = 168
Labour force (LBS) - Question identifier:LBS_Q38
You indicated that you have more than one job.
About how many hours a week do you usually work at your other job(s)? If you usually work extra hours, paid or unpaid, please include these hours.
Min = 1; Max = 168
Education of selected respondent (EDU)
Education of selected respondent (EDU) - Question identifier:EDU_R05
Now some general background questions which will help us compare the health of people in Canada.
Education of selected respondent (EDU) - Question identifier:EDU_Q05
Are you currently attending a school, college, cegep or university?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Education of selected respondent (EDU) - Question identifier:EDU_Q06
Are you enrolled as...?
- 1: A full-time student
- 2: A part-time student
- 3: Both full-time and part-time student
- 8: RF
- 9: DK
Socio-demographic characteristics (SDC)
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q1
In what country were you born?
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q2
Were you born a Canadian citizen?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q3
In what year did you first come to Canada to live?
Min = 1890; Max = 2030
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q4A
To which ethnic or cultural groups did your ancestors belong? (For example: French, Scottish, Chinese, East Indian)
- 01: Canadian
- 02: French
- 03: English
- 04: German
- 05: Scottish
- 06: Irish
- 07: Italian
- 08: Ukrainian
- 09: Dutch (Netherlands)
- 10: Chinese
- 11: Jewish
- 12: Polish
- 13: Portuguese
- 14: South Asian (e.g. East Indian, Pakistani, Sri Lankan)
- 15: Norwegian
- 16: Welsh
- 17: Swedish
- 18: First Nations (North American Indian)
- 19: Métis
- 20: Inuit
- 21: Other - Specify
- 98: RF
- 99: DK
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q4B_1
Are you an Aboriginal person, that is, First nations, Métis or Inuk (Inuit)? First Nations includes Status and Non-Status Indians.
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Socio-demographic characteristics (SDC) - Question identifier:SDC_N4B_2
If the respondent has already specified the Aboriginal group(s), select the group(s) from the list below; if not, ask:
(Are you First Nations, Métis or Inuk (Inuit)?)
INTERVIEWER: Mark all that apply.
First Nations (North American Indian) includes Status and Non-Status Indians.
The terms "First Nations" and "North American Indian" can be interchanged. Some respondents may prefer one term over the other.
"Inuit" is the plural form of "Inuk".
- 1: First Nations (North American Indian)
- 2: Métis
- 3: Inuk (Inuit)
- 8: RF
- 9: DK
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q4C
You may belong to one or more racial or cultural groups on the following list.
Are you?
- 01: White
- 02: South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
- 03: Chinese
- 04: Black
- 05: Filipino
- 06: Latin American
- 07: Arab
- 08: Southeast Asian (e.g., Vietnamese, Cambodian, Malaysian, Laotian,
etc.) - 09: West Asian (e.g., Iranian, Afghan, etc.)
- 10: Korean
- 11: Japanese
- 12: Other - Specify
- 98: RF
- 99: DK
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q5A_1
Of English or French, which language(s) do you speak well enough to conduct a conversation? Is it...?
- 1: English only
- 2: French only
- 3: Both English and French
- 4: Neither English nor French
- 8: RF
- 9: DK
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q5B
What language do you speak most often at home?
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q6
What is the language that you first learned at home in childhood and still understand?
Socio-demographic characteristics (SDC) - Question identifier:SDC_R7
Now a question about the dwelling in which you live.
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q7A
Is this dwelling?
- 1: Owned by you or a member of this household, even if it is still being paid for
- 2: Rented, even if no cash rent is paid
- 8: RF
- 9: DK
Socio-demographic characteristics (SDC) - Question identifier:SDC_R7B
Now one additional background question which will help us compare the health of people in Canada.
Socio-demographic characteristics (SDC) - Question identifier:SDC_Q7B
Do you consider yourself to be...?
- 1: heterosexual (sexual relations with people of the opposite sex)
- 2: homosexual, that is lesbian or gay (sexual relations with people of your own sex)
- 3: bisexual (sexual relations with people of both sexes)
- 8: RF
- 9: DK
Person most knowledgeable about household situation (PMK)
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R16AA
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses or telephone numbers will be provided.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R16AB
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
Territorial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses, telephone numbers or health numbers will be provided.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R16AC
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, the " Institut de la Statistique du Québec ", Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
The " Institut de la Statistique du Québec " and provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses or telephone numbers will be provided.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q016
These organizations have agreed to keep your information confidential and use it only for statistical purposes.
Do you agree to share the information provided?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R020
For the last few questions, I would like to speak with someone who would be best able to answer questions about the entire household such as household income and food purchases.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q020
Who would this person be?
- 01: MEMBER1
- 02: MEMBER2
- 03: MEMBER3
- 04: MEMBER4
- 05: MEMBER5
- 06: MEMBER6
- 07: MEMBER7
- 08: MEMBER8
- 09: MEMBER9
- 10: MEMBER10
- 11: MEMBER11
- 12: MEMBER12
- 13: MEMBER13
- 14: MEMBER14
- 15: MEMBER15
- 16: MEMBER16
- 17: MEMBER17
- 18: MEMBER18
- 19: MEMBER19
- 20: MEMBER20
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q030B
Is [MEMBER1/MEMBER2/MEMBER3/MEMBER4/MEMBER5/MEMBER6/MEMBER7/MEMBER8/MEMBER9/MEMBER10/MEMBER11/MEMBER12/MEMBER13/MEMBER14/MEMBER15/MEMBER16/MEMBER17/MEMBER18/MEMBER19/MEMBER20] available?
- 1: Yes
- 2: No
- 3: Person most knowledgeable about household refuses to participate.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R040
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R045
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time. I would now like to try and find the best time to speak with [MEMBER1/MEMBER2/MEMBER3/MEMBER4/MEMBER5/MEMBER6/MEMBER7/MEMBER8/MEMBER9/MEMBER10/MEMBER11/MEMBER12/MEMBER13/MEMBER14/MEMBER15/MEMBER16/MEMBER17/MEMBER18/MEMBER19/MEMBER20].
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R050
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time. I would now like to speak with ^MEMBERNAME.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R060
Hello, My name is... I've just completed the main portion of the interview with <Respondent's name>. At this point I need to finish the interview with a few general questions on your household's situation. <Respondent's name> said you would be the best person to answer these types of questions.
Income (INC)
Income (INC) - Question identifier:INC_R1
Although many health expenses are covered by health insurance, there is still a relationship between health and income. Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.
Income (INC) - Question identifier:INC_Q1
Thinking about the total income for all household members, from which of the following sources did your household receive any income in the past 12 months?
- 01: Wages and salaries
- 02: Income from self-employment
- 03: Dividends and interest (e.g., on bonds, savings)
- 04: Employment insurance
- 05: Worker's compensation
- 06: Benefits from Canada or Quebec Pension Plan
- 07: Job related retirement pensions, superannuation and annuities
- 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
- 09: Old Age Security and Guaranteed Income Supplement
- 10: Provincial or municipal social assistance or welfare
- 11: Child Tax Benefit
- 12: Child support
- 13: Alimony
- 14: Other (e.g., rental income, scholarships)
- 15: None
- 98: RF
- 99: DK
Income (INC) - Question identifier:INC_Q2
What was the main source of household income?
- 01: Wages and salaries
- 02: Income from self-employment
- 03: Dividends and interest (e.g., on bonds, savings)
- 04: Employment insurance
- 05: Worker's compensation
- 06: Benefits from Canada or Quebec Pension Plan
- 07: Job related retirement pensions, superannuation and annuities
- 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
- 09: Old Age Security and Guaranteed Income Supplement
- 10: Provincial or municipal social assistance or welfare
- 11: Child Tax Benefit
- 12: Child support
- 13: Alimony
- 14: Other (e.g., rental income, scholarships)
- 15: None
- 98: RF
- 99: DK
Income (INC) - Question identifier:INC_Q3
What is your best estimate of the total income received by all household members, from all sources, before taxes and deductions, in the past 12 months?
Min = -9000000; Max = 90000000
Income (INC) - Question identifier:INC_Q5A
Can you estimate in which of the following groups your household income falls? Was the total household income in the past 12 months...?
- 1: Less than $50,000 including income loss
- 2: $50,000 and more
- 8: RF
- 9: DK
Income (INC) - Question identifier:INC_Q5B
Please stop me when I have read the category which applies to your household. Was it...?
- 1: Less than $5,000
- 2: $5,000 to less than $10,000
- 3: $10,000 to less than $15,000
- 4: $15,000 to less than $20,000
- 5: $20,000 to less than $30,000
- 6: $30,000 to less than $40,000
- 7: $40,000 to less than $50,000
- 8: RF
- 9: DK
Income (INC) - Question identifier:INC_Q5C
Please stop me when I have read the category which applies to your household. Was it...?
- 1: $50,000 to less than less than $60,000
- 2: $60,000 to less than less than $70,000
- 3: $70,000 to less than less than $80,000
- 4: $80,000 to less than less than $90,000
- 5: $90,000 to less than less than $100,000
- 6: $100,000 to less than less than $150,000
- 7: $150,000 and over
- 8: RF
- 9: DK
Income (INC) - Question identifier:INC_Q6
Thinking about your total personal income, from which of the following sources did you receive any income in the past 12 months?
- 01: Wages and salaries
- 02: Income from self-employment
- 03: Dividends and interest (e.g., on bonds, savings)
- 04: Employment insurance
- 05: Worker's compensation
- 06: Benefits from Canada or Quebec Pension Plan
- 07: Job related retirement pensions, superannuation and annuities
- 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
- 09: Old Age Security and Guaranteed Income Supplement
- 10: Provincial or municipal social assistance or welfare
- 11: Child Tax Benefit
- 12: Child support
- 13: Alimony
- 14: Other (e.g., rental income, scholarships)
- 15: None
- 98: RF
- 99: DK
Income (INC) - Question identifier:INC_Q7
What was the main source of your personal income?
- 01: Wages and salaries
- 02: Income from self-employment
- 03: Dividends and interest (e.g., on bonds, savings)
- 04: Employment insurance
- 05: Worker's compensation
- 06: Benefits from Canada or Quebec Pension Plan
- 07: Job related retirement pensions, superannuation and annuities
- 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
- 09: Old Age Security and Guaranteed Income Supplement
- 10: Provincial or municipal social assistance or welfare
- 11: Child Tax Benefit
- 12: Child support
- 13: Alimony
- 14: Other (e.g., rental income, scholarships)
- 15: None
- 98: RF
- 99: DK
Income (INC) - Question identifier:INC_Q8A
What is your best estimate of your total personal income, before taxes and deductions, from all sources in the past 12 months?
Min = -9000000; Max = 90000000
Income (INC) - Question identifier:INC_Q8B
Can you estimate in which of the following groups your personal income falls? Was your total personal income in the past 12 months...?
- 1: Less than $30,000 including income loss
- 2: $30,000 and more
- 8: RF
- 9: DK
Income (INC) - Question identifier:INC_Q8C
Please stop me when I have read the category which applies to you. Was it...?
- 1: Less than $5,000
- 2: $5,000 to less than $10,000
- 3: $10,000 to less than $15,000
- 4: $15,000 to less than $20,000
- 5: $20,000 to less than $25,000
- 6: $25,000 to less than $30,000
- 8: RF
- 9: DK
Income (INC) - Question identifier:INC_Q8D
Please stop me when I have read the category which applies to you. Was it...?
- 01: $30,000 to less than $40,000
- 02: $40,000 to less than $50,000
- 03: $50,000 to less than $60,000
- 04: $60,000 to less than $70,000
- 05: $70,000 to less than $80,000
- 06: $80,000 to less than $90,000
- 07: $90,000 to less than $100,000
- 08: $100,000 and over
- 98: RF
- 99: DK
Administration information (ADM)
Administration information (ADM) - Question identifier:ADM_R01
[Statistics Canada, your [territorial/provincial] ministry of health and the « Institut de la Statistique du Québec»/Statistics Canada and your [territorial/provincial] ministry of health] would like your permission to link information collected during this interview. This includes linking your survey information to your past and continuing use of health services such as visits to hospitals, clinics and doctor's offices.
Administration information (ADM) - Question identifier:ADM_Q01B
This linked information will be kept confidential and used only for statistical purposes. Do we have your permission?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration information (ADM) - Question identifier:ADM_Q03A
Having a provincial or territorial health number will assist us in linking to this other information.
Do you have [a Newfoundland and Labrador/a Prince Edward Island/a Nova Scotia/a New Brunswick/a Quebec/an Ontario/a Manitoba/a Saskatchewan/an Alberta/a British Columbia/a Yukon/a Northwest Territories/a Nunavut] health number?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration information (ADM) - Question identifier:ADM_Q03B
For which province or territory is your health number?
- 10: Newfoundland and Labrador
- 11: Prince Edward Island
- 12: Nova Scotia
- 13: New Brunswick
- 24: Quebec
- 35: Ontario
- 46: Manitoba
- 47: Saskatchewan
- 48: Alberta
- 59: British Columbia
- 60: Yukon
- 61: Northwest Territories
- 62: Nunavut
- 88: Does not have a Canadian health number
- 98: RF
- 99: DK
Administration information (ADM) - Question identifier:ADM_Q03HN
What is your health number?
Long Answer Length = 12
Administration information (ADM) - Question identifier:ADM_R04AA
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as [names, addresses, telephone numbers and health numbers will be provided/names, addresses and telephone numbers will be provided].
Administration information (ADM) - Question identifier:ADM_R04AB
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, the " Institut de la Statistique du Québec ", Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
The " Institut de la Statistique du Québec " and provincial ministries of health may make this information available to local health authorities, but no identifiable information such as [names, addresses, telephone numbers and health numbers will be provided/names, addresses and telephone numbers will be provided].
Administration information (ADM) - Question identifier:ADM_Q04B
These organizations have agreed to keep your information confidential and use it only for statistical purposes.
Do you agree to share the information provided?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration information (ADM) - Question identifier:ADM_N09
Was this interview conducted on the telephone or in person?
- 1: On telephone
- 2: In person
- 3: Both
Administration information (ADM) - Question identifier:ADM_N10
Was the respondent alone when you asked this health questionnaire?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration information (ADM) - Question identifier:ADM_N11
Do you think that the answers of the respondent were affected by someone else being there?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration information (ADM) - Question identifier:ADM_N12
Record language of interview
- 01: English
- 02: French
- 03: Chinese
- 04: Italian
- 05: Punjabi
- 06: Spanish
- 07: Portuguese
- 08: Polish
- 09: German
- 10: Vietnamese
- 11: Arabic
- 12: Tagalog (Filipino)
- 13: Greek
- 14: Tamil
- 15: Cree
- 16: Afghan
- 17: Cantonese
- 18: Hindi
- 19: Mandarin
- 20: Persian
- 21: Russian
- 22: Ukrainian
- 23: Urdu
- 24: Inuktitut
- 90: Other - Specify
- 98: RF
- 99: DK
CAPI Frame Evaluation - Sub-block (FRE)
CAPI Frame Evaluation - Sub-block (FRE) - Question identifier:FRE_R1
And finally, a few questions to evaluate the way households were selected for this survey, and to prevent households from being selected more than once for this survey.
CAPI Frame Evaluation - Sub-block (FRE) - Question identifier:FRE_Q1
Excluding cellular phone numbers and phone numbers used strictly for business purposes, or fax machines, how many telephone numbers are there for your household?
- 1: 1
- 2: 2
- 3: 3 or more
- 4: None
- 8: RF
- 9: DK
CAPI Frame Evaluation - Sub-block (FRE) - Question identifier:FRE_Q2
What is [your/your main] phone number, including the area code?
CAPI Frame Evaluation - Sub-block (FRE) - Question identifier:FRE_Q3
What is [your other phone number/another of your phone numbers], including the area code?
CAPI Frame Evaluation - Sub-block (FRE) - Question identifier:FRE_Q4
Do you have a working cellular phone that can place and receive calls?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
CAPI Frame Evaluation - Sub-block (FRE) - Question identifier:FRE_Q5
Among all of the telephone numbers for your home, excluding cellular phone numbers and those used strictly for business purposes and fax machines, are any of them listed in the paper or internet telephone book?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
- Date modified: