Canadian Community Health Survey (CCHS) - 2014

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Table of Contents

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.

Press <1> to continue.

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.

Press <1> to continue.

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.

Press <1> to continue.

General health (GEN) - Question identifier:GEN_Q01

In general, would you say your health is...?

Read categories to respondent.

  • 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...?

Read categories to respondent.

  • 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...?

Read categories to respondent.

  • 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...?

Read categories to respondent.

  • 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.

Press <1> to continue.

General health (GEN) - Question identifier:GEN_Q09

Would you say that most days at work were...?

Read categories to respondent.

  • 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...?

Read categories to respondent.

  • 1: Very strong
  • 2: Somewhat strong
  • 3: Somewhat weak
  • 4: Very weak
  • 8: RF
  • 9: DK

Voluntary organizations - Participation (ORG)

Voluntary organizations - Participation (ORG) - Question identifier:ORG_Q1

Are you a member of any voluntary organizations or associations such as school groups, church social groups, community centres, ethnic associations or social, civic or fraternal clubs?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Voluntary organizations - Participation (ORG) - Question identifier:ORG_Q2

How often did you participate in meetings or activities of these groups in the past 12 months? If you belong to many, just think of the ones in which you are most active.

Read categories to respondent.

  • 1: At least once a week
  • 2: At least once a month
  • 3: At least 3 or 4 times a year
  • 4: At least once a year
  • 5: Not at all
  • 8: RF
  • 9: DK

Sleep (SLP)

Sleep (SLP) - Question identifier:SLP_Q01

Now a few questions about sleep.
How long do you usually spend sleeping each night?

Do not include time spent resting.

  • 01: Under 2 hours
  • 02: 2 hours to less than 3 hours
  • 03: 3 hours to less than 4 hours
  • 04: 4 hours to less than 5 hours
  • 05: 5 hours to less than 6 hours
  • 06: 6 hours to less than 7 hours
  • 07: 7 hours to less than 8 hours
  • 08: 8 hours to less than 9 hours
  • 09: 9 hours to less than 10 hours
  • 10: 10 hours to less than 11 hours
  • 11: 11 hours to less than 12 hours
  • 12: 12 hours or more
  • 98: RF
  • 99: DK

Sleep (SLP) - Question identifier:SLP_Q02

How often do you have trouble going to sleep or staying asleep?

Read categories to respondent.

  • 1: None of the time
  • 2: A little of the time
  • 3: Some of the time
  • 4: Most of the time
  • 5: All of the time
  • 8: RF
  • 9: DK

Sleep (SLP) - Question identifier:SLP_Q03

How often do you find your sleep refreshing?

Read categories to respondent.

  • 1: None of the time
  • 2: A little of the time
  • 3: Some of the time
  • 4: Most of the time
  • 5: All of the time
  • 8: RF
  • 9: DK

Sleep (SLP) - Question identifier:SLP_Q04

How often do you find it difficult to stay awake when you want to?

  • 1: None of the time
  • 2: A little of the time
  • 3: Some of the time
  • 4: Most of the time
  • 5: All of the time
  • 8: RF
  • 9: DK

Changes made to improve health (CIH)

Changes made to improve health (CIH) - Question identifier:CIH_Q1

Next, some questions about changes made to improve health.
In the past 12 months, did you do anything to improve your health? (For example, lost weight, quit smoking, increased exercise).

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Changes made to improve health (CIH) - Question identifier:CIH_Q2

What is the single most important change you have made?

  • 01: Increased exercise, sports / physical activity
  • 02: Lost weight
  • 03: Changed diet / improved eating habits
  • 04: Quit smoking / reduced amount smoked
  • 05: Drank less alcohol
  • 06: Reduced stress level
  • 07: Received medical treatment
  • 08: Took vitamins
  • 09: Other
  • 98: RF
  • 99: DK

Changes made to improve health (CIH) - Question identifier:CIH_Q3

Do you think there is [anything else/anything] you should do to improve your physical health?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Changes made to improve health (CIH) - Question identifier:CIH_Q4

What is the most important thing?

  • 01: Start / Increase exercise, sports / physical activity
  • 02: Lose weight
  • 03: Change diet / improve eating habits
  • 04: Quit smoking / reduce amount smoked
  • 05: Drink less alcohol
  • 06: Reduce stress level
  • 07: Receive medical treatment
  • 08: Take vitamins
  • 09: Other
  • 98: RF
  • 99: DK

Changes made to improve health (CIH) - Question identifier:CIH_Q5

Is there anything stopping you from making this improvement?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Changes made to improve health (CIH) - Question identifier:CIH_Q6

What is that?

Mark all that apply.

  • 01: Lack of will power / self-discipline
  • 02: Family responsibilities
  • 03: Work schedule
  • 04: Addiction to drugs / alcohol
  • 05: Physical condition
  • 06: Disability / health problem
  • 07: Too stressed
  • 08: Too costly / financial constraints
  • 09: Not available - in area
  • 10: Transportation problems
  • 11: Weather problems
  • 12: Other
  • 98: RF
  • 99: DK

Changes made to improve health (CIH) - Question identifier:CIH_Q7

Is there anything you intend to do to improve your physical health in the next year?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Changes made to improve health (CIH) - Question identifier:CIH_Q8

What is that?

Mark all that apply.

  • 01: Start / Increase exercise, sports / physical activity
  • 02: Lose weight
  • 03: Change diet / improve eating habits
  • 04: Quit smoking / reduce amount smoked
  • 05: Drink less alcohol
  • 06: Reduce stress level
  • 07: Receive medical treatment
  • 08: Take vitamins
  • 09: Other
  • 98: RF
  • 99: DK

Oral health 1 (OH1)

Oral health 1 (OH1) - Question identifier:OH1_R20

Next, some questions about the health of your teeth and mouth.

Press <1> to continue.

Oral health 1 (OH1) - Question identifier:OH1_Q20

In general, would you say the health of your teeth and mouth is:

Read categories to respondent.

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor
  • 8: RF
  • 9: DK

Oral health 1 (OH1) - Question identifier:OH1_Q21A

Now a few questions about your ability to chew different foods, whether you eat them or not. Can you:

chew firm foods (e.g., meat)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 1 (OH1) - Question identifier:OH1_Q21B

(Can you:)

bite off and chew a piece of fresh apple?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 1 (OH1) - Question identifier:OH1_Q21C

(Can you:)

chew boiled vegetables?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 1 (OH1) - Question identifier:OH1_Q22

In the past month, how often have you had any pain or discomfort in your teeth or gums?

Read categories to respondent.

  • 1: Often
  • 2: Sometimes
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Health care system satisfaction (HCS)

Health care system satisfaction (HCS) - Question identifier:HCS_Q1

Now, a few questions about health care services in [Newfoundland and Labrador/Prince Edward Island/Nova Scotia/New Brunswick/Quebec/Ontario/Manitoba/Saskatchewan/Alberta/British Columbia/Yukon/the Northwest Territories/Nunavut]. Overall, how would you rate the availability of health care services in [Newfoundland and Labrador/Prince Edward Island/Nova Scotia/New Brunswick/Quebec/Ontario/Manitoba/Saskatchewan/Alberta/British Columbia/Yukon/the Northwest Territories/Nunavut]?
Would you say it is...?

Read categories to respondent.

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Health care system satisfaction (HCS) - Question identifier:HCS_Q2

Overall, how would you rate the quality of the health care services that are available in [Newfoundland and Labrador/Prince Edward Island/Nova Scotia/New Brunswick/Quebec/Ontario/Manitoba/Saskatchewan/Alberta/British Columbia/Yukon/the Northwest Territories/Nunavut]?

Read categories to respondent.

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Health care system satisfaction (HCS) - Question identifier:HCS_Q3

Overall, how would you rate the availability of health care services in your community?

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Health care system satisfaction (HCS) - Question identifier:HCS_Q4

Overall, how would you rate the quality of the health care services that are available in your community?

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 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

Enter amount only.

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:

Read categories to respondent.

  • 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.

Press <1> to continue.

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?

Chronic bronchitis is another name for COPD or emphysema. It is characterized by inflammation of the main air passages to the lung characterized by mucous secretion and chronic cough. It is a long-term condition.

  • 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?

Exclude respondents who have been told they have prediabetes. Only respondents with type 1, type 2 or gestational diabetes should answer yes to this question.

  • 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

Maximum is ^CURRENTAGE.

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?

Include manic depression.

  • 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

Diabetes care (DIA)

Diabetes care (DIA) - Question identifier:DIA_R01

It was reported earlier that you have diabetes. The following questions are about diabetes care.

Press <1> to continue.

Diabetes care (DIA) - Question identifier:DIA_Q01

In the past 12 months, has a health care professional tested you for haemoglobin "A- one-C"? (An "A-one-C" haemoglobin test measures the average level of blood sugar over a 3-month period.)

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Diabetes care (DIA) - Question identifier:DIA_Q02

How many times? (In the past 12 months, has a health care professional tested you for haemoglobin "A-one-C"?)

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_Q03

In the past 12 months, has a health care professional checked your feet for any sores or irritations?

  • 1: Yes
  • 2: No
  • 3: No feet
  • 8: RF
  • 9: DK

Diabetes care (DIA) - Question identifier:DIA_Q04

How many times? (In the past 12 months, has a health care professional checked your feet for any sores or irritations?)

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_Q05

In the past 12 months, has a health care professional tested your urine for protein (i.e., Microalbumin)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Diabetes care (DIA) - Question identifier:DIA_Q06

Have you ever had an eye exam where the pupils of your eyes were dilated? (This procedure would have made you temporarily sensitive to light.)

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Diabetes care (DIA) - Question identifier:DIA_Q07

When was the last time?

Read categories to respondent.

  • 1: Less than one month ago
  • 2: 1 month to less than 1 year ago
  • 3: 1 year to less than 2 years ago
  • 4: 2 or more years ago
  • 8: RF
  • 9: DK

Diabetes care (DIA) - Question identifier:DIA_R08

Now some questions about diabetes care not provided by a health care professional.

Press <1> to continue.

Diabetes care (DIA) - Question identifier:DIA_Q08

How often do you usually have your blood checked for glucose or sugar by yourself or by a family member or friend?

Select the reporting period here and enter the number in the next screen.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Per year
  • 5: Never
  • 8: RF
  • 9: DK

Diabetes care (DIA) - Question identifier:DIA_N08B

Enter number of times per day.

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_N08C

Enter number of times per week.

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_N08D

Enter number of times per month.

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_N08E

Enter number of times per year.

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_Q09

How often do you usually have your feet checked for any sores or irritations by yourself or by a family member or friend?

Select the reporting period here and enter the number in the next screen.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Per year
  • 5: Never
  • 8: RF
  • 9: DK

Diabetes care (DIA) - Question identifier:DIA_N09B

Enter number of times per day.

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_N09C

Enter number of times per week.

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_N09D

Enter number of times per month.

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_N09E

Enter number of times per year.

Min = 1; Max = 99

Diabetes care (DIA) - Question identifier:DIA_R10

Now a few questions about medication.

Press <1> to continue.

Diabetes care (DIA) - Question identifier:DIA_Q10

In the past month, did you take aspirin or other ASA (acetylsalicylic acid) medication every day or every second day?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Diabetes care (DIA) - Question identifier:DIA_Q11

In the past month, did you take prescription medications such as Lipitor or Zocor to control your blood cholesterol levels?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI)

Health utilities index (HUI) - Question identifier:HUI_R01

The next set of questions asks about your day-to-day health.

You may feel that some of these questions do not apply to you, but it is important that we ask the same questions of everyone.

Press <1> to continue.

Health utilities index (HUI) - Question identifier:HUI_Q01

Are you usually able to see well enough to read ordinary newsprint without glasses or contact lenses?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q02

Are you usually able to see well enough to read ordinary newsprint with glasses or contact lenses?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q03

Are you able to see at all?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q04

Are you able to see well enough to recognize a friend on the other side
of the street without glasses or contact lenses?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q05

Are you usually able to see well enough to recognize a friend on the other side of the street with glasses or contact lenses?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q06

Are you usually able to hear what is said in a group conversation with at
least three other people without a hearing aid?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q07A

Are you usually able to hear what is said in a group conversation with at
least three other people with a hearing aid?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q07B

Are you able to hear at all?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q08

Are you usually able to hear what is said in a conversation with one
other person in a quiet room without a hearing aid?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q09

Are you usually able to hear what is said in a conversation with one
other person in a quiet room with a hearing aid?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q10

Are you usually able to be understood completely when speaking with
strangers in your own language?

These questions assess the respondent's ability to speak and be understood (not the ability to communicate). For instance: a respondent who can't speak but uses sign language to communicate is considered as having a speech limitation.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q11

Are you able to be understood partially when speaking with strangers?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q12

Are you able to be understood completely when speaking with those
who know you well?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q13

Are you able to be understood partially when speaking with those who know you well?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q14

Are you usually able to walk around the neighbourhood without difficulty and without mechanical support such as braces, a cane or crutches?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q15

Are you able to walk at all?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q16

Do you require mechanical support such as braces, a cane or
crutches to be able to walk around the neighbourhood?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q17

Do you require the help of another person to be able to walk?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q18

Do you require a wheelchair to get around?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q19

How often do you use a wheelchair?

Read categories to respondent.

  • 1: Always
  • 2: Often
  • 3: Sometimes
  • 4: Never
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q20

Do you need the help of another person to get around in the wheelchair?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q21

Are you usually able to grasp and handle small objects such as a pencil or scissors?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q22

Do you require the help of another person because of limitations in the use of your hands or fingers?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q23

Do you require the help of another person with...?

Read categories to respondent.

  • 1: Some tasks
  • 2: Most tasks
  • 3: Almost all tasks
  • 4: All tasks
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q24

Do you require special equipment, for example, devices to assist in dressing, because of limitations in the use of your hands or fingers?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q25

Would you describe [^FNAME/yourself] as being usually...?

Read categories to respondent.

  • 1: Happy and interested in life
  • 2: Somewhat happy
  • 3: Somewhat unhappy
  • 4: Unhappy with little interest in life
  • 5: So unhappy, that life is not worthwhile
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q26

How would you describe your usual ability to remember things?

Read categories to respondent.

  • 1: Able to remember most things
  • 2: Somewhat forgetful
  • 3: Very forgetful
  • 4: Unable to remember anything at all
  • 8: RF
  • 9: DK

Health utilities index (HUI) - Question identifier:HUI_Q27

How would you describe your usual ability to think and solve day-to-day problems?

Read categories to respondent.

  • 1: Able to think clearly and solve problems
  • 2: Having a little difficulty
  • 3: Having some difficulty
  • 4: Having a great deal of difficulty
  • 5: Unable to think or solve problems
  • 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.

Press <1> to continue.

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?

Read categories to respondent.

  • 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?

Read categories to respondent.

  • 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?

Mark all that apply.

  • 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?

If the respondent indicates more than one usual place, then ask: What kind of place do you go to most often?

  • 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.

Press <1> to continue.

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?

Include both face to face and telephone contacts.

  • 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?

If respondent says "hospital", probe for details.

  • 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)?

Include both face to face and telephone contacts.

  • 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)?

Include both face to face and telephone contacts.

  • 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?

If respondent says "hospital", probe for details.

  • 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?

Include both face to face and telephone contacts.

  • 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?

If respondent says "hospital", probe for details.

  • 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)?

Include both face to face and telephone contacts.

  • 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

Contacts with Health Professionals - Part 2 (CP2)

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q16

[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 chiropractor about your physical, emotional or mental health?

Include both face to face and telephone contacts.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q17

How many times(in the past 12 months)?

Min = 1; Max = 366

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q18

[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 physiotherapist (about your physical, emotional or mental health)?

Include both face to face and telephone contacts.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q19

How many times(in the past 12 months)?

Min = 1; Max = 366

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q20

[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 psychologist (about your physical, emotional or mental health)?

Include both face to face and telephone contacts.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q21

How many times(in the past 12 months)?

Min = 1; Max = 366

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q22

[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 social worker or counsellor (about your physical, emotional or mental health)?

Include both face to face and telephone contacts.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q23

How many times(in the past 12 months)?

Min = 1; Max = 366

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q24

[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 audiologist, a speech or occupational therapist (about your physical, emotional or mental health)?

Include both face to face and telephone contacts.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Contacts with Health Professionals - Part 2 (CP2) - Question identifier:CP2_Q25

How many times(in the past 12 months)?

Min = 1; Max = 200

Unmet health care needs (UCN)

Unmet health care needs (UCN) - Question identifier:UCN_Q010

[During the past 12 months, was there ever a time when you felt that you needed health care but you didn't receive it?/During the past 12 months, was there ever a time when you felt that you needed health care but you didn't receive it?/During the past 12 months, was there ever a time when you felt that you needed health care but you didn't receive it?]

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Unmet health care needs (UCN) - Question identifier:UCN_Q020

Thinking of the most recent time, why didn't you get care?

Mark all that apply.

  • 01: Not available - in the area
  • 02: Not available - at time required (e.g. doctor on
    holidays, inconvenient hours)
  • 03: Waiting time too long
  • 04: Felt would be inadequate
  • 05: Cost
  • 06: Too busy
  • 07: Didn't get around to it / didn't bother
  • 08: Decided not to seek care
  • 09: Doctor - didn't think it was necessary
  • 10: Other - Specify
  • 98: RF
  • 99: DK

Unmet health care needs (UCN) - Question identifier:UCN_Q030

Again, thinking of the most recent time, what was the type of care that was needed?

Mark all that apply.

  • 1: Treatment of - a physical health problem
  • 2: Treatment of - an emotional or mental health problem
  • 3: A regular check-up (including regular pre-natal care)
  • 4: Care of an injury
  • 5: Other - Specify
  • 8: RF
  • 9: DK

Unmet health care needs (UCN) - Question identifier:UCN_Q040

Where did you try to get the service you were seeking?

Mark all that apply.

  • 1: Doctor's office
  • 2: Community health centre / CLSC
  • 3: Walk-in clinic
  • 4: Appointment clinic
  • 5: Hospital - emergency room
  • 6: Hospital - outpatient clinic
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Home care services (HMC)

Home care services (HMC) - Question identifier:HMC_R09

Now some questions on home care services. These are health care, home maker or other support services received at home. People may receive home care due to a health problem or condition that affects their daily activities. Examples include: nursing care, personal care or help with bathing, housework, meal preparation, meal delivery and respite care.

Press <1> to continue.

Home care services (HMC) - Question identifier:HMC_Q09

Have you received any home care services in the past 12 months, with the cost being entirely or partially covered by government?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Home care services (HMC) - Question identifier:HMC_Q10

What type of services have you received?

Read categories to respondent. Mark all that apply. Cost must be entirely or partially covered by government.

  • 01: Nursing care (e.g., dressing changes, preparing medications, V.O.N. visits)
  • 02: Other health care services (e.g., physiotherapy, occupational or speech therapy, nutrition counselling)
  • 03: Medical equipment or supplies
  • 04: Personal care (e.g., bathing, foot care)
  • 05: Housework (e.g., cleaning, laundry)
  • 06: Meal preparation or delivery
  • 07: Shopping
  • 08: Respite care (i.e., caregiver relief)
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Home care services (HMC) - Question identifier:HMC_Q11

Have you received any [other home/home] care services in the past 12 months, with the cost not covered by government (for example: care provided by a private agency or by a spouse or friends)?

Include only health care, homemaker or other support services (e.g., housework) that are provided because of a respondent's health problem or condition.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Home care services (HMC) - Question identifier:HMC_Q12

Who provided these [other home/home] home care services?

Read categories to respondent. Mark all that apply.

  • 1: Nurse from a private agency
  • 2: Homemaker or other support services from a private agency
  • 3: Physiotherapist or other therapist from a private agency
  • 4: Neighbour or friend
  • 5: Family member or spouse
  • 6: Volunteer
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Home care services (HMC) - Question identifier:HMC_Q13

What type of home care services have you received?

Read categories to respondent. Mark all that apply.

  • 01: Nursing care (e.g., dressing changes, preparing medications, V.O.N. visits)
  • 02: Other health care services (e.g., physiotherapy, occupational or speech therapy,
    nutrition counselling)
  • 03: Medical equipment or supplies
  • 04: Personal care (e.g., bathing, foot care)
  • 05: Housework (e.g., cleaning, laundry)
  • 06: Meal preparation or delivery
  • 07: Shopping
  • 08: Respite care (i.e., caregiver relief)
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Home care services (HMC) - Question identifier:HMC_Q14

During the past 12 months, was there ever a time when you felt that you needed home care services but you didn't receive them?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Home care services (HMC) - Question identifier:HMC_Q15

Thinking of the most recent time, why didn't you get these services?

Mark all that apply.

  • 01: Not available - in the area
  • 02: Not available - at time required (e.g., inconvenient hours)
  • 03: Waiting time too long
  • 04: Felt would be inadequate
  • 05: Cost
  • 06: Too busy
  • 07: Didn't get around to it / didn't bother
  • 08: Didn't know where to go / call
  • 09: Language problems
  • 10: Personal or family responsibilities
  • 11: Decided not to seek services
  • 12: Doctor - did not think it was necessary
  • 13: Did not qualify / not eligible for home care
  • 14: Still waiting for home care
  • 15: Other - Specify
  • 98: RF
  • 99: DK

Home care services (HMC) - Question identifier:HMC_Q16

Again, thinking of the most recent time, what type of home care was needed?

Mark all that apply.

  • 01: Nursing care (e.g., dressing changes, preparing medications, V.O.N. visits)
  • 02: Other health care services (e.g., physiotherapy, occupational or speech therapy,
    nutrition counselling)
  • 03: Medical equipment or supplies
  • 04: Personal care (e.g., bathing, foot care)
  • 05: Housework (e.g., cleaning, laundry)
  • 06: Meal preparation or delivery
  • 07: Shopping
  • 08: Respite care (i.e., caregiver relief)
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Home care services (HMC) - Question identifier:HMC_Q17

Where did you try to get this home care service?

Mark all that apply.

  • 1: A government sponsored program
  • 2: A private agency
  • 3: A family member, friend or neighbour
  • 4: A volunteer organization
  • 5: Other
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS)

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_R11

Earlier, I asked about your use of health care services in the past 12 months. Now I'd like to get your opinion on the quality of the care you received.

Press <1> to continue.

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q11

In the past 12 months, have you received any health care services?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q12

Overall, how would you rate the quality of the health care you received?
Would you say it was...?

Read categories to respondent.

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q13

Overall, how satisfied were you with the way health care services were provided? Were you...?

Read categories to respondent.

  • 1: Very satisfied
  • 2: Somewhat satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Somewhat dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q21A

In the past 12 months, have you received any health care services at a hospital, for any diagnostic or day surgery service, overnight stay, or as an emergency room patient?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q21B

Thinking of your most recent hospital visit, were you...?

Read categories to respondent.

  • 1: Admitted overnight or longer (an inpatient)
  • 2: A patient at a diagnostic or day surgery clinic (an outpatient)
  • 3: An emergency room patient
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q22

(Thinking of this most recent hospital visit:)

how would you rate the quality of the care you received? Would you say it was...?

Read categories to respondent.

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q23

(Thinking of this most recent hospital visit:)

how satisfied were you with the way hospital services were provided?
Were you...?

Read categories to respondent.

  • 1: Very satisfied
  • 2: Somewhat satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Somewhat dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q31A

In the past 12 months, not counting hospital visits, have you received any health care services from a family doctor or other physician?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q31B

Thinking of the most recent time, was care provided by...?

Read categories to respondent.

  • 1: A family doctor (general practitioner)
  • 2: A medical specialist
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q32

(Thinking of this most recent care from a physician:)

how would you rate the quality of the care you received? Would you say it was...?

Read categories to respondent.

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Patient satisfaction - Health care services (PAS) - Question identifier:PAS_Q33

(Thinking of this most recent care from a physician:)

how satisfied were you with the way physician care was provided? Were you...?

Read categories to respondent.

  • 1: Very satisfied
  • 2: Somewhat satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Somewhat dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Patient satisfaction - Community-based care (PSC)

Patient satisfaction - Community-based care (PSC) - Question identifier:PSC_R41

The next questions are about community-based health care which includes any health care received outside of a hospital or doctor's office.

Examples are: home nursing care, home-based counselling or therapy, personal care and community walk-in clinics.

Press <1> to continue.

Patient satisfaction - Community-based care (PSC) - Question identifier:PSC_Q41

In the past 12 months, have you received any community-based care?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Patient satisfaction - Community-based care (PSC) - Question identifier:PSC_Q42

Overall, how would you rate the quality of the community-based care you received? Would you say it was...?

Read categories to respondent.

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Patient satisfaction - Community-based care (PSC) - Question identifier:PSC_Q43

Overall, how satisfied were you with the way community-based care was provided?
Were you...?

Read categories to respondent.

  • 1: Very satisfied
  • 2: Somewhat satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Somewhat dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

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.

Press <1> to continue.

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?

Read categories to respondent.

  • 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?

Read categories to respondent.

  • 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.

Press <1> to continue.

Restriction of activities (RAC) - Question identifier:RAC_Q5

Which one of the following is the best description of the cause of this condition?

Read categories to respondent.

  • 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

Activities of Daily Living (ADL)

Activities of Daily Living (ADL) - Question identifier:ADL_R01

The next few questions are about common daily activities. These questions may not apply to you, but we need to ask the same questions of everyone.

Press <1> to continue.

Activities of Daily Living (ADL) - Question identifier:ADL_Q01

Because of any physical condition or mental condition or health problem, do you need the help of another person:

with preparing meals?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Activities of Daily Living (ADL) - Question identifier:ADL_Q02

(Because of any physical condition or mental condition or health problem, do you need the help of another person:)

with getting to appointments and running errands such as shopping for groceries?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Activities of Daily Living (ADL) - Question identifier:ADL_Q03

(Because of any physical condition or mental condition or health problem, do you need the help of another person:)

with doing everyday housework?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Activities of Daily Living (ADL) - Question identifier:ADL_Q04

(Because of any physical condition or mental condition or health problem, do you need the help of another person:)

with personal care such as washing, dressing, eating or taking medication?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Activities of Daily Living (ADL) - Question identifier:ADL_Q05

(Because of any physical condition or mental condition or health problem, do you need the help of another person:)

with moving about inside the house?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Activities of Daily Living (ADL) - Question identifier:ADL_Q06

(Because of any physical condition or mental condition or health problem, do you need the help of another person:)

with looking after your personal finances such as making bank transactions or paying bills?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Flu shots (FLU)

Flu shots (FLU) - Question identifier:FLU_R160

Now a few questions about your use of various health care services.

Press <1> to continue.

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?

Read categories to respondent.

  • 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?

Mark all that apply.

  • 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

Blood pressure check (BPC)

Blood pressure check (BPC) - Question identifier:BPC_Q010

(Now blood pressure)
Have you ever had your blood pressure taken?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Blood pressure check (BPC) - Question identifier:BPC_Q012

When was the last time?

  • 1: less than 6 months ago
  • 2: 6 months to less than 1 year ago
  • 3: 1 year to less than 2 years ago
  • 4: 2 years to less than 5 years ago
  • 5: 5 or more years ago
  • 8: RF
  • 9: DK

Blood pressure check (BPC) - Question identifier:BPC_Q013

Were you pregnant the last time your blood pressure was taken?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Blood pressure check (BPC) - Question identifier:BPC_Q016

What are the reasons that you have not had your blood pressure taken in the past 2 years?

Mark all that apply.

  • 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: Unable to leave the house because of a health problem
  • 14: Other
  • 98: RF
  • 99: DK

PAP smear test (PAP)

PAP smear test (PAP) - Question identifier:PAP_Q020

(Now PAP tests)
Have you ever had a PAP smear test?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

PAP smear test (PAP) - Question identifier:PAP_Q022

When was the last time?

  • 1: Less than 6 months ago
  • 2: 6 months to less than 1 year ago
  • 3: 1 year to less than 3 years ago
  • 4: 3 years to less than 5 years ago
  • 5: 5 or more years ago
  • 8: RF
  • 9: DK

PAP smear test (PAP) - Question identifier:PAP_Q026

What are the reasons that you have not had a PAP smear test in the past 3 years?

Mark all that apply.

  • 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: Have had a hysterectomy
  • 14: Hate / dislike having one done
  • 15: Unable to leave the house because of a health problem
  • 16: Other
  • 98: RF
  • 99: DK

Mammography (MAM)

Mammography (MAM) - Question identifier:MAM_Q30

(Now Mammography)
Have you ever had a mammogram, that is, a breast x-ray?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Mammography (MAM) - Question identifier:MAM_Q31

Why did you have it?

Mark all that apply.
If respondent says "doctor recommended it", probe for reason.

  • 01: Family history of breast cancer
  • 02: Part of regular check-up / routine screening
  • 03: Age
  • 04: Previously detected lump
  • 05: Follow-up of breast cancer treatment
  • 06: On hormone replacement therapy
  • 07: Breast problem
  • 08: Other
  • 98: RF
  • 99: DK

Mammography (MAM) - Question identifier:MAM_Q32

When was the last time?

  • 1: less than 6 months ago
  • 2: 6 months to less than 1 year ago
  • 3: 1 year to less than 2 years ago
  • 4: 2 years to less than 5 years ago
  • 5: 5 or more years ago
  • 8: RF
  • 9: DK

Mammography (MAM) - Question identifier:MAM_Q36

What are the reasons you have not had one in the past 2 years?

Mark all that apply.

  • 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: Unable to leave the house because of a health problem
  • 14: Breasts removed / Mastectomy
  • 15: Other - Specify
  • 98: RF
  • 99: DK

Mammography (MAM) - Question identifier:MAM_Q38

Have you had a hysterectomy (in other words, has your uterus been removed)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Prostate cancer screening (PSA)

Prostate cancer screening (PSA) - Question identifier:PSA_Q170

(Now Prostate tests)
Have you ever had a prostate specific antigen test for prostate cancer, that is, a
PSA blood test?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Prostate cancer screening (PSA) - Question identifier:PSA_Q172

When was the last time?

  • 1: Less than 1 year ago
  • 2: 1 year to less than 2 years ago
  • 3: 2 years to less than 3 years ago
  • 4: 3 years to less than 5 years ago
  • 5: 5 or more years ago
  • 8: RF
  • 9: DK

Prostate cancer screening (PSA) - Question identifier:PSA_Q173

Why did you have it?

Mark all that apply.
If respondent says 'Doctor recommended it' or 'I requested it', probe for reason.

  • 1: Family history of prostate cancer
  • 2: Part of regular check-up / routine screening
  • 3: Age
  • 4: Race
  • 5: Follow-up of problem
  • 6: Follow-up of prostate cancer treatment
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Prostate cancer screening (PSA) - Question identifier:PSA_Q174

A Digital Rectal Exam is an exam in which a gloved finger is inserted into the rectum in order to feel the prostate gland.
Have you ever had this exam?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Prostate cancer screening (PSA) - Question identifier:PSA_Q175

When was the last time?

  • 1: Less than 1 year ago
  • 2: 1 year to less than 2 years ago
  • 3: 2 years to less than 3 years ago
  • 4: 3 years to less than 5 years ago
  • 5: 5 or more years ago
  • 8: RF
  • 9: DK

Colorectal cancer screening (CCS)

Colorectal cancer screening (CCS) - Question identifier:CCS_Q180

Now a few questions about various colorectal exams.

An FOBT is a test to check for blood in your stool, where you have a bowel movement and use a stick to smear a small sample on a special card.

Have you ever had this test?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Colorectal cancer screening (CCS) - Question identifier:CCS_Q182

When was the last time?

  • 1: Less than 1 year ago
  • 2: 1 year to less than 2 years ago
  • 3: 2 years to less than 3 years ago
  • 4: 3 years to less than 5 years ago
  • 5: 5 years to less than 10 years ago
  • 6: 10 or more years ago
  • 8: RF
  • 9: DK

Colorectal cancer screening (CCS) - Question identifier:CCS_Q183

Why did you have it?

Mark all that apply.
If respondent says "Doctor recommended it" or "I requested it", probe for reason.

  • 1: Family history of colorectal cancer
  • 2: Part of regular check-up / routine screening
  • 3: Age
  • 4: Race
  • 5: Follow-up of problem
  • 6: Follow-up of colorectal cancer treatment
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Colorectal cancer screening (CCS) - Question identifier:CCS_Q184

A colonoscopy or sigmoidoscopy is when a tube is inserted into the rectum to view the bowel for early signs of cancer and other health problems. Have you ever had either of these exams?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Colorectal cancer screening (CCS) - Question identifier:CCS_Q185

When was the last time?

  • 1: Less than 1 year ago
  • 2: 1 year to less than 2 years ago
  • 3: 2 years to less than 3 years ago
  • 4: 3 years to less than 5 years ago
  • 5: 5 years to less than 10 years ago
  • 6: 10 or more years ago
  • 8: RF
  • 9: DK

Colorectal cancer screening (CCS) - Question identifier:CCS_Q186

Why did you have it?

Mark all that apply.
If respondent says "Doctor recommended it" or "I requested it", probe for reason.

  • 1: Family history of colorectal cancer
  • 2: Part of regular check-up / routine screening
  • 3: Age
  • 4: Race
  • 5: Follow-up of problem
  • 6: Follow-up of colorectal cancer treatment
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Colorectal cancer screening (CCS) - Question identifier:CCS_Q187

Was the colonoscopy or sigmoidoscopy a follow-up of the results of an FOBT?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Eye examinations (EYX)

Eye examinations (EYX) - Question identifier:EYX_Q140

(Now eye examinations)
It was reported earlier that you have "seen" or "talked to" an optometrist or ophthalmologist in the past 12 months. Did you actually visit one?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Eye examinations (EYX) - Question identifier:EYX_Q142

(Now eye examinations)
When did you last have an eye examination?

  • 1: Less than 1 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
  • 5: Never
  • 8: RF
  • 9: DK

Eye examinations (EYX) - Question identifier:EYX_Q146

What are the reasons that you have not had an eye examination in the past 2 years?

Mark all that apply.

  • 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: Unable to leave the house because of a health problem
  • 14: Other
  • 98: RF
  • 99: DK

Dental visits (DEN)

Dental visits (DEN) - Question identifier:DEN_R130

The following questions are about dental visits.

Press <1> to continue.

Dental visits (DEN) - Question identifier:DEN_Q130

It was reported earlier that you have "seen" or "talked to" a dentist in the past 12 months. Did you actually visit one?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Dental visits (DEN) - Question identifier:DEN_Q132

When was the last time that you went to a dentist?

  • 1: Less than 1 year ago
  • 2: 1 year to less than 2 years ago
  • 3: 2 years to less than 3 years ago
  • 4: 3 years to less than 4 years ago
  • 5: 4 years to less than 5 years ago
  • 6: 5 or more years ago
  • 7: Never
  • 8: RF
  • 9: DK

Dental visits (DEN) - Question identifier:DEN_Q136

What are the reasons that you have not been to a dentist in the past 3 years?

Mark all that apply.

  • 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: Wears dentures
  • 14: Unable to leave the house because of a health problem
  • 15: Other
  • 98: RF
  • 99: DK

Oral health 2 (OH2)

Oral health 2 (OH2) - Question identifier:OH2_Q10

Do you usually visit the dentist...?

Read categories to respondent.

  • 1: more than once a year for check-ups
  • 2: about once a year for check-ups
  • 3: less than once a year for check-ups
  • 4: only for emergency care
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q11

Do you have insurance that covers all or part of your dental expenses?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q11A

Is it...?

Read categories to respondent. Mark all that apply.

  • 1: a government-sponsored plan
  • 2: an employer-sponsored plan
  • 3: a private plan
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q12

In the past 12 months, have you had any teeth removed by a dentist?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q13

(In the past 12 months,) were any teeth removed because of decay or gum disease?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q20

Do you have one or more of your own teeth?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q21

Do you wear dentures or false teeth?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_R22

Now we have some additional questions about oral health, that is the health of your teeth and mouth.

Press <1> to continue.

Oral health 2 (OH2) - Question identifier:OH2_Q22

Because of the condition of your [teeth, mouth or dentures/teeth or mouth], do you have difficulty pronouncing any words or speaking clearly?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q23

In the past 12 months, how often have you avoided:

conversation or contact with other people, because of the condition of your [teeth, mouth or dentures/teeth or mouth]?

Read categories to respondent.

  • 1: Often
  • 2: Sometimes
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q24

(In the past 12 months, how often have you avoided:)

laughing or smiling, because of the condition of your [teeth, mouth or dentures/teeth or mouth]?

  • 1: Often
  • 2: Sometimes
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_R25

Now some questions about the health of your [mouth/teeth and mouth] during the past month.

Press <1> to continue.

Oral health 2 (OH2) - Question identifier:OH2_Q25A

In the past month, have you had:

a toothache?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q25B

In the past month, were your teeth:

sensitive to hot or cold food or drinks?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q25C

In the past month, have you had:

pain in or around the jaw joints?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q25D

(In the past month, have you had:)

other pain in the mouth or face?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q25E

(In the past month, have you had:)

bleeding gums?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q25F

(In the past month, have you had:)

dry mouth?

Do not include thirst caused by exercise.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q25G

(In the past month, have you had:)

bad breath?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 2 (OH2) - Question identifier:OH2_Q30

How often do you brush your teeth?

  • 1: More than twice a day
  • 2: Twice a day
  • 3: Once a day
  • 4: Less than once a day but more than once a week
  • 5: Once a week
  • 6: Less than once a week
  • 8: RF
  • 9: DK

Food choices (FDC)

Food choices (FDC) - Question identifier:FDC_R1

Now, some questions about the foods you eat.

Press <1> to continue.

Food choices (FDC) - Question identifier:FDC_Q1A

Do you choose certain foods or avoid others:

because you are concerned about your body weight?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q1B

(Do you choose certain foods or avoid others:)

because you are concerned about heart disease?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q1C

(Do you choose certain foods or avoid others:)

because you are concerned about cancer?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q1D

(Do you choose certain foods or avoid others:)

because you are concerned about osteoporosis (brittle bones)?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q2A

Do you choose certain foods because of:

the lower fat content?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q2B

(Do you choose certain foods because of:)

the fibre content?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q2C

(Do you choose certain foods because of:)

the calcium content?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q3A

Do you avoid certain foods because of:

the fat content?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q3B

(Do you avoid certain foods because of:)

the type of fat they contain?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q3C

(Do you avoid certain foods because of:)

the salt content?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q3D

(Do you avoid certain foods because of:)

the cholesterol content?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: DK

Food choices (FDC) - Question identifier:FDC_Q3E

(Do you avoid certain foods because of:)

the calorie content?

  • 1: Yes (or sometimes)
  • 2: No
  • 8: RF
  • 9: 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.

Press <1> to continue.

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)

Select the reporting period here and enter the number in the next screen.

  • 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?

Select the reporting period here and enter the number in the next screen.

  • 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?

Select the reporting period here and enter the number in the next screen.

  • 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?

Select the reporting period here and enter the number in the next screen.

  • 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?

Select the reporting period here and enter the number in the next screen.

  • 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?

Select the reporting period here and enter the number in the next screen.

  • 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.

Press <1> to continue.

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?

Read categories to respondent. Mark all that apply.

  • 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.

Press <1> to continue.

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?

Include both walking to and from work and school, if both apply.

  • 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?

Include both bicycling to and from work and school, if both apply.

  • 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 activity - Stages of change (SCP)

Physical activity - Stages of change (SCP) - Question identifier:SCP_Q01

Thinking about the level of physical activity you do every week, do you consider yourself to be...?

Read categories to respondent.

  • 1: Very physically active
  • 2: Moderately physically active
  • 3: A bit physically active
  • 4: Not at all physically active
  • 8: RF
  • 9: DK

Physical activity - Stages of change (SCP) - Question identifier:SCP_Q02

Did you increase your physical activity level in the last 6 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Physical activity - Stages of change (SCP) - Question identifier:SCP_Q03

Do you intend to increase your physical activity level in the next 30 days?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Physical activity - Stages of change (SCP) - Question identifier:SCP_Q04

Do you intend to increase your physical activity level in the next 6 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sedentary activities (SAC)

Sedentary activities (SAC) - Question identifier:SAC_R1

Now, a few additional questions about activities you do in your leisure time, that is, activities not at work or at school.

Press <1> to continue.

Sedentary activities (SAC) - Question identifier:SAC_Q1

In a typical week in the past 3 months, how many hours did you usually spend:

on a computer, including playing computer games and using the Internet?

Min = 0; Max = 70

Include time spent doing homework on a computer. Do not include time spent at work or at school. Round up to the nearest hour.

Sedentary activities (SAC) - Question identifier:SAC_Q2

(In a typical week, in the past 3 months, how many hours did you usually spend:)

playing video games on a game console or on a hand-held electronic device?

Min = 0; Max = 70

Exclude time spent playing video games on a computer. Game console includes i.e. XBOX, Nintendo and Playstation. Round up to the nearest hour.

Sedentary activities (SAC) - Question identifier:SAC_Q3

(In a typical week in the past 3 months, how many hours did you usually spend:)

watching television or videos?

Min = 0; Max = 70

Round up to the nearest hour.

Sedentary activities (SAC) - Question identifier:SAC_Q4

(In a typical week, in the past 3 months, how many hours did you usually spend:)

reading, not counting at work or at school?

Min = 0; Max = 70

Include books, ebooks, magazines, newspapers, homework. Round up to the nearest hour.

Use of protective equipment (UPE)

Use of protective equipment (UPE) - Question identifier:UPE_R10

Now a few questions about precautions you take while participating in some physical activities.

Press <1> to continue.

Use of protective equipment (UPE) - Question identifier:UPE_Q1A

In the past 12 months, have you done any bicycling?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q1B

When riding a bicycle, how often do you wear a helmet?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q2A

In the past 12 months, have you done any in-line skating or rollerblading?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q2B

When in-line skating or rollerblading, how often do you wear a helmet?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q2C

How often do you wear wrist guards or wrist protectors?

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q2D

How often do you wear elbow pads?

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q2E

How often do you wear knee pads?

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q3A

Earlier, you mentioned going downhill skiing or snowboarding in the past 3 months. Was that:?

Read categories to respondent.

  • 1: downhill skiing only
  • 2: snowboarding only
  • 3: both
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q3B

In the past 12 months, did you do any downhill skiing or snowboarding?

Read categories to respondent.

  • 1: Downhill skiing only
  • 2: Snowboarding only
  • 3: Both
  • 4: Neither
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q4A

When downhill skiing, how often do you wear a helmet?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q5A

When snowboarding, how often do you wear a helmet?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q5B

How often do you wear wrist guards or wrist protectors?

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q6A

In the past 12 months, have you done any skateboarding?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q6B

How often do you wear a helmet?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q6C

How often do you wear wrist guards or wrist protectors?

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q6D

How often do you wear elbow pads?

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q7A

In the past 12 months, have you played any ice hockey?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Use of protective equipment (UPE) - Question identifier:UPE_Q7B

When playing ice hockey, how often do you wear a mouth guard?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB)

Sun safety behaviours (SSB) - Question identifier:SSB_R01

The next few questions are about exposure to the sun and sunburns. Sunburn is defined as any reddening or discomfort of the skin, that lasts longer than 12 hours after exposure to the sun or other UV sources, such as tanning beds or sun lamps.

Press <1> to continue.

Sun safety behaviours (SSB) - Question identifier:SSB_Q01

In the past 12 months, has any part of your body been sunburnt?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q02

Did any of your sunburns involve blistering?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q03

Did any of your sunburns involve pain or discomfort that lasted for more than 1 day?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_R06

For the next questions, think about a typical weekend, or day off from work or school in the summer months.

Press <1> to continue.

Sun safety behaviours (SSB) - Question identifier:SSB_Q06

About how much time each day do you spend in the sun between 11 am and 4 pm?

  • 01: None
  • 02: Less than 30 minutes
  • 03: 30 to 59 minutes
  • 04: 1 hour to less than 2 hours
  • 05: 2 hours to less than 3 hours
  • 06: 3 hours to less than 4 hours
  • 07: 4 hours to less than 5 hours
  • 08: 5 hours
  • 98: RF
  • 99: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q07

In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:

seek shade?

Read categories to respondent.

  • 1: Always
  • 2: Often
  • 3: Sometimes
  • 4: Rarely
  • 5: Never
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q08

(In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:)

wear a hat that shades your face, ears and neck?

  • 1: Always
  • 2: Often
  • 3: Sometimes
  • 4: Rarely
  • 5: Never
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q09A

(In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:)

wear long pants or a long skirt to protect your skin from the sun?

  • 1: Always
  • 2: Often
  • 3: Sometimes
  • 4: Rarely
  • 5: Never
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q09B

(In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:)

use sunscreen on your face?

  • 1: Always
  • 2: Often
  • 3: Sometimes
  • 4: Rarely
  • 5: Never
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q10

What Sun Protection factor (SPF) do you usually use?

  • 1: Less than 15
  • 2: 15 to 25
  • 3: More than 25
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q11

In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:

use sunscreen on your body?

  • 1: Always
  • 2: Often
  • 3: Sometimes
  • 4: Rarely
  • 5: Never
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q12

What Sun Protection factor (SPF) do you usually use?

  • 1: Less than 15
  • 2: 15 to 25
  • 3: More than 25
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q13

Do you have skin cancer?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q14

Have you ever been diagnosed with skin cancer?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sun safety behaviours (SSB) - Question identifier:SSB_Q15

What type of skin cancer [do/did] you have?

  • 1: Melanoma
  • 2: Non-melanoma
  • 8: RF
  • 9: DK

Injuries (INJ)

Injuries (INJ) - Question identifier:INJ_R01

Now some questions about [other/null] injuries which occurred in the past 12 months, and were serious enough to limit your normal activities the day after the injury occurred. For example, a broken bone, a bad cut, a burn or a sprain.

Press <1> to continue.

Injuries (INJ) - Question identifier:INJ_Q01

[Not counting repetitive strain injuries or food poisoning,/Not counting food poisoning,] in the past 12 months, that is, from ^DATEONEYEARAGOE to yesterday, were you injured?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q02

How many times were you injured?

Min = 1; Max = 30

Injuries (INJ) - Question identifier:INJ_Q03

[In which/Thinking about the most serious injury, in which] month did it happen?

  • 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

Injuries (INJ) - Question identifier:INJ_Q04

Was that this year or last year?

  • 1: This year
  • 2: Last year
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q05

What type of injury did you have? For example, a broken bone or burn.

  • 01: Multiple serious injuries (excluding multiple minor injuries)
  • 02: Broken or fractured bones
  • 03: Burn, scald, chemical burn
  • 04: Dislocation
  • 05: Sprain or strain (including torn ligaments and muscles)
  • 06: Cut, puncture, animal or human bite (open wound)
  • 07: Scrape(s), bruise(s), blister(s) (including multiple minor injuries)
  • 08: Concussion or other brain injury
  • 09: Poisoning (excluding food poisoning, poison ivy, other contact dermatitis, and allergies)
  • 10: Injury to internal organs
  • 11: Other - Specify
  • 98: RF
  • 99: DK

Injuries (INJ) - Question identifier:INJ_Q06

What part of the body was injured?

  • 01: Multiple sites
  • 02: Eyes (excluding fracture of facial bones around the eye)
  • 03: Head (including facial bones)
  • 04: Neck
  • 05: Shoulder, upper arm
  • 06: Elbow, lower arm
  • 07: Wrist
  • 08: Hand
  • 09: Hip
  • 10: Thigh
  • 11: Knee, lower leg
  • 12: Ankle, foot
  • 13: Upper back or upper spine (excluding neck)
  • 14: Lower back or lower spine
  • 15: Chest (excluding back and spine)
  • 16: Abdomen or pelvis (excluding back and spine)
  • 98: RF
  • 99: DK

Injuries (INJ) - Question identifier:INJ_Q07

What part of the body was injured?

  • 1: Chest (within rib cage)
  • 2: Abdomen or pelvis (below ribs)
  • 3: Other - Specify
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q08

Where were you when you were injured?
For example, someone's house, an office building, construction site.

If respondent says 'At work', probe for type of workplace.

  • 01: In a home or its surrounding area (including respondent's home or other homes)
  • 02: Residential institution
  • 03: School, college, university (exclude sports areas)
  • 04: Sports or athletics area of school, college, university
  • 05: Other sports or athletics area (exclude school sports areas)
  • 06: Other institution (e.g., church, hospital, theatre, civic building)
  • 07: Street, highway, sidewalk
  • 08: Commercial area (e.g., store, restaurant, office building, transport terminal)
  • 09: Industrial or construction area
  • 10: Farm (exclude farmhouse and its surrounding area)
  • 11: Countryside, forest, lake, ocean, mountains, prairie, etc.
  • 12: Other - Specify
  • 98: RF
  • 99: DK

Injuries (INJ) - Question identifier:INJ_Q09

What were you doing when you were injured?

  • 01: Sports or physical exercise (including school activities, and running)
  • 02: Leisure or hobby (including volunteering)
  • 03: Working at a job or business (excluding travel to and from work)
  • 04: Household chores, outdoor yard maintenance, home renovations or
    other unpaid work
  • 05: Sleeping, eating, personal care
  • 06: Going up and down stairs
  • 07: Driver or passenger in/on road motor vehicle (including motorcycles,
    trucks)
  • 08: Driver or passenger in/on off-road motor vehicle (including boat, ATV, snowmobile)
  • 09: Walking
  • 10: Other - Specify
  • 98: RF
  • 99: DK

Injuries (INJ) - Question identifier:INJ_Q10

Was the injury the result of a fall?

Exclude transportation accidents and any falls that involve another person (e.g. collision, contact in sports, fight).

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q11

How did you fall?

  • 01: While skating, skiing or snowboarding
  • 02: While engaged in other sport or physical exercise (including school activities and running)
  • 03: Going up or down stairs / steps (icy or not)
  • 04: Slip, trip, stumble or loss balance while walking on ice or snow
  • 05: Slip, trip or stumble or loss balance while walking on any other surface
  • 06: From furniture or while rising from furniture (e.g., bed, chair)
  • 07: From elevated position (e.g., ladder, tree, scaffolding)
  • 08: Due to health problems (e.g., faint, weakness, dizziness, hip/knee gave out, seizure)
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Injuries (INJ) - Question identifier:INJ_Q12A

What caused the injury?

  • 01: Transportation accident
  • 02: Accidentally bumped, pushed, bitten, etc. by person or animal
  • 03: Accidentally struck or crushed by object(s)
  • 04: Accidental contact with sharp object, tool or machine
  • 05: Smoke, fire, flames
  • 06: Accidental contact with hot object, liquid or gas
  • 07: Extreme weather or natural disaster
  • 08: Overexertion or strenuous movement
  • 09: Physical assault
  • 10: Other - Specify
  • 98: RF
  • 99: DK

Injuries (INJ) - Question identifier:INJ_Q12B

At what time of day did your injury occur?

  • 1: Morning (06:00-11:59)
  • 2: Afternoon (12:00-17:59)
  • 3: Evening (18:00-23:59)
  • 4: Night (00:00-05:59)
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q13

Did you receive any medical attention for the injury from a health professional in the 48 hours following the injury?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q14

Where did you receive treatment in the 48 hours?

Mark all that apply.

  • 01: Doctor's office
  • 02: Hospital emergency room
  • 03: Hospital outpatient clinic (e.g. day surgery, cancer)
  • 04: Other clinic (e.g. walk-in, appointment, sports)
  • 05: Physiotherapist or massage therapist's office
  • 06: Community health centre / CLSC
  • 07: Chiropractor's office
  • 08: Where the injury happened/on-site (workplace, school, sports field,
    hotel, ski hill)
  • 09: Other
  • 98: RF
  • 99: DK

Injuries (INJ) - Question identifier:INJ_Q15A

Were you admitted to a hospital overnight?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q15B

At the present time, are you getting follow-up care from a health professional because of this injury?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q16

In the past 12 months, did you have any other injuries that were treated by a health professional, but did not limit your normal activities?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Injuries (INJ) - Question identifier:INJ_Q17

How many injuries?

Min = 1; Max = 30

Repetitive strain - Sub Block (REP)

Repetitive strain - Sub Block (REP) - Question identifier:REP_R1

This next section deals with repetitive strain injuries. By this we mean injuries to muscles, tendons or nerves caused by overuse or repeating the same movement over an extended period. For example, carpal tunnel syndrome, tennis elbow or tendonitis.

Press <1> to continue.

Repetitive strain - Sub Block (REP) - Question identifier:REP_Q1

In the past 12 months, did you have any injuries due to repetitive strain?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Repetitive strain - Sub Block (REP) - Question identifier:REP_Q2

Were these injuries serious enough to limit your normal activities?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Repetitive strain - Sub Block (REP) - Question identifier:REP_Q3A

Thinking about the most serious repetitive strain, what part of the body was affected?

  • 01: Head
  • 02: Neck
  • 03: Shoulder, upper arm
  • 04: Elbow, lower arm
  • 05: Wrist
  • 06: Hand
  • 07: Hip
  • 08: Thigh
  • 09: Knee, lower leg
  • 10: Ankle, foot
  • 11: Upper back or upper spine (excluding neck)
  • 12: Lower back or lower spine
  • 13: Chest (excluding back and spine)
  • 14: Abdomen or pelvis (excluding back and spine)
  • 98: RF
  • 99: DK

Repetitive strain - Sub Block (REP) - Question identifier:REP_Q3B

Do you know what type of activity caused this repetitive strain injury?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Repetitive strain - Sub Block (REP) - Question identifier:REP_Q4

Was the activity something you did while working at a job or business (excluding travel to or from work)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Repetitive strain - Sub Block (REP) - Question identifier:REP_Q5

What type of activity was this?

Mark all that apply.

  • 01: Walking
  • 02: Sports or physical exercise (including school activities and running)
  • 03: Leisure or hobby (include volunteering)
  • 04: Household chores, outdoor yard maintenance,
    home renovations or other unpaid work
  • 05: Computer use or typing
  • 06: Driving a motor vehicle
  • 07: Lifting or carrying an object or person
  • 08: Other - Specify
  • 98: RF
  • 99: DK

Workplace Injury - Sub Block (INW)

Workplace Injury - Sub Block (INW) - Question identifier:INW_Q01

Did this injury occur in your current main job?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Workplace Injury - Sub Block (INW) - Question identifier:INW_Q02

What kind of business, industry or service were you working in when you were injured? (For example: cardboard box manufacturing, road maintenance, retail shoe store, secondary school, dairy farm, municipal government).

Long Answer Length = 50

Workplace Injury - Sub Block (INW) - Question identifier:INW_Q03

What kind of work were you doing? (For example: babysitting in own home, factory worker, forestry technician)

Long Answer Length = 50

Workplace Injury - Sub Block (INW) - Question identifier:INW_Q04

What were your most important activities or duties? (For example: caring for children, stamp press machine operator, forest examiner.

Long Answer Length = 50

Satisfaction with life (SWL)

Satisfaction with life (SWL) - Question identifier:SWL_R1

Now I'd like to ask about your satisfaction with various aspects of your life. For each question, please tell me whether you are very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, or very dissatisfied.

Press <1> to continue.

Satisfaction with life (SWL) - Question identifier:SWL_Q02

How satisfied are you with your job or main activity?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Satisfaction with life (SWL) - Question identifier:SWL_Q03

How satisfied are you with your leisure activities?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Satisfaction with life (SWL) - Question identifier:SWL_Q04

(How satisfied are you) with your financial situation?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Satisfaction with life (SWL) - Question identifier:SWL_Q05

How satisfied are you with yourself?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Satisfaction with life (SWL) - Question identifier:SWL_Q06

How satisfied are you with the way your body looks?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Satisfaction with life (SWL) - Question identifier:SWL_Q07

How satisfied are you with your relationships with family members?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Satisfaction with life (SWL) - Question identifier:SWL_Q08

(How satisfied are you) with your relationships with friends?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Satisfaction with life (SWL) - Question identifier:SWL_Q09

(How satisfied are you) with your housing?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Satisfaction with life (SWL) - Question identifier:SWL_Q10

(How satisfied are you) with your neighbourhood?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied
  • 8: RF
  • 9: DK

Stress - Sources (STS)

Stress - Sources (STS) - Question identifier:STS_R1

Now a few questions about the stress in your life.

Press <1> to continue.

Stress - Sources (STS) - Question identifier:STS_Q1

In general, how would you rate your ability to handle unexpected and difficult problems, for example, a family or personal crisis? Would you say your ability is...?

Read categories to respondent.

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Stress - Sources (STS) - Question identifier:STS_Q2

In general, how would you rate your ability to handle the day-to-day demands in your life, for example, handling work, family and volunteer responsibilities? Would you say your ability is...?

Read categories to respondent.

  • 1: Excellent
  • 2: Good
  • 3: Fair
  • 4: Poor
  • 8: RF
  • 9: DK

Stress - Sources (STS) - Question identifier:STS_Q3

Thinking about stress in your day-to-day life, what would you say is the most important thing contributing to feelings of stress you may have?

Do not probe.

  • 01: Time pressures / not enough time
  • 02: Own physical health problem or condition
  • 03: Own emotional or mental health problem or condition
  • 04: Financial situation (e.g., not enough money, debt)
  • 05: Own work situation (e.g., hours of work, working conditions)
  • 06: School
  • 07: Employment status (e.g., unemployment)
  • 08: Caring for - own children
  • 09: Caring for - others
  • 10: Other personal or family responsibilities
  • 11: Personal relationships
  • 12: Discrimination
  • 13: Personal and family's safety
  • 14: Health of family members
  • 15: Other - Specify
  • 16: Nothing
  • 98: RF
  • 99: DK

Smoking (SMK)

Smoking (SMK) - Question identifier:SMK_R1

The next questions are about smoking.

Press <1> to continue.

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

Minimum is 5; maximum is ^CURRENTAGE.

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

Minimum is 5; maximum is ^CURRENTAGE.

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...?

Read categories to respondent.

  • 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

Minimum is 3; maximum is [^CURRENTAGE - 5].

Smoking (SMK) - Question identifier:SMK_Q207

At what age did you begin to smoke (cigarettes) daily?

Min = 5; Max = 121

Minimum is 5; maximum is ^CURRENTAGE.

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...?

Read categories to respondent.

  • 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

Minimum is 3; maximum is [^CURRENTAGE -5].

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...?

Read categories to respondent.

  • 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

Minimum is 3; maximum is [^CURRENTAGE - 5].

Smoking - Stages of change (SCH)

Smoking - Stages of change (SCH) - Question identifier:SCH_Q1

Are you seriously considering quitting smoking within the next 6 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Stages of change (SCH) - Question identifier:SCH_Q2

Are you seriously considering quitting within the next 30 days?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Stages of change (SCH) - Question identifier:SCH_Q3

In the past 12 months, did you stop smoking for at least 24 hours because you were trying to quit?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Stages of change (SCH) - Question identifier:SCH_Q4

How many times? (in the past 12 months, did you stop smoking for at least 24 hours because you were trying to quit.)

Min = 1; Max = 95

Smoking cessation methods (SCA)

Smoking cessation methods (SCA) - Question identifier:SCA_Q10A

In the past 12 months, did you try a nicotine patch to quit smoking?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q10B

How useful was that in helping you quit?

  • 1: Very useful
  • 2: Somewhat useful
  • 3: Not very useful
  • 4: Not useful at all
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q11A

(In the past 12 months) did you try Nicorettes or other nicotine gum or candy to quit smoking?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q11B

How useful was that in helping you quit?

  • 1: Very useful
  • 2: Somewhat useful
  • 3: Not very useful
  • 4: Not useful at all
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q12A

In the past 12 months, did you try medication such as Zyban, Prolev or Wellbutrin to quit smoking?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q12B

How useful was that in helping you quit?

  • 1: Very useful
  • 2: Somewhat useful
  • 3: Not very useful
  • 4: Not useful at all
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q50

In the past 12 months, did you stop smoking for at least 24 hours because you were trying to quit?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q60

In the past 12 months, did you try any of the following to quit smoking:

a nicotine patch?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q61

(In the past 12 months, did you try any of the following to quit smoking:)

Nicorettes or other nicotine gum or candy?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking cessation methods (SCA) - Question identifier:SCA_Q62

(In the past 12 months, did you try any of the following to quit smoking:)

medication such as Zyban, Prolev or Wellbutrin?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Physician counselling (SPC)

Smoking - Physician counselling (SPC) - Question identifier:SPC_Q10

Earlier, you mentioned having a regular medical doctor. In the past 12 months, did you go see this doctor?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Physician counselling (SPC) - Question identifier:SPC_Q11

Does your doctor know that you [smoke/smoked] cigarettes?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Physician counselling (SPC) - Question identifier:SPC_Q12

In the past 12 months, did your doctor advise you to quit smoking?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Physician counselling (SPC) - Question identifier:SPC_Q13

(In the past 12 months,) did your doctor give you any specific help or information to quit smoking?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Physician counselling (SPC) - Question identifier:SPC_Q14

What type of help did the doctor give?

Mark all that apply.

  • 1: Referral to a one-on-one cessation program
  • 2: Referral to a group cessation program
  • 3: Recommended use of nicotine patch or nicotine gum
  • 4: Recommended Zyban or other medication
  • 5: Provided self-help information (e.g., pamphlet, referral to website)
  • 6: Own doctor offered counselling
  • 7: Other
  • 8: RF
  • 9: DK

Smoking - Physician counselling (SPC) - Question identifier:SPC_Q20

Earlier, you mentioned having "seen or talked to" a dentist in the past 12 months. Did you actually go to the dentist?

Include both face to face and telephone contacts.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Physician counselling (SPC) - Question identifier:SPC_Q21

Does your dentist or dental hygienist know that you [smoke/smoked] cigarettes?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Physician counselling (SPC) - Question identifier:SPC_Q22

In the past 12 months, did the dentist or hygienist advise you to quit smoking?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Youth smoking (YSM)

Smoking - Youth smoking (YSM) - Question identifier:YSM_Q1

Where do you usually get your cigarettes?

  • 01: Buy from - Vending machine
  • 02: Buy from - Small grocery / corner store
  • 03: Buy from - Supermarket
  • 04: Buy from - Drug store
  • 05: Buy from - Gas station
  • 06: Buy from - Other store
  • 07: Buy from - Friend or someone else
  • 08: Given them by - Brother or sister
  • 09: Given them by - Mother or father
  • 10: Given them by - Friend or someone else
  • 11: Take them from - Mother, father or sibling
  • 12: Other
  • 98: RF
  • 99: DK

Smoking - Youth smoking (YSM) - Question identifier:YSM_Q2

In the past 12 months, have you bought cigarettes for yourself or for someone else?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Youth smoking (YSM) - Question identifier:YSM_Q3

In the past 12 months, have you been asked your age when buying cigarettes in a store?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Youth smoking (YSM) - Question identifier:YSM_Q4

In the past 12 months, has anyone in a store refused to sell you cigarettes?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Youth smoking (YSM) - Question identifier:YSM_Q5

In the past 12 months, have you asked a stranger to buy you cigarettes?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

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.

Press <1> to continue.

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?

Include cigarettes, cigars and pipes. Smoking inside the home excludes smoking inside the garage, whether attached or detached.

  • 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

Include household members and regular visitors. Include cigarettes, cigars and pipes.

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?

Include cigarettes, cigars and pipes.

  • 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)?

Include cigarettes, cigars and pipes.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Exposure to second-hand smoke (ETS) - Question identifier:ETS_Q35

Is smoking allowed inside your home?

Include cigarettes, cigars and pipes. Smoking inside the home excludes smoking inside the garage, whether attached or detached.

  • 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?

Include cigarettes, cigars and pipes. Smoking inside the home excludes smoking inside the garage, whether attached or detached.

  • 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?

Read categories to respondent. Mark all that apply. There is no need to read a response that was volunteered by the respondent.

  • 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

Smoking - Other tobacco products (TAL)

Smoking - Other tobacco products (TAL) - Question identifier:TAL_Q1

Now I'd like to ask about your use of tobacco other than cigarettes.

In the past month, have you smoked cigars?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Other tobacco products (TAL) - Question identifier:TAL_Q2

(In the past month,) have you smoked a pipe?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Other tobacco products (TAL) - Question identifier:TAL_Q3

(In the past month,) have you used snuff?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Smoking - Other tobacco products (TAL) - Question identifier:TAL_Q4

(In the past month,) have you used chewing tobacco?

  • 1: Yes
  • 2: No
  • 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.

Press <1> to continue.

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

Alcohol use during the past week (ALW)

Alcohol use during the past week (ALW) - Question identifier:ALW_Q5

Thinking back over the past week, that is, from last ^DAYLASTWEEKE to yesterday, did you have a drink of beer, wine, liquor or any other alcoholic beverage?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use during the past week (ALW) - Question identifier:ALW_Q5A_1

Starting with yesterday, that is [Sunday/Monday/Tuesday/Wednesday/Thursday/Friday/Saturday], how many drinks did you have?

Min = 0; Max = 99

Alcohol use during the past week (ALW) - Question identifier:ALW_Q5A_2

How many drinks did you have:

on [Saturday/Sunday/Monday/Tuesday/Wednesday/Thursday/Friday]?

Min = 0; Max = 99

Alcohol use during the past week (ALW) - Question identifier:ALW_Q5A_3

(How many drinks did you have:)

on [Friday/Saturday/Sunday/Monday/Tuesday/Wednesday/Thursday]?

Min = 0; Max = 99

Alcohol use during the past week (ALW) - Question identifier:ALW_Q5A_4

(How many drinks did you have:)

on [Thursday/Friday/Saturday/Sunday/Monday/Tuesday/Wednesday]?

Min = 0; Max = 99

Alcohol use during the past week (ALW) - Question identifier:ALW_Q5A_5

(How many drinks did you have:)

on [Wednesday/Thursday/Friday/Saturday/Sunday/Monday/Tuesday]?

Min = 0; Max = 99

Alcohol use during the past week (ALW) - Question identifier:ALW_Q5A_6

(How many drinks did you have:)

on [Tuesday/Wednesday/Thursday/Friday/Saturday/Sunday/Monday]?

Min = 0; Max = 99

Alcohol use during the past week (ALW) - Question identifier:ALW_Q5A_7

(How many drinks did you have:)

on [Monday/Tuesday/Wednesday/Thursday/Friday/Saturday/Sunday]?

Min = 0; Max = 99

Driving and safety (DRV)

Driving and safety (DRV) - Question identifier:DRV_R01

The next questions are about driving a motor vehicle. By motor vehicle, we mean a car, truck or van.

Press <1> to continue.

Driving and safety (DRV) - Question identifier:DRV_Q01A

In the past 12 months, have you driven a motor vehicle?

Include cars, trucks and vans. Exclude motorcycles and off-road vehicles.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q01B

In the past 12 months, have you driven a motorcycle?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q02

How often do you fasten your seat belt when you drive a motor vehicle?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q03A

Excluding hands-free use, how often do you use a cell phone while you are driving a motor vehicle?

Read categories to respondent.
If respondent does not use a cell phone, select «Never».

  • 1: Often
  • 2: Sometimes
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q03B

How often do you use a hands-free when talking on the cell phone while you are driving a motor vehicle?

Read categories to respondent.
If respondent does not use a hands-free, select «Never».

  • 1: Often
  • 2: Sometimes
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q04

How often do you drive when you are feeling tired?

  • 1: Often
  • 2: Sometimes
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q05

Compared to other drivers, would you say you usually drive...?

Read categories to respondent.

  • 1: Much faster
  • 2: A little faster
  • 3: About the same speed
  • 4: A little slower
  • 5: Much slower
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q06

(Compared to other drivers,) would you say you usually drive...?

Read categories to respondent.

  • 1: Much more aggressively
  • 2: A little more aggressively
  • 3: About the same
  • 4: A little less aggressively
  • 5: Much less aggressively
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q07A

In the past 12 months, have you driven a motor vehicle after having 2 or more drinks in the hour before you drove?

Include cars, trucks, vans and motorcycles. Exclude off-road vehicles.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q07B

How many times (in the past 12 months)?

Min = 1; Max = 95

Driving and safety (DRV) - Question identifier:DRV_R08

Now some questions about being a passenger in a motor vehicle.

Press <1> to continue.

Driving and safety (DRV) - Question identifier:DRV_Q08A

When you are a front seat passenger, how often do you fasten your seat belt?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 5: Do not ride in front seat
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q08B

When you are a back seat passenger, how often do you fasten your seat belt?

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 5: Do not ride in back seat
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q09

When you are a passenger in a taxi, how often do you fasten your seat belt?

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 5: Do not take taxis
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q10A

In the past 12 months, have you been a passenger with a driver who had 2 or more drinks in the hour before driving?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q10B

How many times (in the past 12 months)?

Min = 1; Max = 95

Driving and safety (DRV) - Question identifier:DRV_Q11A

In the past 12 months, have you been the driver of, or a passenger in, a snowmobile, motor boat or seadoo?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q11B

In the past 12 months, have you been the driver of, or a passenger in, an ATV (all terrain vehicle)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q12

How often do you wear a helmet when on an ATV?

Read categories to respondent.

  • 1: Always
  • 2: Most of the time
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q13A

In the past 12 months, have you been a passenger on [a snowmobile, motor boat, seadoo or ATV/a snowmobile, motor boat or seadoo/an ATV] with a driver who had 2 or more drinks in the hour before driving?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q13B

How many times (in the past 12 months)?

Min = 1; Max = 95

Driving and safety (DRV) - Question identifier:DRV_Q14A

In the past 12 months, have you driven [a snowmobile, motor boat, seadoo or ATV/a snowmobile, motor boat or seadoo/an ATV] after having 2 or more drinks in the hour before you drove?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Driving and safety (DRV) - Question identifier:DRV_Q14B

How many times (in the past 12 months)?

Min = 1; Max = 95

Alcohol use - Dependence (ALD)

Alcohol use - Dependence (ALD) - Question identifier:ALD_R1

The next questions are about how drinking can affect people in their activities. We will be referring to the past 12 months, that is, from [date one year ago] to yesterday.

Press <1> to continue.

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q01

In the past 12 months, have you ever been drunk or hung-over while at work, school or while taking care of children?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q02

How many times? Was it:

Read categories to respondent.

  • 1: Once or twice?
  • 2: 3 to 5 times?
  • 3: 6 to 10 times?
  • 4: 11 to 20 times?
  • 5: More than 20 times?
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q03

In the past 12 months, were you ever in a situation while drunk or hung-over which increased your chances of getting hurt? (For example, driving a boat, using guns, crossing against traffic, or during sports.)

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q04

(In the past 12 months,) have you had any emotional or psychological problems because of alcohol use, such as feeling uninterested in things, depressed or suspicious of people?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q05

(In the past 12 months,) have you had such a strong desire or urge to drink alcohol that you could not resist it or could not think of anything else?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q06

(In the past 12 months,) have you had a period of a month or more when you spent a great deal of time getting drunk or being hung-over?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q07

In the past 12 months, did you ever drink much more or for a longer period of time than you intended?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q08

How many times? Was it:

Read categories to respondent.

  • 1: Once or twice?
  • 2: 3 to 5 times?
  • 3: 6 to 10 times?
  • 4: 11 to 20 times?
  • 5: More than 20 times?
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q09

In the past 12 months, did you ever find that you had to drink more alcohol than usual to get the same effect or that the same amount of alcohol had less effect on you than usual?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_R10

People who cut down their alcohol use or stop drinking altogether may not feel well if they have been drinking steadily for some time. These feelings are more intense and can last longer than the usual hangover.

Press <1> to continue.

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q10

In the past 12 months, did you ever have a period when you stopped, cut down, or went without alcohol and then experienced symptoms like fatigue, headaches, diarrhea, the shakes or emotional problems?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q11

(In the past 12 months,) did you ever have a period when you drank alcohol even though you promised yourself you wouldn't, or when you drank a lot more than you intended?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q12

(In the past 12 months,) did you ever have a period of several days or more when you spent so much time drinking alcohol or recovering from the effects that you had little time for anything else?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q13

(In the past 12 months,) did you ever have a period of a month or longer when you gave up or greatly reduced important activities because of your use of alcohol?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q14

(In the past 12 months,) did you ever continue to drink alcohol when you knew you had a serious physical or emotional problem that might have been caused by or made worse by your alcohol use?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Alcohol use - Dependence (ALD) - Question identifier:ALD_R15

Please tell me what number best describes how much your use of alcohol interfered with each of the following activities during the past 12 months. For each activity, answer with a number between 0 and 10; 0 means "no interference", while 10 means "very severe interference".

Press <1> to continue.

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q15A

In the past 12 months, how much did your alcohol use interfere with:

your home responsibilities, like cleaning, shopping and taking care of the house or apartment?

0 No interference
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 \/
10 Very severe interference

Min = 0; Max = 10

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q15B_1

(How much did it interfere with:)

your ability to attend school?

0 No interference
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 \/
10 Very severe interference

Min = 0; Max = 11

If necessary, enter "11" to indicate "Not applicable".

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q15B_2

(How much did it interfere with:)

your ability to work at a job?

0 No interference
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 \/
10 Very severe interference

Min = 0; Max = 11

If necessary, enter "11" to indicate "Not applicable".

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q15C

(In the past 12 months,) how much did your alcohol use interfere with your ability to form and maintain close relationships with other people? (Remember that 0 means "no interference" and 10 means "very severe interference".)

0 No interference
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 \/
10 Very severe interference

Min = 0; Max = 10

Alcohol use - Dependence (ALD) - Question identifier:ALD_Q15D

How much did it interfere with your social life?

0 No interference
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 \/
10 Very severe interference

Min = 0; Max = 10

Maternal experiences - Breastfeeding (MEX)

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_R01

The next questions are for recent mothers.

Press <1> to continue.

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q01A

Have you given birth in the past 5 years?

Do not include stillbirths.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q01B

In what year?

Min = 1900; Max = 2099

Enter year of birth of last baby. Minimum is [CURRENTYEAR - 5]; maximum is ^CURRENTYEAR.

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q02

Did you take a vitamin supplement containing folic acid before your (last) pregnancy, that is, before you found out that you were pregnant?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q03

For your last baby, did you breastfeed or try to breastfeed your baby, even if only for a short time?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q04

What is the main reason that you did not breastfeed?

  • 01: Bottle feeding easier
  • 02: Formula as good as breast milk
  • 03: Breastfeeding is unappealing / disgusting
  • 04: Father / partner didn't want me to
  • 05: Returned to work / school early
  • 06: C-Section
  • 07: Medical condition - mother
  • 08: Medical condition - baby
  • 09: Premature birth
  • 10: Multiple births (e.g. twins)
  • 11: Wanted to drink alcohol
  • 12: Wanted to smoke
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q05

Are you still breastfeeding?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q06A

How long did you breastfeed (your last baby)?

  • 01: Less than 1 week
  • 02: 1 to 2 weeks
  • 03: 3 to 4 weeks
  • 04: 5 to 8 weeks
  • 05: 9 weeks to less than 12 weeks
  • 06: 3 months (12 weeks to less than 16 weeks)
  • 07: 4 months (16 weeks to less than 20 weeks)
  • 08: 5 months (20 weeks to less than 24 weeks)
  • 09: 6 months (24 weeks to less than 28 weeks)
  • 10: 7 to 9 months
  • 11: 10 to 12 months
  • 12: More than 1 year
  • 98: RF
  • 99: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q06B

Have other liquids such as milk, formula, water, juice, tea or herbal mixture been introduced to the baby's feeds?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q06C

How old was your (last) baby when other liquids [such as milk, formula, water, juice, tea or herbal mixture/null] were first added to the baby's feeds?

If exact age not known, obtain best estimate. Other liquids may include milk, formula, water, juice, tea or herbal mixture, etc..

  • 01: Less than 1 week
  • 02: 1 to 2 weeks
  • 03: 3 to 4 weeks
  • 04: 5 to 8 weeks
  • 05: 9 weeks to less than 12 weeks
  • 06: 3 months (12 weeks to less than 16 weeks)
  • 07: 4 months (16 weeks to less than 20 weeks)
  • 08: 5 months (20 weeks to less than 24 weeks)
  • 09: 6 months (24 weeks to less than 28 weeks)
  • 10: 7 to 9 months
  • 11: 10 to 12 months
  • 12: More than 1 year
  • 13: Have not added other liquids
  • 98: RF
  • 99: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q08A

How old was your (last) baby when solid foods such as cereals, mashed up or pureed meat vegetables or fruits were first added to the baby's feeds?

If exact age not known, obtain best estimate.

  • 01: Less than 1 week
  • 02: 1 to 2 weeks
  • 03: 3 to 4 weeks
  • 04: 5 to 8 weeks
  • 05: 9 weeks to less than 12 weeks
  • 06: 3 months (12 weeks to less than 16 weeks)
  • 07: 4 months (16 weeks to less than 20 weeks)
  • 08: 5 months (20 weeks to less than 24 weeks)
  • 09: 6 months (24 weeks to less than 28 weeks)
  • 10: 7 to 9 months
  • 11: 10 to 12 months
  • 12: More than 1 year
  • 13: Have not added solid foods
  • 98: RF
  • 99: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q08B

What is the main reason [other liquids/other liquids and solid foods/solid foods] were first added to the baby's feeds?

  • 01: Not enough breast milk
  • 02: Baby was ready for solid foods
  • 03: Inconvenience / fatigue due to breastfeeding
  • 04: Difficulty with BF techniques (e.g., sore nipples, engorged breasts, mastitis)
  • 05: Medical condition - mother
  • 06: Medical condition - baby
  • 07: Advice of doctor / health professional
  • 08: Returned to work / school
  • 09: Advice of partner / family / friends
  • 10: Formula equally healthy for baby
  • 11: Wanted to drink alcohol
  • 12: Wanted to smoke
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q09A

During the time when your (last) baby was less than one year old and fed breast milk, did you give the baby a vitamin supplement containing Vitamin D?

Select "yes" if baby was fed breast milk, even in small quantities and given Vitamin D.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q09B

Overall, how often did you give the baby a supplement containing Vitamin D?

Read categories to respondent.

  • 1: Every day
  • 2: Almost every day
  • 3: Once or twice a week
  • 4: Less than once a week
  • 8: RF
  • 9: DK

Maternal experiences - Breastfeeding (MEX) - Question identifier:MEX_Q10

What is the main reason that you stopped breastfeeding?

  • 01: Not enough breast milk
  • 02: Baby was ready for solid foods
  • 03: Inconvenience / fatigue due to breastfeeding
  • 04: Difficulty with BF techniques (e.g., sore nipples, engorged breasts, mastitis)
  • 05: Medical condition - mother
  • 06: Medical condition - baby
  • 07: Planned to stop at this time
  • 08: Child weaned him / herself (e.g., baby biting, refusing breast)
  • 09: Advice of doctor / health professional
  • 10: Returned to work / school
  • 11: Advice of partner / family / friends
  • 12: Formula equally healthy for baby
  • 13: Wanted to drink alcohol
  • 14: Wanted to smoke
  • 15: Other - Specify
  • 98: RF
  • 99: DK

Maternal experiences - Alcohol use during pregnancy (MXA)

Maternal experiences - Alcohol use during pregnancy (MXA) - Question identifier:MXA_Q30

Did you drink any alcohol during your last pregnancy?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Maternal experiences - Alcohol use during pregnancy (MXA) - Question identifier:MXA_Q31

How often did you drink?

  • 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

Maternal experiences - Alcohol use during pregnancy (MXA) - Question identifier:MXA_Q32

Did you drink any alcohol while you were breastfeeding (your last baby)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Maternal experiences - Alcohol use during pregnancy (MXA) - Question identifier:MXA_Q33

How often did you drink?

  • 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

Maternal experiences - Smoking during pregnancy (MXS)

Maternal experiences - Smoking during pregnancy (MXS) - Question identifier:MXS_Q20

During your last pregnancy, did you smoke daily, occasionally or not at all?

  • 1: Daily
  • 2: Occasionally
  • 3: Not at all
  • 8: RF
  • 9: DK

Maternal experiences - Smoking during pregnancy (MXS) - Question identifier:MXS_Q21

How many cigarettes did you usually smoke each day?

Min = 1; Max = 99

Maternal experiences - Smoking during pregnancy (MXS) - Question identifier:MXS_Q22

On the days that you smoked, how many cigarettes did you usually smoke?

Min = 1; Max = 99

Maternal experiences - Smoking during pregnancy (MXS) - Question identifier:MXS_Q23

When you were breastfeeding (your last baby), did you smoke daily, occasionally or not at all?

  • 1: Daily
  • 2: Occasionally
  • 3: Not at all
  • 8: RF
  • 9: DK

Maternal experiences - Smoking during pregnancy (MXS) - Question identifier:MXS_Q24

How many cigarettes did you usually smoke each day?

Min = 1; Max = 99

Maternal experiences - Smoking during pregnancy (MXS) - Question identifier:MXS_Q25

On the days that you smoked, how many cigarettes did you usually smoke?

Min = 1; Max = 99

Maternal experiences - Smoking during pregnancy (MXS) - Question identifier:MXS_Q26

Did anyone regularly smoke in your presence during or after the pregnancy (about 6 months after)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG)

Illicit drugs use (IDG) - Question identifier:IDG_R01

I am going to ask some questions about drug use. Again, I would like to remind you that everything you say will remain strictly confidential.

Press <1> to continue.

Illicit drugs use (IDG) - Question identifier:IDG_Q01

Have you ever used or tried marijuana, cannabis or hashish?

Read categories to respondent.

  • 1: Yes, just once
  • 2: Yes, more than once
  • 3: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q02

Have you used it in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q03

How often (did you use marijuana, cannabis or hashish in the past 12 months)?

Read categories to respondent.

  • 1: Less than once a month
  • 2: 1 to 3 times a month
  • 3: Once a week
  • 4: More than once a week
  • 5: Every day
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q04

Have you ever used or tried cocaine or crack?

  • 1: Yes, just once
  • 2: Yes, more than once
  • 3: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q05

Have you used it in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q06

How often (did you use cocaine or crack in the past 12 months)?

Read categories to respondent.

  • 1: Less than once a month
  • 2: 1 to 3 times a month
  • 3: Once a week
  • 4: More than once a week
  • 5: Every day
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q07

Have you ever used or tried speed (amphetamines)?

  • 1: Yes, just once
  • 2: Yes, more than once
  • 3: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q08

Have you used it in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q09

How often (did you use speed (amphetamines) in the past 12 months)?

Read categories to respondent.

  • 1: Less than once a month
  • 2: 1 to 3 times a month
  • 3: Once a week
  • 4: More than once a week
  • 5: Every day
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q10

Have you ever used or tried ecstasy (MDMA) or other similar drugs?

  • 1: Yes, just once
  • 2: Yes, more than once
  • 3: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q11

Have you used it in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q12

How often (did you use ecstasy or other similar drugs in the past 12 months)?

Read categories to respondent.

  • 1: Less than once a month
  • 2: 1 to 3 times a month
  • 3: Once a week
  • 4: More than once a week
  • 5: Every day
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q13

Have you ever used or tried hallucinogens, PCP or LSD (acid)?

  • 1: Yes, just once
  • 2: Yes, more than once
  • 3: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q14

Have you used it in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q15

How often (did you use hallucinogens, PCP or LSD in the past 12 months)?

Read categories to respondent.

  • 1: Less than once a month
  • 2: 1 to 3 times a month
  • 3: Once a week
  • 4: More than once a week
  • 5: Every day
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q16

Did you ever sniff glue, gasoline or other solvents?

  • 1: Yes, just once
  • 2: Yes, more than once
  • 3: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q17

Did you sniff some in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q18

How often (did you sniff glue, gasoline or other solvents in the past 12 months)?

Read categories to respondent.

  • 1: Less than once a month
  • 2: 1 to 3 times a month
  • 3: Once a week
  • 4: More than once a week
  • 5: Every day
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q19

Have you ever used or tried heroin?

  • 1: Yes, just once
  • 2: Yes, more than once
  • 3: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q20

Have you used it in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q21

How often (did you use heroin in the past 12 months)?

Read categories to respondent.

  • 1: Less than once a month
  • 2: 1 to 3 times a month
  • 3: Once a week
  • 4: More than once a week
  • 5: Every day
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q22

Have you ever used or tried steroids, such as testosterone, dianabol or growth hormones, to increase your performance in a sport or activity or to change your physical appearance?

  • 1: Yes, just once
  • 2: Yes, more than once
  • 3: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q23

Have you used it in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q24

How often (did you use steroids in the past 12 months)?

Read categories to respondent.

  • 1: Less than once a month
  • 2: 1 to 3 times a month
  • 3: Once a week
  • 4: More than once a week
  • 5: Every day
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q25A

During the past 12 months, did you ever need to use more drugs than usual in order to get high, or did you ever find that you could no longer get high on the amount you usually took?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_R25B

People who cut down their substance use or stop using drugs altogether may not feel well if they have been using steadily for some time. These feelings are more intense and can last longer than the usual hangover.

Press <1> to continue.

Illicit drugs use (IDG) - Question identifier:IDG_Q25B

During the past 12 months, did you ever have times when you stopped, cut down or went without drugs and then experienced symptoms like fatigue, headaches, diarrhea, the shakes or emotional problems?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q25C

(During the past 12 months,) did you ever have times when you used drugs to keep from having such symptoms?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q25D

(During the past 12 months,) did you ever have times when you used drugs even though you promised yourself you wouldn't, or times when you used a lot more drugs than you intended?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q25E

(During the past 12 months,) were there ever times when you used drugs more frequently, or for more days in a row than you intended?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q25F

(During the past 12 months,) did you ever have periods of several days or more when you spent so much time using drugs or recovering from the effects of using drugs that you had little time for anything else?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q25G

(During the past 12 months,) did you ever have periods of a month or longer when you gave up or greatly reduced important activities because of your use of drugs?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_Q25H

(During the past 12 months,) did you ever continue to use drugs when you knew you had a serious physical or emotional problem that might have been caused by or made worse by your use?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Illicit drugs use (IDG) - Question identifier:IDG_R26

Please tell me what number best describes how much your use of drugs interfered with each of the following activities during the past 12 months. For each activity, answer with a number between 0 and 10; 0 means "no interference", while 10 means "very severe interference".

Press <1> to continue.

Illicit drugs use (IDG) - Question identifier:IDG_Q26A

How much did your use of drugs interfere with:

your home responsibilities, like cleaning, shopping and taking care of the house or apartment?

0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 10

Illicit drugs use (IDG) - Question identifier:IDG_Q26B_1

(How much did your use interfere with:)

your ability to attend school?

0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 11

If necessary, enter "11" to indicate "Not applicable".

Illicit drugs use (IDG) - Question identifier:IDG_Q26B_2

(How much did your use interfere with:)

your ability to work at a regular job?

0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 11

If necessary, enter "11" to indicate "Not applicable".

Illicit drugs use (IDG) - Question identifier:IDG_Q26C

(During the past 12 months,) how much did your use of drugs interfere with your ability to form and maintain close relationships with other people? Remember that 0 means "no interference" and 10 means "very severe interference".

0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 10

Illicit drugs use (IDG) - Question identifier:IDG_Q26D

How much did your use of drugs interfere with your social life?

0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 10

Problem gambling (CPG)

Problem gambling (CPG) - Question identifier:CPG_R01

The next questions are about gambling activities and experiences.

People have different definitions of gambling. They may bet money and gamble on many different things, including buying lottery tickets, playing bingo or playing card games with their family or friends.

Some of these questions may not apply to you; however, they need to be asked of all respondents.

Press <1> to continue.

Problem gambling (CPG) - Question identifier:CPG_Q01A

In the past 12 months, how often have you bet or spent money on instant win/scratch tickets or daily lottery tickets (Keno, Pick 3, Encore, Banco, Extra)?

Read categories to respondent.
Exclude all other kinds of lottery tickets such as 6/49, Lotto Max, sports lotteries and fund raising tickets.

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01B

(In the past 12 months,) how often have you bet or spent money on lottery tickets such as 6/49 or Lotto Max, raffles or fund-raising tickets?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01C

(In the past 12 months,) how often have you bet or spent money on Bingo?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01D

(In the past 12 months,) how often have you bet or spent money playing cards or board games with family or friends?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01E

(In the past 12 months,) how often have you bet or spent money on video lottery terminals (VLTs) outside of casinos?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01F

(In the past 12 months,) how often have you bet or spent money on coin slots or VLTs at a casino?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01G

(In the past 12 months,) how often have you bet or spent money on casino games other than coin slots or VLTs (for example, poker, roulette, blackjack, Keno)?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01H

(In the past 12 months,) how often have you bet or spent money on Internet or arcade gambling?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01I

In the past 12 months, how often have you bet or spent money on live horse racing at the track or off track?

Read categories to respondent.

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01J

(In the past 12 months,) how often have you bet or spent money on sports such as sports lotteries (Sport Select, Pro-Line, Mise-au-jeu, Total), sports pool or sporting events?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01K

(In the past 12 months,) how often have you bet or spent money on speculative investments such as stocks, options or commodities?

Speculative investments refer to buying high-risk stocks, but do not include low-risk bonds, RRSPs and/or mutual funds.

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01L

In the past 12 months, how often have you bet or spent money on games of skill such as pool, golf, bowling or darts?

Read categories to respondent.

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01M

(In the past 12 months,) how often have you bet or spent money on any other forms of gambling such as dog races, gambling at casino nights/country fairs, bet on sports with a bookie or gambling pools at work?

  • 01: Daily
  • 02: Between 2 to 6 times a week
  • 03: About once a week
  • 04: Between 2 to 3 times a month
  • 05: About once a month
  • 06: Between 6 to 11 times a year
  • 07: Between 1 to 5 times a year
  • 08: Never
  • 98: RF
  • 99: DK

Problem gambling (CPG) - Question identifier:CPG_Q01N

In the past 12 months, how much money, not including winnings, did you spend on all of your gambling activities?

Read categories to respondent.

  • 1: Between 1 dollar and 50 dollars
  • 2: Between 51 dollars and 100 dollars
  • 3: Between 101 dollars and 250 dollars
  • 4: Between 251 dollars and 500 dollars
  • 5: Between 501 dollars and 1000 dollars
  • 6: More than 1000 dollars
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_R02

The next questions are about gambling attitudes and experiences. Again, all the questions will refer to the past 12 months.

Press <1> to continue.

Problem gambling (CPG) - Question identifier:CPG_Q02

In the past 12 months, how often have you bet or spent more money than you wanted to on gambling?

Read categories to respondent.

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 5: I am not a gambler
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q03

(In the past 12 months,) how often have you needed to gamble with larger amounts of money to get the same feeling of excitement?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q04

(In the past 12 months,) when you gambled, how often did you go back another day to try to win back the money you lost?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q05

In the past 12 months, how often have you borrowed money or sold anything to get money to gamble?

Read categories to respondent.

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q06

(In the past 12 months,) how often have you felt that you might have a problem with gambling?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q07

(In the past 12 months,) how often has gambling caused you any health problems, including stress or anxiety?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q08

(In the past 12 months,) how often have people criticized your betting or told you that you had a gambling problem, regardless of whether or not you thought it was true?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q09

(In the past 12 months,) how often has your gambling caused financial problems for you or your family?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q10

In the past 12 months, how often have you felt guilty about the way you gamble or what happens when you gamble?

Read categories to respondent.

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q11

(In the past 12 months,) how often have you lied to family members or others to hide your gambling?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q12

(In the past 12 months,) how often have you wanted to stop betting money or gambling, but didn't think you could?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q13

In the past 12 months, how often have you bet more than you could really afford to lose?

Read categories to respondent.

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q14

(In the past 12 months,) have you tried to quit or cut down on your gambling but were unable to do it?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q15

(In the past 12 months,) have you gambled as a way of forgetting problems or to feel better when you were depressed?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q16

(In the past 12 months,) has your gambling caused any problems with your relationship with any of your family members or friends?

  • 1: Never
  • 2: Sometimes
  • 3: Most of the time
  • 4: Almost always
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q17

Has anyone in your family ever had a gambling problem?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_Q18

In the past 12 months, have you used alcohol or drugs while gambling?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Problem gambling (CPG) - Question identifier:CPG_R19

Please tell me what number best describes how much your gambling activities interfered with each of the following activities during the past 12 months. For each activity, answer with a number between 0 and 10; 0 means "no interference", while 10 means "very severe interference".

Press <1> to continue.

Problem gambling (CPG) - Question identifier:CPG_Q19A

During the past 12 months, how much did your gambling activities interfere with your home responsibilities, like cleaning, shopping and taking care of the house or apartment?

0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 10

Problem gambling (CPG) - Question identifier:CPG_Q19B_1

How much did these activities interfere with your ability to attend school?

0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 11

If necessary, enter "11" to indicate "Not applicable".

Problem gambling (CPG) - Question identifier:CPG_Q19B_2

How much did they interfere with your ability to work at a job?


0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 11

If necessary, enter "11" to indicate "Not applicable".

Problem gambling (CPG) - Question identifier:CPG_Q19C

(During the past 12 months,) how much did your gambling activities interfere with your ability to form and maintain close relationships with other people? (Remember that 0 means "no interference" and 10 means "very severe interference".)


0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 10

Problem gambling (CPG) - Question identifier:CPG_Q19D

How much did they interfere with your social life?


0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

Min = 0; Max = 10

Sexual behaviours (SXB)

Sexual behaviours (SXB) - Question identifier:SXB_R01

I would like to ask you a few questions about sexual behaviour. We ask these questions because sexual behaviours can have very important and long-lasting effects on personal health. You can be assured that anything you say will remain confidential.

Press <1> to continue.

Sexual behaviours (SXB) - Question identifier:SXB_Q01

Have you ever had sexual intercourse?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_Q02

How old were you the first time [you had sexual intercourse/null]?

Min = 1; Max = 121

Maximum is ^CURRENTAGE.

Sexual behaviours (SXB) - Question identifier:SXB_Q03

In the past 12 months, have you had sexual intercourse?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_Q04

With how many different partners?

  • 1: 1 partner
  • 2: 2 partners
  • 3: 3 partners
  • 4: 4 or more partners
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_Q07

Have you ever been diagnosed with a sexually transmitted infection?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_Q08

Did you use a condom the last time you had sexual intercourse?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_R9A

Now a few questions about birth control.

Press <1> to continue.

Sexual behaviours (SXB) - Question identifier:SXB_R9B

I'm going to read you a statement about pregnancy. Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.

Press <1> to continue.

Sexual behaviours (SXB) - Question identifier:SXB_Q09

It is important to me to avoid getting pregnant right now.

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_R10

I'm going to read you a statement about pregnancy. Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.

Press <1> to continue.

Sexual behaviours (SXB) - Question identifier:SXB_Q10

It is important to me to avoid getting my partner pregnant right now.

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree
  • 6: Doesn't have a partner right now
  • 7: Partner already pregnant
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_Q11

In the past 12 months, did you and your partner usually use birth control?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_Q12

What kind of birth control did you and your partner usually use?

Mark all that apply.

  • 1: Condom (male or female condom)
  • 2: Birth control pill
  • 3: Diaphragm
  • 4: Spermicide (e.g., foam, jelly, film)
  • 5: Birth control injection (Deprovera)
  • 6: Other - Specify
  • 8: RF
  • 9: DK

Sexual behaviours (SXB) - Question identifier:SXB_Q13

What kind of birth control did you and your partner use the last time you had sex?

Mark all that apply.

  • 1: Condom (male or female condom)
  • 2: Birth control pill
  • 3: Diaphragm
  • 4: Spermicide (e.g., foam, jelly, film)
  • 5: Birth control injection (Deprovera)
  • 6: Nothing
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Social Provisions (SPS)

Social Provisions (SPS) - Question identifier:SPS_R01

The next questions are about your current relationships with friends, family members, co-workers, community members, and so on. Please indicate to what extent each statement describes your current relationships with other people.

Press <1> to continue.

Social Provisions (SPS) - Question identifier:SPS_Q01

There are people I can depend on to help me if I really need it.

Read categories to respondent.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q02

There are people who enjoy the same social activities I do.

Read categories to respondent.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q03

I have close relationships that provide me with a sense of emotional security and wellbeing.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q04

There is someone I could talk to about important decisions in my life.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q05

I have relationships where my competence and skill are recognized.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q06

There is a trustworthy person I could turn to for advice if I were having problems.

Read categories to respondent.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q07

I feel part of a group of people who share my attitudes and beliefs.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q08

I feel a strong emotional bond with at least one other person.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q09

There are people who admire my talents and abilities.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions (SPS) - Question identifier:SPS_Q10

There are people I can count on in an emergency.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Consultations about mental health (CMH)

Consultations about mental health (CMH) - Question identifier:CMH_R01

Now I would like to ask you some questions about mental and emotional well-being.

Press <1> to continue.

Consultations about mental health (CMH) - Question identifier:CMH_Q01K

In the past 12 months, that is, from ^DATEONEYEARAGO to yesterday, have you seen or talked to a health professional about your emotional or mental health?

Include both face to face and telephone contacts.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Consultations about mental health (CMH) - Question identifier:CMH_Q01L

How many times (in the past 12 months)?

Min = 1; Max = 366

Consultations about mental health (CMH) - Question identifier:CMH_Q01M

Whom did you see or talk to?

Read categories to respondent. Mark all that apply.

  • 1: Family doctor or general practitioner
  • 2: Psychiatrist
  • 3: Psychologist
  • 4: Nurse
  • 5: Social worker or counsellor
  • 6: Other - Specify
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB)

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_R1

The next set of questions describes some of the ways people feel at different times. Please tell me if you have the feeling often, sometimes or never.

Press <1> to continue.

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q1

During the past few weeks, how often have you felt:

on top of the world?

Read categories to respondent.

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q2

(During the past few weeks, how often have you felt:)

very lonely or remote from other people?

Read categories to respondent.

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q3

(During the past few weeks, how often have you felt:)

particularly excited or interested in something?

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q4

(During the past few weeks, how often have you felt:)

depressed or very unhappy?

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q5

During the past few weeks, how often have you felt:

pleased about having accomplished something?

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q6

(During the past few weeks, how often have you felt:)

bored?

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q7

(During the past few weeks, how often have you felt:)

proud because someone complimented you on something you had done?

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q8

(During the past few weeks, how often have you felt:)

so restless you couldn't sit long in a chair?

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q9

(During the past few weeks, how often have you felt:)

that things were going your way?

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q10

During the past few weeks, how often have you felt:

upset because someone criticized you?

  • 1: Often
  • 2: Sometimes
  • 3: Never
  • 8: RF
  • 9: DK

Mood (Bradburn affect balance scale) (MDB) - Question identifier:MDB_Q11

Taking things all together, how would you say things are these days? Would you say you're...?

Read categories to respondent.

  • 1: very happy?
  • 2: pretty happy?
  • 3: not too happy?
  • 8: RF
  • 9: DK

Distress (DIS)

Distress (DIS) - Question identifier:DIS_R01

The following questions deal with feelings you may have had during the past month.

Press <1> to continue.

Distress (DIS) - Question identifier:DIS_Q01A

During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:

tired out for no good reason?

Read categories to respondent.

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01B

During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:

nervous?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01C

(During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:)

so nervous that nothing could calm you down?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01D

(During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:)

hopeless?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01E

During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:

restless or fidgety?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01F

(During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:)

so restless you could not sit still?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01G

(During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:)

sad or depressed?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01H

(During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:)

so depressed that nothing could cheer you up?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01I

(During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:)

that everything was an effort?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01J

(During the past month, that is, from [CURRENTDATE-1] to yesterday, about how often did you feel:)

worthless?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01K

We just talked about feelings that occurred to different degrees during the past month. Taking them altogether, did these feelings occur more often in the past month than is usual for you, less often than usual or about the same as usual?

  • 1: More often
  • 2: Less often
  • 3: About the same
  • 4: Never have had any
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01L

Is that a lot more, somewhat more or only a little more often than usual?

  • 1: A lot
  • 2: Somewhat
  • 3: A little
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01M

Is that a lot less, somewhat less or only a little less often than usual?

  • 1: A lot
  • 2: Somewhat
  • 3: A little
  • 8: RF
  • 9: DK

Distress (DIS) - Question identifier:DIS_Q01N

During the past month, how much did these feelings usually interfere with your life or activities?

Read categories to respondent.

  • 1: A lot
  • 2: Some
  • 3: A little
  • 4: Not at all
  • 8: RF
  • 9: DK

Depression (DEP)

Depression (DEP) - Question identifier:DEP_Q02

During the past 12 months, was there ever a time when you felt sad, blue, or depressed for 2 weeks or more in a row?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q03

For the next few questions, please think of the 2-week period during the past 12 months when these feelings were the worst. During that time, did these feelings usually last...?

Read categories to respondent.

  • 1: all day long
  • 2: most of the day
  • 3: about half of the day
  • 4: less than half of a day
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q04

How often did you feel this way during those 2 weeks?

Read categories to respondent.

  • 1: Every day
  • 2: Almost every day
  • 3: Less often
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q05

During those 2 weeks did you lose interest in most things?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q06

Did you feel tired out or low on energy all of the time?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q07

Did you gain weight, lose weight or stay about the same?

  • 1: Gained weight
  • 2: Lost weight
  • 3: Stayed about the same
  • 4: Was on a diet
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q08A

About how much did you [gain/lose]?

Min = 1; Max = 99

Enter amount only.

Depression (DEP) - Question identifier:DEP_N08B

Was that in pounds or in kilograms?

  • 1: Pounds
  • 2: Kilograms

Depression (DEP) - Question identifier:DEP_Q09

Did you have more trouble falling asleep than you usually do?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q10

How often did that happen?

Read categories to respondent.

  • 1: Every night
  • 2: Nearly every night
  • 3: Less often
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q11

Did you have a lot more trouble concentrating than usual?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q12

At these times, people sometimes feel down on themselves, no good or worthless. Did you feel this way?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q13

Did you think a lot about death - either your own, someone else's or death in general?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_R14

Reviewing what you just told me, you had 2 weeks in a row during the past 12 months when you were sad, blue or depressed and also had some other things like ([Losing interest/null], [Feeling tired/null], [Gaining weight/Losing weight/null], [Trouble falling asleep/null], [Trouble concentrating/null], [Feeling down on yourself/null], [Thoughts about death/null]).

Press <1> to continue.

Depression (DEP) - Question identifier:DEP_Q14

About how many weeks altogether did you feel this way during the past 12 months?

Min = 2; Max = 53

Depression (DEP) - Question identifier:DEP_Q15

Think about the last time you felt this way for 2 weeks or more in a row. In what month was that?

  • 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

Depression (DEP) - Question identifier:DEP_Q16

During the past 12 months, was there ever a time lasting 2 weeks or more when you lost interest in most things like hobbies, work or activities that usually give you pleasure?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q17

For the next few questions, please think of the 2-week period during the past 12 months when you had the most complete loss of interest in things. During that 2-week period, how long did the loss of interest usually last?

Read categories to respondent.

  • 1: All day long
  • 2: Most of the day
  • 3: About half of the day
  • 4: Less than half of a day
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q18

How often did you feel this way during those 2 weeks?

Read categories to respondent.

  • 1: Every day
  • 2: Almost every day
  • 3: Less often
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q19

During those 2 weeks did you feel tired out or low on energy all the time?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q20

Did you gain weight, lose weight, or stay about the same?

  • 1: Gained weight
  • 2: Lost weight
  • 3: Stayed about the same
  • 4: Was on a diet
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q21A

About how much did you [gain/lose]?

Min = 1; Max = 99

Enter amount only.

Depression (DEP) - Question identifier:DEP_N21B

Was that in pounds or in kilograms?

  • 1: Pounds
  • 2: Kilograms

Depression (DEP) - Question identifier:DEP_Q22

Did you have more trouble falling asleep than you usually do?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q23

How often did that happen?

Read categories to respondent.

  • 1: Every night
  • 2: Nearly every night
  • 3: Less often
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q24

Did you have a lot more trouble concentrating than usual?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q25

At these times, people sometimes feel down on themselves, no good, or worthless. Did you feel this way?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_Q26

Did you think a lot about death - either your own, someone else's, or death in general?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Depression (DEP) - Question identifier:DEP_R27

Reviewing what you just told me, you had 2 weeks in a row during the past 12 months when you lost interest in most things and also had some other things like ([Feeling tired/null], [Gaining weight/Losing weight/null], [Trouble falling asleep/null], [Trouble concentrating/null], [Feeling down on yourself/null], [Thoughts about death/null]).

Press <1> to continue.

Depression (DEP) - Question identifier:DEP_Q27

About how many weeks did you feel this way during the past 12 months?

Min = 2; Max = 53

Depression (DEP) - Question identifier:DEP_Q28

Think about the last time you had 2 weeks in a row when you felt this way. In what month was that?

  • 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

Suicidal thoughts and attempts (SUI)

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_R1

The following questions relate to the sensitive issue of suicide.

Press <1> to continue.

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_Q1

Have you ever seriously considered committing suicide or taking your own life?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_Q2

Has this happened in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_Q3

Have you ever attempted to commit suicide or tried taking your own life?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_Q4

Did this happen in the past 12 months?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_Q5

Did you see or talk to a health professional following your attempt to commit suicide?

Include both face to face and telephone contacts.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_Q6

Whom did you see or talk to?

Read categories to respondent. Mark all that apply.

  • 01: Family doctor or general practitioner
  • 02: Psychiatrist
  • 03: Psychologist
  • 04: Nurse
  • 05: Social worker or counsellor
  • 06: Religious or spiritual advisor such as a priest, chaplain or rabbi
  • 07: Teacher or guidance counsellor
  • 08: Other
  • 98: RF
  • 99: DK

Health status (SF-36) (SFR)

Health status (SF-36) (SFR) - Question identifier:SFR_R03A

Although some of the following questions may seem repetitive, the next section deals with another way of measuring health status.

Press <1> to continue.

Health status (SF-36) (SFR) - Question identifier:SFR_R03B

The questions are about how you feel and how well you are able to do your usual activities.

Press <1> to continue.

Health status (SF-36) (SFR) - Question identifier:SFR_Q03

I'll start with a few questions concerning activities you might do during a typical day. Does your health limit you in any of the following activities:

in vigorous activities, such as running, lifting heavy objects, or participating in strenuous sports?

Read categories to respondent.

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q04

(Does your health limit you:)

in moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf?

Read categories to respondent.

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q05

(Does your health limit you:)

in lifting or carrying groceries?

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q06

(Does your health limit you:)

in climbing several flights of stairs?

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q07

(Does your health limit you:)

in climbing one flight of stairs?

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q08

(Does your health limit you:)

in bending, kneeling, or stooping?

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q09

(Does your health limit you:)

in walking more than one kilometre?

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q10

(Does your health limit you:)

in walking several blocks?

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q11

(Does your health limit you:)

in walking one block?

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q12

(Does your health limit you:)

in bathing and dressing yourself?

  • 1: Limited a lot
  • 2: Limited a little
  • 3: Not at all limited
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q13

Now a few questions about problems with your work or with other regular daily activities. Because of your physical health, during the past 4 weeks, did you:

cut down on the amount of time you spent on work or other activities?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q14

Because of your physical health, during the past 4 weeks, did you:

accomplish less than you would like?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q15

(Because of your physical health, during the past 4 weeks,) were you:

limited in the kind of work or other activities?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q16

(Because of your physical health, during the past 4 weeks,) did you:

have difficulty performing the work or other activities (for example, it took extra effort)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q17

Next, a few questions about problems with your work or with other regular daily activities due to emotional problems (such as feeling depressed or anxious). Because of emotional problems, during the past 4 weeks, did you:

cut down on the amount of time you spent on work or other activities?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q18

Because of emotional problems, during the past 4 weeks, did you:

accomplish less than you would like?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q19

(Because of emotional problems, during the past 4 weeks,) did you:

not do work or other activities as carefully as usual?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q20

During the past 4 weeks, how much has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbours, or groups?

Read categories to respondent.

  • 1: Not at all
  • 2: A little bit
  • 3: Moderately
  • 4: Quite a bit
  • 5: Extremely
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q21

During the past 4 weeks, how much bodily pain have you had?

Read categories to respondent.

  • 1: None
  • 2: Very mild
  • 3: Mild
  • 4: Moderate
  • 5: Severe
  • 6: Very severe
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q22

During the past 4 weeks, how much did pain interfere with your normal work (including work both outside the home and housework)?

Read categories to respondent.

  • 1: Not at all
  • 2: A little bit
  • 3: Moderately
  • 4: Quite a bit
  • 5: Extremely
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_R23

The next questions are about how you felt and how things have been with you during the past 4 weeks. For each question, please indicate the answer that comes closest to the way you have been feeling.

Press <1> to continue.

Health status (SF-36) (SFR) - Question identifier:SFR_Q23

During the past 4 weeks, how much of the time:

did you feel full of pep?

Read categories to respondent.

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q24

(During the past 4 weeks, how much of the time:)

have you been a very nervous person?

Read categories to respondent.

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q25

(During the past 4 weeks, how much of the time:)

have you felt so down in the dumps that nothing could cheer you up?

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q26

(During the past 4 weeks, how much of the time:)

have you felt calm and peaceful?

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q27

(During the past 4 weeks, how much of the time:)

did you have a lot of energy?

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q28

During the past 4 weeks, how much of the time:

have you felt downhearted and blue?

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q29

(During the past 4 weeks, how much of the time:)

did you feel worn out?

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q30

(During the past 4 weeks, how much of the time:)

have you been a happy person?

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q31

(During the past 4 weeks, how much of the time:)

did you feel tired?

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q32

During the past 4 weeks, how much of the time has your health limited your social activities (such as visiting with friends or close relatives)?

  • 1: All of the time
  • 2: Most of the time
  • 3: A good bit of the time
  • 4: Some of the time
  • 5: A little of the time
  • 6: None of the time
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q33

Now please tell me the answer that best describes how true or false each of the following statements is for you.

[I/^FNAME] seem to get sick a little easier than other people.

Read categories to respondent.

  • 1: Definitely true
  • 2: Mostly true
  • 3: Not sure
  • 4: Mostly false
  • 5: Definitely false
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q34

(Please tell me the answer that best describes how true or false each of the following statements is for you.)

[I/^FNAME] [am/is] as healthy as anybody [I/he/she] know.

Read categories to respondent.

  • 1: Definitely true
  • 2: Mostly true
  • 3: Not sure
  • 4: Mostly false
  • 5: Definitely false
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q35

(Please tell me the answer that best describes how true or false each of the following statements is for you.)

[I/^FNAME] expect [my/his/her] health to get worse.

  • 1: Definitely true
  • 2: Mostly true
  • 3: Not sure
  • 4: Mostly false
  • 5: Definitely false
  • 8: RF
  • 9: DK

Health status (SF-36) (SFR) - Question identifier:SFR_Q36

(Please tell me the answer that best describes how true or false each of the following statements is for you.)

[My/^FNAME's] health is excellent.

  • 1: Definitely true
  • 2: Mostly true
  • 3: Not sure
  • 4: Mostly false
  • 5: Definitely false
  • 8: RF
  • 9: DK

Access to health care services (ACC)

Access to health care services (ACC) - Question identifier:ACC_R10

The next questions are about the use of various health care services.

I will start by asking about your experiences getting health care from a medical specialist such as a cardiologist, allergist, [urologist/gynaecologist] or psychiatrist (excluding an optometrist)

Press <1> to continue.

Access to health care services (ACC) - Question identifier:ACC_Q10

In the past 12 months, did you require a visit to a medical specialist for a diagnosis or a consultation?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q11

In the past 12 months, did you ever experience any difficulties getting the specialist care you needed for a diagnosis or consultation?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q12

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty getting a referral
  • 02: Difficulty getting an appointment
  • 03: No specialists in the area
  • 04: Waited too long - between booking appointment and visit
  • 05: Waited too long - to see the doctor (i.e. in-office waiting)
  • 06: Transportation - problems
  • 07: Language - problem
  • 08: Cost
  • 09: Personal or family responsibilities
  • 10: General deterioration of health
  • 11: Appointment cancelled or deferred by specialist
  • 12: Still waiting for visit
  • 13: Unable to leave the house because of a health problem
  • 14: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_R20

The following questions are about any surgery not provided in an emergency that you may have required, such as cardiac surgery, joint surgery, like knee or hip, caesarean sections and cataract surgery, excluding laser eye surgery.

Press <1> to continue.

Access to health care services (ACC) - Question identifier:ACC_Q20

In the past 12 months, did you require any non-emergency surgery?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q21

In the past 12 months, did you ever experience any difficulties getting the surgery you needed?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q22

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty getting an appointment with a surgeon
  • 02: Difficulty getting a diagnosis
  • 03: Waited too long - for a diagnostic test
  • 04: Waited too long - for a hospital bed to become available
  • 05: Waited too long - for surgery
  • 06: Service not available - in the area
  • 07: Transportation - problems
  • 08: Language - problem
  • 09: Cost
  • 10: Personal or family responsibilities
  • 11: General deterioration of health
  • 12: Appointment cancelled or deferred by surgeon or hospital
  • 13: Still waiting for surgery
  • 14: Unable to leave the house because of a health problem
  • 15: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_R30

Now some questions about MRIs, CAT Scans and angiographies provided in a non-emergency situation.

Press <1> to continue.

Access to health care services (ACC) - Question identifier:ACC_Q30

In the past 12 months, did you require one of these tests?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q31

In the past 12 months, did you ever experience any difficulties getting the tests you needed?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q32

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty getting a referral
  • 02: Difficulty getting an appointment
  • 03: Waited too long - to get an appointment
  • 04: Waited too long - to get test (i.e. in-office waiting)
  • 05: Service not available - at time required
  • 06: Service not available - in the area
  • 07: Transportation - problems
  • 08: Language - problem
  • 09: Cost
  • 10: General deterioration of health
  • 11: Did not know where to go (i.e. information problems)
  • 12: Still waiting for test
  • 13: Unable to leave the house because of a health problem
  • 14: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_R40A

Now I'd like you to think about yourself and family members living in your dwelling.

The next questions are about your experiences getting health information or advice when you needed it for yourself or a family member living in your dwelling.

Press <1> to continue.

Access to health care services (ACC) - Question identifier:ACC_R40B

The next questions are about your experiences getting health information or advice when you needed it.

Press <1> to continue.

Access to health care services (ACC) - Question identifier:ACC_Q40

In the past 12 months, have you required health information or advice [null/for yourself or a family member]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q40A

Who did you contact when you needed health information or advice [null/for yourself or a family member]?

Read categories to respondent. Mark all that apply.

  • 1: Doctor's office
  • 2: Community health centre / CLSC
  • 3: Walk-in clinic
  • 4: Telephone health line (for example, HealthLinks, Telehealth Ontario, Health-Line, TeleCare, Info-Santé)
  • 5: Hospital emergency room
  • 6: Other hospital service
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q41

In the past 12 months, did you ever experience any difficulties getting the health information or advice [null/for yourself or a family member]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q42

Did you experience difficulties during "regular" office hours (that is, 9:00 am to 5:00 pm, Monday to Friday)?

It is important to make a distinction between "No" (Did not experience problems) and "Not required at this time".

  • 1: Yes
  • 2: No
  • 3: Not required at this time
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q43

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty contacting a physician or nurse
  • 02: Did not have a phone number
  • 03: Could not get through (i.e. no answer)
  • 04: Waited too long to speak to someone
  • 05: Did not get adequate info or advice
  • 06: Language - problem
  • 07: Did not know where to go / call / uninformed
  • 08: Unable to leave the house because of a health problem
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_Q44

Did you experience difficulties getting health information or advice during evenings and weekends (that is, 5:00 to 9:00 pm Monday to Friday, or 9:00 am to 5:00 pm, Saturdays and Sundays)?

It is important to make a distinction between "No" (Did not experience problems) and "Not required at this time".

  • 1: Yes
  • 2: No
  • 3: Not required at this time
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q45

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty contacting a physician or nurse
  • 02: Did not have a phone number
  • 03: Could not get through (i.e. no answer)
  • 04: Waited too long to speak to someone
  • 05: Did not get adequate info or advice
  • 06: Language - problem
  • 07: Did not know where to go / call / uninformed
  • 08: Unable to leave the house because of a health problem
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_Q46

Did you experience difficulties getting health information or advice during the middle of the night?

It is important to make a distinction between "No" (Did not experience problems) and "Not required at this time".

  • 1: Yes
  • 2: No
  • 3: Not required at this time
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q47

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty contacting a physician or nurse
  • 02: Did not have a phone number
  • 03: Could not get through (i.e. no answer)
  • 04: Waited too long to speak to someone
  • 05: Did not get adequate info or advice
  • 06: Language - problem
  • 07: Did not know where to go / call / uninformed
  • 08: Unable to leave the house because of a health problem
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_R50A

Now some questions about your experiences when you needed health care services for routine or on-going care such as a medical exam or follow-up for yourself or a family member living in your dwelling.

Press <1> to continue.

Access to health care services (ACC) - Question identifier:ACC_R50B

Now some questions about your experiences when you needed health care services for routine or on-going care such as a medical exam or follow-up.

Press <1> to continue.

Access to health care services (ACC) - Question identifier:ACC_Q50A

Do you have a regular family doctor?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q50

In the past 12 months, did you require any routine or on-going care [null/for yourself or a family member]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q51

In the past 12 months, did you ever experience any difficulties getting the routine or on-going care [you/you or a family member] needed?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q52

Did you experience difficulties getting such care during "regular" office hours (that is, 9:00 am to 5:00 pm, Monday to Friday)?

It is important to make a distinction between "No" (Did not experience problems) and "Not required at this time".

  • 1: Yes
  • 2: No
  • 3: Not required at this time
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q53

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty contacting a physician
  • 02: Difficulty getting an appointment
  • 03: Do not have personal / family physician
  • 04: Waited too long - to get an appointment
  • 05: Waited too long - to see the doctor (i.e. in-office waiting)
  • 06: Service not available - at time required
  • 07: Service not available - in the area
  • 08: Transportation - problems
  • 09: Language - problem
  • 10: Cost
  • 11: Did not know where to go (i.e. information problems)
  • 12: Unable to leave the house because of a health problem
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_Q54

Did you experience difficulties getting such care during evenings and weekends (that is, 5:00 to 9:00 pm, Monday to Friday or 9:00 am to 5:00 pm, Saturdays and Sundays)?

It is important to make a distinction between "No" (Did not experience problems) and "Not required at this time".

  • 1: Yes
  • 2: No
  • 3: Not required at this time
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q55

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty contacting a physician
  • 02: Difficulty getting an appointment
  • 03: Do not have personal / family physician
  • 04: Waited too long - to get an appointment
  • 05: Waited too long - to see the doctor (i.e. in-office waiting)
  • 06: Service not available - at time required
  • 07: Service not available - in the area
  • 08: Transportation - problems
  • 09: Language - problem
  • 10: Cost
  • 11: Did not know where to go (i.e. information problems)
  • 12: Unable to leave the house because of a health problem
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_R60

The next questions are about situations when [you/you or a family member] have needed immediate care for a minor health problem such as fever, headache, a sprained ankle, vomiting or an unexplained rash.

Press <1> to continue.

Access to health care services (ACC) - Question identifier:ACC_Q60

In the past 12 months, did [you/you or a family member] require immediate health care services for a minor health problem?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q61

In the past 12 months, did you ever experience any difficulties getting the immediate care needed for a minor health problem [null/for yourself or a family member]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q62

Did you experience difficulties getting such care during "regular" office hours (that is, 9:00 am to 5:00 pm, Monday to Friday)?

It is important to make a distinction between "No" (Did not experience problems) and "Not required at this time".

  • 1: Yes
  • 2: No
  • 3: Not required at this time
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q63

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty contacting a physician
  • 02: Difficulty getting an appointment
  • 03: Do not have personal / family physician
  • 04: Waited too long - to get an appointment
  • 05: Waited too long - to see the doctor (i.e. in-office waiting)
  • 06: Service not available - at time required
  • 07: Service not available - in the area
  • 08: Transportation - problems
  • 09: Language - problem
  • 10: Cost
  • 11: Did not know where to go (i.e. information problems)
  • 12: Unable to leave the house because of a health problem
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_Q64

Did you experience difficulties getting such care during evenings and weekends (that is, 5:00 to 9:00 pm, Monday to Friday or 9:00 am to 5:00 pm, Saturdays and Sundays)?

It is important to make a distinction between "No" (Did not experience problems) and "Not required at this time".

  • 1: Yes
  • 2: No
  • 3: Not required at this time
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q65

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty contacting a physician
  • 02: Difficulty getting an appointment
  • 03: Do not have personal / family physician
  • 04: Waited too long - to get an appointment
  • 05: Waited too long - to see the doctor (i.e. in-office waiting)
  • 06: Service not available - at time required
  • 07: Service not available - in the area
  • 08: Transportation - problems
  • 09: Language - problem
  • 10: Cost
  • 11: Did not know where to go (i.e. information problems)
  • 12: Unable to leave the house because of a health problem
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_Q66

Did you experience difficulties getting such care during the middle of the night?

It is important to make a distinction between "No" (Did not experience problems) and "Not required at this time".

  • 1: Yes
  • 2: No
  • 3: Not required at this time
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q67

What type of difficulties did you experience?

Mark all that apply.

  • 01: Difficulty contacting a physician
  • 02: Difficulty getting an appointment
  • 03: Do not have personal / family physician
  • 04: Waited too long - to get an appointment
  • 05: Waited too long - to see the doctor (i.e. in-office waiting)
  • 06: Service not available - at time required
  • 07: Service not available - in the area
  • 08: Transportation - problems
  • 09: Language - problem
  • 10: Cost
  • 11: Did not know where to go (i.e. information problems)
  • 12: Unable to leave the house because of a health problem
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Waiting times (WTM)

Waiting times (WTM) - Question identifier:WTM_R01

Now some additional questions about your experiences waiting for health care services.

Press <1> to continue.

Waiting times (WTM) - Question identifier:WTM_Q02A

You mentioned that you required a visit to a medical specialist such as a cardiologist, allergist [null/, gynaecologist] or psychiatrist.

In the past 12 months, did you require a visit to a medical specialist for a diagnosis or a consultation for a new illness or condition?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q02B

For what type of condition?

If you have had more than one such visit, please answer for the most recent visit.

Read categories to respondent.

  • 01: Heart condition or stroke
  • 02: Cancer
  • 03: Asthma or other breathing conditions
  • 04: Arthritis
  • 05: Cataract or other eye conditions
  • 06: Mental health disorder
  • 07: Skin conditions
  • 08: [Gynaecological problems/null]
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Waiting times (WTM) - Question identifier:WTM_Q03

Were you referred by...?

Read categories to respondent.

  • 1: A family doctor
  • 2: Another specialist
  • 3: Another health care provider
  • 4: Did not require a referral
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q04

Have you already visited the medical specialist?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q05

Thinking about this visit, did you experience any difficulties seeing the specialist?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q06

What type of difficulties did you experience?

Mark all that apply. Question ACC_Q12 previously asked about any difficulties getting specialist care. This question (WTM_Q06) deals with difficulties experienced for the most recent visit for a new illness or condition.

  • 01: Difficulty getting a referral
  • 02: Difficulty getting an appointment
  • 03: No specialists in the area
  • 04: Waited too long - between booking appointment and visit
  • 05: Waited too long - to see the doctor (i.e. in-office waiting)
  • 06: Transportation - problems
  • 07: Language - problem
  • 08: Cost
  • 09: Personal or family responsibilities
  • 10: General deterioration of health
  • 11: Appointment cancelled or deferred by specialist
  • 12: Unable to leave the house because of a health problem
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Waiting times (WTM) - Question identifier:WTM_Q07A

How long did you have to wait between when [you and your doctor decided that you should see a specialist/you and your health care provider decided that you should see a specialist/the appointment was initially scheduled] and when you actually visited the specialist?

Min = 1; Max = 365

Probe to get the most precise answer possible.

Waiting times (WTM) - Question identifier:WTM_N07B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q08A

How long have you been waiting since [you and your doctor decided that you should see a specialist/you and your health care provider decided that you should see a specialist/the appointment was initially scheduled]?

Min = 1; Max = 365

Probe to get the most precise answer possible.

Waiting times (WTM) - Question identifier:WTM_N08B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q10

In your view, [was the waiting time/has the waiting time been]...?

Read categories to respondent. It is important to make a distinction between "No view" and "Don't Know".

  • 1: Acceptable
  • 2: Not acceptable
  • 3: No view
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q11A

In this particular case, what do you think is an acceptable waiting time?

Min = 1; Max = 365

Waiting times (WTM) - Question identifier:WTM_N11B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q12

Was your visit cancelled or postponed at any time?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q13

Was it cancelled or postponed by...?

Read categories to respondent. Mark all that apply.

  • 1: Yourself
  • 2: The specialist
  • 3: Other - Specify
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q14

Do you think that your health, or other aspects of your life, have been affected in any way because you had to wait for this visit?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q15

How was your life affected as a result of waiting for this visit?

Mark all that apply.

  • 01: Worry, anxiety, stress
  • 02: Worry or stress for family or friends
  • 03: Pain
  • 04: Problems with activities of daily living (e.g., dressing, driving)
  • 05: Loss of work
  • 06: Loss of income
  • 07: Increased dependence on relatives/friends
  • 08: Increased use of over-the-counter drugs
  • 09: Overall health deteriorated, condition got worse
  • 10: Health problem improved
  • 11: Personal relationships suffered
  • 12: Other - Specify
  • 98: RF
  • 99: DK

Waiting times (WTM) - Question identifier:WTM_Q16

You mentioned that in the past 12 months you required non emergency surgery.

What type of surgery did you require? If you have had more than one in the past 12 months, please answer for the most recent surgery.

Read categories to respondent.

  • 1: Cardiac surgery
  • 2: Cancer related surgery
  • 3: Hip or knee replacement surgery
  • 4: Cataract or other eye surgery
  • 5: [Hysterectomy (Removal of uterus)/null]
  • 6: Removal of gall bladder
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q17

Did you already have this surgery?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q18

Did the surgery require an overnight hospital stay?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q19

Did you experience any difficulties getting this surgery?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q20

What type of difficulties did you experience?

Mark all that apply. ACC_Q22 asked previously about any difficulties experienced getting the surgery you needed. This question (WTM_Q20) refers to difficulties experienced for the most recent non emergency surgery.

  • 01: Difficulty getting an appointment with a surgeon
  • 02: Difficulty getting a diagnosis
  • 03: Waited too long - for a diagnostic test
  • 04: Waited too long - for a hospital bed to become available
  • 05: Waited too long - for surgery
  • 06: Service not available - in the area
  • 07: Transportation - problems
  • 08: Language - problem
  • 09: Cost
  • 10: Personal or family responsibilities
  • 11: General deterioration of health
  • 12: Appointment cancelled or deferred by surgeon or hospital
  • 13: Unable to leave the house because of a health problem
  • 14: Other - Specify
  • 98: RF
  • 99: DK

Waiting times (WTM) - Question identifier:WTM_Q21A

How long did you have to wait between when you and the surgeon decided to go ahead with surgery and the day of surgery?

Min = 1; Max = 365

Probe to get the most precise answer possible.

Waiting times (WTM) - Question identifier:WTM_N21B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q22

Will the surgery require an overnight hospital stay?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q23A

How long have you been waiting since you and the surgeon decided to go ahead with the surgery?

Min = 1; Max = 365

Probe to get the most precise answer possible.

Waiting times (WTM) - Question identifier:WTM_N23B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q24

In your view, [was the waiting time/has the waiting time been]...?

Read categories to respondent. It is important to make a distinction between "No view" and "Don't Know".

  • 1: Acceptable
  • 2: Not acceptable
  • 3: No view
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q25A

In this particular case, what do you think is an acceptable waiting time?

Min = 1; Max = 365

Waiting times (WTM) - Question identifier:WTM_N25B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q26

Was your surgery cancelled or postponed at any time?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q27

Was it cancelled or postponed by...?

Read categories to respondent. Mark all that apply.

  • 1: Yourself
  • 2: The surgeon
  • 3: The hospital
  • 4: Other - Specify
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q28

Do you think that your health, or other aspects of your life, have been affected in any way due to waiting for this surgery?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q29

How was your life affected as a result of waiting for surgery?

Mark all that apply.

  • 01: Worry, anxiety, stress
  • 02: Worry or stress for family or friends
  • 03: Pain
  • 04: Problems with activities of daily living (e.g., dressing, driving)
  • 05: Loss of work
  • 06: Loss of income
  • 07: Increased dependence on relatives/friends
  • 08: Increased use of over-the-counter drugs
  • 09: Overall health deteriorated, condition got worse
  • 10: Health problem improved
  • 11: Personal relationships suffered
  • 12: Other - Specify
  • 98: RF
  • 99: DK

Waiting times (WTM) - Question identifier:WTM_Q30

Now for MRIs, CAT Scans and angiographies provided in a non emergency situation.

You mentioned that in the past 12 months you required one of these tests.

What type of test did you require?

If you have had more than one in the past 12 months, please answer for the most recent test.

Read categories to respondent.

  • 1: MRI (Magnetic Resonance Imaging)
  • 2: CAT Scan (Computed Axial Tomography)
  • 3: Angiography (Cardiac Test)
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q31

For what type of condition?

Read categories to respondent.

  • 1: Heart disease or stroke
  • 2: Cancer
  • 3: Joints or fractures
  • 4: Neurological or brain disorders (e.g., for MS, migraine or headaches)
  • 5: Other - Specify
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q32

Did you already have this test?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q33

Where was the test done?

Read categories to respondent.

  • 1: Hospital
  • 2: Public clinic
  • 3: Private clinic
  • 4: Other - Specify
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q34

Was the clinic located...?

Read categories to respondent.

  • 1: In your province
  • 2: In another province
  • 3: Other - Specify
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q35

Were you a patient in a hospital at the time of the test?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q36

Did you experience any difficulties getting this test?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q37

What type of difficulties did you experience?

Mark all that apply. ACC_Q32 asked previously about any difficulties experienced getting the tests you needed. This question (WTM_Q37) refers to difficulties experienced for the most recent diagnostic test.

  • 01: Difficulty getting a referral
  • 02: Difficulty getting an appointment
  • 03: Waited too long - to get an appointment
  • 04: Waited too long - to get test (i.e. in-office waiting)
  • 05: Service not available - at time required
  • 06: Service not available - in the area
  • 07: Transportation - problems
  • 08: Language - problem
  • 09: Cost
  • 10: General deterioration of health
  • 11: Did not know where to go (i.e. information problems)
  • 12: Unable to leave the house because of a health problem
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Waiting times (WTM) - Question identifier:WTM_Q38A

How long did you have to wait between when you and your doctor decided to go ahead with the test and the day of the test?

Min = 1; Max = 365

Probe to get the most precise answer possible.

Waiting times (WTM) - Question identifier:WTM_N38B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q39A

How long have you been waiting for the test since you and your doctor decided to go ahead with the test?

Min = 1; Max = 365

Probe to get the most precise answer possible.

Waiting times (WTM) - Question identifier:WTM_N39B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q40

In your view, [was the waiting time/has the waiting time been]...?

Read categories to respondent. It is important to make a distinction between "No view" and "Don't Know".

  • 1: Acceptable
  • 2: Not acceptable
  • 3: No view
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q41A

In this particular case, what do you think is an acceptable waiting time?

Min = 1; Max = 365

Waiting times (WTM) - Question identifier:WTM_N41B

Enter unit of time.

  • 1: Days
  • 2: Weeks
  • 3: Months

Waiting times (WTM) - Question identifier:WTM_Q42

Was your test cancelled or postponed at any time?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q43

Was it cancelled or postponed by...?

Read categories to respondent.

  • 1: Yourself
  • 2: The specialist
  • 3: The hospital
  • 4: The clinic
  • 5: Other - Specify
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q44

Do you think that your health, or other aspects of your life, have been affected in any way due to waiting for this test?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Waiting times (WTM) - Question identifier:WTM_Q45

How was your life affected as a result of waiting for this test?

Mark all that apply.

  • 01: Worry, anxiety, stress
  • 02: Worry or stress for family or friends
  • 03: Pain
  • 04: Problems with activities of daily living (e.g., dressing, driving)
  • 05: Loss of work
  • 06: Loss of income
  • 07: Increased dependence on relatives/friends
  • 08: Increased use of over-the-counter drugs
  • 09: Overall health deteriorated, condition got worse
  • 10: Health problem improved
  • 11: Personal relationships suffered
  • 12: Other - Specify
  • 98: RF
  • 99: 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.

Press <1> to continue.

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.

If person currently holds more than one job, report on the job for which the number of hours worked per week is the greatest.

Press <1> to continue.

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

Enter the full name of the business.
If there is no business name, enter the respondent's full name.

Labour force (LBS) - Question identifier:LBS_Q33

For whom do you work?

Long Answer Length = 50

Enter the full name of the company, business, government department or agency, or person.

Labour force (LBS) - Question identifier:LBS_Q34

What kind of business, industry or service is this?

Long Answer Length = 50

Enter a detailed description.

For example:
New home construction
Primary school
Municipal police
Wheat farm
Retail shoe store
Food wholesale
Car parts factory
Federal government

Labour force (LBS) - Question identifier:LBS_Q35

What is your work or occupation?

Long Answer Length = 50

Enter a detailed description.

For example: legal secretary, plumber, fishing guide,
wood furniture assembler, secondary school teacher,
computer programmer.

Labour force (LBS) - Question identifier:LBS_Q36

In this work, what are your main activities?

Long Answer Length = 50

Enter a detailed description.

For example: prepare legal documents, install residential plumbing, guide fishing parties, make wood furniture products, teach mathematics, develop software.

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

Minimum is 1; maximum is (168 - LBS_Q37).

Loss of Productivity (LOP)

Loss of Productivity (LOP) - Question identifier:LOP_Q015

Did you work at a job or a business at any time in the past three months?

Include only paid job or business.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Loss of Productivity (LOP) - Question identifier:LOP_Q020

What is the main reason that you have not worked at a job or business in the past three months?

If respondent wants to report more than one reason, ask for the main one.

  • 01: Chronic physical or mental health condition diagnosed by a health professional
  • 02: Own injury such as broken bone, bad cut, burn or sprain
  • 03: Own infectious disease such as a cold, flu or stomach flu
  • 04: Other reason related to physical or mental health
  • 05: Caring for own children
  • 06: Caring for elderly relative(s)
  • 07: Maternity, paternity or parental leave
  • 08: Education, training or school
  • 09: Temporary lay-off
  • 10: Strike or lockout
  • 11: Retired
  • 12: Other
  • 98: RF
  • 99: DK

Loss of Productivity (LOP) - Question identifier:LOP_R030

The next questions are about absence from work because of your OWN health. Please include consultations with health professionals, but exclude absences because of the health of another person.

Press <1> to continue.

Loss of Productivity (LOP) - Question identifier:LOP_Q030

In the past three months, that is from ^DATETHREEMONTHSAGO to yesterday, have you missed any days at work because of a chronic health condition?

By chronic condition, we mean a long-term physical or mental condition that is expected to last or have already lasted 6 months or more and that has been diagnosed by a health professional.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Loss of Productivity (LOP) - Question identifier:LOP_Q040

How many days of work have you missed because of a chronic condition?

Min = 1; Max = 90

Don't enter days for which time has been made up. Enter 1 day if respondent reports less than one day.

Loss of Productivity (LOP) - Question identifier:LOP_Q050

Which chronic condition was this?

If the respondent wants to report more than one condition, probe for the main reason or the one that has required the highest number of days of absence.

  • 01: Arthritis (such as rheumatoid arthritis, osteoarthritis, lupus or gout)
  • 02: Osteoporosis
  • 03: Cardiovascular disease (including stroke and hypertension)
  • 04: Kidney disease
  • 05: Asthma
  • 06: Chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD)
  • 07: Diabetes
  • 08: Migraine
  • 09: Back problems
  • 10: Cancer
  • 11: Mental illnesses (such as depression bipolar disorder, mania or schizophrenia)
  • 12: Neurological diseases (such as Alzheimer, dementia, Parkinson's disease, multiple sclerosis, spina bifida)
  • 13: Digestive diseases (such as celiac disease, irritable bowel syndrome, stomach ulcers)
  • 14: Fibromyalgia, chronic fatigue syndrome or multiple chemical sensitivities
  • 15: Other - Specify
  • 98: RF
  • 99: DK

Loss of Productivity (LOP) - Question identifier:LOP_Q060

In the past three months, have you missed any days at work because of an injury such as a broken bone, a bad cut, a burn or a sprain?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Loss of Productivity (LOP) - Question identifier:LOP_Q070

How many days of work have you missed (because of an injury)?

Min = 1; Max = 90

Don't enter days for which time has been made up. Enter 1 day if respondent reports less than one day.

Loss of Productivity (LOP) - Question identifier:LOP_Q080

In the past three months, have you missed any days at work because of an infectious disease such as a cold, a stomach flu or a respiratory infection?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Loss of Productivity (LOP) - Question identifier:LOP_Q081

Which infectious disease was this?

Read categories to respondent. Mark all that apply.

  • 1: Cold
  • 2: Flu or influenza
  • 3: Stomach flu
  • 4: Respiratory infection
  • 5: Other
  • 8: RF
  • 9: DK

Loss of Productivity (LOP) - Question identifier:LOP_Q082

How many days of work have you missed because of a cold?

Min = 1; Max = 90

Symptoms of a cold include a runny nose, congestion and a cough. Don't enter days for which time has been made up.

Loss of Productivity (LOP) - Question identifier:LOP_Q083

How many days of work have you missed because of a flu or influenza?

Min = 1; Max = 90

Symptoms of influenza include fever, headache and body aches. Don't enter days for which time has been made up.

Loss of Productivity (LOP) - Question identifier:LOP_Q084

How many days of work have you missed because of a stomach flu?

Min = 1; Max = 90

Symptoms of stomach flu include nausea, vomiting, stomach cramps and diarrhea. Don't enter days for which time has been made up.

Loss of Productivity (LOP) - Question identifier:LOP_Q085

How many days of work have you missed because of another respiratory infection such as pneumonia or bronchitis?

Min = 1; Max = 90

Don't enter days for which time has been made up.

Loss of Productivity (LOP) - Question identifier:LOP_Q086

How many days of work have you missed because of any other infectious disease?

Min = 1; Max = 90

Don't enter days for which time has been made up.

Loss of Productivity (LOP) - Question identifier:LOP_Q090

In the past three months, have you been absent from work because of any other reason related to your physical or mental health?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Loss of Productivity (LOP) - Question identifier:LOP_Q100

How many days of work have you missed because of another reason related to your own physical or mental health?

Min = 1; Max = 90

Don't enter days for which time has been made up. Enter 1 day if respondent reports less than one day.

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.

Press <1> to continue.

Education of selected respondent (EDU) - Question identifier:EDU_Q05

Are you currently attending a school, college, cegep or university?

Ask respondent to include attendance only for courses that can be used as credit towards a certificate, diploma or degree.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Education of selected respondent (EDU) - Question identifier:EDU_Q06

Are you enrolled as...?

Read categories to respondent.

  • 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?

Ask the respondent to specify country of birth according to current boundaries. Start typing the name of the country of birth to activate function. Enter (CAN) to select Canada. Enter "Other - Specify" to capture a name of the country that is not part of the list.

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

The respondent may have first come to live in Canada on a work or study permit or by claiming refugee status. If the respondent moved to Canada more than once, enter the first year they arrived in Canada (excluding holiday time spent in Canada).

If the respondent cannot give the exact year of arrival in Canada, ask for a best estimate of the year.

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)

Mark all that apply. An ancestor is usually more distant than a grandparent. If "Canadian" is the only response, probe. If the respondent hesitates, do not suggest Canadian. If the respondent answers "Eskimo", enter "20".

  • 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.

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: 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?

Read categories to respondent and mark up to 4 responses that apply.

If respondent answers "mixed" or "bi-racial", or "multi-racial", etc probe for specific groups and mark each one separately (e.g. White, Black, Chinese).

Aboriginal people or First Nations are not included in the list of response categories because the Employment Equity Act defines visible minorities as "persons, other than Aboriginal persons, who are non-Caucasian in race or non-white in "colour". Guidelines state that "Due to their status as First Nation people, Aboriginal peoples are specifically excluded from the definition".

Under the Employment Equity Act, Aboriginal Peoples are considered to be a separate designated group.

  • 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...?

Read categories to respondent.

  • 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?

Mark up to three responses. Multiple responses are accepted only if languages are spoken equally 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?

Mark up to three responses. If the respondent no longer understands the first language learned, indicate the second language learned. Accept multiple responses only if languages were learned at the same time.

Socio-demographic characteristics (SDC) - Question identifier:SDC_R7

Now a question about the dwelling in which you live.

Press <1> to continue.

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q7A

Is this dwelling?

Read categories to respondent. If the respondent's household contains both owners and renters, such as a boarder, the dwelling should be considered owned.

  • 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.

Press <1> to continue.

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q7B

Do you consider yourself to be...?

Read categories to respondent.

  • 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.

The personal identifiers (names, addresses and telephone numbers) will not be provided to Health Canada or the Public Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.

Press <1> to continue.

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.

The personal identifiers (names, addresses and telephone numbers) will not be provided to Health Canada or the Public Health Agency of Canada.

Press <1> to continue.

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.

The personal identifiers (names, addresses or telephone numbers) will not be provided to Health Canada or the Public Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.

Press <1> to continue.

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.

Press <1> to continue.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q020

Who would this person be?

Select most knowledgeable person from the household roster.

  • 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.

Press <1> to continue.

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].

Press <1> to continue.

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.

You should continue with the most knowledgeable person about the household.

Press < 1> to continue.

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.

Press <1> to continue.

Insurance coverage (INS)

Insurance coverage (INS) - Question identifier:INS_R1

Now, turning to your insurance coverage. Please include any private, government or employer-paid plans.

Press <1> to continue.

Insurance coverage (INS) - Question identifier:INS_Q1

Do you have insurance that covers all or part of the cost of:

your prescription medications?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Insurance coverage (INS) - Question identifier:INS_Q1A

Is it...?

Read categories to respondent. Mark all that apply.

  • 1: A government-sponsored plan
  • 2: An employer-sponsored plan
  • 3: A private plan
  • 8: RF
  • 9: DK

Insurance coverage (INS) - Question identifier:INS_Q2

(Do you have insurance that covers all or part of:)

your dental expenses?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Insurance coverage (INS) - Question identifier:INS_Q2A

Is it...?

Read categories to respondent. Mark all that apply.

  • 1: A government-sponsored plan
  • 2: An employer-sponsored plan
  • 3: A private plan
  • 8: RF
  • 9: DK

Insurance coverage (INS) - Question identifier:INS_Q3

(Do you have insurance that covers all or part of:)

the costs of eye glasses or contact lenses?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Insurance coverage (INS) - Question identifier:INS_Q3A

Is it...?

Read categories to respondent. Mark all that apply.

  • 1: A government-sponsored plan
  • 2: An employer-sponsored plan
  • 3: A private plan
  • 8: RF
  • 9: DK

Insurance coverage (INS) - Question identifier:INS_Q4

(Do you have insurance that covers all or part of:)

hospital charges for a private or semi-private room?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Insurance coverage (INS) - Question identifier:INS_Q4A

Is it...?

Read categories to respondent. Mark all that apply.

  • 1: A government-sponsored plan
  • 2: An employer-sponsored plan
  • 3: A private plan
  • 8: RF
  • 9: DK

Food security (FSC)

Food security (FSC) - Question identifier:FSC_R010

The following questions are about the food situation for your household in the past 12 months.

Press <1> to continue.

Food security (FSC) - Question identifier:FSC_Q010

Which of the following statements best describes the food eaten in your household in the past 12 months, that is, since ^CURRENTMONTH of last year?

Read categories to respondent.

  • 1: [You/You and other household members] always had enough of the kinds of food you wanted to eat.
  • 2: [You/You and other household members] had enough to eat, but not always the kinds of food you wanted.
  • 3: Sometimes [you/you and other household members] did not have enough to eat.
  • 4: Often [you/you and other household members] didn't have enough to eat.
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_R020

Now I'm going to read you several statements that may be used to describe the food situation for a household. Please tell me if the statement was often true, sometimes true, or never true for [you/you and other household members] in the past 12 months.

Press <1> to continue.

Food security (FSC) - Question identifier:FSC_Q020

The first statement is: [You/You and other household members] worried that food would run out before you got money to buy more. Was that often true, sometimes true, or never true in the past 12 months?

  • 1: Often true
  • 2: Sometimes true
  • 3: Never true
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q030

The food that [you/you and other household members] bought just didn't last, and there wasn't any money to get more. Was that often true, sometimes true, or never true in the past 12 months?

  • 1: Often true
  • 2: Sometimes true
  • 3: Never true
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q040

[You/You and other household members] couldn't afford to eat balanced meals. In the past 12 months was that often true, sometimes true, or never true?

  • 1: Often true
  • 2: Sometimes true
  • 3: Never true
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_R050

Now I'm going to read a few statements that may describe the food situation for households with children.

Press <1> to continue.

Food security (FSC) - Question identifier:FSC_Q050

[You/You or other adults in your household] relied on only a few kinds of low-cost food to feed [^CHILDFNAME/the children] because you were running out of money to buy food. Was that often true, sometimes true, or never true in the past 12 months?

  • 1: Often true
  • 2: Sometimes true
  • 3: Never true
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q060

[You/You or other adults in your household] couldn't feed [^CHILDFNAME/the children] a balanced meal, because you couldn't afford it. Was that often true, sometimes true, or never true in the past 12 months?

  • 1: Often true
  • 2: Sometimes true
  • 3: Never true
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q070

[^CHILDFNAME + was/The children were] not eating enough because [you/you or other adults in your household] just couldn't afford enough food. Was that often, sometimes, or never true in the past 12 months?

  • 1: Often true
  • 2: Sometimes true
  • 3: Never true
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_R080

The following few questions are about the food situation in the past 12 months for you or any other adults in your household.

Press <1> to continue.

Food security (FSC) - Question identifier:FSC_Q080

In the past 12 months, since last ^CURRENTMONTH did [you/you or other adults in your household] ever cut the size of your meals or skip meals because there wasn't enough money for food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q081

How often did this happen---almost every month, some months but not every month, or in only 1 or 2 months?

  • 1: Almost every month
  • 2: Some months but not every month
  • 3: Only 1 or 2 months
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q090

In the past 12 months, did you (personally) ever eat less than you felt you should because there wasn't enough money to buy food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q100

In the past 12 months, were you (personally) ever hungry but didn't eat because you couldn't afford enough food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q110

In the past 12 months, did you (personally) ever lose weight because you didn't have enough money for food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q120

In the past 12 months, did [you/you or other adults in your household] ever not eat for a whole day because there wasn't enough money for food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q121

How often did this happen...? Almost every month, some months but not every month, or in only 1 or 2 months?

  • 1: Almost every month
  • 2: Some months but not every month
  • 3: Only 1 or 2 months
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_R130

Now, a few questions on the food experiences for children in your household.

Press <1> to continue.

Food security (FSC) - Question identifier:FSC_Q130

In the past 12 months, did [you/you or other adults in your household] ever cut the size of [^CHILDFNAME + 's/any of the children's] meals because there wasn't enough money for food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q140

In the past 12 months, did [^CHILDFNAME/any of the children] ever skip meals because there wasn't enough money for food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q141

How often did this happen...? Almost every month, some months but not every month, or in only 1 or 2 months?

  • 1: Almost every month
  • 2: Some months but not every month
  • 3: Only 1 or 2 months
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q150

In the past 12 months, [was + ^CHILDFNAME/ were any of the children] ever hungry but you just couldn't afford more food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Food security (FSC) - Question identifier:FSC_Q160

In the past 12 months, did [^CHILDFNAME/any of the children] ever not eat for a whole day because there wasn't enough money for food?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

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.

Press <1> to continue.

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?

Read categories to respondent.
Mark all that apply.

  • 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

Capital gains should not be included in the household income. Income can come from various sources such as from work, investments, pensions or government. Examples include Employment Insurance, Social Assistance, Child Tax Benefit and other income such as child support, alimony and rental income

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...?

Read categories to respondent.

  • 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...?

Read categories to respondent.

  • 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...?

Read categories to respondent.

  • 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?

Read categories to respondent.
Mark all that apply.

  • 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

Capital gains should not be included in the personal income. Income can come from various sources such as from work, investments, pensions or government. Examples include Employment Insurance, Social Assistance, Child Tax Benefit and other income such as child support, alimony and rental income.

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...?

Read categories to respondent.

  • 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...?

Read categories to respondent.

  • 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...?

Read categories to respondent.

  • 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.

Press <1> to continue.

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

Enter a health number for [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]. Do not insert blanks, hyphens or commas between the numbers.

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].

The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public Health Agency of Canada. Provincial ministries of health includes the territorial ministries of health.

Press <1> to continue.

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].

The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public Health Agency of Canada. Provincial ministries of health includes the territorial ministries of health.

Press <1> to continue.

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.

Press <1> to continue.

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?

Do not include cellular phone numbers, or those used strictly for business or fax machines.
Telephone number: [telnum].

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?

Do not include cellular phone numbers, or those used strictly for business or fax machines
Telephone number: [telnum].

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

Language Lookup (LLU)

Language Lookup (LLU) - Question identifier:LLU_Q01

What language do you speak most often at home?

Mark up to three responses. Multiple responses are accepted only if languages
are spoken equally often at home. Start typing name of language to activate the search function. Enter "Other-Specify" if the language is not part of the list. Enter "xyz" to select the item which indicates no (more) languages.

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