Canadian Health Measures Survey (Cycle 5) - Household Questionnaire

Archived Content

Information identified as archived is provided for reference, research or record keeping purposes. It is not subject to the Government of Canada Web Standards and has not been altered or updated since it was archived. Please contact us to request a format other than those available.

For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

Hide all instructions

Table of Contents

Block to Block Logic Health Component (BBH)

Person Providing Information (PPI)

Person Providing Information (PPI) - Question identifier:PPI_N01

Select the person who is providing the information. If the person is not on the list, select "Non-household member".

Long Answer Length = 0

Person Providing Information (PPI) - Question identifier:PPI_N02

Is the person providing the information a parent or guardian of ^FNAME?

  • 1: Yes
  • 2: No

Person Providing Information (PPI) - Question identifier:PPI_N03

Is the person providing the information a birth or biological parent of ^FNAME?

  • 1: Yes
  • 2: No

Parental Consent (PGC)

Parental Consent (PGC) - Question identifier:PGC_N01

Since the selected respondent is under 16 years of age, verbal consent from a parent or guardian must be obtained.

Have you obtained verbal consent from a parent or guardian of the selected respondent to complete the interview?

  • 1: Yes
  • 2: No
  • 3: Not applicable (No parent or guardian living in the household)

Survey Introduction - Supplementary (INS)

Survey Introduction - Supplementary (INS) - Question identifier:INS_R01

One of the main goals of the survey is to gather information to help improve health programs and services in Canada. Your information may also be used by Statistics Canada for other statistical and research purposes.

The survey will collect information on Canadians' health and health habits. The first part of the survey is this interview, which includes questions on many health-related topics. The second part of the survey involves a visit to a mobile clinic to collect direct physical measures such as blood pressure, height and weight, bone density and vision tests.

Press <1> to continue.

Survey Introduction - Supplementary (INS) - Question identifier:INS_R02

Your answers are collected under the authority of the Statistics Act and will be kept strictly confidential. While participation is voluntary, your cooperation is important to ensure the information collected in this survey is as accurate and as comprehensive as possible. (Registration#: STC/HLT-084-75364)

Press <1> to continue.

Video (VID)

Video (VID) - Question identifier:VID_N11

Have you shown the video to ^FNAME yet?

  • 1: Yes
  • 2: No

General Health (GEN)

General Health (GEN) - Question identifier:GEN_R001

This survey deals with various aspects of your health. I'll be asking about such things as physical activity, nutrition, environment 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_Q005

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_Q010

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_Q015

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?


0 Very dissatisfied
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very satisfied

Min = 0; Max = 10

General Health (GEN) - Question identifier:GEN_Q020

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_Q025

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_Q030

During the past 12 months, was your main activity working at a paid job or business, looking for paid work, going to school, caring for children, household work, retired or something else?

If sickness or short-term illness is reported, ask for usual main activity.

  • 01: Working at a paid job or business
  • 02: Looking for paid work
  • 03: Going to school
  • 04: Caring for children
  • 05: Household work
  • 06: Retired
  • 07: Maternity/paternity or parental leave
  • 08: Long term illness
  • 09: Volunteering
  • 10: Providing care to family or friends for a long term health condition
  • 11: Other - Specify
  • 98: RF
  • 99: DK

General Health (GEN) - Question identifier:GEN_Q035

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_Q040

The next question is about your main job or business in the past 12 months.

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_Q045

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

General Health (GEN) - Question identifier:GEN_Q050

Would you rate your quality of life as... ?

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_Q055

Do you have a regular medical doctor?

Include a pediatrician.

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

Health Utility Index (HUI)

Health Utility Index (HUI) - Question identifier:HUI_R001

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 Utility Index (HUI) - Question identifier:HUI_Q005

Are you usually able to see [clearly, and without distortion, the words in a book/well enough to read ordinary newsprint] without glasses or contact lenses?

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

Health Utility Index (HUI) - Question identifier:HUI_Q010

Are you usually able to see [clearly, and without distortion, the words in a book/well enough to read ordinary newsprint] with glasses or contact lenses?

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

Health Utility Index (HUI) - Question identifier:HUI_Q015

Are you able to see at all?

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

Health Utility Index (HUI) - Question identifier:HUI_Q020

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 Utility Index (HUI) - Question identifier:HUI_Q025

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 Utility Index (HUI) - Question identifier:HUI_Q030

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 Utility Index (HUI) - Question identifier:HUI_Q035

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 Utility Index (HUI) - Question identifier:HUI_Q040

Are you able to hear at all?

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

Health Utility Index (HUI) - Question identifier:HUI_Q045

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 Utility Index (HUI) - Question identifier:HUI_Q050

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 Utility Index (HUI) - Question identifier:HUI_Q055

[The next few questions on day-to-day health concern your abilities relative to other children the same age./EMPTY]

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 Utility Index (HUI) - Question identifier:HUI_Q060

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

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

Health Utility Index (HUI) - Question identifier:HUI_Q065

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

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

Health Utility Index (HUI) - Question identifier:HUI_Q070

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

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

Health Utility Index (HUI) - Question identifier:HUI_Q075

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 Utility Index (HUI) - Question identifier:HUI_Q080

Are you able to walk at all?

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

Health Utility Index (HUI) - Question identifier:HUI_Q085

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 Utility Index (HUI) - Question identifier:HUI_Q090

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

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

Health Utility Index (HUI) - Question identifier:HUI_Q095

Do you require a wheelchair to get around?

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

Health Utility Index (HUI) - Question identifier:HUI_Q100

How often do you use a wheelchair?

Read categories to respondent.

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

Health Utility Index (HUI) - Question identifier:HUI_Q105

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

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

Health Utility Index (HUI) - Question identifier:HUI_Q110

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 Utility Index (HUI) - Question identifier:HUI_Q115

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 Utility Index (HUI) - Question identifier:HUI_Q120

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 Utility Index (HUI) - Question identifier:HUI_Q125

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 Utility Index (HUI) - Question identifier:HUI_Q130

Would you describe [yourself/yourself/^FNAME/^FNAME] 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 Utility Index (HUI) - Question identifier:HUI_Q135

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 Utility Index (HUI) - Question identifier:HUI_Q140

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

Health Utility Index (HUI) - Question identifier:HUI_R145

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.

Health Utility Index (HUI) - Question identifier:HUI_Q145

Are you usually free of pain or discomfort?

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

Health Utility Index (HUI) - Question identifier:HUI_Q150

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

Health Utility Index (HUI) - Question identifier:HUI_Q155

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

Chronic Conditions (CCC)

Chronic Conditions (CCC) - Question identifier:CCC_R11

Now, I'd like to ask about certain chronic 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_Q11

Do you have asthma?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q12

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE.

Chronic Conditions (CCC) - Question identifier:CCC_Q13

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_Q14

Do you have chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD)?

Chronic bronchitis is another name for COPD or emphysema. It is characterized by inflammation of the main air passage to the lungs 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_Q15

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE.

Chronic Conditions (CCC) - Question identifier:CCC_Q21

Do you have fibromyalgia?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q22

Do you have arthritis, for example osteoarthritis, rheumatoid arthritis, gout or any other type, excluding fibromyalgia?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q24

Do you have back problems, excluding scoliosis, fibromyalgia and arthritis?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q25

Do you have osteoporosis?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q31

(Remember, we're interested in conditions diagnosed by a health professional.)

Do you have high blood pressure?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q32

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_Q33

Have you ever had your blood cholesterol measured?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q34

[Have you/Have you] ever been told by a health professional that your blood cholesterol was high?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q35

Do you have celiac disease?

Celiac disease is an inflammation of the lining of the small intestine caused by an immune reaction to eating gluten, a protein found in wheat, barley and rye.

Include asymptomatic diagnosed celiac disease.

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

Chronic Conditions (CCC) - Question identifier:CCC_Q36

Do you have an inflammatory bowel disease (IBD), for example, Crohn's disease or ulcerative colitis?

Inflammatory bowel disease or IBD involves chronic inflammation of your digestive tract. IBD can also be known as ulcerative colitis, Crohn's disease or regional enteritis. Do not include irritable bowel syndrome (IBS).

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

Chronic Conditions (CCC) - Question identifier:CCC_Q51

(Remember, we're interested in conditions diagnosed by a health professional.)

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_Q53

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE.

Chronic Conditions (CCC) - Question identifier:CCC_Q54

Were you pregnant when you were first diagnosed with diabetes?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q55

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_Q56

Were you diagnosed with...?

Read categories to respondent. Mark all that apply.

  • 1: Insulin dependent diabetes - Type 1
  • 2: Non-insulin dependent diabetes - Type 2
  • 8: RF
  • 9: DK

Chronic Conditions (CCC) - Question identifier:CCC_Q57

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_Q58

Do you currently take insulin for your diabetes?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q59

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_Q61

Do you have heart disease?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q62

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE.

Chronic Conditions (CCC) - Question identifier:CCC_Q63

[Have you/Have you] ever been told by a health professional that you have had a heart attack?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q71

Do you have cancer?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q72

Have you ever been diagnosed with cancer?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q73

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE.

Chronic Conditions (CCC) - Question identifier:CCC_Q74

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

Mark all that apply.

  • 01: Breast
  • 02: Colorectal
  • 03: Skin - Melanoma
  • 04: Skin - Non-melanoma
  • 05: Ovarian
  • 06: Cervical
  • 07: Uterine
  • 08: Other - Specify
  • 98: RF
  • 99: DK

Chronic Conditions (CCC) - Question identifier:CCC_Q75

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

Mark all that apply.

  • 1: Prostate
  • 2: Colorectal
  • 3: Skin - Melanoma
  • 4: Skin - Non-melanoma
  • 5: Other - Specify
  • 8: RF
  • 9: DK

Chronic Conditions (CCC) - Question identifier:CCC_Q81

Remember, we're interested in conditions diagnosed by a health professional.

Do you suffer from the effects of a stroke?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q82

Do you have a thyroid condition?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q83

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_Q92

Do you suffer from chronic kidney disease?

Include low kidney function; protein or blood in the urine; kidney disease; currently or ever received dialysis treatments; or waiting on a kidney transplant.

Exclude kidney stones or infection.

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

Chronic Conditions (CCC) - Question identifier:CCC_Q93

Do you have liver disease or gallbladder problems?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q94

What kind of liver disease or gallbladder problem do you have?

Mark all that apply. If respondent says gallbladder was removed and no other response to this question is provided, return to CCC_Q93 and select "No".

  • 1: Hepatitis A
  • 2: Hepatitis B
  • 3: Hepatitis C
  • 4: Jaundice
  • 5: Cirrhosis
  • 6: Gallstones
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Chronic Conditions (CCC) - Question identifier:CCC_Q95

Do you have hepatitis?

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

Chronic Conditions (CCC) - Question identifier:CCC_Q96

What type of hepatitis do you have?

Read categories to respondent. Mark all that apply.

  • 1: Hepatitis A
  • 2: Hepatitis B
  • 3: Hepatitis C
  • 8: RF
  • 9: DK

Chronic Conditions (CCC) - Question identifier:CCC_Q101

Do you have any other long-term physical or mental health condition that has been diagnosed by a health professional?

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

Vision (VIS)

Vision (VIS) - Question identifier:VIS_R001

Now, some questions about the health and care of your eyes.

Press <1> to continue.

Vision (VIS) - Question identifier:VIS_Q005

In the past 12 months, that is from ^DATELASTYEARE to yesterday, have you visited an eye care professional, for example, an ophthalmologist or an optometrist? Do not include visits to an optician.

An ophthalmologist is trained to provide comprehensive eye care including surgery and a referral is often required to book an appointment.

An optometrist is trained to perform eye exams and prescribe eyeglasses. An appointment can be made directly and does not require a referral.

An optician is trained to dispense or fix eyeglasses and does not perform eye exams.

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

Vision (VIS) - Question identifier:VIS_Q010

What type of eye care professional did you last visit?

Do not include visits to an optician.

  • 1: Ophthalmologist
  • 2: Optometrist
  • 3: Other - specify
  • 8: RF
  • 9: DK

Vision (VIS) - Question identifier:VIS_Q015

Have you ever had an eye examination? Please include reading letters from a chart or when a health professional shines a light in the child's eye.

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

Vision (VIS) - Question identifier:VIS_Q020

Was the most recent exam done by...?

Read categories to respondent.

An ophthalmologist is trained to provide comprehensive eye care including surgery and a referral is often required to book an appointment.

An optometrist is trained to perform eye exams and prescribe eyeglasses. An appointment can be made directly and does not require a referral.

An optician is trained to dispense or fix eyeglasses and does not perform eye exams.

Do not include visits to an optician.

  • 1: An ophthalmologist
  • 2: An optometrist
  • 3: A family doctor
  • 4: A pediatrician
  • 5: A school nurse
  • 6: Other - Specify
  • 8: RF
  • 9: DK

Vision (VIS) - Question identifier:VIS_R025

Now I'd like to ask about certain chronic vision 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.

Vision (VIS) - Question identifier:VIS_Q030

Have you ever had glaucoma?

Glaucoma refers to damage to the optic nerve usually due to excessively high intraocular (eye) pressure.

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

Vision (VIS) - Question identifier:VIS_Q035

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE

Vision (VIS) - Question identifier:VIS_Q040

Have you ever had diabetic retinopathy?

Diabetic retinopathy refers to damage to the retina as a result of diabetes.

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

Vision (VIS) - Question identifier:VIS_Q045

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE.

Vision (VIS) - Question identifier:VIS_Q050

Have you ever had age-related macular degeneration (AMD)?

AMD refers to a loss of central vision due to the dying of cells in the center of the retina.

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

Vision (VIS) - Question identifier:VIS_Q055

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE.

Vision (VIS) - Question identifier:VIS_Q060

Have you ever had cataracts?

A cataract refers to clouding of the lens of the eye.

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

Vision (VIS) - Question identifier:VIS_Q065

In which eye?

  • 1: Right
  • 2: Left
  • 3: Both
  • 8: RF
  • 9: DK

Vision (VIS) - Question identifier:VIS_Q070

How old were you when this was first diagnosed?

Min = 0; Max = 79

Maximum is ^AWC_AGE

Vision (VIS) - Question identifier:VIS_Q075

Have you ever had cataract surgery?

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

Vision (VIS) - Question identifier:VIS_Q080

In which eye?

  • 1: Right
  • 2: Left
  • 3: Both
  • 8: RF
  • 9: DK

Vision (VIS) - Question identifier:VIS_Q085

Are you waiting for cataract surgery?

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

Vision Prescription (VPR)

Vision Prescription (VPR) - Question identifier:VPR_Q005

Do you wear eyeglasses or contacts?

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_Q010

Do you use eyeglasses or contacts for distance viewing? For example, while watching television or [driving/seeing the board at school]?

Distance viewing requires focus on an object that is at least one meter away. If the respondent confirms that they use eyeglasses or contacts for only one of the examples listed, then this question should be answered as yes.

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_Q015

Do you have your current eyeglass or contact prescription readily available?

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_Q020

In order to record this information accurately, I will need to see a copy of your current prescription. Could you please go and get it?

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

Vision Prescription (VPR) - Question identifier:VPR_Q025

I will now record the values from the prescription; this will just take a few minutes. (Is this your eyeglass or contact prescription?)

Please record the most recent prescription available. However, if the respondent has both an eyeglass and contact prescription with the same date, record the eyeglass prescription only.

  • 1: Eyeglasses
  • 2: Contacts
  • 9: DK

Vision Prescription (VPR) - Question identifier:VPR_N030

Is the sphere value present for the right eye (for example, OD)?

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_N035A

Record the sphere value for the right eye (for example, OD).

Min = -30.00; Max = 30.00

Vision Prescription (VPR) - Question identifier:VPR_N035B

Re-enter the sphere value for the right eye (for example, OD).

Min = -30.00; Max = 30.00

Vision Prescription (VPR) - Question identifier:VPR_N040

Is the cylinder value present for the right eye (for example, OD)?

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_N045A

Record the cylinder value for the right eye (for example, OD).

Min = -10.00; Max = 10.00

Vision Prescription (VPR) - Question identifier:VPR_N045B

Re-enter the cylinder value for the right eye (for example, OD).

Min = -10.00; Max = 10.00

Vision Prescription (VPR) - Question identifier:VPR_N050

Is the axis value present for the right eye (for example, OD)?

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_N055A

Record the axis value for the right eye (for example, OD).

Min = 0; Max = 180

Vision Prescription (VPR) - Question identifier:VPR_N055B

Re-enter the axis value for the right eye (for example, OD).

Min = 0; Max = 180

Vision Prescription (VPR) - Question identifier:VPR_N060

Is the sphere value present for the left eye (for example, OS or OG)?

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_N065A

Record the sphere value for the left eye (for example, OS or OG).

Min = -30.00; Max = 30.00

Vision Prescription (VPR) - Question identifier:VPR_N065B

Re-enter the sphere value for the left eye (for example, OS or OG).

Min = -30.00; Max = 30.00

Vision Prescription (VPR) - Question identifier:VPR_N070

Is the cylinder value present for the left eye (for example, OS or OG)?

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_N075A

Record the cylinder value for the left eye (for example, OS or OG).

Min = -10.00; Max = 10.00

Vision Prescription (VPR) - Question identifier:VPR_N075B

Re-enter the cylinder value for the left eye (for example, OS or OG).

Min = -10.00; Max = 10.00

Vision Prescription (VPR) - Question identifier:VPR_N080

Is the axis value present for the left eye (for example, OS or OG)?

  • 1: Yes
  • 2: No

Vision Prescription (VPR) - Question identifier:VPR_N085A

Record the axis value for the left eye (for example, OS or OG).

Min = 0; Max = 180

Vision Prescription (VPR) - Question identifier:VPR_N085B

Re-enter the axis value for the left eye (for example, OS or OG).

Min = 0; Max = 180

Vision Prescription (VPR) - Question identifier:VPR_Q110

Do you have any problem with vision other than needing eyeglasses or contacts?

Other vision problems can include conditions such as lazy eye, glaucoma or cataracts.

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

Vision Prescription (VPR) - Question identifier:VPR_Q115

Do you have any vision problem?

Vision problems can include conditions such as lazy eye, glaucoma or cataracts.

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

Vision Prescription (VPR) - Question identifier:VPR_R125

If you receive a new eyeglass or contact prescription between now and the clinic appointment, please bring a copy of the prescription.

Vision Prescription (VPR) - Question identifier:VPR_R130

If you can obtain a copy of your eyeglass or contact prescription, please bring it to your clinic appointment. You can obtain a copy by contacting your eye care professional.

Vision Prescription (VPR) - Question identifier:VPR_R135

If you can obtain a copy of your eyeglass or contact prescription, please bring it to your clinic appointment. You can obtain a copy by contacting your eye care professional.

Sleep Apnea (SPA)

Sleep Apnea (SPA) - Question identifier:SPA_R001

Now a few questions about your sleep.

Press <1> to continue.

Sleep Apnea (SPA) - Question identifier:SPA_Q005

Have you ever been referred to a sleep lab for overnight testing?

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

Sleep Apnea (SPA) - Question identifier:SPA_Q010

Has a health care professional ever diagnosed you with sleep apnea?

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

Sleep Apnea (SPA) - Question identifier:SPA_Q015

Has a health professional prescribed you a treatment for sleep apnea?

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

Sleep Apnea (SPA) - Question identifier:SPA_R020

The next questions concern your sleep during the past 12 months.

Press <1> to continue.

Sleep Apnea (SPA) - Question identifier:SPA_Q020

Without the use of sleeping aids, how often do you usually have trouble going to sleep or staying asleep?

Examples of sleeping aids include prescription sedatives and anti-anxiety drugs, over-the-counter antihistamines and natural health products such as melatonin and herbal remedies.

Read categories to respondent.

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

Sleep Apnea (SPA) - Question identifier:SPA_Q025

In the last 12 months, how often have you awakened suddenly with the feeling of gasping or choking?

Read categories to respondent.

  • 1: Never
  • 2: Rarely (only once or a few times)
  • 3: Sometimes (a few nights per month)
  • 4: Often (at least once a week, but pattern may be irregular)
  • 5: Very often (every night or almost every night)
  • 8: RF
  • 9: DK

Sleep Apnea (SPA) - Question identifier:SPA_Q030

Do you usually snore?

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

Sleep Apnea (SPA) - Question identifier:SPA_Q035

[How/According to what others have told you, how] loud do you usually snore? Would you say...?

Read categories to respondent.

  • 1: Slightly louder than heavy breathing
  • 2: About as loud as a normal speaking voice
  • 3: Louder than a normal speaking voice
  • 4: Loud enough to be heard through closed doors
  • 8: RF
  • 9: DK

Sleep Apnea (SPA) - Question identifier:SPA_Q040

In the last 12 months, has anyone observed you stop breathing during your sleep?

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

Sleep Apnea (SPA) - Question identifier:SPA_Q045

(In the last 12 months,) have you often felt tired, fatigued, or sleepy during the daytime?

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

Sleep Apnea (SPA) - Question identifier:SPA_Q050

Using a scale from 0 to 10, where 0 means "no sleepiness" and 10 means "extremely sleepy", how would you assess your sleepiness during a typical day? By "sleepiness", I mean the strong tendency to doze off.

0. No sleepiness
1. I
2. I
3. I
4. I
5. I
6. I
7. I
8. I
9. V
10. Extremely sleepy

Min = 0; Max = 10

Pregnancy (PRS)

Pregnancy (PRS) - Question identifier:PRS_Q11

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

Menopause (MEN)

Menopause (MEN) - Question identifier:MEN_R001

The following questions ask about your menstrual period to help us better understand how women's hormones relate to bone structure.

Press <1> to continue.

Menopause (MEN) - Question identifier:MEN_Q005

Have you had a menstrual period in the last 12 months, that is from ^DATELASTYEARE to today?

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

Menopause (MEN) - Question identifier:MEN_Q010

What is the reason you have not had a period?

Mark all that apply.

  • 01: Contraceptives
  • 02: Medical procedure, medication or drugs (do not include contraceptives)
  • 03: Pregnancy
  • 04: Breast feeding
  • 05: Menopause
  • 06: Stress, weight loss or excessive exercise
  • 07: Removal of the uterus (partial or complete hysterectomy)
  • 08: Removal of ovaries
  • 09: Physical complications (do not include the removal of uterus or ovaries)
  • 10: Other - Specify
  • 98: RF
  • 99: DK

Menopause (MEN) - Question identifier:MEN_Q015

Have you had both ovaries removed?

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

Menopause (MEN) - Question identifier:MEN_Q020

Have you experienced any symptoms of menopause? These symptoms may include hot flushes (flashes), night sweats, or increased vaginal pain, dryness and itching.

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

Menopause (MEN) - Question identifier:MEN_Q025

How long ago did these symptoms first begin?

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

Fracture History (FRH)

Fracture History (FRH) - Question identifier:FRH_R001

Now, a few questions about falls, bone fractures or brakes.

Press <1> to continue.

Fracture History (FRH) - Question identifier:FRH_Q005

Have you fallen in the past 12 months, that is from ^DATELASTYEARE to today?

By a fall, I mean that you unintentionally came to rest on a lower surface or object with all or part of your body.

Include all falls even if they did not result in an injury.

This does not include intercepted falls, for example, tripping on the stairs but stopping from falling by grabbing the railing.

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

Fracture History (FRH) - Question identifier:FRH_Q010

How many times?

Min = 1; Max = 95

Fracture History (FRH) - Question identifier:FRH_Q015

Was [that fall/the most serious fall you had in the last 12 months] caused by any of the following?

Read categories to respondent. Mark all that apply.

  • 1: Sports
  • 2: Running or roughhousing
  • 3: Being hit or pushed
  • 4: A vehicle, for example, a car or bicycle
  • 5: None of the above
  • 8: RF
  • 9: DK

Fracture History (FRH) - Question identifier:FRH_Q020

What was the cause of that fall?

Select the main cause of the fall.

  • 1: Illness, weakness or frailty
  • 2: Alcohol, medications or other substances
  • 3: A natural imbalance due to height (e.g., standing at the top of a ladder or on a roof)
  • 4: Dizziness or loss of consciousness not caused by illness, alcohol, medication or other substances
  • 5: Slipping
  • 6: Tripping or bumping into an obstruction
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Fracture History (FRH) - Question identifier:FRH_Q025

What was the cause of that slip?

Select the main cause of the slip.

  • 1: Slipping while walking or standing indoors (e.g., on a wet floor or in the bath)
  • 2: Slipping while walking or standing outdoors (e.g., on ice)
  • 3: Slipping while climbing something (e.g., climbing a ladder, tree or onto a stool)
  • 4: Other - Specify
  • 8: RF
  • 9: DK

Fracture History (FRH) - Question identifier:FRH_Q030

Have you ever broken or fractured a bone? Please include bone chips and cracks. Do not include bones that were broken for surgical procedures.

Only include breaks confirmed by a health professional.

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

Fracture History (FRH) - Question identifier:FRH_Q035

In your lifetime, on how many occasions have you broken or fractured a bone?

Min = 1; Max = 20

Fracture History (FRH) - Question identifier:FRH_Q045

[The next question is about yourself. Did you ever break or fracture your hip?/Did your birth mother ever break or fracture her hip?]

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

Fracture History (FRH) - Question identifier:FRH_Q050

[How old were you when you broke or fractured your hip (the first time)?/How old was she when she broke or fractured her hip (the first time)?]

Min = 0; Max = 120

Enter age in years.

Fracture History (FRH) - Question identifier:FRH_Q055

[The next question is about yourself. Did you ever break or fracture your hip?/Did your birth father ever break or fracture his hip?]

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

Fracture History (FRH) - Question identifier:FRH_Q060

[How old were you when you broke or fractured your hip (the first time)?/How old was he when he broke or fractured his hip (the first time)?]

Min = 0; Max = 120

Enter age in years.

Fracture Details (FRD)

Fracture Details (FRD) - Question identifier:FRD_Q005

How old were you on the [first/second/third/fourth/fifth/sixth/seventh/eighth/ninth/tenth/eleventh/twelfth/thirteenth/fourteenth/fifteenth/sixteenth/seventeenth/eighteenth/nineteenth/twentieth] occasion?

Min = 0; Max = 79

If the respondent cannot provide an exact answer please ask for a best estimate.
Maximum is ^AWC_AGE. If less than one year enter "0".

Fracture Details (FRD) - Question identifier:FRD_Q010

Which bone(s) did you break or fracture (on that occasion)?

Mark all that apply.

  • 01: Head (skull, face, jaw, nose)
  • 02: Spine (neck, back, tailbone)
  • 03: Ribs/sternum
  • 04: Shoulder/upper arm/collarbone
  • 05: Elbow
  • 06: Forearm/wrist
  • 07: Hand
  • 08: Finger(s)
  • 09: Hip
  • 10: Pelvis
  • 11: Upper leg
  • 12: Knee
  • 13: Lower leg
  • 14: Ankle
  • 15: Foot
  • 16: Toe(s)
  • 17: Other - Specify
  • 98: RF
  • 99: DK

Fracture Details (FRD) - Question identifier:FRD_Q015

How did the bone break or fracture happen?

  • 1: Motor vehicle accident
  • 2: Injury as a result of sports or physical activity
  • 3: Being hit or struck by a person or object (do not include sports injuries)
  • 4: Bumping into or hitting an obstruction (do not include sports injuries)
  • 5: Fall (do not include sports injuries)
  • 6: No fall or significant impact (e.g., as a result of a hug)
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Fracture Details (FRD) - Question identifier:FRD_Q020

What was the type of fall?

Do not include sports injuries.

A fall from a standing height:
- The person came to rest on a surface that was the same
height or higher than the surface on which the person
was originally standing.

- Includes falls due to slipping or tripping on a carpet, wet floor
or icy sidewalk or tripping and falling onto an object
(e.g., table or chair).

A fall from more than a standing height:
- The person came to rest on a surface that was lower than
the surface on which the person was originally standing.
- Includes falling while standing on a chair or falling off a
ladder, play structure or roof.

  • 1: Fall from a lying or sitting position (e.g., out of bed or off a chair)
  • 2: Fall from a standing height while indoors
  • 3: Fall from a standing height while outdoors
  • 4: Fall up the stairs
  • 5: Fall down the stairs
  • 6: Fall from more than a standing height
  • 7: Other - Specify
  • 8: RF
  • 9: DK

Fracture Details (FRD) - Question identifier:FRD_Q025

Was the fall from a height of more than 3 steps?

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

Medication Use (MEU)

Medication Use (MEU) - Question identifier:MEU_R01

Now I'd like to ask a few questions about your use of prescriptions, over-the-counter medications and other health products, including natural health products.

In order to record this information accurately, I will need to see the bottles and containers. We are interested in any prescription and over-the-counter medications, vitamins, minerals, other health products and health remedies that you have taken or used in the past month, that is, from ^DT_DateLastMonthE to today.

Could you please go and get all the bottles and containers for these products now?

Press <1> to continue.

Medication Use (MEU) - Question identifier:MEU_Q02

First I need to capture information on medications that have been prescribed or administered by a health professional such as a doctor or dentist. This includes such things as insulin, [antibiotics and nicotine patches/antibiotics, nicotine patches and birth control pills, patches or injections/antibiotics and asthma medication].

Remember, we are only interested in prescription medications that you have taken or used in the past month.

Has the respondent taken or used any prescription medications in the past month?

This question applies only to medications taken or used within the past month. Medications that have been prescribed but not taken or used within this period of time (e.g., Epi-pen) should not be captured.

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

Medication Use (MEU) - Question identifier:MEU_N11

Do you have another prescription medication to capture?

  • 1: Yes
  • 2: No
  • 8: RF

Medication Use (MEU) - Question identifier:MEU_Q12

Have you taken or used any other prescription medications in the past month?
Please include any prescription creams, injections or patches.

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

Medication Use (MEU) - Question identifier:MEU_Q15

How many other prescription medications have you taken or used in the past month? Please include any prescription creams, injections or patches.

Min = 0; Max = 95

Medication Use (MEU) - Question identifier:MEU_Q20

Have you taken or used any over-the-counter medications or other health products, including natural health products, in the past month?

Over-the-counter medications could include such things as pain killers, antacids, allergy pills and hydrocortisone creams. Examples of health products include vitamins, minerals, amino acids, probiotics, fish oils and other oils, herbal remedies and homeopathic preparations.

This question applies only to products taken or used within the past month. Products that have not been taken or used within this period of time should not be captured.

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

Medication Use (MEU) - Question identifier:MEU_Q21

How many over-the-counter medications or other health products have you taken or used in the past month?

Min = 1; Max = 95

Medication Use (MEU) - Question identifier:MEU_Q22

Now I need to capture information on all over-the-counter medications and other health products, including natural health products, that you have taken or used in the past month, that is, from ^DT_DateLastMonthE to today.

Over-the-counter medications could include such things as pain killers, antacids, allergy pills and hydrocortisone creams. Examples of health products include vitamins, minerals, amino acids, probiotics, fish oils and other oils, herbal remedies and homeopathic preparations.

Has the respondent taken or used any over-the-counter medications or other health products in the past month?

This question applies only to products taken or used within the past month. Products that have not been taken or used within this period of time should not be captured.

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

Medication Use (MEU) - Question identifier:MEU_N26

Do you have another over-the-counter medication or health product to capture?

  • 1: Yes
  • 2: No
  • 8: RF

Medication Use (MEU) - Question identifier:MEU_Q27

Have you taken or used any other over-the-counter medications or health products in the past month? Please include any solutions, powders, creams or pastes.

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

Medication Use (MEU) - Question identifier:MEU_Q29

How many other over-the-counter medications or health products have you taken or used in the past month? Please include any solutions, powders, creams or pastes.

Min = 0; Max = 95

New Product Information - Call Block (NPC)

New Product Information - Call Block (NPC) - Question identifier:NPC_Q10

On the days that you ^DT_TAKE1E this product, how many times did you usually ^DT_TAKE3E it in a single day?

Min = 1; Max = 100

Record the number of times per day.

New Product Information - Call Block (NPC) - Question identifier:NPC_Q11

How much did you usually ^DT_TAKE3E each time you ^DT_TAKE1E it? ^DT_NPC_TEXT1E

Min = 00000.01; Max = 99995.00

Enter the quantity only.

New Product Information - Call Block (NPC) - Question identifier:NPC_N12

Select the unit of measure.

  • 01: Tablets / pills / capsules
  • 02: Lozenges
  • 03: Chews / gummies
  • 04: Millilitres (mL)
  • 05: Milligrams (mg)
  • 06: Grams (g)
  • 07: Tablespoons (Tbsp)
  • 08: Teaspoons (tsp)
  • 09: Capfuls
  • 10: Scoops
  • 11: Packets / sachets
  • 12: Drops
  • 13: Sprays
  • 14: Doses
  • 15: Vials
  • 16: Units
  • 50: Other - Specify
  • 98: RF
  • 99: DK

New Product Information - Call Block (NPC) - Question identifier:NPC_Q14

So you ^DT_TAKE1E ^NPC_Q11 [tablet(s)/lozenge(s)/chew(s)/millilitre(s)/milligram(s)/gram(s)/tablespoon(s)/teaspoon(s)/capful(s)/scoop(s)/packet(s)/drop(s)/spray(s)/dose(s)/vial(s)/unit(s)/^NPC_S12] ^NPC_Q10 [time/times] each day you ^DT_TAKE1E this product (^DV_PRODUCT_NAME). Is that correct?

  • 1: Yes
  • 2: No

New Product Information (NPI)

New Product Information (NPI) - Question identifier:NPI_N05

Is a product identification number available for the product (e.g., DIN, DIN-HM, NPN, EN)?

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_N07

Record the product identification number from the bottle, tube or box. Include all leading zeros.

Long Answer Length = 8

New Product Information (NPI) - Question identifier:NPI_N08

Select the correct product.

New Product Information (NPI) - Question identifier:NPI_N11

Is ^NPI_N07 the correct product identification number?

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_N15

Why is a product identification number not available for the product?

  • 1: Container not available
  • 2: No product identification number

New Product Information (NPI) - Question identifier:NPI_Q16

[To search for this product I will need some of the following information:
- Product name: for example, Accutane, Alesse 21 or Ventolin.
- Product form: for example, pill, powder, liquid or cream.
- Manufacturer: for example, Roche, Pfizer or GlaxoSmithKline./To search for this product, I will need some of the following information:
- Product name: for example, Children's Tylenol® Cold and Cough Nighttime.
- Product form: for example, pill, powder, liquid or cream.
- Manufacturer: for example, Bayer, Jamieson or Sisu./EMPTY]

Use the MedSearch tool to find the product.

Press <1> to continue.

  • 1: Continue

New Product Information (NPI) - Question identifier:NPI_N17

Was an exact product match found?

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_Q17A

Product identification number: ^DV_PIN
Product name: ^DV_PRODUCT_NAME
Form: [NPI_S20/EMPTY/English text of category selected at NPI_Q20]
Strength: ^DT_STRENGTH
Route of administration: ^DT_ROUTEE

Confirm whether the information displayed is correct.

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_N17B

Do you want to search for the product again?

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_Q18

(What is the name of this product? [For example, Accutane, Alesse 21 or Ventolin./For example, Children's Tylenol® Cold and Cough Nighttime.])

Long Answer Length = 80

Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

New Product Information (NPI) - Question identifier:NPI_Q19

What company information is found on the product container? [For example, Roche, Pfizer, GlaxoSmithKline./For example, Bayer, Jamieson or Sisu.]

Long Answer Length = 80

Capture all the company names from the product container. This could include: the manufacturer, the importer and/or the company for which this product was manufactured. If there is no company information on the container, enter <Don't know>.

New Product Information (NPI) - Question identifier:NPI_Q20

(What is the form of this product? For example, is it a pill, powder, liquid or cream?)

Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

Select the product form.

  • 01: Tablet / pill / capsule
  • 02: Lozenge
  • 03: Chew / gummy
  • 04: Globule
  • 05: Drop
  • 06: Tincture
  • 07: Liquid / solution
  • 08: Suspension
  • 09: Cream / ointment / gel / lotion
  • 10: Packet / sachet
  • 11: Powder
  • 12: Granule
  • 13: Spray / aerosol
  • 14: Patch
  • 15: Kit
  • 16: Suppository
  • 50: Other - Specify
  • 98: RF
  • 99: DK

New Product Information (NPI) - Question identifier:NPI_Q21

(What is the strength of this product, for example, 250 mg, 1%, 1000 international units?)

Long Answer Length = 80

Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

New Product Information (NPI) - Question identifier:NPI_Q22

(How is this product administered? For example, is it inhaled, swallowed, dissolved beneath the tongue or applied to the skin?)

Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information as accurately as possible.

Select the route of administration of the product.

  • 01: Oral
  • 02: Sublingual (under tongue)
  • 03: Buccal (inside of cheek)
  • 04: Dental (teeth or gums)
  • 05: By inhalation
  • 06: Nasal (nose)
  • 07: Ophthalmic (eyeball)
  • 08: Otic (ear)
  • 09: Topical (applied to skin)
  • 10: Transdermal (absorbed through skin)
  • 11: By injection
  • 12: Rectal
  • 13: Vaginal
  • 50: Other - Specify
  • 98: RF
  • 99: DK

New Product Information (NPI) - Question identifier:NPI_Q25

When was the last time that you [used/took] this product?
(The response categories are today, yesterday, within the last week or within the last month.)

  • 1: Today
  • 2: Yesterday
  • 3: Within the last week
  • 4: Within the last month
  • 5: More than one month ago
  • 8: RF
  • 9: DK

New Product Information (NPI) - Question identifier:NPI_Q63

[For how long have you been [using/taking] [this or a similar product/this product]? (^DV_PRODUCT_NAME)/For how long did you [use/take] [this or a similar product/this product]? (^DV_PRODUCT_NAME)]

(If you stopped [using/taking] it at some point, only include the most recent period of use.)

Min = 1.0; Max = 500.0

Enter time only.

[Consider a change in prescription (e.g., a change in medication company or dosage) to be a stop in medication use.

Do not consider a short break in the use of a prescribed medication (e.g., temporarily ran out of medication or forgot to take a dose) to be a stop in medication use.

For prescription medication used on an as-needed basis (e.g., medicated cream for a reoccurring condition), only include the period when it was last used./A similar product could be a different company name (e.g., Jamieson Vitamin C® vs. Flintstones Vitamin C®) or a different form (e.g., tablet vs. liquid).

Do not consider a short break in the use of a product (e.g., temporarily ran out of a vitamin supplement or forgot to take a dose) to be a stop in product use.

For over-the-counter medication used on an as-needed basis (e.g., medication for a cold or headache), only include the period when it was last used.]

New Product Information (NPI) - Question identifier:NPI_N64

Select the reporting period.

  • 1: Days
  • 2: Weeks
  • 3: Months
  • 4: Years

New Product Information (NPI) - Question identifier:NPI_Q65

In the past month, on how many days did you [use/take] this product (^DV_PRODUCT_NAME)?

Min = 1; Max = 31

Enter number of days.

If the medication was used every day for the past month, enter "31".

Steroids and Osteoporosis Medications (SOM)

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_R001

Now, a few questions about your use of specific medications.

Press <1> to continue.

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_Q005

Have you ever used steroids administered by inhalation, for example, Flovent, Pulmicort or Vanceril? Do not include nasal sprays.

Ventolin (currently a blue puffer) is not a steroid and should not be included.

Inhaled steroids include: Flovent (orange puffer), Pulmicor (white puffer with brown bottom) and Vanceril (pink puffer).

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

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_Q010

Did you ever use these types of steroids on a daily basis for more than a 12 month period? By daily basis, I mean that you did not miss more than 21 days of use over the course of one year (for example, if [you/you] temporarily ran out of medication or [forgot to take a dose/forgot a dose]).

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

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_Q015

Have you ever taken orally-administered steroid hormones, for example, prednisone, prednisolone, dexamethasone or hydrocortisone? Do not include the use of anabolic steroids, such as testosterone, dihydrotestosterone or DHEA.

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

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_Q020

Did you ever take these types of steroid hormones on a daily basis for longer than a 3 month period?

Do not consider a short break in the use of a product (e.g., temporarily ran out of medication or forgot a dose) or a change in prescription (e.g., a change in medication or dosage) to be a stop in use.

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

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_Q025

Have you ever taken prescription medication for osteoporosis or for the prevention of bone loss or fractures? Do not include calcium and vitamin D.

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

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_Q030

Which medications have you used?

Show respondent the response categories. Mark all that apply.

  • 01: Tamoxifen (e.g., Novaldex, Tamone, Tamoplex)
  • 02: Bazedoxifene (e.g., Viviant)
  • 03: Calcitonin (e.g., Calcimar, Caltine, Miacalcin nasal spray)
  • 04: Clodronate (e.g., Bonefos, Ostac)
  • 05: Etidronate (e.g., Didronel, Didrocal)
  • 06: Risedronate (e.g., Actonel)
  • 07: Pamidronate (e.g., Aredia)
  • 08: Zoledronate (e.g., Aclasta)
  • 09: Alendronate (e.g., Fosamax, Fosavance)
  • 10: Parathyroid Hormone (e.g., Forteo)
  • 11: Denosumab (e.g., Prolia)
  • 12: Raloxifene (e.g., Evista)
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_Q035

In total, over your lifetime, for how long did you take [this medication/these medications]?

Min = 0.5; Max = 500.0

If the medication was used intermittently, sum the durations of use.

Enter amount only.

Steroids and Osteoporosis Medications (SOM) - Question identifier:SOM_N040

Select the reporting period.

  • 1: Days
  • 2: Weeks
  • 3: Months
  • 4: Years

Height and Weight (HWT)

Height and Weight (HWT) - Question identifier:HWT_Q1

The next questions are about height and weight. How tall are you without shoes on?

Is that in feet and inches or in centimetres?

  • 1: Feet and inches
  • 2: Centimetres
  • 8: RF
  • 9: DK

Height and Weight (HWT) - Question identifier:HWT_N1A

Enter feet only.

Min = 0; Max = 7

Height and Weight (HWT) - Question identifier:HWT_N1B

Enter inches only, to the nearest quarter of an inch.

Min = 0.00; Max = 95.75

Height and Weight (HWT) - Question identifier:HWT_N1C

Record the height to the nearest half centimetre.

Min = 31.0; Max = 244.0

Height and Weight (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

Weight Detail (WTD)

Weight Detail (WTD) - Question identifier:WTD_Q11

^DT_QUESTIONE

Min = 1.0; Max = 575.0

Enter amount only.

Weight Detail (WTD) - Question identifier:WTD_N11

Was that in pounds or kilograms?

  • 1: Pounds
  • 2: Kilograms

Meat Consumption (MFC)

Meat Consumption (MFC) - Question identifier:MFC_R11

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.

The answer categories for these questions are number of times per day, per week, per month or per year.

Press <1> to continue.

Meat Consumption (MFC) - Question identifier:MFC_R19A

Now I'd like to ask about the use of omega-3 enriched eggs in the eggs and egg dishes you just reported.

Press <1> to continue.

Food Frequency Detail (FFD)

Food Frequency Detail (FFD) - Question identifier:FFD_Q11

^DT_BOLDQUESTINTROE^DT_NOTBOLDQUESTINTROE

^DT_QUESTIONE

Min = 0; Max = 500

^DT_INTERVIEWERE
Enter amount only.

Food Frequency Detail (FFD) - Question identifier:FFD_N11

^DT_QUESTIONE

^DT_INTERVIEWERE
Select the reporting period.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Per year

Milk and Dairy Product Consumption (MDC)

Milk and Dairy Product Consumption (MDC) - Question identifier:MDC_R01

Now, some questions about your consumption of milk and other dairy products. Remember, think about all the foods you eat and drink, both meals and snacks, at home and away from home.

Again, the answer categories are number of times per day, per week, per month or per year.

Press <1> to continue.

Milk and Dairy Product Consumption (MDC) - Question identifier:MDC_Q03

What kind of enriched milk substitutes do you usually drink or use on cereal?

Mark all that apply.

  • 1: Rice (enriched)
  • 2: Soya (enriched)
  • 3: Almond (enriched)
  • 4: Other - Specify
  • 8: RF
  • 9: DK

Milk and Dairy Product Consumption (MDC) - Question identifier:MDC_Q12

What kind of milk do you usually drink or use on cereal?

If the respondent uses lactose-free milk, probe to determine the fat content and choose the appropriate category. Do not include milk substitutes such as rice, soya or almond milk.

Mark all that apply.

  • 01: 3.25% (Whole or homo)
  • 02: 2%
  • 03: 1%
  • 04: 0.5%
  • 05: Skim or Non-Fat (including powdered milk)
  • 06: Flavoured milk beverages (such as Chocolate milk and flavoured milks such as Oh Henry! ®)
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Grain, Fruit and Vegetable Consumption (GFV)

Grain, Fruit and Vegetable Consumption (GFV) - Question identifier:GFV_R11

Now, a few questions about grains, fruits and vegetables. Remember, think about all the foods you eat, both meals and snacks, at home and away from home.

Again, the answer categories are number of times per day, per week, per month or per year.

Press <1> to continue.

Grain, Fruit and Vegetable Consumption (GFV) - Question identifier:GFV_Q17B

How often do you usually eat:

... strawberries, fresh, frozen or canned, in the summer?

Min = 0; Max = 500

Enter amount only.

Grain, Fruit and Vegetable Consumption (GFV) - Question identifier:GFV_N17B

Select the reporting period.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Per summer

Grain, Fruit and Vegetable Consumption (GFV) - Question identifier:GFV_Q17C

How often do you usually eat:

... strawberries (fresh, frozen or canned) during the rest of the year?

Min = 0; Max = 500

Enter amount only.

Grain, Fruit and Vegetable Consumption (GFV) - Question identifier:GFV_N17C

Select the reporting period.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Overall, during the rest of the year

Dietary Fat Consumption (DFC)

Dietary Fat Consumption (DFC) - Question identifier:DFC_R11

Remember, think about all the foods you eat, both meals and snacks, at home and away from home.

Again, the answer categories are number of times per day, per week, per month or per year.

Press <1> to continue.

Water and Soft Drink Consumption (WSD)

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_R30

Next, some questions about your drink consumption. Think about all the things you drink, both at home and away from home.

Again, the answer categories are number of times per day, per week, per month, or per year.

Press <1> to continue.

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_R34

The next few questions are about the different kinds of juice or fruit flavoured drinks you usually drink. When we say fruit juice, we mean 100% pure fruit juices such as apple, orange or grapefruit juice, whether or not they are made from concentrate. When we say fruit flavoured drinks, we mean drinks such as Sunny Delight®, fruit punch or Kool-Aid®.

Press <1> to continue.

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_R39

Next, some questions about your water consumption. [Do not include vitamin-added water already reported./EMPTY]

Press <1> to continue.

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_Q39

How much water, in cups, do you usually drink at home? A cup is equivalent to the size of a measuring cup: 250 ml or 8 oz.

Min = 0; Max = 100

Enter number of cups only.

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_N39

Select the reporting period.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Per year

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_Q40

When you drink water at home, what is your primary source of drinking water?

Include carbonated water and flavoured water as "bottled water". Do not include vitamin-added water.

Read categories to respondent.

  • 1: Tap water, including water from a Brita®-type jug
  • 2: Bottled water, including water from an individual serving-size bottle or from a water cooler
  • 3: Other - Specify
  • 8: RF
  • 9: DK

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_Q41

How much water, in cups, do you usually drink away from home? [EMPTY/For example, when at school or when away from home during your leisure time./For example, when at work, at school or when away from home during your leisure time.](A cup is equivalent to the size of a measuring cup: 250 ml or 8 oz.)

Min = 0; Max = 100

Enter number of cups only.

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_N41

Select the reporting period.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Per year

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_Q42

When you drink water away from home, what is your primary source of drinking water?

Include carbonated water and flavoured water as "Bottled water". Do not include vitamin-added water.

Read categories to respondent.

  • 1: Tap water, including water from a Brita®-type jug
  • 2: Bottled water, including water from an individual serving-size bottle or from a water cooler
  • 3: Other - Specify
  • 8: RF
  • 9: DK

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_Q43

What is the source of the tap water in this home?

Read categories to respondent.

  • 1: Water supplied by your city, town or municipality
  • 2: Water from a private well
  • 3: Water from a cistern
  • 4: Water from a surface source such as natural spring, lake, river, lagoon or dugout
  • 5: Other - Specify
  • 8: RF
  • 9: DK

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_Q44

Is the water in this home treated using... ?

This refers to any water treatment done at the home. Do not include treatments performed by the municipality.

Read categories to respondent. Mark all that apply.

  • 01: A filter, for example, a faucet attachment, refrigerator filter or Brita®-type jug filter
  • 02: A water softener
  • 03: An ultraviolet system
  • 04: Reverse osmosis
  • 05: Boiling
  • 06: Distilling
  • 07: Other - Specify
  • 08: No treatment
  • 98: RF
  • 99: DK

Water and Soft Drink Consumption (WSD) - Question identifier:WSD_Q45

Is the water used for drinking and food preparation treated using the water softener?

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

Salt Consumption (SLT)

Salt Consumption (SLT) - Question identifier:SLT_R001

Now, some questions about your salt consumption.

Press <1> to continue.

Salt Consumption (SLT) - Question identifier:SLT_Q005

How often [does ^FNAME or someone else/do you] usually add salt to [his/her/your] food, after it has been prepared, for example, at the table?

Read categories to respondent.

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

Salt Consumption (SLT) - Question identifier:SLT_Q010

What type of salt is usually used?

Read categories to respondent.

  • 1: Ordinary table salt
  • 2: Seasoned or other flavoured salt
  • 3: Sea salt or gourmet salt
  • 4: Light salt or half salt
  • 5: Salt substitute
  • 6: Other - Specify
  • 8: RF
  • 9: DK

Salt Consumption (SLT) - Question identifier:SLT_Q015

The next question only refers to the use of ordinary table salt.

How often is ordinary table salt added during the cooking or preparation of foods that you eat?

Only include ordinary table salt. Do not include seasoned/flavoured salt, sea/gourmet salt, light/half salt or salt substitutes.
Read categories to respondent.

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

Physical Activities - Adults (PAA)

Physical Activities - Adults (PAA) - Question identifier:PAA_R001

The following questions are about various types of physical activities done in the last seven days. I want you to only think of activities you did for a minimum of 10 continuous minutes.

Press <1> to continue.

Physical Activities - Adults (PAA) - Question identifier:PAA_Q005

In the last seven days, that is from last ^DT_DAYLASTWEEKE to yesterday, did you use active ways like walking or cycling to get to places such as work, school, the bus stop, the shopping centre or to visit friends?

Do not include walking, cycling or other activities done purely for leisure. These activities will be asked about later.

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

Physical Activities - Adults (PAA) - Question identifier:PAA_Q010

In the last seven days, on which days did you do these activities?

Mark all that apply.

  • 1: Monday
  • 2: Tuesday
  • 3: Wednesday
  • 4: Thursday
  • 5: Friday
  • 6: Saturday
  • 7: Sunday
  • 8: RF
  • 9: DK

Physical Activities - Adults (PAA) - Question identifier:PAA_Q015

How much time in total, in the last seven days, did you spend doing these activities? Please only include activities that lasted a minimum of 10 continuous minutes.

Min = 0; Max = 168

Enter the number of hours on this screen and the number of minutes on the next screen. If the respondent answers in minutes only, enter 0 hours on this screen and the number of minutes on the next screen.

If recall is too difficult for the respondent, ask for their best estimate.

Physical Activities - Adults (PAA) - Question identifier:PAA_N020

Enter number of minutes.

Min = 0; Max = 9995

Physical Activities - Adults (PAA) - Question identifier:PAA_Q030

[Not including activities you just reported, in/In] the last seven days, did you do sports, fitness or recreational physical activities, organized or non-organized, that lasted a minimum of 10 continuous minutes?

Examples are walking, home or gym exercise, swimming, cycling, running, skiing, dancing and all team sports.

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

Physical Activities - Adults (PAA) - Question identifier:PAA_Q035

Did any of these recreational physical activities make you sweat at least a little and breathe harder?

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

Physical Activities - Adults (PAA) - Question identifier:PAA_Q040

In the last seven days, on which days did you do these recreational activities that made you sweat at least a little and breathe harder?

Mark all that apply.

  • 1: Monday
  • 2: Tuesday
  • 3: Wednesday
  • 4: Thursday
  • 5: Friday
  • 6: Saturday
  • 7: Sunday
  • 8: RF
  • 9: DK

Physical Activities - Adults (PAA) - Question identifier:PAA_Q045

(In the last seven days), how much time in total did you spend doing these activities that made you sweat at least a little and breathe harder?

Min = 0; Max = 168

Include only those physical activities that lasted at least 10 minutes at a time, including rest periods.

Enter the number of hours on this screen and the number of minutes on the next screen. If the respondent answers in minutes only, enter 0 hours on this screen and the number of minutes on the next screen.

If recall is too difficult for the respondent, ask for their best estimate.

Physical Activities - Adults (PAA) - Question identifier:PAA_N050

Enter number of minutes.

Min = 0; Max = 9995

Physical Activities - Adults (PAA) - Question identifier:PAA_Q060

In the last seven days, did you do any other physical activities while at work, in or around your home or while volunteering?

Examples are carrying heavy loads, shoveling, and household chores such as vacuuming or washing windows. Please remember to only include activities that lasted a minimum of 10 continuous minutes.

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

Physical Activities - Adults (PAA) - Question identifier:PAA_Q065

Did any of these other physical activities make you sweat at least a little and breathe harder?

Exclude physical activities already reported.

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

Physical Activities - Adults (PAA) - Question identifier:PAA_Q070

In the last seven days, on which days did you do these other activities that made you sweat at least a little and breathe harder?

Mark all that apply.

  • 1: Monday
  • 2: Tuesday
  • 3: Wednesday
  • 4: Thursday
  • 5: Friday
  • 6: Saturday
  • 7: Sunday
  • 8: RF
  • 9: DK

Physical Activities - Adults (PAA) - Question identifier:PAA_Q075

(In the last seven days), how much time in total did you spend doing these activities that made you sweat at least a little and breathe harder?

Min = 0; Max = 168

Include only those physical activities that lasted at least 10 minutes at a time, including rest periods.

Enter the number of hours on this screen and the number of minutes on the next screen. If the respondent answers in minutes only, enter 0 hours on this screen and the number of minutes on the next screen.

If recall is too difficult for the respondent, ask for their best estimate.

Physical Activities - Adults (PAA) - Question identifier:PAA_N080

Enter number of minutes.

Min = 0; Max = 9995

Physical Activities - Adults (PAA) - Question identifier:PAA_Q095

You have reported a total of ^DV_PAATOTAL minutes of physical activity. Of these activities, were there any of vigorous intensity, meaning they caused you to be out of breath?

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

Physical Activities - Adults (PAA) - Question identifier:PAA_Q100

In the last seven days, how much time in total did you spend doing vigorous activities that caused you to be out of breath? Please only include activities that lasted a minimum of 10 continuous minutes.

Min = 0; Max = 168

Include only those physical activities that lasted at least 10 minutes at a time, including rest periods.

Enter the number of hours on this screen and the number of minutes on the next screen. If the respondent answers in minutes only, enter 0 hours on this screen and number of minutes on the next screen.

If recall is too difficult for the respondent, ask for their best estimate.

Physical Activities - Adults (PAA) - Question identifier:PAA_N105

Enter number of minutes.

Min = 0; Max = 9995

Physical Activities for Youth (PAY)

Physical Activities for Youth (PAY) - Question identifier:PAY_R001

The following questions are about various types of physical activities that you have done each day in the past week.

Press <1> to continue.

Physical Activities for Youth (PAY) - Question identifier:PAY_Q005

During the last seven days, that is from last ^DT_DAYLASTWEEKE to yesterday, did you...?

Read categories to respondent.
Mark all that apply.

  • 1: Attend school
  • 2: Attend a day camp
  • 3: Attend paid or unpaid work
  • 4: None of the above
  • 8: RF
  • 9: DK

Physical Activities for Youth (PAY) - Question identifier:PAY_Q010

In the last seven days, did you use active ways like walking or cycling to get to places such as [school, the bus stop, the shopping centre, work/school, the bus stop, the shopping centre/the bus stop, the shopping centre, work/the bus stop, the shopping centre] or to visit friends?

Do not include walking, cycling or other activities done purely for leisure. These activities will be asked about later.

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

Physical Activities for Youth (PAY) - Question identifier:PAY_Q025

In the last seven days, did you do sports, fitness or recreational physical activities while at [school or day camp, including during physical education classes, during your breaks and any other time you played indoors or outdoors/school, including during physical education classes, during your breaks and any other time you played indoors or outdoors/day camp, including any time you played indoors or outdoors]?

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

Physical Activities for Youth (PAY) - Question identifier:PAY_Q030

Did any of these activities make you sweat at least a little and breathe harder?

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

Physical Activities for Youth (PAY) - Question identifier:PAY_Q045

In the last seven days, did you do physical activities in your leisure time including exercising, playing an organized or non-organized sport or playing with your friends?

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

Physical Activities for Youth (PAY) - Question identifier:PAY_Q050

Did any of these leisure-time activities make you sweat at least a little and breathe harder?

Exclude physical activities already reported.

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

Physical Activities for Youth (PAY) - Question identifier:PAY_Q065

In the last seven days, did you do any other physical [activities that you have not already reported/activities], for example, while you [were doing paid or unpaid work or/were] helping your family with chores?

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

Physical Activities for Youth (PAY) - Question identifier:PAY_Q070

Did any of these other physical activities make you sweat at least a little and breathe harder?

Exclude physical activities already reported.

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

Physical Activities for Youth (PAY) - Question identifier:PAY_Q090

You have reported a total of ^DV_PAYTOTAL minutes of physical activity. Of these activities, were there any of vigorous intensity, meaning they caused you to be out of breath?

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

Physical Activities for Youth (PAY) - Question identifier:PAY_Q095

In the last seven days, on which days did you do these vigorous activities that caused you to be out of breath?

Mark all that apply.

  • 1: Yesterday
  • 2: ^DT_DAY2DAYSAGOE
  • 3: ^DT_DAY3DAYSAGOE
  • 4: ^DT_DAY4DAYSAGOE
  • 5: ^DT_DAY5DAYSAGOE
  • 6: ^DT_DAY6DAYSAGOE
  • 7: ^DT_DAYLASTWEEKE
  • 8: RF
  • 9: DK

Physical Activities for Youth (PAY) - Question identifier:PAY_Q100

(In the last seven days), how much time in total did you spend doing vigorous activities that caused you to be out of breath?

Min = 0; Max = 168

Enter the number of hours here. Enter the number of minutes on the next screen. If respondent answers in minutes only, enter 0 hours on this screen and the number of minutes on the next screen.

If recall is too difficult for the respondent, ask for their best estimate.

Physical Activities for Youth (PAY) - Question identifier:PAY_N105

Enter number of minutes.

Min = 0; Max = 9995

Physical Activity Detail (PAD)

Physical Activity Detail (PAD) - Question identifier:PAD_Q005

^DT_BoldQuestIntroE^DT_NotReadQuestIntroE

^DT_QuestionE

Min = 0; Max = 24

If recall is too difficult for the respondent, ask for their best estimate.

Enter the number of hours on this screen and the number of minutes on the next screen. If the respondent answers in minutes only, enter 0 hours on this screen and number of minutes on the next screen.

Enter number of hours.

Physical Activity Detail (PAD) - Question identifier:PAD_N010

Enter number of minutes.

Min = 0; Max = 960

Physical Activity of Children (CPA)

Physical Activity of Children (CPA) - Question identifier:CPA_R001A

The next questions are about your physical activity. Physical activity is any activity that increases your heart rate and causes someone to be out of breath some of the time. Physical activity can take place while playing sports, doing school activities, playing with friends, or walking to school.

Press <1> to continue.

Physical Activity of Children (CPA) - Question identifier:CPA_R001B

Some examples of physical activity are running, brisk walking, dancing, swimming, rollerblading, skateboarding, biking, soccer, basketball and football.

For these next two questions, add up all the time you spend in physical activity each day.

Press <1> to continue.

Physical Activity of Children (CPA) - Question identifier:CPA_Q005

Over the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?

Min = 0; Max = 7

Enter the number of days.

Physical Activity of Children (CPA) - Question identifier:CPA_Q010

Over a typical or usual week, on how many days are you physically active for a total of at least 60 minutes per day?

Min = 0; Max = 7

Physical Activity of Children (CPA) - Question identifier:CPA_Q015

About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:

in your free time at school, for example, at lunch?

Read categories to respondent.

  • 1: Never
  • 2: Less than 2 hours per week
  • 3: 2 to less than 4 hours per week
  • 4: 4 to less than 7 hours per week
  • 5: 7 or more hours per week
  • 8: RF
  • 9: DK

Physical Activity of Children (CPA) - Question identifier:CPA_Q020

(About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:)

in your class time at school?

Read categories to respondent. Class time includes gym / phys. ed. classes.

  • 1: Never
  • 2: Less than 2 hours per week
  • 3: 2 to less than 4 hours per week
  • 4: 4 to less than 7 hours per week
  • 5: 7 or more hours per week
  • 8: RF
  • 9: DK

Physical Activity of Children (CPA) - Question identifier:CPA_Q025

About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:

[outside of school while/while] participating in lessons, leagues, or team sports?

Read categories to respondent. Include organized lessons for team or individual sports, dance, and other physical activities such as aerobics.

  • 1: Never
  • 2: Less than 2 hours per week
  • 3: 2 to less than 4 hours per week
  • 4: 4 to less than 7 hours per week
  • 5: 7 or more hours per week
  • 8: RF
  • 9: DK

Physical Activity of Children (CPA) - Question identifier:CPA_Q030

(About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:)

[outside of school while/while] participating in unorganized activities, either on your own or with friends?

Read categories to respondent.

  • 1: Never
  • 2: Less than 2 hours per week
  • 3: 2 to less than 4 hours per week
  • 4: 4 to less than 7 hours per week
  • 5: 7 or more hours per week
  • 8: RF
  • 9: DK

Physical Activity of Children (CPA) - Question identifier:CPA_Q035

On average, about how many hours a day do you spend watching TV, using a game console, computer, tablet or hand-held electronic device? Include time spent playing games, watching videos or movies, [and using the Internet. Include time spent on the computer with an adult or older child./doing homework, e-mailing, chatting and using the Internet.]

Min = 0; Max = 24.0

Game consoles include Xbox®, Nintendo®, and PlayStation® consoles. Hand-held electronic devices include Nintendo® DS, PSP®, iPad®, iPod® Touch and smartphones. Do not include time spent talking on the phone.

Enter time in hours to the nearest half hour.

Time Spent Outdoors (TSD)

Time Spent Outdoors (TSD) - Question identifier:TSD_R001

Now, I'd like to ask some questions about the time you spent outdoors in the last seven days, that is from ^DateLastWeekE to yesterday.

Press <1> to continue.

Time Spent Outdoors (TSD) - Question identifier:TSD_Q005

During a weekday, did you go to school (including kindergarten)?

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

Time Spent Outdoors (TSD) - Question identifier:TSD_Q010A

During a weekday, did you:
receive before- or after-school care at the school?

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

Time Spent Outdoors (TSD) - Question identifier:TSD_Q010B

During a weekday, did you:
go to a daycare centre?

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

Time Spent Outdoors (TSD) - Question identifier:TSD_Q010C

(During a weekday, did you:)
receive daycare in someone else's home?

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

Time Spent Outdoors (TSD) - Question identifier:TSD_Q010D

(During a weekday, did you:)
go to nursery school or preschool?

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

Time Spent Outdoors (TSD) - Question identifier:TSD_Q010E

(During a weekday, did you:)
stay at home with a parent, guardian, caregiver or relative?

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

Time Spent Outdoors (TSD) - Question identifier:TSD_Q010F

(During a weekday, did you:)
receive any other type of childcare (e.g., go to day camp)?

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

Time Spent Outdoors (TSD) - Question identifier:TSD_Q015

What grade are you in at school?

If the school year has ended, collect the grade the child has just completed.

  • 1: Junior or senior kindergarten
  • 2: Grade 1 or higher
  • 8: RF
  • 9: DK

Time Spent Outdoors (TSD) - Question identifier:TSD_Q020

In the last seven days, that is from ^DateLastWeekE to yesterday, on how many days did you attend kindergarten?

Min = 1; Max = 7

Do not include statutory holidays.

Time Spent Outdoors (TSD) - Question identifier:TSD_R025

When answering the next set of questions, please think of all time ^FNAME spent outside, for example, when walking, bicycling or tricycling, waiting outside for the bus, playing outside and when doing any other activities outdoors.

Press <1> to continue.

Time Spent Outdoors (TSD) - Question identifier:TSD_Q035

In the last seven days, that is from ^DateLastWeekE to yesterday, how many days did you attend school?

Min = 0; Max = 7

Do not include statutory holidays.

Time Spent Outdoors (TSD) - Question identifier:TSD_R050

When answering the next set of questions, please think of all time you spent outside in the last seven days, for example, when [walking, bicycling or tricycling/walking, bicycling], waiting outside for a bus, [playing outside/playing outside, playing sports/playing sports] or when doing any other activities outdoors.

Press <1> to continue.

Time Spent Outdoor Detail (TOD)

Time Spent Outdoor Detail (TOD) - Question identifier:TOD_Q005

^DT_BoldQuestIntroE^DT_NotReadQuestIntroE

^DT_QuestionE

Min = 0; Max = 24

If recall is too difficult for the respondent, ask for their best estimate.

Enter the number of hours on this screen and the number of minutes on the next screen. If the respondent answers in minutes only, enter 0 hours on this screen and number of minutes on the next screen.

Enter number of hours.

Time Spent Outdoor Detail (TOD) - Question identifier:TOD_N010

Enter number of minutes.

Min = 0; Max = 180

Sedentary Activities (SAC)

Sedentary Activities (SAC) - Question identifier:SAC_R001

Now, a few additional questions about activities you do in your leisure time, that is excluding activities you do at work, during class time or while travelling in a vehicle.

Some of these questions may appear similar, but please only report each activity once.

Please report times to the nearest half hour.

Press <1> to continue.

Sedentary Activities (SAC) - Question identifier:SAC_Q005

In the last seven days, that is from ^DateLastWeekE to yesterday, how much of your free time did you spend:

reading books, magazines or newspapers, including in electronic formats? Include time spent reading as part of your homework, but do not include time spent reading at work, during class time, while travelling in a vehicle or while exercising.

Min = 0; Max = 95.5

Include books, eBook readers (e.g., Kindle®, Kobo® and Nook®), magazines, newspapers and homework. Do not include reading on a computer, a tablet or the Internet.

Enter time in hours to the nearest half hour.

Sedentary Activities (SAC) - Question identifier:SAC_Q010

(In the last seven days, that is from ^DateLastWeekE to yesterday, how much of your free time did you spend:)

watching TV, DVDs, movies or Internet videos? Do not include time spent watching while exercising.

Min = 0; Max = 95.5

Include time spent watching downloaded or streaming shows or movies on a computer (e.g., Netflix®). Do not include time when the TV was left on, but the respondent was not watching.

Enter time in hours to the nearest half hour

Sedentary Activities (SAC) - Question identifier:SAC_Q015

(In the last seven days, that is from ^DateLastWeekE to yesterday, how much of your free time did you spend:)

playing video games that require physical activity, such as Wii® Fit, Xbox® Kinect or the game "Just Dance"?

Min = 0; Max = 95.5

Do not include time spent playing video games on a computer.

Enter time in hours to the nearest half hour.

Sedentary Activities (SAC) - Question identifier:SAC_Q020

(In the last seven days, that is from ^DateLastWeekE to yesterday, how much of your free time did you spend:)

playing other video or computer games? Include games played on a game console, computer or hand-held electronic device such as a tablet or smart phone.

Min = 0; Max = 95.5

Include time spent gaming on any electronic device. Game consoles include Xbox®, Nintendo® and PlayStation® consoles. Hand-held electronic devices include Nintendo® DS, PSP®, iPad® and iPod® Touch.

Enter time in hours to the nearest half hour.

Sedentary Activities (SAC) - Question identifier:SAC_Q025

[Excluding the activities you have already reported, in/In] the last seven days, that is from ^DateLastWeekE to yesterday, how much of your free time did you spend on a computer, tablet or smart phone, doing activities such as using the Internet, emailing, using Facebook® or doing homework?

Do not include time spent at work, during class time or while travelling in a vehicle.

Min = 0; Max = 95.5

Include Internet use on other devices such as iPad® or iPod® Touch. Do not include time spent talking on the telephone.

Enter time in hours to the nearest half hour.

Neighbourhood Environment (NBE)

Neighbourhood Environment (NBE) - Question identifier:NBE_R001

We are now going to talk about your neighbourhood. By neighbourhood I mean the area around your home that you could walk to in less than 15 minutes.

If the respondent has difficulty walking or cannot walk at all, ask him/her to think of the area that another household member, friend or neighbour aged 12 or older could walk to in less than 15 minutes.

Press <1> to continue.

Neighbourhood Environment (NBE) - Question identifier:NBE_Q005

What is the main type of housing in your neighbourhood?

Read categories to respondent. Mobile homes and farms should be included in category 1.

  • 1: Single-detached housing
  • 2: Semi-detached or terrace houses, townhouses, apartments or condos of 2 to 3 storeys
  • 3: Apartments or condos of 4 to 12 storeys
  • 4: Apartments or condos of more than 12 storeys
  • 5: Mix of single-detached houses and semi-detached or terrace houses, townhouses, apartments or condos
  • 6: Other - specify
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_R010

The next items are statements about your neighbourhood related to walking and bicycling. Please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree.

Press <1> to continue.

Neighbourhood Environment (NBE) - Question identifier:NBE_Q015

There are many shops, stores, markets or other places to buy things within easy walking distance of your home.

Read categories to respondent. If there are no shops, stores, or markets in respondent's neighbourhood, please select "Strongly disagree".

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q020

It is less than a 15 minute walk to a transit stop (such as bus, train, subway or street car) from your home.

Select "Strongly agree" if there is a transit stop within a 15 minute walk.
Select "Somewhat agree" or "Somewhat disagree" if the transit stop may be within a 15 minute walk, e.g., depending on weather conditions.
Select "Strongly disagree" if there is a transit stop but it is more than a 15 minute walk.
If there is no public transportation, e.g., the respondent lives in a rural area, select category <5> Not applicable

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 5: Not applicable - no public transportation
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q025

There are sidewalks on most of the streets in your neighbourhood.

If there are no sidewalks in respondent's neighbourhood, please select "Strongly disagree".

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q030

In or near your neighbourhood, there are designated areas for bicycling such as special bicycle lanes, separate paths or trails, shared use paths for bicycles and pedestrians.

Read categories to respondent. If there are no designated areas to bicycle in respondent's neighbourhood, please select "Strongly disagree".

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q035

^YOUR1_C neighbourhood has several free or low cost recreation facilities, such as parks, walking trails, bike paths, recreation centres, playgrounds, public swimming pools, etc.

If there are no recreation facilities in respondent's neighbourhood, please select "Strongly disagree".

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q040

The crime rate in your neighbourhood makes it unsafe to go on walks at night.

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q045

There are many interesting things to look at while walking in your neighbourhood.

Read categories to respondent.

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q050

The sidewalks in your neighbourhood are well maintained (paved, with few cracks) and not obstructed.

If there are only a few sidewalks in the respondent's neighbourhood, ask the respondent to answer with respect to the sidewalks that are there.

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q055

There is so much traffic on the streets that it makes it difficult or unpleasant to walk in your neighbourhood.

If there is no traffic, please select "Strongly disagree".

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_Q060

There is so much traffic on the streets that it makes it difficult or unpleasant to ride a bicycle in your neighbourhood.

Read categories to respondent. Please ask the respondent to rate in general, even if they never ride a bicycle. If there is no traffic, please select "Strongly disagree".

  • 1: Strongly agree
  • 2: Somewhat agree
  • 3: Somewhat disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Neighbourhood Environment (NBE) - Question identifier:NBE_R065

Now a few questions about driving.

Press <1> to continue.

Neighbourhood Environment (NBE) - Question identifier:NBE_Q070

Do you have a valid driver's licence? (Do not include a learner's licence where the driver must be accompanied by someone who has a valid driver's licence.)

A valid driver's licence includes graduated driver's licenses where an individual is permitted to drive alone with some restrictions, e.g., zero blood alcohol level.

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

Neighbourhood Environment (NBE) - Question identifier:NBE_Q075

In the last seven days, did you have a vehicle at your disposal?

Include motorcycles. Include access to a family member's, friend's, co-worker's or neighbour's vehicle, rental or shared service car. Also include a vehicle which the respondent uses for employment purposes but may be used during non-employment hours.

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

Toxoplasmosis (TOX)

Toxoplasmosis (TOX) - Question identifier:TOX_R001

The next few questions collect information about behaviours that could expose people to an increased risk of contracting a specific parasite. This parasite can affect unborn children and people who have a compromised immune system.

Press <1> to continue.

Toxoplasmosis (TOX) - Question identifier:TOX_Q005

In the past 12 months, that is from ^DateLastYearE to yesterday, have any cats lived in [your/your] dwelling?

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

Toxoplasmosis (TOX) - Question identifier:TOX_Q010

In the past 12 months, what is the maximum number of cats that lived in [your/your] dwelling at a given time?

Min = 1; Max = 95

Toxoplasmosis (TOX) - Question identifier:TOX_Q015

Did [this cat/any of these cats] have a litter box?

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

Toxoplasmosis (TOX) - Question identifier:TOX_Q020

How often was the cat litter usually changed or scooped?

Read categories to respondent.

  • 1: Daily
  • 2: More than once per week
  • 3: Once per week
  • 4: Less than once per week
  • 8: RF
  • 9: DK

Toxoplasmosis (TOX) - Question identifier:TOX_Q025

[In the past 12 months, that is from ^DateLastYearE to yesterday, did you ever change or scoop the cat litter?/In the past 12 months, did you ever change or scoop the litter?]

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

Toxoplasmosis (TOX) - Question identifier:TOX_Q030

In the past 12 months, did [this cat/any of these cats] go outdoors?

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

Toxoplasmosis (TOX) - Question identifier:TOX_Q035

In the past 12 months,[ that is from ^DateLastYearE to yesterday,/EMPTY] did you handle soil or sand with your bare hands, for example when doing outdoor yard work, gardening or farming, in a sand box or at the beach? Do not include indoor potting soil.

Do not include brief contacts with soil or sand such as a fall during a sport activity (volleyball, soccer, football, baseball, etc.).

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

Toxoplasmosis (TOX) - Question identifier:TOX_Q040

In the past 12 months, [ that is from ^DateLastYearE to yesterday,/EMPTY] have you eaten any hunted game meat? Include both mammals and birds.

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

Toxoplasmosis (TOX) - Question identifier:TOX_Q045

What types of hunted game meat did you eat?

Mark all that apply.

  • 01: Bear
  • 02: Caribou
  • 03: Deer
  • 04: Elk
  • 05: Moose
  • 06: Duck or goose
  • 07: Wild turkey, pheasant, partridge, quail, grouse
  • 08: Rabbit or hare
  • 09: Seal
  • 10: Other - Specify
  • 98: RF
  • 99: DK

Toxoplasmosis (TOX) - Question identifier:TOX_Q050

In the past 12 months, have you eaten any of the following types of meat uncooked, or cooked with some red or pink still showing?

Read categories to respondent. Mark all that apply.

  • 1: Beef
  • 2: Lamb
  • 3: Pork
  • 4: Other red meat - Specify
  • 5: No
  • 8: RF
  • 9: DK

Request for Parent to Leave (RPL)

Request for Parent to Leave (RPL) - Question identifier:RPL_N11

Is the parent or guardian in the room with the youth?

  • 1: Yes
  • 2: No

Request for Parent to Leave (RPL) - Question identifier:RPL_R12

The next set of questions deal with some sensitive topics such as [smoking and alcohol consumption/smoking, drug use and sexual behaviour]. To obtain honest and accurate answers, it is best when these questions are answered in private.

Press <1> to continue.

Request for Parent to Leave (RPL) - Question identifier:RPL_Q13

Would you please leave the room for a few minutes? We will let you know when we have finished these questions and you will be welcome to return.

Is the selected respondent now alone?

  • 1: Yes
  • 2: No

Smoking (SMK)

Smoking (SMK) - Question identifier:SMK_R11

Now, I am going to ask you about cigarette smoking. By cigarettes, we mean both ready-made cigarettes and ones you roll yourself, excluding cigars, cigarillos, marijuana or pipes.

Press <1> to continue.

DK and RF are not allowed.

Smoking (SMK) - Question identifier:SMK_Q11

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_Q12

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_R21

The next questions are about your smoking history. To begin, a question about when you started smoking. You may find it helpful to think back to what you were doing or who you were with when you started smoking.

Press <1> to continue.

DK and RF are not allowed.

Smoking (SMK) - Question identifier:SMK_Q21

At what age did you smoke your first whole cigarette?

Min = 5; Max = 79

Minimum is 5; maximum is ^AWC_AGE.

Smoking (SMK) - Question identifier:SMK_R21A

Now I'd like to know about changes in your smoking pattern from the time you smoked your first whole cigarette until today.

Press <1> to continue.

DK and RF are not allowed.

Smoking (SMK) - Question identifier:SMK_Q21A

Have you ever smoked at least one cigarette a month?

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

Smoking (SMK) - Question identifier:SMK_Q22

How old were you when you started smoking at least one cigarette a month?

Min = 5; Max = 79

Minimum is ^SMK_Q21; maximum is ^AWC_AGE.

Smoking (SMK) - Question identifier:SMK_Q23

When you were ^SMK_Q22 years old, how many days in a typical month did you smoke at least one cigarette?

Min = 1; Max = 31

If the respondent smoked every day or daily, enter "31".
If the respondent smoked 30 days in a month, ask if this means every day. If so, enter "31". If not, enter "30".

Smoking (SMK) - Question identifier:SMK_Q24

When you were ^SMK_Q22 years old...

...[how many cigarettes did you usually smoke each day/on the days you smoked, how many cigarettes did you usually smoke]?

Min = 1; Max = 95

Smoking (SMK) - Question identifier:SMK_Q31

How many cigarettes do you smoke each day now?

Min = 1; Max = 95

Smoking (SMK) - Question identifier:SMK_Q41

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

Min = 1; Max = 95

Smoking (SMK) - Question identifier:SMK_Q42

In the past month, that is, from ^DateLastMonthE to today, on how many days have you smoked one or more cigarettes?

Min = 0; Max = 31

Smoking (SMK) - Question identifier:SMK_Q51

Have you ever smoked cigarettes daily?

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

Smoking (SMK) - Question identifier:SMK_Q52

At what age did you begin to smoke cigarettes daily?

Min = 5; Max = 79

Minimum is ^SMK_Q22; maximum is ^AWC_AGE.

Smoking (SMK) - Question identifier:SMK_Q53

[When you started smoking cigarettes daily, how/How] many cigarettes did you usually smoke each day?

Min = 1; Max = 95

Smoking (SMK) - Question identifier:SMK_Q54

At what age did you stop smoking cigarettes [completely/daily]?

Min = 5; Max = 79

Minimum is [^SMK_Q22/^SMK_Q52]; maximum is ^AWC_AGE.

Smoking (SMK) - Question identifier:SMK_Q60

In the past month, that is, from ^DateLastMonthE to today, have you smoked cigars, cigarillos or a pipe or used snuff or chewing tobacco?

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

Electronic Cigarette (ELC)

Electronic Cigarette (ELC) - Question identifier:ELC_R001

Now, I am going to ask you about electronic cigarette use.

Press <1> to continue.

Electronic Cigarette (ELC) - Question identifier:ELC_Q005

Have you ever tried an electronic cigarette, also known as an e-cigarette?

Another term for an electronic cigarette is "VAPE".

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

Electronic Cigarette (ELC) - Question identifier:ELC_Q010

In the past month, that is, from ^DateLastMonthE to today, did you use an electronic cigarette... ?

Read categories to respondent.

  • 1: Every day
  • 2: Almost every day
  • 3: At least once a week
  • 4: At least once in the past month
  • 5: Never
  • 8: RF
  • 9: DK

Electronic Cigarette (ELC) - Question identifier:ELC_Q015

The last time you used an e-cigarette, did it contain nicotine?

  • 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. Second-hand smoke includes the smoke that smokers exhale and the smoke from burning cigarettes, cigars, cigarillos or little cigars and pipes.

Press <1> to continue.

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q01

Is smoking allowed inside this home?

Include cigarettes, cigars, cigarillos or little 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_Q02

Is smoking inside this home restricted in any way?

Smoking is considered restricted if it is only allowed in certain areas of the home or under certain circumstances. Examples of restrictions include allowing smoking only in certain rooms, when windows are open or in the presence of other ventilation, or banning smoking when there are young children or elderly people present.

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

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q03

How is smoking restricted inside this home?

Read categories to respondent. Mark all that apply.

  • 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

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q04

How often does someone smoke inside this home? Include both household members and visitors.

Include respondent's own smoking. Read categories to respondent.

  • 1: Every day
  • 2: Almost every day
  • 3: At least once a week
  • 4: At least once a month
  • 5: Less than once a month
  • 6: Never
  • 8: RF
  • 9: DK

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q05

How many people smoke inside this home every day or almost every day?

Min = 1; Max = 15

Include both household members and visitors. Include cigarette, cigar, cigarillo or little cigar and pipe smoking. Include respondent's own smoking.

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q06

Which of the following tobacco products are smoked inside this home?

Include respondent's own smoking. Read categories to respondent. Mark all that apply.

  • 1: Cigarettes
  • 2: Cigarillos or little cigars
  • 3: All other types of cigars
  • 4: Pipes
  • 8: RF
  • 9: DK

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q07

On a typical day, how many [cigarettes/cigarillos or little cigars/cigars/cigarettes and cigarillos or little cigars/cigarettes and cigars/cigarillos, little cigars and other types of cigars/cigarettes, cigarillos or little cigars, and other types of cigars] are smoked inside this home?

Min = 1; Max = 995

There are about 20 cigarettes in a pack. Include the respondent's own smoking.

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q08

On a typical day, what is the total period of time that at least one person is smoking a pipe inside this home?

Include the time only once even if more than one person is smoking a pipe at the same time. Include respondent's own smoking.

Read categories to respondent.

  • 1: Less than 1 hour
  • 2: 1 to less than 3 hours
  • 3: 3 to less than 5 hours
  • 4: 5 hours or more
  • 8: RF
  • 9: DK

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q09

[Not including your own smoking, in/In] the past month, that is, from ^DateLastMonthE to today, how often were you exposed to second-hand smoke inside this home?

Select "Never" if the respondent was only exposed to his/her own smoke. Read categories to respondent.

  • 1: Every day
  • 2: Almost every day
  • 3: At least once a week
  • 4: At least once in the past month
  • 5: Never
  • 8: RF
  • 9: DK

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_R14

The next questions are about exposure to second-hand smoke in places other than your own home. Again, second-hand smoke includes the smoke that smokers exhale and the smoke from burning cigarettes, cigars, cigarillos or little cigars and pipes. [Do not include exposure to your own smoke./EMPTY]

Press <1> to continue.

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q14

In the past month, that is, from ^DateLastMonthE to today, were you exposed to second-hand smoke, every day or almost every day:

in a car or other vehicle?

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

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q16

(In the past month, that is, from ^DateLastMonthE to today, were you exposed to second-hand smoke, every day or almost every day:)

at your place of work?

Include exposure outdoors if the respondent works outdoors. Do not include exposure at the entrance to a building (e.g., when arriving at or leaving the place of work); this should be captured at ETS_Q22: outdoors in public places.

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

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q20

(In the past month, that is, from ^DateLastMonthE to today, were you exposed to second-hand smoke, every day or almost every day:)

inside someone else's home?

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

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q21

(In the past month, that is, from ^DateLastMonthE to today, were you exposed to second-hand smoke, every day or almost every day:)

indoors, in public places such as bars, restaurants, shopping malls, arenas, bingo halls, bowling alleys, concert or sporting facilities?

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

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q22

(In the past month, that is, from ^DateLastMonthE to today, were you exposed to second-hand smoke, every day or almost every day:)

outdoors, in public places such as outdoor patios, bus stops or shelters, entrances to buildings, school property, sidewalks or parks?

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

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q23

(In the past month, that is, from ^DateLastMonthE to today, were you exposed to second-hand smoke, every day or almost every day:)

anywhere else?

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

Exposure to Second-Hand Smoke (ETS) - Question identifier:ETS_Q24

Overall,[ excluding inside your own home,/EMPTY] in the past month, that is, from ^DateLastMonthE to today, how often were you exposed to second-hand smoke? [Do not include exposure to your own smoke./EMPTY]

Read categories to respondent.

  • 1: Every day
  • 2: Almost every day
  • 3: At least once a week
  • 4: At least once in the past month
  • 5: Never
  • 8: RF
  • 9: DK

Exposure to Second-Hand Vapor (ETV)

Exposure to Second-Hand Vapor (ETV) - Question identifier:ETV_R001

The next question is about exposure to second-hand vapour from [electronic cigarettes, also known as e-cigarettes/e-cigarettes].

Press <1> to continue.

Exposure to Second-Hand Vapor (ETV) - Question identifier:ETV_Q005

Overall, in the past month, that is, from ^DateLastMonthE to today, how often were you exposed to second-hand vapour inside this home? [Do not include your own vapor./EMPTY]

Read categories to respondent. Select "Never" if the respondent was only exposed to his/her own vapour. Another term for an electronic cigarette is "VAPE".

  • 1: Every day
  • 2: Almost every day
  • 3: At least once a week
  • 4: At least once in the past month
  • 5: Never
  • 8: RF
  • 9: DK

Alcohol Use (ALC)

Alcohol Use (ALC) - Question identifier:ALC_R11

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_Q11

During the past 12 months, that is, from ^DATELASTYEARE 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_Q12

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_Q13A

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 (ALC) - Question identifier:ALC_Q14

Thinking back over the past week, that is, from ^DateLastWeekE 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 (ALC) - Question identifier:ALC_Q15

[Starting with yesterday, that is/EMPTY]^NameYesterdayE, how many drinks did you have?

Min = 0; Max = 95

Alcohol Use (ALC) - Question identifier:ALC_Q16

Is the amount you drank over the last week more, about the same, or less compared to most weeks?

  • 1: More
  • 2: About the same
  • 3: Less
  • 8: RF
  • 9: DK

Alcohol Use (ALC) - Question identifier:ALC_Q17

Have you ever had a drink?

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

Alcohol Use (ALC) - Question identifier:ALC_Q18

Did you ever regularly drink more than 12 drinks a week?

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

Alcohol Use (ALC) - Question identifier:ALC_Q19

Not counting small sips, how old were you when you started drinking alcoholic beverages?

Min = 5; Max = 79

Drinking does not include having a few sips of wine for religious purposes.
Minimum is 5; maximum is ^AWC_AGE.

Illicit Drug Use (IDU)

Illicit Drug Use (IDU) - Question identifier:IDU_R11

Now I am going to ask you some questions about your use of drugs and other substances for non-medicinal purposes, for the experience, for the feeling they cause or to get high. I would like to remind you that everything you say will remain strictly confidential.

Press <1> to continue.

Illicit Drug Use (IDU) - Question identifier:IDU_Q11

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

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

Illicit Drug Use (IDU) - Question identifier:IDU_Q21

Have you ever used or tried prescription drugs for non-medicinal purposes, for the experience, for the feeling they cause or to get high?

Examples include such things as painkillers, stimulants such as Ritalin, sedatives or tranquilizers.

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

Illicit Drug Use (IDU) - Question identifier:IDU_Q22

Have you ever used or tried other drugs or substances such as cocaine, speed, solvents or steroids?

Do not include marijuana or prescription drugs.

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

Illicit Drug Use (IDU) - Question identifier:IDU_R32

The next two questions ask about the [prescription and other drugs or substances/prescription drugs/other drugs or substances] you just reported. [Do not include marijuana, cannabis or hashish./EMPTY]

Press <1> to continue.

Illicit Drug Use (IDU) - Question identifier:IDU_Q32

Have you ever injected or been injected with drugs for non-medicinal purposes, for the experience, for the feeling they cause or to get high?

Examples include such things as cocaine, heroin or steroids.

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

Illicit Drug Use (IDU) - Question identifier:IDU_Q33

Other than by injection, have you ever used or tried drugs for non-medicinal purposes, for the experience, for the feeling they cause or to get high? [Do not include marijuana, cannabis or hashish./EMPTY]

Some drugs can be administered in various ways. For this question, only include drugs taken using non-injection methods (e.g., snorting, sniffing, smoking, or oral ingestion) such as crack cocaine, hallucinogens and speed.

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

Sexual Behaviour (SXB)

Sexual Behaviour (SXB) - Question identifier:SXB_R11

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 Behaviour (SXB) - Question identifier:SXB_Q11

Have you ever had sexual intercourse?

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

Sexual Behaviour (SXB) - Question identifier:SXB_Q12

In the past 12 months, have you had sexual intercourse?

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

Sexual Behaviour (SXB) - Question identifier:SXB_Q13

With how many different partners?

  • 1: 1 partner
  • 2: 2 partners
  • 3: 3 partners
  • 4: 4 or more partners
  • 8: RF
  • 9: DK

Sexual Behaviour (SXB) - Question identifier:SXB_Q21

Have you ever been diagnosed with a sexually transmitted disease or infection?

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

Sexual Behaviour (SXB) - Question identifier:SXB_Q22

Which sexually transmitted disease(s) or infection(s) have you been diagnosed with?

Mark all that apply.

  • 01: HIV (Human Immunodeficiency Virus)
  • 02: AIDS (Acquired Immunodeficiency Syndrome)
  • 03: Chlamydia
  • 04: Genital Herpes (Herpes Simplex Type II)
  • 05: Syphilis
  • 06: Gonorrhoea
  • 07: Genital Warts (Human Papilloma Virus or HPV)
  • 08: Venereal disease
  • 09: Hepatitis B
  • 10: Other - Specify
  • 98: RF
  • 99: DK

Sexual Behaviour (SXB) - Question identifier:SXB_Q23

Did you or your partner use a condom the last time you had sexual intercourse?

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

Sexual Behaviour (SXB) - Question identifier:SXB_Q24

Do you or your partner usually use a condom when you have sexual intercourse?

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

Birth Control (BCL)

Birth Control (BCL) - Question identifier:BCL_R001

I would now like to ask you a few questions about the use of specific birth control medications that can affect personal health. You can be assured that anything you say will remain confidential.

Press <1> to continue.

Birth Control (BCL) - Question identifier:BCL_Q005

Have you ever used birth control pills?

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

Birth Control (BCL) - Question identifier:BCL_Q010

In total, over your lifetime, how many years did you use birth control pills?

Read categories to respondent. If birth control pills were used intermittently, sum the duration of use.

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

Birth Control (BCL) - Question identifier:BCL_Q015

Have you ever had a progesterone birth control injection, for example Depo Provera®?

Do not include Depo Provera® cream.

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

Birth Control (BCL) - Question identifier:BCL_Q020

In total, over your lifetime, how many years did you use progesterone injections?

Read categories to respondent. If progesterone injections were used intermittently, sum the duration of use.

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

Maternal Breastfeeding (MBF)

Maternal Breastfeeding (MBF) - Question identifier:MBF_R11

Now some questions about giving birth and breastfeeding experiences.

Press <1> to continue.

Maternal Breastfeeding (MBF) - Question identifier:MBF_Q11

Have you ever given birth?

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

Maternal Breastfeeding (MBF) - Question identifier:MBF_Q12

How many live births have you had (excluding stillborns and miscarriages)?

Min = 0; Max = 15

Enter number of births.

Breastfeeding (BRF)

Breastfeeding (BRF) - Question identifier:BRF_Q11

Did you breastfeed your [first/EMPTY/second/third/fourth/fifth/sixth/seventh/eighth/ninth/tenth/eleventh/twelfth/thirteenth/fourteenth/fifteenth] baby?

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

Breastfeeding (BRF) - Question identifier:BRF_Q12

For how long did you breastfeed your [first/EMPTY/second/third/fourth/fifth/sixth/seventh/eighth/ninth/tenth/eleventh/twelfth/thirteenth/fourteenth/fifteenth] 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

Request for Parent to Return (RPR)

Request for Parent to Return (RPR) - Question identifier:RPR_R11

We have now finished the sensitive questions. If your parent or guardian is available, please ask him or her to [rejoin/join] us now.

Press <1> to continue.

Request for Parent to Return (RPR) - Question identifier:RPR_N11

Is the parent or guardian in the room?

  • 1: Yes
  • 2: No

Request for Child to Leave (RCL)

Request for Child to Leave (RCL) - Question identifier:RCL_N11

Is the child in the room?

  • 1: Yes
  • 2: No

Request for Child to Leave (RCL) - Question identifier:RCL_R12

[It is best when this next set of questions is answered by an adult in private./This next set of questions deals with topics that are best answered by your parent or guardian in private. Please ask your parent or guardian to come and answer these next questions./This next set of questions deals with topics that are best answered by your parent or guardian in private.]

Press <1> to continue.

Request for Child to Leave (RCL) - Question identifier:RCL_N12

Is the parent or guardian available to answer the next questions?

  • 1: Yes
  • 2: No

Request for Child to Leave (RCL) - Question identifier:RCL_Q13

[Could ^FNAME please leave the room while we complete these questions? We will let ^DT_HIMHER know when we have finished these questions and [he/she] may return./Would you please leave the room so that your parent or guardian may answer these questions in private? We will let you know when we have finished these questions and at that time we would like you to return.]

Has the child left the room?

  • 1: Yes
  • 2: No

Pregnancy Information (PRG)

Pregnancy Information (PRG) - Question identifier:PRG_R11

Next some question about [your pregnancy with ^FNAME/^FNAME's biological mother's pregnancy with ^HIMHER2].

Press <1> to continue.

Pregnancy Information (PRG) - Question identifier:PRG_Q11

Did [you/she] smoke during [your/her] pregnancy with ^FNAME?

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

Pregnancy Information (PRG) - Question identifier:PRG_Q12

How many cigarettes per day did [you/she] smoke?

Min = 1; Max = 95

Enter number of cigarettes.

Pregnancy Information (PRG) - Question identifier:PRG_Q13

At what stage in [her/her/your] pregnancy did [she/she/you] smoke[EMPTY/this amount]?

Mark all that apply.

  • 1: During the first three months
  • 2: During the second three months
  • 3: During the third three months
  • 4: Throughout
  • 8: RF
  • 9: DK

Birth Information (BIR)

Birth Information (BIR) - Question identifier:BIR_R11

The following questions concern ^FNAME's birth.

Press <1> to continue.

Birth Information (BIR) - Question identifier:BIR_Q11

How much did you weigh at birth?

Record the reporting unit.

  • 1: Pounds and Ounces
  • 2: Grams
  • 8: RF
  • 9: DK

Birth Information (BIR) - Question identifier:BIR_N12

Enter pounds only.

Min = 0; Max = 20

Birth Information (BIR) - Question identifier:BIR_N13

Enter ounces only.

Min = 0; Max = 15

Birth Information (BIR) - Question identifier:BIR_N14

Enter grams.

Min = 225; Max = 9995

Birth Information (BIR) - Question identifier:BIR_Q21

Was you born before, after or on the due date?

  • 1: Before the due date
  • 2: After the due date
  • 3: On the due date
  • 8: RF
  • 9: DK

Birth Information (BIR) - Question identifier:BIR_Q22

How many days [before/after] the due date was you born?

Min = 0; Max = 126

If less than one day, enter "0".

Birth Information (BIR) - Question identifier:BIR_Q23

Was this a single birth, or was it twins or triplets?

  • 1: Single birth
  • 2: Twins
  • 3: Triplets
  • 4: More than triplets
  • 8: RF
  • 9: DK

Birth Information (BIR) - Question identifier:BIR_Q24

Was ^FNAME admitted to a special neonatal unit or an intensive care unit immediately following birth, before you left the hospital?

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

Birth Information (BIR) - Question identifier:BIR_Q25

For how many days, in total, was this care received?

Min = 0; Max = 995

If less than one day, enter "0".

Birth Information (BIR) - Question identifier:BIR_Q26

How old [were you/was ^FNAME's biological mother] when ^FNAME was born?

Min = 12; Max = 70

Minimum is 12; maximum is 70.

Breastfeeding Information (BRI)

Breastfeeding Information (BRI) - Question identifier:BRI_Q11

Did [you/^FNAME's biological mother] breastfeed ^FNAME as an infant, even if only for a short period of time?

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

Breastfeeding Information (BRI) - Question identifier:BRI_Q12

For how long did [you/she] breastfeed?

  • 01: Less than one week
  • 02: 1 to less than 3 weeks
  • 03: 3 to less than 5 weeks
  • 04: 5 to less than 9 weeks
  • 05: 9 to less than 12 weeks
  • 06: 3 to less than 7 months
  • 07: 7 to less than 10 months
  • 08: 10 to 12 months
  • 09: More than 1 year
  • 98: RF
  • 99: DK

Breastfeeding Information (BRI) - Question identifier:BRI_Q13

For how long was ^FNAME fed only breast milk?

Water, tea, juice or other liquids are not to be included. Medication and vitamins can be included.

  • 1: Less than one week
  • 2: 1 to less than 3 weeks
  • 3: 3 to less than 5 weeks
  • 4: 5 to less than 9 weeks
  • 5: 9 to less than 12 weeks
  • 6: 3 to 6 months
  • 7: More than 6 months
  • 8: RF
  • 9: DK

Request for Child to Return (RCR)

Request for Child to Return (RCR) - Question identifier:RCR_R11

We have now finished this set of questions. [^FNAME may return now if [he/she] wishes. [He/She] may help answer the remaining questions./^FNAME should return now to answer the remaining questions in the survey. You may wish to remain in the room or close by to provide assistance to ^FNAME if needed./^FNAME should answer the remaining questions in the survey. You may wish to remain in the room or close by to provide assistance to ^FNAME if needed.]

Press <1> to continue.

Request for Child to Return (RCR) - Question identifier:RCR_N11

Has the child returned to the room?

  • 1: Yes
  • 2: No

Labour Market (LAF)

HC: Labour market activity minimum - LMAM

Block from Harmonized content

HC: Labour market activity minimum - LMAM - Question identifier:LMAM_Q01

Last week, did you work at a job or business? (regardless of the number of hours)

  • 1: Yes
  • 2: No
  • 9: Don't know
  • 8: Refusal

HC: Labour market activity minimum - LMAM - Question identifier:LMAM_Q02

Last week, did you have a job or business from which you were absent?

  • 1: Yes
  • 2: No
  • 9: Don't know
  • 8: Refusal

HC: Labour market activity minimum - LMAM - Question identifier:LMAM_Q03

What was the main reason you were absent from work last week?

  • 01: Own illness or disability
  • 02: Caring for own children
  • 03: Caring for elder relative (60 years of age or older)
  • 04: Maternity or parental leave
  • 05: Other personal or family responsibilities
  • 06: Vacation
  • 07: Labour dispute (strike or lockout) (Employees only)
  • 08: Temporary layoff due to business conditions (Employees only)
  • 09: Seasonal layoff (Employees only)
  • 10: Casual job, no work available (Employees only)
  • 11: Work schedule (e.g., shift work) (Employees only)
  • 12: Self-employed, no work available (Self-employed only)
  • 13: Seasonal business (Excluding employees)
  • 14: Other - Specify
  • 99: Don't know
  • 98: Refusal

HC: Labour market activity Sublock Labour force status - LMA2

HC: Labour market activity Sublock Labour force status - LMA2 - Question identifier:LMA2_Q04

In the 4 weeks ending [REFENDE-English date corresponding to the last day of reference week], did you do anything to find work?

  • 1: Yes
  • 2: No
  • 9: Don't know
  • 8: Refusal

HC: Labour market activity Sublock Labour force status - LMA2 - Question identifier:LMA2_Q05

Last week, did you have a job to start at a definite date in the future?

  • 1: Yes
  • 2: No
  • 9: Don't know
  • 8: Refusal

HC: Labour market activity Sublock Labour force status - LMA2 - Question identifier:LMA2_Q06

Will you start that job before or after [NMBEGE-English date corresponding to the first day after 4 weeks from the end of the reference week]?

  • 1: Before the date above
  • 2: On or after the date above
  • 9: Don't know
  • 8: Refusal

HC: Labour market activity Sublock Labour force status - LMA2 - Question identifier:LMA2_Q07

Did you want a job with more or less than 30 hours per week?

  • 1: 30 or more hours per week
  • 2: Less than 30 hours per week
  • 9: Don't know
  • 8: Refusal

HC: Labour market activity Sublock Labour force status - LMA2 - Question identifier:LMA2_Q08

Could you have worked last week if you had been recalled /if a suitable job had been offered?

  • 1: Yes
  • 2: No
  • 9: Don't know
  • 8: Refusal

HC: Labour market activity Sublock Labour force status - LMA2 - Question identifier:LMA2_Q09

What was the main reason you were not available to work last week?

  • 01: Own illness or disability
  • 02: Caring for own children
  • 03: Caring for elder relative (60 years of age or older)
  • 04: Other personal or family responsibilities
  • 05: Going to school
  • 06: Vacation
  • 07: Already has a job
  • 08: Other - Specify
  • 99: Don't know
  • 98: Refusal

HC: Labour market activity Sublock Class of worker - LMA3

HC: Labour market activity Sublock Class of worker - LMA3 - Question identifier:LMA3_Q10

Were you an employee or self-employed?

  • 1: Employee
  • 2: Self-employed
  • 3: Working in a family business without pay
  • 9: Don't know
  • 8: Refusal

Industry (LMA4)

Industry (LMA4) - Question identifier:LMA4_Q11

What was 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.

Industry (LMA4) - Question identifier:LMA4_Q12

For whom did you work?

Long Answer Length = 50

Enter the full name of the company, business, government department or agency, or person.

Industry (LMA4) - Question identifier:LMA4_Q13

What kind of business, industry or service was 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

HC: Labour market activity Sublock Occupation - LMA5

HC: Labour market activity Sublock Occupation - LMA5 - Question identifier:LMA5_Q14

What was your work or occupation?

  • 1: (50 spaces)
  • 9: Don't know
  • 8: Refusal

HC: Labour market activity Sublock Occupation - LMA5 - Question identifier:LMA5_Q15

In this work, what were your main activities?

  • 1: (50 spaces)
  • 9: Don't know
  • 8: Refusal

Labour Market Hours of Work (LMH)

Labour Market Hours of Work (LMH) - Question identifier:LMH_Q16

[On average, how many hours do you usually work per week?/On average, how many hours do you usually work per week?]

Min = 0.0; Max = 168.0

Socio-Demographic Characteristics (SDC)

Socio-Demographic Characteristics (SDC) - Question identifier:SDC_R11

Now some general background questions which will help us compare the health of people in Canada. [EMPTY/It is important that we get this information from each individual that we interview, even those in the same family]

Press <1> to continue.

Immigration Block (IMG)

Immigration Block (IMG) - Question identifier:IMG_Q01

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 to activate function.

Enter "CAN" to select Canada.

Enter "Other - Specify" if the country is not part of the list.

  • 1: Search
  • 2: Other - Specify
  • 8: RF
  • 9: DK

Immigration Block (IMG) - Question identifier:IMG_Q02

In which province or territory were you born?

Ask the respondent to specify province or territory of birth according to current boundaries.

  • 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
  • 98: RF
  • 99: DK

Immigration Block (IMG) - Question identifier:IMG_Q03

Are you now, or have you ever been a landed immigrant in Canada?

A landed immigrant, or permanent resident, is a person who has been granted the right to live in Canada permanently by immigration authorities.

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

Immigration Block (IMG) - Question identifier:IMG_Q04

In what year did you first become a landed immigrant in Canada?

Min = 1870; Max = 2100

If respondent cannot give exact year of immigration, ask for a best estimate of the year.

Immigration Look Up (ILU)

Immigration Look Up (ILU) - Question identifier:ILU_Q01

^QTEXT

^ITEXT
Start typing the country of birth to activate the search function.
Enter "CAN" to select Canada.
Enter "Other - Specify" if the country is not part of the list.

HC: Aboriginal minimum - AMB

*Please note that the skip for Country of birth should be done outside this block*

If General population target and Place of birth of respondent is Canada, USA, Germany or Greenland, then call the AMB block otherwise, skip this block.

HC: Aboriginal minimum - AMB - Question identifier:AMB_Q01

Are you an Aboriginal person, that is, First Nations, Métis or Inuk/Inuit? First Nations includes Status and Non-Status Indians.

  • 1: Yes
  • 2: No
  • 9: Don't know
  • 8: Refusal

HC: Aboriginal minimum - AMB - Question identifier:AMB_Q02

Are you a First Nations, Métis or Inuk/Inuit?

  • 1: First Nations (North American Indian)
  • 2: Métis
  • 3: Inuk/Inuit
  • 9: Don't know
  • 8: Refusal

Population Group (PG)

Population Group (PG) - Question identifier:PG_Q01

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", "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)
  • 03: Chinese
  • 04: Black
  • 05: Filipino
  • 06: Latin American
  • 07: Arab
  • 08: Southeast Asian (e.g., Vietnamese, Cambodian,
    Malaysian, Laotian)
  • 09: West Asian (e.g., Iranian, Afghan)
  • 10: Korean
  • 11: Japanese
  • 12: Other - Specify
  • 98: RF
  • 99: DK

Language Extended (LAE)

Language Extended (LAE) - Question identifier:LAE_Q01

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

Language Look Up (LLU)

Language Look Up (LLU) - Question identifier:LLU_Q01

^QTEXT

^ITEXT
Start typing name of language to activate the search function.
Enter "Other - Specify" if the language is not part of the list.
Start typing "111" to select the item which indicates no (more) languages.

Education (EDU)

Education Minimum Block with Concept (EDM)

Education Minimum Block with Concept (EDM) - Question identifier:EDM_Q01

What type of educational institution [are you attending/did you attend]?

Mark all that apply.

  • 1: Elementary, junior high school or high school
  • 2: Trade school, college, CEGEP or other non-university institution
  • 3: University
  • 8: RF
  • 9: DK

Education Minimum Block with Concept (EDM) - Question identifier:EDM_Q02

[Are you enrolled/Were 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

HC: Education Sublock School attendance "currently" - ESC1

HC: Education Sublock School attendance "currently" - ESC1 - Question identifier:ESC1_Q01

Are you currently attending school, college, CEGEP or university?

  • 1: Yes
  • 2: No
  • 9: Don't know
  • 8: Refusal

Administration Information (ADM)

Administration Information (ADM) - Question identifier:ADM_N31

Is this a fictitious name for the respondent?

  • 1: Yes
  • 2: No
  • 9: DK

Administration Information (ADM) - Question identifier:ADM_N32

Remind respondent about the importance of getting correct names.
Do you want to make corrections to:

  • 1: ... first name only?
  • 2: ... last name only?
  • 3: ... both names?
  • 4: ... no corrections?

Administration Information (ADM) - Question identifier:ADM_N33

Enter the first name only.

Long Answer Length = 25

Administration Information (ADM) - Question identifier:ADM_N34

Enter the last name only.

Long Answer Length = 25

Administration Information (ADM) - Question identifier:ADM_N35

Was this interview conducted on the telephone or in person?

  • 1: On telephone
  • 2: In person
  • 3: Both

Administration Information (ADM) - Question identifier:ADM_N36

Was the respondent alone when you asked the health component questions?

  • 1: Yes
  • 2: No

Administration Information (ADM) - Question identifier:ADM_N37

Do you think that the answers of the respondent were affected by someone else being there?

  • 1: Yes
  • 2: No

Administration Information (ADM) - Question identifier:ADM_N38

Select the 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 (Farsi)
  • 21: Russian
  • 22: Ukrainian
  • 23: Urdu
  • 24: Inuktitut
  • 25: Hungarian
  • 26: Korean
  • 27: Serbo-Croatian
  • 28: Gujarati
  • 29: Dari
  • 90: Other - Specify
Report a problem on this page

Is something not working? Is there information outdated? Can't find what you're looking for?

Please contact us and let us know how we can help you.

Privacy notice

Date modified: