Canadian Community Health Survey (CCHS) Rapid Response July-September 2015 - Risk Factors for Heart Disease

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

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Table of Contents

Proxy interview (GR)

This module identifies the individual who will be providing information for the selected respondent and determines if the interview is to be conducted by proxy if the mental or physical health of the selected member makes it impossible to complete the interview during the collection period.

New since 2013, the interview by proxy could be conducted with a knowledgeable household member, or a non-household member in very rare circumstances.

If the proxy interview is conducted with a non-household member, interviewers will be required to add a Remark (F4) to explain how the non-household member relates to the respondent and the reason why the survey is conducted with a non-household member. An example of a non-household member could be a child or a family member who is taking care of the selected respondent but does not live in the same household.

Proxy interview (GR) - Question identifier:GR_N005

Who is providing the information for this person's component?

  • 01: MEMBER1
  • 02: MEMBER2
  • 03: MEMBER3
  • 04: MEMBER4
  • 05: MEMBER5
  • 06: MEMBER6
  • 07: MEMBER7
  • 08: MEMBER8
  • 09: MEMBER9
  • 10: MEMBER10
  • 11: MEMBER11
  • 12: MEMBER12
  • 13: MEMBER13
  • 14: MEMBER14
  • 15: MEMBER15
  • 16: MEMBER16
  • 17: MEMBER17
  • 18: MEMBER18
  • 19: MEMBER19
  • 20: MEMBER20
  • 88: Not a household member

Proxy interview (GR) - Question identifier:GR_N010

Do you want to complete this component by proxy?

  • 1: Yes
  • 2: No

Proxy interview (GR) - Question identifier:GR_N015

Record the reason why this component is being completed by proxy. Proxy interviews are to occur only if the mental or physical health of the selected member makes it impossible to complete the interview during the collection period. If the reason for the proxy interview is neither of these choices, please press <F10> to exit the application and assign an appropriate outcome code.

  • 1: Physical health condition
  • 2: Mental health condition

Proxy interview (GR) - Question identifier:GR_N020

Enter the condition.

Long Answer Length = 80

Age of respondent (ANC1)

The actual age of the respondent is very important. It influences which questions will be asked and is key to the analysis of the data.

It is particularly important to confirm the age of 11- or 12-year-olds, as 12 is the lower age limit to determine if the respondent is an out-of-scope to our survey. Similarly, because of the use of a different sampling frame for youth and adults, it is also important to confirm the age of 17- or 18-year-olds, as they are the age limits to determine if the respondent is an out-of-scope to the frame (and therefore, of the survey).

Age of respondent (ANC1) - Question identifier:ANC1_Q01

What is ^SPECRESPNAME's date of birth?

Min = 1; Max = 31

Enter the day.
If necessary, ask: (What is the day?)

Age of respondent (ANC1) - Question identifier:ANC1_Q02

(What is ^SPECRESPNAME's date of birth?)

Select the month.
If necessary, ask: (What is the month?)

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 98: RF
  • 99: DK

Age of respondent (ANC1) - Question identifier:ANC1_Q03

(What is ^SPECRESPNAME's date of birth?)

Min = 0; Max = 9997

Enter a four digit year.
If necessary, ask (What is the year?)

Age of respondent (ANC1) - Question identifier:ANC1_Q04

So ^SPECRESPNAME's age on ^REFERENCEDATEE was ^DV_CALCULATEDAGE ^DT_YEARSMONTHSE.
Is that correct?

Date of birth is ^DV_DOBDATEE.

  • 1: Yes
  • 2: No, return and correct date of birth
  • 3: No, collect age

Age of respondent (ANC1) - Question identifier:ANC1_Q05

What is ^SPECRESPNAME's age?

Min = 0; Max = 121

Age of respondent (ANC1) - Question identifier:ANC1_R010

Because you are less than 12 years old, you are not eligible to participate in the Canadian Community Health Survey.

Press <1> to continue.

Age of respondent (ANC1) - Question identifier:ANC1_R015

Because you are more than 17 years old, you are not eligible to participate in the Canadian Community Health Survey.

Press <1> to continue.

Age of respondent (ANC1) - Question identifier:ANC1_R020

Because you are less than 18 years old, you are not eligible to participate in the Canadian Community Health Survey.

Press <1> to continue.

Age of respondent (ANC1) - Question identifier:ANC1_N030

Please confirm the spelling of respondent's first name. Update first name, if necessary.

Original First Name: ^FNAME
Original Last Name: ^LNAME

Long Answer Length = 25

Age of respondent (ANC1) - Question identifier:ANC1_N035

Please confirm the spelling of respondent's last name. Update last name, if necessary.

Original First Name: ^FNAME
Original Last Name: ^LNAME

Long Answer Length = 25

Relationship without confirmation (RNC)

Relationship without confirmation (RNC) - Question identifier:RNC_Q1

What is the relationship...

of: ^SPECRESPNAME1 (^SPECRESPAGE1, ^DT_SPECRESPSEXE1)

to: ^SPECRESPNAME2 (^SPECRESPAGE2, ^DT_SPECRESPSEXE2)?

  • 01: (Husband/Wife)
  • 02: Common-law partner
  • 03: (Father/Mother)
  • 04: (Son/Daughter)
  • 05: (Brother/Sister)
  • 06: (Father/Mother)
  • 07: Foster (Son/Daughter)
  • 08: (Grandfather/Grandmother)
  • 09: (Grandson/Granddaughter)
  • 10: In-law
  • 11: Other related
  • 12: Unrelated
  • 98: RF
  • 99: DK

Relationship without confirmation (RNC) - Question identifier:RNC_Q2A

Is that a(n)... ?

Read categories to respondent.

  • 1: Birth (father/mother)
  • 2: Step(father/mother)
  • 3: Adoptive (father/mother)
  • 8: RF
  • 9: DK

Relationship without confirmation (RNC) - Question identifier:RNC_Q2B

Is that a(n)... ?

Read categories to respondent.

  • 1: Birth (son/daughter)
  • 2: Step (son/daughter)
  • 3: Adopted (son/daughter)
  • 8: RF
  • 9: DK

Relationship without confirmation (RNC) - Question identifier:RNC_Q2C

Is that a(n)... ?

Read categories to respondent.

  • 1: Full (brother/sister)
  • 2: Half (brother/sister)
  • 3: Step(brother/sister)
  • 4: Adopted (brother/sister)
  • 5: Foster (brother/sister)
  • 8: RF
  • 9: DK

Relationship without confirmation (RNC) - Question identifier:RNC_Q2D

Is that a(n)... ?

Read categories to respondent.

  • 1: (Father/Mother)-in-law
  • 2: (Son/Daughter)-in-law
  • 3: (Brother/Sister)-in-law
  • 4: Other in-law
  • 8: RF
  • 9: DK

Relationship without confirmation (RNC) - Question identifier:RNC_Q2E

Is that a(n)... ?

Read categories to respondent.

  • 1: (Uncle/Aunt)
  • 2: Cousin
  • 3: (Nephew/Neice)
  • 4: Other relative
  • 8: RF
  • 9: DK

Relationship without confirmation (RNC) - Question identifier:RNC_Q2F

Is that a(n)... ?

Read categories to respondent.

  • 1: (Boyfriend/Girlfriend)
  • 2: Roommate/lodger/boarder
  • 3: Other - Specify
  • 8: RF
  • 9: DK

Main activity (MAC)

This module collects information about the respondent's main activity in the last week.

If their main activity is not 'caring for children' and they are 15 to 75 years of age, they are asked if they have worked any time in the past 12 months.

If their main activity is not 'going to school' or they are 14 or older, they are asked if they are currently attending school, college, CEGEP or university.

In this module, female respondents aged 15 to 55 are asked if they are pregnant.

Main activity (MAC) - Question identifier:MAC_Q005

Last week, 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?

Main activity means the activity on which the respondent spends most of his/her time: work, job seeking, studies, childcare, etc.
If short-term illness or short-term schooling related to work is reported, ask for usual main activity.

  • 01: Working at a paid job or business
  • 02: Vacation (from paid work)
  • 03: Looking for paid work
  • 04: Going to school (including vacation from school)
  • 05: Caring for children
  • 06: Household work
  • 07: Retired
  • 08: Maternity/paternity leave
  • 09: Long term illness
  • 10: Volunteering
  • 11: Care-giving other than for children
  • 12: Other
  • 98: RF
  • 99: DK

Main activity (MAC) - Question identifier:MAC_Q010

Have you worked at a job or business at any time in the past 12 months?

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

Main activity (MAC) - Question identifier:MAC_Q015

Are you currently attending school, college, CEGEP or university?

Ask respondent to include attendance only for courses that can be used as credit towards a certificate, diploma or degree.

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

Main activity (MAC) - Question identifier:MAC_Q020

Are you enrolled as...?

Read categories to respondent.

  • 1: A full-time student
  • 2: A part-time student
  • 3: Both full-time and part-time student
  • 8: RF
  • 9: DK

Main activity (MAC) - Question identifier:MAC_Q025

To better understand the information you will provide on your health it is important to know if you are pregnant. Are you pregnant?

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

General health (GEN)

The general health module is used to collect data on self-perceived health, satisfaction with life, self-perceived mental health, self-perceived stress at work and with life in general, and sense of belonging to local community.

Researchers are interested in these topics because they are good basic measures of health status. They can also be used to predict other aspects of the respondent's health. For example, respondents who describe their health as fair or poor are more likely to have long-term health problems, to suffer from depression and to be heavy users of the health care system.

General health (GEN) - Question identifier:GEN_R005

The next questions are about your health. 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

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?

Min = 0; Max = 10

General health (GEN) - Question identifier:GEN_Q015

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_Q020

Thinking about the amount of stress in your life, would you say that most of your 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_R025

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

Press <1> to continue.

General health (GEN) - Question identifier:GEN_Q025

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_Q030

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

Height and weight - self reported (HWT)

In this module, respondents are asked to report their height and weight, and indicate whether they consider themselves overweight, underweight or just about right.

Answers to these questions are used in many ways, including calculating the number of people who are overweight, or obese.

Obesity, especially amongst young people, is a major health problem. It can be associated with a number of major medical problems, including high blood pressure, heart disease and diabetes.

Height and weight - self reported (HWT) - Question identifier:HWT_Q005

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

  • 0: Less than 1' / 12" (less than 29.2 cm.)
  • 1: 1'0" to 1'11" / 12" to 23" (29.2 to 59.6 cm.)
  • 2: 2'0" to 2'11" / 24" to 35" (59.7 to 90.1 cm.)
  • 3: 3'0" to 3'11" / 36" to 47" (90.2 to 120.6 cm.)
  • 4: 4'0" to 4'11" / 48" to 59" (120.7 to 151.0 cm.)
  • 5: 5'0" to 5'11" (151.1 to 181.5 cm.)
  • 6: 6'0" to 6'11" (181.6 to 212.0 cm.)
  • 7: 7'0" and over (212.1 cm. and over)
  • 8: RF
  • 9: DK

Height and weight - self reported (HWT) - Question identifier:HWT_N010

Select the exact height.

  • 00: Less than or equal to 1'0" / 12" (29.2 to 31.7 cm.)
  • 01: 1'1" / 13" (31.8 to 34.2 cm.)
  • 02: 1'2" / 14" (34.3 to 36.7 cm.)
  • 03: 1'3" / 15" (36.8 to 39.3 cm.)
  • 04: 1'4" / 16" (39.4 to 41.8 cm.)
  • 05: 1'5" / 17" (41.9 to 44.4 cm.)
  • 06: 1'6" / 18" (44.5 to 46.9 cm.)
  • 07: 1'7" / 19" (47.0 to 49.4 cm.)
  • 08: 1'8" / 20" (49.5 to 52.0 cm.)
  • 09: 1'9" / 21" (52.1 to 54.5 cm.)
  • 10: 1'10" / 22" (54.6 to 57.1 cm.)
  • 11: 1'11" / 23" (57.2 to 59.6 cm.)
  • 98: RF
  • 99: DK

Height and weight - self reported (HWT) - Question identifier:HWT_N015

Select the exact height.

  • 00: 2'0" / 24" (59.7 to 62.1 cm.)
  • 01: 2'1" / 25" (62.2 to 64.7 cm.)
  • 02: 2'2" / 26" (64.8 to 67.2 cm.)
  • 03: 2'3" / 27" (67.3 to 69.8 cm.)
  • 04: 2'4" / 28" (69.9 to 72.3 cm.)
  • 05: 2'5" / 29" (72.4 to 74.8 cm.)
  • 06: 2'6" / 30" (74.9 to 77.4 cm.)
  • 07: 2'7" / 31" (77.5 to 79.9 cm.)
  • 08: 2'8" / 32" (80.0 to 82.5 cm.)
  • 09: 2'9" / 33" (82.6 to 85.0 cm.)
  • 10: 2'10" / 34" (85.1 to 87.5 cm.)
  • 11: 2'11" / 35" (87.6 to 90.1 cm.)
  • 98: RF
  • 99: DK

Height and weight - self reported (HWT) - Question identifier:HWT_N020

Select the exact height.

  • 00: 3'0" / 36" (90.2 to 92.6 cm.)
  • 01: 3'1" / 37" (92.7 to 95.2 cm.)
  • 02: 3'2" / 38" (95.3 to 97.7 cm.)
  • 03: 3'3" / 39" (97.8 to 100.2 cm.)
  • 04: 3'4" / 40" (100.3 to 102.8 cm.)
  • 05: 3'5" / 41" (102.9 to 105.3 cm.)
  • 06: 3'6" / 42" (105.4 to 107.9 cm.)
  • 07: 3'7" / 43" (108.0 to 110.4 cm.)
  • 08: 3'8" / 44" (110.5 to 112.9 cm.)
  • 09: 3'9" / 45" (113.0 to 115.5 cm.)
  • 10: 3'10" / 46" (115.6 to 118.0 cm.)
  • 11: 3'11" / 47" (118.1 to 120.6 cm.)
  • 98: RF
  • 99: DK

Height and weight - self reported (HWT) - Question identifier:HWT_N025

Select the exact height.

  • 00: 4'0" / 48" (120.7 to 123.1 cm.)
  • 01: 4'1" / 49" (123.2 to 125.6 cm.)
  • 02: 4'2" / 50" (125.7 to 128.2 cm.)
  • 03: 4'3" / 51" (128.3 to 130.7 cm.)
  • 04: 4'4" / 52" (130.8 to 133.3 cm.)
  • 05: 4'5" / 53" (133.4 to 135.8 cm.)
  • 06: 4'6" / 54" (135.9 to 138.3 cm.)
  • 07: 4'7" / 55" (138.4 to 140.9 cm.)
  • 08: 4'8" / 56" (141.0 to 143.4 cm.)
  • 09: 4'9" / 57" (143.5 to 146.0 cm.)
  • 10: 4'10" / 58" (146.1 to 148.5 cm.)
  • 11: 4'11" / 59" (148.6 to 151.0 cm.)
  • 98: RF
  • 99: DK

Height and weight - self reported (HWT) - Question identifier:HWT_N030

Select the exact height.

  • 00: 5'0" (151.1 to 153.6 cm.)
  • 01: 5'1" (153.7 to 156.1 cm.)
  • 02: 5'2" (156.2 to 158.7 cm.)
  • 03: 5'3" (158.8 to 161.2 cm.)
  • 04: 5'4" (161.3 to 163.7 cm.)
  • 05: 5'5" (163.8 to 166.3 cm.)
  • 06: 5'6" (166.4 to 168.8 cm.)
  • 07: 5'7" (168.9 to 171.4 cm.)
  • 08: 5'8" (171.5 to 173.9 cm.)
  • 09: 5'9" (174.0 to 176.4 cm.)
  • 10: 5'10" (176.5 to 179.0 cm.)
  • 11: 5'11" (179.1 to 181.5 cm.)
  • 98: RF
  • 99: DK

Height and weight - self reported (HWT) - Question identifier:HWT_N035

Select the exact height.

  • 00: 6'0" (181.6 to 184.1 cm.)
  • 01: 6'1" (184.2 to 186.6 cm.)
  • 02: 6'2" (186.7 to 189.1 cm.)
  • 03: 6'3" (189.2 to 191.7 cm.)
  • 04: 6'4" (191.8 to 194.2 cm.)
  • 05: 6'5" (194.3 to 196.8 cm.)
  • 06: 6'6" (196.9 to 199.3 cm.)
  • 07: 6'7" (199.4 to 201.8 cm.)
  • 08: 6'8" (201.9 to 204.4 cm.)
  • 09: 6'9" (204.5 to 206.9 cm.)
  • 10: 6'10" (207.0 to 209.5 cm.)
  • 11: 6'11" (209.6 to 212.0 cm.)
  • 98: RF
  • 99: DK

Height and weight - self reported (HWT) - Question identifier:HWT_Q040

How much do you weigh?

Min = 1; Max = 575

Enter amount only.

Height and weight - self reported (HWT) - Question identifier:HWT_N045

Was that in pounds or kilograms?

  • 1: Pounds
  • 2: Kilograms

Height and weight - self reported (HWT) - Question identifier:HWT_Q050

Do you consider yourself...?

Read categories to respondent.

  • 1: Overweight
  • 2: Underweight
  • 3: Just about right
  • 8: RF
  • 9: DK

Chronic conditions (CCC)

The first set of questions in this module deal with pain in the joints during the past 30 days. The remaining questions deal with long-term health conditions that have lasted or are expected to last at least 6 months. Chronic conditions reported by respondents must have been diagnosed by a health professional.

Answers to these questions can be used to estimate the number of people in Canada suffering from conditions such as diabetes, heart disease, and asthma.

By combining answers from this module with information from other modules, researchers can look at the relationship between chronic conditions and other characteristics, such as use of health care services or use of medications.

Chronic conditions (CCC) - Question identifier:CCC_R005

The next question refers to your joints. Please do not include the back or neck.

Press <1> to continue.

Chronic conditions (CCC) - Question identifier:CCC_Q005

During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint?

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

Chronic conditions (CCC) - Question identifier:CCC_Q010

Did your joint symptoms first begin more than 3 months ago?

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

Chronic conditions (CCC) - Question identifier:CCC_R015

Now I'd like to ask about certain long-term health conditions which you may have. We are interested in "long-term conditions" which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.

Press <1> to continue.

Chronic conditions (CCC) - Question identifier:CCC_Q015

Do you have asthma?

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

Chronic conditions (CCC) - Question identifier:CCC_Q020

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_Q025

In the past 12 months, have you taken any medicine for asthma such as inhalers (pumps), nebulizers, pills, liquids or injections?

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

Chronic conditions (CCC) - Question identifier:CCC_Q030

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

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

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

Chronic conditions (CCC) - Question identifier:CCC_Q035

Have you been told by a health professional that you have sleep apnea?

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

Chronic conditions (CCC) - Question identifier:CCC_Q040

Do you have scoliosis?

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

Chronic conditions (CCC) - Question identifier:CCC_R045

Remember, we're interested in conditions diagnosed by a health professional and that are expected to last or have already lasted 6 months or more.

Press <1> to continue.

Chronic conditions (CCC) - Question identifier:CCC_Q045

Do you have fibromyalgia?

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

Chronic conditions (CCC) - Question identifier:CCC_Q050

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_Q055

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

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

Chronic conditions (CCC) - Question identifier:CCC_Q060

Do you have osteoporosis?

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

Chronic conditions (CCC) - Question identifier:CCC_Q065

Do you have high blood pressure?

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

Chronic conditions (CCC) - Question identifier:CCC_Q070

In the past month, have you taken any medicine for high blood pressure?

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

Chronic conditions (CCC) - Question identifier:CCC_Q075

Do you have high blood cholesterol or lipids?

Blood cholesterol or lipids are a fatty substance found in blood.

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

Chronic conditions (CCC) - Question identifier:CCC_Q080

In the past month, have you taken any medicine for high blood cholesterol or lipids?

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

Chronic conditions (CCC) - Question identifier:CCC_Q085

Do you have heart disease?

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

Chronic conditions (CCC) - Question identifier:CCC_Q090

Do you suffer from the effects of a stroke?

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

Chronic conditions (CCC) - Question identifier:CCC_Q095

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_Q100

How old were you when this was first diagnosed?

Min = 1; Max = 121

Maximum is ^AGE.

Chronic conditions (CCC) - Question identifier:CCC_Q105

Were you pregnant when you were first diagnosed with diabetes?

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

Chronic conditions (CCC) - Question identifier:CCC_Q110

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_Q115

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_Q120

Do you currently take insulin for your diabetes?

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

Chronic conditions (CCC) - Question identifier:CCC_Q125

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_Q130

Do you have cancer?

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

Chronic conditions (CCC) - Question identifier:CCC_Q135

Have you ever been diagnosed with cancer?

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

Chronic conditions (CCC) - Question identifier:CCC_R140

Remember, we're interested in conditions diagnosed by a health professional and that are expected to last or have already lasted 6 months or more.

Press <1> to continue.

Chronic conditions (CCC) - Question identifier:CCC_Q140

Do you have migraine headaches?

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

Chronic conditions (CCC) - Question identifier:CCC_Q145

Do you have Alzheimer's Disease or any other dementia?

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

Chronic conditions (CCC) - Question identifier:CCC_Q185

Do you have chronic fatigue syndrome?

Also known as CFS, it is a complex disorder characterized by profound fatigue that is not improved by bed rest. Includes myalgic encephalomyelitis.

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

Chronic conditions (CCC) - Question identifier:CCC_Q190

Do you suffer from multiple chemical sensitivities?

Multiple chemical sensitivity (MCS) is a chronic condition where people are sensitive to low levels of multiple unrelated chemicals such as smoke or perfume - levels that do not cause symptoms in most people. He/she may experience symptoms such as fatigue, asthma, blocked nose or sore eyes.

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

Chronic conditions (CCC) - Question identifier:CCC_Q195

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_Q200

Do you have an anxiety disorder such as a phobia, obsessive-compulsive disorder or a panic disorder?

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

Fruit and vegetable consumption (FVC)

The health benefits of vegetable and fruit consumption are popular topics in nutrition promotion programs and research. Among the research findings, there is thought to be a link between increased consumption of vegetables and fruit and a reduction in the risk of many cancers.

In these questions, you may have to probe respondents to remember how often each of the named foods are eaten. Have patience, and encourage the respondent to always give their best estimate.

Fruit and vegetable consumption (FVC) - Question identifier:FVC_R001

These next questions are about the fruits and vegetables you ate or drank during the past month. Please report your consumption either per day, per week or per month. Think about all meals and snacks, at home and away from home.

Press <1> to continue.

Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q005

In the last month, how many times per day, per week or per month did you drink 100% PURE fruit juices, such as pure orange juice, apple juice or pure juice blends? Do not include fruit-flavored drinks with added sugar or fruit punch.

Min = 0; Max = 300

Enter amount only. DO NOT include fruit drinks like reconstituted powdered drink, lemonade, cranberry cocktail or yogurt drinks.

Fruit and vegetable consumption (FVC) - Question identifier:FVC_N005A

Select the reporting period that corresponds to FVC_Q005.

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

Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q010

In the last month, not counting juice, how many times did you eat fruit? Please remember to include frozen, dried or canned fruit.

Min = 0; Max = 300

Enter amount only. INCLUDE fruit you added to yogurt, cereal and other meal items. DO NOT include fruit jam, jelly or fruit preserves as well as baked goods containing fruit like banana bread.

Fruit and vegetable consumption (FVC) - Question identifier:FVC_N010A

Select the reporting period that corresponds to FVC_Q010.

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

Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q015

In the last month, how many times did you eat dark green vegetables such as broccoli, green beans, peas and green peppers or dark leafy greens including romaine or spinach? Please remember to include (frozen or canned vegetables and) vegetables that were cooked in soups or mixed in salad.

Min = 0; Max = 300

Enter amount only. DO NOT include Iceberg lettuce if respondent specifies type of lettuce. DO NOT include cucumber, celery and common cabbage.

Fruit and vegetable consumption (FVC) - Question identifier:FVC_N015A

Select the reporting period that corresponds to FVC_Q015.

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

Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q020

In the last month, how many times did you eat orange-colored vegetables such as carrots, orange bell pepper, sweet potatoes, pumpkin or squash? (Please remember to include frozen or canned vegetables and vegetables that were cooked in soups or mixed in salad).

Min = 0; Max = 300

Enter amount only. INCLUDE all forms of sweet potatoes including baked, mashed or in casserole. INCLUDE pumpkin as soup or pie.

Fruit and vegetable consumption (FVC) - Question identifier:FVC_N020A

Select the reporting period that corresponds to FVC_Q020.

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

Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q025

In the last month, how many times per day, per week or per month did you eat potatoes that are not deep fried?

Min = 0; Max = 300

Enter amount only. INCLUDE potatoes with any peel color (white, red, yellow, blue). DO NOT include sweet potatoes as they should have already been reported.

Fruit and vegetable consumption (FVC) - Question identifier:FVC_N025A

Select the reporting period that corresponds to FVC_Q025.

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

Fruit and vegetable consumption (FVC) - Question identifier:FVC_Q030

Excluding the green and orange vegetables as well as the potatoes you have already reported, in the last month, how many times did you eat OTHER vegetables? Examples include cucumber, celery, corn, cabbage and vegetable juice.

Min = 0; Max = 300

Enter amount only. INCLUDE tomato juice and V-8 type vegetable juice. DO NOT include condiments such as ketchup, salsa, chutney and relish.

Fruit and vegetable consumption (FVC) - Question identifier:FVC_N030A

Select the reporting period that corresponds to FVC_Q030.

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

Smoking (SMK)

Cigarette smoking is a major cause of heart disease and lung disease. The economic cost of illnesses and deaths caused by smoking is a major concern to health care planners and administrators.

The number of people who smoke varies significantly between health regions, between men and women and among age groups.

This module includes a series of questions about current and past smoking habits.

The results of this module can be used to develop smoking prevention and cessation programs for the groups that need them most.

Smoking (SMK) - Question identifier:SMK_R001

The next questions are about cigarette smoking.

Press <1> to continue. Include cigarettes that are bought ready-made as well as cigarettes that are self-made, but do not include electronic cigarettes, also known as "e-cigarettes".

Smoking (SMK) - Question identifier:SMK_Q005

At the present time, do you smoke cigarettes every day, occasionally or not at all?

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

Smoking (SMK) - Question identifier:SMK_Q010

In the past 30 days, did you smoke any cigarettes?

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

Smoking (SMK) - Question identifier:SMK_Q015

During the past 30 days, did you smoke every day?

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

Smoking (SMK) - Question identifier:SMK_Q020

Have you smoked more than 100 cigarettes (about 4 packs) in your life?

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

Smoking (SMK) - Question identifier:SMK_Q025

Have you ever smoked a whole cigarette?

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

Smoking (SMK) - Question identifier:SMK_Q030

Have you ever smoked cigarettes daily?

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

Smoking (SMK) - Question identifier:SMK_Q035

At what age did you smoke your first whole cigarette?

Min = 5; Max = 121

Minimum is 5; maximum is ^AGE.

Smoking (SMK) - Question identifier:SMK_Q040

At what age did you begin to smoke cigarettes daily?

Min = 5; Max = 121

Minimum is [5]; maximum is ^AGE.

Smoking (SMK) - Question identifier:SMK_Q045

How many cigarettes do you smoke each day now?

Min = 1; Max = 99

Smoking (SMK) - Question identifier:SMK_Q050

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

Min = 1; Max = 99

Smoking (SMK) - Question identifier:SMK_Q055

In the past month, on how many days have you smoked one or more cigarettes?

Min = 0; Max = 31

Smoking (SMK) - Question identifier:SMK_Q060

When did you stop smoking? Was it...?

Read categories to respondent.

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

Smoking (SMK) - Question identifier:SMK_Q065

In what month did you stop?

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 98: RF
  • 99: DK

Smoking (SMK) - Question identifier:SMK_Q070

How many years ago was it?

Min = 3; Max = 121

Minimum is 3; maximum is [AGE - 5].

Smoking (SMK) - Question identifier:SMK_Q075

When you smoked every day, how many cigarettes did you usually smoke each day?

Min = 1; Max = 99

Smoking (SMK) - Question identifier:SMK_Q080

When did you stop smoking daily? Was it...?

Read categories to respondent.

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

Smoking (SMK) - Question identifier:SMK_Q085

In what month did you stop?

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 98: RF
  • 99: DK

Smoking (SMK) - Question identifier:SMK_Q090

How many years ago was it?

Min = 3; Max = 121

Minimum is 3; maximum is [AGE - 5].

Smoking (SMK) - Question identifier:SMK_Q095

Was that when you completely quit smoking?

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

Smoking (SMK) - Question identifier:SMK_Q100

When did you stop smoking completely? Was it...?

Read categories to respondent.

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

Smoking (SMK) - Question identifier:SMK_Q105

In what month did you stop?

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 98: RF
  • 99: DK

Smoking (SMK) - Question identifier:SMK_Q110

How many years ago was it?

Min = 3; Max = 121

Minimum is 3; maximum is [AGE - 5].

Exposure to second hand smoke (ETS)

Exposure to second-hand smoke is known to have a variety of negative effects on health, including lung disease and childhood asthma.

This module includes questions about the number of people who smoke regularly inside the home (including household members and regular visitors), and questions about smoking restrictions in the home. These questions are asked of all respondents.

Respondents who do not smoke are asked how often they have been exposed to second-hand smoke in vehicles, the workplace, school and in public places in the past month.

Exposure to second hand smoke (ETS) - Question identifier:ETS_R001

The next questions are about exposure to second-hand smoke.

Press <1> to continue.

Exposure to second hand smoke (ETS) - Question identifier:ETS_Q005

Including both household members and regular visitors, does anyone smoke inside your home, every day or almost every day?

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

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

Exposure to second hand smoke (ETS) - Question identifier:ETS_Q010

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

Min = 1; Max = 15

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

Exposure to second hand smoke (ETS) - Question identifier:ETS_Q015

Is smoking allowed inside your home?

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

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

Exposure to second hand smoke (ETS) - Question identifier:ETS_Q020

Is smoking inside your home restricted in any way?

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

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

Exposure to second hand smoke (ETS) - Question identifier:ETS_Q025

How is smoking restricted inside your 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_Q030

In the past month, were you exposed to second-hand smoke, every day or almost every day, at your workplace or at school?

Include cigarettes, cigars and pipes. Exclude respondent's own smoking.

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

Exposure to second hand smoke (ETS) - Question identifier:ETS_Q035

In the past month, were you exposed to second-hand smoke, every day or almost every day, in a car or other private vehicle?

Include cigarettes, cigars and pipes. Exclude respondent's own smoking.

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

Exposure to second hand smoke (ETS) - Question identifier:ETS_Q040

In the past month, were you exposed to second-hand smoke, every day or almost every day, in public places (such as bars, restaurants, shopping malls, arenas, bingo halls, bowling alleys)?

Include cigarettes, cigars and pipes. Exclude respondent's own smoking.

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

Alcohol use (ALC)

Consumption of alcohol has a number of implications for health. Excessive drinking is related to a number of diseases and social and mental health problems. Drinking is also a leading cause of accidents and injuries.

This module includes questions about how often and how much alcohol the respondent has drunk in the past 12 months, and if they have ever had a drink in their life.

This module will help researchers and health planners to understand patterns of alcohol consumption. For example, which groups are more likely to binge drink, i.e., drink 4 (or 5 in the case of males) or more drinks on one occasion.

Alcohol use (ALC) - Question identifier:ALC_R001

Now, some questions about your alcohol consumption.
A 'drink' refers to:
- a bottle or small can of beer, cider or cooler with 5% alcohol content, or a small draft;
- a glass of wine with 12% alcohol content;
- a glass or cocktail containing 1½ oz. of a spirit with 40% alcohol content.

Press <1> to continue.

Alcohol use (ALC) - Question identifier:ALC_Q005

Have you ever had a drink in your lifetime?

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

Alcohol use (ALC) - Question identifier:ALC_Q010

During the past 12 months, that is, from [CURRENTDATE-1] to yesterday, have you had a drink of beer, wine, liquor or any other alcoholic beverage?

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

Alcohol use (ALC) - Question identifier:ALC_Q015

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_Q020

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

Physical activities - adults 18 years and older (PAA)

Answers to this module are used to determine how active respondents, 18 years of age and older, have been in the last seven days.

Respondents are asked if they have spent a minimum of 10 minutes of physical activity, and on which days of the week, doing various activities, such as walking or cycling to get to places, sports or recreational activities that caused sweating or heavy breathing. They are also asked how much time in total was spent doing vigorous activities.

Higher levels of activity are widely thought to be associated with better health.

Physical activities - adults 18 years and older (PAA) - Question identifier:PAA_R001

The following questions are about various types of physical activities done in the last 7 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 18 years and older (PAA) - Question identifier:PAA_Q005

In the last 7 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 18 years and older (PAA) - Question identifier:PAA_Q010

In the last 7 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 18 years and older (PAA) - Question identifier:PAA_Q015

How much time in total, in the last 7 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 18 years and older (PAA) - Question identifier:PAA_N020

Enter number of minutes.

Min = 0; Max = 9995

Physical activities - adults 18 years and older (PAA) - Question identifier:PAA_Q030

[Not including activities you just reported, in] the last 7 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 18 years and older (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 18 years and older (PAA) - Question identifier:PAA_Q040

In the last 7 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 18 years and older (PAA) - Question identifier:PAA_Q045

(In the last 7 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 18 years and older (PAA) - Question identifier:PAA_N050

Enter number of minutes.

Min = 0; Max = 9995

Physical activities - adults 18 years and older (PAA) - Question identifier:PAA_Q060

In the last 7 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 18 years and older (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 18 years and older (PAA) - Question identifier:PAA_Q070

In the last 7 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 18 years and older (PAA) - Question identifier:PAA_Q075

(In the last 7 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 18 years and older (PAA) - Question identifier:PAA_N080

Enter number of minutes.

Min = 0; Max = 9995

Physical activities - adults 18 years and older (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 18 years and older (PAA) - Question identifier:PAA_Q100

In the last 7 days, how much time in total did you spend doing vigorous activities that caused you to be out of breath?

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 18 years and older (PAA) - Question identifier:PAA_N105

Enter number of minutes.

Min = 0; Max = 9995

Physical activities for youth (PAY)

Answers to this module are used to determine how active respondents, aged 12 to 17, have been in the last seven days.

Respondents are asked on which days of the week they have been active, and for how long, doing various activities such as walking or cycling (to get to school, work, the shopping centre or to visit friends), or participating in sports or recreational activities or other activities that caused sweating or heavy breathing. They are also asked how much time in total was spent doing vigorous activities.

Higher levels of activity are widely thought to be associated with better health.

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 7 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 7 days, did you use active ways like walking or cycling to get to places such as [school, the bus stop, the shopping centre, work] 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_Q015

How much time did you spend using active ways to get to places...
...yesterday?
...on ^DT_DAY2DAYSAGOE?
...on ^DT_DAY3DAYSAGOE?
...on ^DT_DAY4DAYSAGOE?
...on ^DT_DAY5DAYSAGOE?
...on ^DT_DAY6DAYSAGOE?
...on ^DT_DAYLASTWEEKE?

Min = 0; Max = 10080

Enter the number of hours here. Enter the number of minutes on the next screen.

Physical activities for youth (PAY) - Question identifier:PAY_Q025

In the last 7 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]?

  • 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_Q035

How much time did you spend doing these activities at [school or day camp] that made you sweat at least a little and breathe harder...
...yesterday?
...on ^DT_DAY2DAYSAGOE?
...on ^DT_DAY3DAYSAGOE?
...on ^DT_DAY4DAYSAGOE?
...on ^DT_DAY5DAYSAGOE?
...on ^DT_DAY6DAYSAGOE?
...on ^DT_DAYLASTWEEKE?

Min = 0; Max = 10080

Enter the number of hours here. Enter the number of minutes on the next screen.
Question will be skipped for Saturday and Sunday.

Physical activities for youth (PAY) - Question identifier:PAY_Q045

In the last 7 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_Q055

How much time did you spend doing these leisure-time activities that made you sweat at least a little and breathe harder...
...yesterday?
...on ^DT_DAY2DAYSAGOE?
...on ^DT_DAY3DAYSAGOE?
...on ^DT_DAY4DAYSAGOE?
...on ^DT_DAY5DAYSAGOE?
...on ^DT_DAY6DAYSAGOE?
...on ^DT_DAYLASTWEEKE?

Min = 0; Max = 10080

Enter the number of hours here. Enter the number of minutes on the next screen.

Physical activities for youth (PAY) - Question identifier:PAY_Q065

In the last 7 days, did you do any other physical [activities that you have not already reported], for example, while you [were doing paid or unpaid work or] 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_Q075

How much time did you spend doing these other physical activities that made you sweat at least a little and breathe harder...
...yesterday?
...on ^DT_DAY2DAYSAGOE?
...on ^DT_DAY3DAYSAGOE?
...on ^DT_DAY4DAYSAGOE?
...on ^DT_DAY5DAYSAGOE?
...on ^DT_DAY6DAYSAGOE?
...on ^DT_DAYLASTWEEKE?

Min = 0; Max = 10080

Enter the number of hours here. Enter the number of minutes on the next screen.

Physical activities for youth (PAY) - Question identifier:PAY_Q090

You have reported a total of [DV_PAYTRAVEL + DV_PAYSCHOOL + DV_PAYREC + DV_PAYOTHER] 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 7 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 7 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

Maternal experiences (MEX)

Increasingly, health promotion programs are targeted at very young children. Researchers believe that children who have a good start in life become healthier teenagers and adults.

The focus of the next 3 modules is the behaviour of new mothers (aged 15 to 55) of babies under 6 years old.

The questions in the first module cover topics such as folic acid and iron supplements, weight gain, breastfeeding, sleeping arrangements for the child, and the child's diet.

The results of this module can be used to identify which groups of women could benefit from educational programs that promote healthier babies.

Maternal experiences (MEX) - Question identifier:MEX_R001

The next questions are specific to women's health.

Press <1> to continue.

Maternal experiences (MEX) - Question identifier:MEX_Q005

Are you taking a vitamin supplement containing folic acid?

If respondent says she takes a prenatal vitamin but is unsure what the vitamin contains, please select 'Yes'.

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

Maternal experiences (MEX) - Question identifier:MEX_Q010

Have you given birth in the past 5 years?

Do not include stillbirths.

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

Maternal experiences (MEX) - Question identifier:MEX_Q015

What is the name of your last born child?

Long Answer Length = 50

Enter the name of the last child born. If the last birth was a multiple birth, ask respondent to refer to the last baby born during this multiple birth.

Maternal experiences (MEX) - Question identifier:MEX_Q020

What is [your last child]'s date of birth?

Min = 1; Max = 31

Enter the day. If necessary, ask (What is the day?)

Maternal experiences (MEX) - Question identifier:MEX_Q025

(What is [your last child]'s date of birth?)

Enter the month. If necessary, ask (What is the month?)

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 98: RF
  • 99: DK

Maternal experiences (MEX) - Question identifier:MEX_Q030

(What is [your last child]'s date of birth?)

Min = 2010; Max = 2099

Enter a four-digit year. If necessary, ask (What is the year?)

Maternal experiences (MEX) - Question identifier:MEX_R040

The next questions are about your maternal experiences related to [your last child].

Press <1> to continue.

Maternal experiences (MEX) - Question identifier:MEX_Q040

In the three months before you got pregnant with [your last child], did you take a folic acid supplement or a multivitamin containing folic acid?

If respondent says she takes a prenatal vitamin but is unsure what the vitamin contains, please select 'Yes'.

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

Maternal experiences (MEX) - Question identifier:MEX_Q045

Did you take it every day or almost every day?

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

Maternal experiences (MEX) - Question identifier:MEX_Q050

During the first three months of your pregnancy (with [your last child]), did you take a folic acid supplement or a multivitamin containing folic acid?

If respondent says she takes a prenatal vitamin but is unsure what the vitamin contains, please select 'Yes'.

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

Maternal experiences (MEX) - Question identifier:MEX_Q055

Did you take it every day or almost every day?

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

Maternal experiences (MEX) - Question identifier:MEX_Q060

Before your pregnancy (with [your last child]), were you aware that taking folic acid before becoming pregnant can help prevent some birth defects?

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

Maternal experiences (MEX) - Question identifier:MEX_Q065

During your pregnancy (with [your last child]), did you take a vitamin supplement containing iron?

If respondent says she takes a prenatal vitamin but is unsure what the vitamin contains, please select 'Yes'.

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

Maternal experiences (MEX) - Question identifier:MEX_Q070

Just before your pregnancy (with [your last child]), how much did you weigh?

Min = 1; Max = 700

Enter amount only.

Maternal experiences (MEX) - Question identifier:MEX_N075

Was that in pounds or kilograms?

  • 1: Pounds
  • 2: Kilograms

Maternal experiences (MEX) - Question identifier:MEX_Q080

How much weight did you gain during that pregnancy?

Min = -50; Max = 199

Enter amount only. If the respondent declares a weight loss during pregnancy, enter a negative value. If the weight loss or weight gain during pregnancy is more than the values permitted, just enter the minimum or maximum value.

Maternal experiences (MEX) - Question identifier:MEX_N085

Was that in pounds or kilograms?

  • 1: Pounds
  • 2: Kilograms

Maternal experiences (MEX) - Question identifier:MEX_Q090

[How often does [your last child]/When [your last child] was less than one year old, how often did he/she] sleep in the same bed with you or anyone else?

Read categories to respondent.

  • 1: Every day or almost every day
  • 2: Once or twice a week
  • 3: A few times a month
  • 4: Less than once a month
  • 5: Never
  • 8: RF
  • 9: DK

Maternal experiences (MEX) - Question identifier:MEX_Q095

What is the main reason that [your last child] [is/was] sleeping in the same bed with you or someone else?

  • 1: To breastfeed
  • 2: So the baby would sleep / So I could get some sleep
  • 3: Did not have room for a crib
  • 4: Could not afford a crib
  • 5: Believe that bedsharing was best for my child
  • 6: Child was sick
  • 7: Other
  • 8: RF
  • 9: DK

Maternal experiences (MEX) - Question identifier:MEX_Q100

Was [your last child] breastfed or given breast milk even for a short time?

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

Maternal experiences (MEX) - Question identifier:MEX_Q105

What is the main reason that you did not breastfeed or give breast milk?

  • 1: Bottle feeding is easier
  • 2: Formula is as good as breast milk
  • 3: Breastfeeding is unappealing
  • 4: Medical condition - mother
  • 5: Other - Specify
  • 8: RF
  • 9: DK

Maternal experiences (MEX) - Question identifier:MEX_Q110

Are you still breastfeeding or giving breast milk to [your last child]?

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

Maternal experiences (MEX) - Question identifier:MEX_Q115

How long did you breastfeed or give breast milk to [your last child]?

Min = 1; Max = 365

Enter amount only.

Maternal experiences (MEX) - Question identifier:MEX_N115A

Was this time in days, weeks, months or years?

If respondent reports less than 1 year but with a fraction, round the amount up. For example, 3 and ½ months would become 4 months.

If the respondent reports more than a year, with half values, report in months. For example, 2 ½ years = 30 months.

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

Maternal experiences (MEX) - Question identifier:MEX_Q120

What is the main reason that you stopped breastfeeding or giving breast milk?

  • 01: Not enough breast milk
  • 02: Baby was ready for solid foods
  • 03: Inconvenience / fatigue due to breastfeeding
  • 04: Difficulty with breastfeeding (e.g., sore nipples, engorged breasts, mastitis)
  • 05: Medical condition - mother
  • 06: Medical condition - baby
  • 07: Planned to stop at this time
  • 08: Child weaned him / herself (e.g., baby refusing breast, lack of interest)
  • 09: Returned to work / school
  • 10: Other - Specify
  • 98: RF
  • 99: DK

Maternal experiences (MEX) - Question identifier:MEX_Q125

[Are you giving [your last child] a vitamin D supplement?/When [your last child] was less than a year old, did you give him/her a vitamin D supplement?/When [your last child] was less than one year old and fed breast milk, did you give him/her a vitamin D supplement?/When [your last child] was fed breast milk, did you give him/her a vitamin D supplement?]

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

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

Maternal experiences (MEX) - Question identifier:MEX_Q130

[Now that [your last child] is more than a year old, are you still giving him/her a vitamin D supplement?/When [your last child] was older than one and fed breast milk, did you continue to give him/her a vitamin D supplement?]

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

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

Maternal experiences (MEX) - Question identifier:MEX_Q140

Overall, how often [do/did] you give [your last child] a supplement containing vitamin D?

Read categories to respondent.

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

Maternal experiences (MEX) - Question identifier:MEX_Q150

[While you were still breastfeeding, had/Have] liquids such as milk, formula, water, juice, tea or herbal mixture been introduced to [your last child]'s feeds?

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

Maternal experiences (MEX) - Question identifier:MEX_Q155

How old was [your last child] when other liquids were first added to the feeds?

Min = 1; Max = 365

Enter amount only.

Maternal experiences (MEX) - Question identifier:MEX_N160

Was this time in days, weeks, months or years?

If respondent reports less than 1 year but with a fraction, round the amount up. For example, 3 and ½ months would become 4 months.

If the respondent reports more than a year, with half values, report in months. For example, 2 ½ years = 30 months.

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

Maternal experiences (MEX) - Question identifier:MEX_Q170

Have solid foods such as cereals, mashed up or pureed meat, vegetables or fruits been introduced to the baby's feeds?

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

Maternal experiences (MEX) - Question identifier:MEX_Q175

How old was [your last child] when solid foods (such as cereals, mashed up or pureed meat, vegetables or fruits) were first added to their feeds?

Min = 1; Max = 365

Enter amount only.

Maternal experiences (MEX) - Question identifier:MEX_N180

Was this time in days, weeks, months or years?

If respondent reports less than 1 year but with a fraction, round the amount up. For example, 3 and ½ months would become 4 months.

If the respondent reports more than a year, with half values, report in months. For example, 2 ½ years = 30 months.

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

Maternal experiences (MEX) - Question identifier:MEX_Q190

What was the first solid food added to ^BABYSNAME's feeds?

  • 1: Infant cereals
  • 2: Meat, fish or poultry
  • 3: Meat alternatives (includes eggs, tofu, legumes, peas or lentils)
  • 4: Fruits or vegetables
  • 5: Other
  • 8: RF
  • 9: DK

Maternal experiences (MEX) - Question identifier:MEX_Q195

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

  • 01: Not enough breast milk
  • 02: [Baby was ready for solid foods/null]
  • 03: Inconvenience / fatigue due to breastfeeding
  • 04: Difficulty with breastfeeding (e.g., sore nipples, engorged breasts, mastitis)
  • 05: Medical condition - mother
  • 06: Medical condition - baby
  • 07: Advice from health professional / family
  • 08: Returned to work / school
  • 09: Formula equally healthy for baby
  • 10: Other - Specify
  • 98: RF
  • 99: DK

Flu shots (FLU)

Respondents are asked when they last had a flu shot, excluding the H1N1 shot. Respondents who have not had a shot in the past year are asked the reasons why they did not receive one.

Influenza is a serious illness for certain groups, including the elderly. For all groups, the flu is a major cause of days lost from work, school and other activities.

Results of this module will be used to identify groups of people who are less likely to have a flu shot. This information may be useful in planning and designing new programs to promote immunization.

Flu shots (FLU) - Question identifier:FLU_R001

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

Press <1> to continue.

Flu shots (FLU) - Question identifier:FLU_Q005

Have you ever had a seasonal flu shot, excluding the H1N1 flu shot?

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

Flu shots (FLU) - Question identifier:FLU_Q010

When did you have your last seasonal flu shot?

Read categories to respondent.

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

Flu shots (FLU) - Question identifier:FLU_Q015

In which month did you have your last seasonal flu shot?

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 98: RF
  • 99: DK

Flu shots (FLU) - Question identifier:FLU_Q020

Was that this year or last year?

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

Flu shots (FLU) - Question identifier:FLU_Q025

What are the reasons that you have not had a seasonal flu shot in the past year?

Mark all that apply.

  • 01: Lack of time
  • 02: Respondent - did not think it was necessary
  • 03: Doctor - did not think it was necessary
  • 04: Not available - at time required
  • 05: Did not know where to go / uninformed
  • 06: Feelings of fear or discomfort
  • 07: Bad reaction to previous flu shot
  • 08: Bad reaction to previous vaccine other than flu shot
  • 09: Unsure of / does not believe in benefits of vaccine
  • 10: Does not want vaccine for fear of what it contains
  • 11: Other
  • 98: RF
  • 99: DK

Primary health care (PHC)

Primary health care is often the first point of entry into the Canadian health care system. It incorporates diagnosis, treatment and management of health problems.

This module covers a number of topics related to the use of primary health care, including whether the respondent has a usual place to go for immediate care for minor health problems, whether the respondent has a regular health care provider, language spoken during appointments, and the types of health care professionals that are involved in the care of the respondent.

This module has a number of uses for governments, health care planners and researchers. For example, results could be used to compare how different groups-such as men and women, young and old, urban and rural-use health services. It will also track the change over time as to where Canadians go to and whom they chose to see when they need care.

Primary health care (PHC) - Question identifier:PHC_R001

Now I'd like to ask about your primary health care. It is often the first point of entry to the Canadian health system. It incorporates diagnosis, treatment and management of health problems.

Press <1> to continue.

Primary health care (PHC) - Question identifier:PHC_Q005

Is there a place that you usually [go] to when you [need] immediate care for a minor health problem?

If respondent has more than one place he/she went to in the last 12 months, please refer to the one place he/she went to the most often.

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

Primary health care (PHC) - Question identifier:PHC_Q010

What kind of place is it?

Read categories to respondent. Please exclude Internet as a usual "place" to go to for care.

  • 1: A doctor's office
  • 2: A hospital outpatient clinic
  • 3: A community health centre [or CLSC]
  • 4: A walk-in clinic
  • 5: A hospital emergency room
  • 6: Some other place
  • 8: RF
  • 9: DK

Primary health care (PHC) - Question identifier:PHC_Q015

Is this...?

Read categories to respondent.

  • 1: An office with one doctor working in a solo practice
  • 2: An office with several health care professionals working together as a team, that may include a dietician, nurse, social worker or psychologist
  • 3: An office with several doctors working independently of each other, who may share one or more nurses
  • 4: Other
  • 8: RF
  • 9: DK

Primary health care (PHC) - Question identifier:PHC_Q020

Do you have a regular health care provider? By this, we mean one health professional that you regularly see or talk to when you need care or advice for your health.

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

Primary health care (PHC) - Question identifier:PHC_Q025

What are the reasons why you do not have a regular health care provider?

Read categories to respondent.
Mark all that apply.

  • 1: Do not need one in particular, but you have a usual place of care
  • 2: No one available in the area
  • 3: No one in the area is taking new patients
  • 4: [You] have not tried to find one
  • 5: Had one who left or retired
  • 6: Other
  • 8: RF
  • 9: DK

Primary health care (PHC) - Question identifier:PHC_Q030

Is that regular health care provider a...?

Read categories to respondent. If respondent wants to report more than one doctor, ask for the one he/she consults the most. Additional examples of specialists are oncologist or psychiatrist. Examples of "Other" regular health care providers are psychologist or physiotherapist.

  • 1: Family doctor or general practitioner
  • 2: Medical specialist such as a cardiologist or a pediatrician
  • 3: Nurse practitioner
  • 4: Other
  • 8: RF
  • 9: DK

Primary health care (PHC) - Question identifier:PHC_Q035

When you [need] immediate care for a minor health problem, how long do you usually have to wait before you can have an appointment with this [family physician/specialist/nurse practitioner/regular health care provider][, or another care provider from the same office?]

Minor health problem can include fever, headache, a sprained ankle, vomiting or an unexplained rash.

  • 1: On the same day
  • 2: The next day
  • 3: In 2 to 3 days
  • 4: In 4 to 6 days
  • 5: In 1 to 2 weeks
  • 6: Between 2 weeks and one month
  • 7: One month or more
  • 8: RF
  • 9: DK

Primary health care (PHC) - Question identifier:PHC_Q040

Do you usually speak in English, in French or in another language with this [family physician/specialist/nurse practitioner/regular health care provider]?

  • 1: English
  • 2: French
  • 3: English and French
  • 4: English and another language
  • 5: French and another language
  • 6: Another language
  • 8: RF
  • 9: DK

Primary health care (PHC) - Question identifier:PHC_Q045

Is there one or more nurses working with your [family physician/specialist/nurse practitioner/regular health care provider] who are regularly involved in your health care?

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

Primary health care (PHC) - Question identifier:PHC_Q050

Other than doctors and nurses, are there other health professionals like nutritionists working in the same office where you get your regular health care?

The respondent might not use/need the services of these other professionals in the same office but is aware that they are available.

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

Primary health care (PHC) - Question identifier:PHC_Q055

Other than from your [family physician/specialist/nurse practitioner/regular health care provider], who do you receive regular health care from?

Read categories to respondent. Mark all that apply. Regular health care can also be considered as routine health care.

  • 01: Another family doctor or general practitioner
  • 02: Specialist doctor
  • 03: Nurse / Nurse practitioner
  • 04: Chiropractor
  • 05: Registered dietician
  • 06: Pharmacist
  • 07: Physiotherapist
  • 08: Psychologist / Mental Health Professional
  • 09: Social Worker
  • 10: Other
  • 11: None
  • 98: RF
  • 99: DK

Primary health care (PHC) - Question identifier:PHC_Q060

In general, how would you rate the level of coordination between your [family physician/specialist/nurse practitioner/regular health care provider] and other health professionals who provide you with regular care? Would you say the coordination is...?

Read categories to respondent. Examples of care coordination are: sending test results on time; communicating diagnostic or treatment plans to other health providers.

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor
  • 6: Not applicable
  • 8: RF
  • 9: DK

Contacts with health professionals - part 1 (CHP)

The objective of this module is to gather information about contact with various health professionals and use of health care services. This includes the use of home care services during the past 12 months, the use of hospital emergency rooms, or the number of overnight stays for hospital visits, etc.

As well, it asks about contact with, and frequency of visits to, a family doctor/ general practitioner, eye specialist, any other medical doctor, a nurse or a dental professional for physical, mental or emotional reasons.

This module has a number of uses for governments, health care planners and researchers. For example, results could be used to compare how different groups-such as men and women, young and old, urban and rural-use health services. This type of research can be used to determine who needs better access to care.

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_R001

Now I'd like to ask about your contacts with various health professionals and use of various health care services during the past 12 months, that is, from ^DV_DATEONEYEARAGO to yesterday.

Press <1> to continue.

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q010

In the past 12 months, how many times have you personally used a hospital emergency room?

Min = 0; Max = 900

If never, enter 0.

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q015

The last time you went, what were the reasons you went to the emergency room instead of any other health care service (like a doctor's office)?

Mark all that apply.

  • 01: It was clearly an emergency
  • 02: [You] didn't know if your health condition was an emergency
  • 03: It was not an emergency but you felt you would see a health professional or get the test you needed done faster
  • 04: [You] were told to go to the emergency department for follow-up or appointment
  • 05: [Your] primary health care provider was not available at the time you needed it (after hours of clinic, doctor away)
  • 06: [You] do not have a primary health care provider
  • 07: [You] use the emergency department for all your health concerns
  • 08: Other
  • 98: RF
  • 99: DK

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q020

The last time you went to the emergency room, was it for a condition that you thought could have been treated by your primary care provider if he/she had been available?

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

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q025

[In/Excluding the time you spent in an emergency department, in] the past 12 months, have you been a patient overnight in a hospital?

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

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q030

For how many nights in the past 12 months?

Min = 1; Max = 366

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q035

The last time you were an overnight patient in a hospital, what were the reasons for this hospitalisation?

  • 1: Post-surgery
  • 2: Was too sick to go home/ admitted from ER
  • 3: Waiting for care in nursing home
  • 4: Waiting for home care
  • 5: Postpartum care
  • 6: Other
  • 8: RF
  • 9: DK

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q040

[Not counting when you were an overnight patient, in the past 12 months], have you seen or talked to any of the following health professionals about your physical, emotional or mental health:

a family doctor[, pediatrician] or general practitioner?

Include both face to face and telephone contacts.

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

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q045

How many times (in the past 12 months)?

Min = 1; Max = 366

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q050

([Not counting when you were an overnight patient, in the past 12 months], have you seen or talked to:)

an eye specialist, such as an ophthalmologist or optometrist?

Include both face to face and telephone contacts. Exclude visits to an optician (person who dispenses or fixes glasses, but does not do the eye examination).

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

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q055

How many times (in the past 12 months)?

Min = 1; Max = 75

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q060

[Not counting when you were an overnight patient, in the past 12 months], have you seen or talked to:

any other medical doctor or specialist such as a surgeon, allergist, orthopaedist, [urologist/gynaecologist] or psychiatrist (about your physical, emotional or mental health)?

Include both face to face and telephone contacts.

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

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q065

How many times (in the past 12 months)?

Min = 1; Max = 300

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q070

[Not counting when you were an overnight patient, in the past 12 months], have you seen or talked to:

a nurse for care or advice about your physical, emotional or mental health?

Include both face to face and telephone contacts.

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

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q075

How many times (in the past 12 months)?

Min = 1; Max = 366

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q080

([Not counting when you were an overnight patient, in the past 12 months], have you seen or talked to:)

a dental professional, such as a dentist, a dental hygienist or a denturologist?

Include both face to face and telephone contacts. Other dental professionals include orthodontist, periodontist, dental surgeon and dental therapist.

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

Contacts with health professionals - part 1 (CHP) - Question identifier:CHP_Q085

How many times (in the past 12 months)?

Min = 1; Max = 99

Risk Factors for Heart Disease (RFH)

This module deals with various aspects surrounding heart health. It asks questions about factors that may be linked to heart health such as eating habits. It also asks questions around preventative measures taken before or after conditions like a heart attack or stroke have arisen. These can include topics such as taking aspirin on a daily basis, receiving blood tests for high blood cholesterol and sugar, to lifestyle changes recommended by a physician. Questions about specific types of heart tests and procedures undergone by the respondent in the past, as well as family history of heart attacks are also asked.

These questions will be used to help reproduce a heart risk score to help investigate the causes of cardiac diseases across the country. They will also be used to distinguish where important care gaps exist in preventing heart attacks and strokes.

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_R005

The following questions are about some of your lifestyle habits.

Press <1> to continue.

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q005

In the past week, how many times did you eat salty foods or snacks, such as prepared soups, lunch meat and potato chips?

Read categories to respondent.
Other examples of salty foods or snacks are hot dogs, bacon, canned foods, breads, cereals, sauces, pickled foods, commercial rice or pasta mixes, and condiments.

  • 1: More than once a day
  • 2: Once a day
  • 3: Less than once a day
  • 4: Not in the past week
  • 8: RF
  • 9: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q010

In the past week, how many times did you eat meat or poultry, such as beef, pork, chicken or lamb? Please exclude fish.

Read categories to respondent.

  • 1: More than once a day
  • 2: Once a day
  • 3: Less than once a day
  • 4: Not in the past week
  • 8: RF
  • 9: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q015

In the past week, how many times did you eat deep-fried foods or snacks, such as French fries, chicken nuggets or onion rings?

Read categories to respondent.
Other examples of deep-fried foods or snacks are potato chips, fried chicken, fish & chips, etc.

  • 1: 5 times or more (a week)
  • 2: 3-4 times
  • 3: Once or twice
  • 4: Not in the past week
  • 8: RF
  • 9: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_R020

Now some questions that relate to heart health.

Press <1> to continue.

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q020

Do you take aspirin or other ASA (acetylsalicylic acid) medication, every day or every second day, for heart disease and stroke prevention?

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

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q025

When was the last time you had your blood pressure measured by a health professional?

Examples of health professionals are doctors, nurses, specialists and pharmacists.

  • 1: Less than 1 year to 1 year ago
  • 2: More than 1 year to 2 years ago
  • 3: More than 2 years to 3 years ago
  • 4: More than 3 years to 5 years ago
  • 5: More than 5 years ago
  • 6: Never had blood pressure measured
  • 8: RF
  • 9: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q030

When was the last time you had a blood test to measure your cholesterol levels?

  • 1: Less than 1 year to 1 year ago
  • 2: More than 1 year to 2 years ago
  • 3: More than 2 years to 3 years ago
  • 4: More than 3 years to 5 years ago
  • 5: More than 5 years ago
  • 6: Never had blood cholesterol measured
  • 8: RF
  • 9: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q035

When was the last time you had a blood test for high blood sugar or diabetes?

  • 1: Less than 1 year to 1 year ago
  • 2: More than 1 year to 2 years ago
  • 3: More than 2 years to 3 years ago
  • 4: More than 3 years to 5 years ago
  • 5: More than 5 years ago
  • 6: Never had a blood test for high blood sugar or diabetes
  • 8: RF
  • 9: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q040

In the past 12 months, were any of the following lifestyle changes recommended by a health professional? You may specify more than one.

Read categories to respondent.
Examples of health professionals are doctors, nurses, specialists and pharmacists. Mark all that apply.

  • 01: Increase exercise
  • 02: Lose weight
  • 03: Reduce salt (intake)
  • 04: Eat more fruits and vegetables
  • 05: Reduce fatty food (intake)
  • 06: Reduce sugar (intake)
  • 07: Reduce smoking
  • 08: Reduce alcohol
  • 09: Reduce stress
  • 10: Other
  • 11: None
  • 98: RF
  • 99: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q045

Have you had any of the following heart tests in the past 5 years? You may specify more than one.

Read categories to respondent.
Mark all that apply.

  • 1: Electrocardiogram (ECG) (i.e. electrical recording of the heart's activity)
  • 2: Stress Test (i.e. running on a treadmill under the supervision of a doctor or having pictures of the heart taken after a nuclear medicine injection)
  • 3: Echocardiogram (i.e. ultrasound of the heart)
  • 4: None
  • 8: RF
  • 9: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q050

^HEARTDIS. Which of the following conditions have you had? You may specify more than one.

Read categories to respondent.
Please include conditions that are controlled by medication. Mark all that apply.

  • 01: Atrial fibrillation (i.e. an irregular heart rhythm that causes poor blood flow to the body)
  • 02: Heart attack (myocardial infarction)
  • 03: Angina (i.e. chest pain due to heart disease)
  • 04: Heart failure (also known as congestive heart failure)
  • 05: Aortic stenosis (i.e. a narrowing of the heart's aortic valve)
  • 06: Peripheral vascular disease (i.e. poor circulation in limbs)
  • 07: Other
  • 08: None
  • 98: RF
  • 99: DK

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q055

Have you ever had an angioplasty with stent?

This is a procedure where a small structure called a stent is inserted to open up blood vessels in the heart. Also called PCI (percutaneous coronary intervention).

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

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q060

Have you ever had cardiac bypass surgery?

This procedure is performed to improve blood flow to the heart by taking a small piece of blood vessel from elsewhere in the body to create a detour or bypass around the blocked portion of the coronary artery.

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

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q065

Did your biological mother have a heart attack before the age of 65?

If the respondent reports being adopted, please enter "Don't Know".

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

Risk Factors for Heart Disease (RFH) - Question identifier:RFH_Q070

Did your biological father have a heart attack before the age of 55?

If the respondent reports being adopted, please enter "Don't Know".

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

Labour force (LBF)

There are many relationships between work and health. For example, unemployment can cause various stress-related illnesses while some occupations are more likely to cause repetitive strain injuries.

This module includes questions about the respondent's current labour force activities during the past week, including job status and absenteeism, job classification (employee or self-employed), industry, occupation and main activities, number of jobs, and usual hours worked per week.

The concepts and definitions are, for the most part, the same as those used in the Labour Force Survey.

The module is asked of respondents aged between 15 and 75. Not all questions will be asked of all respondents - pay attention to the skip patterns.

Labour force (LBF) - Question identifier:LBF_Q005A

Many of the following questions concern [your] activities last week. By last week, I mean the week beginning on ^REFBEGE, and ending ^REFENDE.

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

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

Labour force (LBF) - Question identifier:LBF_Q005B

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

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

Labour force (LBF) - Question identifier:LBF_Q005C

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
  • 98: RF
  • 99: DK

Labour force (LBF) - Question identifier:LBF_R010

The next questions are about your current job or business.

If person currently holds more than one job, report on the job for which the number of hours worked per week is the greatest.

Press <1> to continue.

Labour force (LBF) - Question identifier:LBF_Q010

Were you an employee or self-employed?

  • 1: Employee
  • 2: Self-employed
  • 3: Working in a family business without pay
  • 8: RF
  • 9: DK

Labour force (LBF) - Question identifier:LBF_Q015A

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.

Labour force (LBF) - Question identifier:LBF_Q015B

For whom did you work?

Long Answer Length = 50

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

Labour force (LBF) - Question identifier:LBF_Q015C

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

Labour force (LBF) - Question identifier:LBF_Q020A

What was your work or occupation?

Long Answer Length = 50

Enter a detailed description.

For example: legal secretary, plumber, fishing guide, wood furniture assembler, secondary school teacher, computer programmer

Labour force (LBF) - Question identifier:LBF_Q020B

In this work, what were your main activities?

Long Answer Length = 50

Enter a detailed description.

For example: prepared legal documents, installed residential plumbing, guided fishing parties, made wood furniture products, taught mathematics, developed software

Labour force (LBF) - Question identifier:LBF_Q025

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

Min = 0.0; Max = 168.0

Labour force (LBF) - Question identifier:LBF_Q030

Did you have more than one job or business last week?

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

Labour force (LBF) - Question identifier:LBF_Q035

On average, how many hours do you usually work per week at your other job(s)?

Min = 1; Max = 168

Minimum is 1; maximum is (168 - LBF_Q025).

Socio-demographic characteristics (SDC)

Very important knowledge of understanding the health of Canadians is obtained by comparing the health of different groups. For example, do recent immigrants to Canada use health care services more or less than people born in Canada? Are people from European ethnic groups more likely to have certain chronic conditions than other groups?

In this module, important social and demographic information is collected, including immigrant status, country/province of birth, ethnic origin, aboriginal status, racial/cultural group, language, dwelling type and sexual orientation.

Socio-demographic characteristics (SDC) - Question identifier:SDC_R001

Now, some general background questions which will help us compare the health of people in Canada.

Press <1> to continue.

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q005

In what country were you born?

Ask the respondent to specify country of birth according to current boundaries.

  • 1: Search
  • 3: Other - Specify
  • 8: RF
  • 9: DK

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q006

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

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q007

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

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q008

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.

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q010

To which ethnic or cultural groups did your ancestors belong? (For example: French, Scottish, Chinese, East Indian)

Mark all that apply. An ancestor is usually more distant than a grandparent. If "Canadian" is the only response, probe. If the respondent hesitates, do not suggest Canadian. If the respondent answers "Eskimo", enter "20".

  • 01: Canadian
  • 02: French
  • 03: English
  • 04: German
  • 05: Scottish
  • 06: Irish
  • 07: Italian
  • 08: Ukrainian
  • 09: Dutch (Netherlands)
  • 10: Chinese
  • 11: Jewish
  • 12: Polish
  • 13: Portuguese
  • 14: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
  • 15: Norwegian
  • 16: Welsh
  • 17: Swedish
  • 18: First Nations (North American Indian)
  • 19: Métis
  • 20: Inuit
  • 21: Other - Specify
  • 98: RF
  • 99: DK

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q015

Are you an Aboriginal person, that is, First Nations, Métis or Inuk (Inuit)? First Nations includes Status and Non-Status Indians.

The terms "First Nations" and "North American Indian" can be interchanged. Some respondents may prefer one term over the other. "Inuit" is the plural form of "Inuk".

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

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q016

Are you First Nations, Métis or Inuk (Inuit)?

Mark all that apply. First Nations (North American Indian) includes Status and Non-Status Indians. The terms "First Nations" and "North American Indian" can be interchanged. Some respondents may prefer one term over the other. "Inuit" is the plural form of "Inuk".

  • 1: First Nations (North American Indian)
  • 2: Métis
  • 3: Inuk (Inuit)
  • 8: RF
  • 9: DK

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q020

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

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q025

Of English or French, which language(s) do you speak well enough to conduct a conversation? Is it... ?

Read categories to respondent.

  • 1: English only
  • 2: French only
  • 3: Both English and French
  • 4: Neither English nor French
  • 8: RF
  • 9: DK

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q026

What language do you speak most often at home?

Long Answer Length = 80

Mark up to three responses. Multiple responses are accepted only if languages are spoken equally often at home.

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q027

What is the language that you first learned at home in childhood and still understand?

Long Answer Length = 80

Mark up to three responses. If the respondent no longer understands the first language learned, indicate the second language learned. Accept multiple responses only if languages were learned at the same time.

Socio-demographic characteristics (SDC) - Question identifier:SDC_R030

Now a question about the dwelling in which you live.

Press <1> to continue.

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q030

Is this dwelling...?

Read categories to respondent. If the respondent's household contains both owners and renters, such as a boarder, the dwelling should be considered owned.

  • 1: Owned by you or a member of this household, even if it is still being paid for
  • 2: Rented, even if no cash rent is paid
  • 8: RF
  • 9: DK

Socio-demographic characteristics (SDC) - Question identifier:SDC_R035

Now, one additional background question which will help us compare the health of people in Canada.

Press <1> to continue.

Socio-demographic characteristics (SDC) - Question identifier:SDC_Q035

Do you consider yourself to be...?

Read categories to respondent.

  • 1: Heterosexual (sexual relations with people of the opposite sex)
  • 2: Homosexual, that is lesbian or gay (sexual relations with people of your own sex)
  • 3: Bisexual (sexual relations with people of both sexes)
  • 8: RF
  • 9: DK

Person most knowledgeable about household situation (PMK)

The purpose of this module is to identify someone who may be more knowledgeable and better prepared than the 12-17 year-old selected respondent to answer household level questions such as income, insurance and food security questions.

This module will be generated only if the selected respondent is between the ages of 12 to 17 and does not live alone or does not have any other person living in the household who is older than 17. If this respondent is not less than 14 years old, they will be asked if they agree to share their information. The interview will not continue unless a suitable PMK is found and is willing to continue the interview. If one is not found then the interviewer will exit the application and select an appropriate outcome code.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R005A

To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.

Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses or telephone numbers will be provided.

The personal identifiers (names, addresses and telephone numbers) will not be provided to Health Canada or the Public Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.

Press <1> to continue.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R005B

To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.

Territorial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses, telephone numbers or health numbers will be provided.

The personal identifiers (names, addresses and telephone numbers) will not be provided to Health Canada or the Public Health Agency of Canada.

Press <1> to continue.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R005C

To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, the " Institut de la Statistique du Québec ", Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.

The " Institut de la Statistique du Québec " and provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses or telephone numbers will be provided.

The personal identifiers (names, addresses or telephone numbers) will not be provided to Health Canada or the Public Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.

Press <1> to continue.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q005

These organizations have agreed to keep your information confidential and use it only for statistical purposes.

Do you agree to share the information provided?

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

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R010

For the last few questions, I would like to speak with someone who would be best able to answer questions about the entire household such as household income and food purchases.

Press <1> to continue.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q010

Who would this person be?

Select most knowledgeable person from the household roster.

  • 01: MEMBER1
  • 02: MEMBER2
  • 03: MEMBER3
  • 04: MEMBER4
  • 05: MEMBER5
  • 06: MEMBER6
  • 07: MEMBER7
  • 08: MEMBER8
  • 09: MEMBER9
  • 10: MEMBER10
  • 11: MEMBER11
  • 12: MEMBER12
  • 13: MEMBER13
  • 14: MEMBER14
  • 15: MEMBER15
  • 16: MEMBER16
  • 17: MEMBER17
  • 18: MEMBER18
  • 19: MEMBER19
  • 20: MEMBER20

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q015

Is [MEMBER#] available?

  • 1: Yes
  • 2: No
  • 3: Person most knowledgeable about household refuses to participate.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R025

This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time.

Press <1> to continue.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R030

This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time. I would now like to try and find the best time to speak with [MEMBER#].

Press <1> to continue.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R035

This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time. I would now like to speak with ^MEMBERNAME.

You should continue with the most knowledgeable person about the household.

Press < 1> to continue.

Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R040

Hello, My name is... I've just completed the main portion of the interview with <Respondent's name>. At this point I need to finish the interview with a few general questions on your household's situation. <Respondent's name> said you would be the best person to answer these types of questions.

Press <1> to continue.

Income (INC)

In this module, respondents are asked to provide the amount of their individual and household incomes, all sources of income, and their main sources of household and personal income, for the last calendar year. Personal income is asked only when there is more than one person living in the household, and when the respondent is aged 16 and over. The respondent is also asked if either total household or personal income includes a supplement for people with disabilities.

Although income is a sensitive topic, this information is very important for studying the link between income and health.

Although many health care costs in Canada are covered by insurance, income still plays an important role in people's health. People with lower incomes are more likely to have poorer health. People with varying income levels also tend to use the health care system differently.

Income (INC) - Question identifier:INC_R001

Although many health expenses are covered by health insurance, there is still an important relationship between health and income. Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.

Press <1> to continue.

Income (INC) - Question identifier:INC_Q005

Thinking about the total income for all household members, from which of the following sources did your household receive any income in the year ending December 31, [CURRENTYEAR [minus] 1]?

Read categories to respondent.
Mark all that apply.

  • 01: Wages and salaries
  • 02: Income from self-employment
  • 03: Dividends and interest (e.g., on bonds, savings)
  • 04: Employment insurance
  • 05: Workers' compensation
  • 06: Benefits from Canada or Quebec Pension Plan
  • 07: Job-related retirement pensions, superannuation and annuities
  • 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
  • 09: Old Age Security and Guaranteed Income Supplement
  • 10: Provincial or municipal social assistance or welfare
  • 11: Child Tax Benefit or family allowances
  • 12: Child support
  • 13: Alimony
  • 14: Other (e.g., rental income, scholarships)
  • 15: None
  • 98: RF
  • 99: DK

Income (INC) - Question identifier:INC_Q010

Does this amount include a supplement for people with disabilities?

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

Income (INC) - Question identifier:INC_Q015

What was the main source of household income?

  • 01: Wages and salaries
  • 02: Income from self-employment
  • 03: Dividends and interest (e.g., on bonds, savings)
  • 04: Employment insurance
  • 05: Workers' compensation
  • 06: Benefits from Canada or Quebec Pension Plan
  • 07: Job-related retirement pensions, superannuation and annuities
  • 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
  • 09: Old Age Security and Guaranteed Income Supplement
  • 10: Provincial or municipal social assistance or welfare
  • 11: Child Tax Benefit or family allowances
  • 12: Child support
  • 13: Alimony
  • 14: Other (e.g., rental income, scholarships)
  • 15: None
  • 98: RF
  • 99: DK

Income (INC) - Question identifier:INC_Q020A

Now a question about your total household income.

What is your best estimate of your total household income received by all household members, from all sources, before taxes and deductions, during the year ending December 31, [CURRENTYEAR [minus] 1]?

Income can come from various sources such as from work, investments, pensions or government. Examples include Employment Insurance, Social Assistance, Child Tax Benefit and other income such as child support, spousal support (alimony) and rental income.

Min = -9000000; Max = 90000000

Capital gains should not be included in the household income.

Income (INC) - Question identifier:INC_Q020B

Can you estimate in which of the following groups your household income falls? Was the total household income during the year ending December 31, [CURRENTYEAR [minus] 1]... ?

Read categories to respondent.

  • 1: Less than $50,000 including income loss
  • 2: $50,000 and more
  • 8: RF
  • 9: DK

Income (INC) - Question identifier:INC_Q020C

Please stop me when I have read the category which applies to your household.

Was it... ?

Read categories to respondent.

  • 1: Less than $5,000
  • 2: $5,000 to less than $10,000
  • 3: $10,000 to less than $15,000
  • 4: $15,000 to less than $20,000
  • 5: $20,000 to less than $30,000
  • 6: $30,000 to less than $40,000
  • 7: $40,000 to less than $50,000
  • 8: RF
  • 9: DK

Income (INC) - Question identifier:INC_Q020D

Please stop me when I have read the category which applies to your household.

Was it... ?

Read categories to respondent.

  • 1: $50,000 to less than $60,000
  • 2: $60,000 to less than $70,000
  • 3: $70,000 to less than $80,000
  • 4: $80,000 to less than $90,000
  • 5: $90,000 to less than $100,000
  • 6: $100,000 to less than $150,000
  • 7: $150,000 and over
  • 8: RF
  • 9: DK

Income (INC) - Question identifier:INC_Q025

Thinking about your total personal income, from which of the following sources did you receive any income in the year ending December 31, [CURRENTYEAR [minus] 1]?

Read categories to respondent.
Mark all that apply.

  • 01: Wages and salaries
  • 02: Income from self-employment
  • 03: Dividends and interest (e.g., on bonds, savings)
  • 04: Employment insurance
  • 05: Workers' compensation
  • 06: Benefits from Canada or Quebec Pension Plan
  • 07: Job-related retirement pensions, superannuation and annuities
  • 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
  • 09: Old Age Security and Guaranteed Income Supplement
  • 10: Provincial or municipal social assistance or welfare
  • 11: Child Tax Benefit or family allowances
  • 12: Child support
  • 13: Alimony
  • 14: Other (e.g., rental income, scholarships)
  • 15: None
  • 98: RF
  • 99: DK

Income (INC) - Question identifier:INC_Q030

Does this amount include a supplement for people with disabilities?

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

Income (INC) - Question identifier:INC_Q035

What was the main source of your personal income?

  • 01: Wages and salaries
  • 02: Income from self-employment
  • 03: Dividends and interest (e.g., on bonds, savings)
  • 04: Employment insurance
  • 05: Workers' compensation
  • 06: Benefits from Canada or Quebec Pension Plan
  • 07: Job-related retirement pensions, superannuation and annuities
  • 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
  • 09: Old Age Security and Guaranteed Income Supplement
  • 10: Provincial or municipal social assistance or welfare
  • 11: Child Tax Benefit or family allowances
  • 12: Child support
  • 13: Alimony
  • 14: Other (e.g., rental income, scholarships)
  • 15: None
  • 98: RF
  • 99: DK

Income (INC) - Question identifier:INC_Q040A

Now a question about your total personal income.

What is your best estimate of your total personal income, before taxes and deductions, from all sources during the year ending December 31, [CURRENTYEAR [minus] 1]?

Income can come from various sources such as from work, investments, pensions or government. Examples include Employment Insurance, Social Assistance, Child Tax Benefit and other income such as child support, spousal support (alimony) and rental income.

Min = -9000000; Max = 90000000

Capital gains should not be included in the personal income.

Income (INC) - Question identifier:INC_Q040B

Can you estimate in which of the following groups your personal income falls? Was your total personal income during the year ending December 31, [CURRENTYEAR [minus] 1]... ?

Read categories to respondent.

  • 1: Less than $30,000, including income loss
  • 2: $30,000 and more
  • 8: RF
  • 9: DK

Income (INC) - Question identifier:INC_Q040C

Please stop me when I have read the category which applies to you.

Was it... ?

Read categories to respondent.

  • 1: Less than $5,000
  • 2: $5,000 to less than $10,000
  • 3: $10,000 to less than $15,000
  • 4: $15,000 to less than $20,000
  • 5: $20,000 to less than $25,000
  • 6: $25,000 to less than $30,000
  • 8: RF
  • 9: DK

Income (INC) - Question identifier:INC_Q040D

Please stop me when I have read the category which applies to you.

Was it... ?

Read categories to respondent.

  • 01: $30,000 to less than $40,000
  • 02: $40,000 to less than $50,000
  • 03: $50,000 to less than $60,000
  • 04: $60,000 to less than $70,000
  • 05: $70,000 to less than $80,000
  • 06: $80,000 to less than $90,000
  • 07: $90,000 to less than $100,000
  • 08: $100,000 and over
  • 98: RF
  • 99: DK

Administration information (ADM)

In this module, respondents are informed that their information may be used for data linkage. Respondents are asked to provide their provincial or territorial health number.

Respondents are also asked to give their permission to share their data with health partners.

The interviewer is then asked to supply additional information. For CAPI respondents, identify whether the interview was completed in person or by telephone. For all respondents, state the language of the interview, whether the respondent was alone when completing the interview and, if not, did this affect the respondent's answers.

Administration information (ADM) - Question identifier:ADM_Q005

[Statistics Canada, your [territorial/provincial] ministry of health and the "Institut de la Statistique du Québec"] may combine [your] responses with information from other survey or administrative sources. This may include information on past and continuing use of health services such as visits to hospitals, clinics and doctor's offices.

Press <1> to continue, unless respondent objects to combining responses with other data sources.

  • 1: Continue (Go to ADM_D010A)
  • 2: Respondent does not want his or her responses combined with other sources
  • 3: Other [e.g., respondent hung up, interview suspended or interrupted]

Administration information (ADM) - Question identifier:ADM_Q010

Having a provincial or territorial health number will assist us in linking to this other information.

[Do you] have [a Newfoundland and Labrador/a Prince Edward Island/a Nova Scotia/a New Brunswick/a Quebec/an Ontario/a Manitoba/a Saskatchewan/an Alberta/a British Columbia/a Yukon/a Northwest Territories/a Nunavut] health number?

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

Administration information (ADM) - Question identifier:ADM_Q015

For which province or territory is [your] health number?

  • 10: Newfoundland and Labrador
  • 11: Prince Edward Island
  • 12: Nova Scotia
  • 13: New Brunswick
  • 24: Quebec
  • 35: Ontario
  • 46: Manitoba
  • 47: Saskatchewan
  • 48: Alberta
  • 59: British Columbia
  • 60: Yukon
  • 61: Northwest Territories
  • 62: Nunavut
  • 88: Does not have a Canadian health number
  • 98: RF
  • 99: DK

Administration information (ADM) - Question identifier:ADM_Q025

What is [your] health number?

Long Answer Length = 50

Administration information (ADM) - Question identifier:ADM_R025

To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.

Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as [names, addresses, telephone numbers and health numbers will be provided].

The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.

Press <1> to continue.

Administration information (ADM) - Question identifier:ADM_R030

To avoid duplication of surveys, Statistics Canada has signed agreements with provincial and territorial ministries of health, the " Institut de la Statistique du Québec ", Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.

The " Institut de la Statistique du Québec " and provincial ministries of health may make this information available to local health authorities, but no identifiable information such as [names, addresses, telephone numbers and health numbers will be provided].

The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.

Press <1> to continue.

Administration information (ADM) - Question identifier:ADM_Q035

These organizations have agreed to keep your information confidential and use it only for statistical purposes.

Do you agree to share the information provided?

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