National Population Health Survey: Household Component - Longitudinal - Cycle 9 (2010-2011) - Questionnaire

Archived Content

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

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

Show all instructions

Table of Contents

Proxy interview (GR)

Proxy interview (GR) - Question identifier:GR_N1

Who is providing the information for the selected respondent?

Proxy interview (GR) - Question identifier:GR_N2

Record the reason why this component is being completed by proxy.

Long Answer, 80 characters.

General Health (GH)

General Health (GH) - Question identifier:GH_QINT

This part of the survey deals with various aspects of [your/FNAME's] health. I'll be asking about such things as physical activity, social relationships and health status. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

General Health (GH) - Question identifier:GH_Q1

I'll start with a few questions concerning [your/FNAME's] health in general. In general, would you say [your/his/her] health is:

1. ... excellent?
2. ... very good?
3. ... good?
4. ... fair?
5. ... poor?
DK, RF

General Health (GH) - Question identifier:GH_Q2

Thinking about the amount of stress in [your/his/her] life, would you say that most days are:

1. ... not at all stressful?
2. ... not very stressful?
3. ... a bit stressful?
4. ... quite a bit stressful?
5. ... extremely stressful?
DK, RF

General Health (GH) - Question identifier:GH_Q3

In general, would you say [your/his/her] eating habits are:

1. ... excellent?
2. ... very good?
3. ... good?
4. ... fair?
5. ... poor?
DK, RF

General Health (GH) - Question identifier:GH_Q4

How satisfied are you with your life in general? Would you say you are:

1. ... very satisfied?
2. ... satisfied?
3. ... neither satisfied nor dissatisfied?
4. ... dissatisfied?
5. ... very dissatisfied?
DK, RF

Sleep (SL)

Sleep (SL) - Question identifier:SL_Q1

How long do you usually spend sleeping each night?

1. Under 2 hours
2. 2 hours to less than 3 hours
3. 3 hours to less than 4 hours
4. 4 hours to less than 5 hours
5. 5 hours to less than 6 hours
6. 6 hours to less than 7 hours
7. 7 hours to less than 8 hours
8. 8 hours to less than 9 hours
9. 9 hours to less than 10 hours
10. 10 hours to less than 11 hours
11. 11 hours to less than 12 hours
12. 12 hours or more
DK
RF

Sleep (SL) - Question identifier:SL_Q2

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

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Sleep (SL) - Question identifier:SL_Q3

How often do you find your sleep refreshing?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Sleep (SL) - Question identifier:SL_Q4

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

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Height and weight (HW)

Height and weight (HW) - Question identifier:HW_Q2

How tall [are/is] [you/FNAME] 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)
DK, RF

Height and weight (HW) - Question identifier:HW_Q2A

Select the exact height.

0. 1'0" / 12" (29.2 to 31.7 cm.)
1. 1'1" / 13" (31.8 to 34.2 cm.)
2. 1'2" / 14" (34.3 to 36.7 cm.)
3. 1'3" / 15" (36.8 to 39.3 cm.)
4. 1'4" / 16" (39.4 to 41.8 cm.)
5. 1'5" / 17" (41.9 to 44.4 cm.)
6. 1'6" / 18" (44.5 to 46.9 cm.)
7. 1'7" / 19" (47.0 to 49.4 cm.)
8. 1'8" / 20" (49.5 to 52.0 cm.)
9. 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.)
DK, RF

Height and weight (HW) - Question identifier:HW_Q2B

Select the exact height.

0. 2'0" / 24" (59.7 to 62.1 cm.)
1. 2'1" / 25" (62.2 to 64.7 cm.)
2. 2'2" / 26" (64.8 to 67.2 cm.)
3. 2'3" / 27" (67.3 to 69.8 cm.)
4. 2'4" / 28" (69.9 to 72.3 cm.)
5. 2'5" / 29" (72.4 to 74.8 cm.)
6. 2'6" / 30" (74.9 to 77.4 cm.)
7. 2'7" / 31" (77.5 to 79.9 cm.)
8. 2'8" / 32" (80.0 to 82.5 cm.)
9. 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.)
DK, RF

Height and weight (HW) - Question identifier:HW_Q2C

Select the exact height.

0. 3'0" / 36" (90.2 to 92.6 cm.)
1. 3'1" / 37" (92.7 to 95.2 cm.)
2. 3'2" / 38" (95.3 to 97.7 cm.)
3. 3'3" / 39" (97.8 to 100.2 cm.)
4. 3'4" / 40" (100.3 to 102.8 cm.)
5. 3'5" / 41" (102.9 to 105.3 cm.)
6. 3'6" / 42" (105.4 to 107.9 cm.)
7. 3'7" / 43" (108.0 to 110.4 cm.)
8. 3'8" / 44" (110.5 to 112.9 cm.)
9. 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.)
DK, RF

Height and weight (HW) - Question identifier:HW_Q2D

Select the exact height.

0. 4'0" / 48" (120.7 to 123.1 cm.)
1. 4'1" / 49" (123.2 to 125.6 cm.)
2. 4'2" / 50" (125.7 to 128.2 cm.)
3. 4'3" / 51" (128.3 to 130.7 cm.)
4. 4'4" / 52" (130.8 to 133.3 cm.)
5. 4'5" / 53" (133.4 to 135.8 cm.)
6. 4'6" / 54" (135.9 to 138.3 cm.)
7. 4'7" / 55" (138.4 to 140.9 cm.)
8. 4'8" / 56" (141.0 to 143.4 cm.)
9. 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.)
DK, RF

Height and weight (HW) - Question identifier:HW_Q2E

Select the exact height.

0. 5'0" (151.1 to 153.6 cm.)
1. 5'1" (153.7 to 156.1 cm.)
2. 5'2" (156.2 to 158.7 cm.)
3. 5'3" (158.8 to 161.2 cm.)
4. 5'4" (161.3 to 163.7 cm.)
5. 5'5" (163.8 to 166.3 cm.)
6. 5'6" (166.4 to 168.8 cm.)
7. 5'7" (168.9 to 171.4 cm.)
8. 5'8" (171.5 to 173.9 cm.)
9. 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.)
DK, RF

Height and weight (HW) - Question identifier:HW_Q2F

Select the exact height.

0. 6'0" (181.6 to 184.1 cm.)
1. 6'1" (184.2 to 186.6 cm.)
2. 6'2" (186.7 to 189.1 cm.)
3. 6'3" (189.2 to 191.7 cm.)
4. 6'4" (191.8 to 194.2 cm.)
5. 6'5" (194.3 to 196.8 cm.)
6. 6'6" (196.9 to 199.3 cm.)
7. 6'7" (199.4 to 201.8 cm.)
8. 6'8" (201.9 to 204.4 cm.)
9. 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.)
DK, RF

Height and weight (HW) - Question identifier:HW_Q3

How much [do/does] [you/FNAME] weigh?

Minimum: 1 Maximum: 575

Height and weight (HW) - Question identifier:HW_N4

Was that in pounds or in kilograms?

1. Pounds
2. Kilograms

Body Image (BI)

Body Image (BI) - Question identifier:BI_Q1

Do you consider yourself:

1. ... overweight?
2. ... underweight?
3. ... just about right?
DK, RF

Body Image (BI) - Question identifier:BI_Q2

Are you presently trying to lose weight?

1. Yes
2. No
DK, RF

Body Image (BI) - Question identifier:BI_Q3

Are you presently trying to gain weight?

1. Yes
2. No
DK, RF

Body Image (BI) - Question identifier:BI_Q4

How much would you like to weigh?

Minimum: 1 Maximum: 575

Body Image (BI) - Question identifier:BI_N5

Was that in pounds or in kilograms?

1. Pounds
2. Kilograms

Fruit and vegetable consumption (FV)

Fruit and vegetable consumption (FV) - Question identifier:FV_QINT

The next questions are about the foods you usually eat or drink. Think about all the foods you eat, both meals and snacks, at home and away from home.

Fruit and vegetable consumption (FV) - Question identifier:FV_Q1A

How often do you usually drink fruit juices such as orange, grapefruit or tomato?
(For example: once a day, three times a week, twice a month)

Minimum: 0 Maximum: 500

Fruit and vegetable consumption (FV) - Question identifier:FV_N1B

Select the reporting period.

1. Daily (hard edit if FV_Q1A more than 20; warning if more than 5)
2. Weekly (hard edit if FV_Q1A more than 90; warning if more than 10)
3. Monthly (hard edit if FV_Q1A more than 200; warning if more than 10)
4. Yearly (warning if FV_Q1A more than 12)

Fruit and vegetable consumption (FV) - Question identifier:FV_Q2A

Not counting juice, how often do you usually eat fruit?

Minimum: 0 Maximum: 500

Fruit and vegetable consumption (FV) - Question identifier:FV_N2B

Select the reporting period.

1. Daily (hard edit if FV_Q2A more than 20; warning if more than 5)
2. Weekly (hard edit if FV_Q2A more than 90; warning if more than 10)
3. Monthly (hard edit if FV_Q2A more than 200; warning if more than 10)
4. Yearly (warning if FV_Q2A more than 12)

Fruit and vegetable consumption (FV) - Question identifier:FV_Q3A

How often do you usually eat green salad?

Minimum: 0 Maximum: 500

Fruit and vegetable consumption (FV) - Question identifier:FV_N3B

Select the reporting period.

1. Daily (hard edit if FV_Q3A more than 20; warning if more than 2)
2. Weekly (hard edit if FV_Q3A more than 90; warning if more than 5)
3. Monthly (hard edit if FV_Q3A more than 200; warning if more than 5)
4. Yearly (warning if FV_Q3A more than 12)

Fruit and vegetable consumption (FV) - Question identifier:FV_Q4A

How often do you usually eat potatoes, not including french fries, fried potatoes or potato chips?

Minimum: 0 Maximum: 500

Fruit and vegetable consumption (FV) - Question identifier:FV_N4B

Select the reporting period.

1. Daily (hard edit if FV_Q4A more than 20; warning if more than 2)
2. Weekly (hard edit if FV_Q4A more than 90; warning if more than 10)
3. Monthly (hard edit if FV_Q4A more than 200; warning if more than 10)
4. Yearly (warning if FV_Q4A more than 12)

Fruit and vegetable consumption (FV) - Question identifier:FV_Q5A

How often do you usually eat carrots?

Minimum: 0 Maximum: 500

Fruit and vegetable consumption (FV) - Question identifier:FV_N5B

Select the reporting period.

1. Daily (hard edit if FV_Q5A more than 20; warning if more than 2)
2. Weekly (hard edit if FV_Q5A more than 90; warning if more than 10)
3. Monthly (hard edit if FV_Q5A more than 200; warning if more than 10)
4. Yearly (warning if FV_Q5A more than 12)

Fruit and vegetable consumption (FV) - Question identifier:FV_Q6A

Not counting carrots, potatoes, or salad, how many servings of other vegetables do you usually eat?

Minimum: 0 Maximum: 500

Fruit and vegetable consumption (FV) - Question identifier:FV_N6B

Select the reporting period.

1. Daily (hard edit if FV_Q6A more than 20; warning if more than 5)
2. Weekly (hard edit if FV_Q6A more than 90; warning if more than 10)
3. Monthly (hard edit if FV_Q6A more than 200; warning if more than 10)
4. Yearly (warning if FV_Q6A more than 12)

Milk Consumption (MK)

Milk Consumption (MK) - Question identifier:MK_Q1A

How often do you usually drink milk?

Minimum: 0 Maximum: 500

Milk Consumption (MK) - Question identifier:MK_N1B

Select the reporting period.

1. Daily (hard edit if MK_Q1A more than 20; warning if more than 5)
2. Weekly (hard edit if MK_Q1A more than 90; warning if more than 10)
3. Monthly (hard edit if MK_Q1A more than 200; warning if more than 10)
4. Yearly (warning if MK_Q1A more than 12)

Milk Consumption (MK) - Question identifier:MK_Q2

What type of milk do you usually drink?

1. Whole milk
2. 2% milk
3. 1% milk
4. Skimmed milk
5. Other - Specify

Preventive Health (PH)

Preventive Health (PH) - Question identifier:PH_Q1

Have you ever had your blood pressure taken?

1. Yes
2. No
DK, RF

Preventive Health (PH) - Question identifier:PH_Q1B

When was the last time that you had your blood pressure taken?

1. Less than 6 months ago
2. 6 months to less than 1 year ago
3. 1 year to less than 2 years ago
4. 2 years to less than 5 years ago
5. 5 or more years ago
DK, RF

Preventive Health (PH) - Question identifier:PH_Q2

Have you ever had a PAP smear test?

1. Yes
2. No
DK, RF

Preventive Health (PH) - Question identifier:PH_Q2B

When was the last time that you had a PAP smear test?

1. Less than 6 months ago
2. 6 months to less than 1 year ago
3. 1 year to less than 3 years ago
4. 3 years to less than 5 years ago
5. 5 or more years ago
DK, RF

Preventive Health (PH) - Question identifier:PH_Q3

Have you ever had a mammogram, that is, a breast x-ray?

1. Yes
2. No
DK, RF

Preventive Health (PH) - Question identifier:PH_Q3B

When was the last time that you had a mammogram?

1. Less than 6 months ago
2. 6 months to less than 1 year ago
3. 1 year to less than 2 years ago
4. 2 years to less than 5 years ago
5. 5 or more years ago
DK, RF

Preventive Health (PH) - Question identifier:PH_Q3C

Why did you have a mammogram?

1. Family history of breast cancer
2. Part of regular check-up / routine screening
3. Age
4. Previously detected lump
5. Follow-up of breast cancer treatment
6. On hormone replacement therapy
7. Breast problem
8. Other - Specify
DK, RF

Preventive Health (PH) - Question identifier:PH_Q4

Now, a few questions for recent mothers. Since our interview in [month and year of last response interview], have you given birth?

1. Yes
2. No
DK, RF

Preventive Health (PH) - Question identifier:PH_Q4A

(For your last baby,) did you use the services of a doctor, a midwife or both?

1. Doctor only
2. Midwife only
3. Both doctor and midwife
4. Neither
DK, RF

Preventive Health (PH) - Question identifier:PH_Q4B

It is important to know when analyzing health whether or not the person is pregnant. Are you pregnant?

1. Yes
2. No
DK, RF

Preventive Health (PH) - Question identifier:PH_Q5

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

1. Yes
2. No
DK, RF

Preventive Health (PH) - Question identifier:PH_Q5B

At what age?

Minimum: 18 Maximum: xxx

Preventive Health (PH) - Question identifier:PH_Q5C

Why did you have it?

1. Cancer treatment
2. Cancer prevention
3. Endometriosis
4. Tubal pregnancy
5. Benign tumors (e.g., fibroids)
6. Menstrual problems / abnormal bleeding
7. Other - Specify
DK, RF

Health Care Utilization (HC)

Health Care Utilization (HC) - Question identifier:HC_QINT1

Now I'd like to ask about [your/FNAME's] contacts with health professionals during the past 12 months, that is, from [date one year ago] to yesterday.

Health Care Utilization (HC) - Question identifier:HC_Q01

In the past 12 months, [have/has] [you/FNAME] been a patient overnight in a hospital, nursing home or convalescent home?

1. Yes
2. No
DK
RF

Health Care Utilization (HC) - Question identifier:HC_Q01A

For how many nights in the past 12 months?

Minimum: 1 Maximum: 366 ; warning after 100

Health Care Utilization (HC) - Question identifier:HC_Q02A

(Not counting when [you/FNAME] [were/was] an overnight patient,) In the past 12 months, how many times [have/has] [you/FNAME/he/she] seen or talked on the telephone about [your/his/her] physical, emotional or mental health with:

... a family doctor [, pediatrician] or general practitioner?

Minimum: 0 Maximum: 366 ; warning after 12

Health Care Utilization (HC) - Question identifier:HC_Q02B

... an eye specialist (such as an ophthalmologist or optometrist)?

Minimum: 0 Maximum: 75 ; warning after 3

Health Care Utilization (HC) - Question identifier:HC_Q02C

... any other medical doctor (such as a surgeon, allergist, orthopedist, gynaecologist or psychiatrist)?

Minimum: 0 Maximum: 300 ; warning after 7

Health Care Utilization (HC) - Question identifier:HC_Q02D

(Not counting when [you/FNAME] [were/was] an overnight patient,) In the past 12 months, how many times [have/has] [you/FNAME/he/she] seen or talked on the telephone about [your/his/her] physical, emotional or mental health with:

... a nurse for care or advice?

Minimum: 0 Maximum: 366 ; warning after 15

Health Care Utilization (HC) - Question identifier:HC_Q02E

... a dentist or orthodontist?

Minimum: 0 Maximum: 99 ; warning after 4

Health Care Utilization (HC) - Question identifier:HC_Q02F

... a chiropractor?

Minimum: 0 Maximum: 366 ; warning after 20

Health Care Utilization (HC) - Question identifier:HC_Q02G

(Not counting when [you/FNAME] [were/was] an overnight patient,) In the past 12 months, how many times [have/has] [you/FNAME/he/she] seen or talked on the telephone about [your/his/her] physical, emotional or mental health with:

... a physiotherapist?

Minimum: 0 Maximum: 366 ; warning after 30

Health Care Utilization (HC) - Question identifier:HC_Q02H

... a social worker or counsellor?

Minimum: 0 Maximum: 366 ; warning after 20

Health Care Utilization (HC) - Question identifier:HC_Q02I

... a psychologist?

Minimum: 0 Maximum: 366 ; warning after 25

Health Care Utilization (HC) - Question identifier:HC_Q02J

(Not counting when [you/FNAME] [were/was] an overnight patient,) In the past 12
months, how many times [have/has] [you/FNAME/he/she] seen or talked on the telephone about [your/his/her] physical, emotional or mental health with:

... a speech, audiology or occupational therapist?

Minimum: 0 Maximum: 200 ; warning after 12

Health Care Utilization (HC) - Question identifier:HC_Q03

[Do/Does] [you/FNAME] have a regular medical doctor?

1. Yes
2. No
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q04A

In the past 12 months, [have/has] [you/he/she] attended a meeting of a self-help group such as AA or a cancer support group?

1. Yes
2. No
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q04

People may also use alternative or complementary medicine. In the past 12 months, [have/has] [you/FNAME] seen or talked on the telephone to an alternative health care provider such as an acupuncturist, homeopath or massage therapist about [your/his/her] physical, emotional or mental health?

1. Yes
2. No
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q05

Who did [you/FNAME] see or talk to?

1. Massage therapist
2. Acupuncturist
3. Homeopath or naturopath
4. Feldenkrais or Alexander teacher
5. Relaxation therapist
6. Biofeedback teacher
7. Rolfer
8. Herbalist
9. Reflexologist
10. Spiritual healer
11. Religious healer
12. Other - Specify
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q06

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

1. Yes
2. No
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q07

Thinking of the most recent time, why didn't [you/he/she] get care?

1. Not available - in the area
2. Not available - at time required (e.g., doctor on holidays, inconvenient hours)
3. Waiting time too long
4. Felt would be inadequate
5. Cost
6. Too busy
7. Didn't get around to it / didn't bother
8. Didn't know where to go
9. Transportation problems
10. Language problems
11. Personal or family responsibilities
12. Dislikes doctors / afraid
13. Decided not to seek care
14. Other - Specify
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q08

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

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

Health Care Utilization (HC) - Question identifier:HC_QINT2

Home care services are health care or homemaker services received at home. Examples are: nursing care, help with bathing or housework, respite care and meal delivery.

Health Care Utilization (HC) - Question identifier:HC_Q09

[Have/Has] [you/FNAME] received any home care services in the past 12 months with the cost entirely or partially covered by government?

1. Yes
2. No
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q10

What type of services [have/has] [you/he/she] received?

1. Nursing care (e.g., dressing changes)
2. Other health care services (e.g., physiotherapy, nutrition counselling)
3. Personal care (e.g., bathing, foot care)
4. Housework (e.g., cleaning, laundry)
5. Meal preparation or delivery
6. Shopping
7. Respite care (i.e., caregiver relief program)
8. Other - Specify
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q11

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

1. Yes
2. No
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q12

Who provided these [other] home care services?

1. Nurse from private agency
2. Homemaker from private agency
3. Neighbour or friend
4. Family member
5. Volunteer
6. Other - Specify
DK, RF

Health Care Utilization (HC) - Question identifier:HC_Q13

What type of services [have/has] [you/he/she] received [from identified person]?

1. Nursing care (e.g., dressing changes)
2. Other health care services (e.g., physiotherapy, nutrition counselling)
3. Personal care (e.g., bathing, foot care)
4. Housework (e.g., cleaning, laundry)
5. Meal preparation or delivery
6. Shopping
7. Respite care (i.e., caregiver relief program)
8. Other - Specify
DK, RF

Restriction of Activities (RA)

Restriction of Activities (RA) - Question identifier:RA_QINT

The next few questions deal with any health limitations which affect [your/FNAME's] daily activities. In these questions, `long-term conditions' refer to conditions that have lasted or are expected to last 6 months or more.

Restriction of Activities (RA) - Question identifier:RA_Q1A

Because of a long-term physical or mental condition or a health problem, [are/is] [you/FNAME] limited in the kind or amount of activity [you/he/she] can do:

... at home?

1. Yes
2. No
DK
RF

Restriction of Activities (RA) - Question identifier:RA_Q1B

... at school?

1. Yes
2. No
3. Not applicable
DK
RF

Restriction of Activities (RA) - Question identifier:RA_Q1C

... at work?

1. Yes
2. No
3. Not applicable
DK
RF

Restriction of Activities (RA) - Question identifier:RA_Q1D

... in other activities such as transportation to or from work or school or leisure time activities?

1. Yes
2. No
DK
RF

Restriction of Activities (RA) - Question identifier:RA_Q2

[Do/Does] [you/FNAME] have any long-term disabilities or handicaps?

1. Yes
2. No
DK
RF

Restriction of Activities (RA) - Question identifier:RA_Q2A

Remember, for this survey it's important to measure change. During our last interview in [month and year of last response interview], there were no activity restrictions or disabilities reported for [you/FNAME], but this time there were. Is this due to a new activity restriction or disability or to the worsening of an old one?

1. New since last interview
2. Worsening since last interview
3. No current activity restriction or disability
4. Same activity restriction or disability
5. Other - Specify
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q2B

Remember, for this survey it's important to measure change. During our last interview in [month and year of last response interview], there were activity restrictions or disabilities reported for [you/FNAME], but this time there were not. Is this due to the disappearance or improvement of an old activity restriction or disability, to the use of special equipment (for example, an artificial limb), or to something else?

1. Disappeared or improved
2. Currently uses special equipment
3. None at last interview
4. Never had
5. Currently have / has activity restriction or disability
6. Other - Specify
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q3

What is the main condition or health problem causing [you/FNAME] (to be limited in [your/his/her] activities / to have a long-term disability or handicap)?

Long Answer, 80 characters.

Restriction of Activities (RA) - Question identifier:RA_Q5

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

1. Injury - at home
2. Injury - sports or recreation
3. Injury - motor vehicle
4. Injury - work-related
5. Existed at birth
6. Work environment
7. Disease or illness
8. Natural aging process
9. Psychological or physical abuse
10. Other - Specify
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q6A

The next few questions may not apply to [you/FNAME], but we need to ask the same questions of everyone. Because of any condition or health problem, [do/does] [you/he/she] need the help of another person:

... in preparing meals?

1. Yes
2. No
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q6B

... in shopping for groceries or other necessities?

1. Yes
2. No
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q6C

... in doing normal everyday housework?

1. Yes
2. No
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q6D

... in doing heavy household chores such as washing walls or yard work?

1. Yes
2. No
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q6E

... in personal care such as washing, dressing or eating?

1. Yes
2. No
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q6F

... in moving about inside the house?

1. Yes
2. No
DK, RF

Restriction of Activities (RA) - Question identifier:RA_Q6G

... in going outdoors in any weather?

1. Yes
2. No
DK, RF

Chronic Conditions (CC)

Chronic Conditions (CC) - Question identifier:CC_QINT

Now I'd like to ask about certain chronic health conditions which [you/FNAME] may have. We are interested in 'long-term conditions' that have lasted or are expected to last 6 months or more and that have been diagnosed by a health professional.
We also want to ask a few questions to help us understand any changes in these conditions.

Chronic Conditions (CC) - Question identifier:CC_Q011

[Do/Does] [you/FNAME] have food allergies?

1. Yes
2. No
DK
RF

Chronic Conditions (CC) - Question identifier:CC_Q021

[Do/Does] [you/FNAME] have any other allergies?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q031

[Do/Does] [you/FNAME] have asthma?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q032

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q032X

So [you/he/she] had asthma prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q033

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] had asthma, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had asthma
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q034

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q035

[Have/Has] [you/he/she] had any asthma symptoms or asthma attacks in the past 12 months?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q036

In the past 12 months, [have/has] [you/he/she] taken any medicine for asthma such as inhalers, nebulizers, pills, liquids or injections?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q041

Remember, we're interested in conditions diagnosed by a health professional. [Do/Does] [you/FNAME] have fibromyalgia?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q042

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q042X

So [you/he/she] had fibromyalgia prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q043

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] had fibromyalgia, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had fibromyalgia
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q044

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q045

[Do/Does] [you/he/she] receive any treatment or medication for [your/his/her] fibromyalgia?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q046

What kind of treatment or medication?

1. Drug
2. Diet
3. Exercise / physiotherapy
4. Other - Specify
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q051

[Do/Does] [you/FNAME] have arthritis or rheumatism excluding fibromyalgia?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q052

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q052X

So [you/he/she] had arthritis or rheumatism prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q053

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] had arthritis or rheumatism, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had arthritis or rheumatism
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q054

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q055

What kind of arthritis [do/does] [you/he/she] have?

1. Rheumatoid arthritis
2. Osteoarthritis
3. Other - Specify
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q056

[Do/Does] [you/he/she] receive any treatment or medication for [your/his/her] arthritis or rheumatism?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q057

What kind of treatment or medication?

1. Drug
2. Diet
3. Exercise / physiotherapy
4. Other - Specify
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q061

Remember, we're interested in conditions diagnosed by a health professional. [Do/Does] [you/FNAME] have back problems, excluding fibromyalgia and arthritis?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q071

[Do/Does] [you/FNAME] have high blood pressure?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q072

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q072X

So [you/he/she] had high blood pressure prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q073

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] had high blood pressure, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had high blood pressure
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q074

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q075

[Do/Does] [you/he/she] receive any treatment or medication for [your/his/her] high blood pressure?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q076

What kind of treatment or medication?

1. Drug
2. Diet
3. Exercise / physiotherapy
4. Other - Specify
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q081

Remember, we're interested in conditions diagnosed by a health professional. [Do/Does] [you/FNAME] have migraine headaches?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q082

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q082X

So [you/he/she] had migraine headaches prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q083

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] had migraine headaches, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had migraine headaches
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q084

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q085

[Do/Does] [you/he/she] receive any treatment or medication for [your/his/her] migraine headaches?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q086

What kind of treatment or medication?

1. Drug
2. Diet
3. Exercise / physiotherapy
4. Other - Specify
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q091

[Do/Does] [you/FNAME] have chronic bronchitis or emphysema?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q101

[Do/Does] [you/FNAME] have diabetes?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q102

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q102X

So [you/he/she] had diabetes prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q103

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] had diabetes, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had diabetes
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q104

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q105

[Do/Does] [you/FNAME] currently take insulin for [your/his/her] diabetes?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q106

[Do/Does] [you/he/she] take any other treatment or medication for [your/his/her] diabetes?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q107

What kind of treatment or medication?

1. Drug
2. Diet
3. Exercise / physiotherapy
4. Other - Specify
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q111

[Do/Does] [you/FNAME] have epilepsy?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q112

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q112X

So [you/he/she] had epilepsy prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q113

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] had epilepsy, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had epilepsy
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q114

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q121

[Do/Does] [you/FNAME] have heart disease?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q122

[Have/Has] [you/he/she] ever had a heart attack (damage to the heart muscle)?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q123

[Do/Does] [you/he/she] currently have angina (chest pain, chest tightness)?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q124

[Do/Does] [you/he/she] currently have congestive heart failure (inadequate heart beat, fluid build-up in the lungs or legs)?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q131

[Do/Does] [you/FNAME] have cancer?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q132

[Have/Has][you/FNAME] ever been diagnosed with cancer?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q141

Remember, we're interested in conditions diagnosed by a health professional. [Do/Does] [you/FNAME] have intestinal or stomach ulcers?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q142

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q142X

So [you/he/she] had intestinal or stomach ulcers prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q143

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] had intestinal or stomach ulcers, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had intestinal or stomach ulcers
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q144

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q151

[Do/Does] [you/FNAME] suffer from the effects of a stroke?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q152

When [were/was] [you/FNAME] diagnosed with this?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q152X

So [you/he/she] suffered from the effects of a stroke prior to our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q153

During our last interview in [month and year of last response interview], it was reported that [you/FNAME] suffered from the effects of a stroke, but this time it was not. Has the condition disappeared since then?

1. Yes
2. No
3. Never had a stroke
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q154

When did it disappear?

1. |_|_| Month
2. |_|_|_|_| Year
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q161

[Do/Does] [you/FNAME] suffer from urinary incontinence?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q171

[Do/Does] [you/FNAME] have a bowel disorder such as Crohn's Disease or colitis?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q181

Remember, we're interested in conditions diagnosed by a health professional. [Do/Does] [you/FNAME] have Alzheimer's Disease or any other dementia (senility)?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q191

[Do/Does] [you/FNAME] have cataracts?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q201

[Do/Does] [you/FNAME] have glaucoma?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q211

[Do/Does] [you/FNAME] have a thyroid condition?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q221

[Do/Does] [you/FNAME] have any other long-term condition that has been diagnosed by a health professional?

1. Yes
2. No
DK, RF

Chronic Conditions (CC) - Question identifier:CC_Q221S

Specify.

Long Answer, 80 characters.

Health Status (HS)

Health Status (HS) - Question identifier:HS_QINT1

The next set of questions asks about [your/FNAME's] day-to-day health. The questions are not about illnesses like colds that affect people for short periods of time. They are concerned with a person's usual abilities.
You may feel that some of these questions do not apply to [you/FNAME], but it is important that we ask the same questions of everyone.

Health Status (HS) - Question identifier:HS_Q01

[Are/Is] [you/he/she] usually able to see well enough to read ordinary newsprint without glasses or contact lenses?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q02

[Are/Is] [you/he/she] usually able to see well enough to read ordinary newsprint with glasses or contact lenses?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q03

[Are/Is] [you/he/she] able to see at all?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q04

[Are/Is] [you/he/she] able to see well enough to recognize a friend on the other side of the street without glasses or contact lenses?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q05

[Are/Is] [you/he/she] usually able to see well enough to recognize a friend on the other side of the street with glasses or contact lenses?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q06

[Are/Is] [you/FNAME] usually able to hear what is said in a group conversation with at least 3 other people without a hearing aid?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q07

[Are/Is] [you/he/she] usually able to hear what is said in a group conversation with at least 3 other people with a hearing aid?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q07A

[Are/Is] [you/he/she] able to hear at all?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q08

[Are/Is] [you/he/she] usually able to hear what is said in a conversation with one other person in a quiet room without a hearing aid?

1. Yes
2. No
DK
RF

Health Status (HS) - Question identifier:HS_Q09

[Are/Is] [you/he/she] usually able to hear what is said in a conversation with one other person in a quiet room with a hearing aid?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q10

[Are/Is] [you/FNAME] usually able to be understood completely when speaking with strangers in [your/his/her] own language?

1. Yes
2. No
DK
RF

Health Status (HS) - Question identifier:HS_Q11

[Are/Is] [you/he/she] able to be understood partially when speaking with strangers?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q12

[Are/Is] [you/he/she] able to be understood completely when speaking with those who know [you/him/her] well?

1. Yes
2. No
DK
RF

Health Status (HS) - Question identifier:HS_Q13

[Are/Is] [you/he/she] able to be understood partially when speaking with those who know [you/him/her] well?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q14

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

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q15

[Are/Is] [you/he/she] able to walk at all?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q16

[Do/Does] [you/he/she] require mechanical support such as braces, a cane or crutches to be able to walk around the neighbourhood?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q17

[Do/Does] [you/he/she] require the help of another person to be able to walk?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q18

[Do/Does] [you/he/she] require a wheelchair to get around?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q19

How often [do/does] [you/he/she] use a wheelchair?

1. Always
2. Often
3. Sometimes
4. Never
DK, RF

Health Status (HS) - Question identifier:HS_Q20

[Do/Does] [you/he/she] need the help of another person to get around in the wheelchair?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q21

[Are/Is] [you/FNAME] usually able to grasp and handle small objects such as a pencil or scissors?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q22

[Do/Does] [you/he/she] require the help of another person because of limitations in the use of hands or fingers?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q23

[Do/Does] [you/he/she] require the help of another person with:

1. ... some tasks?
2. ... most tasks?
3. ... almost all tasks?
4. ... all tasks?
DK, RF

Health Status (HS) - Question identifier:HS_Q24

[Do/Does] [you/he/she] require special equipment, for example, devices to assist in dressing, because of limitations in the use of hands or fingers?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q25

Would you describe [yourself/FNAME] as being usually:

1. ... happy and interested in life?
2. ... somewhat happy?
3. ... somewhat unhappy?
4. ... unhappy with little interest in life?
5. ... so unhappy that life is not worthwhile?
DK, RF

Health Status (HS) - Question identifier:HS_Q26

How would you describe [your/his/her] usual ability to remember things?

1. Able to remember most things
2. Somewhat forgetful
3. Very forgetful
4. UNABLE TO REMEMBER ANYTHING AT ALL
DK, RF

Health Status (HS) - Question identifier:HS_Q27

How would you describe [your/his/her] usual ability to think and solve day-to-day problems?

1. Able to think clearly and solve problems
2. Having a little difficulty
3. Having some difficulty
4. Having a great deal of difficulty
5. UNABLE TO THINK OR SOLVE PROBLEMS
DK, RF

Health Status (HS) - Question identifier:HS_Q28

[Are/Is] [you/FNAME] usually free of pain or discomfort?

1. Yes
2. No
DK, RF

Health Status (HS) - Question identifier:HS_Q29

How would you describe the usual intensity of [your/his/her] pain or discomfort?

1. Mild
2. Moderate
3. Severe
DK, RF

Health Status (HS) - Question identifier:HS_Q30

How many activities does [your/his/her] pain or discomfort prevent?

1. None
2. A few
3. Some
4. Most
DK, RF

Physical Activities (PA)

Physical Activities (PA) - Question identifier:PA_QINT1

Now I'd like to ask you about some of your physical activities. To begin with, I'll be dealing with physical activities not related to work, that is, leisure time activities.

Physical Activities (PA) - Question identifier:PA_Q1

Have you done any of the following in the past 3 months, that is, from [date three months ago] to yesterday?

1. Walking for exercise
2. Gardening or yard work
3. Swimming
4. Bicycling
5. Popular or social dance
6. Home exercises
7. Ice hockey
8. Ice skating
9. In-line skating or rollerblading
10. Jogging or running
11. Golfing
12. Exercise class or aerobics
13. Downhill skiing or snowboarding
14. Bowling
15. Baseball or softball
16. Tennis
17. Weight-training
18. Fishing
19. Volleyball
20. Basketball
21. Any other
22. No physical activity
DK, RF

Physical Activities (PA) - Question identifier:PA_Q1US

What was this activity?

Long Answer, 80 characters.

Physical Activities (PA) - Question identifier:PA_Q1W

In the past 3 months, did you do any other activity for leisure?

1. Yes
2. No
DK, RF

Physical Activities (PA) - Question identifier:PA_Q1WS

What was this activity?

Long Answer, 80 characters.

Physical Activities (PA) - Question identifier:PA_Q1X

In the past 3 months, did you do any other activity for leisure?

1. Yes
2. No
DK, RF

Physical Activities (PA) - Question identifier:PA_Q1XS

What was this activity?

Long Answer, 80 characters.

Physical Activities (PA) - Question identifier:PA_Q2

In the past 3 months, how many times did you participate in [identified activity]?

Minimum: 1 Maximum: 99 for each activity except the following:
Walking: MAX = 270
Bicycling: MAX = 200
Other activities: MAX = 200

Physical Activities (PA) - Question identifier:PA_Q3

About how much time did you spend on each occasion?

1. 1 to 15 minutes
2. 16 to 30 minutes
3. 31 to 60 minutes
4. More than one hour
DK, RF

Physical Activities (PA) - Question identifier:PA_QINT2

Next, some questions about the amount of time you spent in the past 3 months on physical activity at work or while doing daily chores around the house, but not leisure time activity.

Physical Activities (PA) - Question identifier:PA_Q4A

In a typical week in the past 3 months, how many hours did you usually spend walking to work or to school or while doing errands?

1. None
2. Less than 1 hour
3. From 1 to 5 hours
4. From 6 to 10 hours
5. From 11 to 20 hours
6. More than 20 hours
DK, RF

Physical Activities (PA) - Question identifier:PA_Q4B

In a typical week, how much time did you usually spend bicycling to work or to school or while doing errands?

1. None
2. Less than 1 hour
3. From 1 to 5 hours
4. From 6 to 10 hours
5. From 11 to 20 hours
6. More than 20 hours
DK, RF

Physical Activities (PA) - Question identifier:PA_Q5

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

1. Always
2. Most of the time
3. Rarely
4. Never
DK, RF

Physical Activities (PA) - Question identifier:PA_Q6

Thinking back over the past 3 months, which of the following best describes your usual daily activities or work habits?

1. Usually sit during the day and don't walk around very much
2. Stand or walk quite a lot during the day but don't have to carry or lift things very often
3. Usually lift or carry light loads, or have to climb stairs or hills often
4. Do heavy work or carry very heavy loads
DK, RF

UV Exposure (TU)

UV Exposure (TU) - Question identifier:TU_QINT

A sunburn is any reddening or discomfort of your skin that lasts longer than 12 hours after exposure to the sun or other UV sources, such as tanning beds or sun lamps.

UV Exposure (TU) - Question identifier:TU_Q1

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

1. Yes
2. No
DK, RF

Repetitive Strain (RP)

Repetitive Strain (RP) - Question identifier:RP_QINT

This next section deals with repetitive strain injuries. By this we mean injuries caused by overuse or by repeating the same movement frequently. (For example, carpal tunnel syndrome, tennis elbow or tendinitis.)

Repetitive Strain (RP) - Question identifier:RP_Q1

In the past 12 months, that is, from [date one year ago] to yesterday, did [you/FNAME] have any injuries due to repetitive strain which were serious enough to limit [your/his/her] normal activities?

1. Yes
2. No
DK, RF

Repetitive Strain (RP) - Question identifier:RP_Q3

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

1. Head
2. Neck
3. Shoulder, upper arm
4. Elbow, lower arm
5. Wrist, hand
6. Hip
7. Thigh
8. Knee, lower leg
9. Ankle, foot
10. Upper back or upper spine
11. Lower back or lower spine
12. Chest (excluding back and spine)
13. Abdomen or pelvis (excluding back and spine)
DK, RF

Repetitive Strain (RP) - Question identifier:RP_Q4

What type of activity [were/was] [you/he/she] doing when [you/he/she] got this repetitive strain?

1. Sports or physical exercise (include school activities)
2. Leisure or hobby (include volunteering)
3. Working at a job or business (include travel to or from work)
4. Household chores, other unpaid work or education
5. Sleeping, eating, personal care
6. Other - Specify
DK, RF

Injuries (IJ)

Injuries (IJ) - Question identifier:IJ_QINT

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

Injuries (IJ) - Question identifier:IJ_Q01

(Not counting repetitive strain injuries,) In the past 12 months, that is, from [date one year ago] to yesterday, [were/was] [you/FNAME] injured?

1. Yes
2. No
DK, RF

Injuries (IJ) - Question identifier:IJ_Q02

How many times [were/was] [you/he/she] injured?

Minimum: 1 Maximum: 30 ; warning after 6

Injuries (IJ) - Question identifier:IJ_Q03

(Thinking about the most serious injury,) What type of injury did [you/he/she] have? For example, a broken bone or burn.

1. Multiple injuries
2. Broken or fractured bones
3. Burn, scald, chemical burn
4. Dislocation
5. Sprain or strain
6. Cut, puncture, animal bite (open wound)
7. Scrape, bruise, blister
8. Concussion or other brain injury
9. Poisoning
10. Injury to internal organs
11. Other - Specify
DK, RF

Injuries (IJ) - Question identifier:IJ_Q04

What part of the body was injured?

1. Multiple sites
2. Eyes
3. Head (excluding eyes)
4. Neck
5. Shoulder, upper arm
6. Elbow, lower arm
7. Wrist, hand
8. Hip
9. Thigh
10. Knee, lower leg
11. Ankle, foot
12. Upper back or upper spine
13. Lower back or lower spine
14. Chest (excluding back and spine)
15. Abdomen or pelvis (excluding back and spine)
DK, RF

Injuries (IJ) - Question identifier:IJ_Q05

What part of the body was injured?

1. Chest (within rib cage)
2. Abdomen or pelvis (below ribs)
3. Other - Specify
DK, RF

Injuries (IJ) - Question identifier:IJ_Q06

Where did the injury happen?

1. In a home or its surrounding area
2. Residential institution
3. School, college, university (exclude sports areas)
4. Other institution (e.g., church, hospital, theatre, civic building)
5. Sports or athletics area (include school sports areas)
6. Street, highway, sidewalk
7. Commercial area (e.g., store, restaurant, office building, transport terminal)
8. Industrial or construction area
9. Farm (exclude farmhouse and its surrounding area)
10. Other - Specify
DK, RF

Injuries (IJ) - Question identifier:IJ_Q07

What type of activity [were/was] [you/he/she] doing when [you/he/she] [were/was] injured?

1. Sports or physical exercise (include school activities)
2. Leisure or hobby (include volunteering)
3. Working at a job or business (include travel to or from work)
4. Household chores, other unpaid work or education
5. Sleeping, eating, personal care
6. Other - Specify
DK, RF

Injuries (IJ) - Question identifier:IJ_Q08

Was the injury the result of a fall?

1. Yes
2. No
DK, RF

Injuries (IJ) - Question identifier:IJ_Q09

How did [you/he/she] fall?

1. While skating, skiing, snowboarding, in-line skating or skateboarding
2. Going up or down stairs / steps (icy or not)
3. Slip, trip or stumble on ice or snow
4. Slip, trip or stumble on any other surface
5. From furniture (e.g., bed, chair)
6. From elevated position (e.g., ladder, tree)
7. Other - Specify
DK, RF

Injuries (IJ) - Question identifier:IJ_Q10

What caused the injury?

1. Transportation accident
2. Accidentally bumped, pushed, bitten, etc. by person or animal
3. Accidentally struck or crushed by object(s)
4. Accidental contact with sharp object, tool or machine
5. Smoke, fire, flames
6. Accidental contact with hot object, liquid or gas
7. Extreme weather or natural disaster
8. Overexertion or strenuous movement
9. Physical assault
10. Other - Specify
DK, RF

Injuries (IJ) - Question identifier:IJ_Q11

Did [you/FNAME] receive any medical attention for this injury from a health professional within 48 hours?

1. Yes
2. No
DK, RF

Injuries (IJ) - Question identifier:IJ_Q12

Where did [you/he/she] receive treatment?

1. Doctor's office
2. Hospital emergency room
3. Hospital outpatient clinic (e.g., day surgery, cancer)
4. Walk-in clinic
5. Appointment clinic
6. Community health centre / CLSC
7. At work
8. At school
9. At home
10. Telephone consultation only
11. Other - Specify
DK, RF

Injuries (IJ) - Question identifier:IJ_Q13

[Were/Was] [you/he/she] admitted to a hospital overnight?

1. Yes
2. No
DK, RF

Injuries (IJ) - Question identifier:IJ_Q14

Did [you/FNAME] have any other injuries in the past 12 months that were treated by a health professional, but did not limit [your/his/her] normal activities?

1. Yes
2. No
DK, RF

Injuries (IJ) - Question identifier:IJ_Q15

How many injuries?

Minimum: 1 Maximum: 30 ; warning after 6

Stress (ST)

Stress (ST) - Question identifier:ST_QINT1A

The next part of the questionnaire deals with different kinds of stress. Although the questions may seem repetitive, they are related to various aspects of a person's physical, emotional and mental health.

Stress (ST) - Question identifier:ST_QINT1B

I'll start by describing situations that sometimes come up in people's lives. As there are no right or wrong answers, the idea is to choose the answer best suited to your personal situation. I'd like you to tell me if these statements are true for you at this time by answering `true' if it applies to you now or `false' if it does not.

Stress (ST) - Question identifier:ST_Q101

You are trying to take on too many things at once.

1. True
2. False
DK
RF

Stress (ST) - Question identifier:ST_Q102

There is too much pressure on you to be like other people.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q103

Too much is expected of you by others.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q104

You don't have enough money to buy the things you need.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q105

Your partner doesn't understand you.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q106

Your partner doesn't show enough affection.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q107

Your partner is not committed enough to your relationship.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q108

You find it is very difficult to find someone compatible with you.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q109

Do you have any children?

1. Yes
2. No
DK, RF

Stress (ST) - Question identifier:ST_Q110

Remember I want to know if you feel any of these statements are true for you at this time.
One of your children seems very unhappy.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q111

A child's behaviour is a source of serious concern to you.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q112

Your work around the home is not appreciated.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q113

Your friends are a bad influence.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q114

You would like to move but you cannot.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q115

Your neighbourhood or community is too noisy or too polluted.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q116

You have a parent, a child or a partner who is in very bad health and may die.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q117

Someone in your family has an alcohol or drug problem.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_Q118

People are too critical of you or what you do.

1. True
2. False
DK, RF

Stress (ST) - Question identifier:ST_QINT4A

Now I'm going to read you a series of statements that might describe your job situation.

Stress (ST) - Question identifier:ST_Q400

Do you currently work at a job or business?

1. Yes
2. No
DK, RF

Stress (ST) - Question identifier:ST_QINT4B

Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree. If you have more than one job, just think about the main one.

Stress (ST) - Question identifier:ST_Q401

Your job requires that you learn new things.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK
RF

Stress (ST) - Question identifier:ST_Q402

Your job requires a high level of skill.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q403

Your job allows you freedom to decide how you do your job.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q404

Your job requires that you do things over and over.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q405

Your job is very hectic.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q406

You are free from conflicting demands that others make.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q407

Your job security is good.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q408

Your job requires a lot of physical effort.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q409

You have a lot to say about what happens in your job.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q410

You are exposed to hostility or conflict from the people you work with.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q411

Your supervisor is helpful in getting the job done.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q412

The people you work with are helpful in getting the job done.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q413

How satisfied are you with your job?

1. Very satisfied
2. Somewhat satisfied
3. Not too satisfied
4. Not at all satisfied
DK, RF

Stress (ST) - Question identifier:ST_QINT5

Now I am going to read you a series of statements that people might use to describe themselves. Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.

Stress (ST) - Question identifier:ST_Q501

You feel that you have a number of good qualities.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK
RF

Stress (ST) - Question identifier:ST_Q502

You feel that you're a person of worth at least equal to others.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q503

You are able to do things as well as most other people.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q504

You take a positive attitude toward yourself.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q505

On the whole you are satisfied with yourself.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q506

All in all, you're inclined to feel you're a failure.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_QINT6

Now I am going to read you a series of statements that people might use to describe themselves.
Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.

Stress (ST) - Question identifier:ST_Q601

You have little control over the things that happen to you.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK
RF

Stress (ST) - Question identifier:ST_Q602

There is really no way you can solve some of the problems you have.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q603

There is little you can do to change many of the important things in your life.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q604

You often feel helpless in dealing with problems of life.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q605

Sometimes you feel that you are being pushed around in life.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q606

What happens to you in the future mostly depends on you.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Stress (ST) - Question identifier:ST_Q607

You can do just about anything you really set your mind to.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
DK, RF

Medication Use (DG)

Medication Use (DG) - Question identifier:DG_QINT

Now I'd like to ask a few questions about [your/FNAME's] use of medications, both prescription and over-the-counter, as well as other health products.

Medication Use (DG) - Question identifier:DG_Q1A

In the past month, that is, from [date one month ago] to yesterday, did [you/FNAME] take:

... pain relievers such as Aspirin or Tylenol (including arthritis medicine and anti-inflammatories)?

1. Yes
2. No
DK
RF

Medication Use (DG) - Question identifier:DG_Q1B

... tranquilizers such as Valium or Ativan?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1C

... diet pills such as Ponderal, Dexatrim or Fastin?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1D

... anti-depressants such as Prozac, Paxil or Effexor?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1E

... codeine, Demerol or morphine?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1F

... allergy medicine such as Reactine or Allegra?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1G

In the past month, that is, from [date one month ago] to yesterday, did [you/FNAME] take:

... asthma medications such as inhalers or nebulizers?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1H

... cough or cold remedies?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1I

... penicillin or other antibiotics?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1J

... medicine for the heart?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1K

... medicine for blood pressure?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1L

In the past month, that is, from [date one month ago] to yesterday, did [you/FNAME] take:

... diuretics or water pills?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1M

... steroids?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1N

... insulin?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1O

... pills to control diabetes?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1P

... sleeping pills such as Imovane, Nytol or Starnoc?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1Q

... stomach remedies?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1R

... laxatives?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1S

... birth control pills?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1T

... hormones for menopause or aging symptoms?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1T1

What type of hormones [are/is] [you/she] taking?

1. Estrogen only
2. Progesterone only
3. Both
4. Neither
DK, RF

Medication Use (DG) - Question identifier:DG_Q1T2

When did [you/she] start this hormone therapy?

Minimum: 1870 Maximum: 3000

Medication Use (DG) - Question identifier:DG_Q1U

In the past month, that is, from [date one month ago] to yesterday, did [you/FNAME] take:

... thyroid medication such as Synthroid or Levothyroxine?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q1V

... any other medication?

1. Yes - Specify
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q2

Now, I am referring to the last 2 days, that is, yesterday and the day before yesterday. During those 2 days, how many different medications did [you/he/she] take?

Minimum: 0 Maximum: 99 ; warning after 10

Medication Use (DG) - Question identifier:DG_Q3nn

What is the exact name of the medication that [you/FNAME] took?

Long Answer, 80 characters.

Medication Use (DG) - Question identifier:DG_Q3nnA

Was this a prescription from a medical doctor or dentist?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q4

There are many other health products such as ointments, vitamins, herbs, minerals or protein drinks which people use to prevent illness or to improve or maintain their health.
[Do/Does] [you/FNAME] use any of these or other health products?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q4A

In the past 2 days, that is, yesterday and the day before yesterday, did [you/he/she] use any of these health products?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q501

Thinking of the past 2 days, what is the exact name of a health product that [you/he/she] used?

Long Answer, 80 characters.

Medication Use (DG) - Question identifier:DG_Q5nnA

Did [you/he/she] use another health product?

1. Yes
2. No
DK, RF

Medication Use (DG) - Question identifier:DG_Q5nn

What is the exact name of this product?

Long Answer, 80 characters.

Smoking (SM)

Smoking (SM) - Question identifier:SM_Q101

The next questions are about smoking.
Does anyone in this household smoke regularly inside the house?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q102

At the present time [do/does] [you/FNAME] smoke cigarettes daily, occasionally or not at all?

1. Daily
2. Occasionally
3. Not at all
DK, RF

Smoking (SM) - Question identifier:SM_Q103

At what age did [you/he/she] begin to smoke cigarettes daily?

Minimum: 5 Maximum: xxx

Smoking (SM) - Question identifier:SM_Q104

How many cigarettes [do/does] [you/he/she] smoke each day now?

Minimum: 1 Maximum: 99 ; warning after 60

Smoking (SM) - Question identifier:SM_Q104A

[Have/Has] [you/he/she] ever smoked cigarettes at all?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q104B

(Remember, for this survey it's important to measure change.)
During our last interview in [month and year of last response interview], we recorded that you had previously smoked but this time we did not. In fact, have you ever smoked cigarettes?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q105B

On the days that [you/FNAME] [do/does] smoke, about how many cigarettes [do/does] [you/he/she] usually have?

Minimum: 1 Maximum: 99 ; warning after 20

Smoking (SM) - Question identifier:SM_Q105C

In the past month, on how many days [have/has] [you/he/she] smoked 1 or more cigarettes?

Minimum: 0 Maximum: 30

Smoking (SM) - Question identifier:SM_Q105A

In [your/his/her] lifetime, [have/has] [you/FNAME] smoked a total of 100 or more cigarettes (about 4 packs)?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q105D

[Have/Has] [you/he/she] ever smoked cigarettes daily?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q106

At what age did [you/he/she] begin to smoke (cigarettes) daily?

Minimum: 5 Maximum: xxx

Smoking (SM) - Question identifier:SM_Q107

How many cigarettes did [you/he/she] usually smoke each day?

Minimum: 1 Maximum: 99 ; warning after 60

Smoking (SM) - Question identifier:SM_Q108

At what age did [you/he/she] stop smoking (cigarettes) daily?

Minimum: 5 Maximum: xxx

Smoking (SM) - Question identifier:SM_Q108B

What brand of cigarettes [do/does] [you/he/she] usually smoke?

Smoking (SM) - Question identifier:SM_Q108S

Specify.

Long Answer, 80 characters.

Smoking (SM) - Question identifier:SM_Q109

Compared to our interview in [month and year of last response interview], you are reporting that you no longer smoke. Why did you quit?

1. Never smoked
2. Didn't smoke at last interview
3. Affected physical health
4. Cost
5. Social / family pressures
6. Athletic activities
7. Pregnancy
8. Smoking restrictions
9. Doctor's advice
10. Effect of second-hand smoke on others
11. Other - Specify
DK, RF

Smoking (SM) - Question identifier:SM_Q110

Compared to our interview in [month and year of last response interview], you are reporting that you currently smoke. Why did you start smoking?

1. Smoked at last interview
2. Family / friends smoke
3. Everyone around me smokes
4. To be "cool"
5. Curiosity
6. Stress
7. Started again after trying to quit
8. Cost
9. To control weight
10. Other - Specify
DK, RF

Smoking (SM) - Question identifier:SM_Q111

Compared to our interview in [month and year of last response interview], you are reporting that you smoke less. Why did you cut down?

1. Didn't cut down
2. Didn't smoke at last interview
3. Trying to quit
4. Affected physical health
5. Cost
6. Social / family pressures
7. Athletic activities
8. Pregnancy
9. Smoking restrictions
10. Doctor's advice
11. Effect of second-hand smoke on others
12. Other - Specify
DK, RF

Smoking (SM) - Question identifier:SM_Q112

Compared to our interview in [month and year of last response interview], you are reporting that you smoke more. Why have you increased smoking?

1. Haven't increased
2. Family / friends smoke
3. Everyone around me smokes
4. To be "cool"
5. Curiosity
6. Stress
7. Increased after trying to quit / reduce
8. Cost
9. To control weight
10. Other - Specify
DK, RF

Smoking (SM) - Question identifier:SM_Q113

[Have/Has] [you/he/she] ever smoked a whole cigarette?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q114

At what age did [you/he/she] smoke [your/his/her] first whole cigarette?

Minimum: 5 Maximum: xxx

Smoking (SM) - Question identifier:SM_Q201

How soon after you wake up do you smoke your first cigarette?

1. Within 5 minutes
2. 6 to 30 minutes after waking
3. 31 to 60 minutes after waking
4. More than 60 minutes after waking
DK, RF

Smoking (SM) - Question identifier:SM_Q201A

Do you find it difficult to refrain from smoking in places where it is forbidden?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q201B

Which cigarette would you most hate to give up?

1. The first one of the day
2. Another one
DK, RF

Smoking (SM) - Question identifier:SM_Q201C

Do you smoke more frequently during the first hours after waking, compared with the rest of the day?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q201D

Do you smoke even if you are so ill that you are in bed most of the day?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q202

Have you tried quitting in the past 6 months?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q203

How many times have you tried quitting (in the past 6 months)?

Minimum: 1 Maximum: 25

Smoking (SM) - Question identifier:SM_Q204

Are you seriously considering quitting within the next 30 days?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q205

Are you seriously considering quitting within the next 6 months?

1. Yes
2. No
DK, RF

Smoking (SM) - Question identifier:SM_Q206

At your place of work what are the restrictions on smoking?

1. Restricted completely
2. Allowed in designated areas
3. Restricted only in certain places
4. Not restricted at all
DK, RF

Alcohol (AL)

Alcohol (AL) - Question identifier:AL_QINT

Now, some questions about [your/FNAME's] alcohol consumption.
When we use the word drink it means:
- one bottle or can of beer or a glass of draft
- one glass of wine or a wine cooler
- one drink or cocktail with 1 and a 1/2 ounces of liquor.

Alcohol (AL) - Question identifier:AL_Q1A

Since our interview in [month and year of last response interview], [have/has] [you/FNAME] had a drink of beer, wine, liquor or any other alcoholic beverage?

1. Yes
2. No
DK, RF

Alcohol (AL) - Question identifier:AL_Q1B

During the past 12 months, that is, from [date one year ago] to yesterday, [have/has] [you/FNAME] had a drink of beer, wine, liquor or any other alcoholic beverage?

1. Yes
2. No
DK, RF

Alcohol (AL) - Question identifier:AL_Q2

During the past 12 months, how often did [you/he/she] 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
DK, RF

Alcohol (AL) - Question identifier:AL_Q3

How often in the past 12 months [have/has] [you/he/she] had 5 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
DK, RF

Alcohol (AL) - Question identifier:AL_Q5

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

1. Yes
2. No
DK, RF

Alcohol (AL) - Question identifier:AL_Q5A

Starting with yesterday, that is [day name], how many drinks did [you/FNAME] have:

1. ... on Sunday?
2. ... on Monday?
3. ... on Tuesday?
4. ... on Wednesday?
5. ... on Thursday?
6. ... on Friday?
7. ... on Saturday?

Alcohol (AL) - Question identifier:AL_Q5B

[Have/Has] [you/FNAME] ever had a drink?

1. Yes
2. No
DK, RF

Alcohol (AL) - Question identifier:AL_Q6

Did [you/he/she] ever regularly drink more than 12 drinks a week?

1. Yes
2. No
DK, RF

Alcohol (AL) - Question identifier:AL_Q7

Why did [you/he/she] reduce or quit drinking altogether?

1. Dieting
2. Athletic training
3. Pregnancy
4. Getting older
5. Drinking too much / drinking problem
6. Affected - work, studies, employment opportunities
7. Interfered with family or home life
8. Affected - physical health
9. Affected - friendships or social relationships
10. Affected - financial position
11. Affected - outlook on life, happiness
12. Influence of family or friends
13. Other - Specify
DK, RF

Mental Health (MH)

Mental Health (MH) - Question identifier:MH_QINT

Now some questions about mental and emotional well-being.

Mental Health (MH) - Question identifier:MH_Q01A

During the past month, that is, from [date one month ago] to yesterday, about how
often did you feel

... so sad that nothing could cheer you up?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
DK, RF

Mental Health (MH) - Question identifier:MH_Q01B

... nervous?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
DK, RF

Mental Health (MH) - Question identifier:MH_Q01C

... restless or fidgety?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
DK, RF

Mental Health (MH) - Question identifier:MH_Q01D

... hopeless?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
DK, RF

Mental Health (MH) - Question identifier:MH_Q01E

... worthless?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
DK, RF

Mental Health (MH) - Question identifier:MH_Q01F

... that everything was an effort?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
DK, RF

Mental Health (MH) - Question identifier:MH_Q01G

We have just been talking about feelings and experiences that occurred to different degrees during the past month.
Taking them altogether, did these feelings occur more often in the past month than is usual for you, less often than usual or about the same as usual?

1. More often
2. Less often
3. About the same
4. Never have had any
DK, RF

Mental Health (MH) - Question identifier:MH_Q01H

Is that a lot more, somewhat more or only a little more often than usual?

1. A lot
2. Somewhat
3. A little
DK, RF

Mental Health (MH) - Question identifier:MH_Q01I

Is that a lot less, somewhat less or only a little less often than usual?

1. A lot
2. Somewhat
3. A little
DK, RF

Mental Health (MH) - Question identifier:MH_Q01J

How much do these experiences usually interfere with your life or activities?

1. A lot
2. Some
3. A little
4. Not at all
DK, RF

Mental Health (MH) - Question identifier:MH_Q01K

In the past 12 months, that is, from [date one year ago] to yesterday, have you seen or talked on the telephone with a health professional about your emotional or mental health?

1. Yes
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q01L

How many times (in the past 12 months)?

Minimum: 1 Maximum: 366 ; warning after 25

Mental Health (MH) - Question identifier:MH_Q01M

Whom did you see or talk to?

1. Family doctor or general practitioner
2. Psychiatrist
3. Psychologist
4. Nurse
5. Social worker or counsellor
6. Other - Specify
DK, RF

Mental Health (MH) - Question identifier:MH_Q02

During the past 12 months, was there ever a time when you felt sad, blue, or depressed for 2 weeks or more in a row?

1. Yes
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q03

For the next few questions, please think of the 2-week period during the past 12 months when these feelings were the worst.
During that time, how long did these feelings usually last?

1. All day long
2. Most of the day
3. About half of the day
4. Less than half of a day
DK, RF

Mental Health (MH) - Question identifier:MH_Q04

How often did you feel this way during those 2 weeks?

1. Every day
2. Almost every day
3. Less often
DK, RF

Mental Health (MH) - Question identifier:MH_Q05

During those 2 weeks did you lose interest in most things?

1. Yes (KEY PHRASE = Losing interest)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q06

Did you feel tired out or low on energy all of the time?

1. Yes (KEY PHRASE = Feeling tired)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q07

Did you gain weight, lose weight or stay about the same?

1. Gained weight (KEY PHRASE = Gaining weight)
2. Lost weight (KEY PHRASE = Losing weight)
3. Stayed about the same
4. Was on a diet
DK, RF

Mental Health (MH) - Question identifier:MH_Q08A

About how much did you [gain/lose]?

Minimum: 1 Maximum: 99 ; warning after 20 pounds / 9 kilograms

Mental Health (MH) - Question identifier:MH_Q08B

Was that in pounds or in kilograms?

1. Pounds
2. Kilograms

Mental Health (MH) - Question identifier:MH_Q09

Did you have more trouble falling asleep than you usually do?

1. Yes (KEY PHRASE = Trouble falling asleep)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q10

How often did that happen?

1. Every night
2. Nearly every night
3. Less often
DK, RF

Mental Health (MH) - Question identifier:MH_Q11

Did you have a lot more trouble concentrating than usual?

1. Yes (KEY PHRASE = Trouble concentrating)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q12

At these times, people sometimes feel down on themselves, no good or worthless.
Did you feel this way?

1. Yes (KEY PHRASE = Feeling down on yourself)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q13

Did you think a lot about death - either your own, someone else's or death in general?

1. Yes (KEY PHRASE = Thoughts about death)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q14C

Reviewing what you just told me, you had 2 weeks in a row during the past 12 months when you were sad, blue or depressed and also had some other things like (KEY PHRASES).

Mental Health (MH) - Question identifier:MH_Q14

About how many weeks did you feel this way during the past 12 months?

Minimum: 2 Maximum: 53

Mental Health (MH) - Question identifier:MH_Q15

Think about the last time you felt this way for 2 weeks or more in a row. In what month was that?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
DK, RF

Mental Health (MH) - Question identifier:MH_Q16

During the past 12 months, was there ever a time lasting 2 weeks or more when you lost interest in most things like hobbies, work or activities that usually give you pleasure?

1. Yes
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q17

For the next few questions, please think of the 2-week period during the past 12 months when you had the most complete loss of interest in things.
During that 2-week period, how long did the loss of interest usually last?

1. All day long
2. Most of the day
3. About half of the day
4. Less than half of a day
DK, RF

Mental Health (MH) - Question identifier:MH_Q18

How often did you feel this way during those 2 weeks?

1. Every day
2. Almost every day
3. Less often
DK, RF

Mental Health (MH) - Question identifier:MH_Q19

During those 2 weeks, did you feel tired out or low on energy all the time?

1. Yes (KEY PHRASE = Feeling tired)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q20

Did you gain weight, lose weight or stay about the same?

1. Gained weight (KEY PHRASE = Gaining weight)
2. Lost weight (KEY PHRASE = Losing weight)
3. Stayed about the same
4. Was on a diet
DK, RF

Mental Health (MH) - Question identifier:MH_Q21A

About how much did you [gain/lose]?

Minimum: 1 Maximum: 99 ; warning after 20 pounds / 9 kilograms

Mental Health (MH) - Question identifier:MH_Q21B

Was that in pounds or in kilograms?

1. Pounds
2. Kilograms

Mental Health (MH) - Question identifier:MH_Q22

Did you have more trouble falling asleep than you usually do?

1. Yes (KEY PHRASE = Trouble falling asleep)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q23

How often did that happen?

1. Every night
2. Nearly every night
3. Less often
DK, RF

Mental Health (MH) - Question identifier:MH_Q24

Did you have a lot more trouble concentrating than usual?

1. Yes (KEY PHRASE = Trouble concentrating)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q25

At these times, people sometimes feel down on themselves, no good, or worthless.
Did you feel this way?

1. Yes (KEY PHRASE = Feeling down on yourself)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q26

Did you think a lot about death - either your own, someone else's or death in general?

1. Yes (KEY PHRASE = Thoughts about death)
2. No
DK, RF

Mental Health (MH) - Question identifier:MH_Q27C

Reviewing what you just told me, you had 2 weeks in a row during the past 12 months when you lost interest in most things and also had some other things like (KEY PHRASES).

Mental Health (MH) - Question identifier:MH_Q27

About how many weeks did you feel this way during the past 12 months?

Minimum: 2 Maximum: 53

Mental Health (MH) - Question identifier:MH_Q28

Think about the last time you had 2 weeks in a row when you felt this way. In what month was that?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
DK, RF

Social Support (Medical Outcomes Study questions) (SS)

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q01

Next are some questions about the social support that is available to you.
About how many close friends and close relatives do you have, that is, people you feel at ease with and can talk to about what is on your mind?

Minimum: 0 Maximum: 99 ; warning after 20

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_QINT2

People sometimes look to others for companionship, assistance, or other types of support.

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q02

How often is each of the following kinds of support available to you if you need it:

... someone to help you if you were confined to bed?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q03

... someone you can count on to listen to you when you need to talk?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q04

... someone to give you advice about a crisis?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q05

... someone to take you to the doctor if you needed it?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q06

... someone who shows you love and affection?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q07

How often is each of the following kinds of support available to you if you need it:

... someone to have a good time with?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q08

... someone to give you information in order to help you understand a situation?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q09

... someone to confide in or talk to about yourself or your problems?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q10

... someone who hugs you?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q11

... someone to get together with for relaxation?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q12

... someone to prepare your meals if you were unable to do it yourself?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q13

... someone whose advice you really want?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q14

How often is each of the following kinds of support available to you if you need it:

... someone to do things with to help you get your mind off things?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q15

... someone to help with daily chores if you were sick?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q16

... someone to share your most private worries and fears with?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q17

... someone to turn to for suggestions about how to deal with a personal problem?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q18

... someone to do something enjoyable with?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q19

... someone who understands your problems?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Social Support (Medical Outcomes Study questions) (SS) - Question identifier:SS_Q20

... someone to love you and make you feel wanted?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
DK, RF

Language (SD)

Language (SD) - Question identifier:SD_QINT

Now some general background questions.

Language (SD) - Question identifier:SD_Q5

In what languages can [you/he/she] conduct a conversation?

1. English
2. French
3. Arabic
4. Chinese
5. Cree
6. German
7. Greek
8. Hungarian
9. Italian
10. Korean
11. Persian (Farsi)
12. Polish
13. Portuguese
14. Punjabi
15. Spanish
16. Tagalog (Filipino)
17. Ukrainian
18. Vietnamese
19. Other - Specify
DK, RF

Language (SD) - Question identifier:SD_Q6

What is the language that [you/FNAME] first learned at home in childhood and can still understand?

1. English
2. French
3. Arabic
4. Chinese
5. Cree
6. German
7. Greek
8. Hungarian
9. Italian
10. Korean
11. Persian (Farsi)
12. Polish
13. Portuguese
14. Punjabi
15. Spanish
16. Tagalog (Filipino)
17. Ukrainian
18. Vietnamese
19. Other - Specify
DK, RF

Education (ED)

Education (ED) - Question identifier:ED_Q1

[Are/Is] [you/FNAME] currently attending a school, college or university?

1. Yes
2. No
DK, RF

Education (ED) - Question identifier:ED_Q2

[Are/Is] [you/he/she] enrolled as a full-time student or a part-time student?

1. Full-time
2. Part-time
DK, RF

Education (ED) - Question identifier:ED_Q3

[Have/Has] [you/FNAME] attended a school, college or university since our last interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Education (ED) - Question identifier:ED_Q4

Excluding kindergarten, how many years of elementary and high school [have/has] [you/FNAME] successfully completed?

1. No schooling
2. 1 to 5 years
3. 6 years
4. 7 years
5. 8 years
6. 9 years
7. 10 years
8. 11 years
9. 12 years
10. 13 years
DK, RF

Education (ED) - Question identifier:ED_Q5

[Have/Has] [you/FNAME] graduated from high school?

1. Yes
2. No
DK, RF

Education (ED) - Question identifier:ED_Q6

[Have/Has] [you/FNAME] ever attended any other kind of school such as a university, community college, business school, trade or vocational school, CEGEP or other post-secondary institution?

1. Yes
2. No
DK, RF

Education (ED) - Question identifier:ED_Q7

What is the highest level of education that [you/FNAME] [have/has] ever attained?

1. Some - trade, technical or vocational school, or business college
2. Some - community college, CEGEP or nursing school
3. Some - university
4. Diploma or certificate from - trade, technical or vocational school, or business college
5. Diploma or certificate from - community college, CEGEP or nursing school
6. Bachelor's or undergraduate degree, or teacher's college (e.g., B.A., B.Sc., LL.B.)
7. Master's degree (e.g., M.A., M.Sc., M.Ed.)
8. Degree in Medicine, Dentistry, Veterinary Medicine or Optometry (M.D., D.D.S., D.M.D., D.V.M., O.D.)
9. Earned doctorate (e.g., Ph.D., D.Sc., D.Ed.)
10. Other - Specify
DK, RF

Education (ED) - Question identifier:ED_Q8

Thinking about the level of education of all the members of your household. What is the highest level of education that has ever been attained by a member of your
household?

1. Some elementary or high school
2. High school diploma
3. Some post-secondary education
4. Post-secondary degree, certificate or diploma
DK, RF

Labour Force (LF)

Labour Force (LF) - Question identifier:LF_QINT1

The next few questions concern [your/FNAME's] activities in the last 7 days. By the last 7 days, I mean beginning [date one week ago], and ending [date yesterday].

Labour Force (LF) - Question identifier:LF_Q01

Last week, did [you/FNAME] work at a job or business? Please include part- time jobs, seasonal work, contract work, self-employment, baby-sitting and any other paid work, regardless of the number of hours worked.

1. Yes
2. No
3. Permanently unable to work
DK, RF

Labour Force (LF) - Question identifier:LF_Q02

Last week, did [you/FNAME] have a job or business from which [you/he/she] [were/was] absent?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q03

Did [you/he/she] have more than one job or business last week?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q11

In the past 4 weeks, did [you/FNAME] do anything to find work?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q12

Last week, did [you/he/she] have a job to start at a definite date in the future?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q13

What is the main reason that [you/FNAME] [are/is] not currently working at a job or business?

1. Own illness or disability
2. Caring for - own children
3. Caring for - elder relatives
4. Pregnancy (females only)
5. Other personal or family responsibilities
6. Vacation
7. School or educational leave
8. Retired
9. Believes no work available (in area or suited to skills)
10. Other - Specify
DK, RF

Labour Force (LF) - Question identifier:LF_QINT2

Now some questions about jobs or employment which [you/FNAME] [have/has] had during the past 12 months, that is, from [date one year ago] to yesterday.

Labour Force (LF) - Question identifier:LF_Q21

Did [you/he/she] work at a job or business at any time in the past 12 months? Please include part-time jobs, seasonal work, contract work, self-employment, baby-sitting and any other paid work, regardless of the number of hours worked.

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q22

During the past 12 months, did [you/he/she] do anything to find work?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q23

During that 12 months, did [you/he/she] work at more than one job or business at the same time?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_QINT3

The next questions are about [your/FNAME's] [current/most recent] job or business.

Labour Force (LF) - Question identifier:LF_Q31

[Are/Is/Were/Was] [you/he/she] an employee or self-employed?

1. Employee
2. Self-employed
3. Working in a family business without pay
DK, RF

Labour Force (LF) - Question identifier:LF_Q32

What [is/was] the name of [your/his/her] business?

Long Answer, 50 characters.

Labour Force (LF) - Question identifier:LF_Q33

For whom [do/does/did] [you/he/she] [currently/last] work? (For example: name of business, government department or agency, or person)

Long Answer, 50 characters.

Labour Force (LF) - Question identifier:LF_Q34

What kind of business, industry or service [is/was] this? (For example: cardboard box manufacturing, road maintenance, retail shoe store, secondary school, dairy farm, municipal government)

Long Answer, 50 characters.

Labour Force (LF) - Question identifier:LF_Q35

What kind of work [are/is/were/was] [you/he/she] doing? (For example: babysitting in own home, factory worker, forestry technician)

Long Answer, 50 characters.

Labour Force (LF) - Question identifier:LF_Q36

What [are/were] [your/his/her] most important activities or duties? (For example: caring for children, stamp press machine operator, forest examiner)

Long Answer, 50 characters.

Labour Force (LF) - Question identifier:LF_Q41

What was the main reason [you/FNAME] [were/was] absent from work last week?

1. Own illness or disability
2. Caring for - own children
3. Caring for - elder relatives
4. Maternity leave (females only)
5. Other personal or family responsibilities
6. Vacation
7. Labour dispute (strike or lockout)
8. Temporary layoff due to business conditions
(employees only)
9. Seasonal layoff (employees only)
10. Casual job, no work available (employees only)
11. Work schedule (for example, shift work)
(employees only)
12. Self-employed, no work available
(self-employed only)
13. Seasonal business (excluding employees)
14. School or educational leave
15. Other - Specify

Labour Force (LF) - Question identifier:LF_Q42

About how many hours a week [do/does/did] [you/FNAME] usually work at [your/his/her] [job/business]? If [you/he/she] usually [work/works/worked] extra hours, paid or unpaid, please include these hours.

Minimum: 1 Maximum: 168 ; warning after 84

Labour Force (LF) - Question identifier:LF_Q43

Given the choice, at this job would [you/he/she] prefer to work:

1. ... fewer hours for less pay?
2. ... more hours for more pay?
3. ... the same hours for the same pay?
DK, RF

Labour Force (LF) - Question identifier:LF_Q44

Which of the following best describes the hours [you/he/she] usually [work/works/worked] at [your/his/her] [job/business]?

1. Regular - daytime schedule or shift
2. Regular - evening shift
3. Regular - night shift
4. Rotating shift (change from days to evenings to nights)
5. Split shift
6. On call
7. Irregular schedule
8. Other - Specify
DK, RF

Labour Force (LF) - Question identifier:LF_Q45

What is the main reason that [you/he/she] [work/works/worked] this schedule?

1. Requirement of job / no choice
2. Going to school
3. Caring for - own children
4. Caring for - other relatives
5. To earn more money
6. Likes to work this schedule
7. Other - Specify

Labour Force (LF) - Question identifier:LF_Q46

[Do/Does/Did] [you/he/she] usually work on weekends at this [job/business]?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q51

You indicated that [you/FNAME] [have/has/had] more than one job. For how many weeks in a row [have/has/did] [you/he/she] [work/worked] at more than one job [(]in the past 12 months[)]?

Minimum: 1 Maximum: 52

Labour Force (LF) - Question identifier:LF_Q52

What is the main reason that [you/he/she] [work/works/worked] at more than one job?

1. To meet regular household expenses
2. To pay off debts
3. To buy something special
4. To save for the future
5. To gain experience
6. To build up a business
7. Enjoys the work of the second job
8. Other - Specify

Labour Force (LF) - Question identifier:LF_Q53

About how many hours a week [do/does/did] [you/he/she] usually work at [your/his/her] other job(s)? If [you/he/she] usually [work/works/worked] extra hours, paid or unpaid, please include these hours.

Minimum: 1 Maximum: 168 - LF_Q42 ; warning after 30

Labour Force (LF) - Question identifier:LF_Q54

[Do/Does/Did] [you/he/she] usually work on weekends at [your/his/her] other job(s)?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q61

During the past 52 weeks, how many weeks did [you/FNAME] do any work at a job or a business? (Include paid vacation leave, paid maternity leave, and paid sick leave.)

Minimum: 1 Maximum: 52

Labour Force (LF) - Question identifier:LF_Q71

During the past 52 weeks, how many weeks [were/was] [you/he/she] looking for work?

That leaves [52 _ LF_Q61] week[s]. During [those/that] [52 _ LF_Q61] week[s], how many weeks [were/was] [you/he/she] looking for work?

Minimum: 0 Maximum: 52 - LF_Q61

Labour Force (LF) - Question identifier:LF_Q72

That leaves [WEEKS] week[s] during which [you/he/she] [were/was] neither working nor looking for work. Is that correct?

1. Yes
2. No
DK, RF

Labour Force (LF) - Question identifier:LF_Q73

What is the main reason that [you/he/she] [were/was] not looking for work?

1. Own illness or disability
2. Caring for - own children
3. Caring for - elder relatives
4. Pregnancy (Females only)
5. Other personal or family responsibilities
6. Vacation
7. Labour dispute (strike or lockout)
8. Temporary layoff due to business conditions
9. Seasonal layoff
10. Casual job, no work available
11. Work schedule (e.g., shift work)
12. School or educational leave
13. Retired
14. Believes no work available (in area or suited to skills)
15. Other - Specify
DK, RF

Labour Force (LF) - Question identifier:LF_Q74

Were those [LF_Q71] weeks when [you/he/she] [were/was] without work but looking for work:

1. ... all in one period?
2. ... in 2 separate periods?
3. ... in 3 or more periods?
DK, RF

Income (IN)

Income (IN) - Question identifier:IN_Q1

Thinking about the total income for all household members, from which of the following sources did your household receive any income in the past 12 months?

1. Wages and salaries
2. Income from self-employment
3. Dividends and interest (e.g., on bonds, savings)
4. Employment insurance
5. Worker's compensation
6. Benefits from Canada or Quebec Pension Plan
7. Retirement pensions, superannuation and annuities
8. Old Age Security and Guaranteed Income Supplement
9. Child Tax Benefit
10. Provincial or municipal social assistance or welfare
11. Child support
12. Alimony
13. Other (e.g., rental income, scholarships)
14. None
DK, RF

Income (IN) - Question identifier:IN_Q2

What was the main source of income?

1. Wages and salaries
2. Income from self-employment
3. Dividends and interest (e.g., on bonds, savings)
4. Employment insurance
5. Worker's compensation
6. Benefits from Canada or Quebec Pension Plan
7. Retirement pensions, superannuation and annuities
8. Old Age Security and Guaranteed Income Supplement
9. Child Tax Benefit
10. Provincial or municipal social assistance or welfare
11. Child support
12. Alimony
13. Other (e.g., rental income, scholarships)
14. None (category created during processing)
DK, RF

Income (IN) - Question identifier:IN_Q3

What is your best estimate of the total income, before taxes and deductions, of all household members from all sources in the past 12 months?

Minimum: 0 Maximum: 500000 ; warning after 150,000

Income (IN) - Question identifier:IN_Q3A

Can you estimate in which of the following groups your household income falls? Was the total household income less than $20,000 or $20,000 or more?

1. Less than $20,000
2. $20,000 or more
3. No income
DK, RF

Income (IN) - Question identifier:IN_Q3B

Was the total household income from all sources less than $10,000 or $10,000 or more?

1. Less than $10,000
2. $10,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q3C

Was the total household income from all sources less than $5,000 or $5,000 or more?

1. Less than $5,000
2. $5,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q3D

Was the total household income from all sources less than $15,000 or $15,000 or more?

1. Less than $15,000
2. $15,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q3E

Was the total household income from all sources less than $40,000 or $40,000 or more?

1. Less than $40,000
2. $40,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q3F

Was the total household income from all sources less than $30,000 or $30,000 or more?

1. Less than $30,000
2. $30,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q3G

Was the total household income from all sources:

1. ... less than $50,000?
2. ... $50,000 to less than $60,000?
3. ... $60,000 to less than $80,000?
4. ... $80,000 to less than $100,000?
5. ... $100,000 or more?
DK, RF

Income (IN) - Question identifier:IN_Q4

What is your best estimate of [your/FNAME's] total personal income, before taxes and deductions, from all sources in the past 12 months?

Minimum: 0 Maximum: 500000 ; warning after 150 000

Income (IN) - Question identifier:IN_Q4A

Can you estimate in which of the following groups [your/FNAME's] personal income falls? Was [your/his/her] total personal income less than $20,000 or $20,000 or more?

1. Less than $20,000
2. $20,000 or more
3. No income
DK, RF

Income (IN) - Question identifier:IN_Q4B

Was [your/his/her] total personal income less than $10,000 or $10,000 or more?

1. Less than $10,000
2. $10,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q4C

Was [your/his/her] total personal income less than $5,000 or $5,000 or more?

1. Less than $5,000
2. $5,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q4D

Was [your/his/her] total personal income less than $15,000 or $15,000 or more?

1. Less than $15,000
2. $15,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q4E

Was [your/his/her] total personal income less than $40,000 or $40,000 or more?

1. Less than $40,000
2. $40,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q4F

Was [your/his/her] total personal income less than $30,000 or $30,000 or more?

1. Less than $30,000
2. $30,000 or more
DK, RF

Income (IN) - Question identifier:IN_Q4G

Was [your/his/her] total personal income:

1. ... less than $50,000?
2. ... $50,000 to less than $60,000?
3. ... $60,000 to less than $80,000?
4. ... $80,000 to less than $100,000?
5. ... $100,000 or more?
DK, RF

Food Insecurity (FI)

Food Insecurity (FI) - Question identifier:FI_Q1

In the past 12 months, did [you/FNAME] or anyone else in [your/his/her] household:

... worry that there would not be enough to eat because of a lack of money?

1. Yes
2. No
DK, RF

Food Insecurity (FI) - Question identifier:FI_Q2

(In the past 12 months, did [you/FNAME] or anyone else in [your/his/her] household:)

... not have enough food to eat because of a lack of money?

1. Yes
2. No
DK, RF

Food Insecurity (FI) - Question identifier:FI_Q3

(In the past 12 months, did [you/FNAME] or anyone else in [your/his/her] household:)

... not eat the quality or variety of foods that you wanted to eat because of a lack of money?

1. Yes
2. No
DK, RF

Provincial Health Number and Administration (AM)

Provincial Health Number and Administration (AM) - Question identifier:AM_Q01A

Statistics Canada and your provincial ministry of health would like your permission to link information collected during all interviews conducted as part of this survey. This includes linking your survey information to your past and continuing use of health services such as visits to hospitals, clinics and doctor's offices.

Provincial Health Number and Administration (AM) - Question identifier:AM_Q01B

This linked information will be kept confidential and used only for statistical purposes.
Do we have your permission?

1. Yes
2. No
DK, RF

Provincial Health Number and Administration (AM) - Question identifier:AM_Q02

Has [your/FNAME's] health number changed since our interview in [month and year of last response interview]?

1. Yes
2. No
DK, RF

Provincial Health Number and Administration (AM) - Question identifier:AM_Q03A

(Having a provincial health number will assist us in linking to this other information.)
[Do/Does] [you/he/she] have a health number for [province]?

1. Yes
2. No
DK, RF

Provincial Health Number and Administration (AM) - Question identifier:AM_Q03B

For which province is [your/his/her] 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. Do not have a provincial health number
DK, RF

Provincial Health Number and Administration (AM) - Question identifier:AM_HN

What is your provincial health number?

Provincial Health Number and Administration (AM) - Question identifier:AM_Q04A

Statistics Canada would like your permission to share the information from all interviews conducted as part of this survey with provincial ministries of health, Health Canada and the Public Health Agency of Canada.

Provincial Health Number and Administration (AM) - Question identifier:AM_Q04B

All information will be kept confidential and used only for statistical purposes.
Do you agree to share the information provided?

1. Yes
2. No
DK, RF

Provincial Health Number and Administration (AM) - Question identifier:AM_N05

Is this a fictitious name for the respondent?

1. Yes
2. No
DK

Provincial Health Number and Administration (AM) - Question identifier:AM_N06

Remind respondent about the importance of getting correct names for longitudinal studies.
Do you want to make corrections to:

1. ... first name only?
2. ... last name only?
3. ... both names?
4. ... no corrections?
DK, RF

Provincial Health Number and Administration (AM) - Question identifier:AM_N07

Enter the first name only.

Long Answer, 25 characters.

Provincial Health Number and Administration (AM) - Question identifier:AM_N08

Enter the last name only.

Long Answer, 25 characters.

Provincial Health Number and Administration (AM) - Question identifier:AM_N09

Was this interview conducted on the telephone or in person?

1. On telephone
2. In person
3. Both

Provincial Health Number and Administration (AM) - Question identifier:AM_N12

Record language of interview.

1. English
2. French
3. Arabic
4. Chinese
5. Cree
6. German
7. Greek
8. Hungarian
9. Italian
10. Korean
11. Persian (Farsi)
12. Polish
13. Portuguese
14. Punjabi
15. Spanish
16. Tagalog (Filipino)
17. Ukrainian
18. Vietnamese
19. Other - Specify
DK, RF

Report a problem on this page

Is something not working? Is there information outdated? Can't find what you're looking for?

Please contact us and let us know how we can help you.

Privacy notice

Date modified: