[p. 63]
HYPERTENSION PAGE (SAMPLE PERSONS ONLY)
HP1
2 [] Eligible resp. avail. (1)
3 [] Return call required (Next Hypertension Page)
1a. Have you EVER been told by a doctor that you had high blood pressure?
2 [] N
b. Another name for high blood pressure is hypertension. Have you EVER been told by a doctor that you had hypertension?
2 [] N (10)
c. About how long ago were you FIRST told by a doctor that you had (high blood pressure/hypertension)?
1 [] ____ Months
2 [] ____ Years
2. During the past 12 months about how many times have you seen or talked to a doctor about your (high blood pressure/hypertension)?
000 [] None
3. Has a doctor EVER advised you to lose weight BECAUSE OF (HIGH BLOOD PRESSURE/HYPERTENSION)?
2 [] N
4a. Do you now use more salt, less salt, or about the same amount of salt since you learned you had (high blood pressure/hypertension)?
2 [] Less
3 [] Same
b. Were you EVER advised by a doctor, nurse, or other medical person to use less salt?
2 [] N
5a. Has a doctor EVER prescribed medicine for your (high blood pressure/hypertension)?
2 [] N
b. Are you now taking any medicine prescribed by a doctor for your (high blood pressure/hypertension)?
2 [] N (6)
c. How often are you supposed to take this medicine -- more than once a day, once a day, or less than once a day?
2 [] Once a day
3 [] Less than once a day
d. How often do you take your medicine when you are supposed to - all the time, often, once in a while, or never?
2 [] Often
3 [] Once in a while
0 [] Never
[] Other (Specify) ____
e. Does your medicine ever cause side effects or make you feel funny in any way?
2 [] N (6)
f. Why did you stop taking the medicine?
Any other reason?
Mark all that apply
2 [] No longer has high blood pressure
3 [] Side effects
[] Other (Specify) ____
g. Did a doctor advise you to stop taking the medicine?
2 [] N
If "Side effects" in 5f, go to 6; otherwise ask:
h. When you were taking this medicine did it cause any side effects or make you feel funny in any way?
2 [] N
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6. ABOUT how many days during the past 12 months has (high blood pressure/hypertension) kept you in bed all or most of the day?
000 [] None
If "No longer has high blood pressure" in 5f, go to 7d, otherwise ask:
7a. How often does your (high blood pressure/hypertension) bother you -- all the time, often, once in a while, ore never?
2 [] Often
3 [] Once in a while
0 [] Never (7c)
[] Other (Specify) ____
b. When it does bother you, are you bothered a great deal, some, or very little?
2 [] Some
3 [] Very little
[] Other (Specify) ____
If "All the time" in 7a, go to 8, otherwise ask:
c. Do you still have (high blood pressure/hypertension)?
2 [] N
9 [] DK
d. Is this condition completely cured or is it under control?
2 [] Under control
8. Can you tell when your blood pressure is high - that is, do you have any symptoms?
2 [] N
9. Have you ever been refused life insurance or health insurance coverage because you had (high blood pressure/hypertension)?
2 [] N
10a. Has a doctor EVER talked to you about problems that can be caused by high blood pressure or hypertension?
2 [] N
b. Has a nurse or other medical person EVER talked to you about problems that can be caused by high blood pressure or hypertension?
2 [] N (HP2)
c. What type of medical person was this?
[] Other (Specify) ____
Refer to THIS PERSON'S doctor visit columns. If "Y" in 7a in ANY column, go to 14, otherwise go to 11. 11. ABOUT how long has it been since you LAST had your blood pressure taken?
HP2
[] 2-week DV in C1
[MK Note: End section HP2]
000 [] Less than 1 month
1 [] ____ Months
2 [] ____ Years (16)
12.Who took your blood pressure the LAST time?
2 [] Nurse
3 [] Friend or relative
4 [] Druggist
5 [] Self (13b)
[] Other (specify)
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13a. Were you told that your reading was high, low, normal, or were you not told?
2 [] Low (14)
3 [] Normal (14)
4 [] Not told (14)
[] Other (Specify) ____ (14)
b. Was your reading high, low, or normal?
2 [] Low (15)
3 [] Normal (15)
[] Other (Specify) ____ (15)
14. During the past 12 months, have you taken your own blood pressure?
2 [] N
15. During the past 12 months, how many times was your blood pressure taken? (Do not count times while a patient in a hospital.)
16a. ABOUT how long has it been since you had an electrocardiogram, which involves placing wires on the chest and arms?
00 [] Less than 1 year
Years ____
b. ABOUT how long has it been since you had a chest X-ray?
00 [] Less than 1 year
Years ____
17a. ABOUT how much do you weigh?
Inches _ _
c. Do you consider yourself overweight, underweight, or just about right?
2 [] Underweight (18)
3 [] About right (17a)
d. Are you now trying to lose weight?
2 [] N
e. Are you now trying to keep from gaining weight?
2 [] N (18)
f. Is this based on advice from a doctor, nurse, or other medical person?
2 [] N
g. What are you doing to (lose/control your) weight -- watching what you eat, exercising, or something else? Anything else?
Mark all that apply
2 [] Exercise
3 [] Medication
[] Other (Specify) ____
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18. Have you EVER been told by a doctor that you had diabetes?
2 [] N
19. Have you EVER been told by a doctor that you had heart trouble?
2 [] N
20. Have you EVER had a stroke?
2 [] N
21a. Have you ever smoked at least 100 cigarettes in your entire life?
2 [] N (Medical Care Page)
b. Do you smoke cigarettes now?
2 [] N (21e)
c. On the average, ABOUT how many cigarettes a day do you smoke?
d. Have you EVER tried to stop smoking?
2 [] N
e. Have you EVER been advised by a doctor to stop smoking?
2 [] N (Medical Care Page)
f. Was this because of a specific condition you had at that time?
2 [] N (Medical Care Page)
g. What condition was it? ____
h. Any other condition?
[] N