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ahp
[p. 174]

O. ALCOHOL/HEALTH PRACTICES PAGE

Sample Person Number

____
O1
Refer to household composition and age

1[] Deleted (Next SP)
2[] Under 18 (Next SP)
3[] 18 and over, callback required (Next SP)
4[] 18 and over, noninterview (Specify, then next SP)
5[] 18 and over, available (1)

Read to respondent:
(Name of SP), the following questions concern your health practices, smoking, and alcohol use. (It is not necessary for anyone else to be present.)

1. How many hours do you usually sleep at night?

Hours ____


2. How often do you eat breakfast - almost every day, sometimes, rarely, or never?

1[] Every day
2[] Sometimes
3[] Rarely or Never
8[] Other - Specify ____


3. Including evening snacks, how often do you eat between meals - almost every day, sometimes, rarely, or never?

1[] Every day
2[] Sometimes
3[] Rarely or Never
8[] Other - Specify ____


4. Would you say that you are physically more active, less active, or about as active as other persons your age?

1[] More active
2[] Less active
3[] Same
8[] Other - Specify ____


5a. Have you smoked at least 100 cigarettes in your life?

1[] Yes
2[] No (8)


b. Do you smoke cigarettes now?

1[] Yes
2[] No


c. On the average, about how many cigarettes a day [do/did] you smoke?

Number ____
98[] Never smoked regularly (8)

O2
Refer to 5b

1[] "Yes" in 5b (7)
2[] "No" in 5b (6)

6. About how long has it been since you last smoked cigarettes fairly regularly?

Number ____
2[] Days
3[] Weeks
4[] Months
5[] Years


000[] Never smoked regularly (8)

O3

Refer to 6.

1[] Less than 5 years (7b)
2[] 5 years or more (8)

7a. In the past 5 years, have you ever tried to stop smoking cigarettes?

1[] Yes
2[] No (8)


b. Now I am going to use a list of methods which some people use to stop smoking cigarettes. Tell me which of these methods you used in the past 5 years to stop or try to stop smoking.


(1) Did you attend a formal program such as SmokEnders, the American Cancer Society program or American Lung Association program?

1[] Yes
2[] No




(2) Did you go to a health professional for help, SUCH AS a physician, psychologist, or psychiatrist?

1[] Yes
2[] No




(3) Did you use special filters or cigarette holders to regulate the amount of smoke inhaled in an attempt to stop smoking?

1[] Yes
2[] No




(4) Did you switch to a lower tar and nicotine cigarette in an attempt to stop smoking?

1[] Yes
2[] No




(5) Did you stop or try to stop smoking with a few friends, relatives, or acquaintances?

1[] Yes
2[] No




(6) Did you stop or try to stop entirely on your own?

1[] Yes
2[] No




(7) Did you use some other method to stop or try to stop smoking?

1[] Yes
Specify ____
2[] No

Read to respondent:

These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey, rum, gin, or vodka, and beer, and wine, and any other type of alcoholic beverage.
8a. In your entire life , have you had at least 12 drinks of any kind of alcoholic beverage?

1[] Yes
2[] No (8c)


b. In any one year, have you had at least 12 drinks of any kind of alcoholic beverage?

1[] Yes (9)
2[] No


c. What is your MAIN reason for not drinking?

00[] No need/not necessary (36)
01[] Don't care for/dislike it (36)
02[] Medical/health reasons (36)
03[] Religious/moral reasons } [36]
04[] Brought up not to drink (36)
05[] Costs too much (36)
06[] Family member an alcoholic or problem drinker (36)
07[] Infrequent drinker (36)
88[] Other (Specify) ____ (36)

[p. 175]


9. Not counting small tastes, how old were you when you started drinking alcoholic beverages?

Years Old ____


Hand calendar.
10a. Did you have a drink during the 2-week period [outlined on that calendar/beginning Monday, (date) and ending Sunday (date)]?

1[] Yes
2[] No (10c)


b. During that period, when did you last have a drink?

Month ____
Date ____
Year 19__


O4
Refer to 10c.

1[] Over 2 weeks, less than 1 year (17)
2[] 1 year or more (26)


11a. During that 2-week period, on how many days did you drink any beer?

Days ____
00[] None or never (12)


b. During that 2-week period, on the day(s) when you drank beer, about how many beers did you drink a day?

Beers ____


c. During that 2-week period, what was the total number of beers you drank?

Beers ____


d. About how many ounces were in a typical can or bottle or glass of beer that you drank during that period?

Ounces ____


12a. During that 2-week period, on how many days did you drink any wine?

Days ____
00[] None or never (13)


b. During that 2-week period, on the day(s) when you drank wine, about how many glasses of wine did you drink a day?

Glasses ____


c. During that 2-week period, what was the total number of glasses of wine you drank?

Glasses ____


d. About how many ounces of wine were in a typical glass that you drank during that period?

Ounces ____


13a. During that 2-week period, on how many days did you drink any liquor, such as whiskey, rum, gin, or vodka?

Days ____
00[] None or never (O5)


b. During that 2-week period, on the day(s) when you drank liquor, about how many drinks did you have a day?

Drinks ____


c. During that 2-week period, what was the total number of drinks of liquor that you had?

Drinks ____


d. About how many ounces of liquor were in a typical drink that you had during that period? [73-74]

Ounces ____

O5
Refer to 11a, 12a, and 13a.

1[] One day and one beverage type (16)
2[] Only one beverage type (15)
3[] 14 days in 11a, 12a, or 13a (Intro)
8[] Other (14)

Read to respondent:

I have asked you about beer, wine, and liquor separately. Now I want you to think about them combined.
14. During the 2-week period [outlined on that calendar/beginning Monday, (date) and ending Sunday (date)], on how many days altogether did you drink alcoholic beverages, that is, beer, or wine, or liquor?

Days ____ (15)
01[] One day only (16)

INTRO
I have asked you about beer, wine, and liquor separately. Now I want you to think about them combined.


Refer to questions 11b, 12b, and 13b.
15a. During that 2-week period, did you have more than (largest number in 11b, 12b, or 13b) drink(s) on a single day?

1[] Yes
2[] No (16)


b. During that 2-week period, on how many days did you have more than (largest number in 11b, 12b, or 13b) drink(s) of beer, or wine, or liquor?

Days ____
01[] One day only (15e)


c. What was the largest number of drinks you had on any one of those days?

Drinks ____


d. On how many days during that 2-week period did you have (number in 15c) drinks?

Drinks ____ (16)


e. How many drinks did you have on that day?

Drinks ____

[p. 176]


16a. Was the amount of your drinking during that 2-week period typical of your drinking during the past 12 months?

1[] Yes (16c)
2[] No


b. Was the amount of your drinking during that past 2-week period more or less than your drinking during the past 12 months?

1[] More (23)
2[] Less (23)


c. For how many years has this been typical of your drinking?

Years ____ (23)
00[] Less than one (23)


Read to respondent:
Let's talk about the 2-week period ending with and including the day you had your last drink.
17a. During that 2-week period, on how many days did you drink any beer?

Days ____
00[] None or never (18)


b. During that 2-week period, on the day(s) when you drank beer, about how many beers did you drink a day?

Beers ____


c. During that 2-week period, what was the total number of beers you drank?

Beers ____


d. About how many ounces were in a typical can or bottle or glass of beer that you drank during that period?

Ounces ____


18a. During that 2-week period, on how many days did you drink any wine?

Days ____
00[] None or never (19)


b. During that 2-week period, on the day(s) when you drank wine, about how many glasses of wine did you drink a day?

Glasses ____


c. During that 2-week period, what was the total number of glasses of wine you drank?

Glasses ____


d. About how many ounces of wine were in a typical glass that you drank during that period?

Ounces ____


19a. During that 2-week period, on how many days did you drink any liquor, such as whiskey, rum, gin, or vodka?

Days ____
00[] None or never (O6)


b. During that 2-week period, on the day(s) when you drank liquor, about how many drinks did you have a day?

Drinks ____


c. During that 2-week period, what was the total number of drinks of liquor that you had?

Drinks ____


d. About how many ounces of liquor were in a typical drink that you had during that period?

Ounces ____


O6
Refer to 17a, 18a, and 19a.

1[] Only one beverage type (21)
2[] 14 days in 17a, 18a, or 19a (21)
8[] Other (20)

Read to respondent:
I have asked you about beer, wine and liquor separately. Now I want you to think about them combined.
20. During the 2-week period ending with and including the day you had your last drink, on how many days altogether did you drink alcoholic beverages, that is, beer, or wine, or liquor?

Days ____


21a. Was the amount of your drinking during that 2-week period typical of your drinking during the 12 months before your last drink?

1[] Yes (21c)
2[] No


b. Was the amount of your drinking during that 2-week period more or less than your drinking during the 12 months before your last drink?

1[] More (22)
2[] Less (22)


c. For how many years was this typical of your drinking?

Years ____
00[] Less than one

[p. 177]


22a. What is your main reason for not drinking since (date in 10c)?

00[] No need/not necessary
01[] Don't care for/dislike it
02[] Medical/health reasons
03[] Religious/moral reasons
04[] Alcoholic/problem drinker-self
05[] Costs too much
06[] Family member an alcoholic or problem drinker
07[] Quit drinking (23b)
08[] Infrequent drinker (23a)
88[] Other (Specify) ____


b. Have you completely stopped drinking alcoholic beverages?

1[] Yes (23b)
2[] No


23a. During the past year, in how many months did you have at least one drink of any alcoholic beverage?
Months ____ (24)


b. During the year before your last drink, in how many months did you have at least one drink of any alcoholic beverage?

Months ____
00[] None (25)


24a. During [that month/those months], on how many days did you have 9 or more drinks of any alcoholic beverage?

Days ____
000[] None


b. During [that month/those months], on how many days did you have 5 or more drinks of any alcoholic beverage? (Include the (number in 24a) days you had 9 or more drinks.)

Days ____
000[] None

Read to respondent:

These next questions are about drinking during your lifetime beginning with the age you started drinking. I will ask you about heavy, moderate, and light drinking.
25a. Was there ever a period in your life when you considered yourself to be a heavy drinker?

1[] Yes
2[] No (25d)


b. For how many years were you a heavy drinker?

Years ____
00[] Less than one


c. When you were a heavy drinker, how many drinks of alcoholic beverages did you have in a week?

Drinks ____
000[] Less than one


d. Was there ever a period in your life when you considered yourself to be a moderate drinker?

1[] Yes
2[] No (25g)


e. For how many years were you a moderate drinker?

Years ____
00[] Less than one


f. When you were a moderate drinker, how many drinks of alcoholic beverages did you have in a week?

Drinks ____
00[] Less than one


g. Was there ever a period in your life when you considered yourself to be a light drinker?

1[] Yes
2[] No (O7)


h. For how many years were you a light drinker?

Years ____
00[] Less than one


i. When you were a light drinker, how many drinks of alcoholic beverages did you have in a week.

Years ____
00[] Less than one

O7
Refer to 25a, 25d, and 25g.

1[] 25a, 25d, 25g are all "No" (25j)
8[] Other (25n)

25j. Was there ever a period in your life when you considered yourself to be a very light, occasional, or infrequent drinker?

1[] Yes
2[] No (25m)


k. For how many years were you a very light, occasional, or infrequent drinker?

Years ____
00[] Less than one


l. When you were a very light, occasional, or infrequent drinker, how many drinks of alcoholic beverages did you have in a week?

Drinks ____
00[] Less than one


m. Do you now consider yourself to be an abstainer or a very light, occasional, or infrequent drinker?

1[] Light (31)
2[] Moderate (31)
3[] Heavy (31)
4[] Abstainer (31)
5[] Very light, occasional, infrequent (31)
8[] Other (Specify) ____ (31)

n. Do you now consider yourself to be an abstainer or a very light, occasional, or infrequent drinker?

1[] Light
2[] Moderate
3[] Heavy } (31)
4[] Abstainer
5[] Very light, occasional, infrequent
8[] Other (Specify) ____

[p. 178]


Read to respondent:
I would like you to think about your drinking of alcoholic beverages, that is, beer, or wine, or liquor, around (date in 10c. [time of last drink, more than 1 year ago])
26a. In a typical week, on how many days did you drink alcoholic beverages?

Days ____
00[] None (27)


b. One the day(s) when you drank, about how many drinks did you have a day?

Drinks ____


c. For how many years was this typical of your drinking? [84-85]

Years ____
00[] Less than one
98[] Not typical


27. During the year before your last drink, in how many months did you have at least one drink of any alcoholic beverage?

Months ____
00[] None (29)


28a. During [that month/those months], on how many days did you have 9 or more drinks of any alcoholic beverage?

Days ____
000[] None


b. During [that month/those months], on how many days did you have 5 or more drinks of any alcoholic beverage? (Include the (number in 28a) days you had 9 or more drinks.)

Days ____
000[] None


Read to respondent:
These next questions are about drinking during your lifetime beginning with the age you started drinking. I will ask you about heavy, moderate, and light drinking.
29a. Was there ever a period in your life when you considered yourself to be a heavy drinker?

1[] Yes
2[] No (29d)


b. For how many years were you a heavy drinker?

Years ____
00[] Less than one


c. When you were a heavy drinker, how many drinks of alcoholic beverages did you have in a week?

Drinks ____
000[] Less than one


d. Was there ever a period in your life when you considered yourself to be a moderate drinker?

1[] Yes
2[] No (29g)


e. For how many years were you a moderate drinker?

Years ____
00[] Less than one


f. When you were a moderate drinker, how many drinks of alcoholic beverages did you have in a week?

Drinks ____


g. Was there ever a period in your life when you considered yourself to be a light drinker?

1[] Yes
00[] Less than one


h. For how many years were you a light drinker?

Years ____
00[] Less than one


i. When you were a light drinker, how many drinks of alcoholic beverages did you have in a week?

Drinks ____
00[] Less than one

O8
Refer to 29a, 29d, and 29g.

1[] 29a, 29d, 29g are all "No" (29j)
8[] Other (29n)

29j. Was there ever a period in your life when you considered yourself to be a very light, occasional, or infrequent drinker?

1[] Yes
2[] No (30)


k. For how many years were you a very light, occasional, or infrequent drinker?

Years ____
00[] Less than one


l. When you were a very light, occasional, or infrequent drinker, how many drinks of alcoholic beverages did you have in a week?

Drinks ____
00[] Less than one


30a. What is your main reason for not drinking since (date in 10c)?

00[] No need/not necessary
01[] Don't care for/dislike it
02[] Medical/health reasons
03[] Religious/moral reasons
04[] Alcoholic/problem drinker - self
05[] Costs too much
06[] Family member an alcoholic or problem drinker
07[] Quit drinking (31)
08[] Infrequent drinker (31)
88[] Other (Specify) ____


b. Have you completely stopped drinking alcoholic beverages?

1[] Yes
2[] No

[p. 179]


31a. Some people have problems related to drinking. Have you ever had a family or marital problem related to your drinking?

1[] Yes
2[] No (32)

b. What problem did you have?

________
________
________

c. Anything else?

[] Yes (Reask 31b and c)
[] No

Mark box or ask.
[] "1 year or more" in O4 (32)

d. Did [this problem/any of these problems] occur in the past 12 months?

1[] Yes
2[] No


32a. Have you ever had a job or work problem related to your drinking?

1[] Yes
2[] No (33)

b. What problem did you have?

________
________
________

c. Anything else?

[] Yes (Reask 32b and c)
[] No

Mark box or ask.

[] "1 year or more" in O4 (32)

d. Did [this problem/any of these problems] occur in the past 12 months?

1[] Yes
2[] No


33a. Have you ever had an injury related to your drinking?

1[] Yes
2[] No (34)

b. What was the injury?

________
________
________

c. Anything else?

[] Yes (Reask 33b and c)
[] No

Mark box or ask.

[] "1 year or more" in O4 (34)

d. Did [this injury/any of these injuries] occur in the past 12 months?

1[] Yes
2[] No


34a. Did you ever have any (other) health problem related to your drinking?

1[] Yes
2[] No (35)

b. What was the health problem?

________
________
________

c. Anything else?

[] Yes (Reask 34b and c)
[] No

Mark box or ask.

[] "1 year or more" in O4 (35)

d. Did [this problem/any of these problems] occur in the past 12 months?

1[] Yes
2[] No


35a. While you were driving, did you ever have a motor vehicle accident or traffic violation related to your drinking?

1[] Yes
2[] No (36)


b. Which, a motor vehicle accident or a traffic violation?

1[] Accident
2[] Violation
3[] Both


Mark box or ask.

[] "1 year or more" in O4 (39)

c. Did you have a [motor vehicle accident/(or) traffic violation] related to your drinking in the past 12 months?

1[] Yes
2[] No

[p. 180]


36. Tell me whether or not you have EVER had any of the following conditions even if you have mentioned them before.


a. Hypertension or high blood pressure?

1[] Yes
2[] No




b. Hardening of the arteries?

1[] Yes
2[] No




c. Tachycardia, arrhythmia, or rapid heart?

1[] Yes
2[] No




d. Arthritis or rheumatism?

1[] Yes
2[] No




e. Convulsions or seizures?

1[] Yes
2[] No




f. Blackouts?

1[] Yes
2[] No




g. Shortness of breath?

1[] Yes
2[] No




h. Insomnia or sleeplessness?

1[] Yes
2[] No




i. Hepatitis?

1[] Yes
2[] No




j. Any disease of the pancreas?

1[] Yes
2[] No




k. An ulcer, other than a skin ulcer?

1[] Yes
2[] No




l. Any gastrointestinal bleeding?

1[] Yes
2[] No




m. Diabetes?

1[] Yes
2[] No




n. Heart attack or heart failure?

1[] Yes
2[] No




o. Coronary hearth disease?

1[] Yes
2[] No




p. Stroke or hemorrhage of the brain?

1[] Yes
2[] No




q. Angina pectoris?

1[] Yes
2[] No




r. Cancer?

1[] Yes
2[] No




s. Yellow jaundice?

1[] Yes
2[] No




t. Fatty liver?

1[] Yes
2[] No




u. Enlarged liver?

1[] Yes
2[] No




v. Cirrhosis of the liver?

1[] Yes
2[] No




w. Any other liver trouble?

1[] Yes
2[] No




x. DT's or delirium tremens?

1[] Yes
2[] No




y. Alcoholism?

1[] Yes
2[] No


O9
Mark by observation. Mark all that apply.
Who was present during the interview?

1[] Telephone interview
1[] No one else present
1[] Husband/wife
1[] Child/children under 18 years old
1[] Parent(s)
1[] Other adult(s)