hpsp
[p. 166]

Section N. GENERAL HEALTH HABITS

Sample Person Number ____

N1

Read to respondent:
These are questions about general health practices.

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

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

3. When you visit a doctor or other health professional for routine care, is eating proper foods discussed often, sometimes, rarely or never?

N2
Refer to page 46 or 47, item R, of HIS-1.

4a. About how tall are you without shoes?

b. About how much do weigh without shoes?

Hand Card N1 or read responses for telephone interview.
CARD N1
Choose two

5. In your opinion which of these are the TWO best ways to lose weight?

6. Are you now trying to lose weight?

7. Are you eating fewer calories to lose weight?

8. Have you increased your physical activity to lose weight?

9a. Do you consider yourself overweight, underweight, or just about right?

b. Would you say you are very overweight, somewhat overweight, or only a little overweight?

10. On the average, how many hours of sleep do you get in a 24-hour period?

[p. 167]

Section N. GENERAL HEALTH HABITS - Continued

11. Is there a particular clinic, health center, doctor's office, or other place that you usually go to if you are sick or need advice about your health?

12. What kind of place is it -- a clinic, a health center, a hospital, a doctor's office, or some other place?
IF HOSPITAL: Is this an outpatient clinic or the emergency room?
IF CLINIC: Is this a hospital outpatient clinic, a company clinic, or some other kind of clinic?

13. Is there ONE particular doctor you usually see at (place in 12)?

Hand Card N2 or read reasons for telephone interview.
CARD N2

14. Which of these is the MAIN reason you don't have a particular place you usually go?

N3
Refer to sex.

15. About how long has it been since you had a Pap smear test?

Years ____
98 [] Never
00 [] Less than 1 year

16a. About how long has it been since you had a breast examination by a doctor or other health professional?

b. Do you know how to examine your own breasts for lumps?

c. About how many times a year do you examine your own breasts for lumps?

[p. 170]

Section P. HIGH BLOOD PRESSURE

1. I am going to read a list of things which may or may not affect a person's chances of getting HEART DISEASE.
Hand Card P
CARD P

After I read each one, tell me if you think it definitely increases, probably increases, probably does not, or definitely does not increase a person's chances of getting heart disease.

First -

2. The following conditions are related to having a STROKE. In your opinion, which of these conditions MOST increases a person's chances of having a stroke -- diabetes, high blood pressure, or high cholesterol?

3. Which one of the following substances in food is MOST often associated with HIGH BLOOD PRESSURE -- sodium, cholesterol or sugar?

4. Have you EVER been told by a doctor or other health professional that you had hypertension, sometimes called high blood pressure?

5. Were you told two or more DIFFERENT times that you had hypertension or high blood pressure?

6. Are you NOW taking any medicine prescribed by a doctor for your hypertension or high blood pressure?

7a. Was any medicine EVER prescribed by a doctor for your hypertension or high blood pressure?

b. Did a doctor advise you to stop taking the medicine?

[p. 171]

Section P. HIGH BLOOD PRESSURE - Continued

8. Because of your hypertension or high blood pressure, has a doctor or other health professional EVER advised you to --

9. Have you EVER followed this advice

10. Are you NOW following this advice?

11a. Do you still have hypertension or high blood pressure?

b. Is this condition completely cured or is it under control?

12a. ABOUT how long has it been since you LAST had your blood pressure taken by a doctor or other health professional?

b. Blood pressure is usually given as one number over another. Were you told what your blood pressure was, in NUMBERS?

c. What was your blood pressure in NUMBERS?

d. At that time, was your blood pressure high, low, or normal?

13. Do you NOW have diabetes or sugar diabetes?

14. Have you ever been told by a doctor or other health professional that you had high cholesterol?

15. Do you have any kind of heart condition or heart trouble?

16. Have you ever had a stroke?

[p. 172]

Section Q. STRESS

Read to respondent:
These next questions are about stress.

1. During the past 2 weeks, would you say that you experienced a lot of stress, a moderate amount of stress, relatively little stress, or almost no stress at all?

2. In the past year, how much effect has stress had on your health - a lot, some, hardly any or none?

3. In the past year, did you think about seeking help for any personal or emotional problems

a. from family or friends?

b. from a helping professional or a self-help group?

Q1
Refer to 3a and b.

4a. Did you actually seek any help?

1 [] Yes
2 [] No (Section R)

b. From whom did you seek help?
Number up to four items in the order mentioned.
Do not read list.

c. Anyone else?

Section R. EXERCISE

R1

Read to respondent:

These next questions are about physical exercise. Hand calendar.

1a. In the past 2 weeks (outlined on that calendar), beginning Monday (date) and ending this past Sunday (date), have you done any exercises, sports, or physically active hobbies? [6]

b. What were they? ____
Record on next page, THEN 1c.

c. Anything else?

[p. 173]

Section R. EXERCISE - Continued

NOTE - ASK ALL OF 2a BEFORE GOING TO 2b - d.

Read to respondent: These next questions are about physical exercise. Hand calendar.

2a. In the past 2 weeks (outlined on that calendar), beginning Monday, (date), and ending this past Sunday, (date), have you done any (of the following exercises, sports, or physically active hobbies) --

R2

Refer to age

(4) Gardening or yard work?

(8) Golf?

(10) Bowling?

R3

Refer to age

(23) Have you done any (other) exercises, sports, or physically active hobbies in the past 2 weeks (that I haven't mentioned)? Anything else?

NOTE - Ask 2b - d FOR EACH ACTIVITY MARKED "YES" IN 2a.

b. How many times in the past 2 weeks did you [play/go/do] (activity in 2a)?

(2) Jogging or running

c. On the average, about how many minutes did you actually spend (activity in 2a) on each occasion?

d. (What usually happened to your heart rate or breathing when you (activity in 2a))? Did you have a small, moderate, or large increase, or no increase at all in your heart rate or breathing?

(23) Anything else

1 [] Small
2 [] Moderate
3 [] Large
4 [] None

[p. 174]

Section R. EXERCISE - Continued

3. Do you exercise or play sports regularly?

4. For how long have you exercised or played sports regularly?

5a. Would you say that you are physically more active, less active, or about as active as other persons your age?

b. Is that (a lot more or a little more/a lot less or a little less) active?

R4
Refer to "Wa/Wb" boxes in C1 on HIS-1.

6a. How much hard physical work is required on your job? Would you say a great deal, a moderate amount, a little, or none?

1 [] Great deal
2 [] Moderate amount
3 [] A little (7)
4 [] None (7)

b. About how many hours per day do you perform hard physical work on your job?

c. How much hard physical work is required in your main daily activity? Would you say a great deal, a moderate amount, a little, or none?

d. About how many hours per day do you perform hard physical work in your main daily activity?

Read to respondent:
These next questions are about strengthening the heart and lungs through exercise.

7a. How many days a week do you think a person should exercise to strengthen the heart and lungs?

b. For how many minutes do you think a person should exercise on EACH occasion so that the heart and lungs are strengthened?

Hand Card R1
CARD R1

c. (During those (number in 7b) minutes), How fast do you think a person's heart rate and breathing should be to strengthen the heart and lungs?

Do you think that the heart and breathing rate should be -

[p. 175]

Section S. SMOKING

S1
Refer to "Smoking asked" box on HIS-1.

Read to respondent:
These next questions are about smoking cigarettes.

1. Have you smoked at least 100 cigarettes in your entire life?

2a. Do you smoke cigarette now?

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

3. On the average, about how many cigarettes a day do you now smoke? [11-12]

4. (These next questions are about smoking cigarettes.) (Hand Card S)
CARD S
Cigarette smoking -

Tell me if you think CIGARETTE SMOKING definitely increases, probably increases, probably does not, or definitely does not increase a person's chances of getting the following problems.

S2
Refer to age.

Read to respondent:
Does cigarette smoking during pregnancy definitely increases, probably increases, probably does not, or definitely does not increase the chances of -

5a. If a woman takes birth control pills, is she more likely to have a stroke if she smokes than if she does not smoke?

b. Is she much more likely or somewhat more likely to have a stroke?

S3
Refer to 1.

6. Did a doctor EVER advise you to quit or cut down on smoking?

1 [] Yes
2 [] No
9 [] DK

[p. 176]

Section T. ALCOHOL USE

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.

1a. In YOUR ENTIRE LIFE have you had at least 12 drinks of ANY kind of alcoholic beverage?

b. In ANY ONE YEAR have you had at least 12 drinks of ANY kind of alcoholic beverage?

c. Have you had at least one drink of beer, wine, or liquor during the PAST YEAR?

d. What is your MAIN reason for not drinking?

2. In the past 2 WEEKS (outlined on that calendar), beginning Monday (date) and ending this past Sunday (date), on how many days did you drink any alcoholic beverages, such as beer, wine, or liquor?
Use list to probe if necessary.

3. On the (number in 2) days that you drank alcoholic beverages, how many drinks did you have per day, on the average?
Use list to probe if necessary.

4a. Was the amount of your drinking during that 2-WEEK period typical of your drinking during the past 12 months?

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

5. During the past 12 months, in how many MONTHS did you have at least one drink of ANY alcoholic beverage?

6. During (that month/those months), on how many DAYS did you have 9 or more drinks of ANY alcoholic beverage?

7. During (that month/those months), on how many DAYS did you have 5 or more drinks of ANY alcoholic beverage? (Include the (number in 6) days you had 9 or more drinks.)

8. During the past year, how many times did you drive when you had perhaps too much to drink?

[p. 177]

Section T. ALCOHOL USE - Continued

9. (Hand Card T)
CARD T
Heavy alcohol drinking -

Tell me if you think HEAVY ALCOHOL DRINKING definitely increases, probably increases, probably does not, or definitely does not increase a person's chances of getting the following problems. First -

T1
Refer to age.

Read to respondent:
Does heavy drinking during pregnancy definitely increase, probably increase, probably not or definitely not increase the chance of -

10a. Have you ever heard of FETAL ALCOHOL SYNDROME?

b. In your opinion, which ONE of the following best describes Fetal Alcohol Syndrome - a baby is born drunk, or born addicted to alcohol, or born with certain birth defects?

[p. 178]

Section U. DENTAL CARE

1. This next question is about preventing TOOTH DECAY.
Hand Card U.
CARD U

After I read each of the following, tell me if you think it is definitely important, probably important, probably not, or definitely not important in preventing TOOTH DECAY. First--

2. Now I'm going to ask about preventing GUM DISEASE. In your opinion, how important or not important is each of the following in preventing GUM DISEASE

3. In your opinion, which of the following is the MAIN cause of tooth loss in CHILDREN - tooth decay, gum disease, or injury to the teeth?

4. In your opinion, which of the following is the MAIN cause of tooth loss in ADULTS - tooth decay, gum disease, or injury to the teeth?

5a. Have you ever heard of DENTAL SEALANTS?

b. Which of the following BEST describes the purpose of dental sealants -- to prevent gum disease, to prevent tooth decay, or to hold dentures in place?

[p. 179]

Section V. OCCUPATIONAL SAFETY AND HEALTH

V1
Refer to 'Wa/Wb" boxes in C1 on HIS-1. [5]

Read to respondent:
These questions are about your present job.
1a. In your present job, are you exposed to any SUBSTANCES that could endanger your health, such as chemicals, dusts, fumes, or gases?

1 [] Yes
2 [] No (2)
9 [] DK (2)

b. What substances are you exposed to that could endanger your health? ____
Any other? ____

Enter each substance in a separate column.

Ask 1c for each response in 1b

c. How can (response in 1b) endanger your health? ________
Any other way? ____

Record verbatim response(s).

2a. In your current job, are you exposed to any WORK CONDITIONS that could endanger your health, such as loud noise, extreme heat or cold, physical or mental stress, or radiation?

b. What work conditions are you exposed to that could endanger your health? ____
Any other? ____

Enter each substance in a separate column.

Ask 2c for each response in 2b

c. How can (response in 2b) endanger your health?
Any other way? ____

Record verbatim response(s).

3a. In your present job are you exposed to any risks of accidents or injuries? [66]

b. What (other) risks of accidents or injuries are you exposed to? ____
Record verbatim response(s)

c. Any other?