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hpsp
[p. 166]

Section N. GENERAL HEALTH HABITS

Sample Person Number ____

N1

1 [] Callback required (Hhld. page)
2 [] Noninterview (Cover page)
3 [] Available (1)

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


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

1 [] Almost every day
2 [] Sometimes
3 [] Rarely or never


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

1 [] Almost every day
2 [] Sometimes
3 [] 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?

1 [] Often
2 [] Sometimes
3 [] Rarely or never
4 [] Don't visit for routine care


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

1 [] SP is Hhld. resp. (5)
8 [] Other (4)


4a. About how tall are you without shoes?

Feet___
Inches ____


b. About how much do weigh without shoes?

Pounds ____


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

1. Don't eat at bedtime
2. Eat fewer calories
3. Take diet pills
4. Increase physical activity
5. Eat NO fat
6. Eat grapefruit with each meal

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

1 [] Don't eat at bedtime
2 [] Eat fewer calories
3 [] Take diet pills
4 [] Increase physical activity
5 [] Eat NO fat
6 [] Eat grapefruit with each meal


6. Are you now trying to lose weight?

1 [] Yes
2 [] No (9)


7. Are you eating fewer calories to lose weight?

1 [] Yes
2 [] No


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

1 [] Yes
2 [] No


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

1 [] Overweight
2 [] Underweight (10)
3 [] About right (10)


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

1 [] Very overweight
2 [] Somewhat overweight
3 [] Only a little overweight


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

Hours ____

[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?

1 [] Yes
2 [] No (14)


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?

1 [] Doctor's office (group practice or doctor's clinic)
2 [] Hospital outpatient clinic
3 [] Sample person's home
4 [] Hospital emergency room
5 [] Company or industry clinic
6 [] Health center
8 [] Other (Specify) ____


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

1 [] Yes (N3)
2 [] No (N3)


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

1. Have two or more usual doctors or places depending on what is wrong
2. Haven't needed a doctor
3. Previous doctor no longer available
4. Haven't been able to find the right doctor
5. Recently moved to area
6. Can't afford medical care
8. Other reason (Specify)

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

1 [] Have two or more usual doctors or places depending on what is wrong
2 [] Haven't needed a doctor
3 [] Previous doctor no longer available
4 [] Haven't been able to find the right doctor
5 [] Recently moved to area
6 [] Can't afford medical care
8 [] Other reason (Specify) ____

N3
Refer to sex.

1 [] Male (Section O)
2 [] Female (15)

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?

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


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

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


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

Times per year ____
88 [] Other (Specify) ____
98 [] Never

[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

1. Definitely increases the chances of heart disease
2. Probably increases the chances of heart disease
3. Probably does not increase the chances of heart disease
4. Definitely does not increase the chances of heart disease
9. Don't know or no opinion


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 -


a. Cigarette smoking? (Give me a number from the card.)
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


b. Worry or anxiety?
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


c. High blood pressure
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


d. Diabetes?
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


e. Being VERY overweight?
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


f. Overwork?
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


g. Drinking coffee with caffeine?
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


h. Eating a diet high in animal fat?
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


i. Family history of heart disease?
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


j. High cholesterol?
1 [] Definitely Increases
2 [] Probably Increases
3 [] Probably Does Not Increase
4 [] Definitely Does Not Increase
9 [] DK/No Opinion


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?

1 [] Diabetes
2 [] High blood pressure
3 [] High cholesterol
9 [] DK


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

1 [] Sodium
2 [] Cholesterol
3 [] Sugar
8 [] Other (Specify) ____
9 [] DK


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

1 [] Yes
2 [] No (12)
3 [] Only during pregnancy (12)


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

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


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

1 [] Yes (8)
2 [] No


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

1 [] Yes
2 [] No (8)


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

1 [] Yes
2 [] No

[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 --

a. Diet to lose weight?
1 [] Yes (9)
2 [] No (8b)
b. Cut down on salt or sodium in your diet?
1 [] Yes (9)
2 [] No (8c)
c. Exercise?
1 [] Yes (9)
2 [] No (11)


9. Have you EVER followed this advice

[a. Diet to lose weight?]
1 [] Yes (10)
2 [] No (8b)


[b. Cut down on salt or sodium in your diet?]
1 [] Yes (10)
2 [] No (8c)


[c. Exercise?]
1 [] Yes (10)
2 [] No (11)


10. Are you NOW following this advice?

[a. Diet to lose weight?]
1 [] Yes (8b)
2 [] No (8b)


[b. Cut down on salt or sodium in your diet?]
1 [] Yes (8c)
2 [] No (8c)


[c. Exercise?]
1 [] Yes (11)
2 [] No (11)


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

1 [] Yes (12)
2 [] No
9 [] DK


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

1 [] Cured
2 [] Under control
9 [] DK


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

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


999 [] DK (13)
000 [] Never (13)


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

1 [] Yes
2 [] No (12d)
9 [] DK (12d)


c. What was your blood pressure in NUMBERS?

_ _ _ / _ _ _
999 999 [] DK [40-42]


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

1 [] High
2 [] Low
3 [] Normal
8 [] Other (Specify) ____
9 [] DK


13. Do you NOW have diabetes or sugar diabetes?

1 [] Yes
2 [] No
8 [] Other (Specify) ____


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

1 [] Yes
2 [] No


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

1 [] Yes
2 [] No


16. Have you ever had a stroke?

1 [] Yes
2 [] No

[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?

1 [] A lot
2 [] Moderate
3 [] Relatively little
4 [] Almost none
5 [] DK what stress is (3)


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

1 [] A lot
2 [] Some
3 [] 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?

1 [] Yes
2 [] No


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

1 [] Yes
2 [] No

Q1
Refer to 3a and b.

1 [] "No" in 3a and 3b (Section R)
8 [] Other (4)

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.

___Family member or relative
___Friend
___Psychologist
___Psychiatric social worker
___Other mental health professional
___Medical doctor
___Religious counselor
___Alcoholics Anonymous
___Gamblers Anonymous
___Weight Watchers
___Counselor at work
___Counselor at school
___Probation officer
___Other (Specify)
_____
_____
_____

c. Anyone else?

[] Yes (Reask 4b and c)
[] No

Section R. EXERCISE


R1

1 [] SP is physically handicapped (Describe in footnotes, THEN 1)
8 [] Other (2)

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]

1 [] Yes
2 [] No (3, page 13)


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

c. Anything else?

[] Yes (Reask 1b and c)
[] No (2b)

[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) --


(1) Walking for exercise?
1 [] Yes
2 [] No

R2

Refer to age

1 [] SP is 75+ (23)
8 [] Other (2)


(2) Jogging or running?
1 [] Yes
2 [] No


(3) Hiking?
1 [] Yes
2 [] No


(4) Gardening or yard work?

1 [] Yes
2 [] No


(5) Aerobics or aerobic dancing?
1 [] Yes
2 [] No


(6) Other dancing?
1 [] Yes
2 [] No


(7) Calisthenics or general exercise?
1 [] Yes
2 [] No


(8) Golf?

1 [] Yes
2 [] No


(9) Tennis?
1 [] Yes
2 [] No


(10) Bowling?

1 [] Yes
2 [] No


(11) Biking?
1 [] Yes
2 [] No


(12) Swimming or water exercises?
1 [] Yes
2 [] No


(13) Yoga?
1 [] Yes
2 [] No

R3

Refer to age

1 [] SP is 65-74 (23)
8 [] Other (14)


(14) Weight lifting or training?
1 [] Yes
2 [] No


(15) Basketball?
1 [] Yes
2 [] No


(16) Baseball or softball?
1 [] Yes
2 [] No


(17) Football?
1 [] Yes
2 [] No


(18) Soccer?
1 [] Yes
2 [] No


(19) Volleyball?
1 [] Yes
2 [] No


(20) Handball, racquetball, or squash?
1 [] Yes
2 [] No


(21) Skating?
1 [] Yes
2 [] No


(22) Skiing?
1 [] Yes
2 [] No


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

[] Yes - What were they?
____
____

[] No


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)?


(1) Walking for exercise
Times ____


(2) Jogging or running

Times ____


(3) Hiking
Times ____


(4) Gardening or yard work
Times ____


(5) Aerobics or aerobic dancing
Times ____


(6) Other dancing
Times ____


(7) Calisthenics or general exercise
Times ____


(8) Golf
Times ____


(9) Tennis
Times ____


(10) Bowling
Times ____


(11) Biking
Times ____


(12) Swimming or water exercises
Times ____


(13) Yoga
Times ____


(14) Weight lifting or training
Times ____


(15) Basketball
Times ____


(16) Baseball or softball
Times ____


(17) Football
Times ____


(18) Soccer
Times ____


(19) Volleyball
Times ____


(20) Handball, racquetball, or squash
Times ____


(21) Skating
Times ____


(22) Skiing
Times ____


(23) Anything else
Times ____


(23) Anything else
Times _____


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


(1) Walking for exercise
Minutes ____


(2) Jogging or running
Minutes ____


(3) Hiking
Minutes ____


(4) Gardening or yard work
Minutes ____


(5) Aerobics or aerobic dancing
Minutes ____


(6) Other dancing
Minutes ____


(7) Calisthenics or general exercise
Minutes ____


(8) Golf
Minutes ____


(9) Tennis
Minutes ____


(10) Bowling
Minutes ____


(11) Biking
Minutes ____


(12) Swimming or water exercises
Minutes ____


(13) Yoga
Minutes ____


(14) Weight lifting or training
Minutes ____


(15) Basketball
Minutes ____


(16) Baseball or softball
Minutes ____


(17) Football
Minutes ____


(18) Soccer
Minutes ____


(19) Volleyball
Minutes ____


(20) Handball, racquetball, or squash
Minutes ____


(21) Skating
Minutes ____


(22) Skiing
Minutes ____


(23) Anything else
Minutes ____


(23) Anything else
Minutes ____


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?


(1) Walking for exercise
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(2) Jogging or running
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(3) Hiking
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(4) Gardening or yard work
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(5) Aerobics or aerobic dancing
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(6) Other dancing
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(7) Calisthenics or general exercise
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(8) Golf
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(9) Tennis
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(10) Bowling
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(11) Biking
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(12) Swimming or water exercises
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(13) Yoga
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(14) Weight lifting or training
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(15) Basketball
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(16) Baseball or softball
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(17) Football
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(18) Soccer
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(19) Volleyball
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(20) Handball, racquetball, or squash
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(21) Skating
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(22) Skiing
1 [] Small
2 [] Moderate
3 [] Large
4 [] None


(23) Anything else
1 [] Small
2 [] Moderate
3 [] Large
4 [] None




(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?

1 [] Yes
2 [] No (5)


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

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


5a. 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 [] About as active (R4)
8 [] Other (Specify) ____ (R4)


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

1 [] A lot more
2 [] A little more
3 [] A lot less
4 [] A little less

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

1 [] Wa or Wb box marked (6a)
8 [] Other (6c)

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?

Hours ____ (7)


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?

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


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

Hours ____


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?

Days ____
8 [] Other (Specify) ____
9 [] DK


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

Minutes ____
999 [] DK


Hand Card R1
CARD R1

1. No faster than usual
2. A little faster than usual
3. A lot faster but talking is possible
4. So fast that talking is not possible

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 -

1 [] No faster than usual
2 [] A little faster than usual
3 [] A lot faster but talking is possible
4 [] So fast that talking is not possible
9 [] DK

[p. 175]

Section S. SMOKING

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

1 [] "Smoking asked" box marked (4)
8 [] Other (1)

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


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

1 [] Yes
2 [] No (4)


2a. Do you smoke cigarette now?

1[] Yes (3)
2 [] No


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

_____
Number
1 [] Days (4)
2 [] Weeks (4)
3 [] Months (4)
4 [] Years (4)


998 [] Never smoked regularly (4)


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

Number ____
00 [] Less than 1 per day


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

1. Definitely increases the chances
2. Probably increases the chances
3. Probably does not increase the chances
4. Definitely does not increase the chances
9. Don't know or no opinion


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.


a. Emphysema? (Give me a number from the card.)
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


b. Bladder cancer?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


c. Cancer of the larynx (lar'inks) or voice box?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


d. Cataracts?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


e. Cancer of the esophagus?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


f. Chronic bronchitis?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


g. Gallstones?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


h. Lung cancer?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion

S2
Refer to age.

1 [] SP is under 45 (4i)
2 [] SP is 45 + (S3)

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


i. Miscarriage?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


j. Stillbirth?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


k. Premature birth?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


l. Low birth weight of the newborn?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/ No opinion


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?

1 [] Yes
2 [] No (S3)
9 [] DK (S3)

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

1 [] Much more
2 [] Somewhat more

S3
Refer to 1.

1 [] "Yes" in 1 (6)
8 [] Other (Section T)

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?

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


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

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


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

1 [] Yes (2)
2 [] No


d. What is your MAIN reason for not drinking?

00 [] No need/not necessary (9)
01 [] Don't care for/dislike it (9)
02 [] Medical/health reasons (9)
03 [] Religious/moral reasons (9)
04 [] Brought up not to drink (9)
05 [] Costs too much (9)
06 [] Family member an alcoholic or problem drinker (9)
07 [] Infrequent drinker (9)
08 [] Other (Specify) ____ (9)


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.

01 [] 14 (Every day)
02 [] 13-14
03 [] 13 14
04 [] 12-13
05 [] 12
06 [] 11-12
07 [] 11
08 [] 10-11
09 [] 10
10 [] 9-10
11 [] 9
12 [] 8-9
13 [] 8
14 [] 7-8
15 [] 7
16 [] 6-7
17 [] 6
18 [] 5-6
19 [] 5
20 [] 4-5
21 [] 4
22 [] 3-4
23 [] 3
24 [] 2-3
25 [] 2
26 [] 1-2
27 [] 1
00 [] None/Never (4)
99 [] DK


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.

01 [] Twelve or more
02 [] Seven to eleven
03 [] Six
04 [] Five or six
05 [] Five
06 [] Four or five
07 [] Four
08 [] Three or four
09 [] Three
10 [] Two or three
11 [] Two
12 [] One or two
13 [] One
99 [] DK


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

1 [] Yes (5)
2 [] No


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

1 [] More
2 [] Less


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

Months ____


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

Days ____
000 [] None or never


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.)

Days ____
000 [] None or never


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

Times ____
000 [] None
998 [] Don't drive

[p. 177]

Section T. ALCOHOL USE - Continued


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

1. Definitely increases the chances
2. Probably increases the chances
3. Probably does not increase the chances
4. Definitely does not increase the chances
9. Don't know or no opinion

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 -


a. Throat cancer? (Give me a number from the card.)
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


b. Cirrhosis of the liver?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


c. Bladder cancer?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


d. Cancer of the mouth?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


e. Arthritis?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


f. Blood clots?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion

T1
Refer to age.

1 [] SP is under 45 (9g)
2 [] SP is 45 + (Section U)

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


g. Miscarriage?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


h. Mental retardation of the newborn?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


i. Low birth weight of the newborn?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


j. Birth defects?
1 [] Definitely increases
2 [] Probably increases
3 [] Probably does not increase
4 [] Definitely does not increase
9 [] DK/No opinion


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

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


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?

1 [] Drunk
2 [] Addicted to alcohol
3 [] With certain birth defects

[p. 178]

Section U. DENTAL CARE


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

1. Definitely important
2. Probably important
3. Probably not important
4. Definitely not important
9. Don't know or no opinion

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--


a. Seeing a dentist regularly? (Give me a number from the card.)
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


b. Drinking water with fluoride from early childhood?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


c. Regular brushing and flossing of the teeth?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


d. Using fluoride toothpaste or fluoride mouth rinse?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


e. Avoiding between-meal sweets?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


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


a. Seeing a dentist regularly?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


b. Drinking water with fluoride from early childhood?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


c. Regular brushing and flossing of the teeth?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


d. Using fluoride toothpaste or fluoride mouth rinse?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


e. Avoiding between-meal sweets?
1 [] Definitely important
2 [] Probably important
3 [] Probably not important
4 [] Definitely not important
9 [] DK/No opinion


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?

1 [] Tooth decay
2 [] Gum disease
3 [] 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?

1 [] Tooth decay
2 [] Gum disease
3 [] Injury to the teeth


5a. Have you ever heard of DENTAL SEALANTS?

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


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?

1 [] Prevent gum disease
2 [] Prevent tooth decay
3 [] Hold dentures in place

[p. 179]

Section V. OCCUPATIONAL SAFETY AND HEALTH

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

1 [] Wa or Wb box marked (1)
8 [] Other (Cover page)

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).

99 [] DK


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?

1 [] Yes
2 [] No (3)
9 [] DK (3)


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? ____

99 [] DK

Record verbatim response(s).


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

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


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

c. Any other?

[] Yes (Reask 3b and c)
[] No (Cover page)
[] DK (Cover page)