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[p.182]

Section Q -- General Health Habits

Item Q1

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

These next questions are 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


4a. About how tall are you without shoes?

Feet ____
Inches ____


b. About how much do you weigh without shoes?

Pounds ____


Hand Card Q1. Read categories if telephone interview.
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 palls
4[] Increase physical activity
5[] Eat no fat
6[] Eat grapefruit with each meal
9[] DK
0[] None of these


6. Are you now trying to lose weight?

1[] Yes
2[] No


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.183]

Section Q -- 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, doctor's clinic, or HMO)
2[] Hospital outpatient clinic
3[] Sample person's home
4[] Hospital emergency room
5[] Company or industry clinic
6[] Health center
8[] Other


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

1[] Yes (Q2)
2[] No (Q2)


Hand Card Q2. Read categories if telephone interview.
Card Q2

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

14. Which of these is the main reason you don't have a particular place you usually go to?
Mark only one.

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

Item Q2
Refer to sex.

[] Male (Section S, page 10)
[] Female (15)

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

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


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

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


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

Times per year ____
000[] Never/Less than once a year
999[] DK

[p.184]

Section R -- Mammography

Item R1
Refer to age.

[] Female 25 or over (1)
[] Other (Section S)

1a. A mammogram is an X-ray taken only of the breasts by a machine that presses against the breast while the picture is taken.
Have you ever had a mammogram?

1[] Yes
2[] No (4)
9[] DK (5)


b. How many times have you had a mammogram?

Times ____


2. (Please think about your first mammogram) Did a doctor or other health professional suggest that you have this (first) mammogram or did you decide this on your own?

1[] Doctor or other health professional suggested
2[] Decided on own
8[] Other (Specify) ____
9[] DK


3a. When did you have your (most recent) mammogram?

Number ____
[] Days ago
[] Weeks ago
[] Months ago
[] Years ago
9[] DK


b. Was your (most recent) mammogram done because of some breast symptom or condition, or as a routine checkup?

1[] Breast symptom or condition
2[] Routine checkup, no symptoms
3[] Family history of breast cancer
8[] Other reason (Specify) ____
9[] DK/Don't remember


Item R2
Refer to question 3a.

[] More than 3 years in 3a (4)
[] Other (5)


4. What is the most important reason why you have (never had a mammogram/not had a mammogram in the past few years)?
Mark only one.

01[] Not recommended by doctor or doctor never said it was needed
02[] Didn't think necessary or needed
03[] No problems
04[] Put it off; procrastinated
05[] Didn't know I should
06[] Cost too much or insurance doesn't cover it
07[] Fear (of radiation, pain; or of results)
08[] Not due yet; too young
09[] Don't go to doctors/don't have doctor
10[] Never heard of mammogram (Section S)
11[] Breasts missing (Section S)
98[] Other (Specify) ____
99[] DK


5a. Do you plan to have a mammogram in the future?

1[] Yes (5b)
2[] No (Section S)
3[] If doctor recommends (5b)
9[] DK (Section S)


b. When do you plan to have your (first/next) mammogram?
Mark the first appropriate response.

1[] Less than 1 year
2[] 1 year, less than 3 years
3[] 3 years, less than 5 years
4[] When doctor recommends
8[] Other (Specify) ____
9[] DK

[p.187]

Section T -- Radon


1. Have you ever heard of radon, a gas that is found in the air in some homes?

1[] Yes
2[] No (10)
9[] DK/Not sure (10)


2. Do you believe that exposure to radon is unhealthy, or do you believe that it has little or no effect on health?

1[] Exposure to radon is unhealthy
2[] Exposure to radon has little or no effect on health (4)
9[] Not sure/DK/ No opinion (4)


Hand card T. Read categories if telephone interview.
Card T

1. Headache
2. Arthritis
3. Lung cancer
4. Other cancer
5. Asthma
0. None of these

3. Which, if any, of these conditions do you believe can be caused by radon exposure?
Mark all that apply.

1[] Headache
2[] Arthritis
3[] Lung cancer
4[] Other cancer
5[] Asthma
0[] None of these
9[] DK


4. Has your household air been tested for the presence of radon?

1[] Yes (6)
2[] No
9[] DK


5. Do you or anyone plan to have this home tested for radon within the next year?

1[] Yes (10)
2[] No (10)
9[] DK (10)


6. Were followup tests conducted to verify the results of the first test?

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


7a. Has anything been done in this home to reduce the radon level or reduce the radon exposure?

1[] Yes (7c)
2[] No
9[] DK


b. Do you or anyone plan to do anything to reduce the radon level or radon exposure in this home?

1[] Yes (8)
2[] No (8)
9[] DK (8)


c. What has been done?
Anything else?
Mark all that apply.

[] Increase ventilation by opening windows, doors, etc.
[] Stopped or decreased smoking
[] Moved out of or spend less time in basement
[] Modified home -- sealed cracks, installed ventilation system, etc.
[] Other (Specify) ____
[] DK


8a. What was the radon level from that (last) test (before any corrective action was taken)?

Picocuries per liter ____(9)
9996[] DK results yet (10)
9999[] DK level (8b)


b. Was it above or below 4 picocuries (pi'-ko-kurees) per liter?

1[] Above 4
2[] At or below 4
9[] DK (10)


9. How harmful to health is this radon level -- would you say not harmful, somewhat harmful, very harmful, or do you not know?

1[] Not harmful
2[] Somewhat harmful
3[] Very harmful
9[] DK


Mark box or ask:
10. Which of the following best describes your residence?
Read answer categories.

1[] Single home, duplex, townhouse
2[] Basement, first or second floor apartment or condominium
3[] Apartment or condominium above second floor
4[] Trailer/mobile home
8[] Other (Specify) ____

[p.188]

Section U -- Cardiovascular Disease


1. I am going to read a list of things which may or may not affect a person's chance of getting heart disease.
Hand Card U1. Repeat answer categories if telephone interview.
Card U1

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. High blood pressure?

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




c. Diabetes?

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




d. Being very overweight?

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




e. 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




f. 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




g. 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


Hand card U2. Repeat answer categories if telephone interview.
Card U2

1. Strongly associated with high blood pressure
2. Somewhat associated with high blood pressure
3. Probably not at all associated with high blood pressure
9. Don't know or no opinion


3. For each of the following, tell me if you think it is strongly associated with high blood pressure, somewhat associated with high blood pressure, or probably not at all associated with high blood pressure.


a. Sodium or salt?

1[] Strongly associated
2[] Somewhat associated
3[] Probably not at all associated
9[] DK/No opinion




b. Alcohol?

1[] Strongly associated
2[] Somewhat associated
3[] Probably not at all associated
9[] DK/No opinion




c. Cholesterol?

1[] Strongly associated
2[] Somewhat associated
3[] Probably not at all associated
9[] DK/No opinion


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 high blood pressure?

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


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

1[] Yes (8)
2[] No


7a. Was any medicine ever prescribed by a doctor for your high blood pressure?

1[] Yes
2[] No (8)


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

1[] Yes
2[] No

[p.189]

Section U -- Cardiovascular Disease -- Continued


8. Because of your 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 (8d)

d. Cut down on alcohol use?

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 (8d)


d. Cut down on alcohol use?
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 (8d)
2[] No (8d)


d. Cut down on alcohol use?
1[] Yes (11)
2[] No (11)


11a. Do you still have 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 ____
[] Days
[] Weeks
[] Months
[] Years
[] Never
9[] DK


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
9[] DK


c. 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
9[] DK


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

1[] Yes
2[] No


15. Have you ever had a stroke?

1[] Yes
2[] No


16. Have you ever made any lasting changes in the types of foods you eat in order to lower your blood cholesterol?

1[] Yes
2[] No


17. Have you ever had your blood cholesterol level checked?

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


18. Have you ever been told by a doctor or other health professional that your blood cholesterol level was high?

1[] Yes
2[] No

[p.190]

Section V -- Stress

These next questions are about stress.


1a. 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 (Section W)
9[] DK


b. During the past year, 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
9[] DK


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
9[] DK


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

1[] Yes
2[] No

Item V1
Refer to 3a and b.

[] "No" in 3a and 3b (5)
[] Other (4)

4a. Did you actually seek any help?

1[] Yes
2[] No (5)
9[] DK (5)


b. From whom did you seek help?
Mark all that apply.
Do not read list.

[] Family member or relative
[] Friend/neighbor/peer
[] Medical doctor
[] Psychologist
[] Psychiatrist
[] Social worker
[] Other mental health professional/therapist/counselor
[] Religious counselor/religious support group/religious therapy group/minister, etc.
[] Alcoholics Anonymous/Al Anon/Alateen
[] National Alliance for the Mentally Ill
[] Other self-help group (examples: Recovery Inc., Emotions Anonymous, Phobia - Panic Disorder Support Group, Tough Love, Overeaters Anonymous, Parents without Partners, Bereavement Groups, Children of Divorce, etc.)
[] At work counselor/at work support group/at work therapy group
[] Other (Specify) ____
[] DK or refused

c. Anyone else?

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


Ask for each category marked in 4b.
d. Overall, how much help have you received from (entry in 4b) in relieving your stress -- a lot, some, hardly any or none?


[] Family member or relative
1[] A lot
2[] Some
3[] Hardly any/none


[] Friend/neighbor/peer
1[] A lot
2[] Some
3[] Hardly any/none


[] Medical doctor
1[] A lot
2[] Some
3[] Hardly any/none


[] Psychologist
1[] A lot
2[] Some
3[] Hardly any/none


[] Psychiatrist
1[] A lot
2[] Some
3[] Hardly any/none


[] Social worker
1[] A lot
2[] Some
3[] Hardly any/none


[] Other mental health professional/therapist/counselor
1[] A lot
2[] Some
3[] Hardly any/none


[] Religious counselor/religious support group/religious therapy group/minister, etc.
1[] A lot
2[] Some
3[] Hardly any/none


[] Alcoholics Anonymous/Al Anon/Alateen
1[] A lot
2[] Some
3[] Hardly any/none


[] National Alliance for the Mentally Ill
1[] A lot
2[] Some
3[] Hardly any/none


[] Other self-help group (examples: Recover Inc., Emotions Anonymous, Phobia - Panic Disorder Support Group, Tough Love, Overeaters Anonymous, Parents Without Partners, Bereavement Groups, Children of Divorce, etc.)
1[] A lot
2[] Some
3[] Hardly any/none


[] At work counselor/at work support group/at work therapy group
1[] A lot
2[] Some
3[] Hardly any/none


[] Other (Specify) ____
1[] A lot
2[] Some
3[] Hardly any/none


5. (Besides seeking help) During the past year, have you consciously taken any (other) steps to control or reduce stress in your life?

1[] Yes
2[] No

[p.191]

Section W -- Exercise

Item W1
Refer to "Wa/Wb" boxes in C1 on HIS-1.

1[] Wa or Wb box marked
8[] Other

Item W2
Mark from observation or previous information.

1[] SP Is physically handicapped (Describe in footnotes, then 1)
8[] Other (2)


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?

1[] Yes
2[] No (3 on page 19)


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

c. Anything else?

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

[p.192]

Section W -- Exercise -- Continued

Note -- Ask all of 2a before going to 2b-d.
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


Item W2
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


Item W3
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)?
[] Yes - What were they? Anything else? ____
[] No


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


(1) Walking for exercise
1[] Times ____


(2) Jogging or running
1[] Times ____


(3) Hiking
1[] Times ____


(4) Gardening or yard work
1[] Times ____


(5) Aerobics or aerobic dancing
1[] Times ____


(6) Other dancing
1[] Times ____


(7) Calisthenics or general exercise
1[] Times ____


(8) Golf
1[] Times ____


(9) Tennis
1[] Times ____


(10) Bowling
1[] Times ____


(11) Biking
1[] Times ____


(12) Swimming or water exercises
1[] Times ____


(13) Yoga
1[] Times ____


(14) Weight lifting or training
1[] Times ____


(15) Basketball
1[] Times ____


(16) Baseball or softball
1[] Times ____


(17) Football
1[] Times ____


(18) Soccer
1[] Times ____


(19) Volleyball
1[] Times ____


(20) Handball, racquetball, or squash
1[] Times ____


(21) Skating
1[] Times ____


(22) Skiing
1[] Times ____


(23) any (other) exercises, sports, or physically active hobbies in the past 2 weeks (that I haven't mentioned)
1[] Times ____


c. On the average, about how many minutes did you actually spend on (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) any (other) exercises, sports, or physically active hobbies in the past 2 weeks (that I haven't mentioned)

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) any (other) exercises, sports, or physically active hobbies in the past 2 weeks (that I haven't mentioned)

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

[p.193]

Section W -- 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 ____
[] Days
[] Weeks
[] Months
[] 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 (W4)
8[] Other (W4)


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

Item W4
Refer to "Wa/Wb" boxes in C1 on HIS-1.

[] Wa or Wb box marked (6a)
[] 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 ____


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?

0[] No days (Section X)
Days a week ____
8[] Other
9[] DK or refused


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 W.
Card W

1. No faster than usual
2. A little faster than usual
3. A lot faster, but talking is possible
3. 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 -- [no faster than usual, a little faster than usual, a lot faster but talking is possible, so fast that talking is not possible?]

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.194]

Section X -- Smoking

Item X1
Refer to "Sm" box on HIS-1.

1[] "Sm" box marked (6)
8[] Other (1)

These next questions are about smoking cigarettes.

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

1[] Yes
2[] No (6)


2a. Do you smoke cigarettes now?

1[] Yes (3)
2[] No


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

Number ____
[] Days
[] Weeks
[] Months
[] Years
[] Never smoked regularly (6)


3. On the average, about how many cigarettes a day (do you now smoke/did you smoke when you last smoked regularly)?

00[] Less than 1 per day
Number ____

Item X2
Refer to question 2a.

1[] "No" in 2a (6)
8[] Other (4)

4. Have you ever made a serious attempt to stop smoking cigarettes?

1[] Yes
2[] No (6)
9[] DK (6)


5a. When was the start of your most recent serious quit attempt?

Number ____
[] Days
[] Weeks
[] Months
[] Years
9[] DK


b. How long did you actually stay off cigarettes that time?

000[] Less than 1 day
Number ____
[] Days
[] Weeks
[] Months
[] Years
9[] DK

[p.195]

Section X -- Smoking -- Continued


6. (These next questions are about smoking cigarettes.)
Hand Card X.
Card X
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 chance of the getting the following problems. First --


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. Cancer of the esophagus?

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




e. Chronic bronchitis?

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




f. Lung cancer?

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

Item X3
Refer to age.

[] SP is under 45 (6g)
[] SP is 45+ (X4)

Does cigarette smoking during pregnancy definitely increase, probably increase, probably not or definitely not increase the chances of --

g. Miscarriage?

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




h. Stillbirth?

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




i. Premature birth?

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




j. 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


7a. 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 (X4)
9[] DK (X4)

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

1[] Much more
2[] Somewhat more

Item X4
Refer to 1 on page 37.

[] "Yes" in 1 (8)
[] Other (Section Y)

8. Did a doctor ever advise you to quit or cut down on smoking?

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

[p.196]

Section Y -- Alcohol Use

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 (in the past year)?

00[] No need/not necessary (7)
01[] Don't care for/dislike it (7)
02[] Medical/health reasons (7)
03[] Religious/moral reasons (7)
04[] Brought up not to drink (7)
05[] Costs too much (7)
06[] Family member an alcoholic or problem drinker (7)
07[] Infrequent drinker (7)
08[] Recovering alcoholic (7)
98[] Other (Specify) ____ (7)


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.

[] None/Never (4)
[] 1
[] 1-2
[] 2
[] 2-3
[] 3
[] 3-4
[] 4
[] 4-5
[] 5
[] 5-6
[] 6
[] 6-7
[] 7
[] 7-8
[] 8
[] 8-9
[] 9
[] 9-10
[] 10
[] 10-11
[] 11
[] 11-12
[] 12
[] 12-13
[] 13
[] 13-14
[] 14 (Every day)
[] 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.

[] One
[] One or two
[] Two
[] Two or three
[] Three
[] Three or four
[] Four
[] Four or five
[] Five
[] Five or six
[] Six
[] Seven to eleven
[] Twelve or more
[] DK


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

1[] Yes (6)
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

Item Y1
Refer to 2 and 4a.

[] "None/Never" in 2 and "No" in 4a (5)
[] Other (6)
[p.197]

Section Y -- Alcohol Use -- Continued


5a. When was your last drink prior to that two week period?

Month ____
Date ____
Year 19____


Let's talk about the 2-week period ending the day you had your last drink. Please include that last day.
b. During that 2-week period, on how many days did you drink any alcoholic beverages, such as beer, wine, or liquor?
Use list to probe, if necessary.

[] 1
[] 1-2
[] 2
[] 2-3
[] 3
[] 3-4
[] 4
[] 4-5
[] 5
[] 5-6
[] 6
[] 6-7
[] 7
[] 7-8
[] 8
[] 8-9
[] 9
[] 9-10
[] 10
[] 10-11
[] 11
[] 11-12
[] 12
[] 12-13
[] 13
[] 13-14
[] 14 (Every day)
[] DK


c. On the (number in 5b) days that you drank alcoholic beverages, how many drinks did you have per day, on the average?
Use list to probe, if necessary.

[] One
[] One or two
[] Two
[] Two or three
[] Three
[] Three or four
[] Four
[] Four or five
[] Five
[] Five or six
[] Six
[] Seven to eleven
[] Twelve or more
[] DK


d. Was the amount of your drinking during that 2-week period typical of your drinking during the previous 12 months?

1[] Yes (6)
2[] No


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

1[] More
2[] Less


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

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

[p.198]

Section Y -- Alcohol Use -- Continued


Hand Card Y. Repeat answer categories if telephone interview.
Card Y
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


7. 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. Cancer of the mouth?

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

Item Y2
Refer to age.

[] SP is under 45 (7d)
[] SP Is 45+ (Section Z)

Does heavy drinking during pregnancy definitely increase, probably increase, probably not or definitely not increase the chance of --

d. Miscarriage?

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




e. 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




f. 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




g. Birth defects?

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


8a. Have you ever heard of Fetal Alcohol Syndrome?

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


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

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

[p.199]

Section Z -- Dental Care


This question is about water fluoridation.
1. As you understand it, what is the purpose of adding fluoride to the public drinking water?
Do not read answer categories, Mark the one that best fits respondent's answer.

1[] Prevent tooth decay, protect teeth, or related response
2[] To purify the water or related response
8[] Other (Specify) ____
9[] DK


2. During the past 12 months that is, since (12-month date) a year ago, how many visits did you make to a dentist?

00[] None
Visits ____ [number]


3. Have you lost ALL of your permanent teeth, both upper and lower?

1[] Yes
2[] No


4a. Have you ever heard of dental sealants?

1[] Yes
2[] No (5)


Hand card Z1.
Card Z1

1. Fill cavities
2. Prevent tooth decay
3. Improve appearance of teeth
4. Hold dentures in place
9. Don't know

b. Which of the following best describes the purpose of dental sealants -- to fill cavities, to prevent tooth decay, to improve the appearance of the teeth, or to hold dentures in place?

1[] Fill cavities
2[] Prevent tooth decay
3[] Improve appearance of teeth
4[] Hold dentures in place
9[] DK


5. What is one common sign of gum disease?
Do not read answer categories.
Mark the one that best fits respondent's answer.
Do not probe.

1[] Swollen, red, inflamed, sore or bleeding gums
2[] Chronic bad breath
3[] Loose teeth
4[] Receding gums
8[] Other (Specify) ____
9[] DK


6. What is one early sign of mouth cancer?
Do not read answer categories.
Mark the one that best fits respondent's answer.
Do not probe.

1[] White patches in mouth which are not painful
2[] Red patches in mouth which are not painful
3[] Sore/lesion in mouth which does not heal
4[] Sore/lesion in mouth
5[] Bleeding in mouth
8[] Other (Specify) ____
9[] DK


Hand card Z2. Repeat categories if telephone interview.
Card Z2

1. Definitely increases chances of getting mouth or lip cancer
2. Probably increases chances of getting mouth or lip cancer
3. Probably does not increase chances of getting mouth or lip cancer
4. Definitely does not increase chances of getting mouth or lip cancer
9. Don't know or no opinion


7. I am going to read a list of things which may or may not increase a person's chances of getting mouth or lip cancer. For each of these, tell me if you think it definitely increases, probably increases, probably does not, or definitely does not increase a person's chances of getting mouth or lip cancer.
First --


a. Excessive exposure to sunlight?

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




b. Eating hot spicy foods?

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




c. Regular alcohol drinking?

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




d. Tobacco use in any form?

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




e. Frequently biting the cheek or lip?

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


Hand card Z3. Read all categories if telephone interview.
Card Z3
1. Limiting sugary snacks
2. Using fluoridated water and dental products with fluoride
3. Chewing sugarless gum
4. Brushing and flossing the teeth
5. Visiting the dentist every 6 months
9. Don't know

8. In your opinion, which one of these is the best method for preventing tooth decay?

1[] Limiting sugary snacks
2[] Using fluoridated water and dental products with fluoride
3[] Chewing sugarless gum
4[] Brushing and flossing the teeth
5[] Visiting the dentist every 6 months
9[] DK