hpdp
[p.182]

Section Q -- General Health Habits

Item Q1

These next questions are 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?

4a. About how tall are you without shoes?

b. About how much do you weigh without shoes?

Hand Card Q1. Read categories if telephone interview.
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.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?

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 Q2. Read categories if telephone interview.
Card Q2

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

Item Q2
Refer to sex.

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.184]

Section R -- Mammography

Item R1
Refer to age.

b. How many times have you had a mammogram?

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?

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

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

Item R2
Refer to question 3a.

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.

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

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

[p.187]

Section T -- Radon

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[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

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 --

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

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.

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

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

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

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

[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?

b. Cut down on salt or sodium in your diet?

c. Exercise?

d. Cut down on alcohol use?

9. Have you EVER followed this advice?

10. Are you now following this advice?

11a. Do you still have 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. At that time, was your blood pressure high, low, or normal?

13. Do you now have diabetes or sugar diabetes?

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

15. Have you ever had a stroke?

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

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

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

[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?

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?

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?

Item V1
Refer to 3a and b.

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

c. Anyone else?

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?

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

[p.191]

Section W -- Exercise

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

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?

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

c. Anything else?

[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) --

Item W2
Refer to age.

Item W3
Refer to age.

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

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

Section W -- 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?

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

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?

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 W.
Card W

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?]

[p.194]

Section X -- Smoking

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

These next questions are about smoking cigarettes.

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

2a. Do you smoke cigarettes 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/did you smoke when you last smoked regularly)?

Item X2
Refer to question 2a.

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

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

[p.195]

Section X -- Smoking -- Continued

6. (These next questions are about smoking cigarettes.)
Hand Card X.
Card X
Cigarette smoking --

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 --

Item X4
Refer to 1 on page 37.

[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?

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 (in the past year)?

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?

Item Y1
Refer to 2 and 4a.

Section Y -- Alcohol Use -- Continued

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

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.

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.

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

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

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

[p.198]

Section Y -- Alcohol Use -- Continued

Hand Card Y. Repeat answer categories if telephone interview.
Card Y
Heavy alcohol drinking --

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 --

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?

[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.

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

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

4a. Have you ever heard of dental sealants?

Hand card Z1.
Card Z1

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?

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.

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.

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

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 --