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[p. 178]

Section E -- ENVIRONMENTAL HEALTH

These next questions are about this home.


1. Does anyone smoke cigarettes, cigars, or pipes anywhere inside this home?

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


2. On the average, about how many days per week is there smoking anywhere inside this home?

0[] Less than 1 day per week/Rarely
Days per week (Number) ____
9[] DK


3. Was your home built before 1950?

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


4. Has paint from this home ever been analyzed for lead content?
Read if necessary:
This can be done by sending paint chips to a laboratory for testing, having a measurement by an x-ray fluorescence or XRF machine or having a chemical spot test on the wall.

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

hpdp

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

1[] Yes (6)
2[] No (11)
9[] DK (11)


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

1[] Yes (8)
2[] No (7)
9[] DK (7)


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

1[] Yes (11)
2[] No (11)
9[] DK (11)


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

Picocuries per liter ____ (E1)
9999[] DK (8b)


b. Was it above or below the EPA radon guideline of 4 picocuries (pi-k-kurees) per liter?

1[] Above the EPA guideline (9)
2[] At or below the EPA guideline (11)
9[] DK (9)


Item E1
Refer to question 8a.

1[] Above 4 picocuries (9)
2[] At or below 4 picocuries (11)


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

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


10a. Has anything been done in this home to reduce the level of radon exposure?

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


b. What has been done?
Mark all that apply.

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


c. Do you or anyone plan to do anything (else) to reduce the radon level or radon exposure in this home?

1[] Yes
2[] No
3[] I did not think it was needed
9[] DK


Mark by observations or ask:
11. Which of the following best describes your home?
Read answer categories, if necessary.

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) ____
9[] DK

[p. 179]

Section F -- TOBACCO

Item F1
Refer to the "Sm" box on the HIS-1 for adult sample person.

1[] Available, "Sm" box marked (22)
2[] Available, Other (1)
3[] Callback required (Household page)
4[] Noninterview (Inside back cover, then Section R)

These next questions are about tobacco use.


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

1[] Yes (2)
2[] No (22)
9[] DK (22)


2. Around this time last year, were you smoking cigarettes every day, some days, or not at all?

1[] Every day
2[] Some days
3[] Not at all
9[] DK


3. Do you smoke cigarettes now?

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


4. Do you now smoke cigarettes every day or some days?

1[] Every day (6)
2[] Some days (13)


5. Do you now smoke cigarettes "not at all" or "some days"?

1[] Not at all (F2)
2[] Some days (13)


6. On the average, how many cigarettes do you now smoke a day?

Cigarettes a day ____ (7)
99[] DK (7)

Item F2
Refer to question 2.

1[] "Every day" in 2 (9)
8[] All others in 2 (15)

7. Have you EVER quit smoking for one day or longer?

1[] Yes (8)
2[] No (19)
9[] DK (19)


8. During the past 12 months, have you quit smoking for one day or longer?

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


9. How many times during the past 12 months have you quit smoking for one day or longer?

Times (Number) ____
99[] DK


Hand Card C1. Read answer categories if telephone interview.
CARD C1

1. I quit on purpose
2. I could not smoke because I was sick
3. I could not smoke for some other reason


10. Thinking about the most recent time you stopped smoking, which of all the following describes why you stopped?
Mark all that apply.

1[] I quit on purpose
2[] I could not smoke because I was sick
3[] I could not smoke fr some other reason
9[] DK

Item F3
Refer to questions 4 and 5.

1[] "Every day" in 4 (11)
2[] "Not at all" in 5

11a. How long ago was the start of your most recent quit attempt that lasted for one day or longer?

Month ____
Year 19____ or (12)

Number ____
1[] Days ago (12)
2[] Weeks ago (12)
3[] Months ago (if 1 year or 12 months ago, go to 11b, otherwise go to 12)
4[] Years ago (if 1 year or 12 months ago, go to 11b, otherwise go to 12)
999[] DK (11b)


b. Was it within the past year or a year or more ago?

1[] Within the past year
2[] 1 year or more
9[] DK


12. How long did you actually stay off cigarettes that time before you started smoking agin?

000[] Still off (19)

Number ____
1[] Days (19)
2[] Weeks (19)
3[] Months (19)
4[] Years (19)
999[] DK (19)


13. On how many of the past 30 days did you smoke cigarettes?

00[] None (F4)
Days ____ (F4)
99[] DK

[p. 180]

Section F -- TOBACCO -- Continued


14. On the average, when you smoked, how many cigarettes did you smoke a day?

Cigarettes a day (Number) ____
99[] DK

Item F4

Refer to question 2.

1[] "Every day" in 2 (16)
2[] All others in 2 (15)

15. Have you ever smoked cigarettes every day?

1[] Yes (16)
2[] No (F5)
9[] DK (F5)


16a. About how long has it been since you last smoked cigarettes every day?

Number ____
1[] Days (17)
2[] Weeks (17)
3[] Months (if 1 year or 12 months ago, go to 16b, otherwise go to 17)
4[] Years (if 1 year or 12 months ago, to to 16 b, otherwise go to 17)
999[] DK (16b)


b. Was it within the past year or a year or more ago?

1[] Within the past year
2[] 1 year or more ago
9[] DK

Item F5
Refer to questions 2 and 5.

1[] "Not at all" in 2 and 5 (18)
8[] All others (19a)

18. Did you smoke cigarettes at all during the past 12 months?

1[] Yes (19a)
2[] No (21)
9[] DK (21)


19a. During the past 12 months, how many different times did you stay overnight in a hospital?

00[] None (20)
Times ____ Number (19b)
99[] DK (20)


b. On how many of those hospital stays were you advised to quit smoking?

00[] None
Stays ____ Number
99[] DK


20a. During the past 12 months, how many times have you visited a doctor or other health professional? (Do not count visits while staying overnight in a hospital).

00[] None (21)
Visits ____ Number (20b)
99[] DK (21)


b. On how many of these visits were you advised to quit smoking by a doctor or other health professional?

00[] None (21)
Visits ____ Number (22)
99[] DK (21)


21. Has a doctor or other health professional ever advised you to quit smoking?

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

[p. 181]

Section F -- TOBACCO -- Continued

These next questions are about your use of other tobacco products.


22. Have you ever smoked a pipe?

1[] Yes (23)
2[] No (27)
9[] DK (27)


23. Have you smoked a pipe at least 50 times in your entire life?

1[] Yes (24)
2[] No (27)
9[] DK (27)


24. Do you smoke a pipe now?

1[] Yes (25)
2[] No (26)


25. Do you now smoke a pipe every day or some days?

1[] Every day (27)
2[] Some days (27)


26. Do you now smoke a pipe "not at all" or "some days"?

1[] Not at all
2[] Some days


27. Have you ever smoked cigars?

1[] Yes (28)
2[] No (32)
9[] DK (32)


28. Have you smoked at least 50 cigars in your entire life?

1[] Yes (29)
2[] No (32)
9[] DK (32)


29. Do you smoke cigars now?

1[] Yes (30)
2[] No (31)


30. Do you now smoke cigars every day or some days?

1[] Every day (32)
2[] Some days (32)


31. Do you now smoke cigars "not at all" or "some days"?

1[] Not at all
2[] Some days


32. Have you ever used snuff, such as Skoal, Skoal Bandits, or Copenhagen?

1[] Yes (33)
2[] No (37)
9[] DK (37)


33. Have you used snuff at least 20 times in your entire life?

1[] Yes (34)
2[] No (37)
9[] DK (37)


34. Do you use snuff now?

1[] Yes (35)
2[] No (36)


35. Do you now use snuff every day or some days?

1[] Every day (37)
2[] Some days (37)


36. Do you now use snuff "not at all" or "some days"?

1[] Not at all
2[] Some days


37. Have you ever used chewing tobacco, such as Redman, Levi Garrett, or Beechnut?

1[] Yes (38)
2[] No (Section G)
9[] DK (Section G)


38. Have you used chewing tobacco at least 20 times in your entire life?

1[] Yes (39)
2[] No (Section G)
9[] DK (Section G)


39. Do you use chewing tobacco now?

1[] Yes (40)
2[] No (41)


40. Do you now use chewing tobacco every day or some days?

1[] Every day (Section G)
2[] Some days (Section G)


41. Do you now use chewing tobacco "not at all" or "some days"?

1[] Not at all
2[] Some days

[p. 182]

Section G -- NUTRITION

These next questions are about weight control and nutrition.


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

1[] Overweight
2[] Underweight
3[] Just about right


2. Are you now trying to lose weight, gain weight, stay about the same, or are you not trying to do anything about your weight?

1[] Lose weight (3)
2[] Gain weight (4)
3[] Stay about the same (3)
4[] Not trying to do anything (4)


Hand Card G1. Read each category if telephone interview.
CARD G1

1. Joined a weight loss program
2. Eating fewer calories
3. Eating special products, such as canned or powdered food supplements
4. Exercising more
5. Fasting for 24 hours or longer
6. Skipping meals
7. Taking diet pills
8. Taking laxatives
9. Taking water pills or diuretics
10. Vomiting
98. Something else -- Specify
00. Nothing


3. Are you currently doing any of these things to control your weight?
Mark each that applies.

01[] Joined a weight loss program
02[] Eating fewer calories
03[] Eating special products, such as canned or powdered food supplements
04[] Exercising more
05[] Fasting for 24 hours or longer
06[] Skipping meals
07[] Taking diet pills
08[] Taking laxatives
09[] Taking water pills or diuretics
10[] Vomiting
98[] Something else (Specify) ____
00[] Nothing



4a. About how tall are you without shoes?

Feet ____
Inches ____


b. About how much do you weigh without shoes?

Pounds ____



5a. How often do you or the person who shops for your food buy items that are labeled "low salt" or "low sodium" -- would you say always, often, sometimes, rarely or never?

1[] Always
2[] Often
3[] Sometimes
4[] Rarely
5[] Never
9[] DK


b. How often do you add salt to your food at the table -- would you say always, often, sometimes, rarely or never?
Do not include salt substitutes.

1[] Always
2[] Often
3[] Sometimes
4[] Rarely
5[] Never
9[] DK


6a. When you buy a food item for the first time, how often would you say you read the INGREDIENT list on the package -- would you say always, often, sometimes, rarely, or never?

0[] Don't buy food (G1)
1[] Always
2[] Often
3[] Sometimes
4[] Rarely
5[] Never
9[] DK


b. When you buy a food item for the first time, how often would you say you read the information about calorie, fat and/or cholesterol content sometimes listed on the label -- would you say always, often, sometimes, rarely or never?

1[] Always
2[] Often
3[] Sometimes
4[] Rarely
5[] Never
9[] DK


Item G1
Refer to age.

1[] 65+ (7)
2[] Under 65 (Section H)


7a. Do you have meals delivered to your home by an agency or organization like Meals on Wheels?

1[] Yes (Section H)
2[] No (7b)
9[] DK (7b)


b. Do you need to have meals delivered to your home by an agency or organization like Meals on Wheels?

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

[p. 183]

Section H -- IMMUNIZATION AND INFECTIOUS DISEASES


The next questions are about foreign travel and the prevention of communicable diseases.
1a. During the past 5 years, did you travel outside the U.S. or Canada?

1[] Yes (1b)
2[] No (Section I)
9[] DK (Section I)


b. During the past 5 years, how many trips did you make outside the U.S. or Canada?

Trips ____ Number
99[] DK


c. In which year(s) did you take the(se) trip(s)?
Mark all that apply.

1[] 1991
2[] 1990
3[] 1989
4[] 1988
5[] 1987
6[] 1986
9[] DK


Hand Card H1. Read each category if telephone interview.
CARD H1

1. Europe
2. Middle East
3. East Africa
4. West Africa
5. Central Africa
6. Northern Africa
7. Southern Africa
8. Asia or Pacific Islands
9. Australia or New Zealand
10. Mexico
11. Central America
12. Caribbean
13. South America
98. Other -- Specify

d. Where did you travel during the past 5 years?
Mark each that applies.
If Africa, ask: "Was that East Africa, West Africa, Central Africa, Northern Africa, or Southern Africa?"

01[] Europe
02[] Middle East
03[] East Africa
04[] West Africa
05[] Central Africa
06[] Northern Africa
07[] Southern Africa
08[] Asia or Pacific Islands
09[] Australia or New Zealand
10[] Mexico
11[] Central America
12[] Caribbean
13[] South America
98[] Other (Specify) ____
99[] DK


Item H1
Refer to question 1d.

1[] Only Box 01 "Europe" marked (Section I)
8[] Other (2)

2a. Before you left on (any of) your trip(s), did you get any shots to prevent infectious diseases?

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


Hand Card H2. Read each category if telephone interview.
CARD H2

0. Cholera vaccine
1. Gamma globulin or immune globulin
2. Hepatitis B vaccine
3. Meningococcal vaccine
4. Rabies vaccine
5. Typhoid fever vaccine
6. Yellow fever vaccine
8. Other (Specify)

b. Which shots did you receive? Any others?
Mark each that applies.

0[] Cholera
1[] Gamma globulin or immune globulin
2[] Hepatitis B
3[] Meningococcal meningitis
4[] Rabies
5[] Typhoid fever
6[] Yellow fever
8[] Other (Specify) ____
9[] DK


3a. Before or during (any of) your trip(s), did you take any prescription medicine to PREVENT malaria?

1[] Yes (3b)
2[] No (Section I)
9[] DK (Section I)


Hand Card H3. Read each category if telephone interview.
CARD H3

1. Aralen (Chloroquine phosphate)
2. Doxycycline
3. Fansidar (Pyrimethamine Sulfadoxine)
4. Lariam (Mefloquine)
5. Paludrine (Proguanil)
6. Plaquenil (Hydroxy-cholroquine sulfate)
8. Other -- Specify

b. Which medications did you take? Any others?
Mark each that applies.

1[] Aralen (AIR-uh-len) Chloroquine phosphate (Klo-roh-KWIN fos-FATE)
2[] Doxycycline (dox-i-SIGH--kleen)
3[] Fansidar (Fan-see-DAR; last syllable rhymes with car) Pyrimethamine Sulfadoxine (Pie-rih-METH-uh-mean sulfa-DOX-een)
4[] Lariam (LAIR-e-am) Mefloquine (meh-flow-KWIN); e in first syllable has short vowel sound.
5[] Paludrine (Pal-you-DRUN) Proguanil (Pro-GWAN-nil)
6[] Plaquenil (Plah-GWAN-nil) Hydroxy-chloroquine sulfate (hi-DROCKS-e kloro-KWIN sul-FATE)
8[] Other (Specify) ____
9[] DK

[p. 184]

Section I -- OCCUPATIONAL SAFETY AND HEALTH

Item I1
Refer to "Wa/Wb" boxes in C1 on HIS-1.

1[] Wa or Wb box marked (Item I2)
8[] Other (Section J)
Item I2
Refer to 6g on page 44 or 45 on HIS-1.

1[] Entry of P, F, S or L (1)
8[] Other (Section J)

These next questions are about health and safety in the work place.
1. [You told me/I was told] that you were employed during the past two weeks. How long have you worked at your main job?

000[] Less than one month

Number ____
1[] Months
2[] Years
996[] Not employed in past 2 weeks (section J)
999[] DK


2a. Altogether, does your employer have 50 or more employees?

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


b. Does your employer have 50 or more employees at the building or location where you work?

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


3. How many hours did you work at your main job during the past two weeks?

Hours ____ Number
00[] Did not work in past 2 weeks (7)
99[] DK


4a. During the past 2 weeks, did you drive or travel in a motor vehicle AS PART OF YOUR JOB? Do not count air travel or time spent traveling to and from work.

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


b. During the past 2 weeks, what kind of vehicle did you spend the most time traveling in as part of you work.
Mark only one.

1[] Car
2[] Light truck/van
3[] Heavy truck
4[] Motorcycle
5[] Motorized bicycle/moped
6[] Taxi
7[] Bus/trolley
8[] Other vehicle (Specify) ____
9[] DK


c. During the past 2 weeks, about how many hours did you drive or travel in a (vehicle in 4b) as part of your job? Do not count time spent traveling to and from your job.

00[] None
Hours ____ Number
99[] DK


d. Does your employer require you to use vehicle safety devices, such as seat belts, helmets, or other types of protection? Do not count use when traveling to and from your job.

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


Hand card I1. Read all categories if telephone interview.
CARD I1

1. Private enclosed office with door
2. Enclosed office with door shared with one or more other persons
3. Cubicle with floor to ceiling bookcases or partitions and no door
4. Cubicle surrounded by mid-height bookcases or partitions
5. Open office areas
6. In one building, but no regular work area
7. Mainly work outdoors
8. Travel to different buildings or sites
9. In a motor vehicle
98. Other -- Specify

The next few questions are about smoking at work.
5. Which of these best describes the area in which you work most of the time?
Mark only one.

01[] Private enclosed office with door
02[] Enclosed office with door shared with one or more other persons
03[] Cubicle with floor to ceiling bookcases or partitions and no door
04[] Cubicle surrounded by mid-height bookcases or partitions
05[] Open office areas
06[] In one building, but no regular work area (7)
07[] Mainly work outdoors (7)
08[] Travel to different buildings or sites (8)
09[] In a motor vehicle (8)
98[] Other -- Specify -- ____ (8)
99[] DK (8)

[p. 185]

Section I -- OCCUPATIONAL SAFETY AND HEALTH -- Continued


6a. During the past 2 weeks, has anyone smoked in your immediate work area?

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


b. In general, would you say that your immediate work area is very smoky, somewhat smoky, a little smoky, or not smoky at all?

1[] Very smoky
2[] Somewhat smoky
3[] A little smoky
4[] Not smoky at all
9[] DK


c. Is smoking allowed in your immediate work area?

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


7a. Does your employer have an official policy that restricts smoking in any way?

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


Hand card I2. Read all categories if telephone interview.
CARD I2

1. Not allowed in any indoor or common public areas
2. Allowed in some public areas, including designated smoking areas
3. Allowed in all indoor or common public areas

b. Which of these best describes your employer's smoking policy for indoor public or common areas, such as lobbies, rest rooms, and lunch rooms?
Mark only one.

1[] Not allowed in any indoor or common public areas
2[] Allowed in some public areas, including designated smoking areas
3[] Allowed in all indoor or common public areas
9[] DK


Hand card I3. Read all categories if telephone interview.
CARD I3

1. Not allowed in any work areas
2. Allowed in some work areas
3. Allowed in all work areas

c. Which of these best describes your employer's smoking policy for work areas?
Mark only one.

1[] Not allowed in any work areas
2[] Allowed in some work areas
3[] Allowed in all working areas
9[] DK


8. Does your employer offer a quit smoking program or any other help to employees who want to quit smoking?

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


9a. Not counting Medicare or Medicaid, are you now covered by a health insurance plan which pays any part of hospital or doctor bills?

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


b. Does your health insurance cover any part of the cost of quit smoking programs or other treatment for quitting smoking?

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


Hand Card I4. Read each category if telephone interview.
CARD I4

1. Walking group
2. Jogging/Running group
3. Biking/Cycling group
4. Aerobics classes
5. Swimming classes
6. Non-aerobic exercise classes
7. Weight lifting classes
8. Fully paid membership in health/fitness club
9. Partially paid membership in health/fitness club
10. Physical activity or exercise competitions
98. Other -- Specify
00. No programs

10a. Which of these exercise programs are made available to you by your employer?
Mark each that applies.

01[] Walking group
02[] Jogging/Running group
03[] Biking/Cycling group
04[] Aerobics classes
05[] Swimming classes
06[] Non-aerobic exercise classes
07[] Weight lifting classes
08[] Fully paid membership in health/fitness club
09[] Partially paid membership in health/fitness club
10[] Physical activity or exercise competitions
98[] Other -- Specify -- ____
00[] No programs
99[] DK


Hand Card I5. Read each category if telephone interview.
CARD I5

1. Gymnasium/Exercise room
2. Weight lifting equipment
3. Exercise equipment
4. Walking/Jogging path
5. Parcours/Fitness trails
6. Bike path
7. Bike racks
8. Swimming pool
9. Showers
10. Lockers
98. Other -- Specify
00. No facilities

b. Which of these exercise facilities are made available to you by your employer, on the premises?
Mark each that applies.

01[] Gymnasium/Exercise room
02[] Weight lifting equipment
03[] Exercise equipment
04[] Walking/Jogging path
05[] Parcours/Fitness trails
06[] Bike path
07[] Bike racks
08[] Swimming pool
09[] Showers
10[] Lockers
98[] Other (Specify) ____
00[] No facilities
99[] DK

[p. 186]

Section J -- HEART DISEASE AND STROKE

These next questions are about health conditions.

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

0[] Borderline (2)
1[] Yes (2)
2[] No (6)
3[] Only during pregnancy (6)
9[] DK (3)


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

1[] Yes
2[] No
3[] Only during pregnancy (6)
9[] DK


3a. Has a doctor or other health professional EVER advised you to go on a diet or change your eating habits to help lower your high blood pressure?

1[] Yes (3b)
2[] No (4)
9[] DK (4)

b. Did you ever follow this advice?

1[] Yes (3c)
2[] No (4)
9[] DK (4)

c. Are you now following this advice?

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


4a. Was any medication ever prescribed by a doctor to help you lower your high blood pressure?

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


b. Did you EVER take this medication?

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


c. Are you NOW taking this medication?

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


5a. Do you still have high blood pressure?

1[] Yes (6)
2[] No (5b)
9[] DK (5b)


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

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


6. About how long has it been since you had your blood pressure checked by a doctor or other health professional?

000[] Never (8)

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


7. At that time, did the doctor or other health professional say your blood pressure was high, low, or normal?

1[] Not told
2[] High
3[] Low
4[] Normal
5[] Borderline
8[] Other (Specify -- ____
9[] DK

[p. 187]

Section J -- HEART DISEASE AND STROKE -- Continued

These next questions are about blood cholesterol.


8. When was the last time you had your blood cholesterol checked by a doctor or other health professional?

0[] Never (Section K)
1[] Less than 1 year
2[] 1 year, less than 2 years
3[] 2 years, less than 3 years
4[] 3 years, less than 3 years
5[] 4+ years
9[] DK


9a. Has a doctor or other health professional ever advised you to go on a diet or change your eating habits to lower your cholesterol?

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

b. Did you ever follow this advice?

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

c. Are you NOW following this advice?

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


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

1[] Yes (11)
2[] No (Section K)
9[] DK (Section K)


11a. Was any medication EVER prescribed by a doctor to help lower your cholesterol level?

[] 1 Yes (11b)
[] 2 No (Section K)
[] 9 DK (Section K)

b. Did you EVER take this medication?

1[] Yes (11c)
2[] No (Section K)
9[] DK (Section K)

c. Are you NOW taking this medication?

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

[p. 188]

Section K -- OTHER CHRONIC AND DISABLING CONDITIONS

These next questions are about health conditions.


1. Have you EVER been told by a doctor that you had diabetes? Do not include pre, potential, or borderline diabetes.

1[] Yes (2)
2[] No (11)
9[] DK (11)

Ask if female, otherwise go to 4:

2. Were you pregnant when you were first told that you had diabetes?

1[] Yes (3)
2[] No (4)
9[] DK (4)


3. Other than during pregnancy, did a doctor EVER tell you that you had diabetes? Do not include pre, potential, or borderline diabetes.

1[] Yes (4)
2[] No (11)
9[] DK (11)


4. How old were you when your diabetes was diagnosed?

Years old ____
99[] DK


5. Are you now taking insulin?

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


6a. In the past 6 months, on your own, about how often did you check your blood for glucose or sugar? Include times when checked by a family member or friend.

000[] Never

Times per ____
1[] Day
2[] Week
3[] Month
4[] Year
999[] DK


b. In the past 6 months, about how many times has a health professional checked your blood for glucose or sugar? Do not count times when an overnight patient in a hospital.

00[] None
Times ____
99[] DK


If "Never" in 6a AND "None" in 6b, mark Box O; otherwise, ask:
7. Based on ALL your blood sugar tests during the past 6 months, how often would you say your blood sugar level has been too high? Would you say always, most of the time, some of the time, rarely, or never?

0[] No test in past 6 months
1[] Always
2[] Most of the time
3[] Some of the time
4[] Rarely
5[] Never
9[] DK


8a. Have you EVER been told that diabetes has affected the back of your eyes, that is, the retina?

1[] Yes (8b)
2[] No (10)
9[] DK (10)


b. How old were you when the doctor first told you this?

Years old ____
99[] DK


9a. Have you ever had laser or photocoagulation treatment for this problem? Do not include treatments for cataracts.

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


b. Did you receive this treatment within the past 12 months?

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


c. Was this the first time you had this treatment?

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


10a. Have you ever taken a course or class in how to manage your diabetes yourself?

1[] Yes (11)
2[] No (10b)
9[] DK (10b)


b. Would you like to take a course or class in how to manage your diabetes yourself?

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

[p. 189]

Section K -- OTHER CHRONIC AND DISABLING CONDITIONS -- Continued


11. Do you have trouble seeing with one or both eyes even when wearing glasses or contact lenses?

1[] Yes (12)
2[] No (13)
9[] DK (13)


12. Are you blind in one or both eyes?
If "Yes," ask: In one or both?

[] Yes
0[] One
1[] Both
2[] No


13. In the past two years, have you had any kind of eye exam by a medical doctor? Do not include visits to an optometrist or optician.

1[] Yes (14)
2[] No (16)
9[] DK (16)


14. In the past 12 months, have you seen a ophthalmologist, that is, a medical doctor who specializes in eye care?

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


15. In the past 12 months, have you had any kind of eye exam by any (other) kind of medical doctor?

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


16a. Have you ever had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light.

1[] Yes (16b)
2[] No (18)
9[] DK (18)


b. When was the last time you had this exam?

1[] Less than 1 month
2[] 1 month, less than 1 year
3[] 1 year, less than 2 years
4[] 2 years or more
9[] DK


17. Have you ever had photographs taken of the retina or inside of your eyes?

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


18a. Has a doctor ever told you that you had glaucoma?

1[] Yes (18b)
2[] No (18c)
9[] DK (18c)


b. Are you now using medication for glaucoma?

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


c. Is there a history of glaucoma in your family?

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


19. Has a doctor EVER told you that you had cataracts?

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


20a. During the past 12 months, have you had asthma?

1[] Yes (20b)
2[] No (21)
9[] DK (21)


b. Have you ever taken a course or class in how to manage your asthma yourself?

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

[p. 190]

Section K -- OTHER CHRONIC AND DISABLING CONDITIONS -- Continued

Ask all of 21a before going to 21b.
The next questions are about how well you are able to do certain activities.


21a. Because of any physical or mental condition, do you have difficulty --
If "Doesn't do," ask before marking a box: Is this because of a physical or mental health condition? If "Yes," mark "Yes." If "No," mark "Doesn't do."


(1) Lifting and carrying something as heavy as 10 lbs., such as a full bag of groceries?
1[] Yes
2[] No
3[] Doesn't do


(2) Climbing a flight of stairs without resting?
1[] Yes
2[] No
3[] Doesn't do


(3) Walking a quarter of a mile -- about 3 city blocks?
1[] Yes
2[] No
3[] Doesn't do


(4) Doing heavy work around the house, such as scrubbing floors or washing windows?
1[] Yes
2[] No
3[] Doesn't do


(5) Shopping for personal items, such as food or medication?
1[] Yes
2[] No
3[] Doesn't do


(6) Going outside the home alone, such as to shop or visit a doctor's office?
1[] Yes
2[] No
3[] Doesn't do


(7) Doing light work around the house, such as washing dishes or doing light yard work?
1[] Yes
2[] No
3[] Doesn't do


(8) Preparing your meals?
1[] Yes
2[] No
3[] Doesn't do


Because of any physical or mental condition, do you have difficulty --


(9) Managing your money, such as keeping track of expenses or paying bills?
1[] Yes
2[] No
3[] Doesn't do


(10) Using a telephone?
1[] Yes
2[] No
3[] Doesn't do


(11) Getting around inside the home?

1[] Yes
2[] No
3[] Doesn't do


(12) Walking?
1[] Yes
2[] No
3[] Doesn't do


(13) Getting in and out of bed or chairs?
1[] Yes
2[] No
3[] Doesn't do


(14) Eating?
1[] Yes
2[] No
3[] Doesn't do


(15) Using the toilet, including getting to and from the toilet?
1[] Yes
2[] No
3[] Doesn't do


(16) Bathing or showering?
1[] Yes
2[] No
3[] Doesn't do


(17) Dressing?
1[] Yes
2[] No
3[] Doesn't do


Ask 21b for each activity marked "Yes" in 21a.
b. Do you need help from another person (activity in 21a)?


(1) Lifting and carrying something as heavy as 10 lbs., such as a full bag of groceries
1[] Yes
2[] No


(2) Climbing a flight of stairs without resting
1[] Yes
2[] No


(3) Walking a quarter of a mile -- about 3 city blocks
1[] Yes
2[] No


(4) Doing heavy work around the house, such as scrubbing floors or washing windows?
1[] Yes
2[] No


(5) Shopping for personal items, such as food or medication
1[] Yes
2[] No


(6) Going outside the home alone, such as to shop or visit a doctor's office
1[] Yes
2[] No


(7) Doing light work around the house, such as washing dishes or doing light yard work?
1[] Yes
2[] No


(8) Preparing your meals
1[] Yes
2[] No


(9) Managing your money, such as keeping track of expenses or paying bills
1[] Yes
2[] No


(10) Using a telephone
1[] Yes
2[] No


(11) Getting around inside the home
1[] Yes
2[] No


(12) Walking
1[] Yes
2[] No


(13) Getting in and out of bed or chairs
1[] Yes
2[] No


(14) Eating?
1[] Yes
2[] No


(15) Using the toilet, including getting to and from the toilet
1[] Yes
2[] No


(16) Bathing or showering
1[] Yes
2[] No


(17) Dressing
1[] Yes
2[] No


Item K1
Refer to age.

1[] 65 and over (22)
8[] Other (Section L)


22a. Do you have trouble controlling your urination?

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


b. Do you have a urinary catheter or a device to help control urination?

1[] Yes
2[] No

Item K2
Refer to 22a and b. Mark first appropriate box.

1[] "Yes" in 22b (Section L)
2[] "Yes" in 22a (23)
8[] Other (Section L)

23. Have YOU told your doctor or other health professional about the trouble you have controlling your urination?

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

[p. 191]

Section L -- CLINICAL AND PREVENTIVE SERVICES

The next questions are about prevention of injury and illness.

1a. When driving or riding in the front seat of a car, do you wear a seat belt all or most of the time, some of the time, once in awhile, or never?

1[] All or most of the time
2[] Some of the time
3[] Once in awhile
4[] Never
5[] Don't ride in front seat
6[] Don't ride in a car (2)
9[] DK


b. When riding in the back seat of a car, do you wear a seat belt all or most of the time, some of the time, once in awhile, or never?

1[] All or most of the time
2[] Some of the time
3[] Once in awhile
4[] Never
5[] Don't ride in front seat
6[] Don't ride in a car
9[] DK


2a. 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 (3)


b. 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


These next questions are about medical check-ups and routine tests.
3. About how long has it been since your last routine check-up by a medical doctor or other health professional?

1[] Less than 1 year
2[] 1 year, less than 2 years
3[] 2 years, less than 3 years
4[] 3 years, less than 4 years
5[] 4+ years
6[] Never (8)
9[] DK


4. During this last check-up, were you asked about --


a. Your diet and eating habits?

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




b. The amount of physical activity or exercise you get?

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




c. Whether you smoke cigarettes or use other forms of tobacco?

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




d. How much and how often you drink alcohol?

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



e. Whether you use marijuana, cocaine, or other drugs?

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




f. Sexually transmitted diseases?

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


Ask only if SP is less than 50 otherwise, skip to 5.

The use of contraceptives?
1[] Yes
2[] No
9[] DK


5. During this last check-up, did you have any of the following things checked --


a. Your blood pressure?

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



b. Your cholesterol level?

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




c. Your height?

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




d. Your weight?

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

[p. 192]

Section L -- CLINICAL AND PREVENTIVE SERVICES -- Continued


Item L1
Refer to age.

1[] SP is 65+ (6)
8[] Other (8)


6a. During this last check-up, were you asked about the symptoms of a transient ischemic attack(TIA)?
Read if necessary: This is an episode of weakness or paralysis in the arms and legs, loss of vision, speech, or memory, and facial droop that lasted for less than 24 hours?

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


b. During this last check-up, were you asked about whether you have difficulty taking care of yourself, including dressing, using the toilet, bathing, eating, or getting around inside your home without help?

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


c. During this last check-up, were you asked about whether you have difficulty doing every day activities and chores, including preparing your meals, managing your money, using the telephone, doing light housework, and shopping?

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


7. During this last check-up, did you have --


A vision test to see how well you see?
1[] Yes
2[] No
9[] DK


b. A hearing test?
1[] Yes
2[] No
9[] DK


c. A urine test?
1[] Yes
2[] No
9[] DK


d. A blood test to check your thyroid function?
1[] Yes
2[] No
9[] DK


e. A stool test to check for blood in the stool?
1[] Yes
2[] No
9[] DK


8. During the past 12 months, have you had a flu shot?
Read if necessary: This vaccination is usually given in the fall and protects against influenza for the flu season.

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


9. Have you EVER had a pneumonia vaccination? This shot is given only once in a person's lifetime.

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


10. During the past TEN years, have you had a tetanus shot?

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

Item L2
Refer to sex.

1[] Male (Section M)
2[] Female (11)

11. During the past 12 months, did you have a pap smear or pap test to check for cancer of the cervix?

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


12. Have you had a hysterectomy?

1[] Yes
2[] No


Item L3
Refer to age.

1[] Under 40 (Section M)
2[] 40+ (13)


13a. During the past 12 months, have you had a breast physical exam in which a medical doctor or health professional checked your breasts for lumps?

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


b. During the past two years have you had a mammogram?
Read if necessary: That is, an x-ray taken only of the breasts by a machine that presses against the breast while the picture is taken.

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

[p. 193]

Section M -- PHYSICAL ACTIVITY AND FITNESS

These next questions are about physical exercise.


Item M1
Mark from observation or previous information.

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


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 (1b)
2[] No (3 on page 40)
9[] DK (3 on page 40)


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

c. Anything else?

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

[p. 194]

Section M -- PHYSICAL ACTIVITY AND FITNESS -- Continued

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


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


(2) Gardening or yard work?
1[] Yes
2[] No


(3) Stretching exercises?
1[] Yes
2[] No


(4) Weightlifting or other exercises to increase muscle strength?
1[] Yes
2[] No


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


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


(7) Riding a bicycle or exercise bike?
1[] Yes
2[] No


(8) Stair climbing?
1[] Yes
2[] No


(9) Swimming for exercise?
1[] Yes
2[] No


(10) Playing tennis?
1[] Yes
2[] No


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


(12) Playing golf?
1[] Yes
2[] No


(13) Playing baseball or softball?
1[] Yes
2[] No


(14) Playing handball, racquetball, or squash?
1[] Yes
2[] No


(15) Skiing?


1[] Yes


(a) Downhill
1[] Yes
2[] No


(b)Cross-country
1[] Yes
2[] No


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


2[] No


(16) Playing basketball?
1[] Yes
2[] No


(17) Playing volleyball?
1[] Yes
2[] No


(18) Playing soccer?
1[] Yes
2[] No


(19) Playing football?
1[] Yes
2[] No


(20) Have you done any (other) exercises, sports, or physically active hobbies in the past 2 weeks?
1[] Yes- What were they? Anything else? If listed activity, mark "Yes" for that activity, otherwise, specify ____
2[] No
Anything else?
1[] Yes ____
2[] No


NOTE: ASK 2b-d FOR EACH ACTIVITY MARKED "YES" IN 2a.
b. How many times in the past 2 weeks did you (go/do) (activity in 2a)?


(1) Walking for exercise?
Times ____


(2) Gardening or yard work?
Times ____


(3) Stretching exercises?
Times ____


(4) Weightlifting or other exercises to increase muscle strength?
Times ____


(5) Jogging or running?
Times ____


(6) Aerobics or aerobic dancing?
Times ____


(7) Riding a bicycle or exercise bike?
Times ____


(8) Stair climbing?
Times ____


(9) Swimming for exercise?
Times ____


(10) Playing tennis?
Times ____


(11) Bowling
Times ____ (Next activity)


(12) Playing golf
Times ____ (Next activity)


(13) Playing baseball or softball
Times ____


(14) Playing handball, racquetball, or squash
Times ____


(15) Skiing


(a) Downhill
Times ____ (Next activity)


(b)Cross-country
Times ____


(c) Water
Times ____ (Next activity)


(16) Playing basketball
Times ____


(17) Playing volleyball
Times ____


(18) Playing soccer
Times ____


(19) Playing football
Times ____


(20) Have you done any (other) exercises, sports, or physically active hobbies in the past 2 weeks
Times ____
Anything else
Times ____


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


(1) Walking for exercise
Minutes ____


(2) Gardening or yard work
Minutes ____


(3) Stretching exercises
Minutes ____ (Next activity)


(4) Weightlifting or other exercises to increase muscle strength
Minutes ____


(5) Jogging or running
Minutes ____


(6) Aerobics or aerobic dancing
Minutes ____


(7) Riding a bicycle or exercise bike
Minutes ____


(8) Stair climbing
Minutes ____


(9) Swimming for exercise
1[] Times ____


(10) Playing tennis
Minutes ____


(13) Playing baseball or softball
Minutes ____


(14) Playing handball, racquetball, or squash
Minutes ____


(15) Skiing
(b)Cross-country
Minutes ____


(16) Playing basketball
Minutes ____


(17) Playing volleyball
Minutes ____


(18) Playing soccer
Minutes ____


(19) Playing football
Minutes ____


(20) Have you done any (other) exercises, sports, or physically active hobbies in the past 2 weeks
Minutes ____
Anything else
Minutes ____


d. (What usually happened to your heart rate or breathing when you (did/went) (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
0[] No. inc
9[] DK


(2) Gardening or yard work
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(4) Weightlifting or other exercises to increase muscle strength
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(5) Jogging or running
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(6) Aerobics or aerobic dancing
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(7) Riding a bicycle or exercise bike
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(8) Stair climbing
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(9) Swimming for exercise
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(10) Playing tennis
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(13) Playing baseball or softball
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(14) Playing handball, racquetball, or squash
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(15) Skiing
(b)Cross-country
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(16) Playing basketball
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(17) Playing volleyball
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(18) Playing soccer
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(19) Playing football
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK


(20) Have you done any (other) exercises, sports, or physically active hobbies in the past 2 weeks
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK
Anything else
1[] Small
2[] Moderate
3[] Large
0[] No. inc
9[] DK

[p. 195]

Section M -- PHYSICAL ACTIVITY AND FITNESS -- Continued

Item M2
Refer to Section L, question 3 on page 36 about last routine check-up.

1[] Less than1year (3)
8[] Other (Section N)

3. During your last routine check-up, did the doctor or other health professional recommend that you begin or continue to do any type of exercise or physical activity?
If "Yes," ask if this was to begin or continue.

1[] Yes, to BEGIN (4a)
2[] Yes, to CONTINUE (4a)
3[] Yes, Both (4a)
4[] No (Section N)
9[] DK (Section N)


4a. What type of exercise or physical activity did the doctor or other health professional recommend that you (begin (or) continue) to do?
Read all categories.


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


(2) Riding a bicycle or exercise bike?
1[] Yes
2[] No


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


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


(5) Walking?
1[] Yes
2[] No


(6) Other aerobic type exercise?
1[] Yes
2[] No


(7) Exercises to increase muscle strength?
1[] Yes
2[] No


(8) Stretching exercises?
1[] Yes
2[] No


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


Ask 4b, c, and d for each activity marked "Yes" in 4a.
b. How many times per week did the doctor or other health professional tell you to (play/go/do) (activity in 4a)?


(1) Aerobics or aerobic dancing
Times ____
97[] No rec.


(2) Riding a bicycle or exercise bike
Times ____
97[] No rec.


(3) Jogging or running
Times ____
97[] No rec.


(4) Swimming laps or water exercises
Times ____
97[] No rec.


(5) Walking
Times ____
97[] No rec.


(6) Other aerobic type exercise
Times ____
97[] No rec.


(7) Exercises to increase muscle strength
Times ____
97[] No rec.


(8) Stretching exercises
Times ____
97[] No rec.


(9) Other (Specify) ____
Times ____
97[] No rec.


c. How many minutes did the doctor or other health professional tell you to spend (playing/going/doing) (activity in 4a) each time that you do it?


(1) Aerobics or aerobic dancing
Minutes ____
997[] No rec.


(2) Riding a bicycle or exercise bike
Minutes ____
997[] No rec.


(3) Jogging or running
Minutes ____
997[] No rec.


(4) Swimming laps or water exercises
Minutes ____
997[] No rec.


(5) Walking
Minutes ____
997[] No rec.


(6) Other aerobic type exercise
Minutes ____
997[] No rec.


(7) Exercises to increase muscle strength
Minutes ____
997[] No rec.


(8) Stretching exercises
Minutes ____
997[] No rec.


(9) Other (Specify) ____
Minutes ____
997[] No rec.


Hand card M1. Read all categories if telephone interview. Mark all that apply.
CARD M1

0. No recommendation was made
1. Measure heart rate or pulse
2. Pay attention to rate or depth of breathing
3. Told to work up a sweat
4. Measure the distance or speed of walking/cycling/swimming, etc.
5. The talk test -- exercising to the level that talking is difficult
8. Other


d. Which of these ways, if any, did the doctor or other health professional recommend to check how hard you should exercise?


(1) Aerobics or aerobic dancing
0[] No rec.
1[] Heart
2[] Breath
3[] Sweat
4[] Distance/speed
5[] Talk
8[] Other


(2) Riding a bicycle or exercise bike
0[] No rec.
1[] Heart
2[] Breath
3[] Sweat
4[] Distance/speed
5[] Talk
8[] Other


(3) Jogging or running
0[] No rec.
1[] Heart
2[] Breath
3[] Sweat
4[] Distance/speed
5[] Talk
8[] Other


(4) Swimming laps or water exercises
0[] No rec.
1[] Heart
2[] Breath
3[] Sweat
4[] Distance/speed
5[] Talk
8[] Other


(5) Walking
0[] No rec.
1[] Heart
2[] Breath
3[] Sweat
4[] Distance/speed
5[] Talk
8[] Other


(6) Other aerobic type exercise
0[] No rec.
1[] Heart
2[] Breath
3[] Sweat
4[] Distance/speed
5[] Talk
8[] Other


(9) Other (Specify) ____
0[] No rec.
1[] Heart
2[] Breath
3[] Sweat
4[] Distance/speed
5[] Talk
8[] Other

[p. 196]

Section N -- ALCOHOL


These next questions are about drinking alcohol beverages. Included are liquor, such as whiskey or gin, beer, wine, and any other type of alcoholic beverage.

1. Have you had at least one drink of beer, wine, or liquor during the past year?

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


Hand calendar.
2. During 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?

00[] None/never (4)
Days [number] ____ (3)
14[] Everyday (3)
99[] DK (3)


3. On the (number in 2) day(s) that you drank alcoholic beverages, how many drinks did you have (per day on the average)?

Drinks/day ____ Number

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 (Section O)
2[] No (4b)
9[] DK (4b)


b. During that 2-week period, did you drink more or less than usually?

1[] More
2[] Less
9[] DK


[p. 197]

Section O -- MENTAL HEALTH


These questions are about how you have been feeling emotionally.

Hand Card O1. Read categories, if telephone interview.

CARD O1

0. Never
1. Rarely
2. Sometimes
3. Often
4. Very often


1. During the past 2 weeks, how often have you felt bored?

0[] Never
1[] Rarely
2[] Sometimes
3[] Often
4[] Very often
9[] DK


2. (During the past 2 weeks,) How often have you felt so restless that you could hardly sit still?

0[] Never
1[] Rarely
2[] Sometimes
3[] Often
4[] Very often
9[] DK


3. (During the past 2 weeks,) How often have you felt depressed or very low about something?

0[] Never
1[] Rarely
2[] Sometimes
3[] Often
4[] Very often
9[] DK


4. (During the past 2 weeks,) How often have you felt upset because of something someone said about you?

0[] Never
1[] Rarely
2[] Sometimes
3[] Often
4[] Very often
9[] DK


5. (During the past 2 weeks,) How often have you felt very lonely or abandoned?

0[] Never
1[] Rarely
2[] Sometimes
3[] Often
4[] Very often
9[] DK

[p. 198]

Section P -- ORAL HEALTH

These next questions are about oral health.


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

00[] None
Dental visits ____ Number
99[] DK


2. Have you lost ALL of your UPPER natural teeth?

1[] Yes
2[] No


3. Have you lost ALL of your LOWER natural teeth?

1[] Yes
2[] No