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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?

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

3. Was your home built before 1950?

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.

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

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

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

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

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

Item E1
Refer to question 8a.

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

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

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

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

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

[p. 179]

Section F -- TOBACCO

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

These next questions are about tobacco use.

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

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

3. Do you smoke cigarettes now?

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

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

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

Item F2
Refer to question 2.

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?

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

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

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

Item F3
Refer to questions 4 and 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?

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

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

[p. 180]

Section F -- TOBACCO -- Continued

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

Item F4

Refer to question 2.

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?

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

Item F5
Refer to questions 2 and 5.

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?

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

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).

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

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

[p. 181]

Section F -- TOBACCO -- Continued

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

22. Have you ever smoked a pipe?

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

24. Do you smoke a pipe now?

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

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

27. Have you ever smoked cigars?

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

29. Do you smoke cigars now?

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

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

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

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

34. Do you use snuff now?

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

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

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

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

39. Do you use chewing tobacco now?

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

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

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?

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

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

4a. About how tall are you without shoes?

b. About how much do you weigh without shoes?

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?

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.

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?

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?

Item G1
Refer to age.

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

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

[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?

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

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

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

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?"

Item H1
Refer to question 1d.

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

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

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

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

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

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

[p. 184]

Section I -- OCCUPATIONAL SAFETY AND HEALTH

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

Item I2
Refer to 6g on page 44 or 45 on HIS-1.

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?

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

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

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.

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.

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.

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.

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

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.

[p. 185]

Section I -- OCCUPATIONAL SAFETY AND HEALTH -- Continued

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

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

c. Is smoking allowed in your immediate work area?

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

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

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.

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

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

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

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

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

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

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

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

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

[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?

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

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?

b. Did you ever follow this advice?

c. Are you now following this advice?

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

b. Did you EVER take this medication?

c. Are you NOW taking this medication?

5a. Do you still have high blood pressure?

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

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

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

[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?

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?

b. Did you ever follow this advice?

c. Are you NOW following this advice?

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

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

b. Did you EVER take this medication?

c. Are you NOW taking this medication?

[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.

Ask if female, otherwise go to 4:

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

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

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

5. Are you now taking insulin?

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.

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.

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?

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

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

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

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

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

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

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

[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?

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

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.

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

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

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

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

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

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

b. Are you now using medication for glaucoma?

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

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

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

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

[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."

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

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

Item K1
Refer to age.

22a. Do you have trouble controlling your urination?

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

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

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?

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?

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?

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?

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?

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

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 --

[p. 192]

Section L -- CLINICAL AND PREVENTIVE SERVICES -- Continued

Item L1
Refer to age.

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?

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?

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?

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

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.

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

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

Item L2
Refer to sex.

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?

Item L3
Refer to age.

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?

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.

[p. 193]

Section M -- PHYSICAL ACTIVITY AND FITNESS

These next questions are about physical exercise.

Item M1
Mark from observation or previous information.

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. 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 --

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)?

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

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?

[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.

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.

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)?

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?

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

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

[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?

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?

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

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

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

[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

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

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

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

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

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

[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?

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

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