[p. 169]
Section B -- ACCULTURATION
ITEM B1
SP Status
2[] Callback required (Household page)
3[] Noninterview (Section L)
ITEM B2
Refer to Hispanic origin in 4e and f on page 2 and 3 of HIS-1 and expected language for this supplement.
2[] Hispanic/Spanish Supp. interview (1b)
8[] Other (Section C)
Read to respondent:
I'm going to be asking questions that are related to health concerns, such as smoking, eating practices, vitamin use and so forth. Before I ask these questions I would like to ask a few questions about the language you use most often.
1a. Do you speak any Spanish?
2[] No (4)
Read to respondent:
I'm going to be asking questions that are related to health concerns, such as smoking, eating practices, vitamin use and so forth. Before I ask these questions I would like to ask a few questions about the language you use most often.
b. Do you speak any English?
2[] No (4)
2. Would you say that you speak mostly Spanish, mostly English, or do you speak Spanish and English about the same?
2[] Mostly English
3[] Both about the same
3. What language do you prefer: Spanish only, mostly Spanish, mostly English, English only, or Spanish and English about equally?
Mark only one.
2[] Mostly Spanish
3[] Mostly English
4[] English only
5[] Spanish and English equally
2[] No
2[] No
Ask if "Yes" to both 4 and 5; otherwise skip to 7.
6. In which language do you read better?
2[] English
3[] Both the same
2[] No
2[] No
Ask if "Yes" to both 7 and 8; otherwise skip to 10.
9. In which language do you write better?
2[] English
3[] Both the same
10. Which of these groups best describes your national origin?
HAND CARD B. Read categories if telephone interview.
CARD B
02. Cuban
03. Cuban American
04. Mexican/Mexicano
05. Mexican American
06. Chicano
07. Hispano
08. Other Latin American
09. Other Spanish or Hispanic
10. American
11. Anglo American
88. Other (Specify)
Mark only one.
02[] Cuban
03[] Cuban American
04[] Mexican/Mexicano
05[] Mexican American
06[] Chicano
07[] Hispano
08[] Other Latin American
09[] Other Spanish or Hispanic
10[] American
11[] Anglo American
88[] Other (Specify) ____
11. Which of these groups best describes your mother's national origin?
Mark only one.
02[] Cuban
03[] Cuban American
04[] Mexican/Mexicano
05[] Mexican American
06[] Chicano
07[] Hispano
08[] Other Latin American
09[] Other Spanish or Hispanic
10[] American
11[] Anglo American
88[] Other (Specify) ____
12. Which of these groups best describes your father's national origin?
Mark only one.
02[] Cuban
03[] Cuban American
04[] Mexican/Mexicano
05[] Mexican American
06[] Chicano
07[] Hispano
08[] Other Latin American
09[] Other Spanish or Hispanic
10[] American
11[] Anglo American
88[] Other (Specify) ____
[p. 170]
Section B -- ACCULTURATION -- Continued
13a. In what country were you born?
2[] Puerto Rico (13b)
3[] Cuba (13b)
4[] Mexico (13b)
8[] Other (Specify) ____ (13b)
b. Altogether, how many years have you lived in the United States?
2[] 1 yr., less than 5
3[] 5 yrs., less than 10
4[] 10 yrs., less than 15
5[] 15 yrs. or more
9[] DK
14. In what country was your father born?
2[] Puerto Rico
3[] Cuba
4[] Mexico
8[] Other (Specify) -- ____
9[] DK
15. In what country was your mother born?
2[] Puerto Rico
3[] Cuba
4[] Mexico
8[] Other (Specify) ____
9[] DK
[p. 171]
Section C -- FOOD FREQUENCY
Read to respondent:
These questions are about the foods YOU eat. For each food I read from this list (Hand card), please tell me how often you eat it; for example, twice a week, three times a month and so forth. Then I will ask if you eat a small, medium or large portion of the food. Remember, I'm only interested in the foods YOU eat. Now, please look at the fruits and juices list, as I ask these first questions.
(food cards not found)
1. During the past year or so, how many times per day, week, month or year, did you usually drink orange juice or grapefruit juice?
2[] Week
3[] Month
4[] Year
2[] Medium (6 oz.)
3[] Large
2. During the past year or so, how many times per day, week, month or year did you usually drink other fruit juices or fortified juice drinks?
2[] Week
3[] Month
4[] Year
2[] Medium (6 oz.)
3[] Large
3. During the past year or so, how many times per day, week, month or year did you usually eat oranges?
2[] Week
3[] Month
4[] Year
2[] Medium
3[] Large
Read to respondent:
I am going to continue in this way asking about how often you eat the other foods on this list and what your portion size is. Please be as accurate as possible without spending too much time on any one food. We just want a picture of your diet in general.
Any questions?
4. During the past year or so how often did you eat
grapefruit?
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 grapefruit)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1/4 medium)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. or 1/2 cup)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium
3[] Large
9. Any other fruit, such as fruit cocktail or berries?
2[] Week
3[] Month
4[] Year
2[] Medium
3[] Large
[p. 172]
Section C -- FOOD FREQUENCY -- Continued
(Now look at the vegetables list.)
(food cards not found)
During the past year or so, how often did you usually eat --
10. Beans, such as baked, pinto, or kidney beans, including in chili?
Do not include green beans.
2[] Week
3[] Month
4[] Year
2[] Medium (3/4 cup)
3[] Large
11. Carrots or mixed vegetables containing carrots?
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 cup)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. bowl)
3[] Large
13. Tomatoes, including in salad?
2[] Week
3[] Month
4[] Year
2[] Medium (1 tomato)
3[] Large
14. Salad dressing or mayonnaise, including on sandwiches?
2[] Week
3[] Month
4[] Year
2[] Medium (2 tbs.)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 cup)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 cup)
3[] Large
17. Mustard greens, turnip greens, or collards?
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 cup)
3[] Large
18. Coleslaw, cabbage, or sauerkraut?
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 cup)
3[] Large
19. French fries or fried potatoes?
2[] Week
3[] Month
4[] Year
2[] Medium (3/4 cup)
3[] Large
20. Potatoes, baked, boiled, or mashed?
2[] Week
3[] Month
4[] Year
2[] Medium (1 potato or 1/2 cup)
3[] Large
[p. 173]
Section C -- FOOD FREQUENCY -- Continued
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 cup)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 cup)
3[] Large
23. ANY other vegetables, such as string beans, peas, corn?
2[] Week
3[] Month
4[] Year
2[] Medium (1/2 cup)
3[] Large
(Now look at the meat, fish, and poultry list.)
(food cards not found)
During the past year or so, how often did you usually eat --
24. Hamburgers, cheeseburgers, or meatloaf?
2[] Week
3[] Month
4[] Year
2[] Medium (1/4 lb.)
3[] Large
25. Beef, such as steaks or roasts?
2[] Week
3[] Month
4[] Year
>
2[] Medium (4 oz.)
3[] Large
26. Beef stew or beef pot pie with vegetables?
2[] Week
3[] Month
4[] Year
2[] Medium (1 cup)
3[] Large
27. Liver, including chicken livers?
2[] Week
3[] Month
4[] Year
2[] Medium (4 oz.)
3[] Large
28. Pork, such as pork chops or roasts?
2[] Week
3[] Month
4[] Year
2[] Medium (2 pork chops or 4 oz. of roast)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (2 sm. or 1 lg. piece)
3[] Large
30. Chicken or turkey, baked or broiled?
2[] Week
3[] Month
4[] Year
2[] Medium (2 sm. or 1 lg. piece)
3[] Large
[p. 174]
Section C -- FOOD FREQUENCY -- Continued
31. Chicken stew or chicken pot pie?
2[] Week
3[] Month
4[] Year
2[] Medium (1 cup)
3[] Large
32. FRIED fish or fish sandwiches?
2[] Week
3[] Month
4[] Year
2[] Medium (2 sm. or 1 lg. piece)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (2 sm. or 1 lg. piece)
3[] Large
34. Spaghetti, lasagna, or other pasta with tomato sauce?
2[] Week
3[] Month
4[] Year
2[] Medium (1 cup)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (2 pieces)
3[] Large
36. Macaroni and cheese; other mixed dishes with cheese?
2[] Week
3[] Month
4[] Year
2[] Medium (1 cup)
3[] Large
(Now look at the cereal and other foods list.)
(food cards not found)
During the past year or so, how often did you usually eat --
37. Cooked cereals like oatmeal?
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. bowl)
3[] Large
38. High fiber cereals like bran, granola, or shredded wheat?
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. bowl)
3[] Large
39. Highly fortified cereals like Product 19, Total, or Just Right?
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. bowl)
3[] Large
40. Other cold cereals like Rice Krispies or Corn Flakes?
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. bowl)
3[] Large
[p. 175]
Section C -- FOOD FREQUENCY -- Continued
2[] Week
3[] Month
4[] Year
2[] Week
3[] Month
4[] Year
2[] Week
3[] Month
4[] Year
>
(Now turn the card over and look at the lunch and other foods list.)
(food cards not found)
During the past year or so, how often did you usually eat --
44. Vegetable soup, vegetable beef, minestrone, or tomato soup?
Do not include other kinds of soup.
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. bowl)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Week
3[] Month
4[] Year
2[] Medium (2 slices)
3[] Large
47. White bread, rolls or crackers, including sandwiches, bagels, and so forth? I'm going to ask about dark bread and corn bread separately.
2[] Week
3[] Month
4[] Year
2[] Medium (2 slices or 4 crackers)
3[] Large (3+ slices)
48. Dark breads like whole wheat, rye, or pumpernickel?
2[] Week
3[] Month
4[] Year
2[] Medium (2 slices)
3[] Large (3+ slices)
49. Corn bread, corn muffins, corn tortillas, or grits?
2[] Week
3[] Month
4[] Year
2[] Medium (1 piece or 1/2 cup grits)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1 medium)
3[] Large
[p. 176]
Section C -- FOOD FREQUENCY -- Continued
51. Butter on bread, rolls, or vegetables?
I'll ask about margarine next.
2[] Week
3[] Month
4[] Year
2[] Medium (2 pats)
3[] Large
52. Margarine on bread, rolls, or vegetables?
2[] Week
3[] Month
4[] Year
2[] Medium (2 pats)
3[] Large
53. Cheese or cheese spreads, not including cottage cheese?
2[] Week
3[] Month
4[] Year
2[] Medium (2 slices or 2 oz.)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (2 tbs.)
3[] Large
55. Salty snacks like chips or popcorn?
2[] Week
3[] Month
4[] Year
2[] Medium (1 handful)
3[] Large
(Now look at the desserts list.)
(food cards not found)
During the past year or so, how often did you usually eat --
56. Ice cream, not including fat free ice cream?
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. scoop)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. slice)
3[] Large
58. Doughnuts, cookies, cake, or pastry?
2[] Week
3[] Month
4[] Year
2[] Medium (1 med. piece, 1 donut)
3[] Large
2[] Week
3[] Month
4[] Year
2[] Medium (1 oz.)
3[] Large
60. (Now look at the beverages list.)
(food cards not found)
During the past year or so, how often did you usually (use/drink)
-- milk or cream in coffee or tea including non-dairy creamer?
2[] Week
3[] Month
4[] Year
2[] Medium (1 tbs.)
3[] Large
[p. 177]
Section C -- FOOD FREQUENCY -- Continued
61. Sugar, in coffee or tea or on cereal?
2[] Week
3[] Month
4[] Year
2[] Medium (2 tsp.)
3[] Large
62. Whole milk or drinks made with whole milk, not including on cereal? I'm going to ask about 1%, 2%, and skim milk separately.
2[] Week
3[] Month
4[] Year
2[] Medium (8 oz. glass)
3[] Large
63. 2% milk, or drinks made with 2% milk, not including on cereal?
2[] Week
3[] Month
4[] Year
2[] Medium (8 oz. glass)
3[] Large
64. Skim milk, 1% milk, 1/2% milk or buttermilk, not including on cereal?
2[] Week
3[] Month
4[] Year
2[] Medium (8 oz. glass)
3[] Large
65. Non-diet soda or soft drinks?
2[] Week
3[] Month
4[] Year
2[] Medium (12 oz.)
3[] Large
66a. During the past year or so, how often did you drink beer?
Days per ____
3[] Months
4[] Year
b. On the days you drank beer, how many cans, bottles, or glasses did you drink?
99[] DK
c. Were they small, medium, or large?
2[] Medium (12 oz.)
3[] Large (16 oz.)
67a. During the past year or so, how often did you drink wine?
Days per ____
3[] Months
4[] Year
b. On the days you drank wine, how many glasses did you drink?
99[] DK
c. Were they small, medium, or large?
2[] Medium (1 med. wine glass)
3[] Large
[p. 178]
Section C -- FOOD FREQUENCY -- Continued
68a. During the past year or so, how often did you drink liquor?
Days per ____
3[] Months
4[] Year
b. On the days you drank liquor, how many drinks did you have?
99[] DK
c. Were they small, medium, or large?
2[] Medium (1 shot)
3[] Large
69. About how many servings of vegetables do you eat per day or per week, not counting salad or potatoes?
Servings ____
2[] Per week
70. About how many servings of fruit do you eat per day or per week, not counting juices?
Servings ____
2[] Per week
71. About how many servings of cold cereal do you eat per day or per week?
Servings ____
2[] Per week
72. When you eat chicken or other poultry, how often do you eat it with the skin on? Would you say often, sometimes, rarely, or never?
2[] Sometimes
3[] Rarely
4[] Never
5[] Don't eat chicken or poultry
73. When you eat red meat, how often do you eat the fat? Would you say often, sometimes, rarely, or never?
2[] Sometimes
3[] Rarely
4[] Never
5[] Don't eat red meat
74. In a typical week, how many meals do you usually get in restaurants, cafeterias, or fast food places?
(Meals) per week ____
99[] DK
[p. 179]
Section D -- VITAMIN AND MINERAL INTAKE
1. During the past 12 months, did you take any vitamin or mineral supplements of any kind, such as vitamin pills, wafers, liquid vitamins or minerals?
2[] No (Section E)
2a. During the past 12 months did you take any MULTI-vitamins?
2[] No (3)
b. In how many of the past 12 months did you take multi-vitamins?
Number of months ____
c. During (the/those) (number in 2b) month(s), about how many days per month did you take multi-vitamins?
Number ____
2[] Days per week
(The following questions are about individual vitamins and minerals. Do not include the multi-vitamins you already told me about.)
3a. During the past 12 months, did you take any vitamin A?
2[] No (4)
b. In how many of the past 12 months did you take vitamin A?
Number of months ____
c. During (the/those) (number in 3b) month(s), about how many days per month did you take vitamin A?
Number ____
2[] Days per week
4a. During the past 12 months, did you take any vitamin C?
2[] No (5)
b. In how many of the past 12 months did you take vitamin C?
Number of months ____
c. During (the/those) (number in 4b) month(s), about how many days per month did you take vitamin C?
Number ____
2[] Days per week
5a. During the past 12 months, did you take any vitamin E?
2[] No (6)
b. In how many of the past 12 months did you take vitamin E?
Number of months ____
c. During (the/those) (number in 5b) month(s), about how many days per month did you take vitamin E?
Number ____
2[] Days per week
6a. During the past 12 months, did you take any calcium?
2[] No (Section E)
b. In how many of the past 12 months did you take calcium?
Number of months ____
c. During (the/those) (number in 6b) month(s), about how many days per month did you take calcium?
Number ____
2[] Days per week
[p. 180]
Section E -- HEIGHT AND WEIGHT
[] SP was NOT household respondent for HIS-1 (1)
1. About how tall are you without shoes?
Inches ____
2. About how much do you weigh without shoes?
Note: If SP is pregnant, weight referred to is pre-pregnancy weight.
[p. 181]
Section F -- FOOD KNOWLEDGE
1. Please tell me if you agree or disagree with the following statements, or if you have no opinion --
a. There are plenty of healthy foods that taste good.
2[] Disagree/No
9[] No opinion/DK
b. It is easy to eat a healthy diet.
2[] Disagree/No
9[] No opinion/DK
c. In general, healthy foods cost more than other kinds of foods.
2[] Disagree/No
9[] No opinion/DK
d. There is a lot of conflicting advice on healthy ways to eat.
2[] Disagree/No
9[] No opinion/DK
2. Do you get encouragement from your family or friends to eat more healthy food?
2[] Disagree/No
9[] No opinion/DK
HAND CARD F1.
CARD F1
OR
B. By eating the right kinds of foods people can reduce their chances of developing major diseases.
3. I am going to read two statements. Please tell me which you agree with MORE.
A. What people eat or drink has little effect on whether they will develop major diseases.
OR
B. By eating the right kinds of foods, people can reduce their chances of developing major diseases.
Which do you agree with MORE?
2[] B (4)
9[] DK (5)
4. In your opinion, what major diseases may be related to what people eat and drink?
Mark all that apply.
2[] Heart disease
3[] Obesity/overweight
4[] Diabetes
5[] Hypertension or high blood pressure
6[] Ulcers/other digestive problems (not cancer)
7[] Other disease(s)
0[] None
9[] DK
If box 1, Cancer is marked in 4, skip to 6; otherwise, ask --
5. Do you think cancer may be related to what people eat and drink?
2[] No (7)
7[] Probably (6)
9[] DK (7)
6. Which of these would be helpful if a person wanted to reduce his or her chances of getting certain kinds of cancer?
HAND CARD F2. Read each category if telephone interview.
CARD F2
2. Eating less sugar
3. Avoiding foods with additives
4. Eating less fat
5. Eating less salt
6. Eating more fruit and vegetables
7. Taking vitamins
8. None of these changes would be helpful
(Please give me the numbers from the card.)
Mark each that applies.
2[] Eating less sugar
3[] Avoiding foods with additives
4[] Eating less fat
5[] Eating less salt
6[] Eating more fruit and vegetables
7[] Taking vitamins
0[] None of these changes would be helpful
9[] Don't know
If box 1, Fiber is marked in 6, skip to 8; otherwise, ask --
7. Some foods contain fiber. Have you heard of fiber?
2[] No (9)
9[] DK (9)
[p. 182]
Section F -- FOOD KNOWLEDGE -- Continued
8. I am going to read a list of foods two at a time. For each food pair, please tell me which one you think contains more FIBER. If you are not sure which food contains more fiber, let me know.
a. First, 1 bowl of shredded wheat OR 1 bowl of corn flakes -- which has more fiber?
2[] Corn flakes
3[] Both the same
9[] DK/Not sure
b. 1 cup of iceberg lettuce OR 1 cup of carrots? (Which has more fiber?)
2[] Carrots
3[] Both the same
9[] DK/Not sure
c. 1 cup of spaghetti with meatballs OR 1 cup of chili with beans? (Which has more fiber?)
2[] Chili
3[] Both the same
9[] DK/Not sure
9. Now I am going to read another list of foods two at a time. For each food pair please tell me which one you think contains more FAT. If you're not sure which one contains more fat, let me know.
a. First, regular potato chips OR pretzels -- which has more fat?
2[] Pretzels
3[] Both the same
9[] DK/Not sure
b. 1 glass of cola OR 1 glass of whole milk? (Which has more fat?)
2[] Whole milk
3[] Both the same
9[] DK/Not sure
c. 1 small bran muffin OR 1 slice of whole wheat bread? (Which has more fat?)
2[] Whole wheat bread
3[] Both the same
9[] DK/Not sure
10. How many servings of fruits and vegetables do you think a person should eat each day for good health?
99[] DK/Not sure
11. How often do you or the person who shops for your food buy items that are labelled "low fat" or "non-fat" -- would you say often, sometimes, rarely, or never?
2[] Sometimes
3[] Rarely
4[] Never
9[] DK
[p. 183]
Section G -- CANCER SURVIVORSHIP
1. Has a medical doctor ever told you that you had cancer of any kind (including any cancer you have already mentioned)?
2[] No (Section H)
2. How many different kinds of cancer have you had?
9[] DK (If 1 cancer (3), If 2 or more cancers (4))
3a. What kind of cancer was it
b. What part of the body was affected
c. In what year was this cancer first diagnosed?
99[] DK (3d)
d. How old were you when this cancer was first diagnosed?
99[] DK
e. (Please look at this card and tell me) how was your cancer first detected?
HAND CARD G1. Read categories if telephone interview.
CARD G1
2. I noticed something was wrong and went to a doctor
3. I noticed something was wrong but did not talk to a doctor about it until my regular physical exam
8. It was detected in some other way (Specify)
Mark only one.
2[] I noticed something was wrong and went to a doctor
3[] I noticed something was wrong but did not talk to a doctor about it until my regular physical exam
8[] It was detected in some other way (Specify) -- ____
9[] DK
ITEM G1
Refer to question 3c or 3d for when the cancer was first diagnosed.
2[] 10 or fewer years ago (6)
4a. What kind of cancer was diagnosed first
799[] DK
b. What part of the body was affected
99[] DK
c. What year was this cancer first diagnosed?
99[] DK (4d)
d. How old were you when this cancer was first diagnosed?
99[] DK
e. (Please look at this card and tell me) how was the (cancer in 4a) first detected?
HAND CARD G1. Read categories if telephone interview.
CARD G1
2. I noticed something was wrong and went to a doctor
3. I noticed something was wrong but did not talk to a doctor about it until my regular physical exam
8. It was detected in some other way (Specify)
Mark only one.
2[] I noticed something was wrong and went to a doctor
3[] I noticed something was wrong but did not talk to a doctor about it until my regular physical exam
8[] It was detected in some other way (Specify) -- ____
9[] DK
[p. 184]
Section G -- CANCER SURVIVORSHIP -- Continued
5a. What kind of cancer was diagnosed most recently
b. What part of the body was affected
c. In what year was this cancer first diagnosed?
99[] DK (5d)
d. How old were you when this cancer was first diagnosed?
99[] DK
ITEM G2
Refer to question 5c or 5d for when the most recent cancer was first diagnosed.
2[] 10 or fewer years ago (6)
The following questions refer only to the (cancer in questions 4a and 5a).
HAND CARD G2. Read each category if telephone interview.
CARD G2
2. Cancer specialist (oncologist)
3. General Surgeon
4. Cancer Surgeon
5. Reconstructive Surgeon
6. Radiologist
8. Other specialist (Specify)
6. What types of doctors did you see for your diagnosis and treatment?
Mark each that applies.
2[] Cancer specialist (oncologist)
3[] General surgeon
4[] Cancer surgeon
5[] Plastic surgeon/Reconstructive surgeon
6[] Radiologist
8[] Other specialist (Specify) -- ____
9[] DK
7a. Did you get more than one opinion about the type of treatment you should have?
2[] No
9[] DK
b. What types of treatment did you receive for this cancer?
HAND CARD G3. Read each category if telephone interview.
CARD G3
2. Radiation
3. Chemotherapy
4. Special diets
5. Self healing techniques, including imaging
8. Other (Specify)+
Mark each that applies.
2[] Radiation
3[] Chemotherapy
4[] Special diets
5[] Self healing techniques, including imaging
8[] Other (Specify) -- ____
9[] DK
8. After your cancer was diagnosed, did you receive any counseling or join any support groups to help you cope?
2[] No (9)
9[] DK (10)
9a. What was the main reason you did not get counseling?
HAND CARD G4. Read categories if telephone interview.
CARD G4
2. I didn't want it
3. I didn't think I needed it
8. Some other reason (Specify)
Mark only one.
2[] I didn't want it (10)
3[] I didn't think I needed it (10)
8[] Some other reason (Specify) -- ____ (10)
9[] DK (10)
b. Would you have been interested in receiving counseling if you had known about it?
2[] No
9[] DK
10. Did a doctor, nurse, or social worker give you written information about your cancer or its treatment?
If no, ask --
Even though no one gave you any written information did you pick any up on your own?
If Yes, mark box 3.
If No, mark box 2.
2[] No, no information given (12)
3[] No, but I picked it up myself (12)
9[] DK (12)
[p. 185]
Section G -- CANCER SURVIVORSHIP -- Continued
11a. What subjects did the materials cover? (Anything else?)
HAND CARD G5. Read each category if telephone interview.
CARD G5
2. Information about your specific type of cancer
3. Cancer treatment options
4. Coping with the physical side effects of cancer treatment
5. Coping with the emotional effects of cancer
8. Other (Specify)
Mark each that applies.
2[] Information about your specific type of cancer
3[] Cancer treatment options
4[] Coping with the physical side effects of cancer treatment
5[] Coping with the emotional effects of cancer
8[] Other (Specify) -- ____
9[] DK
b. (Was this/Were any of these) material(s) helpful?
2[] No
9[] DK
12a. After you were diagnosed with cancer, did you contact any of these cancer organizations?
HAND CARD G6. Read 12b categories if telephone interview.
CARD G6
2. National Cancer Institute
3. The Cancer Information Service: 1-800-4-CANCER
8. Other
2[] No (13)
b. Which cancer organizations did you contact? (Any others?)
Mark each that applies.
2[] National Cancer Institute
3[] The 1-800-4-CANCER HOTLINE
8[] Other
9[] Don't know
13. Did you participate in a research study or clinical trial as a part of your cancer treatment?
2[] No
9[] DK
14a. Not counting Medicare or Medicaid, did you have health insurance that paid for all or part of your treatment?
2[] No (15)
9[] DK (15)
b. Did your health insurance change in any of these ways because of your cancer?
HAND CARD G7. Read all categories if telephone interview.
CARD G7
2. Yes -- My insurance was cancelled or not renewed
8. Yes -- Other change (Specify)
0. No -- Did not change
Mark only one.
2[] Yes -- My insurance was cancelled or not renewed
8[] Yes -- Other change (Specify) -- ____
0[] No -- Did not change
15a. Were you ever denied health or life insurance coverage because of your cancer?
2[] No
9[] DK
b. Were you ever asked to waive coverage of your cancer in order to get health insurance?
2[] No
9[] DK
16a. Were you working at a job or business immediately before your diagnosis of cancer?
2[] No (17)
b. Were you self-employed?
2[] No (16c)
c. Did your employer have a long-term disability plan that covered cancer?
2[] No (18)
9[] DK (18)
17a. Have you worked at a job for pay after your cancer was diagnosed?
2[] No (Section H)
b. Were you self-employed?
2[] No (18)
18. Some people have problems with employment because of cancer. Have you ever...
a. Faced on-the-job problems for your employer or supervisor directly related to your cancer?
2[] No
b. Been fired or laid off from your job because of your cancer?
2[] No
c. Felt you couldn't change jobs because of your cancer?
2[] No
d. Felt you couldn't take a new job because of a change in insurance related to your cancer?
2[] No
e. Refrained from applying for a new job because you didn't want your medical records made public?
2[] No
Section H -- SMOKING HABITS
These next questions are about cigarette smoking.
1. Have you smoked at least 100 cigarettes in your entire life?
If asked: approximately 5 packs
2[] No (Section J)
9[] DK (Section J)
2. How old were you when you first started smoking cigarettes?
99[] DK
3. Do you now smoke cigarettes every day, some days, or not at all?
2[] Some days (5)
3[] Not at all (Section J)
4. On the average, how many cigarettes do you now smoke a day?
99[] DK (Section J)
5a. On how many of the past 30 days did you smoke cigarettes?
Days ____ (5b)
99[] DK (5b)
b. On the average, when you smoked, about how many cigarettes did you smoke a day?
99[] DK
[p. 187]
Section J -- OCCUPATIONAL EXPOSURE
ITEM J1
Refer to "Work" box in C1 of HIS-1 for the SP.
2[] All others (Section K)
1a. On your current job, do you work with any substances that you believe may be harmful if you breathed them or got them on your skin?
2[] No
9[] DK
b. On your current job, are you exposed to radiation, not counting computer screen exposure?
2[] No
9[] DK
ITEM J2
Refer to 1a and 1b.
2[] All others (Section K)
2. How concerned are you about your exposure to (these substances/(and) radiation) on your current job? Are you very concerned, somewhat concerned, slightly concerned, or not at all concerned?
2[] Somewhat concerned
3[] Slightly concerned
4[] Not at all concerned
3. From which of these did you find out that you were working with (harmful substances/(and) radiation)?
HAND CARD J1. Read each category if telephone interview.
CARD J1
2. Union
3. Co-workers
4. Previous training/education
5. By reading about it
8. Other (Specify)
Mark each mentioned.
2[] Union
3[] Co-workers
4[] Previous training/education
5[] By reading about it
8[] Other (Specify) -- ____
9[] DK
4. Is protective gear available for your use in your current job? Examples of protective gear are gloves, respirator, filter mask, boots, ear plugs, and film badge.
2[] No (Section K)
9[] DK (Section K)
5. When you have contact with (substances that might be harmful/(and) radiation), how often do you use protective gear? Never, some of the time, most of the time, or always?
2[] Some of the time
3[] Most of the time
4[] Always (Section K)
6. Which of these reasons for not wearing protective gear are true for you?
HAND CARD J2. Read each category if telephone interview.
CARD J2
2. Because it interferes with job performance
3. Because it is uncomfortable
4. Because I don't know how to use it
5. Because it is not needed
8. Some other reason (Specify)
(Please give me the numbers from the card.)
Mark each mentioned.
2[] Because it interferes with job performance
3[] Because it is uncomfortable
4[] Because I don't know how to use it
5[] Because it is not needed
8[] Some other reason (Specify) -- ____
[p. 188]
SKIP TO SECTION L ON PAGE 30