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y2k

[p. 267]

Section IV -- YEAR 2000 OBJECTIVES

ITEM IV2
Refer to sample person selection label.

[] 1 Y (Item A1)
[] 2 A (Section V, AIDS on page 67)
Part A -- ENVIRONMENTAL HEALTH

ITEM A1
Adult SP status. Begin here on Section IV callbacks.

[] Available (1)
[] Callback required (Item 16 on Household page of HIS-1)
[] Noninterview (Response status on Back Cover)

These next questions are about this home.
Mark (X) by observation or ask:
1a. Which of the following best describes your home?
Read answer categories.

[] 1 Apartment or condominium (1b)
[] 2 Single family home or townhouse (2a)
[] 3 Trailer or mobile home (2a)
[] 8 Something else (2a)
[] 9 DK (2a)


Mark (X) by observation or ask:
b. What floor of the building is the apartment or condominium on?

[] 1 Basement, first or second floor apartment or condominium
[] 2 Apartment or condominium on the third floor or above
[] 9 DK


2a. How many smoke detectors are installed in this home?

[] 00 None (4)
[] 01 One (2b)
Smoke detectors ____ (2c)
[] 99 DK (4)


b. Does this smoke detector now work?

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


c. How many of these smoke detectors now work?

[] 00 None (4)
[] 01 One (2d)
____ Working (2d)
[] 96 All (2d)
[] 99 DK (3)


d. How do you know (it is/they are) working?
Anything else?
Mark (X) all that apply.

[] 1 Tested it/them
[] 2 Went off because of cooking
[] 3 Went off because of other smoke
[] 4 Changed batteries
[] 5 Light is on
[] 6 hasn't beeped because of low battery
[] 7 Other
[] 9 DK


3. Do you have at least one working smoke detector on each floor of your home? Include a finished basement or attic.

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


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

[] 1 Yes (5)
[] 2 No (8)
[] 9 DK (8)


5a. Has your household air been tested for the presence of radon?

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


b. Who decided to have a radon test done -- was it someone in this household or was it someone else?

[] 1 Someone in this household
[] 4 Someone else
[] 9 DK

[p. 268]

Part A -- ENVIRONMENTAL HEALTH -- Continued


6a. Was the radon level from that test above or below the EPA radon guideline of 4 picocuries (pi-ko-kurees) per liter?

Read if necessary: What was the radon level from the last test BEFORE any corrective action was taken?

[] 1 Above the EPA guideline (6b)
[] 2 At or below the EPA guideline (8)
[] 3 DK results yet (8)
[] 9 DK level (8)


b. What was the radon level from that test, in picocuries per liter?

____ Picocuries per liter
[] 9999 DK


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

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


The next questions are about smoking inside the home.
8a. Does ANYONE who lives here smoke cigarettes, cigars, or pipes ANYWHERE INSIDE this home?

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


b. In an average week, how many PEOPLE who live here smoke cigarettes, cigars, or pipes anywhere inside this home?

People ____


c. On the average, about how DAYS PER WEEK do people who live here smoke ANYWEHRE INSIDE this home?

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


d. On the average, about how many DAYS PER WEEK are there VISITORS who smoke ANYWHERE INSIDE this home?

[] 0 Less than 1 day per week/Rarely/None
Days per week ____
[] 9 DK

[p. 269]

Part B -- TOBACCO

These next questions are about cigarette smoking.


1. Have you smoked at least 100 cigarettes in your entire life?
If asked: approximately 5 packs

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


2. Around this time LAST YEAR, were you smoking cigarettes everyday, some days, or not at all?

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


3a. Do you NOW smoke cigarettes everyday, some days, or not at all?

[] 1 Everyday (4)
[] 2 Some days (6)
[] 3 Not at all (3b)
[] 9 DK (6)


3b. How long has it been since you quit smoking cigarettes?

____ [number] (8)
1[] Days
2[] Weeks
3[] Months
4[] Years
999 [] DK (8)


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

____ Cigarettes a day
[] 99 DK


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

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


6a. On how many of the past 30 days did you smoke cigarettes?

[] 00 None (7)
Days ____ (6b)
[] 99 DK (6b)


b. On the average, when you smoked DURING THE PAST 30 DAYS, about how many cigarettes did you smoke EACH day?

____ Cigarettes a day
[] 99 DK


7. Would you like to completely quit smoking cigarettes?

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


8a. Have you ever used snuff such as Skoal, Skoal Bandits, or Copenhagen?

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


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

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


c. Do you use snuff now?

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




9a. Have you ever used chewing tobacco, such as Redman, Levi Garrett, or Beechnut?

[] 1 Yes (9b)
[] 2 No (Part C, page 57)
[] 9 DK (Part C, page 57)


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

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


c. Do you use chewing tobacco now?

[] 1 Yes
[] 2 No
[] 9 Dk



[p. 270]

Part C -- OCCUPATIONAL SAFETY AND HEALTH

The next questions are about health and safety in the workplace.
Ask or verify:


1a. Were you employed at a job or business during the past two weeks?

[] 1 Yes (1b)
[] 2 No (Part D on page 60)
[] 9 DK (Part D on page 60)


b. Were you an employee of a private company, the federal, state, or local government, or were you self-employed?

[] 1 Private company (1c)
[] 2 Federal government (1c)
[] 3 State government (1c)
[] 4 Local government (1c)
[] 5 Self employed (Part D, page 60)
[] 6 Other (Part D, page 60)
[] 9 DK (Part D, page 60)


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

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


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

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


HAND CARD YC1. Read all categories if telephone interview.
CARD YC1

1. Work mainly indoors
2. Work mainly outdoors
3. Travel to different buildings or sites
4. In a motor vehicle
5. Other (Specify)

2. Which of these best describes the area in which you work most of the time?

[] 1 Work mainly indoors (3)
[] 2 Work mainly outdoors (Check item C1)
[] 3 Travel to different buildings or sites (Check item C1)
[] 4 In a motor vehicle (Check item C1)
[] 5 Other (Check item C1)
[] 9 DK (Check item C1)

The next few questions are about smoking at work.


3a. Does your employer have an official policy that restricts smoking in any way?

[] 1 Yes (3b)
[] 2 No (Check item C1)
[] 9 DK (Check item C1)


HAND CARD YC2. Read all categories if telephone interview.
CARD YC2

1. Not allowed in ANY indoor common areas
2. Allowed in SOME indoor common areas including designated smoking areas
3. Allowed in ALL indoor common 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 (X) only one.

[] 1 Not allowed in ANY indoor common areas
[] 2 Allowed in SOME indoor common areas, including designated smoking areas
[] 3 Allowed in ALL indoor common areas
[] 9 DK


HAND CARD YC3. Read all categories if telephone interview.
CARD YC3

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 (X) only one.

[] 1 Not allowed in ANY work areas
[] 2 Allowed in SOME work areas
[] 3 Allowed in ALL work areas
[] 9 DK

ITEM C1
Refer to Part B, question 3a on page 56. (Smokes cigarettes now)

[] 1 Box 1, Every day (4)
[] 2 Box 2, Some days (4)
[] 3 All others (5)
[p. 271]

Part C -- OCCUPATIONAL SAFETY AND HEALTH -- Continued


4a. Do you ever smoke during the time you are at work?

[] 1 Yes (4b)
[] 2 No (Item C2)
[] 9 DK (Item C2)


b. Where do you smoke when you are at work?
Mark (X) all that apply.

[] 1 In my work area
[] 2 In a public area, such as a restroom, lunchroom, lobby, or other smoking area
[] 3 Outside the building
[] 4 Not applicable -- I work outside or at different sites
[] 5 In my car or other vehicles
[] 6 Other -- Specify -- ____
[] 9 DK


ITEM C2
Refer to question 3a, on page 57. (Employer has official smoking policy)

[] 1 "Yes" in 3a (4c)
[] 2 All others (5)


c. Do you feel that you smoke fewer cigarettes per day because of your employer's smoking policy?

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


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

[] 1 Yes (Item C3)
[] 2 No (Item C4)
[] 9 DK (Item C4)

ITEM C3


Refer to Part B, question 1, page 56. (Smoked at least 100 cigarettes)

[] 1 "Yes" in 1 (6)
[] 2 All others (Item C4)


6. In the past year, have you participated in a quit smoking program made available by your employer?

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


ITEM C4
Refer to Part C, question 1d, page 57. (50+ employees at building)

[] 1 "Yes" in 1d (7)
[] 2 All others (Part D on page 60)


HAND CARD YC4. Read categories if telephone interview.
CARD YC4

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

7a. In the past year, which of these exercise facilities, if any, were made available to you by your employer?
(Anything else?)
Mark (X) 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
[] 11 Other (Specify) ____
[] 99 DK
[] 00 No facilities (8)


Refer to Card YC4. Read categories marked in 7a if telephone interview.
CARD YC4

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

b. In the past year, which of these facilities did you use?
(Anything else?)
Mark (X) 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
[] 11 Other -- Specify -- ____
[] 99 DK
[] 00 None

[p. 272]

Part C -- OCCUPATIONAL SAFETY AND HEALTH -- Continued


HAND CARD YC5. Read categories if telephone interview.
CARD YC5

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

8a. In the past year, which of these exercise programs, if any, were made available to you on the premises by your employer?
(Anything else?)
Mark (X) each that applies.

[] 01 Walking group
[] 02 Jogging/Running group
[] 03 Biking/Cycling group
[] 04 Aerobics class
[] 05 Swimming class
[] 06 Non-aerobic exercise class
[] 07 Weight lifting class
[] 08 Fully paid membership in health/fitness club
[] 09 Partially paid membership in health/fitness club
[] 10 Physical activity or exercise competition
[] 11 Other -- Specify -- ____
[] 99 DK
[] 00 No Programs (9)


Refer to Card YC5. Read categories marked in 8a if telephone interview.
CARD YC5

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

b. In the past year, which of these programs did you participate in?
(Anything else?)
Mark (X) each that applies.

[] 01 Walking group
[] 02 Jogging/Running group
[] 03 Biking/Cycling group
[] 04 Aerobics class
[] 05 Swimming class
[] 06 Non-aerobic exercise class
[] 07 Weight lifting class
[] 08 Fully paid membership in health/fitness club
[] 09 Partially paid membership in health/fitness club
[] 10 Physical activity or exercise competition
[] 11 Other -- Specify -- ____
[] 99 DK
[] 00 None


9a. In the past year, have screening tests been available at your work place for --


(1) Blood pressure?
[] 1 Yes
[] 2 No
[] 9 DK


(2) Cholesterol?
[] 1 Yes
[] 2 No
[] 9 DK


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


Ask for each "Yes" in 9a.
b. In the past year, did you receive a screening test at your workplace for --


(1) Blood pressure?
[] 1 Yes
[] 2 No
[] 9 DK


(2) Cholesterol?
[] 1 Yes
[] 2 No
[] 9 DK


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


HAND CARD YC6. Read categories if telephone interview.
CARD YC6

1. Weight control
2. Nutrition information
3. Prenatal education
4. Stress reduction and management
5. Alcohol and other drugs
6. Sexually transmitted diseases (including HIV or AIDS)
7. Job hazards and injury prevention
8. Back care and prevention of back injury
9. Preventing off-the-job accidents
10. Other (Specify)
00. None

10a. In the past year, at your workplace, have any materials or programs been made available to employees on any of these topics?
If "Yes," ask: Which?
Read if necessary: This includes brochures, programs, talks, or counseling.
(Anything else?)
Mark (X) all that apply.

[] 01 Weight control
[] 02 Nutrition information
[] 03 Prenatal education
[] 04 Stress reduction and management
[] 05 Alcohol and other drugs
[] 06 Sexually transmitted diseases (including HIV or AIDS)
[] 07 Job hazards and injury prevention
[] 08 Back care and prevention of back injury
[] 09 Preventing off-the-job accidents
[] 10 Other -- Specify -- ____
[] 00 None (Part D on page 60)
[] 99 DK


Refer to Card YC6. Read categories marked in 10a if telephone interview.
CARD YC6

1. Weight control
2. Nutrition information
3. Prenatal education
4. Stress reduction and management
5. Alcohol and other drugs
6. Sexually transmitted diseases (including HIV or AIDS)
7. Job hazards and injury prevention
8. Back care and prevention of back injury
9. Preventing off-the-job accidents
10. Other (Specify)
00. None

b. In the past 12 months, which programs did you participate in at your workplace?
(Anything else?)
Mark (X) all that apply.

[] 01 Weight control
[] 02 Nutrition information
[] 03 Prenatal education
[] 04 Stress reduction and management
[] 05 Alcohol and other drugs
[] 06 Sexually transmitted diseases (including HIV or AIDS)
[] 07 Job hazards and injury prevention
[] 08 Back care and prevention of back injury
[] 09 Preventing off-the-job accidents
[] 10 Other -- Specify -- ____
[] 00 None
[] 99 DK

[p. 273]

Part D -- HEART DISEASE AND STROKE

These next questions are about blood pressure.


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 (8)
[] 3 Only during pregnancy (8)
[] 9 DK (3)


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

[] 1 Yes (3)
[] 2 No (3)
[] 3 Only during pregnancy (8)
[] 9 DK (3)


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 blood pressure?

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

b. Are you NOW following this advice?

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


4a. Has a doctor or other health professional ever advised you to cut down on salt or sodium in your diet to help lower your blood pressure?

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

b. Are you NOW following this advice?

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


5a. Has a doctor or other health professional ever advised you to exercise to help lower your blood pressure?

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

b. Are you NOW following this advice?

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


6a. Was any medication EVER prescribed by a doctor to help you lower your blood pressure?

[] 1 Yes (6b)
[] 2 No (7)
[] 9 DK (7)


b. Are you NOW taking this medication?

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


7a. Do you NOW have high blood pressure?

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


b. Is this condition under control?

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


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

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


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

000 [] Never (Part E on page 62)

____ [number] (9)
1[] Days
2[] Weeks
3[] Months
4[] Years


999 [] DK (9)

[p. 274]

Part D -- HEART DISEASE AND STROKE -- Continued


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

[] 1 Not told
[] 2 High
[] 3 Low
[] 4 Normal
[] 5 Borderline
[] 6 Other (Specify) ___
[] 9 DK


10. Blood pressure is usually given as one number over another. Were you told what your blood pressure was, in NUMBERS?

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

[p. 275]

Part E -- CLINICAL PREVENTIVE SERVICES


1. Would you say your health in general is excellent, very good, good, fair, or poor?

[] 1 Excellent
[] 2 Very good
[] 3 Good
[] 4 Fair
[] 5 Poor
[] 9 DK


2a. What was the reason for your last visit to a medical doctor or other health professional? Was it for a new problem, followup for a previous problem, a general physical exam, (Females only: an ob/gyn checkup, related to pregnancy) or something else?

Mark (X) only one

[] 1 A new problem
[] 2 Followup of a previous problem
[] 3 A general physical exam
[] 4 An ob/gyn checkup
[] 5 Combined general and ob/gyn checkup
[] 6 Related to pregnancy
[] 7 Other (Specify) ____
[] 9 DK

The next questions are about medical checkups and routine tests.


b. About how long has it been since your last general physical exam or routine checkup by a medical doctor or other health professional? Do not include a visit about a specific problem.

[] 1 Less than 1 year (3)
[] 2 1 year, less than 2 years (3)
[] 3 2 years, less than 3 years (3)
[] 4 3 years, less than 4 years (7)
[] 5 4+ years (7)
[] 6 Never (7)
[] 9 DK (3)


3. 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


Were you asked about --

e. Whether you use marijuana, cocaine, or other drugs?
[] 1 Yes
[] 2 No
[] 9 DK


Ask ONLY IF SP is less than 65 otherwise, skip to 4.

f. Sexually transmitted diseases?
[] 1 Yes
[] 2 No
[] 9 DK


Ask ONLY IF SP is less than 50 otherwise, skip to 4.
Were you asked about --

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


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


a. Your blood pressure checked?

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




b. Your cholesterol level checked?

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




c. Your height checked?

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




d. Your weight checked?

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


ITEM E1
Refer to age.

[] 1 SP is 65+ (5)
[] 2 Other (7)


5a. During this last check-up, were you asked about any episodes of weakness or paralysis in the arms and legs, loss of vision, speech, or memory, or facial droop that lasted for less than 24 hours? These are symptoms of transient ischemic (IS-KEE-MIK) attack or TIA.

[] 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

[p. 276]

Part E -- CLINICAL PREVENTIVE SERVICES -- Continued


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


a. A vision test to check 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 thyroid function blood test?

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




e. A stool test to check for blood in the stool?

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


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

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


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

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


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

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

ITEM E2
Refer to sex.

[] 1 Male (Part F on page 64)
[] 2 Female (10)

10. About how long has it been since you had a Pap smear test? Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
Read if necessary: A Pap smear is a routine gynecologic test in which the doctor examines the cervix and sends a cell sample to the lab.

[] 0 Never had a Pap smear test
[] 1 Within the past year
[] 2 1 to 3 years ago
[] 3 Over 3 years ago
[] 9 DK


11. Have you had a hysterectomy?

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


ITEM E3
Refer to age.

[] 1 Under 30 (Part F on page 64)
[] 2 30 and over (12)


12. About how long has it been since you had a mammogram?
Read if necessary: A mammogram is an x-ray taken only of the breasts by a machien that presses the breast against a plate.

[] 0 Never had a mammogram
[] 1 Within the past year
[] 2 1 to 2 years ago
[] 3 Over 2 years ago
[] 9 DK


13. A breast physical exam is when the breast is felt for lumps by a doctor or other health care professional. About how long has it been since you had a breast physical exam done?

[] 0 Never had a breast physical exam
[] 1 Within the past year
[] 2 1 to 2 years ago
[] 3 Over 2 years ago
[] 9 DK


ITEM E4
Refer to age.

[] 1 40-60 (14)
[] 2 Other (Part F on page 64)


14. Are you now experiencing any of the changes or symptoms of menopause?

[] 1 Yes
[] 2 No
[] 3 Note sure
[] 9 DK


b. Has a medical doctor or other health care professional ever discussed with you the pros and cons of taking estrogen pills after menopause?

[] 1 Yes (14c)
[] 2 No (Part F on page 64)
[] 9 DK (Part F on page 64)


c. Has a medical doctor or other health care professional ever discussed with you the pros and cons of taking estrogen TO PREVENT BONE LOSS after menopause?

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

[p. 277]

Part F -- FAMILY


Ask if unknown; otherwise, mark (X) without asking.
1. How many family members who are 10 or over live with you in your household?

[] 0 None (Item F1)
[] 1 One or more (2)


2. Thinking only of the family members 10 or over who live with you, in the past month, have you had any discussions about --


a. Nutrition and healthy eating habits?

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




b. Exercise, sports or other physical activities, as related to health?

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




c. Safety and things that you can do to prevent injuries?

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




d. Health issues related to cigarette smoking or other tobacco use?

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




e. Health issues related to drinking beer, wine, liquor, and other alcoholic beverages?

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




f. Health issues related to sexual behavior, sexually transmitted diseases, AIDS, or unwanted pregnancy?

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




g. Health issues related to using illegal drugs?

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

ITEM F1

Refer to age.

[] 1 SP is 25+ (3)
[] 2 Other (Part G)

3. Do you have any children aged 10 through 17?

[] 1 Yes (4)
[] 2 No (Part G)
[] 9 DK (Part G)


4. Have you ever discussed human sexuality with any of your children aged 10 through 17?

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


5. Have any of your children aged 10 through 17 had instruction at school about human sexuality?

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


6. Have any of your children aged 10 through 17 had instruction about human sexuality from a youth or religious program?

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

[p. 278]

Part G -- FIREARM SAFETY


The next questions are about safety and firearms. Firearms include pistols, shotguns, rifles, and other types of guns. Do not include guns that cannot fire, starter pistols, or BB guns.

Read if necessary: Sometimes the use of firearms can lead to injury, which is a health problem.


1. Are any firearms now kept in or around your home? Include those kept in a garage, outdoor storage area, truck or car.

[] 1 Yes (2)
[] 2 No (End of interview)
[] 9 DK (End of interview)


2. Is there one or more than one firearm?

[] 1 One (3)
[] 2 More than one (4 on page 66)
[] 9 DK (4 on page 66)


3a. What kind of firearm is it?
Mark (X) only one.

[] 1 Handgun, including pistol or revolver
[] 2 Shotgun
[] 3 Rifle
[] 4 Other (Specify) ____
[] 9 DK


HAND CARD YG1. Read categories if telephone interview.
CARD YG1

1. The firearm is kept in a LOCKED PLACE, such as a drawer, cabinet, or closet
2. The firearm is kept in an UNLOCKED place

b. Which statement best describes the PLACE the firearm is kept?

[] 1 The firearm is kept in a LOCKED PLACE, such as a drawer cabinet, or closet
[] 2 The firearm is kept in an UNLOCKED place
[] 9 DK


HAND CARD YG2. Read categories if telephone interview.
CARD YG2

1. Taken apart
2. With a trigger lock or other locking mechanism
3. Assembled without a locking mechanism
4. Other (Specify)

c. Which statement best describes the WAY the firearm is kept?

[] 1 Taken apart (3f)
[] 2 With a trigger lock or other locking mechanism (3d)
[] 3 Assembled without a locking mechanism (3d)
[] 4 Other (Specify) ____ (3d)
[] 9 DK (3d)


d. Is the firearm kept loaded or unloaded?

[] 1 Loaded (3e)
[] 2 Unloaded (3f)
[] 9 DK (3f)


e. Besides the ammunition in the firearm, is any other ammunition now kept in or around your home?

[] 1 Yes (3g)
[] 2 No (End interview)
[] 9 DK (End interview)


f. Is any ammunition now kept in or around your home?

[] 1 Yes (3g)
[] 2 No (End interview)
[] 9 DK (End interview)


g. How much of the ammunition is kept in a locked place? Would you say all, some or none?

[] 1 All
[] 2 Some
[] 3 None
[] 9 DK


h. Where is this ammunition kept -- is it kept with the firearm, or kept in a separate place away from the firearm?

[] 1 With the firearm (End interview)
[] 2 In a separate place (End interview)
[] 9 DK

[p. 279]

Part G -- FIREARM SAFETY -- Continued


4a. What kinds of firearms are they?
Mark (X) all that apply.

[] 1 Handgun, including pistol or revolver
[] 2 Shotgun
[] 3 Rifle
[] 4 Other -- Specify -- ____
[] 9 DK


HAND CARD YG3. Read categories if telephone interview.
CARD YG3

1. ALL the firearms are kept in LOCKED PLACES, such as drawers, cabinets, or closets
2. One or more firearms are kept in an UNLOCKED PLACE
9. DK

b. Which statement best describes the PLACES the firearms are kept?

[] 1 ALL the firearms are kept in LOCKED PLACES, such as drawers, cabinets, or closets
[] 2 One or more firearms are kept in an UNLOCKED place
[] 9 DK


HAND CARD YG2. Read categories if telephone interview.
CARD YG2

1. Taken apart
2. With a trigger lock or other locking mechanism
3. Assembled without a locking mechanism
4. Other (Specify)

c. Which statements describe the WAYS in which the firearms are kept?
Mark (X) all that apply.

[] 1 Taken apart
[] 2 With a trigger lock or other locking mechanism
[] 3 Assembled without a locking mechanism
[] 4 Other -- Specify -- ____
[] 9 DK


d. Are the firearms kept loaded or unloaded?

[] 1 One or more are kept loaded (4e)
[] 2 All are kept unloaded (4f)
[] 9 DK


e. Besides the ammunition kept in any firearm, is any other ammunition now kept in or around your home?

[] 1 Yes (4g)
[] 2 No (4i)
[] 9 DK (4i)


f. Is any ammunition now kept in or around your home?

[] 1 Yes (4g)
[] 2 No (End of interview)
[] 9 DK (End of interview)


g. How much of the ammunition is kept in a locked place? Would you say all, some or none?

[] 1 All
[] 2 Some
[] 3 None
[] 9 DK


h. Where is this ammunition kept -- is it kept with a firearm, or kept in a separate place away from all firearms?

[] 1 With a firearm
[] 2 In a separate place
[] 3 Both
[] 9 DK


i. Is at least one of the firearms kept loaded and unlocked?

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

RECORD FINAL STATUS ON BACK COVER