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[p.262]

Section IV - Year 2000 Objectives

ITEM IV2
Refer to sample person selection label.

1[] Y (Item A1)
2[] A (Section V, AIDS on page 59)
Part A -- Tobacco

ITEM A1
Adult SP status
Begin here on Section IV callbacks

[] Available (1)
[] Callback required (Item 18 on Household page of HIS-1)
[] Noninterview (Response status on Back Cover)

These next questions are about cigarette smoking.

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

1[] Yes (1b)
2[] No (Part B on page 51)
9[] DK (Part B on page 51)


b. How old were you when you first TRIED cigarettes?

_____ Age

99[] DK


c. How old were you when you first started to smoke every day?

____ Age

00[] Never smoked every day
99[] DK


2. Around this time LAST YEAR, were you smoking cigarettes everyday, some days, or not at all?
Mark (X) only one.

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


3a. Do you NOW smoke cigarettes everyday, some days, or not at all?
Mark (X) only one.

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


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

________ (Part B on page 51)
(Number)
1[] Days
2[] Weeks
3[] Months
4[] Years


999[] DK (Part B on page 51)


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

________ Cigarettes a day
(Number)

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)
(Number)

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
(Number)

99[] DK


7. Would you like to completely quit smoking cigarettes?

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

[p.263]

Part B - Nutrition


1. Are you NOW trying to lose weight, gain weight, stay about the same, or are you not trying to do anything about your weight?
Mark (X) only one.

1[] Lose weight (2)
2[] Gain weight (B1)
3[] Stay about the same (2)
4[] Not trying to do anything (B1)


Hand card YB1. Read categories if telephone interview.
CARD YB1

1. Joined a weight program
2. Eating fewer calories
3. Eating special products such as canned or powdered food supplements
4. Exercising more
5. Eating less fat
6. Skipping meals
7. Taking diet pills
8. Taking laxatives
9. Taking water pills or diuretics
10. Vomiting
11. Fasting for 24 hours or longer
98. Something else - (Specify)


2. Are you currently doing any of these things to control your weight?
Mark (X) all that apply.

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

ITEM B1
Refer to HIS-1

1[] SP was respondent for HIS-1 (Transcribe question 5 from HIS-1, page 22-23, then ask 4a)
2[] SP was not respondent for HIS-1 (3)

3a. About how tall are you without shoes?

_____
(Feet)
______
(Inches)

b. About how much do you weigh without shoes?
Read if SP is pregnant: Please give me your usual weight before becoming pregnant.

_______
(Pounds)


The next questions are about salt in your diet.
4a. 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, sometimes, rarely or never?
Mark (X) only one.

0[] Don't shop for food
1[] Always
2[] Often
3[] Sometimes
4[] Rarely
5[] Never
9[] DK


b. When you sit down at the table to eat, how often do you add salt to your food -- would you say always, often, sometimes, rarely, or never? Do not include salt substitutes.
Mark (X) only one.

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


5a. When you buy a food item for the first time, how often would you say you read the NUTRITIONAL INFORMATION about calories, fat and cholesterol sometimes listed on the label -- would you say always, often, sometimes, rarely or never?
Mark (X) only one.

0[] Don't buy food (B2 on page 52)
1[] Always (5b)
2[] Often (5b)
3[] Sometimes (5b)
4[] Rarely (5b)
5[] Never (5b)
9[] DK (5b)


b. When you buy a food item for the first time, how often would you say you read the INGREIDENT list on the package -- (would you say always, sometimes, rarely or never?)
Mark (X) only one.

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

[p.264]

Part B - Nutrition - Continued


ITEM B2
Refer to age.

1[] 65+ (6)
2[] Under 65 (Part C on page 53)


6a. Do you have meals delivered to your home by an agency or organization like Meals on Wheels?

1[] Yes (Part C on page 53)
2[] No (6b)
9[] DK (6b)


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


7a. In the past 12 months, have you taken a class or attended a presentation on health topics?

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


b. Where was the class given -- at a senior center, hospital, or some other place?
If multiple classes, probe for the location of the most recent.
Mark (X) only one.

1[] Senior center
2[] Hospital
3[] Other place
9[] DK


8a. In the past 12 months, did you participate in an exercise class or exercise program?

1[] Yes (8)
2[] No (Part C on page 53)
9[] DK (Part C on page 53)


b. Where was the exercise class given -- at a senior center, hospital, or some other place?

1[] Senior center
2[] Hospital
3[] Other place
9[] DK

[p.265]

Part C - Clinical Preventive Services

The following questions are on immunizations.


1. 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


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

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


3. Have you EVER had a pneumonia vaccination? This shot was first made available in 1977 and is usually given once in a person's lifetime.

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

The following questions are about certain diseases and illnesses.

4. During the past 12 months, have you had diabetes?
(If appropriate, read: Do not include diabetes diagnosed ONLY during pregnancy.)

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


5. (During the past 12 months, have you had) asthma, emphysema, chronic bronchitis, or tuberculosis?

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


6. (During the past 12 months, have you had) any kind of chronic kidney disease?

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


7. (During the past 12 months, have you had) liver disease, including cirrhosis?

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


8. In the past 12 months, have you suffered from extreme fatigue lasting one month or longer?

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


9. Are you currently being treated for any kind of cancer?

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


10. Have you ever been told by a doctor that you have had a heart attack, heart failure, a chronic heart condition, or rheumatic heart disease?

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

[p.266]

Part D - Mental Health


1a. During the past 2 weeks, would you say that you experiences a lot of stress, a moderate amount of stress, relatively little stress, or almost no stress at all?
Mark (X) only one.

1[] A lot (1b)
2[] Moderate (1b)
3[] Relatively little (1b)
4[] Almost none (1b)
5[] DK what stress is (4)
9[] DK (1b)


These next questions are about stress during the past 12 months.
b. During the past 12 MONTHS, would you say that you experienced a lot of stress, a moderate amount of stress, relatively little stress, or almost no stress at all?
Mark (X) only one.

1[] A lot
2[] Moderate
3[] Relatively little
4[] Almost none
9[] DK


2. During the past 12 months, how much effect has stress had on your health -- a lot, some, hardly any, or none?
Mark (X) only one.

1[] A lot
2[] Some
3[] Hardly any or none
9[] DK


3. (During the past 12 months), have you taken any steps to control or reduce stress in your life?

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


4. (During the past 12 months), have you had any SERIOUS personal or emotional problems?

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


5a. During the past 12 months, did you seek help from family or friends for ANY personal or emotional problems?

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


b. (During the past 12 months), did you seek help from a therapist, counselor, or self-help group for ANY personal or emotional problems?

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


c. (During the past 12 months), did you seek help from a priest, minister, rabbi, or other religious counselor for ANY personal or emotional problems?

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

[p.267]

Part E - Physical Activity and Fitness

These next questions are about physical exercise.


ITEM E1
Mark from observation or previous information.

1[] SP is physically handicapped (Describe in notes, then 1)
8[] Other (2 on page 57)


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 exercise, sports, or physically active hobbies?

1[] Yes (1b)
2[] No (3 on page 58)
9[] DK (3 on page 58)


b. What were they?

Record in 2a on page 57, then 1c


c. Anything else?

[] Yes (Reask 1b and c)
[] No (Mark "No" for all remaining activities in 2a, then go to 2b)

[p.268]

Part E - Physical Activity and Fitness

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 physical activity 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 for exercise?

1[] Yes
2[] No




(9) Swimming for exercise?

1[] Yes
2[] No




(10) Playing tennis?

1[] Yes
2[] No




(11) Playing golf?

1[] Yes
2[] No




(12) Bowling?

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
2[] No (16)





a. Downhill?

1[] Yes
2[] No





b. Cross-country?

1[] Yes
2[] No





c. Water?

1[] Yes
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?
2[] No



If activity listed above, mark "Yes" for it; otherwise, specify

(a) ______

(b) ______


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 for exercise

____ Times




(9) Swimming for exercise

____ Times




(10) Playing tennis

____ Times




(11) Playing golf

____ Times (Next activity)




(12) Bowling

____ 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




(20a) Any other exercise

____ Times




(20b) Any other exercise

____ 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




(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 for exercise

____ Minutes




(9) Swimming for exercise

____ Minutes




(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




(20a) Any other exercise

____ Minutes




(20b) Any other exercise

____ Minutes


d. (What usually happened to your heart rate or breathing when you [did/went] (activity in 2a)?) Did you usually 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 increase
9[] DK




(2) Gardening or yard work

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK



(3) Stretching exercises

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK



(4)Weightlifting or other exercises to increase muscle strength

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(5) Jogging or running

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(6) Aerobics or aerobic dancing

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(7) Riding a bicycle or exercise bike

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(8) Stair climbing for exercise

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(9) Swimming for exercise

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(10) Playing tennis

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(13) Playing baseball or softball

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(14) Playing handball, racquetball, or squash

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(15) Skiing

(b) Cross-country
1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(16) Playing basketball

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(17) Playing volleyball

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(18) Playing soccer

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(19) Playing football

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(20a) Any other exercise

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK




(20b) Any other exercise

1[] Small
2[] Moderate
3[] Large
0[] No increase
9[] DK

[p.269]

Part E - Physical Activity and Fitness - Continued


3. About how long has it been since your last medical check-up?
Mark (X) only one.

1[] Less than 1 year (4)
2[] 1 year, less than 2 years (end interview)
3[] 2 years, less than 3 year years (end interview)
4[] 3 years, less than 4 years (end interview)
5[] 4+ years (end interview)
6[] Never had a check-up (end interview)
9[] DK (4)


4. During your last check-up, did the doctor recommend that you BEGIN or CONTINUE to do any type of exercise or physical activity?
If "Yes", ask: Was that begin or continue?

1[] Yes, to BEGIN (end interview)
2[] Yes, to CONTINUE (end interview)
3[] Yes, BOTH (end interview)
4[] No (end interview)
9[] DK (end interview)