C1
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Now I have some questions about your health. Would you say your health is... |
C2a
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Comparing your health now with your health two years ago, would you say your health now is... |
C2b
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In the last two years, have you seen a doctor or medical personnel? |
C3
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Compared with other people your age, would you say that currently your health is...? |
C4
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Has a doctor or medical personnel ever diagnosed you with hypertension or high blood pressure? |
C5
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Are you currently taking any medication to lower your blood pressure? |
C6
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Has a doctor or medical personnel ever diagnosed you with diabetes? |
C7
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Are you currently taking any oral medication in order to control your diabetes? |
C8
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Are you currently using insulin shots? |
C9
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Do you follow a special diet to control your diabetes? |
C10
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In general, is your diabetes under control now? |
C11
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How frequently do you measure your blood sugar level or urine-sugar level? INDICATE THE NUMBER OF TIME AND PERIOD |
C12
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Has a doctor or medical personnel ever diagnosed you with cancer? |
C13
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In total, how many cancers in different places or organs have you ever had? |
C14
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What type of cancer? INDICATE ALL THAT APPLY |
C15
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In the last two years, have you consulted a doctor or medical personnel about your cancer? |
C16
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In the last two years, what type of treatments have you received for your cancer? (Other) |
C17
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Are you currently receiving treatment for your cancer? |
C18
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In what year or at what age was your (most recent) cancer diagnosed? |
C19
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Has a doctor or medical personnel ever told/diagnosed you with a respiratory illness, such as asthma or emphysema? |
C20a
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Are you currently taking medication or using another treatment for your respiratory illness? |
C20b
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Are you receiving oxygen for your pulmonary disease? |
C21
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Does this condition limit your daily activities such as household chores or your job? |
C22a
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Has a doctor or medical personnel ever told you that you have had a heart attack? |
C22b
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In what year or at about what age did you have your (most recent) heart attack? |
C23
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Are you currently taking medication for your heart condition? |
C24
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Do you carry any medicine with you for chest pain? |
C25a
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Does this heart problem limit your daily activities such as household chores or your job? |
C25b
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Has a doctor or medical personnel ever told you that you have had heart failure/cardiac failure/congestive heart failure, arrhythmia, or angina? |
C26
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Has a doctor or medical personnel (ever/in the last two years) told you that you had a stroke? [VOL] POSSIBLE STROKE OR TIA (TRANSIENT ISCHEMIC ATTACK) |
C27_1
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Because of your stroke do you have weakness in the arms and/or legs, or the capacity to move them has diminished? |
C27_2
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Because of your stroke do you have difficulties when speaking or eating? |
C27_3
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Because of your stroke do you have difficulties with sight or vision? |
C27_4
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Because of your stroke do you have difficulties when thinking or saying what you want? |
C28
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Are you currently taking any medications because of your stroke or for complications due to the stroke? |
C29
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Are you doing physical therapy or rehabilitation because of the stroke or the complications that resulted from the stroke? |
C30
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In what year or at about what age did you have your (most recent) stroke? |
C31
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Has this stroke limited your daily activities such as household chores or your job? |
C.32
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Has a doctor or medical personnel ever diagnosed you with arthritis or rheumatism? |
C33
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Do you feel pain, stiffness, or swelling in your joints? |
C34
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Are you taking medication or are you receiving other treatment for your arthritis or rheumatism? |
C35
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Are your daily activities such as household chores or your job limited because of your arthritis? |
C36_1
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In the last 2 years, has a doctor or medical personnel told you that you have...Kidney infection |
C36_2
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In the last 2 years, has a doctor or medical personnel told you that you have...Liver infection |
C36_3
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In the last 2 years, has a doctor or medical personnel told you that you have...Tuberculosis |
C36_4
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In the last 2 years, has a doctor or medical personnel told you that you have...Pneumonia |
C36_5
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In the last 2 years, has a doctor or medical personnel told you that you have...Herpes or Zoster herpes |
C37
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Have you fallen down in the last two years? |
C38
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Approximately how many times has this happened? |
C39
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Have you hurt yourself in these falls badly enough to need medical treatment? |
C40a
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Since your fiftieth birthday, have you fractured any bone(s) including your hip? |
C40b
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In the last 10 years, have you fractured any bone(s) including your hip? |
C40c
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Did this fracture occur in the last 2 years? |
C41
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Do you usually wear glasses? |
C42
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How is your vision (with glasses)? |
C43
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Do you usually use a hearing aid or auditory device? |
C44
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How is you hearing/auditory range (using hearing aid or auditory device)? |
C45
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Do you often suffer from pain? |
C46
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How is the pain the majority of the time? |
C47
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Does this pain limit your usual activities such as household chores or your job? |
C48a
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In the last two years, have you had any of the following exams or medical procedures? Tetanus vaccine |
C48b
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In the last two years, have you had any of the following exams or medical procedures? Cholesterol blood test |
C48c
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In the last two years, have you had any of the following exams or medical procedures? Tuberculosis test |
C48d
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In the last two years, have you had any of the following exams or medical procedures? Diabetes |
C48e
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In the last two years, have you had any of the following exams or medical procedures? Blood pressure test |
C48f
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In the last two years, have you had any of the following exams or medical procedures? Flu vaccine |
C48g
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In the last two years, have you had any of the following exams or medical procedures? Pneumonia vaccine |
C48h
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Monthly self-breast exam? |
C48i
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Had you had a mammogram or x-ray to check for breast cancer? |
C48j
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Have you had a pap smear to check for uterine cancer? |
C48k
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In the last 2 years, have you had an exam or blood test to screen for prostate cancer? |
C49_1
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Have you felt depressed? |
C49_2
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Everything you did was difficult to do? |
C49_3
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Had restless sleep? |
C49_4
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Felt happy? |
C49_5
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Felt alone? |
C49_6
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Felt you enjoyed life? |
C49_7
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Felt sad? |
C49_8
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Felt tired? |
C49_9
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These questions refer to how you have felt during the past week. For each question please tell me if the majority of the time: Felt very energetic? |
C50a
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In the last 2 years, have you ever felt sad, blue, or depressed for more than two weeks in a row? |
C50b
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On average during the last two years, have you exercised or done hard physical work three or more times a week? INCLUDES VARIOUS ACTIVITES SUCH AS SPORTS, HEAVY HOUSEHOLD CHORES, OR OTHER PHYSICAL WORK |
C51
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Have you ever smoked cigarettes? INCLUDE MORE THAN 100 CIGARETTES OR 5 PACKS IN YOUR LIFETIME. DO NOT INCLUDE PIPES OR CIGARS. |
C52
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About how old were you when you started smoking? |
C53
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Have you smoked cigarettes in the last two years? |
C54
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Do you smoke cigarettes now? |
C55
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How often do you smoke? |
C56
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About how many cigarettes or packs do you usually smoke in a day? REGISTER THE AVERAGE AND CONVERT TO CIGARETTES |
C57
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When you were smoking the most, about how many cigarettes or packs did you usually smoke in a day? |
C58
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About how many years ago did you stop smoking? MARK RESPONSE IN CORRESPONDING SPACE |
C59a
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Do you ever drink any alcoholic beverages such as beer, wine, liquor, or pulque (drink made from fermented cactus sap)? |
C59b
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In the last three months, about how many days a week have you had an alcoholic beverage? NONE, OR LESS THAN ONE PER WEEK MARK "0" |
C59c
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On the days that you drank alcoholic beverages in the last three months, about how many drinks did you have per day? |
C59d
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In the last three months, on how many days have you had four or more drinks on one occasion? |
C59e
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During the last two years, have you had any alcoholic drinks such as beer, wine, liqour, or pulque (drink made from fermented cactus sap)? |
C60
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(When you were drinking), have you ever felt that you should (have) cut down on the quantity of drinks you have (had)? |
C61
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(When you were drinking), have (did) people ever annoy you by criticizing your drinking habits? |
C62
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Have you ever felt bad or guilty about drinking? |
C63
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Have you ever had an alcoholic drink when you woke up in the morning in order to calm your nerves or to get rid of a "hangover"? |
C64
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Compared with two years ago, your weight.. |
C65
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In the last two years, have you changed your diet or your exercise habits in order to gain or lose weight? |
C66
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About how much do you weigh now? |
C67
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About how tall are you without shoes? |
C68a
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During the last two years have you frequently had any of the following problems or inconveniences? Frequent swelling in the feet or ankles |
C68b
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During the last two years have you frequently had any of the following problems or inconveniences? Difficulty breathing , panting or coughing, or phlegm |
C68c
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During the last two years have you frequently had any of the following problems or inconveniences? Nausea or fainting |
C68d
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During the last two years have you frequently had any of the following problems or inconveniences? Extreme thirst |
C68e
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During the last two years have you frequently had any of the following problems or inconveniences? Severe fatigue or exhaustion |
C68f
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During the last two years have you frequently had any of the following problems or inconveniences? Stomach pain, indigestion or diarrhea |
C68g
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During the last two years have you frequently had any of the following problems or inconveniences? Incontinence when coughing, sneezing, picking something up, or exercising |
C68h
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During the last two years have you frequently had any of the following problems or inconveniences? Incontinence when had the urge to urinate, but couldn't reach the bathroom in time |
C68i
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During the last two years have you frequently had any of the following problems or inconveniences? Burning sensation when urinating |
C69a
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How would you evaluate your hand strength (your dominant hand)? Would you say... |
C69b
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How often do you have difficulty with balance? Would you say... |
C70
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In the last two years, have you eaten less because of loss of appetite, digestive problems, and difficulties chewing or swallowing? |
C71a
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Have you lost an extremity or part of your feet or arms due to an accident or sickness? |
C71b
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Did this loss occur in the last 2 years? |
C72
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Have you ever (or in the last two years) been told by a doctor or medical personnel that you suffer from a health problem caused by your job? INCLUDE WORK ACCIDENTS |
C73
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Due to sickness or injury, during the last 12 months, how many days did you stay in bed for at least half the day? INCLUDE DAYS WHEN YOU WERE IN HOSPITAL |
C74
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How often do you feel really rested when you wake up in the morning? Would you say... |
C75
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INTERVIEWER: HOW FREQUENTLY DID THE RESPONDENT NEED HELP TO ANSWER SECTION C. HEALTH? |