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Start of C. Health
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C1
Now I have some questions about your health. Would you say your health is...
NOW I HAVE SOME QUESTIONS ABOUT YOUR HEALTH. WOULD YOU SAY YOUR HEALTH IS...
1 Excellent
2 Very Good
3 Good
4 Fair
5 Poor
8 RF
9 DK
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C2A
Comparing your health now with your health two years ago, would you say your health now is...
COMPARING YOUR HEALTH NOW WITH YOUR HEALTH TWO YEARS AGO, WOULD YOU SAY YOUR HEALTH NOW IS...
1 Much better
2 Somewhat better
3 More or less the same
4 Somewhat worse
5 Much worse
8 RF
9 DK
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C2B
In the last two years, have you seen a doctor or medical personnel?
IN THE LAST TWO YEARS, HAVE YOU SEEN A DOCTOR OR MEDICAL PERSONNEL?
1 YES
2 NO
8 RF
9 DK
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C3
Compared with other people your age, would you say that currently your health is...?
COMPARED WITH OTHER PEOPLE YOUR AGE, WOULD YOU SAY THAT CURRENTLY YOUR HEALTH IS...?
1 Better
2 More or less the same
3 Worse
8 RF
9 DK
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C4
Has a doctor or medical personnel ever diagnosed you with hypertension or high blood pressure?
HAS A DOCTOR OR MEDICAL PERSONNEL EVER DIAGNOSED YOU WITH HYPERTENSION OR HIGH BLOOD PRESSURE?
1 YES
2 NO
8 RF
9 DK
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C5
Are you currently taking any medication to lower your blood pressure?
ARE YOU CURRENTLY TAKING ANY MEDICATION TO LOWER YOUR BLOOD PRESSURE?
1 YES
2 NO
8 RF
9 DK
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C6
Has a doctor or medical personnel ever diagnosed you with diabetes?
HAS A DOCTOR OR MEDICAL PERSONNEL EVER DIAGNOSED YOU WITH DIABETES?
1 YES
2 NO
8 RF
9 DK
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C7
Are you currently taking any oral medication in order to control your diabetes?
ARE YOU CURRENTLY TAKING ANY ORAL MEDICATION IN ORDER TO CONTROL YOUR DIABETES?
1 YES
2 NO
8 RF
9 DK
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C8
Are you currently using insulin shots?
ARE YOU CURRENTLY USING INSULIN SHOTS?
1 YES
2 NO
8 RF
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C9
Do you follow a special diet to control your diabetes?
DO YOU FOLLOW A SPECIAL DIET TO CONTROL YOUR DIABETES?
1 YES
2 NO
8 RF
9 DK
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C10
In general, is your diabetes under control now?
IN GENERAL, IS YOUR DIABETES UNDER CONTROL NOW?
1 YES
2 NO
8 RF
9 DK
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C11
How frequently do you measure your blood sugar level or urine-sugar level? INDICATE THE NUMBER OF TIME AND PERIOD
HOW FREQUENTLY DO YOU MEASURE YOUR BLOOD SUGAR LEVEL OR URINE-SUGAR LEVEL? INDICATE THE NUMBER OF TIME AND PERIOD
_________ NUMBER OF TIMES
1 Week
2 Month
3 Year
5 NEVER
88/8 RF
99/9 DK
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C12
Has a doctor or medical personnel ever diagnosed you with cancer?
HAS A DOCTOR OR MEDICAL PERSONNEL EVER DIAGNOSED YOU WITH CANCER?
1 YES
2 NO
8 RF
9 DK
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C13
In total, how many cancers in different places or organs have you ever had?
IN TOTAL, HOW MANY CANCERS IN DIFFERENT PLACES OR ORGANS HAVE YOU EVER HAD?
____________ NUMBER OF CANCERS
88 RF
99 DK
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C14
What type of cancer? INDICATE ALL THAT APPLY
WHAT TYPE OF CANCER? INDICATE ALL THAT APPLY
01 Breast
02 Cervical/Cervix
03 Endometrial/Uterine
04 Liver
05 Stomach
06 Pancreas
07 Prostate
08 Colorectal
09 Lung
10 Other
88 RF
99 DK
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C15
In the last two years, have you consulted a doctor or medical personnel about your cancer?
IN THE LAST TWO YEARS, HAVE YOU CONSULTED A DOCTOR OR MEDICAL PERSONNEL ABOUT YOUR CANCER?
1 YES
2 NO
8 RF
9 DK
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C16
In the last two years, what type of treatments have you received for your cancer? (Other)
IN THE LAST TWO YEARS, WHAT TYPE OF TREATMENTS HAVE YOU RECEIVED FOR YOUR CANCER?
1 Chemotherapy/ Medication
2 Surgery or Biopsy
3 Radiation or X-Ray
4 Medication or Treatment for Symptoms (Pain, Nausea, Rash)
5 NONE
7 OTHER ________________
8 RF
9 DK
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C17
Are you currently receiving treatment for your cancer?
ARE YOU CURRENTLY RECEIVING TREATMENT FOR YOUR CANCER?
1 YES
2 NO
8 RF
9 DK
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C18
In what year or at what age was your (most recent) cancer diagnosed?
IN WHAT YEAR OR AT WHAT AGE WAS YOUR (MOST RECENT) CANCER DIAGNOSED?
____________ YEAR OR AGE
8888 RF
9999 DK
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C19
Has a doctor or medical personnel ever told/diagnosed you with a respiratory illness, such as asthma or emphysema?
HAS A DOCTOR OR MEDICAL PERSONNEL EVER TOLD/DIAGNOSED YOU WITH A RESPIRATORY ILLNESS, SUCH AS ASTHMA OR EMPHYSEMA?
1 YES
2 NO
8 RF
9 DK
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C20A
Are you currently taking medication or using another treatment for your respiratory illness?
ARE YOU CURRENTLY TAKING MEDICATION OR USING ANOTHER TREATMENT FOR YOUR RESPIRATORY ILLNESS?
1 YES
2 NO
8 RF
9 DK
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C20B
Are you receiving oxygen for your pulmonary disease?
ARE YOU RECEIVING OXYGEN FOR YOUR PULMONARY DISEASE?
1 YES
2 NO
8 RF
9 DK
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C21
Does this condition limit your daily activities such as household chores or your job?
DOES THIS CONDITION LIMIT YOUR DAILY ACTIVITIES SUCH AS HOUSEHOLD CHORES OR YOUR JOB?
1 YES
2 NO
8 RF
9 DK
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C22A
Has a doctor or medical personnel ever told you that you have had a heart attack?
HAS A DOCTOR OR MEDICAL PERSONNEL EVER TOLD YOU THAT YOU HAVE HAD A HEART ATTACK?
1 YES
2 NO
8 RF
9 DK
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C22B
In what year or at about what age did you have your (most recent) heart attack?
IN WHAT YEAR OR AT ABOUT WHAT AGE DID YOU HAVE YOUR (MOST RECENT) HEART ATTACK?
______________ YEAR OR AGE
8888 RF
9999 DK
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C23
Are you currently taking medication for your heart condition?
ARE YOU CURRENTLY TAKING MEDICATION FOR YOUR HEART CONDITION?
1 YES
2 NO
8 RF
9 DK
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C24
Do you carry any medicine with you for chest pain?
DO YOU CARRY ANY MEDICINE WITH YOU FOR CHEST PAIN?
1 YES
2 NO
8 RF
9 DK
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C25A
Does this heart problem limit your daily activities such as household chores or your job?
DOES THIS HEART PROBLEM LIMIT YOUR DAILY ACTIVITIES SUCH AS HOUSEHOLD CHORES OR YOUR JOB?
1 YES
2 NO
8 RF
9 DK
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C25B
Has a doctor or medical personnel ever told you that you have had heart failure/cardiac failure/congestive heart failure, arrhythmia, or angina?
HAS A DOCTOR OR MEDICAL PERSONNEL EVER TOLD YOU THAT YOU HAVE HAD HEART FAILURE/CARDIAC FAILURE/CONGESTIVE HEART FAILURE, ARRHYTHMIA, OR ANGINA?
1 YES
2 NO
8 RF
9 DK
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C26
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)
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)
1 YES
2 NO
8 RF
9 DK
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C27_1
Because of your stroke do you have weakness in the arms and/or legs, or the capacity to move them has diminished?
BECAUSE OF YOUR STROKE DO YOU HAVE WEAKNESS IN THE ARMS AND/OR LEGS, OR THE CAPACITY TO MOVE THEM HAS DIMINISHED?
1 YES
2 NO
8 RF
9 DK
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C27_2
Because of your stroke do you have difficulties when speaking or eating?
BECAUSE OF YOUR STROKE DO YOU HAVE DIFFICULTIES WHEN SPEAKING OR EATING?
1 YES
2 NO
8 RF
9 DK
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C27_3
Because of your stroke do you have difficulties with sight or vision?
BECAUSE OF YOUR STROKE DO YOU HAVE DIFFICULTIES WITH SIGHT OR VISION?
1 YES
2 NO
8 RF
9 DK
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C27_4
Because of your stroke do you have difficulties when thinking or saying what you want?
BECAUSE OF YOUR STROKE DO YOU HAVE DIFFICULTIES WHEN THINKING OR SAYING WHAT YOU WANT?
1 YES
2 NO
8 RF
9 DK
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C28
Are you currently taking any medications because of your stroke or for complications due to the stroke?
ARE YOU CURRENTLY TAKING ANY MEDICATIONS BECAUSE OF YOUR STROKE OR FOR COMPLICATIONS DUE TO THE STROKE?
1 YES
2 NO
8 RF
9 DK
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C29
Are you doing physical therapy or rehabilitation because of the stroke or the complications that resulted from the stroke?
ARE YOU DOING PHYSICAL THERAPY OR REHABILITATION BECAUSE OF THE STROKE OR THE COMPLICATIONS THAT RESULTED FROM THE STROKE?
1 YES
2 NO
8 RF
9 DK
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C30
In what year or at about what age did you have your (most recent) stroke?
IN WHAT YEAR OR AT ABOUT WHAT AGE DID YOU HAVE YOUR (MOST RECENT) STROKE?
________________ YEAR OR AGE
8888 RF
9999 DK
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C31
Has this stroke limited your daily activities such as household chores or your job?
HAS THIS STROKE LIMITED YOUR DAILY ACTIVITIES SUCH AS HOUSEHOLD CHORES OR YOUR JOB?
1 YES
2 NO
8 RF
9 DK
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C.32
Has a doctor or medical personnel ever diagnosed you with arthritis or rheumatism?
HAS A DOCTOR OR MEDICAL PERSONNEL EVER DIAGNOSED YOU WITH ARTHRITIS OR RHEUMATISM?
1 YES
2 NO
8 RF
9 DK
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C33
Do you feel pain, stiffness, or swelling in your joints?
DO YOU FEEL PAIN, STIFFNESS, OR SWELLING IN YOUR JOINTS?
1 YES
2 NO
8 RF
9 DK
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C34
Are you taking medication or are you receiving other treatment for your arthritis or rheumatism?
ARE YOU TAKING MEDICATION OR ARE YOU RECEIVING OTHER TREATMENT FOR YOUR ARTHRITIS OR RHEUMATISM?
1 YES
2 NO
8 RF
9 DK
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C35
Are your daily activities such as household chores or your job limited because of your arthritis?
ARE YOUR DAILY ACTIVITIES SUCH AS HOUSEHOLD CHORES OR YOUR JOB LIMITED BECAUSE OF YOUR ARTHRITIS?
1 YES
2 NO
8 RF
9 DK
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C36_1
In the last 2 years, has a doctor or medical personnel told you that you have...Kidney infection
IN THE LAST 2 YEARS, HAS A DOCTOR OR MEDICAL PERSONNEL TOLD YOU THAT YOU HAVE...KIDNEY INFECTION
1 YES
2 NO
8 RF
9 DK
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C36_2
In the last 2 years, has a doctor or medical personnel told you that you have...Liver infection
IN THE LAST 2 YEARS, HAS A DOCTOR OR MEDICAL PERSONNEL TOLD YOU THAT YOU HAVE...LIVER INFECTION
1 YES
2 NO
8 RF
9 DK
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C36_3
In the last 2 years, has a doctor or medical personnel told you that you have...Tuberculosis
IN THE LAST 2 YEARS, HAS A DOCTOR OR MEDICAL PERSONNEL TOLD YOU THAT YOU HAVE...TUBERCULOSIS
1 YES
2 NO
8 RF
9 DK
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C36_4
In the last 2 years, has a doctor or medical personnel told you that you have...Pneumonia
IN THE LAST 2 YEARS, HAS A DOCTOR OR MEDICAL PERSONNEL TOLD YOU THAT YOU HAVE...PNEUMONIA
1 YES
2 NO
8 RF
9 DK
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C36_5
In the last 2 years, has a doctor or medical personnel told you that you have...Herpes or Zoster herpes
IN THE LAST 2 YEARS, HAS A DOCTOR OR MEDICAL PERSONNEL TOLD YOU THAT YOU HAVE...HERPES OR ZOSTER HERPES
1 YES
2 NO
8 RF
9 DK
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C37
Have you fallen down in the last two years?
HAVE YOU FALLEN DOWN IN THE LAST TWO YEARS?
1 YES
2 NO
8 RF
9 DK
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C38
Approximately how many times has this happened?
APPROXIMATELY HOW MANY TIMES HAS THIS HAPPENED?
___________ NUMBER OF TIMES
88 RF
99 DK
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C39
Have you hurt yourself in these falls badly enough to need medical treatment?
HAVE YOU HURT YOURSELF IN THESE FALLS BADLY ENOUGH TO NEED MEDICAL TREATMENT?
1 YES
2 NO
8 RF
9 DK
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C40A
Since your fiftieth birthday, have you fractured any bone(s) including your hip?
SINCE YOUR FIFTIETH BIRTHDAY, HAVE YOU FRACTURED ANY BONE(S) INCLUDING YOUR HIP?
1 YES
2 NO
8 RF
9 DK
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C40C
Did this fracture occur in the last 2 years?
DID THIS FRACTURE OCCUR IN THE LAST 2 YEARS?
1 YES
2 NO
8 RF
9 DK
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C40B
In the last 10 years, have you fractured any bone(s) including your hip?
IN THE LAST 10 YEARS, HAVE YOU FRACTURED ANY BONE(S) INCLUDING YOUR HIP?
1 YES
2 NO
8 RF
9 DK
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C40C
Did this fracture occur in the last 2 years?
DID THIS FRACTURE OCCUR IN THE LAST 2 YEARS?
1 YES
2 NO
8 RF
9 DK
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C41
Do you usually wear glasses?
DO YOU USUALLY WEAR GLASSES?
1 YES
2 NO
8 RF
9 DK
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C42
How is your vision (with glasses)?
HOW IS YOUR VISION (WITH GLASSES)?
1 Excellent
2 Very Good
3 Good
4 Fair
5 Poor
6 (Vol) LEGALLY BLIND
8 RF
9 DK
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C43
Do you usually use a hearing aid or auditory device?
DO YOU USUALLY USE A HEARING AID OR AUDITORY DEVICE?
1 YES
2 NO
8 RF
9 DK
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C44
How is you hearing/auditory range (using hearing aid or auditory device)?
HOW IS YOU HEARING/AUDITORY RANGE (USING HEARING AID OR AUDITORY DEVICE)?
1 Excellent
2 Very Good
3 Good
4 Fair
5 Poor
6 (Vol) LEGALLY DEAF
8 RF
9 DK
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C45
Do you often suffer from pain?
DO YOU OFTEN SUFFER FROM PAIN?
1 YES
2 NO
8 RF
9 DK
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C46
How is the pain the majority of the time?
HOW IS THE PAIN THE MAJORITY OF THE TIME?
1 Mild
2 Moderate
3 Severe
8 RF
9 DK
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C47
Does this pain limit your usual activities such as household chores or your job?
DOES THIS PAIN LIMIT YOUR USUAL ACTIVITIES SUCH AS HOUSEHOLD CHORES OR YOUR JOB?
1 YES
2 NO
8 RF
9 DK
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C48A
In the last two years, have you had any of the following exams or medical procedures? Tetanus vaccine
IN THE LAST TWO YEARS, HAVE YOU HAD ANY OF THE FOLLOWING EXAMS OR MEDICAL PROCEDURES? TETANUS VACCINE
1 YES
2 NO
8 RF
9 DK
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C48B
In the last two years, have you had any of the following exams or medical procedures? Cholesterol blood test
IN THE LAST TWO YEARS, HAVE YOU HAD ANY OF THE FOLLOWING EXAMS OR MEDICAL PROCEDURES? CHOLESTEROL BLOOD TEST
1 YES
2 NO
8 RF
9 DK
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C48C
In the last two years, have you had any of the following exams or medical procedures? Tuberculosis test
IN THE LAST TWO YEARS, HAVE YOU HAD ANY OF THE FOLLOWING EXAMS OR MEDICAL PROCEDURES? TUBERCULOSIS TEST
1 YES
2 NO
8 RF
9 DK
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C48D
In the last two years, have you had any of the following exams or medical procedures? Diabetes
IN THE LAST TWO YEARS, HAVE YOU HAD ANY OF THE FOLLOWING EXAMS OR MEDICAL PROCEDURES? DIABETES
1 YES
2 NO
8 RF
9 DK
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C48E
In the last two years, have you had any of the following exams or medical procedures? Blood pressure test
IN THE LAST TWO YEARS, HAVE YOU HAD ANY OF THE FOLLOWING EXAMS OR MEDICAL PROCEDURES? BLOOD PRESSURE TEST
1 YES
2 NO
8 RF
9 DK
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C48F
In the last two years, have you had any of the following exams or medical procedures? Flu vaccine
IN THE LAST TWO YEARS, HAVE YOU HAD ANY OF THE FOLLOWING EXAMS OR MEDICAL PROCEDURES? FLU VACCINE
1 YES
2 NO
8 RF
9 DK
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C48G
In the last two years, have you had any of the following exams or medical procedures? Pneumonia vaccine
IN THE LAST TWO YEARS, HAVE YOU HAD ANY OF THE FOLLOWING EXAMS OR MEDICAL PROCEDURES? PNEUMONIA VACCINE
1 YES
2 NO
8 RF
9 DK
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C48H
Monthly self-breast exam?
MONTHLY SELF-BREAST EXAM?
1 YES
2 NO
8 RF
9 DK
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C48I
Had you had a mammogram or x-ray to check for breast cancer?
HAD YOU HAD A MAMMOGRAM OR X-RAY TO CHECK FOR BREAST CANCER?
1 YES
2 NO
8 RF
9 DK
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C48J
Have you had a pap smear to check for uterine cancer?
HAVE YOU HAD A PAP SMEAR TO CHECK FOR UTERINE CANCER?
1 YES
2 NO
8 RF
9 DK
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C48K
In the last 2 years, have you had an exam or blood test to screen for prostate cancer?
IN THE LAST 2 YEARS, HAVE YOU HAD AN EXAM OR BLOOD TEST TO SCREEN FOR PROSTATE CANCER?
1 YES
2 NO
3 ALREADY HAD OPERATION
8 RF
9 DK
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C49_1
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?
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?
1 YES
2 NO
8 RF
9 DK
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C49_2
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?
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?
1 YES
2 NO
8 RF
9 DK
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C49_3
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?
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?
1 YES
2 NO
8 RF
9 DK
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C49_4
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?
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?
1 YES
2 NO
8 RF
9 DK
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C49_5
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?
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?
1 YES
2 NO
8 RF
9 DK
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C49_6
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?
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?
1 YES
2 NO
8 RF
9 DK
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C49_7
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?
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?
1 YES
2 NO
8 RF
9 DK
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C49_8
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?
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?
1 YES
2 NO
8 RF
9 DK
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C49_9
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?
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?
1 YES
2 NO
8 RF
9 DK
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C50A
In the last 2 years, have you ever felt sad, blue, or depressed for more than two weeks in a row?
IN THE LAST 2 YEARS, HAVE YOU EVER FELT SAD, BLUE, OR DEPRESSED FOR MORE THAN TWO WEEKS IN A ROW?
1 YES
2 NO
8 RF
9 DK
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C50B
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
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
1 YES
2 NO
8 RF
9 DK
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C51
Have you ever smoked cigarettes? INCLUDE MORE THAN 100 CIGARETTES OR 5 PACKS IN YOUR LIFETIME. DO NOT INCLUDE PIPES OR CIGARS.
HAVE YOU EVER SMOKED CIGARETTES? INCLUDE MORE THAN 100 CIGARETTES OR 5 PACKS IN YOUR LIFETIME. DO NOT INCLUDE PIPES OR CIGARS.
1 YES
2 NO
8 RF
9 DK
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If Have you ever smoked cigarettes? INCLUDE MORE THAN 100 CIGARETTES OR 5 PACKS IN YOUR LIFETIME. DO NOT INCLUDE PIPES OR CIGARS. = 1 YES »
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C52
About how old were you when you started smoking?
ABOUT HOW OLD WERE YOU WHEN YOU STARTED SMOKING?
___________________ AGE OR YEAR STARTED SMOKING
___________________ OR STARTED SMOKING YEARS AGO
88 RF
99 DK
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C53
Have you smoked cigarettes in the last two years?
HAVE YOU SMOKED CIGARETTES IN THE LAST TWO YEARS?
1 YES
2 NO
8 RF
9 DK
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If Have you smoked cigarettes in the last two years? = 1 YES »
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C54
Do you smoke cigarettes now?
DO YOU SMOKE CIGARETTES NOW?
1 YES
2 NO
8 RF
9 DK
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If Do you smoke cigarettes now? = 1 YES »
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C55
How often do you smoke?
HOW OFTEN DO YOU SMOKE?
1 Every day
2 Not every day
8 RF
9 DK
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If How often do you smoke? = 1 Every day »
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C56
About how many cigarettes or packs do you usually smoke in a day? REGISTER THE AVERAGE AND CONVERT TO CIGARETTES
ABOUT HOW MANY CIGARETTES OR PACKS DO YOU USUALLY SMOKE IN A DAY? REGISTER THE AVERAGE AND CONVERT TO CIGARETTES
_____________ CIGARETTES/DAY
______________ OR PACKS/DAY
87 87 OR MORE CIGARETTES
88 RF
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If Do you smoke cigarettes now? != 1 YES »
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C57
When you were smoking the most, about how many cigarettes or packs did you usually smoke in a day?
WHEN YOU WERE SMOKING THE MOST, ABOUT HOW MANY CIGARETTES OR PACKS DID YOU USUALLY SMOKE IN A DAY?
______________ CIGARETTES/DAY
_______________ OR PACKS/DAY
87 87 OR MORE CIGARETTES
88 RF
99 DK
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C58
About how many years ago did you stop smoking? MARK RESPONSE IN CORRESPONDING SPACE
ABOUT HOW MANY YEARS AGO DID YOU STOP SMOKING? MARK RESPONSE IN CORRESPONDING SPACE
______________ YEARS AGO
__________________ OR YEAR STOPPED SMOKING
__________________ OR AGE WHEN STOPPED SMOKING
88 RF
99 DK
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C59A
Do you ever drink any alcoholic beverages such as beer, wine, liquor, or pulque (drink made from fermented cactus sap)?
DO YOU EVER DRINK ANY ALCOHOLIC BEVERAGES SUCH AS BEER, WINE, LIQUOR, OR PULQUE (DRINK MADE FROM FERMENTED CACTUS SAP)?
1 YES
2 NO
3 (VOL) HAS NEVER USED ALCOHOL
8 RF
9 DK
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C59B
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"
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"
______________ NUMBER OF DAYS
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If C59B!=8 and C59B!=9 and 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" > 1 »
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C59C
On the days that you drank alcoholic beverages in the last three months, about how many drinks did you have per day?
ON THE DAYS THAT YOU DRANK ALCOHOLIC BEVERAGES IN THE LAST THREE MONTHS, ABOUT HOW MANY DRINKS DID YOU HAVE PER DAY?
_______________ NUMBER OF DRINKS
88 RF
99 DK
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C59D
In the last three months, on how many days have you had four or more drinks on one occasion?
IN THE LAST THREE MONTHS, ON HOW MANY DAYS HAVE YOU HAD FOUR OR MORE DRINKS ON ONE OCCASION?
___________ NUMBER OF DAYS
00 NONE
87 87 OR MORE DAYS
88 RF
99 DK
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C60
(When you were drinking), have you ever felt that you should (have) cut down on the quantity of drinks you have (had)?
(WHEN YOU WERE DRINKING), HAVE YOU EVER FELT THAT YOU SHOULD (HAVE) CUT DOWN ON THE QUANTITY OF DRINKS YOU HAVE (HAD)?
1 YES
2 NO
8 RF
9 DK
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C61
(When you were drinking), have (did) people ever annoy you by criticizing your drinking habits?
(WHEN YOU WERE DRINKING), HAVE (DID) PEOPLE EVER ANNOY YOU BY CRITICIZING YOUR DRINKING HABITS?
1 YES
2 NO
8 RF
9 DK
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C62
Have you ever felt bad or guilty about drinking?
HAVE YOU EVER FELT BAD OR GUILTY ABOUT DRINKING?
1 YES
2 NO
8 RF
9 DK
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C63
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"?
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"?
1 YES
2 NO
8 RF
9 DK
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C59E
During the last two years, have you had any alcoholic drinks such as beer, wine, liqour, or pulque (drink made from fermented cactus sap)?
DURING THE LAST TWO YEARS, HAVE YOU HAD ANY ALCOHOLIC DRINKS SUCH AS BEER, WINE, LIQOUR, OR PULQUE (DRINK MADE FROM FERMENTED CACTUS SAP)?
1 YES
2 NO
8 RF
9 DK
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C60
(When you were drinking), have you ever felt that you should (have) cut down on the quantity of drinks you have (had)?
(WHEN YOU WERE DRINKING), HAVE YOU EVER FELT THAT YOU SHOULD (HAVE) CUT DOWN ON THE QUANTITY OF DRINKS YOU HAVE (HAD)?
1 YES
2 NO
8 RF
9 DK
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C61
(When you were drinking), have (did) people ever annoy you by criticizing your drinking habits?
(WHEN YOU WERE DRINKING), HAVE (DID) PEOPLE EVER ANNOY YOU BY CRITICIZING YOUR DRINKING HABITS?
1 YES
2 NO
8 RF
9 DK
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C62
Have you ever felt bad or guilty about drinking?
HAVE YOU EVER FELT BAD OR GUILTY ABOUT DRINKING?
1 YES
2 NO
8 RF
9 DK
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C63
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"?
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"?
1 YES
2 NO
8 RF
9 DK
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C64
Compared with two years ago, your weight..
COMPARED WITH TWO YEARS AGO, YOUR WEIGHT..
1 Has increased 5 kilos or more?
2 Has decreased 5 kilos or more?
3 Has remained more or less the same?
8 RF
9 DK
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C65
In the last two years, have you changed your diet or your exercise habits in order to gain or lose weight?
IN THE LAST TWO YEARS, HAVE YOU CHANGED YOUR DIET OR YOUR EXERCISE HABITS IN ORDER TO GAIN OR LOSE WEIGHT?
1 YES
2 NO
8 RF
9 DK
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C66
About how much do you weigh now?
ABOUT HOW MUCH DO YOU WEIGH NOW?
___________________ KILOS
888 RF
999 DK
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C67
About how tall are you without shoes?
ABOUT HOW TALL ARE YOU WITHOUT SHOES?
_______________ METERS AND CENTIMETERS
8.88 RF
9.99 DK
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C68A
During the last two years have you frequently had any of the following problems or inconveniences? Frequent swelling in the feet or ankles
DURING THE LAST TWO YEARS HAVE YOU FREQUENTLY HAD ANY OF THE FOLLOWING PROBLEMS OR INCONVENIENCES? FREQUENT SWELLING IN THE FEET OR ANKLES
1 YES
2 NO
8 RF
9 DK
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C68B
During the last two years have you frequently had any of the following problems or inconveniences? Difficulty breathing , panting or coughing, or phlegm
DURING THE LAST TWO YEARS HAVE YOU FREQUENTLY HAD ANY OF THE FOLLOWING PROBLEMS OR INCONVENIENCES? DIFFICULTY BREATHING , PANTING OR COUGHING, OR PHLEGM
1 YES
2 NO
8 RF
9 DK
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C68C
During the last two years have you frequently had any of the following problems or inconveniences? Nausea or fainting
DURING THE LAST TWO YEARS HAVE YOU FREQUENTLY HAD ANY OF THE FOLLOWING PROBLEMS OR INCONVENIENCES? NAUSEA OR FAINTING
1 YES
2 NO
8 RF
9 DK
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C68D
During the last two years have you frequently had any of the following problems or inconveniences? Extreme thirst
DURING THE LAST TWO YEARS HAVE YOU FREQUENTLY HAD ANY OF THE FOLLOWING PROBLEMS OR INCONVENIENCES? EXTREME THIRST
1 YES
2 NO
8 RF
9 DK
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C68E
During the last two years have you frequently had any of the following problems or inconveniences? Severe fatigue or exhaustion
DURING THE LAST TWO YEARS HAVE YOU FREQUENTLY HAD ANY OF THE FOLLOWING PROBLEMS OR INCONVENIENCES? SEVERE FATIGUE OR EXHAUSTION
1 YES
2 NO
8 RF
9 DK
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C68F
During the last two years have you frequently had any of the following problems or inconveniences? Stomach pain, indigestion or diarrhea
DURING THE LAST TWO YEARS HAVE YOU FREQUENTLY HAD ANY OF THE FOLLOWING PROBLEMS OR INCONVENIENCES? STOMACH PAIN, INDIGESTION OR DIARRHEA
1 YES
2 NO
8 RF
9 DK
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C68G
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
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
1 YES
2 NO
8 RF
9 DK
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C68H
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
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
1 YES
2 NO
8 RF
9 DK
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C68I
During the last two years have you frequently had any of the following problems or inconveniences? Burning sensation when urinating
DURING THE LAST TWO YEARS HAVE YOU FREQUENTLY HAD ANY OF THE FOLLOWING PROBLEMS OR INCONVENIENCES? BURNING SENSATION WHEN URINATING
1 YES
2 NO
8 RF
9 DK
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C69A
How would you evaluate your hand strength (your dominant hand)? Would you say...
HOW WOULD YOU EVALUATE YOUR HAND STRENGTH (YOUR DOMINANT HAND)? WOULD YOU SAY...
1 Very strong
2 Somewhat strong
3 Somewhat weak
4 Very weak
8 RF
9 DK
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C69B
How often do you have difficulty with balance? Would you say...
HOW OFTEN DO YOU HAVE DIFFICULTY WITH BALANCE? WOULD YOU SAY...
1 OFTEN
2 SOMETIMES
3 RARELY
4 NEVER
8 RF
9 DK
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C70
In the last two years, have you eaten less because of loss of appetite, digestive problems, and difficulties chewing or swallowing?
IN THE LAST TWO YEARS, HAVE YOU EATEN LESS BECAUSE OF LOSS OF APPETITE, DIGESTIVE PROBLEMS, AND DIFFICULTIES CHEWING OR SWALLOWING?
1 Often
2 Sometimes
3 Rarely
8 RF
9 DK
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C71A
Have you lost an extremity or part of your feet or arms due to an accident or sickness?
HAVE YOU LOST AN EXTREMITY OR PART OF YOUR FEET OR ARMS DUE TO AN ACCIDENT OR SICKNESS?
1 YES
2 NO
8 RF
9 DK
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C71B
Did this loss occur in the last 2 years?
DID THIS LOSS OCCUR IN THE LAST 2 YEARS?
1 YES
2 NO
8 RF
9 DK
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C72
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
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
1 YES
2 NO
3 NEVER WORKED
8 RF
9 DK
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C73
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
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
________________ NUMBER OF DAYS
000 NONE
888 RF
999 DK
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C74
How often do you feel really rested when you wake up in the morning? Would you say...
HOW OFTEN DO YOU FEEL REALLY RESTED WHEN YOU WAKE UP IN THE MORNING? WOULD YOU SAY...
1 Most of the time
2 Sometimes
3 Rarely or never
8 RF
9 DK
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C75
INTERVIEWER: HOW FREQUENTLY DID THE RESPONDENT NEED HELP TO ANSWER SECTION C. HEALTH?
INTERVIEWER: HOW FREQUENTLY DID THE RESPONDENT NEED HELP TO ANSWER SECTION C. HEALTH?
1 NEVER
2 A FEW TIMES
3 MOST OR ALL OF THE TIME
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End of C. Health
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