SC1-1
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Watch television. |
SC1-2
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Go out to films, plays and concerts. |
SC1-3
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Attend classes and lectures. |
SC1-4
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Travel for pleasure. |
SC1-5
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Work in the garden, or your home, or on a car. |
SC1-6
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Read books or magazines for pleasure. |
SC1-7
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Listen to music, radio. |
SC1-8
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Spend time on hobbies or creative activities. |
SC1-9
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Play cards, bingo, games in general. |
SC1-10
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Go to the pub. |
SC1-11
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Eat out of the house. |
SC1-12
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Participate in sport activities or exercise. |
SC1-13
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Visit to or from family or friends, either in person or talking on the phone. |
SC1-14
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Do voluntary work. |
SC2-1
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Political Party, trade union or environmental groups |
SC2-2
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Tenants groups, resident groups, neighborhood watch |
SC2-3
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Church or other religious groups |
SC2-4
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Charitable associations |
SC2-5
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Education, arts or music groups or evening classes |
SC2-6
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Social clubs |
SC2-7
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Sports clubs, GAA or gym exercise classes |
SC2-8
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Any other organisations, clubs or societies |
SC3-1
|
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How often do you feel you lack companionship? |
SC3-2
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How often do you feel left out? |
SC3-3
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How often do you feel isolated from others? |
SC3-4
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How often do you feel in tune with the people around you? |
SC3-5
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How often do you feel lonely? |
SC4-1
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How much does he/she really understand the way you feel about things? |
SC4-2
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How much can you rely on him/her if you have a serious problem? |
SC4-3
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How much can you open up to him/her if you need to talk about your worries? |
SC4-4
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How much does he/she make too many demands on you? |
SC4-5
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How much does he/she criticise you? |
SC4-6
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How much does he/she let you down when you are counting on him/her? |
SC4-7
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How much does he/she get on your nerves? |
SC5
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HOW CLOSE IS YOUR RELATIONSHIP WITH YOUR SPOUSE OR PARTNER WITH WHOM YOU LIVE? |
SC6-1
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How much do they really understand the way you feel about things? |
SC6-2
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How much can you rely on them if you have a serious problem? |
SC6-3
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How much can you open up to them if you need to talk about your worries? |
SC6-4
|
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How much do they make too many demands on you? |
SC6-5
|
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How much do they criticise you? |
SC6-6
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How much do they let you down when you are counting on them? |
SC6-7
|
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How much do they get on your nerves? |
SC7
|
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APART FROM YOUR SPOUSE/PARTNER AND CHILDREN (IF ANY), DO YOU HAVE ANY OTHER FAMILY MEMBERS (SUCH AS BROTHERS, SISTERS, PARENTS, COUSINS, ETC.)? |
SC8-1
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How much do they really understand the way you feel about things? |
SC8-2
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How much can you rely on them if you have a serious problem? |
SC8-3
|
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How much can you open up to them if you need to talk about your worries? |
SC8-4
|
|
How much do they make too many demands on you? |
SC8-5
|
|
How much do they criticise you? |
SC8-6
|
|
How much do they let you down when you are counting on them? |
SC8-7
|
|
How much do they get on your nerves? |
SC9-1
|
|
How much do they really understand the way you feel about things? |
SC9-2
|
|
How much can you rely on them if you have a serious problem? |
SC9-3
|
|
How much can you open up to them if you need to talk about your worries? |
SC9-4
|
|
How much do they make too many demands on you? |
SC9-5
|
|
How much do they criticise you? |
SC9-6
|
|
How much do they let you down when you are counting on them? |
SC9-7
|
|
How much do they get on your nerves? |
SC10
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FOR SOME PEOPLE, SEX IS A VERY IMPORTANT PART OF THEIR LIVES AND FOR OTHERS, IT IS NOT VERY IMPORTANT AT ALL. HOW IMPORTANT A PART OF YOUR LIFE WOULD YOU SAY THAT SEX IS? |
SC11
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ARE YOU CURRENTLY SEXUALLY ACTIVE (WITHIN THE LAST 12 MONTHS?) |
SC12
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HOW OFTEN DO YOU ENGAGE IN SEXUAL ACTIVITY? |
SC13
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THE NEXT QUESTION IS RELATED TO YOUR SEXUAL ORIENTATION. THIS DESCRIBES WHO YOU ARE SEXUALLY AND EMOTIONALLY ATTRACTED TO. |
SC14-1
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In the last month, how often have you felt that you were unable to control the important things in your life? |
SC14-2
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In the last month, how often have you felt confident about your ability to handle your personal problems? |
SC14-3
|
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In the last month, how often have you felt that things were going your way? |
SC14-4
|
|
In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? |
SC15-1
|
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Repeated, disturbing memories, thoughts or images of a stressful experience from the past? |
SC15-2
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Feeling very upset when something reminded you of a stressful experience from the past? |
SC15-3
|
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Avoided activities or situations because they reminded you of a stressful experience from the past? |
SC15-4
|
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Feeling distant or cut off from other people? |
SC15-5
|
|
Feeling irritable or having angry outbursts? |
SC15-6
|
|
Difficulty concentrating? |
SC16-1
|
|
My age prevents me from doing the things I would like to. |
SC16-2
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I feel that what happens to me is out of my control. |
SC16-3
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I feel free to plan for the future. |
SC16-4
|
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I feel left out of things. |
SC16-5
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I feel that I can please myself in what I can do. |
SC16-6
|
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My health stops me from doing the things I want to do. |
SC16-7
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Shortage of money stops me from doing the things that I want to do. |
SC16-8
|
|
I look forward to each day. |
SC16-9
|
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I feel that my life has meaning. |
SC16-10
|
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I enjoy being in the company of others. |
SC16-11
|
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I feel satisfied with the way my life has turned out. |
SC16-12
|
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I feel that life is full of opportunities. |
SC17-1
|
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I enjoy making plans for the future and working to make them a reality. |
SC17-2
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My daily activities often seem trivial and unimportant to me. |
SC17-3
|
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I am an active person in carrying out the plans I set for myself. |
SC17-4
|
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I don’t have a good sense of what it is I’m trying to accomplish in life. |
SC17-5
|
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I sometimes feel as if I’ve done all there is to do in life. |
SC17-6
|
|
I live life one day at a time and don’t really thing about the future. |
SC17-7
|
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I have a sense of direction and purpose in my life. |
SC18
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|
HAVE YOU EVER HAD DRINKS CONTAINING ALCOHOL, E.G. GLASS OF WINE, GLASS OF BEER, ETC.? |
SC19
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HAVE YOU HAD DRINKS CONTAINING ALCOHOL OF ANY KIND IN THE LAST 6 MONTHS? |
SC20
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DURING THE LAST 6 MONTHS, HOW OFTEN HAVE YOU HAD DRINKS CONTAINING ALCOHOL, LIKE BEER, CIDER, WINE, SPIRITS OR COCKTAILS? |
SC21
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MORE RECENTLY (I.E. IN THE LAST MONTH), WOULD YOU DESCRIBE YOUR CURRENT ALCOHOL INTAKE AS: |
SC22
|
|
FROM THE PICTURES BELOW, PLEASE TICK THE BOX THAT REPRESENTS THE DRINK YOU WOULD BE MOST LIKELY TO DRINK |
SC23
|
|
THINKING ABOUT YOUR DRINK OF CHOICE, ON AVERAGE, IN THE LAST 6 MONTHS ON THE DAYS THAT YOU DRANK, ABOUT HOW MANY DID YOU HAVE? |
SC24
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|
THINKING ABOUT YOUR DRINK OF CHOICE, DURING THE LAST 6 MONTHS, APPROXIMATELY WHAT WAS THE LARGEST NUMBER OF DRINKS YOU HAD ON ANY ONE DAY? |
SC25
|
|
HOW OFTEN IN THE LAST 6 MONTHS WOULD YOU SAY YOU DRANK THE MAXIMUM NUMBER OF DRINKS YOU INDICATED IN THE LAST QUESTION? |
SC26
|
|
HAVE YOU EVER FELT THAT YOU SHOULD CUT DOWN ON DRINKING? |
SC27
|
|
HAVE YOU REDUCED YOUR ALCOHOL INTAKE IN THE LAST 2 YEARS? |
SC28
|
|
WHY DID YOU REDUCE YOUR ALCOHOL INTAKE? |
SC29
|
|
HAVE PEOPLE EVER ANNOYED YOU BY CRITICISING YOUR DRINKING? |
SC30
|
|
HAVE YOU EVER FELT BAD OR GUILTY ABOUT DRINKING? |
SC31
|
|
HAVE YOU EVER TAKEN A DRINK FIRST THING IN THE MORNING TO STEADY YOUR NERVES OR GET RID OF A HANGOVER? |
SC32-1
|
|
My worries overwhelm me. |
SC32-2
|
|
Many situations make me worry. |
SC32-3
|
|
I know I should not worry about things, but I just cannot help it. |
SC32-4
|
|
When I am under pressure, I worry a lot. |
SC32-5
|
|
I am always worrying about something. |
SC32-6
|
|
As soon as I finish one task, I start to worry about everything else I must do. |
SC32-7
|
|
I have been a worrier all my life. |
SC32-8
|
|
I have been worrying about things. |
SC33
|
|
HAVE ANY OF YOUR CLOSE FRIENDS DIED IN THE PAST TWO YEARS? |
SC34
|
|
WHAT IS THE MAIN WAY IN WHICH YOU HEAT YOUR ACCOMMODATION IN THE WINTER (TICK ONE BOX ONLY) |
SC35-1
|
|
A leaking roof? |
SC35-2
|
|
Leaking or moisture getting in through walls? |
SC35-3
|
|
Leaking or moisture getting in at doors or windows? |
SC35-4
|
|
Leaks from water pipes? |
SC35-5
|
|
Rising damp? |
SC35-6
|
|
Condensation dampness? |
SC35-7
|
|
General dampness from unknown sources? |
SC35-8
|
|
Mould on walls/ceilings, etc? |
SC35-9
|
|
Corrosion or rot around any external door(s)? |
SC35-10
|
|
Badly fitting doors? |
SC35-11
|
|
Corrosion or rot around any window(s)? |
SC35-12
|
|
Leaky or draughty windows? |
SC35-13
|
|
Windows that don’t open/close properly? |
SC35-14
|
|
Rot in timbers other than windows/doors, such as rot in joists, floor boards, etc? |
SC35-15
|
|
Structural cracks in internal or external support walls? |
SC35-16
|
|
Subsidence in floors? |
SC35-17
|
|
Pests – rats, mice, cockroaches? |
SC35-18
|
|
Noise from neighbouring houses? |
SC35-19
|
|
Difficulty in heating your accommodation? |
SC35-20
|
|
Other problems (tick level of problem and specify below)? |
SC36-1
|
|
I really feel part of this area. |
SC36-2
|
|
Vandalism and graffiti are a big problem in this area. |
SC36-3
|
|
I often feel lonely living in this area. |
SC36-4
|
|
Most people in this area can be trusted. |
SC36-5
|
|
People would be afraid to walk alone after dark in this area. |
SC36-6
|
|
Most people in this area are friendly. |
SC36-7
|
|
People in this area will take advantage of you. |
SC36-8
|
|
This area is kept very clean. |
SC36-9
|
|
If you were in trouble, there are lots of people in this area who would help you. |
SC37-1
|
|
Measles |
SC37-2
|
|
Chicken Pox |
SC37-3
|
|
Mumps |
SC37-4
|
|
Polio |
SC37-5
|
|
Tuberculosis (TB) |
SC37-6
|
|
Broken Bones |
SC37-7
|
|
Asthma |
SC37-8
|
|
Allergies other than asthma (e.g. food intolerance, hayfever) |
SC37-9
|
|
Respiratory problems other than asthma (e.g. bronchitis) |
SC37-10
|
|
Chronic ear problems |
SC37-11
|
|
Severe headaches or migraines |
SC37-12
|
|
Epilepsy, fits or seizures |
SC37-13
|
|
Emotional, nervous or psychiatric problem |
SC37-14
|
|
Appendicitis |
SC37-15
|
|
Childhood diabetes or high blood sugar |
SC37-16
|
|
Heart trouble |
SC37-17
|
|
Leukaemia or lymphoma |
SC37-18
|
|
Cancer or malignant tumour (excluding minor skin cancers) |
SC38
|
|
THINK OF THIS LADDER AS REPRESENTING WHERE PEOPLE STAND IN OUR SOCIETY. |
SC38-1
|
|
Beef or lamb including roast, steak stew, mince |
SC38-2
|
|
Pork including roast, chops, slices |
SC38-3
|
|
Ham, bacon |
SC38-4
|
|
Chicken or turkey portion including breast, thigh, leg |
SC38-5
|
|
Chicken products including chicken nuggets or breaded chicken |
SC38-6
|
|
Fresh fish |
SC38-7
|
|
Fish, including breaded, battered, or fish fingers |
SC38-8
|
|
Processed meat including meat pies, pasties, sausage rolls, burgers, sausages |
SC38-9
|
|
Lentils, tofu, soya meat, vegeburger |
SC38-10
|
|
White bread |
SC38-11
|
|
Brown bread |
SC38-12
|
|
Porridge, readybrek |
SC38-13
|
|
High fibre cereal e.g. Weetabix, all bran branflakes, bran buds, muesli |
SC38-14
|
|
Other cereal e.g. cornflakes, rice crispies |
SC38-15
|
|
Potatoes, including boiled, mashed, baked potatoes, but excluding roast potatoes, chips or potato products e.g. waffles |
SC38-16
|
|
Chips, roast potatoes, and potato products, e.g. potato waffles, smiles |
SC38-17
|
|
Rice |
SC38-18
|
|
Pasta |
SC38-19
|
|
Yoghurt (carton) |
SC38-20
|
|
Cheese including cheddar, cheese slices, soft cheese |
SC38-21
|
|
Eggs (one) including boiled, scrambled, poached, fried |
SC38-22
|
|
Cream (tablespoon) |
SC38-23
|
|
Salad dressings (tablespoon) |
SC38-24
|
|
Butter (teaspoon) |
SC38-25
|
|
Low fat spread (teaspoon) |
SC38-26
|
|
Cholesterol lowering spread e.g. Benecol, Flora pro-active |
SC38-27
|
|
Fruit including fresh, frozen, dried, tinned |
SC38-28
|
|
Green vegetables, including cabbage, broccoli, peas, green beans |
SC38-29
|
|
Orange/Yellow vegetables, including carrots, turnips, cauliflower |
SC38-30
|
|
Salad or other vegetables, including leeks, onions, garlic, sweet peppers, mushrooms, sweetcorn, tomatoes, beetroot |
SC38-31
|
|
Plain biscuits |
SC38-32
|
|
Chocolate biscuits, including wrapped chocolate biscuits, e.g. Twix, Kit-Kat, Penguin |
SC38-33
|
|
Confectionary, including sweets and chocolate bars |
SC38-34
|
|
Cakes, buns, desserts, e.g. cheesecakes, apple tart |
SC38-35
|
|
Savoury snacks, e.g. crisps, tortilla chips |
SC38-36
|
|
Vegetable soup (homemade/carton) |
SC38-37
|
|
Vegetable soup (packet, cup-a-soup) |
SC38-38
|
|
Sauces e.g. white sauce, cheese sauce, gravy (tablespoon) |
SC38-39
|
|
Marmite, bovril |
SC38-40
|
|
Jam, marmalade |
SC38-41
|
|
Water (glass) |
SC38-42
|
|
Tea (cup) |
SC38-43
|
|
Coffee (cup) |
SC38-44
|
|
Cocoa, hot chocolate (cup) |
SC38-45
|
|
Horlicks, Ovaltine (cup) |
SC38-46
|
|
Wine (glass) |
SC38-47
|
|
Beer (half pint) |
SC38-48
|
|
Spirits (single measure) |
SC38-49
|
|
Low Calorie or Diet Fizzy drinks (glass) |
SC38-50
|
|
Fizzy drinks (glass) |
SC38-51
|
|
Pure fruit juice (glass) |
SC38-52
|
|
Fruit squash, diluted orange (glass) |
SC40
|
|
WHAT TYPE OF MILK DO YOU USE MOST OFTEN? |
SC41
|
|
HOW MUCH MILK DO YOU USE EACH DAY? |
SC42
|
|
PLEASE FILL IN THE DATE ON WHICH YOU COMPLETED YOUR BOOKLET. |
SC43
|
|
IF THERE IS ANYTHING YOU WOULD LIKE TO TELL US, PLEASE WRITE IN THE SPACE BELOW. FEEL FREE TO ADD A PAGE IF THIS SPACE IS INSUFFICIENT. WE SHALL BE VERY INTERESTED TO READ WHAT YOU HAVE TO SAY. |