Proxy interview (GR)
Survey Introduction (INT)
Age of respondent (ANC)
General health (GEN)
Positive Mental Health (PMH)
Voluntary organizations - Participation (ORG)
Sleep (SLP)
Changes made to improve health (CIH)
Oral health 1 (OH1)
Health care system satisfaction (HCS)
Height and weight - Self-reported (HWT)
Chronic conditions (CCC)
Diabetes care (DIA)
Medication use (MED)
Pain and discomfort (HUP)
Health care utilization (HCU)
Contacts with Health Professionals (CHP)
Unmet health care needs (UCN)
Home care services (HMC)
Patient satisfaction - Health care services (PAS)
Patient satisfaction - Community-based care (PSC)
Restriction of activities (RAC)
Activities of Daily Living (ADL)
Flu shots (FLU)
Blood test (BLT)
Blood pressure check (BPC)
PAP smear test (PAP)
Mammography (MAM)
Breast examinations (BRX)
Breast self-examinations (BSX)
Spirometry (SPI)
Hormone replacement therapy (HRT)
Physical check-up (PCU)
Prostate cancer screening (PSA)
Colorectal cancer screening (CCS)
Eye examinations (EYX)
Dental visits (DEN)
Oral health 2 (OH2)
Food choices (FDC)
Dietary supplement use - Vitamins and minerals (DSU)
Fruit and vegetable consumption (FVC)
Physical activities (PAC)
Physical activity - Stages of change (SCP)
Neighbourhood Environment (NBE)
Sedentary activities (SAC)
Use of protective equipment (UPE)
Sun safety behaviours (SSB)
Injuries (INJ)
Repetitive strain - Sub Block (REP)
Workplace Injury - Sub Block (INW)
Satisfaction with life (SWL)
Stress - Sources (STS)
Stress - Recent life events (RLE)
Stress - Childhood and adult stressors (CST)
Self-esteem (SFE)
Mastery (MAS)
Smoking (SMK)
Smoking - Stages of change (SCH)
Smoking cessation methods (SCA)
Smoking - Physician counselling (SPC)
Smoking - Youth smoking (YSM)
Exposure to second-hand smoke (ETS)
Smoking - Other tobacco products (TAL)
Alcohol use (ALC)
Alcohol use during the past week (ALW)
Driving and safety (DRV)
Maternal experiences - Breastfeeding (MEX)
Maternal experiences - Alcohol use during pregnancy (MXA)
Maternal experiences - Smoking during pregnancy (MXS)
Illicit drugs use (IDG)
Sexual behaviours (SXB)
Social Provisions (SPS)
Social support - Availability (SSA)
Spiritual values (SPR)
Consultations about mental health (CMH)
Distress (DIS)
Depression (DEP)
Suicidal thoughts and attempts (SUI)
Access to health care services (ACC)
Labour force (LBS)
Loss of Productivity (LOP)
Socio-demographic characteristics (SDC)
Language Lookup (LLU)
Person most knowledgeable about household situation (PMK)
Home safety (HMS)
Insurance coverage (INS)
Food security (FSC)
Neurological Conditions (NEU)
Education (EDU)
Education of the respondent (EDU1)
Education of other household members (EDU2)
Income (INC)
Administration information (ADM)
CAPI Frame Evaluation - Sub-block (FRE)

Proxy interview (GR)

GR_BEG
Content block

• External variables required:
  PROXMODE: proxy identifier, from the GR block.
  FNAME: first name of respondent from household block.
  DOGR: do block flag, from the sample file.
  PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
  Screen display:
  Display on header bar PE_Q01 and PE_Q02 separated by a space

GR_N01
INTERVIEWER: Who is providing the information for this person's component?

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: I

GR_C01
If If selected respondent, go to GR_END.
Otherwise, go to GR_N01A.

GR_N01A
INTERVIEWER: Do you want to complete this component by proxy?

1. Yes (Go to GR_N02)
2. No

(DK, RF are not allowed)
Go to GR_E01A

GR_E01A
You may not proceed with the rest of this questionnaire.  Please press <F10> to exit, or return and update GR_N01 or GR_N01A.

Note: Trigger hard edit if GR_N01A = 2 and not Selected Respondent.

GR_N02
INTERVIEWER: Record the reason why this component is being completed by proxy.    Proxy interviews are to occur only if the mental or physical health of the selected member makes it impossible to complete the interview during the collection period. If the reason for the proxy interview is neither of these choices, please press <F10> to exit the application and assign an appropriate outcome code.

1. Physical health condition
2. Mental health condition

(DK, RF are not allowed)

GR_N03
INTERVIEWER : Enter the condition.
(DK, RF are not allowed)

GR_END

Survey Introduction (INT)

INT_BEG

INT_R01
This survey is conducted under the Statistics Act, which protects the confidentiality and privacy of all your answers.

Note: (Help text)

Purpose: to introduce the survey to respondents so that they are aware of its nature and purposes.

Functionality: <F5> "Refusal" and <F6> "Don't Know" are disabled for this question

INT_R02
Your answers will be kept strictly confidential and used only for statistical purposes.  While this survey is voluntary, your participation is essential if the results are to be accurate.
(Registration#: STC/HLT-082-75168)

INT_END

Age of respondent  (ANC)

ANC_BEG
Core content

ANC_C01A
If (do ANC block = 1), go to ANC_D01.
Otherwise, go to ANC_END.

ANC_D01
(not applicable)

ANC_R01
For some of the questions I’ll be asking, I need to know ^YOUR2 exact date of birth.
INTERVIEWER: Press <Enter> to continue.

Note: Date Block

ANC_N01A
INTERVIEWER: Enter the day. If necessary, ask (What is the day?)

• (MIN: 1) (MAX: 31)
  DK, RF

ANC_N01B
INTERVIEWER: Enter the month. If necessary, ask (What is the month?)

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
    DK, RF

ANC_E1
An impossible day/month combination has been entered. Please return and correct.

Note: Trigger hard edit if a month is selected that is invalid in combination with the previously entered numeric day.

ANC_N01C
INTERVIEWER: Enter a four-digit year. If necessary, ask (What is the year?)

• DK, RF

ANC_C02
If ANC_N01C (Year) = DK, RF, go to ANC_Q03.
Otherwise, go to ANC_D02.

ANC_E2
An impossible day/month/year combination has been entered. Please return and correct.

Note: Trigger hard edit if a year is entered that is invalid in combination with the previously entered month and day.

ANC_D02
Calculate age based on the entered date of birth.

ANC_Q02
So ^YOUR1 age is [calculated age].
Is that correct?

1. Yes (Go to ANC_C03)
2. No, return and correct date of birth
3. No, collect age (Go to ANC_Q03)
   (DK, RF are not allowed)

ANC_E02
Return to ANC_N01A and correct the date of birth.

Note: Trigger hard edit if ANC_Q02 = 2.

ANC_C03
If [calculated age] < 12 years, go to ANC_R04.
Otherwise, go to ANC_END.

ANC_Q03
What is ^YOUR1 age?

• Age in years
  (MIN: 0) (MAX: 130)
  (DK, RF are not allowed)

ANC_C04
If age < 12 years, go to ANC_R04.
Otherwise, go to ANC_END.

ANC_D04
(not applicable)

ANC_R04
Because ^YOU1 ^ARE less than 12 years old, ^YOU1 ^ARE not eligible to participate in the Canadian Community Health Survey.

INTERVIEWER: Press <Enter> to continue.

Note: Auto code as 90 Unusual/Special circumstances and call the exit block.

ANC_END

General health (GEN)

GEN_BEG
Core content

GEN_C01
If (do GEN block = 1), go to GEN_R01.
Otherwise, go to GEN_END.

GEN_D01
(not applicable)

GEN_R01
This survey deals with various aspects of ^YOUR2 health. The following questions ask about physical activity, social relationships and health status. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

INTERVIEWER: Press <1> to continue.

GEN_Q01
To start, in general, would you say ^YOUR1 health is...?

INTERVIEWER: Read categories to respondent.

1. Excellent
2. Very good
3. Good
4. Fair
5. Poor
   DK, RF

GEN_Q02A
Compared to one year ago, how would you say ^YOUR1 health is now? Is it...?

INTERVIEWER: Read categories to respondent.

1. Much better now than 1 year ago
2. Somewhat better now (than 1 year ago)
3. About the same as 1 year ago
4. Somewhat worse now (than 1 year ago)
5. Much worse now (than 1 year ago)
   DK, RF

GEN_C02B
If proxy interview, go to GEN_Q07.
Otherwise, go to GEN_Q02.

GEN_Q02B
Using a scale of 0 to 10, where 0 means "Very dissatisfied" and 10 means "Very satisfied", how ^DOVERB ^YOU1 feel about ^YOUR1 life as a whole right now?

• 00 Very dissatisfied
  01
  02
  03
  04
  05
  06
  07
  08
  09
  10 Very satisified
  DK, RF

GEN_Q02C
In general, would you say your mental health is...?
INTERVIEWER: Read categories to respondent.

1. Excellent
2. Very good
3. Good
4. Fair
5. Poor
   DK, RF

GEN_Q07
Thinking about the amount of stress in ^YOUR1 life, would you say that most days are...?
INTERVIEWER: Read categories to respondent.

1. Not at all stressful
2. Not very stressful
3. A bit stressful
4. Quite a bit stressful
5. Extremely stressful
   DK, RF

GEN_C08A
If proxy interview, go to GEN_END.
Otherwise, go to GEN_C08B.

GEN_C08B
If age < 15 or age > 75, go to GEN_Q10.
Otherwise, go to GEN_Q08.

GEN_Q08
Have you worked at a job or business at any time in the past 12 months?

1. Yes
2. No (Go to GEN_Q10)
   DK, RF (Go to GEN_Q10)

GEN_R09
The next question is about your main job or business in the past 12 months.
INTERVIEWER: Press <1> to continue.

GEN_Q09
Would you say that most days at work were...?
INTERVIEWER: Read categories to respondent.

1. Not at all stressful
2. Not very stressful
3. A bit stressful
4. Quite a bit stressful
5. Extremely stressful
   DK, RF

GEN_Q10
How would you describe your sense of belonging to your local community?
Would you say it is...?
INTERVIEWER: Read categories to respondent.

1. Very strong
2. Somewhat strong
3. Somewhat weak
4. Very weak
   DK, RF

GEN_END

Positive Mental Health (PMH)

PMH_BEG
Theme Content block

• External variables required:
  PROXMODE: Proxy interview
  SEX_Q01: sex of specific respondent (1 = male, 2 = female) from Sex block.
  FNAME : prénom du répondant sélectionné
  DOPMH: do block flag, from the sample file.
• PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
• Screen display:
  Display on header bar PE_Q01 and PE_Q02 separated by a space

PMH_C01A
If DOPMH = 1, go to PMH_C01B.
Otherwise, go to PMH_END.

PMH_C01B
If proxmode = 1, go to PMH_END.
Otherwise, go to PMH_R01.

PMH_R01
The following questions are about how you have been feeling during the past month.

INTERVIEWER: Press <1> to continue.

PMH_Q01
In the past month, how often did you feel
...happy?
INTERVIEWER: Read categories to respondent.

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

(Go to PMH_END)

PMH_Q02
(In the past month, how often did you feel:)
...interested in life?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q03
(In the past month, how often did you feel:)
...satisfied with your life?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q04
In the past month, how often did you feel
...that you had something important to contribute to society?
INTERVIEWER: Read categories to respondent.

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q05
(In the past month, how often did you feel:)
...that you belonged to a community (like a social group, your neighborhood, your city, your school)?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q06
(In the past month, how often did you feel:)
...that our society is becoming a better place for people like you?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q07
In the past month, how often did you feel
...that people are basically good?

INTERVIEWER: Read categories to respondent.

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q08
(In the past month, how often did you feel:)
...that the way our society works makes sense to you?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q09
(In the past month, how often did you feel:)
...that you liked most parts of your personality?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q10
In the past month, how often did you feel
...good at managing the responsibilities of your daily life?
INTERVIEWER: Read categories to respondent.

 

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q11
(In the past month, how often did you feel:)
...that you had warm and trusting relationships with others?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q12
(In the past month, how often did you feel:)
...that you had experiences that challenge you to grow and become a better person?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q13
In the past month, how often did you feel
...confident to think or express your own ideas and opinions?
INTERVIEWER: Read categories to respondent.

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_Q14
(In the past month, how often did you feel:)
...that your life has a sense of direction or meaning to it?

1. Every day
2. Almost every day
3. About 2 or 3 times a week
4. About once a week
5. Once or twice
6. Never
   DK, RF

PMH_END

Voluntary organizations - Participation (ORG)

ORG_BEG
Optional Content (See Appendix 2)

ORG_C1A
If (do ORG block = 1), go to ORG_C1B.
Otherwise, go to ORG_END.

ORG_C1B
If proxy interview, go to ORG_END.
Otherwise, go to ORG_Q1.

ORG_Q1
Are you a member of any voluntary organizations or associations such as schoolgroups, church social groups, community centres, ethnic associations or social, civic or fraternal clubs?

1. Yes
2. No (Go to ORG_END)
   DK, RF (Go to ORG_END)

ORG_Q2
How often did you participate in meetings or activities of these groups in the past 12 months? If you belong to many, just think of the ones in which you are most active.

INTERVIEWER: Read categories to respondent.

1. At least once a week
2. At least once a month
3. At least 3 or 4 times a year
4. At least once a year
5. Not at all
   DK, RF

ORG_END

Sleep (SLP)

SLP_BEG
Optional Content (See Appendix 2)

SLP_C1
If (do SLP block = 2), go to SLP_END.
Otherwise, go to SLP_C2.

SLP_C2
If proxy interview, go to SLP_END.
Otherwise, go to SLP_Q01.

SLP_Q01
Now a few questions about sleep.
How long do you usually spend sleeping each night?
INTERVIEWER: Do not include time spent resting.

1. Under 2 hours
2. 2 hours to less than 3 hours
3. 3 hours to less than 4 hours
4. 4 hours to less than 5 hours
5. 5 hours to less than 6 hours
6. 6 hours to less than 7 hours
7. 7 hours to less than 8 hours
8. 8 hours to less than 9 hours
9. 9 hours to less than 10 hours
10. 10 hours to less than 11 hours
11. 11 hours to less than 12 hours
12. 12 hours or more
    DK
    RF (Go to SLP_END)

SLP_Q02
How often do you have trouble going to sleep or staying asleep?
INTERVIEWER: Read categories to respondent.

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

SLP_Q03
How often do you find your sleep refreshing?
INTERVIEWER: Read categories to respondent.

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

SLP_Q04
How often do you find it difficult to stay awake when you want to?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

SLP_END

Changes made to improve health (CIH)

CIH_BEG
Optional Content (See Appendix 2)

CIH_C1A
If (do CIH block = 1), go to CIH_C1B.
Otherwise, go to CIH_END.

CIH_C1B
If proxy interview, go to CIH_END.
Otherwise, go to CIH_Q1.

CIH_Q1
Next, some questions about changes made to improve health.
In the past 12 months, did you do anything to improve your health? (For example, lost weight, quit smoking, increased exercise)

1. Yes
2. No (Go to CIH_Q3)
   DK, RF (Go to CIH_END)

CIH_Q2
What is the single most important change you have made?

1. Increased exercise, sports / physical activity
2. Lost weight
3. Changed diet / improved eating habits
4. Quit smoking / reduced amount smoked
5. Drank less alcohol
6. Reduced stress level
7. Received medical treatment
8. Took vitamins
9. Other
   DK, RF

CIH_D3
If CIH_Q1 = 1, ^DT_ANYTHING = "anything else".
Otherwise, ^DT_ANYTHING = "anything".

CIH_Q3
Do you think there is ^DT_ANYTHING you should do to improve your physical health?

1. Yes
2. No (Go to CIH_END)
   DK, RF

(Go to CIH_END)

CIH_Q4
What is the most important thing?

1. Start / Increase exercise, sports / physical activity
2. Lose weight
3. Change diet / improve eating habits
4. Quit smoking / reduce amount smoked
5. Drink less alcohol
6. Reduce stress level
7. Receive medical treatment
8. Take vitamins
9. Other
   DK, RF

CIH_Q5
Is there anything stopping you from making this improvement?

1. Yes
2. No (Go to CIH_Q7)
   DK, RF (Go to CIH_Q7)

CIH_Q6
What is that?
INTERVIEWER: Mark all that apply.

1. Lack of will power / self-discipline
2. Family responsibilities
3. Work schedule
4. Addiction to drugs / alcohol
5. Physical condition
6. Disability / health problem
7. Too stressed
8. Too costly / financial constraints
9. Not available - in area
10. Transportation problems
11. Weather problems
12. Other
    DK, RF

CIH_Q7
Is there anything you intend to do to improve your physical health in the next year?

1. Yes
2. No (Go to CIH_END)
   DK, RF (Go to CIH_END)

CIH_Q8
What is that?
INTERVIEWER: Mark all that apply.

1. Start / Increase exercise, sports / physical activity
2. Lose weight
3. Change diet / improve eating habits
4. Quit smoking / reduce amount smoked
5. Drink less alcohol
6. Reduce stress level
7. Receive medical treatment
8. Take vitamins
9. Other
   DK, RF

CIH_END

Oral health 1 (OH1)

OH1_BEG
Optional Content (See Appendix 2)

OH1_C20A
If (do OH1 block = 1), go to OH1_C20B.
Otherwise, go to OH1_END.

OH1_C20B
If proxy interview, go to OH1_END.
Otherwise, go to OH1_R20.

OH1_R20
Next, some questions about the health of your teeth and mouth.

INTERVIEWER: Press <Enter> to continue.

OH1_Q20
In general, would you say the health of your teeth and mouth is:
INTERVIEWER: Read categories to respondent.

1. ... excellent?
2. ... very good?
3. ... good?
4. ... fair?
5. ... poor?
   DK, RF (Go to OH1_END)

OH1_Q21A
Now a few questions about your ability to chew different foods, whether you eat them or not. Can you:
...chew firm foods ( e.g. , meat)?

1. Yes
2. No
   DK, RF

OH1_Q21B
(Can  you:)
...bite off and chew a piece of fresh apple?

1. Yes
2. No
   DK, RF

OH1_C21C
If OH1_Q21A = 1 or OH1_Q21B = 1, go to OH1_Q22.
Otherwise, go to OH1_Q21C.

Note: OH1_Q21C will be filled with "Yes" during head office processing.

OH1_Q21C
(Can you:) ...chew boiled vegetables?

1. Yes
2. No
   DK, RF

OH1_Q22
In the past month, how often have you had any pain or discomfort in your teeth or gums?
INTERVIEWER: Read categories to respondent.

1. Often
2. Sometimes
3. Rarely
4. Never
   DK, RF

OH1_END

Health care system satisfaction (HCS)

HCS_BEG
Optional Content (See Appendix 2)

HCS_C1A
If (do HCS block = 1), go to HCS_C1B.
Otherwise, go to HCS_END.

HCS_C1B
If proxy interview or if age < 15, go to HCS_END.
Otherwise, go to HCS_D1.

HCS_D1

• If province = 10, ^DT_ProvinceE = "Newfoundland and Labrador".
• If province = 11, ^DT_ProvinceE = "Prince Edward Island".
• If province = 12, ^DT_ProvinceE = "Nova Scotia".
• If province = 13, ^DT_ProvinceE = "New Brunswick".
• If province = 24, ^DT_ProvinceE = "Quebec".
• If province = 35, ^DT_ProvinceE = "Ontario".
• If province = 46, ^DT_ProvinceE = "Manitoba".
• If province = 47, ^DT_ProvinceE = "Saskatchewan".
• If province = 48, ^DT_ProvinceE = "Alberta".
• If province = 59, ^DT_ProvinceE = "British Columbia".
• If province = 60, ^DT_ProvinceE = "Yukon".
• If province = 61, ^DT_ProvinceE = "the Northwest Territories".
• If province = 62, ^DT_ProvinceE = "Nunavut".

HCS_Q1
Now, a few questions about health care services in ^DT_ProvinceE. Overall, how would you rate the availability of health care services in ^DT_ProvinceE?
Would you say it is:
INTERVIEWER: Read categories to respondent.

1. ...excellent?
2. ...good?
3. ...fair?
4. ...poor?
   DK, RF (Go to HCS_END)

HCS_D2
(not applicable)

HCS_Q2
Overall, how would you rate the quality of the health care services that are available in ^DT_ProvinceE?
INTERVIEWER: Read categories to respondent.

1. Excellent
2. Good
3. Fair
4. Poor
   DK, RF

HCS_Q3
Overall, how would you rate the availability of health care services in your community?

1. Excellent
2. Good
3. Fair
4. Poor
   DK, RF

HCS_Q4            
Overall, how would you rate the quality of the health care services that are available in your community?

1. Excellent
2. Good
3. Fair
4. Poor
   DK, RF

HCS_END

Height and weight - Self-reported (HWT)

HWT_BEG
Core content

HWT_C1
If (do HWT block = 1), go to HWT_C2.
Otherwise, go to HWT_END.

HWT_C2
If (proxy interview = No and sex = female and (14 < age < 50)), go to HWT_Q1.
Otherwise, go to HWT_Q2.

HWT_Q1
It is important to know when analyzing health whether or not the person is pregnant. Are you pregnant?

MAM_037

1. Yes (Go to HWT_END)
2. No
   DK, RF

HWT_Q2
The next questions are about height and weight. How tall ^ARE ^YOU2 without shoes on?

• 0 Less than 1’ / 12" (less than 29.2 cm.)
  1 1’0" to 1’11" / 12" to 23" (29.2 to 59.6 cm.)
  2 2’0" to 2’11" / 24" to 35" (59.7 to 90.1 cm.)
  3 3’0" to 3’11" / 36" to 47" (90.2 to 120.6 cm.) (Go to HWT_N2C)
  4 4’0" to 4’11" / 48" to 59" (120.7 to 151.0 cm.) (Go to HWT_N2D)
  5 5’0" to 5’11" (151.1 to 181.5 cm.) (Go to HWT_N2E)
  6 6’0" to 6’11" (181.6 to 212.0 cm.) (Go to HWT_N2F)
  7 7’0" and over (212.1 cm. and over) (Go to HWT_Q3)
  DK, RF (Go to HWT_Q3)

HWT_E2
The selected height is too short for a [current age] year old respondent. Please return and correct.

Note: Trigger hard edit if (HWT_Q2 < 3).

HWT_N2A
INTERVIEWER: Select the exact height.

• 00 1’0" / 12" (29.2 to 31.7 cm.)
  01 1’1" / 13" (31.8 to 34.2 cm.)
  02 1’2" / 14" (34.3 to 36.7 cm.)
  03 1’3" / 15" (36.8 to 39.3 cm.)
  04 1’4" / 16" (39.4 to 41.8 cm.)
  05 1’5" / 17" (41.9 to 44.4 cm.)
  06 1’6" / 18" (44.5 to 46.9 cm.)
  07 1’7" / 19" (47.0 to 49.4 cm.)
  08 1’8" / 20" (49.5 to 52.0 cm.)
  09 1’9" / 21" (52.1 to 54.5 cm.)
  10 1’10" / 22" (54.6 to 57.1 cm.)
  11 1’11" / 23" (57.2 to 59.6 cm.)
  DK, RF

HWT_N2B
INTERVIEWER: Select the exact height.

• 00 2’0" / 24" (59.7 to 62.1 cm.)
  01 2’1" / 25" (62.2 to 64.7 cm.)
  02 2’2" / 26" (64.8 to 67.2 cm.)
  03 2’3" / 27" (67.3 to 69.8 cm.)
  04 2’4" / 28" (69.9 to 72.3 cm.)
  05 2’5" / 29" (72.4 to 74.8 cm.)
  06 2’6" / 30" (74.9 to 77.4 cm.)
  07 2’7" / 31" (77.5 to 79.9 cm.)
  08 2’8" / 32" (80.0 to 82.5 cm.)
  09 2’9" / 33" (82.6 to 85.0 cm.)
  10 2’10" / 34" (85.1 to 87.5 cm.)
  11 2’11" / 35" (87.6 to 90.1 cm.)
  DK, RF

HWT_N2C
INTERVIEWER: Select the exact height.

• 00 3’0" / 36" (90.2 to 92.6 cm.)
  01 3’1" / 37" (92.7 to 95.2 cm.)
  02 3’2" / 38" (95.3 to 97.7 cm.)
  03 3’3" / 39" (97.8 to 100.2 cm.)
  04 3’4" / 40" (100.3 to 102.8 cm.)
  05 3’5" / 41" (102.9 to 105.3 cm.)
  06 3’6" / 42" (105.4 to 107.9 cm.)
  07 3’7" / 43" (108.0 to 110.4 cm.)
  08 3’8" / 44" (110.5 to 112.9 cm.)
  09 3’9" / 45" (113.0 to 115.5 cm.)
  10 3’10" / 46" (115.6 to 118.0 cm.)
  11 3’11" / 47" (118.1 to 120.6 cm.)
  DK, RF

Go to HWT_Q3

HWT_N2D
INTERVIEWER: Select the exact height.

• 00 4’0" / 48" (120.7 to 123.1 cm.)
  01 4’1" / 49" (123.2 to 125.6 cm.)
  02 4’2" / 50" (125.7 to 128.2 cm.)
  03 4’3" / 51" (128.3 to 130.7 cm.)
  04 4’4" / 52" (130.8 to 133.3 cm.)
  05 4’5" / 53" (133.4 to 135.8 cm.)
  06 4’6" / 54" (135.9 to 138.3 cm.)
  07 4’7" / 55" (138.4 to 140.9 cm.)
  08 4’8" / 56" (141.0 to 143.4 cm.)
  09 4’9" / 57" (143.5 to 146.0 cm.)
  10 4’10" / 58" (146.1 to 148.5 cm.)
  11 4’11" / 59" (148.6 to 151.0 cm.)
  DK, RF

Go to HWT_Q3

HWT_N2E
INTERVIEWER: Select the exact height.

• 00 5’0" (151.1 to 153.6 cm.)
  01 5’1" (153.7 to 156.1 cm.)
  02 5’2" (156.2 to 158.7 cm.)
  03 5’3" (158.8 to 161.2 cm.)
  04 5’4" (161.3 to 163.7 cm.)
  05 5’5" (163.8 to 166.3 cm.)
  06 5’6" (166.4 to 168.8 cm.)
  07 5’7" (168.9 to 171.4 cm.)
  08 5’8" (171.5 to 173.9 cm.)
  09 5’9" (174.0 to 176.4 cm.)
  10 5’10" (176.5 to 179.0 cm.)
  11 5’11" (179.1 to 181.5 cm.)
  DK, RF

Go to HWT_Q3

HWT_N2F
INTERVIEWER: Select the exact height.

• 00 6’0" (181.6 to 184.1 cm.)
  01 6’1" (184.2 to 186.6 cm.)
  02 6’2" (186.7 to 189.1 cm.)
  03 6’3" (189.2 to 191.7 cm.)
  04 6’4" (191.8 to 194.2 cm.)
  05 6’5" (194.3 to 196.8 cm.)
  06 6’6" (196.9 to 199.3 cm.)
  07 6’7" (199.4 to 201.8 cm.)
  08 6’8" (201.9 to 204.4 cm.)
  09 6’9" (204.5 to 206.9 cm.)
  10 6’10" (207.0 to 209.5 cm.)
  11 6’11" (209.6 to 212.0 cm.)
  DK, RF

HWT_Q3
How much ^DOVERB ^YOU2 weigh?
INTERVIEWER: Enter amount only.

• Weight
  (MIN: 1) (MAX: 575)
  DK, RF (Go to HWT_END)

HWT_N4
INTERVIEWER: Was that in pounds or kilograms?

1. Pounds
2. Kilograms
   (DK, RF are not allowed)

HWT_E4
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if ((HWT_Q3 > 300 and HWT_N4 = 1) or (HWT_Q3 > 136 and HWT_N4 = 2)) or ((HWT_Q3 < 60 and HWT_N4 = 1) or (HWT_Q3 < 27 and HWT_N4 = 2)).

HWT_C4
If proxy interview, go to HWT_END.
Otherwise, go to HWT_Q4.

HWT_Q4
Do you consider yourself:
INTERVIEWER: Read categories to respondent.

1. ...overweight?
2. ...underweight?
3. ...just about right?
   DK, RF

HWT_END

Chronic conditions (CCC)

CCC_BEG
Core content

CCC_C011
If (do CCC block = 1), go to CCC_R011.
Otherwise, go to CCC_END.

CCC_R011
Now I’d like to ask about certain long-term health conditions which ^YOU2 may have. We are interested in "long-term conditions" which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.
INTERVIEWER: Press <1> to continue.

CCC_Q031
^DOVERB_C ^YOU2 have asthma?

1. Yes
2. No (Go to CCC_C051)
   DK (Go to CCC_C051)
   RF (Go to CCC_END)

CCC_Q035
^HAVE_C ^YOU1 had any asthma symptoms or asthma attacks in the past 12 months?

1. Yes
2. No
   DK, RF

CCC_Q036
In the past 12 months, ^HAVE ^YOU1 taken any medicine for asthma such as inhalers, nebulizers, pills, liquids or injections?

1. Yes
2. No
   DK, RF

CCC_C051
If age < 14, go to CCC_Q061.
Otherwise, go to CCC_Q051.

CCC_D051
Not applicable

CCC_Q051
^DOVERB_C ^YOU1 have arthritis, excluding fibromyalgia?

1. Yes
2. No
   DK, RF

CCC_Q061
^DOVERB_C ^YOU2 have back problems, excluding fibromyalgia and arthritis?

1. Yes
2. No
   DK, RF

CCC_Q071
Remember, we’re interested in conditions diagnosed by a health professional and are expected to last or have already lasted 6 months or more. ^DOVERB_C ^YOU2 have high blood pressure?

1. Yes (Go to CCC_Q073)
2. No
   DK
   RF (Go to CCC_Q081)

CCC_Q072
^HAVE_C ^YOU1 ever been diagnosed with high blood pressure?

1. Yes
2. No (Go to CCC_Q081)
   DK, RF (Go to CCC_Q081)

CCC_Q073
In the past month, ^HAVE ^YOU1 taken any medicine for high blood pressure?

1. Yes
2. No
   DK, RF

CCC_C073A
If sex = female and age > 15 and (CCC_Q071 = 1 or [CCC_Q072 = 1 and CCC_Q073 = 1]), go to CCC_Q073A.
Otherwise, go to CCC_Q081.

CCC_Q073A
^WERE_C ^YOU1 pregnant when ^YOU1 ^WERE first diagnosed with high blood pressure?

1. Yes
2. No (Go to CCC_Q081)
   DK, RF (Go to CCC_Q081)

CCC_Q073B
Other than during pregnancy, has a health professional ever told ^YOU2 that ^YOU1 ^HAVE high blood pressure?

1. Yes
2. No

DK, RF
CCC_Q081
Remember, we’re interested in conditions diagnosed by a health professional and are expected to last or have already lasted 6 months or more. ^DOVERB_C ^YOU1 have migraine headaches?

1. Yes
2. No
   DK, RF
   If age < 35, go to CCC_Q101.
   Otherwise, go to CCC_Q091.

CCC_Q091
^DOVERB_C ^YOU2 have chronic bronchitis, emphysema or chronic obstructive pulmonary disease or COPD?

1. Yes
2. No
   DK, RF

CCC_Q101
(Remember, we’re interested in conditions diagnosed by a health professional and are expected to last or have already lasted 6 months or more.) ^DOVERB_C ^YOU2 have diabetes?
INTERVIEWER: Exclude respondents who have been told they have prediabetes. Only respondents with type 1, type 2 or gestational diabetes should answer yes to this question.

1. Yes
2. No (Go to CCC_Q121)
   DK, RF (Go to CCC_Q121)

CCC_Q102
How old ^WERE ^YOU1 when this was first diagnosed?
INTERVIEWER: Maximum is [current age].

• Age in years
  (MIN: 0) (MAX: current age)
  DK, RF

CCC_C10A
If age < 15 or sex = male or CCC_Q102 < 15 or CCC_Q102 > 49, go to CCC_Q10C.
Otherwise, go to CCC_Q10A.

CCC_Q10A
^WERE ^YOU1 pregnant when ^YOU1 ^WERE first diagnosed with diabetes?

1. Yes
2. No (Go to CCC_Q10C)
   DK, RF (Go to CCC_Q10C)

CCC_Q10B
Other than during pregnancy, has a health professional ever told ^YOU2 that ^YOU1 ^HAVE diabetes?

1.  (Go to CCC_Q121)
2. Yes
   No DK, RF (Go to CCC_Q121)

CCC_Q10C
When ^YOU1 ^WERE first diagnosed with diabetes, how long was it before ^YOU1 ^WERE started on insulin?

1. Less than 1 month
2. 1 month to less than 2 months
3. 2 months to less than 6 months
4. 6 months to less than 1 year
5. 1 year or more
6. Never (Go to CCC_Q106)
   DK, RF

CCC_Q105
^DOVERB_C ^YOU2 currently take insulin for ^YOUR1 diabetes?

1. Yes
2. No
   DK, RF

Note: If CCC_Q10C = 6, CCC_Q105 will be filled with "No" during processing.

CCC_Q106
In the past month, did ^YOU2 take pills to control ^YOUR1 blood sugar?

1. Yes
2. No
   DK, RF

CCC_Q121
^DOVERB_C ^YOU1 have heart disease?

1. Yes
2. No
   DK, RF

CCC_Q131
(^DOVERB_C ^YOU1 have:) ... cancer?

1. Yes (Go to CCC_Q141)
2. No
   DK
   RF (Go to CCC_Q141)

CCC_Q132
^HAVE ^YOU1 ever been diagnosed with cancer?

CCC_31A

1. Yes
2. No
   DK, RF

CCC_Q141
Remember, we’re interested in conditions diagnosed by a health professional and are expected to last or have already lasted 6 months or more. ^DOVERB ^YOU1 have intestinal or stomach ulcers?

1. Yes
2. No
   DK, RF

CCC_Q151
^DOVERB ^YOU2 suffer from the effects of a stroke?

1. Yes
2. No
   DK, RF

CCC_C161
If age < 25, go to CCC_Q171.
Otherwise, go to CCC_Q161.

CCC_Q161
(^DOVERB_C ^YOU2 suffer:) …Urinary incontinence?

1. Yes
2. No
   DK, RF

CCC_Q171
^DOVERB_C ^YOU2 have a bowel disorder such as Crohn’s Disease, ulcerative colitis, Irritable Bowel Syndrome or bowel incontinence?

1. Yes
2. No (Go to CCC_C181)
   DK, RF (Go to CCC_C181)

CCC_Q171A
What kind of bowel disease ^DOVERB ^YOU1 have?

1. Crohn’s Disease
2. Ulcerative colitis
3. Irritable Bowel Syndrome
4. Bowel incontinence
5. Other
   DK, RF

CCC_C181
If age < 35, go to CCC_Q280.
Otherwise, go to CCC_Q181.

CCC_Q181
^DOVERB_C ^YOU2 have: ... Alzheimer’s Disease or any other dementia?

1. Yes
2. No
   DK, RF

CCC_Q280
Remember, we’re interested in conditions diagnosed by a health professional and are expected to last or have already lasted 6 months or more. ^DOVERB_C ^YOU2 have a mood disorder such as depression, bipolar disorder, mania or dysthymia?
INTERVIEWER: Include manic depression.

1. Yes
2. No
   DK, RF

CCC_Q290
^DOVERB_C ^YOU2 have an anxiety disorder such as a phobia, obsessive- compulsive disorder or a panic disorder?

1. Yes
2. No
   DK, RF

CCC_END

Diabetes care (DIA)

DIA_BEG
Optional Content (See Appendix 2)

DIA_C01A
If (do DIA block = 1), go to DIA_C01B.
Otherwise, go to DIA_END.

DIA_C01B
If (CCC_Q101 = 1), go to DIA_C01C.
Otherwise, go to DIA_END.

DIA_C01C
If (CCC_Q10A = 1), go to DIA_END.
Otherwise, go to DIA_R01.

DIA_R01
It was reported earlier that ^YOU2 ^HAVE diabetes. The following questions are about diabetes care.

INTERVIEWER: Press <Enter> to continue.

DIA_Q01
In the past 12 months, has a health care professional tested ^YOU2 for haemoglobin "A- one-C"? (An "A-one-C" haemoglobin test measures the average level of blood sugar over a 3-month period.)

1. Yes
2. No (Go to DIA_Q03)
   DK (Go to DIA_Q03)
   RF (Go to DIA_END)

DIA_Q02
How many times? (In the past 12 months, has a health care professional tested ^YOU2 for haemoglobin "A-one-C"?)

• Times
  (MIN: 1) (MAX: 99)
  DK, RF

DIA_Q03
In the past 12 months, has a health care professional checked ^YOUR1 feet for any sores or irritations?

1. Yes
2. No (Go to DIA_Q05)
3. No feet (Go to DIA_Q05)
   DK, RF (Go to DIA_Q05)

DIA_Q04
How many times? (In the past 12 months, has a health care professional checked ^YOUR1 feet for any sores or irritations?)

• Times
  (MIN: 1) (MAX: 99)
  DK, RF

DIA_Q05
In the past 12 months, has a health care professional tested ^YOUR1 urine for protein ( i.e. , Microalbumin)?

1. Yes
2. No
   DK, RF

DIA_Q06
^HAVE_C ^YOU2 ever had an eye exam where the pupils of ^YOUR1 eyes were dilated? (This procedure would have made ^HIMHER temporarily sensitive to light.)

1. Yes
2. No (Go to DIA_R08)
   DK, RF (Go to DIA_R08)

DIA_Q07
When was the last time?
INTERVIEWER: Read categories to respondent.

1. Less than one month ago
2. 1 month to less than 1 year ago
3. 1 year to less than 2 years ago
4. 2 or more years ago
   DK, RF

DIA_R08
Now some questions about diabetes care not provided by a health care professional.

INTERVIEWER: Press <Enter> to continue.

DIA_Q08
How often ^DOVERB ^YOU2 usually have ^YOUR1 blood checked for glucose or sugar by ^YOURSELF or by a family member or friend?
INTERVIEWER: Select the reporting period here and enter the number in the next

1. Per day
2. Per week (Go to DIA_N08C)
3. Per month (Go to DIA_N08D)
4. Per year (Go to DIA_N08E)
5. Never (Go to DIA_C09)
   DK, RF (Go to DIA_C09)

DIA_N08B
INTERVIEWER: Enter number of times per day.

• Times
  (MIN: 1) (MAX: 99)
  DK, RF
  Go to DIA_C09

DIA_N08C
INTERVIEWER: Enter number of times per week.

• Times
  (MIN: 1) (MAX: 99)
  DK, RF
  Go to DIA_C09

DIA_N08D
INTERVIEWER: Enter number of times per month.

• Times
  (MIN: 1) (MAX: 99)
  DK, RF
  Go to DIA_C09

DIA_N08E
INTERVIEWER: Enter number of times per year.

• Times
  (MIN: 1) (MAX: 99)
  DK, RF

DIA_C09
If DIA_Q03 = 3 (no feet), go to DIA_C10.
Otherwise, go to DIA_Q09.

DIA_Q09
How often ^DOVERB ^YOU2 usually have ^YOUR1 feet checked for any sores or irritations by ^YOURSELF or by a family member or friend?
INTERVIEWER: Select the reporting period here and enter the number in the next

1. Per day
2. Per week (Go to DIA_N09C)
3. Per month (Go to DIA_N09D)
4. Per year (Go to DIA_N09E)
5. Never (Go to DIA_C10)
   DK, RF (Go to DIA_C10)

DIA_N09B
INTERVIEWER: Enter number of times per day.

• Times
  (MIN: 1) (MAX: 99)
  DK, RF
  Go to DIA_C10

DIA_N09C
INTERVIEWER: Enter number of times per week.

• Times
  (MIN: 1) (MAX: 99)
  DK, RF
  Go to DIA_C10

DIA_N09D
INTERVIEWER: Enter number of times per month.

• Times
  (MIN: 1) (MAX: 99)
  DK, RF
  Go to DIA_C10

DIA_N09E
INTERVIEWER: Enter number of times per year.

• Times
  (MIN: 1) (MAX: 99)
  DK, RF

DIA_C10
If age >= 35, go to DIA_R10.
Otherwise, go to DIA_END.

DIA_R10
Now a few questions about medication.
INTERVIEWER: Press <Enter> to continue.

DIA_Q10
In the past month, did ^YOU2 take aspirin or other ASA (acetylsalicylic acid) medication every day or every second day?

1. Yes
2. No
   DK, RF

DIA_Q11
In the past month, did ^YOU1 take prescription medications such as Lipitor or Zocor to control ^YOUR1 blood cholesterol levels?

1. Yes
2. No
   DK, RF

DIA_END

Medication use (MED)

MED_BEG
Optional Content (See Appendix 2)

MED_C1
If (do MED block = 1), go to MED_R1.
Otherwise, go to MED_END.

MED_R1
Now I’d like to ask a few questions about ^YOUR2 use of medications, both prescription and over-the-counter.

INTERVIEWER: Press <Enter> to continue.

MED_Q1A
In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:
... pain relievers such as aspirin or Tylenol (including arthritis medicine and antiinflammatories)?

1. Yes
2. No
   DK
   RF (Go to MED_END)

MED_Q1B
In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:

1. Yes
2. No
   DK, RF

MED_Q1C
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... diet pills such as Dexatrim, Ponderal or Fastin?

1. Yes
2. No
   DK, RF

MED_Q1D
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... anti-depressants such as Prozac, Paxil or Effexor?

1. Yes
2. No
   DK, RF

MED_Q1E
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... codeine, Demerol or morphine?

1. Yes
2. No
   DK, RF

MED_Q1F
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... allergy medicine such as Reactine or Allegra?

1. Yes
2. No
   DK, RF

MED_Q1G
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... asthma medications such as inhalers or nebulizers?

1. Yes
2. No
   DK, RF

MED_E1G
Inconsistent answers have been entered. The respondent has taken medicine for asthma in the past month but previously reported that he/she did not. Please confirm.

Note: Trigger soft edit if MED_Q1G = 1 and CCC_Q036 = 2.

MED_Q1H
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... cough or cold remedies?

1. Yes
2. No
   DK, RF

MED_Q1I
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... penicillin or other antibiotics?

1. Yes
2. No
   DK, RF

MED_Q1J
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... medicine for the heart?

1. Yes
2. No
   DK, RF

MED_Q1L
In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:

1. Yes
2. No
   DK, RF

MED_Q1M
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... steroids?

1. Yes
2. No
   DK, RF

MED_Q1P
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... sleeping pills such as Imovane, Nytol or Starnoc?

1. Yes
2. No
   DK, RF

MED_Q1Q
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... stomach remedies?

1. Yes
2. No
   DK, RF

MED_Q1R
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... laxatives?

1. Yes
2. No
   DK, RF

MED_C1S
If sex = female and age <= 49, go to MED_Q1S.
Otherwise, go to MED_C1TA.

MED_Q1S
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... birth control pills or other kind of prescribed birth control method?

1. Yes
2. No
   DK, RF

MED_C1TA
If (do HRT block = 1), go to MED_Q1U.
Otherwise, go to MED_C1T.

MED_C1T
If sex is female and age >= 30, go to MED_Q1T.
Otherwise, go to MED_Q1U.

MED_Q1T
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... hormones for menopause or ageing symptoms?

1. Yes
2. No (Go to MED_Q1U)
   DK, RF (Go to MED_Q1U)

MED_Q1T1
What type of hormones ^ARE ^YOU1 taking?
INTERVIEWER: Read categories to respondent.

1. Estrogen only
2. Progesterone only
3. Both
4. Neither
   DK, RF

MED_D1T2
^MinYear = ^Info.YearofBirth + 30;

MED_Q1T2
When did ^YOU1 start this hormone therapy?
INTERVIEWER: Enter the year (minimum is [^MinYear]; maximum is [^Info.CurrentYear]).

• Year
  (MIN: ^MinYear) (MAX: ^Info.CurrentYear)
  DK, RF

MED_E1T2
Year must be between ^MinYear and ^Info.CurrentYear. Please return and correct.

Note: Trigger hard edit if outside these ranges.

MED_Q1U
In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:

1. Yes
2. No
   DK, RF

MED_Q1V
(In the past month, that is, from [date one month ago] to yesterday, did ^YOU2 take:)
... any other medication?

1. Yes – Specify (Go to MED_S1V)
2. No
   DK, RF
   Go to MED_END

MED_S1V
INTERVIEWER: Specify.
DK, RF

MED_END

Pain and discomfort (HUP)

HUP_BEG
Core content

HUP_C1
If (do HUP block = 1), go to HUP_D1.
Otherwise, go to HUP_END.

HUP_D1
(not applicable)

HUP_R1
The next set of questions asks about the level of pain or discomfort ^YOU2 usually experience. They are not about illnesses like colds that affect people for short periods of time.
INTERVIEWER: Press <Enter> to continue.

HUP_Q28
^ARE_C ^YOU2 usually free of pain or discomfort?

1. Yes (Go to HUP_END)
2. No
   DK, RF (Go to HUP_END)

HUP_Q29
How would you describe the usual intensity of ^YOUR1 pain or discomfort?
INTERVIEWER: Read categories to respondent.

1. Mild
2. Moderate
3. Severe
   DK, RF

HUP_Q30
How many activities does ^YOUR1 pain or discomfort prevent?
INTERVIEWER: Read categories to respondent.

1. None
2. A few
3. Some
4. Most
   DK, RF

HUP_END

Health care utilization (HCU)

HCU_BEG
Core content

HCU_C01
If (do HCU block = 1), go to HCU_D01.
Otherwise, go to HCU_END.

HCU_D01
(not applicable)

HCU_Q01AA
^DOVERB_C ^YOU2 have a regular medical doctor?

1. Yes (Go to HCU_D01AC)
2. No
   DK, RF (Go to HCU_END)

HCU_Q01AB
Why ^DOVERB ^YOU2 not have a regular medical doctor?
INTERVIEWER: Mark all that apply.

1. No medical doctors available in the area
2. Medical doctors in the area are not taking new patients
3. Have not tried to contact one
4. Had a medical doctor who left or retired
5. Other - Specify (Go to HCU_S01AB)
   DK, RF
   Go to HCU_D01A1

HCU_S01AB
INTERVIEWER: Specify.

DK, RF
HCU_D01A1
If proxy interview, ^DT_GOVERB = "goes".
Otherwise, ^DT_GOVERB = "go".

HCU_Q01A1
Is there a place that ^YOU2 usually ^DT_GOVERB to when ^YOU1 ^ARE sick or need^S advice about ^YOUR1 health?

1. Yes
2. No (Go to HCU_END)
   DK, RF (Go to HCU_END)

HCU_Q01A2
What kind of place is it?
INTERVIEWER: If the respondent indicates more than one usual place, then ask: What kind of place do you go to most often?

1. Doctor’s office
2. Community health centre / CLSC
3. Walk-in clinic
4. Appointment clinic
5. Telephone health line (for example, HealthLinks, Telehealth Ontario, Health-Line, TeleCare, Info-Santé)
6. Hospital emergency room
7. Hospital outpatient clinic
8. Other - Specify (Go to HCU_S01A2)
   DK, RF
   Go to HCU_END

HCU_S01A2
INTERVIEWER: Specify.
DK, RF
Go to HCU_END

HCU_D01AC
(not applicable)

HCU_Q01AC
^DOVERB_C ^YOU2 and this doctor usually speak in English, in French, or in another language?

1. English
2. French
3. Arabic
4. Chinese
5. Cree
6. German
7. Greek
8. Hungarian
9. Italian
10. Korean
11. Persian (Farsi)
12. Polish
13. Portuguese
14. Punjabi
15. Spanish
16. Tagalog (Filipino)
17. Ukrainian
18. Vietnamese
19. Dutch
20. Hindi
21. Russian
22. Tamil
23. Other - Specify (Go to HCU_S01AC)
    DK, RF
    Go to HCU_END

HCU_S01AC
INTERVIEWER: Specify.
DK, RF

HCU_END

Contacts with Health Professionals (CHP)

CHP_BEG
Theme content

CHP_C01
If (do CHP block = 1), go to CHP_D01.
Otherwise, go to CHP_END.

CHP_D01
(not applicable)

CHP_R01
Now I’d like to ask about ^YOUR2 contacts with various health professionals during the past 12 months, that is, from [date one year ago] to yesterday.

CHP_Q01
In the past 12 months, ^HAVE ^YOU2 been a patient overnight in a hospital, nursing home or convalescent home?

1. Yes
2. No (Go to CHP_ D03)
   DK (Go to CHP_ D03)
   RF (Go to CHP_END)

CHP_Q02
For how many nights in the past 12 months?

• Nights
  (MIN: 1) (MAX: 366; warning after 100)
  DK, RF

Note: In processing, if a respondent answered CHP_Q01 = 2, the variable CHP_Q02 is given the value of "0".

CHP_D03
If CHP_Q01 = 1, ^DT_COUNT = "Not counting when ^YOU2 ^WERE an overnight patient, in the past 12 months".
Otherwise, ^DT_COUNT = "In the past 12 months".

CHP_D03A     
If age < 18, ^DT_PED = "pediatrician".
Otherwise, ^DT_PED = "null".

CHP_Q03
^DT_COUNT, ^HAVE ^YOU2 seen, or talked to any of the following health professionals about ^YOUR1 physical, emotional or mental health:
...a family doctor, ^DT_PED or general practitioner?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_Q06)
   DK, RF (Go to CHP_Q06)

CHP_Q04
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 366; warning after 12)
  DK, RF

Note: In processing, if a respondent answered CHP_Q03 = 2, the variable CHP_Q04 is given the value of "0".

CHP_Q05
Where did the most recent contact take place?
INTERVIEWER: If respondent says "hospital", probe for details.

1. Doctor’s office
2. Hospital emergency room
3. Hospital outpatient clinic ( e.g. day surgery, cancer)
4. Walk-in clinic
5. Appointment clinic
6. Community health centre / CLSC
7. At work
8. At school
9. At home
10. Telephone consultation only
11. Other - Specify (Go to CHP_S05)
    DK, RF
    Go to CHP_ Q06

CHP_S05
INTERVIEWER: Specify.
DK, RF

CHP_Q06
(^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:)
...an eye specialist, such as an ophthalmologist or optometrist (about ^YOUR1 physical, emotional or mental health)?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_D08)
   DK, RF (Go to CHP_D08)

CHP_Q07
(How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 75; warning after 3)
  DK, RF

Note: In processing, if a respondent answered CHP_Q06 = 2, the variable CHP_Q07 is given the value of "0".
If respondent is male, ^DT_DOCTOR = "urologist".
Otherwise, ^DT_DOCTOR = "gynaecologist".

CHP_Q08
^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:)
...any other medical doctor or specialist such as a surgeon, allergist, orthopaedist, ^DT_DOCTOR or psychiatrist (about ^YOUR1 physical, emotional or mental health)?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_Q11)
   DK, RF (Go to CHP_Q11)

CHP_Q09
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 300; warning after 7)
  DK, RF

Note: In processing, if a respondent answered CHP_Q08 = 2, the variable CHP_Q09 is given the value of "0".

CHP_Q10
Where did the most recent contact take place?
INTERVIEWER: If respondent says "hospital", probe for details.

1. Doctor’s office
2. Hospital emergency room
3. Hospital outpatient clinic ( e.g. day surgery, cancer)
4. Walk-in clinic
5. Appointment clinic
6. Community health centre / CLSC
7. At work
8. At school
9. At home
10. Telephone consultation only
11. Other - Specify (Go to CHP_S10)
    DK, RF
    Go to CHP_Q11

CHP_S10
INTERVIEWER: Specify.
DK, RF

CHP_Q11
^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:
...a nurse for care or advice about ^YOUR1 physical, emotional or mental health?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_Q14)
   DK, RF (Go to CHP_Q14)

CHP_Q12
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 366; warning after 15)
  DK, RF

Note: In processing, if a respondent answered CHP_Q11 = 2, the variable CHP_Q12 is given the value of "0".

CHP_Q13
Where did the most recent contact take place?
INTERVIEWER: If respondent says "hospital", probe for details.

1. Doctor’s office
2. Hospital emergency room
3. Hospital outpatient clinic ( e.g. day surgery, cancer)
4. Walk-in clinic
5. Appointment clinic
6. Community health centre / CLSC
7. At work
8. At school
9. At home
10. Telephone consultation only
11. Other - Specify (Go to CHP_S13)
    DK, RF
    Go to CHP_Q14

CHP_S13
INTERVIEWER: Specify.
DK, RF

CHP_Q14
(^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:)
...a dentist, dental hygienist or orthodontist (about ^YOUR1 physical, emotional or mental health)?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_Q16)
   DK, RF (Go to CHP_Q16)

CHP_Q15
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 99; warning after 4)
  DK, RF

Note: In processing, if a respondent answered CHP_Q14 = 2, the variable CHP_Q15 is given the value of "0".

CHP_Q16
(^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:)
...a chiropractor (about ^YOUR1 physical, emotional or mental health)?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_Q18)
   DK, RF (Go to CHP_Q18)
   CHP_Q17

How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 366; warning after 20)
  DK, RF

Note: In processing, if a respondent answered CHP_Q16 = 2, the variable CHP_Q17 is given the value of "0".

CHP_Q18
^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:
...a physiotherapist about ^YOUR1 physical, emotional or mental health?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_Q20)
   DK, RF (Go to CHP_Q20)

CHP_Q19
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 366; warning after 30)
  DK, RF

Note: In processing, if a respondent answered CHP_Q18 = 2, the variable CHP_Q19 is given the value of "0".

CHP_Q20
(^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:)
...a psychologist (about ^YOUR1 physical, emotional or mental health)?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_Q22)
   DK, RF (Go to CHP_Q22)

CHP_Q21
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 366; warning after 25)
  DK, RF

Note: In processing, if a respondent answered CHP_Q20 = 2, the variable CHP_Q21 is given the value of "0".

CHP_Q22
(^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:)
...a social worker or counsellor (about ^YOUR1 physical, emotional or mental health)?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_Q24)
   DK, RF (Go to CHP_Q24)

CHP_Q23
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 366; warning after 20)
  DK, RF

Note: In processing, if a respondent answered CHP_Q22 = 2, the variable CHP_Q23 is given the value of "0".

CHP_Q24
^DT_COUNT, ^HAVE ^YOU2 seen, or talked to:
...an audiologist, a speech or occupational therapist about ^YOUR1 physical, emotional or mental health?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CHP_END)
   DK, RF (Go to CHP_END)

CHP_Q25
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 200; warning after 12)
  DK, RF

Note: In processing, if a respondent answered CHP_Q24 = 2, the variable CHP_Q25 is given the value of "0".

CHP_END

Unmet health care needs (UCN)

UCN_BEG
Optional Content (See Appendix 2)

• External variables required:
• PROXMODE: proxy identifier, from the GR block.
  AGE: Respondent's age
  HCU_Q06:Unmet health care needs
  DOUCN: do block flag, from the sample file.
• PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
• Screen display:
  Display on header bar PE_Q01 and PE_Q02 separated by a space

UCN_C010UCN_C10   
If DOUCN = 1, go to UCN_D010.
Otherwise, go to UCN_END.

UCN_D010

UCN_Q010
^PHRASE_E

1. Yes
2. No (Go to UCN_END)
   DK, RF (Go to UCN_END)

UCN_Q020
Again, thinking of the most recent time, what was the type of care that was needed?
INTERVIEWER: Mark all that apply.

1. Not available - in the area
2. Not available - at time required ( e.g. doctor on holidays, inconvenient hours)
3. Waiting time too long
4. Felt would be inadequate
5. Cost
6. Too busy
7. Didn’t get around to it / didn’t bother
8. Decided not to seek care
9. Doctor - didn't think it was necessary
10. Other - Specify (Go to UCN_S020)
    DK, RF

UCN_S020
INTERVIEWER: Specify.
DK, RF

UCN_Q030
Again, thinking of the most recent time, what was the type of care that was
INTERVIEWER: Mark all that apply.

1. Treatment of - a physical health problem
2. Treatment of - an emotional or mental health problem
3. A regular check-up (including regular pre-natal care)
4. Care of an injury
5. Other - Specify (Go to UCN_S030)
   DK, RF

UCN_S030
INTERVIEWER: Specify.
DK, RF

UCN_Q040
Where did ^YOU1 try to get the service ^YOU1 ^WERE seeking?
INTERVIEWER: Mark all that apply.

1. Doctor’s office
2. Community health centre / CLSC
3. Appointment clinic
4. Hospital - emergency room
5. Hospital - outpatient clinic
6. Other - Specify (Go to UCN_S040)
   DK, RF

UCN_S040
INTERVIEWER: Specify.
DK, RF

UCN_END

Home care services (HMC)

HMC_BEG
Optional Content (See Appendix 2)

HMC_C09A
If (do HMC block = 1), go to HMC_C09B.
Otherwise, go to HMC_END.

HMC_C09B
If age < 18, go to HMC_END.
Otherwise, go to HMC_R09.
Now some questions on home care services. These are health care, home maker or other support services received at home. People may receive home care due to a health problem or condition that affects their daily activities.
Examples include: nursing care, personal care or help with bathing, housework, meal preparation, meal delivery and respite care.
INTERVIEWER: Press <Enter> to continue.

HMC_Q09
^HAVE_C ^YOU2 received any home care services in the past 12 months, with the cost being entirely or partially covered by government?

1. Yes
2. No (Go to HMC_D11)
   DK (Go to HMC_D11
   RF (Go to HMC_END)

HMC_Q10
What type of services ^HAVE ^YOU1 received?
INTERVIEWER: Read categories to respondent. Mark all that apply. Cost must be entirely or partially covered by government.

1. Nursing care ( e.g. , dressing changes, preparing medications,  V.O.N. visits)
2. Other health care services ( e.g. , physiotherapy, occupational  or speech therapy, nutrition counselling)
3. Medical equipment or supplies
4. Personal care ( e.g. , bathing, foot care)
5. Housework ( e.g. , cleaning, laundry)
6. Meal preparation or delivery
7. Shopping
8. Respite care ( i.e. , caregiver relief)
9. Other - Specify (Go to HMC_S10)
   DK, RF
   Go to HMC_D11

HMC_S10
INTERVIEWER: Specify.
DK, RF

HMC_D11
If HMC_Q09 = 1, ^DT_OTHER = "other home".
Otherwise, ^DT_OTHER = "home".

HMC_Q11
^HAVE ^YOU2 received any ^DT_OTHER care services in the past 12 months, with the cost not covered by government (for example: care provided by a private agency or by a spouse or friends)?
INTERVIEWER: Include only health care, homemaker or other support services ( e.g. , housework) that are provided because of a respondent’s health problem or condition.

1. Yes
2. No (Go to HMC_Q14)
   DK, RF (Go to HMC_Q14)

HMC_D12
(not applicable)

HMC_Q12
Who provided these ^DT_OTHER home care services?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Nurse from a private agency
2. Homemaker or other support services from a private agency
3. Physiotherapist or other therapist from a private agency
4. Neighbour or friend
5. Family member or spouse
6. Volunteer
7. Other - Specify (Go to HMC_S12)
   DK, RF
   Go to HMC_Q13

HMC_S12
INTERVIEWER: Specify.
DK, RF

HMC_Q13
What type of home care services ^HAVE ^YOU1 received?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Nursing care ( e.g. , dressing changes, preparing medications, V.O.N. visits)
2. Other health care services ( e.g. , physiotherapy, occupational or speech therapy, nutrition counselling)
3. Medical equipment or supplies
4. Personal care ( e.g. , bathing, foot care)
5. Housework ( e.g. , cleaning, laundry)
6. Meal preparation or delivery
7. Shopping
8. Respite care ( i.e. , caregiver relief)
9. Other - Specify (Go to HMC_S13)
   DK, RF
   Go to HMC_Q14

HMC_S13
INTERVIEWER: Specify.
DK, RF

HMC_Q14
During the past 12 months, was there ever a time when ^YOU2 felt that ^YOU1 needed home care services but ^YOU1 didn’t receive them?

1. Yes
2. No (Go to HMC_END)
   DK, RF (Go to HMC_END)

HMC_Q15
Thinking of the most recent time, why didn’t ^YOU1 get these services?
INTERVIEWER: Mark all that apply.

1. Not available - in the area
2. Not available - at time required ( e.g. , inconvenient hours)
3. Waiting time too long
4. Felt would be inadequate
5. Cost
6. Too busy
7. Didn’t get around to it / didn’t bother
8. Didn’t know where to go / call
9. Language problems
10. Personal or family responsibilities
11. Decided not to seek services
12. Doctor - did not think it was necessary
13. Did not qualify / not eligible for home care
14. Still waiting for home care
15. Other - Specify (Go to HMC_S15)
    DK, RF
    Go to HMC_Q16

HMC_S15
INTERVIEWER: Specify.
DK, RF

HMC_Q16
Again, thinking of the most recent time, what type of home care was needed?
INTERVIEWER: Mark all that apply.

1. Nursing care ( e.g. , dressing changes, preparing medications, V.O.N. visits)
2. Other health care services ( e.g. , physiotherapy, occupational or speech therapy, nutrition counselling)
3. Medical equipment or supplies
4. Personal care ( e.g. , bathing, foot care)
5. Housework ( e.g. , cleaning, laundry)
6. Meal preparation or delivery
7. Shopping
8. Respite care ( i.e. , caregiver relief)
9. Other - Specify (Go to HMC_S16)
   DK, RF
   Go to HMC_Q17

HMC_S16
INTERVIEWER: Specify.
DK, RF

HMC_Q17
Where did ^YOU2 try to get this home care service?
INTERVIEWER: Mark all that apply.

1. A government sponsored program
2. A private agency
3. A family member, friend or neighbour
4. A volunteer organization
5. Other
   DK, RF

HMC_END

Patient satisfaction - Health care services (PAS)

PAS_BEG
Optional Content (See Appendix 2)

PAS_C11A
If (do PAS block = 1), go to PAS_C11B.

Otherwise, go to PAS_END.

PAS_C11B
If proxy interview or if age < 15, go to PAS_END.
Otherwise, go to PAS_R1.

PAS_R1
Earlier, I asked about your use of health care services in the past 12 months. Now I’d like to get your opinion on the quality of the care you received.
INTERVIEWER: Press <Enter> to continue.

PAS_C11D
If CHP_Q01 = 1 or at least one of CHP_Q03 to CHP_Q24 = 1 (Yes), go to PAS_Q12.
Otherwise, go to PAS_Q11.

Note: In processing, if a respondent answered CHP_Q01 = 1 or at least one of CHP_Q03 to CHP_Q24 = 1, set PAS_Q11 = 1.

PAS_Q11
In the past 12 months, have you received any health care services?

1. Yes
2. No (Go to PAS_END)
   DK, RF (Go to PAS_END)

PAS_Q12
Overall, how would you rate the quality of the health care you received?
Would you say it was:
INTERVIEWER: Read categories to respondent.

1. ...excellent?
2. ...good?
3. ...fair?
4. ...poor?
   DK, RF

PAS_Q13
Overall, how satisfied were you with the way health care services were 13provided? Were you:
INTERVIEWER: Read categories to respondent.

1. ...very satisfied?
2. ...somewhat satisfied?
3. ...neither satisfied nor dissatisfied?
4. ...somewhat dissatisfied?
5. ...very dissatisfied?
   DK, RF

PAS_Q21A
In the past 12 months, have you received any health care services at a hospital, for any diagnostic or day surgery service, overnight stay, or as an emergency room patient?

1. Yes
2. No (Go to PAS_Q31A)
   DK, RF (Go to PAS_Q31A)

PAS_Q21B
Thinking of your most recent hospital visit, were you:
INTERVIEWER: Read categories to respondent.

1. ...admitted overnight or longer (an inpatient)?
2. ...a patient at a diagnostic or day surgery clinic (an outpatient)?
3. ...an emergency room patient?
   DK, RF (Go to PAS_Q31A)

PAS_Q22
(Thinking of this most recent hospital visit:)
...how would you rate the quality of the care you received? Would you say it was:
INTERVIEWER: Read categories to respondent.

1. ...excellent?
2. ...good?
3. ...fair?
4. ...poor?
   DK, RF

PAS_Q23
(Thinking of this most recent hospital visit:)
...how satisfied were you with the way hospital services were provided?
Were you:

INTERVIEWER: Read categories to respondent.

1. ...very satisfied?
2. ...somewhat satisfied?
3. ...neither satisfied nor dissatisfied?
4. ...somewhat dissatisfied?
5. ...very dissatisfied?
   DK, RF

PAS_Q31A
In the past 12 months, not counting hospital visits, have you received any health care services from a family doctor or other physician?

1. Yes
2. No (Go to PAS_END)
   DK, RF (Go to PAS_END)

PAS_Q31B
Thinking of the most recent time, was care provided by:
INTERVIEWER: Read categories to respondent.

1. ...a family doctor (general practitioner)?
2. ...a medical specialist?
   DK, RF (Go to PAS_END)

PAS_Q32
(Thinking of this most recent care from a physician:)
...how would you rate the quality of the care you received? Would you say it was:
INTERVIEWER: Read categories to respondent.

1. ... excellent?
2. ... good?
3. ... fair?
4. ... poor?
   DK, RF

PAS_Q33
(Thinking of this most recent care from a physician:)
...how satisfied were you with the way physician care was provided?
Were you:
INTERVIEWER: Read categories to respondent.

1. ...very satisfied?
2. ...somewhat satisfied?
3. ...neither satisfied nor dissatisfied?
4. ...somewhat dissatisfied?
5. ...very dissatisfied?
   DK, RF

PAS_END

Patient satisfaction - Community-based care (PSC)

PSC_BEG
Optional Content (See Appendix 2)

PSC_C11A
If (do PSC block = 1), go to PSC_C11B.
Otherwise, go to PSC_END.

PSC_C11B
If proxy interview or if age < 15, go to PSC_END.
Otherwise, go to PSC_C11C.

PSC_C11C     
If PAS_Q11 = (2, DK, RF) and CHP_Q01 <> 1 and all of (CHP_Q03 to CHP_Q24) <> 1, go to PSC_END.
Otherwise, go to PSC_R1.

PSC_R1
The next questions are about community-based health care which includes any     health care received outside of a hospital or doctor’s office.
Examples are: home nursing care, home-based counselling or therapy, personal care and community walk-in clinics.
INTERVIEWER: Press <Enter> to continue.

PSC_Q41
In the past 12 months, have you received any community-based care?

1. Yes
2. No (Go to PSC_END)
   DK, RF (Go to PSC_END)

PSC_Q42
Overall, how would you rate the quality of the community-based care you received? Would you say it was:
INTERVIEWER: Read categories to respondent.

1. ... excellent?
2. ... good?
3. ... fair?
4. ... poor?
   DK, RF

PSC_Q43
Overall, how satisfied were you with the way community-based care was provided?
INTERVIEWER: Read categories to respondent.

1. ...very satisfied?
2. ...somewhat satisfied?
3. ...neither satisfied nor dissatisfied?
4. ...somewhat dissatisfied?
5. ...very dissatisfied?
   DK, RF

PSC_END

Restriction of activities (RAC)

RAC_BEG
Optional Content - 2011 only (See Appendix 2)

RAC_C1
If (do RAC block = 1), go to RAC_R1.
Otherwise, go to RAC_END.

RAC_R1
The next few questions deal with any current limitations in ^YOUR2 daily   activities caused by a long-term health condition or problem. In these questions, a "long-term condition" refers to a condition that is expected to last        or has already lasted 6 months or more.
INTERVIEWER: Press <Enter> to continue.

RAC_Q1
^DOVERB ^YOU1 have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?
INTERVIEWER: Read categories to respondent.

1. Sometimes
2. Often
3. Never
   DK
   RF (Go to RAC_END)

RAC_Q2A
Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:
... at home?
INTERVIEWER: Read categories to respondent.

1. Sometimes
2. Often
3. Never
   DK
   RF (Go to RAC_END)

RAC_Q2B_1
(Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:)
... at school?

1. Sometimes
2. Often
3. Never
4. Does not attend school
   DK
   RF (Go to RAC_END)

RAC_Q2B_2
(Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:)
... at work?

1. Sometimes
2. Often
3. Never
4. Does not work at a job
   DK
   RF (Go to RAC_END)

RAC_Q2C
(Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:)
... in other activities, for example, transportation or leisure?

1. Sometimes
2. Often
3. Never
   DK
   RF (Go to RAC_END)

RAC_C5
If respondent has difficulty or is limited in activities (RAC_Q1 = 1 or 2) or (RAC_Q2A-C = 1 or 2), go to RAC_C5A.
Otherwise, go to RAC_END.

RAC_C5A
If (RAC_Q2A to RAC_Q2C = 3 or 4) and RAC_Q1 < 3, go to RAC_R5.
Otherwise, go to RAC_Q5.

RAC_R5
You reported that ^YOU2 ^HAVE difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities.

RAC_Q5
Which one of the following is the best description of the cause of this condition?
INTERVIEWER: Read categories to respondent.

1. Accident at home
2. Motor vehicle accident
3. Accident at work
4. Other type of accident
5. Existed from birth or genetic
6. Work conditions
7. Disease or illness
8. Ageing
9. Emotional or mental health problem or condition
10. Use of alcohol or drugs
11. Other - Specify (Go to RAC_S5)
    DK, RF

RAC_S5
INTERVIEWER: Specify.
DK, RF

RAC_END

Activities of Daily Living (ADL)

ADL_BEG
Optional Content (See Appendix 2)

ADL_C01ADL
If do ADL block = 1, go to ADL_R01.
Otherwise, go to ADL_END.

ADL_R01
The next few questions are about common daily activities. These questions may not apply to ^YOU2, but we need to ask the same questions of everyone.

INTERVIEWER: Press <1> to continue.

ADL_Q01
Because of any physical condition or mental condition or health problem, ^DOVERB ^YOU1 need the help of another person:
... with preparing meals?

1. Yes
2. No
   DK, RF

ADL_Q02
Because of any physical condition or mental condition or health problem, ^DOVERB ^YOU1 need the help of another person:
... with getting to appointments and running errands such as shopping for groceries?

1. Yes
2. No
   DK, RF

ADL_Q03
Because of any physical condition or mental condition or health problem, ^DOVERB ^YOU1 need the help of another person:
... with doing everyday housework?

1. Yes
2. No
   DK, RF

ADL_Q04
Because of any physical condition or mental condition or health problem,
^DOVERB ^YOU1 need the help of another person:
... with personal care such as washing, dressing, eating or taking medication?

1. Yes
2. No
   DK, RF

ADL_Q05
Because of any physical condition or mental condition or health problem, ^DOVERB ^YOU1 need the help of another person:
... with moving about inside the house?

1. Yes
2. No
   DK, RF

ADL_Q06
Because of any physical condition or mental condition or health problem, ^DOVERB ^YOU1 need the help of another person:
... with looking after ^YOUR1 personal finances such as making bank transactions or paying bills?

1. Yes
2. No
   DK, RF

ADL_END

Flu shots (FLU)

FLU_BEG
Core content

FLU_C1
If (do FLU block = 1), go to FLU_C160AA.
Otherwise, go to FLU_END.

FLU_C160A
If proxy interview, go to FLU_END.
Otherwise, go to FLU_R160.

FLU_R160
Now a few questions about your use of various health care services.
INTERVIEWER: Press <1> to continue.

FLU_Q160
Have you ever had a seasonal flu shot?

1. Yes
2. No (Go to FLU_Q166)
   DK, RF (Go to FLU_END)

FLU_Q162
When did you have your last seasonal flu shot?
INTERVIEWER: Read categories to respondent.

1. Less than 1 year ago
2. 1 year to less than 2 years ago
3. 2 years ago or more
   DK, RF (Go to FLU_END)

FLU_C164
If FLU_Q162 = 2 or 3, go to FLU_Q166.
Otherwise, go to FLU_Q164.

FLU_Q164
In which month did you have your last seasonal flu shot?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
    DK, RF

FLU_C165
If FLU_Q164 = [current month], go to FLU_Q165.
Otherwise, go to FLU_END.

FLU_Q165
Was that this year or last year?

1. This year
2. Last year
   DK, RF
   Go to FLU_END

FLU_Q166
What are the reasons that you have not had a seasonal flu shot in the past year?
INTERVIEWER: Mark all that apply.

1. Have not gotten around to it
2. Respondent - did not think it was necessary
3. Doctor - did not think it was necessary
4. Personal or family responsibilities
5. Not available - at time required
6. Not available - at all in the area
7. Waiting time was too long
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go / uninformed
12. Fear ( e.g. , painful, embarrassing, find something wrong)
13. Bad reaction to previous shot
14. Unable to leave the house because of a health problem
15. Other - Specify (Go to FLU_S166)
    DK, RF
    Go to FLU_END

FLU_S166
INTERVIEWER: Specify.
DK, RF

FLU_END

Blood test (BLT)

BLT_BEG
Optional Content (See Appendix 2)

BLT_C01A
If (do BLT block = 1), go to BLT_C01B.
Otherwise, go to BLT_END.

BLT_C01B
If proxy interview, go to BLT_END.
Otherwise, go to BLT_C01C.

BLT_C01C
If age < 35, go to BLT_END.
Otherwise, go to BLT_Q01.

BLT_Q01
In the past 12 months, did a health professional order a blood test for you?

1. Yes
2. No (Go to BLT_END)
   DK, RF (Go to BLT_END)

BLT_Q02
Why was your most recent blood test ordered?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. For assessment as part of a general physical check-up
2. To monitor an existing health condition
3. To check for a new specific disease or health condition
4. As the result of an emergency (for example, heart attack, food  poisoning, car accident)
5. Other - Specify (Go to BLT_S02)
   Go to BLT_C02B

BLT_S02
INTERVIEWER: Specify.
DK, RF

BLT_C02B
If BLT_Q02 = 2 or 3, go to BLT_Q03.
Otherwise, go to BLT_END.

BLT_Q03
For which health conditions was your last blood test ordered?
INTERVIEWER: Mark all that apply.

1. High cholesterol or other heart-related conditions
2. Diabetes
3. Thyroid
4. Prostate
5. Infectious disease
6. Liver function
7. Hormone-related
8. Other - Specify (Go to BLT_S03)
   DK, RF
   Go to BLT_END

BLT_S03
INTERVIEWER: Specify.
DK, RF

BLT_END

Blood pressure check (BPC)

BPC_BEG
Optional Content (See Appendix 2)

BPC_C01
If (do BPC block = 2) or proxy interview, go to BPC_END.
Otherwise, go to BPC_Q010.

BPC_Q010
(Now blood pressure)
Have you ever had your blood pressure taken?

1. Yes
2. No (Go to BPC_C016)
   DK, RF (Go to BPC_END)
   BPC_Q012

When was the last time?
BPC_012

1. Less than 6 months ago
2. 6 months to less than 1 year ago
3. 1 year to less than 2 years ago
4. 2 years to less than 5 years ago
5. 5 or more years ago
   DK, RF (Go to BPC_END)

BPC_C012A
If BPC_Q012 < 4, go to BPC_C012B.
Otherwise, go to BPC_C016.

BPC_C012B
If sex = female and (14 < age < 56 ), go to BPC_Q013.
Otherwise, go to BPC_END.

BPC_Q013
Were you pregnant the last time your blood pressure was taken?

1. Yes
2. No
   DK, RF
   Go to BPC_END

BPC_C016
If age < 25, go to BPC_END.
Otherwise, go to BPC_Q016.

BPC_Q016
What are the reasons that you have not had your blood pressure taken in the past 2 years?
INTERVIEWER: Mark all that apply.

1. Have not gotten around to it
2. Respondent - did not think it was necessary
3. Doctor - did not think it was necessary
4. Personal or family responsibilities
5. Not available - at time required
6. Not available - at all in the area
7. Waiting time was too long
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go / uninformed
12. Fear ( e.g. , painful, embarrassing, find something wrong)
13. Unable to leave the house because of a health problem
14. Other
    DK, RF

BPC_END

PAP smear test (PAP)

PAP_BEG
Optional Content (See Appendix 2)

PAP_C1
If (do PAP block = 1), go to PAP_C020.
Otherwise, go to PAP_END.

PAP_C020
If proxy interview or male or age < 18, go to PAP_END.
Otherwise, go to PAP_Q020.

PAP_Q020
(Now PAP tests)
Have you ever had a PAP smear test?

1. Yes
2. No (Go to PAP_Q026)
   DK, RF (Go to PAP_END)

PAP_Q022
When was the last time?

1. Less than 6 months ago (Go to PAP_END)
2. 6 months to less than 1 year ago (Go to PAP_END)
3. 1 year to less than 3 years ago (Go to PAP_END)
4. 3 years to less than 5 years ago
5. 5 or more years ago
   DK, RF (Go to PAP_END)

PAP_Q026
What are the reasons that you have not had a PAP smear test in the past 2 years?
INTERVIEWER: Mark all that apply.

1. Have not gotten around to it
2. Respondent - did not think it was necessary
3. Doctor - did not think it was necessary
4. Personal or family responsibilities
5. Not available - at time required
6. Not available - at all in the area
7. Waiting time was too long
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go / uninformed
12. Fear ( e.g. , painful, embarrassing, find something wrong)
13. Have had a hysterectomy
14. Hate / dislike having one done
15. Unable to leave the house because of a health problem
16. Other
    DK, RF

Note: If HWT_Q1 = 1 (pregnant), then PAP_Q026M (Have had a hysterectomy) should be a blank 'fill' (not a possible value for the interviewer).

PAP_END

Mammography (MAM)

MAM_BEG
Optional Content (See Appendix 2)

MAM_C1
If (do MAM block = 1), go to MAM_C030.
Otherwise, go to MAM_END.

MAM_C030
If proxy interview or male, go to MAM_END.
Otherwise, go to MAM_C030A.

MAM_C030A
If female and age < 35, go to MAM_C038.
Otherwise, go to MAM_Q030.

MAM_Q030
(Now Mammography)
Have you ever had a mammogram, that is, a breast x-ray?

1. Yes
2. No (Go to MAM_C036)
   DK, RF (Go to MAM_END)

MAM_Q031
Why did you have it?
INTERVIEWER: Mark all that apply.

1. If respondent says "doctor recommended it", probe for reason.
2. Family history of breast cancer
3. Part of regular check-up / routine screening
4. Age
5. Previously detected lump
6. Follow-up of breast cancer treatment
7. On hormone replacement therapy
8. Breast problem
9. Other
   DK, RF

MAM_Q032
When was the last time?

1. Less than 6 months ago (Go to MAM_C038)
2. 6 months to less than 1 year ago (Go to MAM_C038)
3. 1 year to less than 2 years ago (Go to MAM_C038)
4. 2 years to less than 5 years ago
5. 5 or more years ago
   DK, RF (Go to MAM_C038)

MAM_C036
If age < 50 or age > 69, go to MAM_C038.
Otherwise, go to MAM_Q036.

MAM_Q036
What are the reasons you have not had one in the past 2 years?
INTERVIEWER: Mark all that apply.

1. Have not gotten around to it
2. Respondent - did not think it was necessary
3. Doctor - did not think it was necessary
4. Personal or family responsibilities
5. Not available - at time required
6. Not available - at all in the area
7. Waiting time was too long
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go / uninformed
12. Fear ( e.g. , painful, embarrassing, find something wrong)
13. Unable to leave the house because of a health problem
14. Breasts removed / Mastectomy
15. Other - Specify (Go to MAM_S036)
    DK, RF
    Go to MAM_C038

MAM_S036
INTERVIEWER: Specify.
DK, RF

MAM_C038
If age < 18, go to MAM_END.
Otherwise, go to MAM_C038A.

MAM_C038A
If PAP_Q026 = 13 or if HWT_Q1 = 1, go to MAM_END.
Otherwise, go to MAM_Q038.

MAM_Q038
Have you had a hysterectomy? (in other words, has your uterus been in other words, has your uterus been removed)?

1. Yes
2. No
   DK, RF

Note: In processing, if a respondent answered HWT_Q1 = 1, the variable MAM_Q038 is given the value of 2.

If a respondent answered PAP_Q026 = 13 and MAM_Q030 ≠ (DK, RF), the variable MAM_Q038 is given the value of 1.

MAM_END

Breast examinations (BRX)

BRX_BEG
Optional Content (See Appendix 2)

BRX_C1
If (do BRX block = 1), go to BRX_C110.
Otherwise, go to BRX_END.

BRX_C110
If proxy interview or sex = male or age < 18, go to BRX_END.
Otherwise, go to BRX_Q110.

BRX_Q110
(Now breast examinations)
Other than a mammogram, have you ever had your breasts examined for lumps (tumours, cysts) by a doctor or other health professional?

1. Yes
2. No (Go to BRX_Q116)
   DK, RF (Go to BRX_END)

BRX_Q112
When was the last time?

1. Less than 6 months ago (Go to BRX_END)
2. 6 months to less than 1 year ago (Go to BRX_END)
3. 1 year to less than 2 years ago (Go to BRX_END)
4. 2 years to less than 5 years ago
5. 5 or more years ago
   DK, RF (Go to BRX_END)

BRX_Q116
What are the reasons that you have not had a breast exam in the past 2 years?
INTERVIEWER: Mark all that apply.

1. Have not gotten around to it
2. Respondent - did not think it was necessary
3. Doctor - did not think it was necessary
4. Personal or family responsibilities
5. Not available - at time required
6. Not available - at all in the area
7. Waiting time was too long
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go / uninformed
12. Fear ( e.g. , painful, embarrassing, find something wrong)
13. Unable to leave the house because of a health problem
14. Breasts removed / Mastectomy
15. Other
    DK, RF

BRX_END

Breast self-examinations (BSX)

BSX_BEG
Optional Content (See Appendix 2)

BSX_C120A
If (do BSX block = 1), go to BSX_C120B.
Otherwise, go to BSX_END.

BSX_C120B
If proxy interview, go to BSX_END.
Otherwise, go to BSX_C120C.

BSX_C120C
If male or age < 18, go to BSX_END.
Otherwise, go to BSX_Q120.

BSX_Q120
(Now breast self examinations)
Have you ever examined your breasts for lumps (tumours, cysts)?

1. Yes
2. No (Go to BSX_END)
   DK, RF (Go to BSX_END)

BSX_Q121
How often?

1. At least once a month
2. Once every 2 to 3 months
3. Less often than every 2 to 3 months
   DK, RF

BSX_Q122
How did you learn to do this?
INTERVIEWER: Mark all that apply.

1. Doctor
2. Nurse
3. Book / magazine / pamphlet
4. TV / video / film
5. Family member ( e.g. , mother, sister, cousin)
6. Other - Specify (Go to BSX_S122)
   DK, RF
   Go to BSX_END

BSX_S122
INTERVIEWER: Specify.
DK, RF

BSX_END

Spirometry (SPI)

SPI_BEG
Optional Content (See Appendix 2)

SPI_C01A
If (do SPI block = 1), go to SPI_C01B.
Otherwise, go to SPI_END.

SPI_C01B
If proxy interview, go to SPI_END.
Otherwise, go to SPI_Q01.

SPI_Q01
Spirometry is a common lung function test that consists of blowing into a small tube attached to a machine.
Have you ever had this test?

1. Yes
2. No (Go to SPI_END)
   DK, RF (Go to SPI_END)

SPI_Q02
When was the last time?

1. Less than 6 months ago
2. 6 months to less than 1 year ago
3. 1 year to less than 2 years ago
4. 2 years to less than 5 years ago
5. 5 or more years ago
   DK, RF

SPI_END

Hormone replacement therapy (HRT)

HRT_BEG
Optional Content (See Appendix 2)

HRT_C01A
If (do HRT block = 1), go to HRT_C01B.
Otherwise, go to HRT_END.

HRT_C01B
If proxy interview, go to HRT_END.
Otherwise, go to HRT_C01C.

HRT_C01C
If (female and age > 30), go to HRT_R01.
Otherwise, go to HRT_END.

HRT_R01
Now some additional questions on women’s health and the use of hormone medication.
INTERVIEWER: Press <Enter> to continue.

HRT_Q01
In the past 12 months, have you experienced any symptoms of menopause or ageing. These symptoms may include hot flashes, night sweats, or an irregularity or the stopping of your periods?

1. Yes
2. No
   DK
   RF (Go to HRT_END)

HRT_Q02
In the past 12 months, did you take any form of Hormone Replacement Therapy for menopause symptoms or for conditions due to ageing?

1. Yes
2. No (Go to HRT_Q07)
   DK, RF (Go to HRT_END)

HRT_Q03
Are you currently taking hormones?

1. Yes
2. No
   DK, RF

HRT_D04
If HRT_Q03 = 1, ^DT_DODID = "do".
Otherwise, ^DT_DODID = "did".

HRT_Q04
What type of hormones ^DT_DODID you take?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Estrogen only ( e.g. , Premarin, Estrace, Vivelle)
2. Progestin or progesterone only ( e.g. , Provera, Prometrium)
3. Both estrogen and progestin ( e.g. , Premplus, FemHRT, Estalis)
4. Other - Specify (Go to HRT_S04)
   DK, RF
   Go to HRT_D05

HRT_S04
INTERVIEWER: Specify.
DK, RF

HRT_D05
^MinYear = ^Info.YearofBirth + 30;

HRT_Q05
When did you start this hormone therapy?
INTERVIEWER: Enter the year (minimum is ^MinYear; maximum is ^Info.CurrentYear).

• Year
  (MIN: ^MinYear) (MAX: ^Info.CurrentYear)
  DK, RF

HRT_E05
Year must be between ^MinYear and ^Info.CurrentYear. Please return and correct.

Note: Trigger hard edit if HRT_Q05 < ^MinYear or HRT_Q05 > ^Info.CurrentYear.

HRT_D06
If HRT_Q03 = 1, ^DT_TAKE = "take".
Otherwise, ^DT_TAKE = "took".

HRT_Q06
What are the reasons that you ^DT_TAKE these hormones?
INTERVIEWER: Mark all that apply.

1. To treat - Menopausal symptoms ( e.g. , hot flashes, night sweats)
2. To treat - Gynecological problems ( e.g. , irregular bleeding)
3. To treat or prevent - Osteoporosis
4. To prevent - Heart disease
5. To treat - Reproductive problems
6. Other - Specify (Go to HRT_S06)
   DK, RF
   Go to HRT_C07

HRT_S06
INTERVIEWER: Specify.
DK, RF

HRT_C07
If HRT_Q03 = 1, go to HRT_C10.
Otherwise, go to HRT_Q09.

HRT_Q07
Have you ever taken any form of Hormone Replacement Therapy for menopause symptoms or for conditions due to ageing?

1. Yes
2. No (Go to HRT_C10)
   DK, RF (Go to HRT_C10)

HRT_Q08
What are the reasons that you took these hormones?
INTERVIEWER: Mark all that apply.

1. To treat - Menopausal symptoms ( e.g. , hot flashes, night sweats)
2. To treat - Gynecological problems ( e.g. , irregular bleeding)
3. To treat or prevent - Osteoporosis
4. To prevent - Heart disease
5. To treat - Reproductive problems
6. To help with - Fatigue, mood or memory loss
7. Other - Specify (Go to HRT_S08)
   DK, RF
   Go to HRT_Q09

HRT_S08
INTERVIEWER: Specify.
DK, RF

HRT_Q09
What are the reasons that you stopped taking hormones?
INTERVIEWER: Mark all that apply.

1. Worried / read about possible health risks
2. Doctor recommended
3. Menopausal symptoms improved
4. Learned about alternative health products
5. Diagnosed with health problem / condition
6. Adverse reaction to medication
7. Other - Specify (Go to HRT_S09)
   DK, RF
   Go to HRT_C10

HRT_S09
INTERVIEWER: Specify.
DK, RF

HRT_C10
If HRT_Q01 = 1 or HRT_Q02 = 1, go to HRT_Q10.
Otherwise, go to HRT_END.

HRT_Q10
Some women use health products such as herbs, minerals or homeopathic supplements to relieve symptoms of menopause or conditions of ageing.
In the past 12 months, have you used any of these health products to relieve your symptoms?

1. Yes
2. No (Go to HRT_Q12)
   DK, RF (Go to HRT_Q12)

HRT_Q11
What have you used?
INTERVIEWER: Mark all that apply.

1. Vitamins or other dietary supplements ( e.g. , Melatonin, Calcium)
2. Herbs ( e.g. , Black Cohosh, Oil of Evening Primrose)
3. Herbal teas
4. Other - Specify (Go to HRT_S11)
   DK, RF
   Go to HRT_Q12

HRT_S11
INTERVIEWER: Specify.
DK, RF

HRT_Q12
Other than taking hormones or health products, in the past 12 months, did you do anything else to relieve your symptoms?

1. Yes
2. No (Go to HRT_END)
3. DK, RF (Go to HRT_END)
   HRT_Q13

What did you do?
INTERVIEWER: Mark all that apply.

1. Ate more foods rich in soy, flax or calcium
2. Ate more legumes ( i.e. , beans, peas)
3. Avoided certain foods or activities ( e.g. , spicy foods, alcohol, hot tubs)
4. Increased exercise
5. Did relaxation exercises ( e.g. , yoga, Tai Chi)
6. Received massage therapy treatments
7. Other - Specify (Go to HRT_S13)
   DK, RF
   Go to HRT_END

HRT_S13
INTERVIEWER: Specify.
DK, RF

HRT_END

Physical check-up (PCU)

PCU_BEG
Optional Content (See Appendix 2)

PCU_C01A
If (do PCU block = 1), go to PCU_C01B.
Otherwise, go to PCU_END.

PCU_C01B
If proxy interview, go to PCU_END.
Otherwise, go to PCU_D01.

PCU_D01
If sex = female and age is between (15 and 55), ^DT_PREGNANCY = "or during a pregnancy".
Otherwise, ^DT_PREGNANCY = "null".

PCU_R01
Next I would like to ask you some questions related to general physical check-ups. Please do not include check-ups you may have had during a visit for a specific health problem ^DT_PREGNANCY.
INTERVIEWER: Press <Enter> to continue.

PCU_Q150
Have you ever had a general physical check-up?

1. Yes
2. No (Go to PCU_Q154)
   DK, RF (Go to PCU_END)

PCU_Q152
How often do you usually have a general physical check-up?

1. More than once a year
2. Once a year
3. Once every 2 years
4. Once every 3 years
5. Less than once every 3 years
6. No regular pattern
   DK, RF

PCU_Q153
When was the last time?

1. Less than 1 year ago
2. 1 year to less than 2 years ago
3. 2 years to less than 3 years ago
4. 3 years to less than 4 years ago
5. 4 years to less than 5 years ago
6. 5 or more years ago
   DK, RF (Go to PCU_Q155)

PCU_C153
If PCU_Q153 < 4, go to PCU_Q155.
Otherwise, go to PCU_Q154.

PCU_Q154
What are the reasons that you have not had a general physical check-up in the past 3 years?
INTERVIEWER: Mark all that apply.

1. Have not gotten around to it
2. Doctor - did not think it was necessary
3. Personal or family responsibilities
4. Not available - at time required
5. Not available - at all in the area
6. Waiting time was too long
7. Transportation - problems
8. Language - problem
9. Cost
10. Did not know where to go / uninformed
11. Fear ( e.g. , painful, embarrassing, find something wrong)
12. Unable to leave the house because of a health problem
13. Other - Specify (Go to PCU_S154)
    DK, RF
    Go to PCU_END

PCU_S154
INTERVIEWER: Specify.
DK, RF
Go to PCU_END

PCU_Q155
During your last general physical check-up, did a health professional weigh you?

1. Yes
2. No
   DK, RF

PCU_Q156
(During your last general physical check-up,)
...did a health professional measure your height?

1. Yes
2. No
   DK, RF

PCU_Q157
During your last general physical check-up, did a health professional check your blood pressure?

1. Yes
2. No
   DK, RF

PCU_Q158
(During your last general physical check-up,)
...did a health professional discuss with you any risks that your weight might pose to your health?

1. Yes
2. No
   DK, RF

PCU_END

Prostate cancer screening (PSA)

PSA_BEG
Optional Content (See Appendix 2)

PSA_C1
If (do PSA block = 1), go to PSA_C170.
Otherwise, go to PSA_END.

PSA_C170
If proxy interview, go to PSA_END.
Otherwise, go to PSA_C170A.

PSA_C170A
If female or age < 35, go to PSA_END.
Otherwise, go to PSA_Q170.

PSA_Q170
(Now Prostate tests)
Have you ever had a prostate specific antigen test for prostate cancer, that is, a PSA blood test?

1. Yes
2. No (Go to PSA_Q174)
   DK (Go to PSA_Q174)
   RF (Go to PSA_END)

PSA_Q172
When was the last time?

1. Less than 1 year ago
2. 1 year to less than 2 years ago
3. 2 years to less than 3 years ago
4. 3 years to less than 5 years ago
5. 5 or more years ago
   DK, RF

PSA_Q173
Why did you have it?
INTERVIEWER: Mark all that apply.
If respondent says ‘Doctor recommended it’ or ‘I requested it’, probe for reason.

1. Family history of prostate cancer
2. Part of regular check-up / routine screening
3. Age
4. Race
5. Follow-up of problem
6. Follow-up of prostate cancer treatment
7. Other - Specify (Go to PSA_S173)
   DK, RF
   Go to PSA_Q174

PSA_S173
INTERVIEWER: Specify.
DK, RF

PSA_Q174
A Digital Rectal Exam is an exam in which a gloved finger is inserted into the rectum in order to feel the prostate gland.
Have you ever had this exam?

1. Yes
   No (Go to PSA_END)
   DK, RF (Go to PSA_END)

PSA_Q175
When was the last time?

1. Less than 1 year ago
2. 1 year to less than 2 years ago
3. 2 years to less than 3 years ago
4. 3 years to less than 5 years ago
5. 5 or more years ago
   DK, RF

PSA_END

Colorectal cancer screening (CCS)

CCS_BEG
Optional Content (See Appendix 2)

CCS_C180A
If (do CCS block = 1), go to CCS_C180B.
Otherwise, go to CCS_END.

CCS_C180B
If proxy interview or age < 35, go to CCS_END.
Otherwise, go to CCS_Q180.

CCS_Q180
Now a few questions about various colorectal exams.
An FOBT is a test to check for blood in your stool, where you have a bowel movement and use a stick to smear a small sample on a special card.
Have you ever had this test?

1. Yes
2. No (Go to CCS_Q184)
   DK (Go to CCS_Q184)
   RF (Go to CCS_END)

CCS_Q182
When was the last time?

1. Less than 1 year ago
2. 1 year to less than 2 years ago
3. 2 years to less than 3 years ago
4. 3 years to less than 5 years ago
5. 5 years to less than 10 years ago
6. 10 or more years ago
   DK, RF

CCS_Q183
Why did you have it?
INTERVIEWER: Mark all that apply.
If respondent says "Doctor recommended it" or "I requested it", probe for reason.

1. Family history of colorectal cancer
2. Part of regular check-up / routine screening
3. Age
4. Race
5. Follow-up of problem
6. Follow-up of colorectal cancer treatment
7. Other - Specify (Go to CCS_S183)
   DK, RF
   Go to CCS_Q184

CCS_S183
INTERVIEWER: Specify.
DK, RF

CCS_Q184
A colonoscopy or sigmoidoscopy is when a tube is inserted into the rectum to view the bowel for early signs of cancer and other health problems. Have you ever had either of these exams?

1. Yes
2. No (Go to CCS_END)
   DK, RF (Go to CCS_END)

CCS_Q185
When was the last time?

1. Less than 1 year ago
2. 1 year to less than 2 years ago
3. 2 years to less than 3 years ago
4. 3 years to less than 5 years ago
5. 5 years to less than 10 years ago
6. 10 or more years ago
   DK, RF

CCS_Q186
Why did you have it?
INTERVIEWER: Mark all that apply.
If respondent says "Doctor recommended it" or "I requested it", probe for reason.

1. Family history of colorectal cancer
2. Part of regular check-up / routine screening
3. Age
4. Race
5. Follow-up of problem
6. Follow-up of colorectal cancer treatment
7. Other - Specify (Go to CCS_S186)
   DK, RF
   Go to CCS_C187

CCS_S186
INTERVIEWER: Specify.
DK, RF

CCS_C187
If CCS_Q180 = 1 (had a FOBT), go to CCS_Q187.
Otherwise, go to CCS_END.

CCS_Q187
Was the colonoscopy or sigmoidoscopy a follow-up of the results of an FOBT?

1. Yes
2. No
   DK, RF

CCS_END

Eye examinations (EYX)

EYX_BEG
Optional Content (See Appendix 2)

EYX_C140A
If (EYX block = 2) or proxy interview, go to EYX_END.
Otherwise, go to EYX_C140B.

EYX_C140B
If CHP_Q06 = 2, DK or RF (not seen or talked to an eye specialist) or EMPTY (Module not asked), go to EYX_Q142.
Otherwise, go to EYX_Q140.

EYX_Q140
(Now eye examinations)
It was reported earlier that you have "seen" or "talked to" an optometrist or ophthalmologist in the past 12 months. Did you actually visit one?

1. Yes (Go to EYX_END)
2. No
   DK, RF (Go to EYX_END)

EYX_Q142
(Now eye examinations)
When did you last have an eye examination?

1. Less than 1 year ago (Go to EYX_END)
2. 1 year to less than 2 years ago (Go to EYX_END)
3. 2 years to less than 3 years ago
4. 3 or more years ago
5. Never
   DK, RF (Go to EYX_END)

Note: In processing, if a respondent answered EYX_Q140 = 1, the variable EYX_Q142 is given the value of 1.

EYX_Q146
What are the reasons that you have not had an eye examination in the past 2 years?
INTERVIEWER: Mark all that apply.

1. Have not gotten around to it
2. Respondent - did not think it was necessary
3. Doctor - did not think it was necessary
4. Personal or family responsibilities
5. Not available - at time required
6. Not available - at all in the area
7. Waiting time was too long
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go / uninformed
12. Fear ( e.g. , painful, embarrassing, find something wrong)
13. Unable to leave the house because of a health problem
14. Other
    DK, RF
    EYX_END

Dental visits (DEN)

DEN_BEG
Optional Content (See Appendix 2)

DEN_C130A
If (do DEN block = 1), go to DEN_C130B.
Otherwise, go to DEN_END.

DEN_C130B
If proxy interview, go to DEN_END.
Otherwise, go to DEN_C130C.

DEN_C130C
If CHP_Q14 = 1, go to DEN_Q130.
Otherwise, go to DEN_Q132.

DEN_Q130
(Now dental visits)
It was reported earlier that you have "seen" or "talked to" a dentist in the past 12 months. Did you actually visit one?

1. Yes (Go to DEN_END)
2. No
   DK, RF (Go to DEN_END)

DEN_Q132
(Now dental visits)
When was the last time that you went to a dentist?

1. Less than 1 year ago
2. 1 year to less than 2 years ago (Go to DEN_END)
3. 2 years to less than 3 years ago (Go to DEN_END)
4. 3 years to less than 4 years ago (Go to DEN_Q136)
5. 4 years to less than 5 years ago (Go to DEN_Q136)
6. 5 or more years ago (Go to DEN_Q136)
7. Never (Go to DEN_Q136)
   DK, RF (Go to DEN_END)

Note: In processing, if a respondent answered DEN_Q130 = 1, the variable DEN_Q132 is given the value of 1.

DEN_E132
Inconsistent answers have been entered. The respondent went to a dentist less than 1 year ago but previously reported that he/she had not "seen" or "talked" to a dentist in the past 12 months. Please confirm.

Note: Trigger soft edit if DEN_Q132 = 1 and CHP_Q14 = 2.

DEN_C133
If DEN_Q132 = 1, go to DEN_END.
Otherwise, go to DEN_Q136.

DEN_Q136
What are the reasons that you have not been to a dentist in the past 3 years?
INTERVIEWER: Mark all that apply.

1. Have not gotten around to it
2. Respondent - did not think it was necessary
3. Doctor - did not think it was necessary
4. Personal or family responsibilities
5. Not available - at time required
6. Not available - at all in the area
7. Waiting time was too long
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go / uninformed
12. Fear ( e.g. , painful, embarrassing, find something wrong)
13. Wears dentures
14. Unable to leave the house because of a health problem
15. Other
    DK, RF

DEN_END

Oral health 2 (OH2)

OH2_BEG
Optional Content (See Appendix 2)

OH2_C10A
If (do OH2 block = 1), go to OH2_C10B.
Otherwise, go to OH2_END.

OH2_C10B
If proxy interview, go to OH2_END.
Otherwise, go to OH2_C10C.

OH2_C10C
If DEN_Q132 = 7 (never goes to dentist), go to OH2_Q11.
Otherwise, go to OH2_Q10.

OH2_Q10
Do you usually visit the dentist:
INTERVIEWER: Read categories to respondent.

1. ...more than once a year for check-ups?
2. ...about once a year for check-ups?
3. ...less than once a year for check-ups?
4. ...only for emergency care?
   DK, RF (Go to OH2_END)

OH2_Q11
Do you have insurance that covers all or part of your dental expenses?

1. Yes
2. No (Go to OH2_C12)
   DK, RF (Go to OH2_C12)

OH2_Q11A
Is it:
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. ...a government-sponsored plan?
2. ...an employer-sponsored plan?
3. ...a private plan?
   DK, RF

OH2_C12
If DEN_Q130 = 1 or DEN_Q132 = 1 (went to the dentist in the past year), go to OH2_Q12.

OH2_Q12
In the past 12 months, have you had any teeth removed by a dentist?

1. Yes
2. No (Go to OH2_Q20)
   DK, RF (Go to OH2_Q20)

OH2_Q13
(In the past 12 months,) were any teeth removed because of decay or gum disease?

1. Yes
2. No
   DK, RF

OH2_Q20
Do you have one or more of your own teeth?

1. Yes
2. No
   DK, RF

OH2_C21
If DEN_Q136 = 13, go to OH2_D22.
Otherwise, go to OH2_Q21.

OH2_Q21
Do you wear dentures or false teeth?

1. Yes
2. No
   DK, RF

Note: In processing, if a respondent answered DEN_Q136 = 13 and OH2_Q10 Not in (DK, RF), the variable OH2_Q21 is given the value of 1.

OH2_R22
Now we have some additional questions about oral health, that is the health of your teeth and mouth.
INTERVIEWER: Press <Enter> to continue.

OH2_D22
If OH2_Q21= 1 or DEN_Q136 = 13, ^DT_TEETH = "teeth, mouth or dentures".
Otherwise, ^DT_TEETH = "teeth or mouth".

OH2_Q22
Because of the condition of your ^DT_TEETH, do you have difficulty pronouncing any words or speaking clearly?

1. Yes
2. No
   DK, RF

OH2_Q23
In the past 12 months, how often have you avoided:
...conversation or contact with other people, because of the condition of your ^DT_TEETH?
INTERVIEWER: Read categories to respondent.

1. Often
2. Sometimes
3. Rarely
4. Never
   DK, RF

OH2_Q24
(In the past 12 months, how often have you avoided:)
...laughing or smiling, because of the condition of your ^DT_TEETH?

1. Often
2. Sometimes
3. Rarely
4. Never
   DK, RF

OH2_D25
If OH2_Q20=2, ^DT_MOUTH = "mouth".
Otherwise, ^DT_MOUTH = "teeth and mouth".

OH2_R25
Now some questions about the health of your ^DT_MOUTH during the past month.
INTERVIEWER: Press <1> to continue.

OH2_C25
If OH2_Q20=2, go to OH2_Q25C.
Otherwise, go to OH2_Q25A.

OH2_Q25A
In the past month, have you had:
...a toothache?

1. Yes
2. No
   DK, RF

OH2_Q25B
In the past month, were your teeth:
...sensitive to hot or cold food or drinks?

1. Yes
2. No
   DK, RF

OH2_Q25C
In the past month, have you had:
...pain in or around the jaw joints?

1. Yes
2. No
   DK, RF

OH2_Q25D
(In the past month, have you had:)
...other pain in the mouth or face?

1. Yes
2. No
   DK, RF

OH2_Q25E
(In the past month, have you had:)
...bleeding gums?

1. Yes
2. No
   DK, RF

OH2_Q25F
(In the past month, have you had:)
...dry mouth?
INTERVIEWER: Do not include thirst caused by exercise.

1. Yes
2. No
   DK, RF

OH2_Q25G
(In the past month, have you had:)
...bad breath?

1. Yes
2. No
   DK, RF

OH2_C30
If OH2_Q20 = 1, go to OH2_Q30.
Otherwise, go to OH2_END.

OH2_Q30
How often do you brush your teeth?

1. More than twice a day
2. Twice a day
3. Once a day
4. Less than once a day but more than once a week
5. Once a week
6. Less than once a week
   DK, RF

OH2_END

Food choices (FDC)

FDC_BEG
Optional Content (See Appendix 2)

FDC_C1A
If (do FDC block = 1), go to FDC_C1B.
Otherwise, go to FDC_END.

FDC_C1B
If proxy interview, go to FDC_END.
Otherwise, go to FDC_R1.

FDC_R1
Now, some questions about the foods you eat.
INTERVIEWER: Press <Enter> to continue.

FDC_Q1A
Do you choose certain foods or avoid others:
...because you are concerned about your body weight?

1. Yes (or sometimes)
2. No
   DK, RF (Go to FDC_END)

FDC_Q1B
(Do you choose certain foods or avoid others:)
...because you are concerned about heart disease?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q1C
(Do you choose certain foods or avoid others:)
...because you are concerned about cancer?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q1D
(Do you choose certain foods or avoid others:)
...because you are concerned about osteoporosis (brittle bones)?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q2A
Do you choose certain foods because of:
...the lower fat content?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q2B
(Do you choose certain foods because of:)
...the fibre content?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q2C
(Do you choose certain foods because of:)
...the calcium content?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q3A
Do you avoid certain foods because of:
...the fat content?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q3B
(Do you avoid certain foods because of:)
...the type of fat they contain?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q3C
(Do you avoid certain foods because of:)
...the salt content?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q3D
(Do you avoid certain foods because of:)
...the cholesterol content?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_Q3E
(Do you avoid certain foods because of:)
...the calorie content?

1. Yes (or sometimes)
2. No
   DK, RF

FDC_END

Dietary supplement use - Vitamins and minerals (DSU)

DSU_BEG
Optional Content (See Appendix 2)

DSU_C1A
If (do DSU block = 1), go to DSU_C1B.
Otherwise, go to DSU_END.

DSU_C1B
If proxy interview, go to DSU_END.
Otherwise, go to DSU_Q1A.

DSU_Q1A
Now, some questions about the use of nutritional supplements.
In the past 4 weeks, did you take any vitamin or mineral supplements?

1. Yes
2. No (Go to DSU_END)
   DK, RF (Go to DSU_END)

DSU_Q1B
Did you take them at least once a week?

1. Yes
2. No (Go to DSU_Q1D)
   DK, RF (Go to DSU_END)

DSU_Q1C
Last week, on how many days did you take them?

• Days
  (MIN: 1) (MAX: 7)
  DK, RF

Go to DSU_END

DSU_Q1D
In the past 4 weeks, on how many days did you take them?

• Days
  (MIN: 1) (MAX: 21)
  DK, RF

DSU_END

Fruit and vegetable consumption (FVC)

FVC_BEG
Core content

FVC_C1A
If (do FVC block = 2) or proxy interview, go to FVC_END.
Otherwise, go to FVC_R1.

FVC_R1
The next questions are about the foods you usually eat or drink. Think about all the foods you eat, both meals and snacks, at home and away from home.
INTERVIEWER: Press <Enter> to continue.

FVC_Q1A
How often do you usually drink fruit juices such as orange, grapefruit or tomato? (For example: once a day, three times a week, twice a month)
INTERVIEWER: Select the reporting period here and enter the number in the next

1. Per day
2. Per week (Go to FVC_N1C)
3. Per month (Go to FVC_N1D)
4. Per year (Go to FVC_N1E)
5. Never (Go to FVC_Q2A)
   DK, RF (Go to FVC_END)

FVC_N1B
INTERVIEWER: Enter number of times per day.

• Times
  (MIN: 1) (MAX: 20)
  DK, RF
  Go to FVC_Q2A

FVC_N1C
INTERVIEWER: Enter number of times per week.

• Times
  (MIN: 1) (MAX: 90)
  DK, RF
  Go to FVC_Q2A

FVC_N1D
INTERVIEWER: Enter number of times per month.

• Times
  (MIN: 1) (MAX: 200)
  DK, RF
  Go to FVC_Q2A

FVC_N1E
INTERVIEWER: Enter number of times per year.

• Times
  (MIN: 1) (MAX: 500)
  DK, RF

FVC_Q2A
Not counting juice, how often do you usually eat fruit?
INTERVIEWER: Select the reporting period here and enter the number in the next

1. Per day
2. Per week (Go to FVC_N2C)
3. Per month (Go to FVC_N2D)
4. Per year (Go to FVC_N2E)
5. Never (Go to FVC_Q3A)
   DK, RF (Go to FVC_Q3A)

FVC_N2B
INTERVIEWER: Enter number of times per day.

• Times
  (MIN: 1) (MAX: 20)
  DK, RF
  Go to FVC_Q3A

FVC_N2C
INTERVIEWER: Enter number of times per week.

• Times
  (MIN: 1) (MAX: 90)
  DK, RF
  Go to FVC_Q3A

FVC_N2D
INTERVIEWER: Enter number of times per month.

• Times
  (MIN: 1) (MAX: 200)
  DK, RF
  Go to FVC_Q3A

FVC_N2E
INTERVIEWER: Enter number of times per year.

• Times
  (MIN: 1) (MAX: 500)
  DK, RF

FVC_Q3A
How often do you (usually) eat green salad?
INTERVIEWER: Select the reporting period here and enter the number in the next

1. Per day
2. Per week (Go to FVC_N3C)
3. Per month (Go to FVC_N3D)
4. Per year (Go to FVC_N3E)
5. Never (Go to FVC_Q4A)
   DK, RF (Go to FVC_Q4A)

FVC_N3B
INTERVIEWER: Enter number of times per day.

• Times
  (MIN: 1) (MAX: 20)
  DK, RF
  Go to FVC_Q4A

FVC_N3C
INTERVIEWER: Enter number of times per week.

• Times
  (MIN: 1) (MAX: 90)
  DK, RF
  Go to FVC_Q4A

FVC_N3D
INTERVIEWER: Enter number of times per month.

• Times
  (MIN: 1) (MAX: 200)
  DK, RF
  Go to FVC_Q4A

FVC_N3E
INTERVIEWER: Enter number of times per year.

• Times
  (MIN: 1) (MAX: 500)
  DK, RF

FVC_Q4A
How often do you usually eat potatoes, not including french fries, fried potatoes, or potato chips?
INTERVIEWER: Select the reporting period here and enter the number in the next

1. Per day
2. Per week (Go to FVC_N4C)
3. Per month (Go to FVC_N4D)
4. Per year (Go to FVC_N4E)
5. Never (Go to FVC_Q5A)
   DK, RF (Go to FVC_Q5A)

FVC_N4B
INTERVIEWER: Enter number of times per day.

• Times
  (MIN: 1) (MAX: 20)
  DK, RF
  Go to FVC_Q5A

FVC_N4C
INTERVIEWER: Enter number of times per week.

• Times
  (MIN: 1) (MAX: 90)
  DK, RF
  Go to FVC_Q5A

FVC_N4D
INTERVIEWER: Enter number of times per month.

• Times
  (MIN: 1) (MAX: 200)
  DK, RF
  Go to FVC_Q5A

FVC_N4E
INTERVIEWER: Enter number of times per year.

• Times
  (MIN: 1) (MAX: 500)
  DK, RF

FVC_Q5A
How often do you (usually) eat carrots?
INTERVIEWER: Select the reporting period here and enter the number in the next

1. Per day
2. Per week (Go to FVC_N5C)
3. Per month (Go to FVC_N5D)
4. Per year (Go to FVC_N5E)
5. Never (Go to FVC_Q6A)
   DK, RF (Go to FVC_Q6A)

FVC_N5B
INTERVIEWER: Enter number of times per day.

• Times
  (MIN: 1) (MAX: 20)
  DK, RF
  Go to FVC_Q6A

FVC_N5C
INTERVIEWER: Enter number of times per week.

• Times
  (MIN: 1) (MAX: 90)
  DK, RF
  Go to FVC_Q6A

FVC_N5D
INTERVIEWER: Enter number of times per month

• Times
  (MIN: 1) (MAX: 200)
  DK, RF
  Go to FVC_Q6A

FVC_N5E
INTERVIEWER: Enter number of times per year.

• Times
  (MIN: 1) (MAX: 500)
  DK, RF

FVC_Q6A
Not counting carrots, potatoes, or salad, how many servings of other vegetables do you usually eat?
INTERVIEWER: Select the reporting period here and enter the number in the next

1. Per day
2. Per week (Go to FVC_N6C)
3. Per month (Go to FVC_N6D)
4. Per year (Go to FVC_N6E)
5. Never (Go to FVC_END)
   DK, RF (Go to FVC_END)

FVC_N6B
INTERVIEWER: Enter number of servings per day.

• Servings
  (MIN: 1) (MAX: 20)
  DK, RF
  Go to FVC_END

FVC_N6C
INTERVIEWER: Enter number of servings per week.

• Servings
  (MIN: 1) (MAX: 90)
  DK, RF
  Go to FVC_END

FVC_N6D
INTERVIEWER: Enter number of servings per month.

• Servings
  (MIN: 1) (MAX: 200)
  DK, RF
  Go to FVC_END

FVC_N6E
INTERVIEWER: Enter number of servings per year.

• Servings
  (MIN: 1) (MAX: 500)
  DK, RF

FVC_END

Physical activities (PAC)

PAC_BEG
Core content

PAC_C1A
If (do PAC block = 1), go to PAC_C1B.
Otherwise, go to PAC_END.

PAC_C1B
If proxy interview, go to PAC_END.
Otherwise, go to PAC_R1.

PAC_R1
Now I’d like to ask you about some of your physical activities. To begin with, I’ll be dealing with physical activities not related to work, that is, leisure time
INTERVIEWER: Press <Enter> to continue.

PAC_Q1
Have you done any of the following in the past 3 months, that is, from [date three months ago] to yesterday?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Walking for exercise
2. Gardening or yard work
3. Swimming
4. Bicycling
5. Popular or social dance
6. Home exercises
7. Ice hockey
8. Ice skating
9. In-line skating or rollerblading
10. Jogging or running
11. Golfing
12. Exercise class or aerobics
13. Downhill skiing or snowboarding
14. Bowling
15. Baseball or softball
16. Tennis
17. Weight-training
18. Fishing
19. Volleyball
20. Basketball
21. Soccer
22. Any other
23. No physical activity
    DK, RF (Go to PAC_END)

PAC_E1
You cannot select "No physical activity" and another category.
Please return and correct.

Note: Trigger hard edit if "No physical activity" is chosen in PAC_Q1 with any other

PAC_C1VA
If PAC_Q1 = 23 only, go to PAC_R7.
Otherwise, go to PAC_C1VB.

PAC_C1VB
If PAC_Q1 = 22, go to PAC_S1V.
Otherwise, go to PAC_Q2n.

PAC_S1V
What was this activity?
INTERVIEWER: Enter one activity only.
(DK, RF are not allowed)

PAC_Q1X
In the past 3 months, did you do any other physical activity for leisure?

PAC_1W

1. Yes
2. No (Go to PAC_Q2n)
   DK, RF (Go to PAC_Q2n)

PAC_S1X
What was this activity?
INTERVIEWER: Enter one activity only.
DK, RF
(Go to PAC_Q2n)

PAC_Q1Y
In the past 3 months, did you do any other physical activity for leisure?

PAC_1X

1. Yes
2. No (Go to PAC_Q2n)
   DK, RF (Go to PAC_Q2n)

PAC_S1Y
What was this activity?
INTERVIEWER: Enter one activity only.
DK, RF
(Go to PAC_Q2n)

Note: For each activity identified in PAC_Q1, ask PAC_Q2n and PAC_Q3n.
When PAC_S1X or PAC_S1Y = DK, RF, their respective PAC_Q2 and PAC_Q3 will not be asked.

PAC_Q2N
In the past 3 months, how many times did you [participate in identified activity]?

• Times
  (MIN: 1) (MAX: 99; for each activity except the following: Walking: MAX = 270,
  Bicycling: MAX = 200, Other activities: MAX = 200)
  DK, RF
  (Go to next activity)

PAC_Q3N
About how much time did you spend on each occasion?

1. 1 to 15 minutes
2. 16 to 30 minutes
3. 31 to 60 minutes
4. More than one hour
   DK, RF

PAC_R7
The last questions were about leisure time activities. Next, some questions about walking and bicycling that you do only as a way of getting to and from work or school.
INTERVIEWER: Press <Enter> to continue.
If PAC_Q2n > 0, where n = 1, X = PAC_Q2n, ^DT_TIMEW = "Other than the (X) times you already reported walking for exercise was there any other time".
Otherwise, ^DT_TIMEW = "Was there any time".

PAC_Q7
^DT_TIMEW in the past 3 months when you walked to and from work or school?

1. Yes
2. No (Go to PAC_D8)
3. Does not work or go to school (Go to PAC_END)
   DK, RF (Go to PAC_D8)

PAC_Q7A
How many times?

• Times
  (MIN: 1) (MAX: 270)
  DK, RF
  (Go to PAC_D8)

PAC_Q7B
About how much time did you spend on each occasion?
INTERVIEWER: Include both walking to and from work and school, if both apply.

1. 1 to 15 minutes
2. 16 to 30 minutes
3. 31 to 60 minutes
4. More than one hour
   DK, RF

PAC_D8

If PAC_Q2n > 0, where n = 4, X = PAC_Q2n, ^DT_TIMEB = "Other than the (X) times you already reported bicycling was there any other time".

Otherwise, ^DT_TIMEB = "Was there any time".

PAC_Q8
^DT_TIMEB in the past 3 months when you bicycled to and from work or school?

1. Yes
2. No (Go to PAC_END)
3. Does not work or go to school (Go to PAC_END)
   DK, RF (Go to PAC_END)

Note: If PAC_Q7 = 3, PAC_Q8 will be filled with "Does not work or go to school" in processing (PAC_Q8 = 3).

PAC_Q8A
How many times?

• Times
  (MIN: 1) (MAX: 200)
  DK, RF
  (Go to PAC_END)

PAC_Q8B
About how much time did you spend on each occasion?
INTERVIEWER: Include both bicycling to and from work and school, if both apply.

1. 1 to 15 minutes
2. 16 to 30 minutes
3. 31 to 60 minutes
4. More than one hour
   DK, RF

PAC_END

Physical activity - Stages of change (SCP)

SCP_BEG
Optional Content (See Appendix 2)

• External variables required:
• PROXMODE: proxy identifier, from the GR block.
  FNAME: first name of respondent from household block.
  DOSCP: do block flag, from the sample file.
• PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
• Screen display:
  Display on header bar PE_Q01 and PE_Q02 separated by a space

SCP_C1A
If do SCP block = 1, go to SCP_C1B.
Otherwise, go to SCP_END.

SCP_C1B
If proxy interview, go to SCP_END.
Otherwise, go to SCP_C1C.

SCP_C1C
If HWT_Q1 = 1, go to SCP_END.
Otherwise, go to SCP_Q01.

SCP_Q01
Thinking about the level of physical activity you do every week, do you consider yourself to be...?
INTERVIEWER: Read categories to respondent.

1. Very physically active
2. Moderately physically active
3. A bit physically active
4. Not at all physically active
   DK, R (Go to SCP_END)

SCP_C02
If SCP_Q01=1 or SCP_Q01=2, go to SCP_Q02.
Otherwise, go to SCP_Q03.

SCP_Q02
Did you increase your physical activity level in the last 6 months?

1. Yes
2. No
   DK, R

SCP_C03
If SCP_Q01 = 1 or SCP_Q01 = 2, go to SCP_END.
Otherwise, go to SCP_Q03.

SCP_Q03
Do you intend to increase your physical activity level in the next 30 days?

1. Yes (Go to SCP_END)
2. No
   DK, R (Go to SCP_END)

SCP_Q04
Do you intend to increase your physical activity level in the next 6 months?

1. Yes
2. No
   DK, R

SCP_END

Neighbourhood Environment (NBE)

NBE_BEG
Rapid Response (July - August)

• External variables required:
  AGE: Age of selected respondent
  FNAME: first name of respondent from household block.
  DONBE: do block flag, from the sample file.
  PROXMODE: Proxy interview
  PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
  Screen display:
  Display on header bar PE_Q01 and PE_Q02 separated by a space

NBE_C10A
If do NBE = 1, go to NBE_C10B.
Otherwise, go to NBE_END.

NBE_C10B
If Proxy interview, go to NBE_END.
Otherwise, go to NBE_R10.

NBE_R10
We are now going to talk about your neighbourhood. Think about the different facilities in your neighbourhood. By this, we mean the area around your home that you could walk to in less than 15 minutes.
INTERVIEWER: Press <1> to continue.

NBE_Q10
What is the main type of housing in your neighbourhood?
INTERVIEWER: Read categories to respondent.

1. Detached single-family housing
2. Townhouses, row houses, apartments or condos of 2-3 storeys
3. Mix of single-family residences and townhouses, row houses, apartments or condos
4. Apartments or condos of 4-12 storeys
5. Apartments or condos of more than 12 storeys
   DK, R

NBE_R20
The next items are statements about your neighbourhood related to walking and bicycling. Please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree.
INTERVIEWER: Press <1> to continue.

NBE_Q20
Many shops, stores, markets or other places to buy things I need are within easy walking distance of my home.

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q30
It is less than a 15 minute walk to a transit stop (such as bus, train, subway or street car) from my home.
INTERVIEWER: If there is no public transportation in respondent’s neighbourhood, please select "Strongly disagree"

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q40
There are sidewalks on most of the streets in my neighbourhood.
INTERVIEWER: If there are no sidewalks in respondent’s neighbourhood, please select "Strongly disagree".

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q50
In or near my neighbourhood, there are designated areas for bicycling such as special bicycle lanes, separate paths or trails, shared use paths for bicycles and pedestrians.
INTERVIEWER: If there are no designated areas to bicycle in respondent’s neighbourhood, please select "Strongly disagree".

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q60
My neighbourhood has several free or low cost recreation facilities, such as parks, walking trails, bike paths, recreation centers, playgrounds, public swimming pools, etc.

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q70
The crime rate in my neighbourhood makes it unsafe to go on walks at night.

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q80
There are many interesting things to look at while walking in my neighbourhood.

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q90
The sidewalks in my neighbourhood are well maintained (paved, with few cracks) and not obstructed.

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q100

There is so much traffic on the streets that it makes it difficult or unpleasant to walk in my neighbourhood.

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_Q110
There is so much traffic on the streets that it makes it difficult or unpleasant to ride a bicycle in my neighbourhood.

1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
   DK, R

NBE_C120
If age of respondent <18, go to NBE_END.
Otherwise, go to NBE_R120.

NBE_R120
Now a few questions about driving.
INTERVIEWER: Press <1> to continue.

NBE_Q120
Do you have a valid driver’s licence?
INTERVIEWER: This includes graduated driver’s licenses where an individual is permitted to drive alone with some restrictions, e.g. zero blood alcohol level. Exclude learner’s licence where driver must be accompanied by someone who has a valid driver’s licence.

1. Yes
2. No (Go to NBE_END)
   DK, R (Go to NBE_END)

NBE_Q130
In the last 7 days, did you have a vehicle at your disposal?
INTERVIEWER: Includes motorcycles. Include access to a family member, friend, co-worker or neighbour’s vehicle. Also include a vehicle which the respondent uses for employment purposes buy may be used during non-employment hours.

1. Yes
2. No
   DK, R

NBE_END

Sedentary activities (SAC)

SAC_BEG
Theme content

SAC_C1A
If (do SAC block = 1), go to SAC_C1B.
Otherwise, go to SAC_END.

SAC_C1B
If proxy interview, go to SAC_END.
Otherwise, go to SAC_R1.

SAC_R1
Now, a few additional questions about activities you do in your leisure time, that is, activities not at work or at school.
INTERVIEWER: Press <1> to continue.

SAC_Q1
In a typical week in the past 3 months, how many hours did you usually spend:
... On a computer, including playing computer games and using the Internet?
INTERVIEWER: Include time spent doing homework on a computer. Do not include time spent at work or at school. Round to the upper nearest hour.

• Hours
  (MIN: 0) (MAX: 70; warning after 35)
  DK, RF
  (Go to SAC_END)

SAC_E1
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if SAC_Q1 > 35.

SAC_Q2
(In a typical week, in the past 3 months, how many hours did you usually spend:)
INTERVIEWER: Exclude time spent playing video games on a computer. Game console includes i.e. XBOX, Nintendo and Playstation. Round to the upper nearest hour.

• Hours
  (MIN: 0) (MAX: 70; warning after 35)
  DK, RF

SAC_E2A
An unusual value has been entered. Please confirm.
INTERVIEWER: Trigger soft edit if SAC_Q2 > 35.

Note: Trigger soft edit if SAC_Q2 > 35.

SAC_E2B
An impossible value has been entered. Please return and correct.

Note: Trigger hard edit if SAC_Q1 + SAC_Q2 > 98.

SAC_Q3
(In a typical week in the past 3 months, how many hours did you usually spend:)
INTERVIEWER: Round to the upper nearest hour.

• Hours
  (MIN: 0) (MAX: 70; warning after 35)
  DK, RF

SAC_E3A
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if SAC_Q3 > 35.

SAC_E3B
An impossible value has been entered. Please return and correct.

Note: Trigger hard edit if SAC_Q1 + SAC_Q2 + SAC_Q3 > 98.

SAC_Q4
(In a typical week, in the past 3 months, how many hours did you usually spend:)
INTERVIEWER: Include books, ebooks, magazines, newspapers, homework. Round to the upper nearest hour.

• Hours
  (MIN: 0) (MAX: 70, warning after 35)
  DK, RF

SAC_E4A
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if SAC_Q4 > 35.

SAC_E4B
An impossible value has been entered. Please return and correct.

Note: Trigger hard edit if SAC_Q1 + SAC_Q2 + SAC_Q3 +SAC_Q4 > 98.

SAC_END

Use of protective equipment (UPE)

UPE_BEG
Optional Content (See Appendix 2)

UPE_C1A
If (do UPE block = 1), go to UPE_C1B.
Otherwise, go to UPE_END.

UPE_C1B
If proxy interview, go to UPE_END.
Otherwise, go to UPE_C1C.

UPE_C1C
If PAC_Q1 = 4 (bicycling for leisure) or PAC_Q1 = 7 (ice hockey) or PAC_Q1 = 9 (in-line skating or rollerblading) or PAC_Q1 = 13 (downhill skiing or snowboarding) or (PAC_Q8 = 1 (bicycling to work or school)), go to UPE_R1.
Otherwise, go to UPE_C1D.

UPE_R1
Now a few questions about precautions you take while participating in some physical activities.
INTERVIEWER: Press <Enter> to continue.

UPE_C1D
If PAC_Q1 = 4 (bicycling for leisure) or (PAC_Q8 = 1 (bicycling to work or school)), go to UPE_Q1.
Otherwise, go to UPE_Q1A.

UPE_Q1A
In the past 12 months, have you done any bicycling?

1. Yes
2. No (Go to UPE_C2)
   DK (Go to UPE_C2)
   RF (Go to UPE_END)

UPE_Q1
When riding a bicycle, how often do you wear a helmet?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_C2
If PAC_Q1 = 9 (in-line skating or rollerblading), go to UPE_Q2A.
Otherwise, go to UPE_Q2.

UPE_Q2
In the past 12 months, have you done any in-line skating or rollerblading?

1. Yes
2. No (Go to UPE_C3A)
   DK, RF (Go to UPE_C3A)

UPE_Q2A
When in-line skating or rollerblading, how often do you wear a helmet?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_Q2B
How often do you wear wrist guards or wrist protectors?

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_Q2C
How often do you wear elbow pads?

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_Q2D
How often do you wear knee pads?

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_C3A
If PAC_Q1 = 13 (downhill skiing or snowboarding), go to UPE_Q3A.
Otherwise, go to UPE_Q3B.

UPE_Q3A
Earlier, you mentioned going downhill skiing or snowboarding in the past 3 months. Was that:
INTERVIEWER: Read categories to respondent.

1. ...downhill skiing only? (Go to UPE_Q4A)
2. ...snowboarding only? (Go to UPE_C5A)
3. ...both? (Go to UPE_Q4A)
   DK, RF (Go to UPE_C6)

UPE_Q3B
In the past 12 months, did you do any downhill skiing or snowboarding?

INTERVIEWER: Read categories to respondent.

1. Downhill skiing only (Go to UPE_Q4A)
2. Snowboarding only (Go to UPE_C5A)
3. Both (Go to UPE_Q4A)
4. Neither (Go to UPE_C6)
   DK, RF (Go to UPE_C6)

UPE_Q4A
When downhill skiing, how often do you wear a helmet?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_C5A
If UPE_Q3A = 2 or 3 (snowboarding or both) or UPE_Q3B = 2 or 3, go to UPE_Q5A.
Otherwise, go to UPE_C6.

UPE_Q5A
When snowboarding, how often do you wear a helmet?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_Q5B
How often do you wear wrist guards or wrist protectors?

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_C6
If age >= 12 or <= 19, go to UPE_Q6.
Otherwise, go to UPE_C7.

UPE_Q6
In the past 12 months, have you done any skateboarding?

1. Yes
2. No (Go to UPE_C7)
   DK, RF (Go to UPE_C7)

UPE_Q6A
How often do you wear a helmet?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_Q6B
How often do you wear wrist guards or wrist protectors?

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_Q6C
How often do you wear elbow pads?

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_C7
If PAC Q1=7 (ice hockey), go to UPE_Q7A.
Otherwise, go to UPE_Q7.

UPE_Q7
In the past 12 months, have you played any ice hockey?

1. Yes
2. No (Go to UPE_END)
   DK, RF (Go to UPE_END)

UPE_Q7A
When playing ice hockey, how often do you wear a mouth guard?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

UPE_END

Sun safety behaviours (SSB)

SSB_BEG
Optional Content (See Appendix 2)

SSB_C1
If (do SSB block = 1), go to SSB_C2.
Otherwise, go to SSB_END.

SSB_C2
If proxy interview, go to SSB_END.
Otherwise, go to SSB_R01.

SSB_R01
The next few questions are about exposure to the sun and sunburns. Sunburn is defined as any reddening or discomfort of the skin, that lasts longer than 12 hours after exposure to the sun or other UV sources, such as tanning beds or sun lamps.
INTERVIEWER: Press <Enter> to continue.

SSB_Q01
In the past 12 months, has any part of your body been sunburnt?

1. Yes
2. No (Go to SSB_R06)
   DK, RF (Go to SSB_END)

SSB_Q02
Did any of your sunburns involve blistering?

1. Yes
2. No  
   DK, RF

SSB_Q03
Did any of your sunburns involve pain or discomfort that lasted for more than 1 day?

1. Yes
2. No
   DK, RF

SSB_R06
For the next questions, think about a typical weekend, or day off from work or school in the summer months.
INTERVIEWER: Press <Enter> to continue.

SSB_Q06
About how much time each day do you spend in the sun between 11 am and 4 pm?

1. None (Go to SSB_Q13)
2. Less than 30 minutes (Go to SSB_Q13)
3. 30 to 59 minutes
4. 1 hour to less than 2 hours
5. 2 hours to less than 3 hours
6. 3 hours to less than 4 hours
7. 4 hours to less than 5 hours
8. 5 hours
   DK, RF (Go to SSB_Q13)

SSB_Q07
In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:
...seek shade?
INTERVIEWER: Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SSB_Q08
(In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:)
...wear a hat that shades your face, ears and neck?

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SSB_Q09A
(In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:)
...wear long pants or a long skirt to protect your skin from the sun?

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SSB_Q09B
(In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:)
...use sunscreen on your face?

1. Always
2. Often
3. Sometimes
4. Rarely (Go to SSB_Q11)
5. Never (Go to SSB_Q11)
   DK, RF (Go to SSB_Q11)

SSB_Q10
What Sun Protection factor (SPF) do you usually use?

1. Less than 15
2. 15 to 25
3. More than 25
   DK, RF

SSB_Q11
In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you:
...use sunscreen on your body?

1. Always
2. Often
3. Sometimes
4. Rarely (Go to SSB_Q13)
5. Never (Go to SSB_Q13)
   DK, RF (Go to SSB_Q13)

SSB_Q12
What Sun Protection factor (SPF) do you usually use?

1. Less than 15
2. 15 to 25
3. More than 25
   DK, RF

SSB_Q13
Do you have skin cancer?

1. Yes
2. No
   DK, RF (Go to SSB_END)

SSB_E13
Inconsistent answers have been entered. The respondent reported having skin cancer but previously reported that he/she did not have cancer. Please confirm.

Note: Trigger soft edit if SSB_Q13 = 1 and CCC_Q131 = 2.

SSB_C14
If SSB_Q13 = 1, go to SSB_Q15.
Otherwise, go to SSB_Q14.

SSB_Q14
Have you ever been diagnosed with skin cancer?

1. Yes
2. No (Go to SSB_END)
   DK, RF (Go to SSB_END)

SSB_E14
Inconsistent answers have been entered. The respondent reported having (ever) been diagnosed with skin cancer but previously reported that he/she had not ever been diagnosed cancer. Please confirm.

Note: Trigger soft edit if SSB_Q14 = 1 and CCC_Q132 = 2.

SSB_D15
If SSB_Q13 = 1 (Yes), ^DT_DODID = "do".
Otherwise, ^DT_DODID = "did".

SSB_Q15
What type of skin cancer ^DT_DODID you have?

1. Melanoma
2. Non-melanoma
   DK, RF

SSB_END

Injuries (INJ)

INJ_BEG
Optional Content (See Appendix 2)

INJ_C1
If (do INJ block = 1), go to INJ_B1.
Otherwise, go to INJ_END.

INJ_B1
Call "Repetitive strain" sub block (REP)

Note: Number of injuries and details of most serious injury

INJ_D1A
If REP_Q1 = 1 (Yes), ^DT_OTHINJ = "other".
Otherwise, ^DT_OTHINJ = "null".

INJ_D1B
(not applicable)

INJ_R1
Now some questions about ^DT_OTHINJ injuries which occurred in the past 12 months, and were serious enough to limit ^YOUR2 normal activities the day after the injury occurred. For example, a broken bone, a bad cut, a burn or a burn or a sprain.
INTERVIEWER: Press <Enter> to continue.

INJ_D01
If REP_Q1 = 1 (Yes), ^DT_INJURIES1 = "Not counting repetitive strain injuries or food poisoning,".
Otherwise, ^DT_INJURIES1 = "Not counting food poisoning,".

INJ_Q01
^DT_INJURIES1 in the past 12 months, that is, from [date one year ago] to yesterday, ^WERE ^YOU1 injured?

1. Yes
2. No (Go to INJ_Q16)
   DK, RF (Go to INJ_END)

INJ_Q02
How many times ^WERE ^YOU1 injured?

• Times
  (MIN: 1) (MAX: 30 warning after 6)
  DK, RF
  (Go to INJ_END)

INJ_D03

If INJ_Q02 = 1 (one injury), ^DT_INJURIES2 = "In which".
Otherwise, ^DT_INJURIES2 = "Thinking about the most serious injury, in which".

INJ_Q03
^DT_INJURIES2 month did it happen?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
    DK, RF (Go to INJ_Q05)

INJ_C04
If INJ_Q03 = « C_MONTH », go to INJ_Q04.
Otherwise, go to INJ_Q05.

INJ_Q04
Was that this year or last year?

1. This year
2. Last year
   DK, RF

INJ_Q05
What type of injury did ^YOU1 have? For example, a broken bone or burn.

1. Multiple serious injuries (excluding multiple minor injuries)
2. Broken or fractured bones
3. Burn, scald, chemical burn
4. Dislocation
5. Sprain or strain (including torn ligaments and muscles)
6. Cut, puncture, animal or human bite (open wound)
7. Scrape(s), bruise(s), blister(s) (including multiple minor injuries)
8. Concussion or other brain injury (Go to INJ_Q08)
9. Poisoning (excluding food poisoning, poison ivy, other contact  (Go to INJ_Q08) dermatitis, and allergies)
10. Injury to internal organs (Go to INJ_Q07)
11. Other - Specify (Go to INJ_S05)
    DK, RF
    Go to INJ_Q06

INJ_S05
INTERVIEWER: Specify.
DK, RF

INJ_Q06
What part of the body was injured?

1. Multiple sites
2. Eyes (excluding fracture of facial bones around the eye)
3. Head (including facial bones)
4. Neck
5. Shoulder, upper arm
6. Elbow, lower arm
7. Wrist
8. Hand
9. Hip
10. Thigh
11. Knee, lower leg
12. Ankle, foot
13. Upper back or upper spine (excluding neck)
14. Lower back or lower spine
15. Chest (excluding back and spine)
16. Abdomen or pelvis (excluding back and spine)
    DK, RF
    Go to INJ_Q08

INJ_Q07
What part of the body was injured?

1. Chest (within rib cage)
2. Abdomen or pelvis (below ribs)
3. Other - Specify (Go to INJ_S07)
   DK, RF
   Go to INJ_Q08

INJ_S07
INTERVIEWER: Specify.
DK, RF

INJ_Q08
Where ^WERE ^YOU1 when ^YOU1 ^WERE injured?
For example, someone’s house, an office building, construction site.
INTERVIEWER: If respondent says ‘At work’, probe for type of workplace.

1. In a home or its surrounding area (including respondent’s home or other homes)
2. Residential institution
3. School, college, university (exclude sports areas)
4. Sports or athletics area of school, college, university
5. Other sports or athletics area (exclude school sports areas)
6. Other institution ( e.g. , church, hospital, theatre, civic building)
7. Street, highway, sidewalk
8. Commercial area ( e.g. , store, restaurant, office building, transport terminal)
9. Industrial or construction area
10. Farm (exclude farmhouse and its surrounding area)
11. Countryside, forest, lake, ocean, mountains, prairie, etc.
12. Other - Specify (Go to INJ_S08)
    DK, RF
    Go to INJ_Q09

INJ_S08
INTERVIEWER: Specify.
DK, RF

INJ_Q09
What ^WERE ^YOU1 doing when ^YOU1 ^WERE injured?

1. Sports or physical exercise (including school activities, and running)
2. Leisure or hobby (including volunteering)
3. Working at a job or business (excluding travel to and from work)
4. Household chores, outdoor yard maintenance, home renovations or other unpaid work
5. Sleeping, eating, personal care
6. Going up and down stairs
7. Driver or passenger in/on road motor vehicle (including motorcycles, trucks)
8. Driver or passenger in/on off-road motor vehicle (including boat, ATV, snowmobile)
9. Walking
10. Other - Specify (Go to INJ_S09)
    DK, RF
    Go to INJ_C09

INJ_S09
INTERVIEWER: Specify.
DK, RF

INJ_C09
If INJ_Q09 = 3, and (14 < age < 75), go to INJ_B09.
Otherwise, go to INJ_C10.

INJ_B09
Call "Workplace Injuries" Sub Block (INW)

INJ_C10
If INJ_Q05 = 9 (poisoning), go to INJ_Q13.
Otherwise, go to INJ_Q10.

INJ_Q10
Was the injury the result of a fall?
INTERVIEWER: Exclude transportation accidents and any falls that involve another person ( e.g. collision, contact in sports, fight)

1. Yes
2. No (Go to INJ_Q12)
   DK, RF (Go to INJ_Q12)

INJ_Q11A
How did ^YOU1 fall?

1. While skating, skiing or snowboarding
2. While engaged in other sport or physical exercise (including school activities and running)
3. Going up or down stairs / steps (icy or not)
4. Slip, trip, stumble or loss balance while walking on ice or snow
5. Slip, trip or stumble or loss balance while walking on any other surface
6. From furniture or while rising from furniture ( e.g. , bed, chair)
7. From elevated position ( e.g. , ladder, tree, scaffolding)
8. Due to health problems ( e.g. , faint, weakness, dizziness, hip/knee gave out, seizure)
9. Other - Specify (Go to INJ_S11A)
   DK, RF
   Go to INJ_Q12A

INJ_S11A
INTERVIEWER: Specify.
DK, RF
Go to INJ_Q12A

INJ_Q12
What caused the injury?

1. Transportation accident
2. Accidentally bumped, pushed, bitten, etc. by person or animal
3. Accidentally struck or crushed by object(s)
4. Accidental contact with sharp object, tool or machine
5. Smoke, fire, flames
6. Accidental contact with hot object, liquid or gas
7. Extreme weather or natural disaster
8. Overexertion or strenuous movement
9. Physical assault
10. Other - Specify (Go to INJ_S12)
    DK, RF
    Go to INJ_Q12A

INJ_S12
INTERVIEWER: Specify.
DK, RF

INJ_Q12A
At what time of day did ^YOUR1 injury occur?

1. Morning (06:00-11:59)
2. Afternoon (12:00-17:59)
3. Evening (18:00-23:59)
4. Night (00:00-05:59)
   DK, RF

INJ_Q13
Did ^YOU2 receive any medical attention for the injury from a health professional in the 48 hours following the injury?

1. Yes
2. No (Go to INJ_Q15A)
   DK, RF (Go to INJ_Q15A)

INJ_Q14
Where did ^YOU1 receive treatment in the 48 hours?
INTERVIEWER: Mark all that apply.

1. Doctor’s office
2. Hospital emergency room
3. Hospital outpatient clinic ( e.g. day surgery, cancer)
4. Other clinic ( e.g. walk-in, appointment, sports)
5. Physiotherapist or massage therapist’s office
6. Community health centre / CLSC
7. Chiropractor’s office
8. Where the injury happened/on-site (workplace, school, sports field, hotel, ski hill)
9. Other
   DK, RF

INJ_Q15
^WERE_C ^YOU1 admitted to a hospital overnight?

1. Yes
2. No
   DK, RF

INJ_E15
Inconsistent answers have been entered. Please confirm.

Note: Trigger soft edit If INJ_Q15 = 1 and CHP_Q01 = 2 (No)

INJ_Q15A
At the present time, ^ARE ^YOU1 getting follow-up care from a health professional because of this injury?

1. Yes
2. No
   DK, RF

INJ_Q16
In the past 12 months, did ^YOU2 have any other injuries that were treated by a health professional, but did not limit ^YOUR1 normal activities?

1. Yes
2. No (Go to INJ_END)
   DK, RF (Go to INJ_END)

INJ_Q17
How many injuries?

• Injuries
  (MIN: 1) (MAX: 30 warning after 6)
  DK, RF

INJ_END

Repetitive strain - Sub Block (REP)

REP_BEG
Theme content

REP_R1
This next section deals with repetitive strain injuries. By this we mean injuries to muscles, tendons or nerves caused by overuse or repeating the same movement over an extended period. For example, carpal tunnel syndrome, tennis elbow or tendonitis.
INTERVIEWER: Press <Enter> to continue.

REP_Q1
In the past 12 months, did ^YOU2 have any injuries due to repetitive strain?

1. Yes
2. No (Go to INJ_D1A)
   DK, RF (Go to INJ_D1A)

REP_Q2
Were these injuries serious enough to limit ^YOUR1 normal activities?

1. Yes
2. No (Go to INJ_D1A)
   DK, RF (Go to INJ_D1A)

REP_Q3
Thinking about the most serious repetitive strain, what part of the body was affected?

1. Head
2. Neck
3. Shoulder, upper arm
4. Elbow, lower arm
5. Wrist
6. Hand
7. Hip
8. Thigh
9. Knee, lower leg
10. Ankle, foot
11. Upper back or upper spine (excluding neck)
12. Lower back or lower spine
13. Chest (excluding back and spine)
14. Abdomen or pelvis (excluding back and spine)
    DK, RF

REP_D3A
(not applicable)

REP_Q3A
^DOVERB_C ^YOU1 know what type of activity caused this repetitive strain injury?

1. Yes
2. No (Go to INJ_D1A)
   DK, RF (Go to INJ_D1A)

REP_Q4
Was the activity something you did while working at a job or business
(excluding travel to or from work)?

1. Yes
2. No
   DK, RF

REP_Q5
What type of activity was this?
INTERVIEWER: Mark all that apply.

1. Walking
2. Sports or physical exercise (including school activities and running)
3. Leisure or hobby (include volunteering)
4. Household chores, outdoor yard maintenance, home renovations or other unpaid work
5. Computer use or typing
6. Driving a motor vehicle
7. Lifting or carrying an object or person
8. Other - Specify (Go to REP_S5)
   DK, RF
   Go to INJ_DIA

REP_S5
INTERVIEWER: Specify.
DK, RF

REP_END

Workplace Injury - Sub Block (INW)

INW_BEG
Theme content

INW_Q01
Did this injury occur in your current main job?

1. Yes (Go to INW_END)
2. No

DK, RF (Go to INW_END)

INW_Q02
What kind of business, industry or service were you working in when you were injured? (For example: cardboard box manufacturing, road maintenance, retail shoe store, secondary school, dairy farm, municipal government).
DK, RF

INW_Q03
What kind of work ^WERE ^YOU1 doing? (For example: babysitting in own home, factory worker, forestry technician)
DK, RF

Note: Use trigram search, source file is PrepSOC.tdf

INW_D03
SIC_CODE
(4 bytes)

Note: Store SOC Code associated with INW_Q03

INW_C03
If INW_D03 = 1 or INW_D03 = 2 (OtherSpec), go to INW_S03.
Otherwise, go to INW_Q04.

INW_S03
INTERVIEWER: Specify.
DK, RF

INW_Q04
What were ^YOUR1 most important activities or duties? (For example: caring for children, stamp press machine operator, forest examiner.

INW_4
DK, RF

INW_END

Satisfaction with life (SWL)

SWL_BEG
Optional Content (See Appendix 2)

SWL_C1
If (do SWL block = 2), go to SWL_END.
Otherwise, go to SWL_C2.

SWL_C2
If proxy interview, go to SWL_END.
Otherwise, go to SWL_R1.

SWL_R1
Now I’d like to ask about your satisfaction with various aspects of your life. For each question, please tell me whether you are very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, or very dissatisfied.
INTERVIEWER: Press <Enter> to continue.

SWL_Q02
How satisfied are you with your job or main activity?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied
   DK
   RF (Go to SWL_END)

SWL_Q03
How satisfied are you with your leisure activities?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied
   DK, RF

SWL_Q04
(How satisfied are you) with your financial situation?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied
   DK, RF

SWL_Q05
How satisfied are you with yourself?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied
   DK, RF

SWL_Q06
How satisfied are you with the way your body looks?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied  
   DK, RF

SWL_Q07
How satisfied are you with your relationships with family members?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied
   DK, RF

SWL_Q08
(How satisfied are you) with your relationships with friends?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied
   DK, RF

SWL_Q09
(How satisfied are you) with your housing?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied
   DK, RF

SWL_Q10
(How satisfied are you) with your neighbourhood?

1. Very satisfied
2. Satisfied
3. Neither satisfied nor dissatisfied
4. Dissatisfied
5. Very dissatisfied
   DK, RF

SWL_END

Stress - Sources (STS)

STS_BEG
Optional Content (See Appendix 2)

STS_C1
If (do STS block = 1), go to STS_C2.
Otherwise, go to STS_END.

STS_C2
If proxy interview, go to STS_END.
Otherwise, go to STS_R1.

STS_R1
Now a few questions about the stress in your life.
INTERVIEWER: Press <Enter> to continue.

STS_Q1
In general, how would you rate your ability to handle unexpected and difficult problems, for example, a family or personal crisis? Would you say your ability is:
INTERVIEWER: Read categories to respondent.

1. ...excellent?
2. ...very good?
3. ...good?
4. ...fair?
5. ...poor?
   DK, RF (Go to STS_END)

STS_Q2
In general, how would you rate your ability to handle the day-to-day demands in your life, for example, handling work, family and volunteer responsibilities?
Would you say your ability is:
INTERVIEWER: Read categories to respondent.

1. ... excellent?
2. ... very good?
3. ... good?
4. ... fair?
5. ... poor?
   DK, RF

STS_Q3
Thinking about stress in your day-to-day life, what would you say is the most important thing contributing to feelings of stress you may have?
INTERVIEWER: Do not probe.

1. Time pressures / not enough time
2. Own physical health problem or condition
3. Own emotional or mental health problem or condition
4. Financial situation ( e.g. , not enough money, debt)
5. Own work situation ( e.g. , hours of work, working conditions)
6. School
7. Employment status ( e.g. , unemployment)
8. Caring for - own children
9. Caring for - others
10. Other personal or family responsibilities
11. Personal relationships
12. Discrimination
13. Personal and family’s safety
14. Health of family members
15. Other - Specify (Go to STS_S3)
16. Nothing
    DK, RF

Go to STS_END

STS_S3
INTERVIEWER: Specify.
DK, RF

STS_END

Stress - Recent life events (RLE)

RLE_BEG
Optional Content (See Appendix 2)

RLE_C100
If (do RLE block = 1), go to RLE_C200.
Otherwise, go to RLE_END.

RLE_C200
If proxy interview or age < 18, go to RLE_END.
Otherwise, go to RLE_C201.

RLE_C201
If (do OGP block = 1), go to RLE_R2.
Otherwise, go to RLE_R1.

RLE_R1
The next part of the questionnaire deals with different kinds of stress. Although the questions may seem repetitive, they are related to various aspects of a person’s physical, emotional and mental health.
INTERVIEWER: Press <Enter> to continue.

RLE_R2
I’d like to ask you about some things that may have happened in the past 12 months, that is, from [date one year ago] to yesterday. Some of these experiences happen to most people at one time or another, while some happen to only a few. First, I’d like to ask about yourself or anyone close to you (that is, your spouse or partner, children, relatives or close friends).
INTERVIEWER: Press <Enter> to continue.

RLE_Q201
In the past 12 months, was any one of you beaten up or physically attacked?

1. Yes
2. No
   DK

RF (Go to RLE_END)

RLE_D202
If sex = female, ^DT_YOUSOMEONE = "you or someone".
Otherwise, ^DT_YOUSOMEONE = "someone".

RLE_Q202
Now I’d like you to think just about your family, that is, yourself and your spouse/partner or children, if any.
In the past 12 months, did ^DT_YOUSOMEONE in your family, have an unwanted pregnancy?

1. Yes
2. No
   DK, RF

RLE_D203
(not applicable)

RLE_Q203
(In the past 12 months,) did ^DT_YOUSOMEONE in your family have an abortion or miscarriage?

1. Yes
2. No
   DK, RF

RLE_Q204
(In the past 12 months,) did you or someone in your family have a major financial crisis?

1. Yes
2. No
   DK, RF

RLE_Q205
(In the past 12 months,) did you or someone in your family fail school or a training program?

1. Yes
2. No
   DK, RF

RLE_D206A
If marital status = married or living common-law, ^DT_YOURSPOUSE = "yourself and your spouse or partner".
Otherwise, ^DT_YOURSPOUSE = "yourself".

RLE_D206B
If marital status = married or living common-law, ^DT_YOURPARTNER = "you or your partner".
Otherwise, ^DT_YOURPARTNER = "you".

RLE_Q206
Now I’d like you to think just about ^DT_YOURSPOUSE.
In the past 12 months, did ^DT_YOURPARTNER experience a change of job for a worse one?

1. Yes
2. No
   DK, RF

RLE_D207
If marital status = married or living common-law, ^DT_EITHERYOU = "either of you".
Otherwise, ^DT_EITHERYOU = "you".

RLE_Q207
(In the past 12 months,) were ^DT_YOURPARTNER demoted at work or did ^DT_EITHERYOU take a cut in pay?

1. Yes
2. No
   DK, RF

RLE_C208
If marital status = married or living common-law, go to RLE_Q208.
Otherwise, go to RLE_Q209.

RLE_Q208
(In the past 12 months,) did you have increased arguments with your partner?

1. Yes
2. No
   DK, RF

RLE_D209
If marital status = married or living common-law, ^DT_PERSONALLY = "Now, just you personally, did".
Otherwise, ^DT_PERSONALLY = "Did".

RLE_Q209
^DT_PERSONALLY you receive welfare anytime in the past 12 months?

1. Yes
2. No
   DK, RF

RLE_C210
If OGP_Q109 = 1 (has children), go to RLE_Q211.
Otherwise, go to RLE_C210A.

RLE_C210A
If (do OGP block = 2), go to RLE_Q210.
Otherwise, go to RLE_END.

RLE_Q210
Do you have any children?

1. Yes
2. No (Go to RLE_END)
   DK, RF (Go to RLE_END)

RLE_Q211
In the past 12 months, did you have a child move back into the house?

1. Yes
2. No
   DK, RF

RLE_END

Stress - Childhood and adult stressors (CST)

CST_BEG

CST_C1
If (do CST block = 1), go to CST_C2.
Otherwise, go to CST_END.

CST_C2
If proxy interview or age < 18, go to CST_END.
Otherwise, go to CST_R1.

CST_R1
The next few questions ask about some things that may have happened to you while you were a child or a teenager, before you moved out of the house.
INTERVIEWER: Press <Enter> to continue.

CST_Q1
Did you spend 2 weeks or more in the hospital?

1. Yes
2. No
   DK
   RF (Go to CST_END)

CST_Q2
Did your parents get a divorce?

1. Yes
2. No
   DK, RF

CST_Q3
Did your father or mother not have a job for a long time when they wanted to be working?

1. Yes
2. No
   DK, RF

CST_Q4
Did something happen that scared you so much you thought about it for years after?

1. Yes
2. No
   DK, RF

CST_Q5
Were you sent away from home because you did something wrong?

1. Yes
2. No
   DK, RF

CST_Q6
Did either of your parents drink or use drugs so often that it caused problems for the family?

1. Yes
2. No
   DK, RF

CST_Q7
Were you ever physically abused by someone close to you?

1. Yes
2. No
   DK, RF

CST_END

Self-esteem (SFE)

SFE_BEG
Optional Content (See Appendix 2)

SFE_C500A
If (do SFE block = 1), go to SFE_C500B.
Otherwise, go to SFE_END.

SFE_C500B
If proxy interview, go to SFE_END.
Otherwise, go to SFE_R5.

SFE_R5
Now a series of statements that people might use to describe themselves.
Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.
INTERVIEWER: Press <Enter> to continue.

SFE_Q501
You feel that you have a number of good qualities.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK

RF (Go to SFE_END)

SFE_Q502
You feel that you’re a person of worth at least equal to others.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

SFE_Q503
You are able to do things as well as most other people.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

SFE_Q504
You take a positive attitude toward yourself.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

SFE_Q505
On the whole you are satisfied with yourself.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

SFE_Q506
All in all, you’re inclined to feel you’re a failure.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

SFE_END

Mastery (MAS)

MAS_BEG
Optional Content (See Appendix 2)

MAS_C600A
If (do MAS block = 1), go to MAS_C600B.
Otherwise, go to MAS_END.

MAS_C600B
If proxy interview, go to MAS_END.
Otherwise, go to MAS_C600C.

MAS_C600C
If (do SFE block = 1), go to MAS_Q601.
Otherwise, go to MAS_R6.

MAS_R6
Now a series of statements that people might use to describe themselves. Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.
INTERVIEWER: Press <Enter> to continue.

MAS_Q601
You have little control over the things that happen to you.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK

RF (Go to MAS_END)

MAS_Q602
There is really no way you can solve some of the problems you have.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

MAS_Q603
There is little you can do to change many of the important things in your life.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

MAS_Q604
You often feel helpless in dealing with problems of life.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

MAS_Q605
Sometimes you feel that you are being pushed around in life.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

MAS_Q606
What happens to you in the future mostly depends on you.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

MAS_Q607
You can do just about anything you really set your mind to.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK, RF

MAS_END

Smoking (SMK)

SMK_BEG
Core content

SMK_C1
If (do SMK block = 2), go to SMK_END.
Otherwise, go to SMK_R1.

SMK_R1
The next questions are about smoking.
INTERVIEWER: Press <1> to continue.

SMK_D201A
(not applicable)

SMK_Q201A
In ^YOUR1 lifetime, ^HAVE ^YOU2 smoked a total of 100 or more cigarettes (about 4 packs)?

1. Yes (Go to SMK_Q201C)
2. No
   DK, RF

SMK_Q201B
^HAVE_C ^YOU1 ever smoked a whole cigarette?

1. Yes (Go to SMK_Q201C)
2. No (Go to SMK_Q202)
   DK (Go to SMK_Q202)
   RF

SMK_C201C
If SMK_Q201A = RF and SMK_Q201B = RF, go to SMK_END.
Otherwise, go to SMK_Q202.

SMK_Q201C
At what age did ^YOU1 smoke ^YOUR1 first whole cigarette?
INTERVIEWER: Minimum is 5; maximum is [current age].

• Age in years
  (MIN: 5) (MAX: current age)
  DK, RF (Go to SMK_Q202)

SMK_E201C
The entered age at which the respondent first smoked a whole cigarette is invalid. Please return and correct.

Note: Trigger hard edit if SMK_Q201C > current age.

SMK_Q202
At the present time, ^DOVERB ^YOU2 smoke cigarettes daily, occasionally or not at all?

1. Daily
2. Occasionally (Go to SMK_Q205B)
3. Not at all (Go to SMK_C205D)
   DK, RF (Go to SMK_END)

Note: Daily smoker (current)

SMK_Q203
At what age did ^YOU1 begin to smoke cigarettes daily?
INTERVIEWER: Minimum is 5; maximum is [current age].

• Age in years
  (MIN: 5) (MAX: current age)
  DK, RF

SMK_E203A
The entered age at which the respondent first began to smoke cigarettes daily is invalid.
Please return and correct.

Note: Trigger hard edit if SMK_Q203 > current age.

SMK_E203B
The respondent has indicated that they began smoking cigarettes daily at a younger age than when they smoked their first whole cigarette. Please confirm.

Note: Trigger soft edit if SMK_Q201C > SMK_Q203.

SMK_Q204
How many cigarettes ^DOVERB ^YOU1 smoke each day now?

• Cigarettes
  (MIN: 1) (MAX: 99; warning after 60)
  DK, RF
  Go to SMK_END

Note: Occasional smoker (current)

SMK_E204
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if SMK_Q204 > 60

SMK_Q205B
On the days that ^YOU2 ^DOVERB smoke, how many cigarettes ^DOVERB ^YOU1 usually smoke?

• Cigarettes
  (MIN: 1) (MAX: 99; warning after 60)
  DK, RF

SMK_E205B
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if SMK_Q205B > 60.

SMK_Q205C
In the past month, on how many days ^HAVE ^YOU1 smoked 1 or more cigarettes?

• Days
  (MIN: 0) (MAX: 30)
  DK, RF

SMK_E205C

The respondent has previously indicated that they smoke cigarettes occasionally, but that they have smoked every day for the past month. Please verify.

Note: Trigger soft edit if SMK_Q202 = 2 and SMK_Q205C = 30.

SMK_C205D
If SMK_Q201A <> 1 (has not smoked 100 or more cigarettes lifetime), go to SMK_END.
Otherwise, go to SMK_Q205D.

Note: Occasional smoker or non-smoker (current)

SMK_Q205D
^HAVE_C ^YOU1 ever smoked cigarettes daily?

1. Yes (Go to SMK_Q207)
2. No
   DK, RF (Go to SMK_END)

SMK_C206A
If SMK_Q202 = 2 (current occasional smoker), go to SMK_END.
Otherwise, go to SMK_Q206A.

Note: Non-smoker (current)

SMK_Q206A
When did ^YOU1 stop smoking? Was it...?
INTERVIEWER: Read categories to respondent.

1. Less than one year ago
2. 1 year to less than 2 years ago (Go to SMK_END)
3. 2 years to less than 3 years ago (Go to SMK_END)
4. 3 or more years ago (Go to SMK_Q206C)
   DK, RF (Go to SMK_END)

SMK_Q206B
In what month did ^YOU1 stop?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
    DK, RF
    Go to SMK_END

SMK_Q206C
How many years ago was it?
INTERVIEWER: Minimum is 3; maximum is [current age - 5].

• Years
  (MIN: 3) (MAX: current age-5)
  DK, RF (Go to SMK_END)
  Go to SMK_END

SMK_E206C
The number of years ago that the respondent stopped smoking is invalid.
Please return and correct.

Note: Trigger hard edit if SMK_Q206C > current age-5.

Occasional smoker or non-smoker (current) - Daily smoker (previously)

SMK_Q207
At what age did ^YOU1 begin to smoke (cigarettes) daily?
INTERVIEWER: Minimum is 5; maximum is [current age].

• Age in years
  (MIN: 5) (MAX: current age)
  DK, RF (Go to SMK_Q208)

SMK_E207
The entered age at which the respondent first began to smoke cigarettes daily is invalid. Please return and correct

Note: Trigger hard edit if SMK_Q207 > current age.

SMK_Q208
How many cigarettes did ^YOU1 usually smoke each day?

• Cigarettes
  (MIN: 1) (MAX: 99; warning after 60)
  DK, RF

SMK_E208
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if SMK_Q208 > 60.

SMK_Q209A
When did ^YOU1 stop smoking daily? Was it...?
INTERVIEWER: Read categories to respondent.

1. Less than one year ago
2. 1 year to less than 2 years ago (Go to SMK_C210)
3. 2 years to less than 3 years ago (Go to SMK_C210)
4. 3 or more years ago (Go to SMK_Q209C)
   DK, RF (Go to SMK_END)

SMK_Q209B
In what month did ^YOU1 stop?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
    DK, RF
    Go to SMK_C210

SMK_Q209C
How many years ago was it?
INTERVIEWER: Minimum is 3; maximum is [current age-5].

• Years
  (MIN: 3) (MAX: current age-5)
  DK, RF (Go to SMK_C210)

SMK_E209C
The number of years ago that the respondent stopped smoking daily is invalid. Please return and correct.

Note: Trigger hard edit if SMK_Q209C > current age-5.

SMK_E209D
The number of years ago that the respondent stopped smoking daily is invalid. Please return and correct.

Note: Trigger hard edit if SMK_Q207 > (current age - SMK_Q209C).

SMK_C210
If SMK_Q202 = 2 (current occasional smoker), go to SMK_END.
Otherwise, go to SMK_Q210.

Note: Non-smoker (current)

SMK_Q210
Was that when ^YOU1 completely quit smoking?

1. Yes (Go to SMK_END)
2. No
   DK, RF (Go to SMK_END)

SMK_Q210A
When did ^YOU1 stop smoking completely? Was it...?
INTERVIEWER: Read categories to respondent.

1. Less than one year ago
2. 1 year to less than 2 years ago (Go to SMK_END)
3. 2 years to less than 3 years ago (Go to SMK_END)
4. 3 or more years ago (Go to SMK_Q210C)
   DK, RF (Go to SMK_END)

SMK_Q210B
In what month did ^YOU1 stop?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
    DK, RF
    Go to SMK_END

SMK_Q210C
How many years ago was it?
INTERVIEWER: Minimum is 3; maximum is [current age-5].

• Years
  (MIN: 3) (MAX: current age-5)
  DK, RF

SMK_E210C
The number of years ago that the respondent completely stopped smoking is invalid.
Please return and correct.

Note: Trigger hard edit if SMK_Q210C > current age-5.

SMK_END

Smoking - Stages of change (SCH)

SCH_BEG
Optional Content (See Appendix 2)

SCH_C1
If (do SCH block = 2), go to SCH_END.
Otherwise, go to SCH_C2.

SCH_C2
If SMK_Q202 = 1 or 2 (current daily or occasional smokers), go to SCH_C3.
Otherwise, go to SCH_END.

SCH_C3
If proxy interview, go to SCH_END.
Otherwise, go to SCH_Q1.

SCH_Q1
Are you seriously considering quitting smoking within the next 6 months?

1. Yes
2. No (Go to SCH_Q3)
   DK, RF (Go to SCH_Q3)

SCH_Q2
Are you seriously considering quitting within the next 30 days?

1. Yes
2. No
   DK, RF

SCH_Q3
In the past 12 months, did you stop smoking for at least 24 hours because you were trying to quit?

1. Yes
2. No (Go to SCH_END)
   DK, RF (Go to SCH_END)

SCH_Q4
How many times? (in the past 12 months, did you stop smoking for at least 24 hours because you were trying to quit)

• Times
  (MIN: 1) (MAX: 95 warning after 48)
  DK, RF

SCH_END

Smoking cessation methods (SCA)

SCA_BEG
Optional Content (See Appendix 2)

SCA_C1
If (do SCA block = 1), go to SCA_C10A.
Otherwise, go to SCA_END.

SCA_C10A
If proxy interview, go to SCA_END.
Otherwise, go to SCA_C10B.

SCA_C10B
If SMK_Q202 = 1 or 2 (current daily or occasional smoker), go to SCA_C50.
Otherwise, go to SCA_C10C.

SCA_C10C
If SMK_Q206A = 1 or SMK_Q209A = 1 (former smoker who quit less than 1 year ago), go to SCA_Q10.
Otherwise, go to SCA_END.

SCA_Q10
In the past 12 months, did you try a nicotine patch to quit smoking?

1. Yes
2. No (Go to SCA_Q11)
   DK, RF (Go to SCA_END)

SCA_Q10A
How useful was that in helping you quit?

1. Very useful
2. Somewhat useful
3. Not very useful
4. Not useful at all
   DK, RF

SCA_Q11
Did you try Nicorettes or other nicotine gum or candy to quit smoking? (In the past 12 months)

1. Yes
2. No (Go to SCA_Q12)
   DK, RF (Go to SCA_Q12)

SCA_Q11A
How useful was that in helping you quit?

1. Very useful
2. Somewhat useful
3. Not very useful
4. Not useful at all
   DK, RF

SCA_Q12
In the past 12 months, did you try medication such as Zyban, Prolev or Wellbutrin to quit smoking?

1. Yes
2. No (Go to SCA_END)
   DK, RF (Go to SCA_END)

SCA_Q12A
How useful was that in helping you quit?

1. Very useful
2. Somewhat useful
3. Not very useful
4. Not useful at all
   DK, RF
   Go to SCA_END

SCA_C50
If SMK_Q202 = 3, go to SCA_END.
Otherwise, go to SCA_C50A.

SCA_C50A
If (do SCH block = 2), go to SCA_Q50.
Otherwise, go to SCA_C50B.

SCA_C50B
If SCH_Q3 = 1, go to SCA_Q60.
Otherwise, go to SCA_END.

SCA_Q50
In the past 12 months, did you stop smoking for at least 24 hours because you were trying to quit?

1. Yes
2. No (Go to SCA_END)
   DK, RF (Go to SCA_END)

Note: In processing, if a respondent answered SCH_Q3 = 1, 2, the variable SCA_Q50 is given the value of SCH_Q3.

SCA_Q60
In the past 12 months, did you try any of the following to quit smoking:
...a nicotine patch?

1. Yes
2. No
   DK, RF

SCA_Q61
(In the past 12 months, did you try any of the following to quit smoking:)
...Nicorettes or other nicotine gum or candy?

1. Yes
2. No
   DK, RF

SCA_Q62
(In the past 12 months, did you try any of the following to quit smoking:)
...medication such as Zyban, Prolev or Wellbutrin?

1. Yes
2. No
   DK, RF

SCA_END

Smoking - Physician counselling (SPC)

SPC_BEG
Optional Content (See Appendix 2)

SPC_C1
If (do SPC block = 1), go to SPC_C2.
Otherwise, go to SPC_END.

SPC_C2
If proxy interview, go to SPC_END.
Otherwise, go to SPC_C3.

SPC_C3
If SMK_Q202 = 1 or 2 or SMK_Q206A = 1 or SMK_Q209A = 1, go to SPC_C4.
Otherwise, go to SPC_END.

SPC_C4
If (do HCU block = 1) and (HCU_Q01AA = 1) ( i.e. has a regular medical doctor), go to

SPC_Q10.
Otherwise, go to SPC_C20A.

SPC_Q10
Earlier, you mentioned having a regular medical doctor. In the past 12 months, did you go see this doctor?

1. Yes
2. No (Go to SPC_C20A)
   DK, RF (Go to SPC_C20A)

SPC_D11
If SMK_Q202 = 1 or 2, ^DT_SMOKING = "smoke".
If SMK_Q206A = 1 or SMK_Q209A = 1, ^DT_SMOKING = "smoked".

SPC_Q11
Does your doctor know that you ^DT_SMOKING cigarettes?

1. Yes
2. No (Go to SPC_C20A)
   DK, RF (Go to SPC_C20A)

SPC_Q12
In the past 12 months, did your doctor advise you to quit smoking?

1. Yes
2. No
   DK, RF (Go to SPC_C20A)

SPC_Q13
(In the past 12 months,) did your doctor give you any specific help or information to quit smoking?

1. Yes
2. No (Go to SPC_C20A)
   DK, RF (Go to SPC_C20A)

SPC_Q14
What type of help did the doctor give?
INTERVIEWER: Mark all that apply.

1. Referral to a one-on-one cessation program
2. Referral to a group cessation program
3. Recommended use of nicotine patch or nicotine gum
4. Recommended Zyban or other medication
5. Provided self-help information ( e.g. , pamphlet, referral to website)
6. Own doctor offered counselling
7. Other
   DK, RF

SPC_C20A
If (do DEN block = 1) and (DEN_Q130 = 1 or DEN_Q132 = 1) (visited dentist in past 12 months), go to SPC_Q21.
Otherwise, go to SPC_C20B.

SPC_C20B
If (do DEN block = 1) and (DEN_Q130 = 2, DK or RF) (did not visit dentist in past 12 months), go to SPC_END.
Otherwise, go to SPC_C20C.

SPC_C20C
If (do CHP block = 1) and (CHP_Q14 = 1) (saw or talked to dentist in past 12 months), go to SPC_Q20.
Otherwise, go to SPC_END.

SPC_Q20
Earlier, you mentioned having "seen or talked to" a dentist in the past 12 months. Did you actually go to the dentist?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to SPC_END)
   DK, RF (Go to SPC_END)

SPC_Q21
Does your dentist or dental hygienist know that you ^DT_SMOKING cigarettes?

1. Yes
2. No (Go to SPC_END)
   DK, RF (Go to SPC_END)

SPC_Q22
In the past 12 months, did the dentist or hygienist advise you to quit smoking?

1. Yes
2. No
   DK, RF

SPC_END

Smoking - Youth smoking (YSM)

YSM_BEG

YSM_C1
If (do YSM block = 2), go to YSM_END.
Otherwise, go to YSM_C1A.

YSM_C1A
If proxy interview or age greater than 19, go to YSM_END.
Otherwise, go to YSM_C1B.

YSM_C1B
If SMK_Q202 = 1 or 2 (current daily or occasional smoker), go to YSM_Q1.
Otherwise, go to YSM_END.

YSM_Q1
Where do you usually get your cigarettes?

1. Buy from - Vending machine
2. Buy from - Small grocery / corner store
3. Buy from - Supermarket
4. Buy from - Drug store
5. Buy from - Gas station
6. Buy from - Other store
7. Buy from - Friend or someone else
8. Given them by - Brother or sister
9. Given them by - Mother or father
10. Given them by - Friend or someone else
11. Take them from - Mother, father or sibling
12. Other
    DK, RF (Go to YSM_END)

YSM_C2
If YSM_Q1 = 1, 2, 3, 4, 5, 6 or 7, go to YSM_Q3.
Otherwise, go to YSM_Q2.

YSM_Q2
In the past 12 months, have you bought cigarettes for yourself or for someone else?

1. Yes
2. No (Go to YSM_Q5)
   DK, RF (Go to YSM_Q5)

YSM_Q3
In the past 12 months, have you been asked your age when buying cigarettes in a store?

1. Yes
2. No
   DK, RF

YSM_Q4
In the past 12 months, has anyone in a store refused to sell you cigarettes?

1. Yes
2. No
   DK, RF

YSM_Q5
In the past 12 months, have you asked a stranger to buy you cigarettes?

1. Yes
2. No
   DK, RF

YSM_END

Exposure to second-hand smoke (ETS)

ETS_BEG
Core content

ETS_C1
If (do ETS block = 2), go to ETS_END.
Otherwise, go to ETS_R1.

ETS_R1
The next questions are about exposure to second-hand smoke.
INTERVIEWER: Press <1> to continue.

ETS_C10
If the number of household members = 1 and (SMK_Q202 = 1 or 2), go to ETS_Q35.
Otherwise, go to ETS_Q10.

ETS_Q10
Including both household members and regular visitors, does anyone smoke inside your home, every day or almost every day?
INTERVIEWER: Include cigarettes, cigars and pipes.

1. Yes
2. No (Go to ETS_C20)
   DK, RF (Go to ETS_END)

ETS_Q11
How many people smoke inside your home every day or almost every day?
INTERVIEWER: Include household members and regular visitors.

• Number of people
  (MIN: 1) (MAX: 15)
  DK, RF

ETS_C20
If SMK_Q202 = 1 or 2 (current daily or occasional smoker), go to ETS_C35.
Otherwise, go to ETS_Q20.

ETS_Q20
In the past month, ^WERE ^YOU2 exposed to second-hand smoke, every day or almost every day, in a car or other private vehicle?

1. Yes
2. No
   DK, RF

ETS_Q20B
(In the past month,) ^WERE ^YOU1 exposed to second-hand smoke, every day or almost every day, in public places (such as bars, restaurants, shopping malls, arenas, bingo halls, bowling alleys)?

1. Yes
2. No
   DK, RF

ETS_C35
If ETS_Q10 = 1 (at least one person smokes inside the home), go to ETS_Q36.
Otherwise, go to ETS_Q35.

ETS_Q35
Is smoking allowed inside your home?

1. Yes
2. No (Go to ETS_END)
   DK, RF (Go to ETS_END)

ETS_Q36
Is smoking inside your home restricted in anyway?

1. Yes
2. No (Go to ETS_END)
   DK, RF (Go to ETS_END)

ETS_Q37
How is smoking restricted inside your home?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Allowed in certain rooms only
2. Restricted in the presence of young children
3. Allowed only if windows are open or with another type of ventilation
4. Other restriction(s)
   DK, RF

ETS_END

Smoking - Other tobacco products (TAL)

TAL_BEG
Optional Content (See Appendix 2)

TAL_C1
If (do TAL block = 1), go to TAL_Q1.
Otherwise, go to TAL_END.

TAL_Q1
Now I’d like to ask about ^YOUR1 use of tobacco other than cigarettes.
In the past month, ^HAVE ^YOU1 smoked cigars?

1. Yes
2. No
   DK, RF (Go to TAL_END)

TAL_Q2
(In the past month,) ^HAVE ^YOU1 smoked a pipe?

1. Yes
2. No
   DK, RF

TAL_Q3
(In the past month,) ^HAVE ^YOU1 used snuff?

1. Yes
2. No
   DK, RF

TAL_Q4
(In the past month,) ^HAVE ^YOU1 used chewing tobacco?

1. Yes
2. No
   DK, RF

TAL_END

Alcohol use (ALC)

ALC_BEG
Core content

ALC_C1A
If (do ALC block = 1), go to ALC_R1.
Otherwise, go to ALC_END.

ALC_D1
(not applicable)

ALC_R1
Now, some questions about ^YOUR2 alcohol consumption.
When we use the word ‘drink’ it means:

• one bottle or can of beer or a glass of draft
• one glass of wine or a wine cooler
• one drink or cocktail with 1 and a 1/2 ounces of liquor.
  INTERVIEWER: Press <Enter> to continue.

ALC_Q1
During the past 12 months, that is, from [date one year ago] to yesterday, ^HAVE ^YOU2 had a drink of beer, wine, liquor or any other alcoholic beverage?

1. Yes
2. No (Go to ALC_END)
   DK, RF (Go to ALC_END)

ALC_Q2
During the past 12 months, how often did ^YOU1 drink alcoholic beverages?

1. Less than once a month
2. Once a month
3. 2 to 3 times a month
4. Once a week
5. 2 to 3 times a week
6. 4 to 6 times a week
7. Every day
   DK, RF

ALC_Q3
How often in the past 12 months ^HAVE ^YOU1 had 5 or more drinks on one occasion?

1. Never
2. Less than once a month
3. Once a month
4. 2 to 3 times a month
5. Once a week
6. More than once a week
   DK, RF

ALC_END

Alcohol use during the past week (ALW)

ALW_BEG
Optional Content (See Appendix 2)

ALW_C1
If (do ALW block = 1), go to ALW_C2.
Otherwise, go to ALW_END.

ALW_C2
If ALC_Q1 = No, DK or RF, go to ALW_END.
Otherwise, go to ALW_Q5.

ALW_Q5
Thinking back over the past week, that is, from [date last week] to yesterday, did ^YOU2 have a drink of beer, wine, liquor or any other alcoholic beverage?  

1. Yes
2. No (Go to ALW_END)
   DK, RF (Go to ALW_END)

ALW_D5
Yesterday = WEEKDAY(TODAY - 1)

ALW_D5A

• If Yesterday = 1, DayE[1] = "Sunday".
• If Yesterday = 1, DayE[2] = "Saturday".
• If Yesterday = 1, DayE[3] = "Friday".
• If Yesterday = 1, DayE[4] = "Thursday".
• If Yesterday = 1, DayE[5] = "Wednesday".
• If Yesterday = 1, DayE[6] = "Tuesday".
• If Yesterday = 1, DayE[7] = "Monday".
• If Yesterday = 2, DayE[1] = "Monday".
• If Yesterday = 2, DayE[2] = "Sunday".
• If Yesterday = 2, DayE[3] = "Saturday".
• If Yesterday = 2, DayE[4] = "Friday".
• If Yesterday = 2, DayE[5] = "Thursday".
• If Yesterday = 2, DayE[6] = "Wednesday".
• If Yesterday = 2, DayE[7] = "Tuesday".
• If Yesterday = 3, DayE[1] = "Tuesday".
• If Yesterday = 3, DayE[2] = "Monday".
• If Yesterday = 3, DayE[3] = "Sunday".
• If Yesterday = 3, DayE[4] = "Saturday".
• If Yesterday = 3, DayE[5] = "Friday".
• If Yesterday = 3, DayE[6] = "Thursday".
• If Yesterday = 3, DayE[7] = "Wednesday".
• If Yesterday = 4, DayE[1] = "Wednesday".
• If Yesterday = 4, DayE[2] = "Tuesday".
• If Yesterday = 4, DayE[3] = "Monday".
• If Yesterday = 4, DayE[4] = "Sunday".
• If Yesterday = 4, DayE[5] = "Saturday".
• If Yesterday = 4, DayE[6] = "Friday".
• If Yesterday = 4, DayE[7] = "Thursday".
• If Yesterday = 5, DayE[1] = "Thursday".
• If Yesterday = 5, DayE[2] = "Wednesday".
• If Yesterday = 5, DayE[3] = "Tuesday".
• If Yesterday = 5, DayE[4] = "Monday".
• If Yesterday = 5, DayE[5] = "Sunday".
• If Yesterday = 5, DayE[6] = "Saturday".
• If Yesterday = 5, DayE[7] = "Friday".
• If Yesterday = 6, DayE[1] = "Friday".
• If Yesterday = 6, DayE[2] = "Thursday".
• If Yesterday = 6, DayE[3] = "Wednesday".
• If Yesterday = 6, DayE[4] = "Tuesday".
• If Yesterday = 6, DayE[5] = "Monday".
• If Yesterday = 6, DayE[6] = "Sunday".
• If Yesterday = 6, DayE[7] = "Saturday".
• If Yesterday = 7, DayE[1] = "Saturday".
• If Yesterday = 7, DayE[2] = "Friday".
• If Yesterday = 7, DayE[3] = "Thursday".
• If Yesterday = 7, DayE[4] = "Wednesday".
• If Yesterday = 7, DayE[5] = "Tuesday".
• If Yesterday = 7, DayE[6] = "Monday".
• If Yesterday = 7, DayE[7] = "Sunday".

ALW_Q5A1
Starting with yesterday, that is ^DayE[1], how many drinks did ^YOU2 have?

ALW_2A1

• Number of drinks
  (MIN: 0) (MAX: 99)
  DK, RF

ALW_C5A1
If response to Question ALW_Q5A1 is RF, go to ALW_END.
Otherwise, go to ALW_Q5A2.

ALW_E5A1A
Inconsistent answers have been entered. The respondent has not had 5 or more drinks on one occasion in the past 12 months but had 5 drinks on ^DayE[1].

Note: Trigger hard edit if ALC_Q3 = 1 and ALW_Q5A1 => 5.

ALW_E5A1B
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if ALW_Q5A1 > 12.

ALW_Q5A2
(How many drinks did ^YOU1 have:)
...on ^DayE[2]?

ALW_2A2

• Number of drinks
  (MIN: 0) (MAX: 99)
  DK, RF

ALW_E5A2A
Inconsistent answers have been entered. The respondent has not had 5 or more drinks on one occasion in the past 12 months but had 5 drinks on ^DayE[2].

Note: Trigger hard edit if ALC_Q3 = 1 and ALW_Q5A2 => 5.

ALW_E5A2B
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if ALW_Q5A2 > 12.

ALW_Q5A3
(How many drinks did ^YOU1 have:)
...on ^DayE[3]?

ALW_2A3

• Number of drinks
  (MIN: 0) (MAX: 99)
  DK, RF

ALW_E5A3A
Inconsistent answers have been entered. The respondent has not had 5 or more drinks on one occasion in the past 12 months but had 5 drinks on ^DayE[3].

Note: Trigger hard edit if ALC_Q3 = 1 and ALW_Q5A3 => 5.

ALW_E5A3B
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if ALW_Q5A3 > 12.

ALW_Q5A4
(How many drinks did ^YOU1 have:)
...on ^DayE[4]?

ALW_2A4

• Number of drinks
  (MIN: 0) (MAX: 99)
  DK, RF

ALW_E5A4A
Inconsistent answers have been entered. The respondent has not had 5 or more drinks on one occasion in the past 12 months but had 5 drinks on ^DayE[4].

Note: Trigger hard edit if ALC_Q3 = 1 and ALW_Q5A4 => 5.

ALW_E5A4B
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if ALW_Q5A4 > 12.

ALW_Q5A5
(How many drinks did ^YOU1 have:)
...on ^DayE[5]?

ALW_2A5

• Number of drinks
  (MIN: 0) (MAX: 99)
  DK, RF

ALW_E5A5A
Inconsistent answers have been entered. The respondent has not had 5 or more drinks on one occasion in the past 12 months but had 5 drinks on ^DayE[5].

Note: Trigger hard edit if ALC_Q3 = 1 and ALW_Q5A5 => 5.

ALW_E5A5B
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if ALW_Q5A5 > 12.

ALW_Q5A6
(How many drinks did ^YOU1 have:)
...on ^DayE[6]?

ALW_2A6

• Number of drinks
  (MIN: 0) (MAX: 99)
  DK, RF

ALW_E5A6A
Inconsistent answers have been entered. The respondent has not had 5 or more drinks on one occasion in the past 12 months but had 5 drinks on ^DayE[6].

Note: Trigger hard edit if ALC_Q3 = 1 and ALW_Q5A6 => 5.

ALW_E5A6B

An unusual value has been entered. Please confirm.
Note: Trigger soft edit if ALW_Q5A6 > 12.

ALW_Q5A7
(How many drinks did ^YOU1 have:)

ALW_2A7
...on ^DayE[7]?

• Number of drinks
  (MIN: 0) (MAX: 99)
  DK, RF

ALW_E5A7A
Inconsistent answers have been entered. The respondent has not had 5 or more drinks on one occasion in the past 12 months but had 5 drinks on ^DayE[7].

Note: Trigger hard edit if ALC_Q3 = 1 and ALW_Q5A7 => 5.

ALW_E5A7B
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if ALW_Q5A7 > 12.

ALW_E5A1
Inconsistent answers have been entered. The respondent had a drink in the past week but has not had any drinks in the last seven days.

Note: Trigger hard edit if ALW_Q5A1 to ALW_Q5A7 all = 0.

ALW_END

Driving and safety (DRV)

DRV_BEG
Optional Content (See Appendix 2)

DRV_C01A
If (do DRV block = 2), go to DRV_END.
Otherwise, go to DRV_C01B.

DRV_C01B
If proxy interview, go to DRV_END.
Otherwise, go to DRV_R1.

DRV_R1
The next questions are about driving a motor vehicle. By motor vehicle, we mean a car, truck or van.
INTERVIEWER: Press <Enter> to continue.

DRV_Q01A
In the past 12 months, have you driven a motor vehicle?
INTERVIEWER: Include cars, trucks and vans. Exclude motorcycles and off-road vehicles.

1. Yes
2. No
   DK, RF (Go to DRV_END)

DRV_Q01B
In the past 12 months, have you driven a motorcycle?

1. Yes
2. No
   DK, RF

DRV_C02
If DRV_Q01A = 2 and DRV_Q01B = 2 or DK or RF, go to DRV_R2.
Otherwise, go to DRV_C02A.

DRV_C02A
If DRV_Q01A = 1, go to DRV_Q02.
Otherwise, go to DRV_Q04.

DRV_Q02
How often do you fasten your seat belt when you drive a motor vehicle?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

DRV_Q03A
Excluding hands-free use, how often do you use a cell phone while you are driving a motor vehicle?
INTERVIEWER: Read categories to respondent.
If respondent does not use a cell phone, select «Never».

1. Often
2. Sometimes
3. Rarely
4. Never
   DK, RF

DRV_Q03B
How often do you use a hands-free when talking on the cell phone while you are driving a motor vehicle?
INTERVIEWER: Read categories to respondent.
If respondent does not use a hands-free, select «Never».

1. Often
2. Sometimes
3. Rarely
4. Never
   DK, RF

DRV_Q04
How often do you drive when you are feeling tired?

1. Often
2. Sometimes
3. Rarely
4. Never
   DK, RF

DRV_Q05
Compared to other drivers, would you say you usually drive:
INTERVIEWER: Read categories to respondent.

1. ...much faster?
2. ...a little faster?
3. ...about the same speed?
4. ...a little slower?
5. ...much slower?
   DK, RF

DRV_Q06
(Compared to other drivers,) would you say you usually drive:
INTERVIEWER: Read categories to respondent.

1. ...much more aggressively?
2. ...a little more aggressively?
3. ...about the same?
4. ...a little less aggressively?
5. ...much less aggressively?
   DK, RF

DRV_C07
If ALC_Q1 = 1 (drank alcohol in past 12 months) and (DRV_Q01A = 1 (drove a motor vehicle) or DRV_Q01B = 1 (Drove a motorcycle)), go to DRV_Q07.
Otherwise, go to DRV_R2.

DRV_Q07
In the past 12 months, have you driven a motor vehicle after having 2 or more drinks in the hour before you drove?
INTERVIEWER: Include cars, trucks, vans and motorcycles. Exclude off-road vehicles.

1. Yes
2. No (Go to DRV_R2)
   DK, RF (Go to DRV_R2)

DRV_Q07A
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 95; warning after 20)
  DK, RF

DRV_R2
Now some questions about being a passenger in a motor vehicle.
INTERVIEWER: Press <Enter> to continue.

DRV_Q08A
When you are a front seat passenger, how often do you fasten your seat belt?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
5. Do not ride in front seat
   DK, RF

DRV_Q08B
When you are a back seat passenger, how often do you fasten your seat belt?

1. Always
2. Most of the time
3. Rarely
4. Never
5. Do not ride in back seat
   DK, RF

DRV_Q09
When you are a passenger in a taxi, how often do you fasten your seat belt?

1. Always
2. Most of the time
3. Rarely
4. Never
5. Do not take taxis
   DK, RF

DRV_Q10
In the past 12 months, have you been a passenger with a driver who had 2 or more drinks in the hour before driving?

1. Yes
2. No (Go to DRV_Q11A)
   DK, RF (Go to DRV_Q11A)

DRV_Q10A
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 95; warning after 20)
  DK, RF

DRV_Q11A
In the past 12 months, have you been the driver of, or a passenger in, a snowmobile, motor boat or seadoo?

1. Yes
2. No
   DK, RF (Go to DRV_END)

DRV_Q11B
In the past 12 months, have you been the driver of, or a passenger in, an ATV (all terrain vehicle)?

1. Yes
2. No (Go to DRV_C13)
   DK, RF (Go to DRV_END)

DRV_Q12
How often do you wear a helmet when on an ATV?
INTERVIEWER: Read categories to respondent.

1. Always
2. Most of the time
3. Rarely
4. Never
   DK, RF

DRV_C13
If DRV_Q11A = 2 (not driven/passenger - snowmobile, motor boat or seadoo) and DRV_Q11B = 2 (not driven/passenger - ATV), go to DRV_END.
Otherwise, go to DRV_D13.

DRV_D13
If DRV_Q11A = 1 and DRV_Q11B = 1, ^DT_ATV = "a snowmobile, motor boat, seadoo or ATV".
If DRV_Q11A = 1 and DRV_Q11B = 2, ^DT_ATV = "a snowmobile, motor boat or seadoo".
If DRV_Q11A = 2 and DRV_Q11B = 1, ^DT_ATV = "an ATV".

DRV_Q13
In the past 12 months, have you been a passenger on ^DT_ATV with a driver who had 2 or more drinks in the hour before driving?

1. Yes
2. No (Go to DRV_C14)
   DK, RF (Go to DRV_C14)

DRV_Q13A
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 95; warning after 20)
  DK, RF

DRV_C14
If ALC_Q1 = 1 (drank alcohol in the past 12 months), go to DRV_Q14.
Otherwise, go to DRV_END.

DRV_Q14
In the past 12 months, have you driven ^DT_ATV after having 2 or more drinks in the hour before you drove?

1. Yes
2. No (Go to DRV_END)
   DK, RF (Go to DRV_END)

DRV_Q14A
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 95; warning after 20)
  DK, RF

DRV_END

Maternal experiences - Breastfeeding (MEX)

MEX_BEG
Core content

MEX_C01A
If (do MEX block = 1), go to MEX_C01B.
Otherwise, go to MEX_END.

MEX_C01B
If proxy interview or sex = male or age < 15 or > 55, go to MEX_END.
Otherwise, go to MEX_Q01.

MEX_R01
The next questions are for recent mothers.
INTERVIEWER: Press <1> to continue.

MEX_Q01
Have you given birth in the past 5 years?
INTERVIEWER: Do not include stillbirths.

1. Yes
2. No (Go to MEX_END)
   DK, RF (Go to MEX_END)

MEX_D01A
DV_YEARAGO = ^info.CurrentYear - 5

MEX_Q01A
In what year?
INTERVIEWER: Enter year of birth of last baby. Minimum is [DV_YEARAGO]; maximum is [^info.CurrentYear].

• Year
  (MIN: DV_YEARAGO) (MAX: ^info.CurrentYear)
  DK, RF

MEX_Q02
Did you take a vitamin supplement containing folic acid before your (last) pregnancy, that is, before you found out that you were pregnant?

1. Yes
2. No
   DK, RF

MEX_Q03
For your last baby, did you breastfeed or try to breastfeed your baby, even if only for a short time?

1. Yes (Go to MEX_Q05
2. No
   DK, RF (Go to MEX_END)

MEX_Q04
What is the main reason that you did not breastfeed?

1. Bottle feeding easier
2. Formula as good as breast milk
3. Breastfeeding is unappealing / disgusting
4. Father / partner didn’t want me to
5. Returned to work / school early
6. C-Section
7. Medical condition - mother
8. Medical condition - baby
9. Premature birth
10. Multiple births ( e.g. twins)
11. Wanted to drink alcohol
12. Wanted to smoke
13. Other - Specify (Go to MEX_S04)
    DK, RF
    Go to MEX_END

MEX_S04
What is the main reason that you did not breastfeed?
INTERVIEWER: Specify.
DK, RF
Go to MEX_END

MEX_Q05
Are you still breastfeeding?

1. Yes (Go to MEX_C06A)
2. No
   DK, RF (Go to MEX_END)

MEX_Q06
How long did you breastfeed (your last baby)?

1. Less than 1 week
2. 1 to 2 weeks
3. 3 to 4 weeks
4. 5 to 8 weeks
5. 9 weeks to less than 12 weeks
6. 3 months (12 weeks to less than 16 weeks)
7. 4 months (16 weeks to less than 20 weeks)
8. 5 months (20 weeks to less than 24 weeks)
9. 6 months (24 weeks to less than 28 weeks)
10. 7 to 9 months
11. 10 to 12 months
12. More than 1 year
    DK, RF (Go to MEX_END)

MEX_C06A
If MEX_Q05=1 (Still breastfeeding), go to MEX_Q06A.
Otherwise, go to MEX_D06B.

MEX_Q06A
Have other liquids such as milk, formula, water, juice, tea or herbal mixture been introduced to the baby’s feeds?

1. Yes
2. No (Go to MEX_Q08A)
   DK, RF (Go to MEX_C09A)

MEX_D06B
If MEX_Q05=2, ^DT_LIQUIDS = "such as milk, formula, water, juice, tea or herbal mixture".
Otherwise, ^DT_LIQUIDS = "null".

MEX_Q06B
How old was your (last) baby when other liquids ^DT_LIQUIDS were first added to the baby’s feeds?
INTERVIEWER: If exact age not known, obtain best estimate. Other liquids may include milk, formula, water, juice, tea or herbal mixture, etc.

1. Less than 1 week
2. 1 to 2 weeks
3. 3 to 4 weeks
4. 5 to 8 weeks
5. 9 weeks to less than 12 weeks
6. 3 months (12 weeks to less than 16 weeks)
7. 4 months (16 weeks to less than 20 weeks)
8. 5 months (20 weeks to less than 24 weeks)
9. 6 months (24 weeks to less than 28 weeks)
10. 7 to 9 months
11. 10 to 12 months
12. More than 1 year
13. Have not added other liquids
    DK, RF (Go to MEX_C09A)

MEX_E06B
An unusual length of time has passed between when the baby stopped breastfeeding and when other liquids were first added to the feeds. Please confirm.
INTERVIEWER: If answers are valid, ask for the reason explaining the gap and enter it as a remark.

Note: Trigger soft edit if (MEX_Q05=2) and MEX_Q06B < 13 and (ORD(MEX_Q06B) – ORD(MEX_Q06) > 1)
In other words, if MEX_Q06B < 13 and category number in MEX_Q06B minus category number in MEX_Q06 is greater than 1.
In other words, if MEX_Q06B < 13 and category number in MEX_Q06B minus category number in MEX_Q06 is greater than 1.

MEX_Q08A
How old was your (last) baby when solid foods such as cereals, mashed up or pureed meat vegetables or fruits were first added to the baby’s feeds?

1. Less than 1 week
2. 1 to 2 weeks
3. 3 to 4 weeks
4. 5 to 8 weeks
5. 9 weeks to less than 12 weeks
6. 3 months (12 weeks to less than 16 weeks)
7. 4 months (16 weeks to less than 20 weeks)
8. 5 months (20 weeks to less than 24 weeks)
9. 6 months (24 weeks to less than 28 weeks)
10. 7 to 9 months
11. 10 to 12 months
12. More than 1 year
13. Have not added solid foods
    DK, RF

MEX_C08B
If IF MEX_Q06B = 13 and MEX_Q08A = 13, go to MEX_C09AA.
Otherwise, go to MEX_D08B.

MEX_D08B
If MEX_Q06B<MEX_Q08A, ^DT_LIQUIDSOLID = "other liquids".
If MEX_Q06B=MEX_Q08A, ^DT_LIQUIDSOLID = "other liquids and solid foods".
Otherwise, ^DT_LIQUIDSOLID = "solid foods".

MEX_Q08B
What is the main reason ^DT_ LIQUIDSOLID were first added to the baby’s feeds?

1. Not enough breast milk
2. Baby was ready for solid foods
3. Inconvenience / fatigue due to breastfeeding
4. Difficulty with BF techniques ( e.g. , sore nipples, engorged breasts, mastitis)
5. Medical condition - mother
6. Medical condition - baby
7. Advice of doctor / health professional
8. Returned to work / school
9. Advice of partner / family / friends
10. Formula equally healthy for baby
11. Wanted to drink alcohol
12. Wanted to smoke
13. Other - Specify (Go to MEX_S08BB)
    DK, RF
    Go to MEX_C09A

MEX_S08B
What is the main reason ^DT_ LIQUIDSOLID were first added to the baby’s feeds?
INTERVIEWER: Specify.
DK, RF

MEX_C09A
If MEX_Q06B = 1 or MEX_Q08A=1 (baby less than 1 week when other liquids or solids introduced), go to MEX_C10.
Otherwise, go to MEX_Q09A.

MEX_Q09A
During the time when your (last) baby was less than one year old and fed breast milk, did you give the baby a vitamin supplement containing Vitamin D?
INTERVIEWER: Read categories to respondent. Select "yes" if baby was fed breast milk, even in small quantities and given Vitamin D.

1. Yes (Go to MEX_Q09B)
2. No (Go to MEX_C10)
   DK, RF (Go to MEX_C10)

MEX_Q09B
Overall, how often did you give the baby a supplement containing Vitamin D?
INTERVIEWER: Read categories to respondent.

1. Every day
2. Almost every day
3. Once or twice a week
4. Less than once a week
   DK, R

MEX_C10
If MEX_Q05 = 1 (still breastfeeding), go to MEX_END.
Otherwise, go to MEX_Q10.

MEX_Q10
What is the main reason that you stopped breastfeeding?

1. Not enough breast milk
2. Baby was ready for solid foods
3. Inconvenience / fatigue due to breastfeeding
4. Difficulty with breast feeding techniques ( e.g. , sore nipples, engorged breasts, mastitis)
5. Medical condition - mother
6. Medical condition - baby
7. Planned to stop at this time
8. Child weaned him / herself ( e.g. , baby biting, refusing breast)
9. Advice of doctor / health professional
10. Returned to work / school
11. Advice of partner / family / friends
12. Formula equally healthy for baby
13. Wanted to drink alcohol
14. Wanted to smoke
15. Other - Specify (Go to MEX_S10)
    DK, RF

Go to MEX_END

MEX_S10
What is the main reason that you stopped breastfeeding?
INTERVIEWER: Specify.
DK, RF

MEX_END

Maternal experiences - Alcohol use during pregnancy (MXA)

MXA_BEG
Optional Content (See Appendix 2)

MXA_C01A
If (do MXA block = 1), go to MXA_C01B.
Otherwise, go to MXA_END.

MXA_C01B
If proxy interview or sex = male or age < 15 or > 55 or MEX_Q01 = 2, DK or RF, go to MXA_END.
Otherwise, go to MXA_C30.

MXA_C30
If (ALN _Q5B = 2, or RF ( never drank), go to MXA_END.
Otherwise, go to MXA_C30.

MXA_Q30
Did you drink any alcohol during your last pregnancy?

1. Yes
2. No (Go to MXA_C32)
   DK, RF (Go to MXA_END)

MXA_Q31
How often did you drink?

1. Less than once a month
2. Once a month
3. 2 to 3 times a month
4. Once a week
5. 2 to 3 times a week
6. 4 to 6 times a week
7. Every day
   DK, RF

MXA_C32
If MEX_Q03 = 2 (did not breastfeed last baby), go to MXA_END.
Otherwise, go to MXA_Q32.

MXA_Q32
Did you drink any alcohol while you were breastfeeding (your last baby)?

1. Yes
2. No (Go to MXA_END)
   DK, RF (Go to MXA_END)

MXA_Q33
How often did you drink?

1. Less than once a month
2. Once a month
3. 2 to 3 times a month
4. Once a week
5. 2 to 3 times a week
6. 4 to 6 times a week
7. Every day
   DK, RF

MXA_END

Maternal experiences - Smoking during pregnancy (MXS)

MXS_BEG
Optional Content (See Appendix 2)

MXS_C01A
If (do MXS block = 1), go to MXS_C01B.
Otherwise, go to MXS_END.

MXS_C01B
If proxy interview or sex = male or age < 15 or > 55 or MEX_Q01 = 2, DK or RF, go to MXS_END.
Otherwise, go to MXS_C20.

MXS_C20
If SMK_Q202 = (1 or 2) or SMK_Q201A = 1 or SMK_Q201B = 1, go to MXS_Q20.
Otherwise, go to MXS_END.

MXS_Q20
During your last pregnancy, did you smoke daily, occasionally or not at all?

1. Daily
2. Occasionally (Go to MXS_Q22)
3. Not at all (Go to MXS_C23)
   DK, RF (Go to MXS_Q26)

Note: Daily Smokers only

MXS_Q21
How many cigarettes did you usually smoke each day?

• Number of cigarettes
  (MIN: 1) (MAX: 99 warning after 60)
  DK, RF

Go to MXS_C23
Note: Occasional Smokers only

MXS_Q22
On the days that you smoked, how many cigarettes did you usually smoke?

• Number of cigarettes
  (MIN: 1) (MAX: 99 warning after 60)
  DK, RF

MXS_C23
If MEX_Q03 = 1 (breastfed last baby), go to MXS_Q23.
Otherwise, go to MXS_Q26.

MXS_Q23
When you were breastfeeding (your last baby), did you smoke daily, occasionally or not at all?

1. Daily
2. Occasionally (Go to MXS_Q25)
3. Not at all (Go to MXS_Q26)
   DK, RF (Go to MXS_Q26)

Note: Daily smokers only

MXS_Q24
How many cigarettes did you usually smoke each day?

• Number of cigarettes
  (MIN: 1) (MAX: 99 warning after 60)
  DK, RF
  Go to MXS_Q26

Note: Occasional smokers only

MXS_Q25
On the days that you smoked, how many cigarettes did you usually smoke?

• Number of cigarettes
  (MIN: 1) (MAX: 99 warning after 60)
  DK, RF

MXS_Q26
Did anyone regularly smoke in your presence during or after the pregnancy (about 6 months after)?

1. Yes
2. No
   DK, RF

MXS_END

Illicit drugs use (IDG)

DRG_BEG
Optional Content (See Appendix 2)

DRG_C1
If (do DRG block = 1), go to DRG_C2.
Otherwise, go to DRG_END.

DRG_C2
If proxy interview, go to DRG_END.
Otherwise, go to DRG_R1.

DRG_R1
I am going to ask some questions about drug use. Again, I would like to remind you that everything you say will remain strictly confidential.
INTERVIEWER: Press <Enter> to continue.

DRG_Q01
Have you ever used or tried marijuana, cannabis or hashish?
INTERVIEWER: Read categories to respondent.

1. Yes, just once
2. Yes, more than once
3. No (Go to DRG_Q04)
   DK, RF (Go to DRG_END)

DRG_Q02
Have you used it in the past 12 months?

1. Yes
2. No (Go to DRG_Q04)
   DK, RF (Go to DRG_Q04)

DRG_C03
If DRG_Q01 = 1, go to DRG_Q04.
Otherwise, go to DRG_Q03.

DRG_Q03
How often (did you use marijuana, cannabis or hashish in the past 12 months)?
INTERVIEWER: Read categories to respondent.

1. Less than once a month
2. 1 to 3 times a month
3. Once a week
4. More than once a week
5. Every day
   DK, RF

DRG_Q04
Have you ever used or tried cocaine or crack?

1. Yes, just once
2. Yes, more than once
3. No (Go to DRG_Q07)
   DK, RF (Go to DRG_Q07)

DRG_Q05
Have you used it in the past 12 months?

1. Yes
2. No (Go to DRG_Q07)
   DK, RF (Go to DRG_Q07)

DRG_C06
If DRG_Q04 = 1, go to DRG_Q07.
Otherwise, go to DRG_Q06.

DRG_Q06
How often (did you use cocaine or crack in the past 12 months)?
INTERVIEWER: Read categories to respondent.

1. Less than once a month
2. 1 to 3 times a month
3. Once a week
4. More than once a week
5. Every day
   DK, RF

DRG_Q07
Have you ever used or tried speed (amphetamines)?

1. Yes, just once
2. Yes, more than once
3. No (Go to DRG_Q10)
   DK, RF (Go to DRG_Q10)

DRG_Q08
Have you used it in the past 12 months?

1. Yes
2. No (Go to DRG_Q10)
   DK, RF (Go to DRG_Q10)

DRG_C09
If DRG_Q07 = 1, go to DRG_Q10.
Otherwise, go to DRG_Q09.

DRG_Q09
How often (did you use speed (amphetamines) in the past 12 months)?
INTERVIEWER: Read categories to respondent.

1. Less than once a month
2. 1 to 3 times a month
3. Once a week
4. More than once a week
5. Every day
   DK, RF

DRG_Q10
Have you ever used or tried ecstasy (MDMA) or other similar drugs?

1. Yes, just once
2. Yes, more than once
3. No (Go to DRG_Q13)
   DK, RF (Go to DRG_Q13)

DRG_Q11
Have you used it in the past 12 months?

1. Yes
2. No (Go to DRG_Q13)
   DK, RF (Go to DRG_Q13)

DRG_C12
If DRG_Q10 = 1, go to DRG_Q13.
Otherwise, go to DRG_Q12.
How often (did you use ecstasy or other similar drugs in the past 12 months)?

IDG_12
INTERVIEWER: Read categories to respondent.

1. Less than once a month
2. 1 to 3 times a month
3. Once a week
4. More than once a week
5. Every day
6.  
   DK, RF

DRG_Q13
Have you ever used or tried hallucinogens, PCP or LSD (acid)?

1. Yes, just once
2. Yes, more than once
3. No (Go to DRG_Q16)
   DK, RF (Go to DRG_Q16)

DRG_Q14
Have you used it in the past 12 months?

1. Yes
2. No (Go to DRG_Q16)
   DK, RF (Go to DRG_Q16)

DRG_C15
If DRG_Q13 = 1, go to DRG_Q16.
Otherwise, go to DRG_Q15.

DRG_Q15
How often (did you use hallucinogens, PCP or LSD in the past 12 months)?
INTERVIEWER: Read categories to respondent.

1. Less than once a month
2. 1 to 3 times a month
3. Once a week
4. More than once a week
5. Every day
   DK, RF

DRG_Q16
Did you ever sniff glue, gasoline or other solvents?

1. Yes, just once
2. Yes, more than once
3. No (Go to DRG_Q19)
   DK, RF (Go to DRG_Q19)

DRG_Q17
Did you sniff some in the past 12 months?

1. Yes
2. No (Go to DRG_Q19)
   DK, RF (Go to DRG_Q19)

DRG_C18
If DRG_Q16 = 1, go to DRG_Q19.
Otherwise, go to DRG_Q18.

DRG_Q18
How often (did you sniff glue, gasoline or other solvents in the past 12 months)?
INTERVIEWER: Read categories to respondent.

1. Less than once a month
2. 1 to 3 times a month
3. Once a week
4. More than once a week
5. Every day
   DK, RF

DRG_Q19
Have you ever used or tried heroin?

1. Yes, just once
2. Yes, more than once
3. No (Go to DRG_Q22)
   DK, RF (Go to DRG_Q22)

DRG_Q20
Have you used it in the past 12 months?

1. Yes
2. No (Go to DRG_Q22)
   DK, RF (Go to DRG_Q22)

DRG_C21
If DRG_Q19 = 1, go to DRG_Q22.
Otherwise, go to DRG_Q21.

DRG_Q21
How often (did you use heroin in the past 12 months)?
INTERVIEWER: Read categories to respondent.

1. Less than once a month
2. 1 to 3 times a month
3. Once a week
4. More than once a week
5. Every day
   DK, RF

DRG_Q22
Have you ever used or tried steroids, such as testosterone, dianabol or growth hormones, to increase your performance in a sport or activity or to change your physical appearance?

1. Yes, just once
2. Yes, more than once
3. No (Go to DRG_C25A_1)
   DK, RF (Go to DRG_C25A_1)

DRG_Q23
Have you used it in the past 12 months?

1. Yes
2. No (Go to DRG_C25A1)
   DK, RF (Go to DRG_C25A1)

DRG_C24
If DRG_Q22 = 1, go to DRG_C25A1.
Otherwise, go to DRG_Q24.

DRG_Q24
How often (did you use steroids in the past 12 months)?
INTERVIEWER: Read categories to respondent.

1. Less than once a month
2. 1 to 3 times a month
3. Once a week
4. More than once a week
5. Every day
   DK, RF

Note: DRG_C25A1 = Count of instances where DRG_Q01, DRG_Q04, DRG_Q07, DRG_Q10, DRG_Q13, DRG_Q16 and DRG_Q19 = 3, DK or RF.

DRG_C25A_1
If DRG_C25A1 = 7, go to DRG_END.
Otherwise, go to DRG_C25A_2.

Note: DRG_C25A2 = Count of instances where DRG_Q03, DRG_Q06, DRG_Q09, DRG_Q12, DRG_Q15, DRG_Q18 and DRG_Q21 >= 2.

DRG_C25A_2
If DRG_C25A_2 >= 1, go to DRG_Q25A.
Otherwise, go to DRG_END.

DRG_Q25A
During the past 12 months, did you ever need to use more drugs than usual in order to get high, or did you ever find that you could no longer get high on the amount you usually took?

1. Yes
2. No
   DK, RF

DRG_R25B
People who cut down their substance use or stop using drugs altogether may not feel well if they have been using steadily for some time. These feelings are more intense and can last longer than the usual hangover.
INTERVIEWER: Press <Enter> to continue.

DRG_Q25B
During the past 12 months, did you ever have times when you stopped, cut down or went without drugs and then experienced symptoms like fatigue, headaches, diarrhea, the shakes or emotional problems?

1. Yes
2. No
   DK, RF

DRG_Q25C
(During the past 12 months,) did you ever have times when you used drugs to keep from having such symptoms?

1. Yes
2. No
   DK, RF

DRG_Q25D
(During the past 12 months,) did you ever have times when you used drugs even though you promised yourself you wouldn’t, or times when you used a lot more drugs than you intended?

1. Yes
2. No
   DK, RF

DRG_Q25E
(During the past 12 months,) were there ever times when you used drugs more frequently, or for more days in a row than you intended?

1. Yes
2. No
   DK, RF

DRG_Q25F
(During the past 12 months,) did you ever have periods of several days or more when you spent so much time using drugs or recovering from the effects of using drugs that you had little time for anything else?

1. Yes
2. No
   DK, RF

DRG_Q25G
(During the past 12 months,) did you ever have periods of a month or longer when you gave up or greatly reduced important activities because of your use

1. Yes
2. No
   DK, RF

DRG_Q25H
(During the past 12 months,) did you ever continue to use drugs when you knew you had a serious physical or emotional problem that might have been caused by or made worse by your use?

1. Yes
2. No
   DK, RF

DRG_R26
Please tell me what number best describes how much your use of drugs interfered with each of the following activities during the past 12 months. For each activity, answer with a number between 0 and 10; 0 means "no interference", while 10 means "very severe interference".
INTERVIEWER: Press <Enter> to continue.

DRG_Q26A
How much did your use of drugs interfere with:
...your home responsibilities, like cleaning, shopping and taking care of the house or apartment?
0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

• Number
  (MIN: 0) (MAX: 10)
  DK, RF

DRG_Q26B_1
(How much did your use interfere with:)
...your ability to attend school?
0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference
INTERVIEWER: If necessary, enter "11" to indicate "Not applicable".

• Number
  (MIN: 0) (MAX: 11)
  DK, RF

DRG_Q26B_2
(How much did your use interfere with:)
...your ability to work at a regular job?
0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference
INTERVIEWER: If necessary, enter "11" to indicate "Not applicable".

• Number
  (MIN: 0) (MAX: 11)
  DK, RF

DRG_Q26C
(During the past 12 months,) how much did your use of drugs interfere with your ability to form and maintain close relationships with other people? Remember that 0 means "no interference" and 10 means "very severe interference".
0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

• Number
  (MIN: 0) (MAX: 10)
  DK, RF

DRG_Q26D
How much did your use of drugs interfere with your social life?
0 No interference
1 I
2 I
3 I
4 I
5 I
6 I
7 I
8 I
9 V
10 Very severe interference

• Number
  (MIN: 0) (MAX: 10)
  DK, RF

DRG_END

Sexual behaviours (SXB)

SXB_BEG
Theme content

SXB_C01A
If (do SXB block = 1), go to SXB_C01B.
Otherwise, go to SXB_END.

SXB_C01B
If proxy interview or age < 15 or > 49, go to SXB_END.
Otherwise, go to SXB_R01.

SXB_R01
I would like to ask you a few questions about sexual behaviour. We ask these questions because sexual behaviours can have very important and long-lasting effects on personal health. You can be assured that anything you say will remain confidential.
INTERVIEWER: Press <Enter> to continue.

SXB_Q01
Have you ever had sexual intercourse?

1. Yes
2. No (Go to SXB_END)
   DK, RF (Go to SXB_END)

SXB_Q02
How old were you the first time?
INTERVIEWER: Maximum is [current age].

• Age in years
  (MIN: 1) (MAX: Warning, value is below 12 or above current age)
  DK, RF (Go to SXB_END)

SXB_E02
The entered age at which the respondent first had sexual intercourse is invalid.
Please return and correct.

Note: Trigger hard edit if SXB_Q02 < 1 or SXB_Q02 > [current age].

SXB_Q03
In the past 12 months, have you had sexual intercourse?

1. Yes
2. No (Go to SXB_Q07)
   DK, RF (Go to SXB_END)

SXB_Q04
With how many different partners?

1. 1 partner
2. 2 partners
3. 3 partners
4. 4 or more partners
   DK
   RF (Go to SXB_END)

SXB_Q07
Have you ever been diagnosed with a sexually transmitted infection?

1. Yes
2. No
   DK, RF

SXB_C08A
If SXB_Q03 = 1 (had intercourse in last 12 months), go to SXB_C08C.
Otherwise, go to SXB_END.

SXB_C08C
If marital status = 1 (married) or 2 (common-law) and SXB_Q04 = 1 (one partner), go to SXB_C09B.
Otherwise, go to SXB_Q08.

SXB_Q08
Did you use a condom the last time you had sexual intercourse?

1. Yes
2. No
   DK, RF

SXB_C09B
If age > 24 or if respondent's sex = spouse's sex, go to SXB_END.
Otherwise, go to SXB_R9A.

SXB_R9A
Now a few questions about birth control.
INTERVIEWER: Press <Enter> to continue.

SXB_C09C
If sex = female, go to SXB_C09D.
Otherwise, go to SXB_R10.

SXB_C09D
If HWT_Q1 = 1 (currently pregnant), go to SXB_Q11.
Otherwise, go to SXB_R9B.

SXB_R9B
I’m going to read you a statement about pregnancy. Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly
INTERVIEWER: Press <Enter> to continue.

SXB_Q09
It is important to me to avoid getting pregnant right now.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
   DK
   RF (Go to SXB_END)

SXB_C10
If sex = male, go to SXB_R10.
Otherwise, go to SXB_Q11.

SXB_R10
I’m going to read you a statement about pregnancy. Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.
INTERVIEWER: Press <Enter> to continue.

SXB_Q10
It is important to me to avoid getting my partner pregnant right now.

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
6. Doesn’t have a partner right now
7. Partner already pregnant
   DK
   RF (Go to SXB_END)

SXB_Q11
In the past 12 months, did you and your partner usually use birth control?

1. Yes (Go to SXB_Q12)
2. No (Go to SXB_END)
   DK, RF (Go to SXB_END)

SXB_Q12
What kind of birth control did you and your partner usually use?
INTERVIEWER: Mark all that apply.

1. Condom (male or female condom)
2. Birth control pill
3. Diaphragm
4. Spermicide ( e.g. , foam, jelly, film)
5. Birth control injection (Deprovera)
6. Other - Specify (Go to SXB_S12)
   DK, RF (Go to SXB_END)
   Go to SXB_C13

SXB_S12
INTERVIEWER: Specify.
DK, RF

SXB_C13
If HWT_Q1 = 1 (currently pregnant) or SXB_Q10 = 7 (Partner already pregnant), go to SXB_END.
Otherwise, go to SXB_Q13.

SXB_Q13
What kind of birth control did you and your partner use the last time you had sex?
INTERVIEWER: Mark all that apply.

1. Condom (male or female condom)
2. Birth control pill
3. Diaphragm
4. Spermicide ( e.g. , foam, jelly, film)
5. Birth control injection (Deprovera)
6. Nothing
7. Other - Specify (Go to SXB_S13)
   DK, RF

Go to SXB_END

SXB_S13
INTERVIEWER: Specify.
DK, RF

SXB_END

Social Provisions (SPS)

SPS_BEG
Optional content block

• External variables required:
  PROXYMODE - proxy interview
  DOSPS: do block flag, from the sample file.
  PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
  Screen display:
  Display on header bar PE_Q01 and PE_Q02 separated by a space

SPS_C01
If DOSPS = 1, go to SPS_C02.
Otherwise, go to SPS_END.

SPS_C02
If PROXMODE=1, go to SPS_END.
Otherwise, go to SPS_R01.

SPS_R01
The next questions are about your current relationships with friends, family members, co-workers, community members, and so on. Please indicate to what extent each statement describes your current relationships with other people.
INTERVIEWER: Press <1> to continue.

SPS_Q01
There are people I can depend on to help me if I really need it.
INTERVIEWER: Read categories to respondent.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF (Go to SPS_END)

SPS_Q02
There are people who enjoy the same social activities I do.
INTERVIEWER: Read categories to respondent.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_Q03
I have close relationships that provide me with a sense of emotional security and wellbeing.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_Q04
There is someone I could talk to about important decisions in my life.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_Q05
I have relationships where my competence and skill are recognized.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_Q06
There is a trustworthy person I could turn to for advice if I were having problems.
INTERVIEWER: Read categories to respondent.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_Q07
I feel part of a group of people who share my attitudes and beliefs.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_Q08
I feel a strong emotional bond with at least one other person.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_Q09
There are people who admire my talents and abilities.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_Q10
There are people I can count on in an emergency.

1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
   DK, RF

SPS_END

Social support - Availability (SSA)

SSA_BEG
Optional Content (See Appendix 2)

SSA_C1
If (do SSA block = 1), go to SSA_C2.
Otherwise, go to SSA_END.

SSA_C2
If proxy interview, go to SSA_END.
Otherwise, go to SSA_R1.

SSA_R1
Next are some questions about the support that is available to you.
INTERVIEWER: Press <Enter> to continue.

SSA_Q01
Starting with a question on friendship, about how many close friends and close relatives do you have, that is, people you feel at ease with and can talk to about what is on your mind?

• Close friends
  (MIN: 0) (MAX: 99 ; warning after 20)
  DK, RF (Go to SSA_END)

SSA_R2
People sometimes look to others for companionship, assistance or other types of support.
INTERVIEWER: Press <Enter> to continue.

SSA_Q02
How often is each of the following kinds of support available to you if you need it:
INTERVIEWER: Read categories to respondent.

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF (Go to SSA_END)

Note: If SSA_Q02 = 2, 3, 4 or 5 then ^DT_KEYPHRASES21A = "to help you if you were confined to bed".

SSA_Q03
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q03 = 2, 3, 4 or 5 then ^DT_KEYPHRASES24A = "to listen to you".

SSA_Q04
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q04 = 2, 3, 4 or 5 then ^DT_KEYPHRASES24A = "to give you advice".

SSA_Q05
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q05 = 2, 3, 4 or 5 then ^DT_KEYPHRASES21A = "to take you to the doctor".

SSA_Q06
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q06 = 2, 3, 4 or 5 then ^DT_KEYPHRASES22A = "to show you affection".

SSA_Q07
Again, how often is each of the following kinds of support available to you if you need it:)
... someone to have a good time with?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q07 = 2, 3, 4 or 5 then ^DT_KEYPHRASES23A = "to have a good time with".

SSA_Q08
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q08 = 2, 3, 4 or 5 then ^DT_KEYPHRASES24A = "to give you information".

SSA_Q09
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q09 = 2, 3, 4 or 5 then ^DT_KEYPHRASES24A ="to confide in".

SSA_Q10
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q10 = 2, 3, 4 or 5 then ^DT_KEYPHRASES22A = "to hug you".

SSA_Q11
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q11 = 2, 3, 4 or 5 then ^DT_KEYPHRASES23A = "to relax with".

SSA_Q12
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q12 = 2, 3, 4 or 5 then ^DT_KEYPHRASES21A = "to prepare your meals".

SSA_Q13
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q13 = 2, 3, 4 or 5 then ^DT_KEYPHRASES24A = "to advise you".

SSA_Q14
Again, how often is each of the following kinds of support available to you if you need it:)
... someone to do things with to help you get your mind off things?

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q14 = 2, 3, 4 or 5 then ^DT_KEYPHRASES23A = "to do things with".

SSA_Q15
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q15 = 2, 3, 4 or 5 then ^DT_KEYPHRASES21A = "to help with daily chores".

SSA_Q16
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q16 = 2, 3, 4 or 5 then ^DT_KEYPHRASES24A = "to share your worries and fears with".

SSA_Q17
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q17 = 2, 3, 4 or 5 then ^DT_KEYPHRASES24A = "to turn to for suggestions".

SSA_Q18
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q18 = 2, 3, 4 or 5 then ^DT_KEYPHRASES23A = "to do something enjoyable with".

SSA_Q19
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q19 = 2, 3, 4 or 5 then ^DT_KEYPHRASES24A = "to understand your problems".

SSA_Q20
(How often is each of the following kinds of support available to you if you need it:)

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
   DK, RF

Note: If SSA_Q20 = 2, 3, 4 or 5 then ^DT_KEYPHRASES22A = "to love you and make you feel wanted".

Spiritual values (SPR)

SPR_BEG

SPR_C1
If (do SPR block = 1), go to SPR_C2.
Otherwise, go to SPR_END.

SPR_C2
If proxy interview, go to SPR_END.
Otherwise, go to SPR_R1.

SPR_D01
Create fields DV_RELTEXT (String 80) = SPR_Q5 and DV_RELCODE (0..9990) = SPR_Q5

SPR_R1
I now have a few questions about spiritual values in your life.
INTERVIEWER: Press <1> to continue.

SPR_Q1
Do spiritual values play an important role in your life?

1. Yes
2. No (Go to SPR_Q5)
   DK, RF (Go to SPR_END)

SPR_Q2
To what extent do your spiritual values:
...help you to find meaning in your life?
INTERVIEWER: Read categories to respondent.

1. A lot
2. Some
3. A little
4. Not at all
   DK, RF

SPR_Q3
(To what extent do your spiritual values:)
...give you the strength to face everyday difficulties?

1. A lot
2. Some
3. A little
4. Not at all
   DK, RF

SPR_Q4
(To what extent do your spiritual values:)
...help you to understand the difficulties of life?

1. A lot
2. Some
3. A little
4. Not at all
   DK, RF

SPR_Q5
What is your religion? Specify one denomination or religion only, even if you are not currently a practicing member of that group.
INTERVIEWER: Start typing the name of the religion to activate the search function.
Enter "Other - Specify" if the religion is not part of this list.
If no religion, enter "No religion".
Go to SPR_C5

Note: Call Trigram Search. Null is not allowed. Don't know and Refusal are allowed. The Search File to be used corresponds to the Excel file “Religion_LookUpList.xls".

The DV_RELCODE and the DV_RELTEXT are the two fields that should be displayed on the pop-up screen when the Search File is called. However, the corresponding DV_RELCODE also needs to be saved and used as the key to indicate exactly which unique entry in the Search File was selected ( i.e. , it is the code that differentiates between the English, French and other spelling variations of religion names).

SPR_C5
If DV_RELCODE=1 (Other - Specify), go to SPR_S5.
Otherwise, go to SPR_Q6.

SPR_S5
What is your religion?
INTERVIEWER: Specify.
DK, RF

SPR_Q6
Not counting events such as weddings or funerals, during the past 12 months, how often did you participate in religious activities or attend religious services or meetings?
INTERVIEWER: Read categories to respondent. Exclude special occasions like marriages, funerals, baptisms, bar mitzvahs, etc.

All respondents should be asked the religious participation question, even if they said that they were not affiliated with a religion. For example, some respondents who said that they had "no religion", may attend church services on special occasions ( e.g. At Christmas or Easter) with family members who said that they had a religious affiliation.

1. At least once a week
2. At least once a month
3. At least 3 times a year
4. Once or twice a year
5. Not at all
   DK, RF

SPR_Q6B
In the past 12 months, how often did you engage in religious or spiritual activities on your own, including prayer, meditation and other forms of worship  taking place at home or in any other location?
INTERVIEWER: Read categories to respondent.

1. At least once a day
2. At least once a week
3. At least once a month
4. At least 3 times a year
5. Once or twice a year
6. Not at all
   DK, R

SPR_Q7
In general, would you say that you are...?
INTERVIEWER: Read categories to respondent.

1. Very religious
2. Religious
3. Not very religious
4. Not religious at all
   DK, R

SPR_END

Consultations about mental health (CMH)

CMH_BEG
Theme content

CMH_C01A
If (CMH block = 1), go to CMH_C01B.
Otherwise, go to CMH_END.

CMH_C01B
If proxy interview, go to CMH_END.
Otherwise, go to CMH_R01K.

CMH_R01K
Now I would like to ask you some questions about mental and emotional well-
INTERVIEWER: Press <1> to continue.

CMH_Q01K
In the past 12 months, that is, from [date one year ago] to yesterday, have you seen or talked to a health professional about your emotional or mental health?

CMH_01K
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to CMH_END)
   DK, RF (Go to CMH_END)

CMH_Q01L
How many times (in the past 12 months)?

• Times
  (MIN: 1) (MAX: 366; warning after 25)
  DK, RF

CMH_E01L
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if CMH_Q01L >25.

CMH_Q01M
Whom did you see or talk to?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Family doctor or general practitioner
2. Psychiatrist
3. Psychologist
4. Nurse
5. Social worker or counsellor
6. Other - Specify (Go to CMH_S01M)
   DK, RF
   Go to CMH_END

CMH_S01M
INTERVIEWER: Specify.
DK, RF

CMH_E01M[1]
Inconsistent answers have been entered. The respondent has seen or talked with a family doctor or general practitioner in the past 12 months but previously reported that he/she did not. Please confirm.

Note: Trigger soft edit If CMH_Q01M = 1 (saw a family medical doctor) and CHP_Q03 = 2.

CMH_E01M[2]
Inconsistent answers have been entered. The respondent has seen or talked with a psychiatrist in the past 12 months but previously reported that he/she did not. Please confirm.

Note: Trigger soft edit If CMH_Q01M = 2 (saw a psychiatrist) and CHP_Q08 = 2.

CMH_E01M[3]
Inconsistent answers have been entered. The respondent has seen or talked with a psychologist in the past 12 months but previously reported that he/she did not. Please confirm.

Note: Trigger soft edit If CMH_Q01M = 3 (saw a psychologist) and CHP_Q20 = 2.

CMH_E01M[4]
Inconsistent answers have been entered. The respondent has seen or talked with a nurse in the past 12 months but previously reported that he/she did not. Please confirm.

Note: Trigger soft edit If CMH_Q01M = 4 (saw a nurse) and CHP_Q11 = 2.

CMH_E01M[5]
Inconsistent answers have been entered. The respondent has seen or talked with a social worker or counsellor in the past 12 months but previously reported that he/she did not. Please confirm.

Note: Trigger soft edit If CMH_Q01M = 5 (saw a social worker or counsellor) and CHP_Q22 = 2.

CMH_END

Distress (DIS)

DIS_BEG
Optional Content (See Appendix 2)

DIS_C1
If (do DIS block = 1), go to DIS_C2.
Otherwise, go to DIS_END.

DIS_C2
If proxy interview, go to DIS_END.
Otherwise, go to DIS_R01.

DIS_R01
The following questions deal with feelings you may have had during the past month.
INTERVIEWER: Press <Enter> to continue.

DIS_Q01A
During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:
... tired out for no good reason?
INTERVIEWER: Read categories to respondent.

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
   DK, RF (Go to DIS_END)

DIS_Q01B
During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:
... nervous?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time (Go to DIS_Q01D)
   DK, RF (Go to DIS_Q01D)

DIS_Q01C
(During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:)
... so nervous that nothing could calm you down?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
   DK, RF

Note: In processing, if a respondent answered DIS_Q01B = 5 (none of the time), the variable DIS_Q01C will be given the value of 5 (none of the time).

DIS_Q01D
(During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:)
... hopeless?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
   DK, RF

DIS_Q01E
During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:
... restless or fidgety?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time (Go to DIS_Q01G)
   DK, RF (Go to DIS_Q01G)

DIS_Q01F
(During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:)
... so restless you could not sit still?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
   DK, RF

Note: In processing, if a respondent answered DIS_Q01E = 5 (none of the time), the variable DIS_Q01F will be given the value of 5 (none of the time).

DIS_Q01G
(During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:)
... sad or depressed?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time (Go to DIS_Q01I)
   DK, RF (Go to DIS_Q01I)

DIS_Q01H
(During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:)
... so depressed that nothing could cheer you up?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
   DK, RF

Note: In processing, if a respondent answered DIS_Q01G = 5 (none of the time), the variable DIS_Q01H will be given the value of 5 (none of the time).

DIS_Q01I
(During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:)
... that everything was an effort?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
   DK, RF

DIS_Q01J
(During the past month, that is, from [date one month ago] to yesterday, about how often did you feel:)
... worthless?

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
   DK, RF

DIS_C01K
If DIS_Q01B to DIS_Q01J are DK or RF, go to DIS_END.
Otherwise, go to DIS_Q01K.

DIS_Q01K
We just talked about feelings that occurred to different degrees during the past month. Taking them altogether, did these feelings occur more often in the past month than is usual for you, less often than usual or about the same as usual?

1. More often
2. Less often (Go to DIS_Q01M)
3. About the same (Go to DIS_Q01N)
4. Never have had any (Go to DIS_END)
   DK, RF (Go to DIS_END)

DIS_Q01L
Is that a lot more, somewhat more or only a little more often than usual?

1. A lot
2. Somewhat
3. A little
   DK, RF
   Go to DIS_Q01N

DIS_Q01M
Is that a lot less, somewhat less or only a little less often than usual?

1. A lot
2. Somewhat
3. A little
   DK, RF

DIS_Q01N
During the past month, how much did these feelings usually interfere with your life or activities?
INTERVIEWER: Read categories to respondent.

1. A lot
2. Some
3. A little
4. Not at all
   DK, RF

DIS_END

Depression (DEP)

DEP_BEG
Optional Content (See Appendix 2)

DEP_C01

If (do DEP block = 1), go to DEP_C02.
Otherwise, go to DEP_END.

DEP_C02
If proxy interview, go to DEP_END.
Otherwise, go to DEP_Q02.

DEP_Q02
During the past 12 months, was there ever a time when you felt sad, blue, or depressed for 2 weeks or more in a row?

1. Yes
2. No (Go to DEP_Q16)
   DK, RF (Go to DEP_END)

DEP_Q03
For the next few questions, please think of the 2-week period during the past 12 months when these feelings were the worst. During that time, did these feelings usually last:

DPS_03
INTERVIEWER: Read categories to respondent.

1. ...all day long?
2. ...most of the day?
3. ...about half of the day? (Go to DEP_Q16)
4. ...less than half of a day? (Go to DEP_Q16)
   DK, RF (Go to DEP_END)

DEP_Q04
How often did you feel this way during those 2 weeks?
INTERVIEWER: Read categories to respondent.

1. Every day
2. Almost every day
3. Less often (Go to DEP_Q16)
   DK, RF (Go to DEP_END)

DEP_Q05
During those 2 weeks did you lose interest in most things?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D05
If DEP_Q05 = 1 (Yes), ^DT_KEYPHRASEQ05 = "Losing interest".
Otherwise, ^DT_KEYPHRASEQ05 = "null".

DEP_Q06
Did you feel tired out or low on energy all of the time?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D06
If DEP_Q06 = 1 (Yes), ^DT_KEYPHRASEQ06 = "Feeling tired".
Otherwise, ^DT_KEYPHRASEQ06 = "null".

DEP_Q07
Did you gain weight, lose weight or stay about the same?

1. Gained weight
2. Lost weight
3. Stayed about the same (Go to DEP_Q09)
4. Was on a diet (Go to DEP_Q09)
   DK, RF (Go to DEP_END)

DEP_D07A
If DEP_Q07 = 1, ^DT_KEYPHRASEQ07 = "Gaining weight".
If DEP_Q07 = 2, ^DT_KEYPHRASEQ07 = "Losing weight".
Otherwise, ^DT_KEYPHRASEQ07 = "null".

DEP_D07B
If DEP_Q07 = 1, ^DT_GAINLOST = "gain".
Otherwise, ^DT_GAINLOST = "lose".

DEP_Q08A
About how much did you ^DT_GAINLOST?
INTERVIEWER: Enter amount only.

• Weight
  MIN: 1) (MAX: 99)
  DK, RF
  (Go to DEP_Q09)

DEP_N08A
INTERVIEWER: Was that in pounds or in kilograms?

1. Pounds
2. Kilograms
   (DK, RF are not allowed)

DEP_E08A
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if (DEP_Q08A > 20 and DEP_N08A = 1 or DEP_Q08A > 9 and DEP_N08A = 2).

DEP_Q09
Did you have more trouble falling asleep than you usually do?

1. Yes
2. No (Go to DEP_Q11)
   DK, RF (Go to DEP_END)

DEP_D09
If DEP_Q09 = 1 (Yes), ^DT_KEYPHRASEQ09 = "Trouble falling asleep".
Otherwise, ^DT_KEYPHRASEQ09 = "null".

DEP_Q10
How often did that happen?
INTERVIEWER: Read categories to respondent.

1. Every night
2. Nearly every night
3. Less often
   DK, RF (Go to DEP_END)

DEP_Q11
Did you have a lot more trouble concentrating than usual?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D11
If DEP_Q11 = 1 (Yes), ^DT_KEYPHRASEQ11 = "Trouble concentrating".
Otherwise, ^DT_KEYPHRASEQ11 = "null".

DEP_Q12
At these times, people sometimes feel down on themselves, no good or worthless. Did you feel this way?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D12
If DEP_Q12 = 1 (Yes), ^DT_KEYPHRASEQ12 = "Feeling down on yourself".
Otherwise, ^DT_KEYPHRASEQ12 = "null".

DEP_Q13
Did you think a lot about death - either your own, someone else’s or death in general?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D13
If DEP_Q13 = 1 (Yes), ^DT_KEYPHRASEQ13 = "Thoughts about death".
Otherwise, ^DT_KEYPHRASEQ13 = "null".

DEP_C14
If "Yes" in DEP_Q05, DEP_Q06, DEP_Q09, DEP_Q11, DEP_Q12 or DEP_Q13, or
DEP_Q07 is "gain" or "lose", go to DEP_R14.
Otherwise, go to DEP_END.

DEP_R14
Reviewing what you just told me, you had 2 weeks in a row during the past 12 months when you were sad, blue or depressed and also had some other things like (^DT_KEYPHRASEQ05, ^DT_KEYPHRASEQ06, ^DT_KEYPHRASEQ07, ^DT_KEYPHRASEQ09, ^DT_KEYPHRASEQ11, ^DT_KEYPHRASEQ12, ^DT_KEYPHRASEQ13).
INTERVIEWER: Press <Enter> to continue.

DEP_Q14
About how many weeks altogether did you feel this way during the past 12

•  (MIN: 2) (MAX: 53)
  DK, RF
  (Go to DEP_END)

DEP_C15
If DEP_Q14 > 51 weeks, go to DEP_END.
Otherwise, go to DEP_Q15.

DEP_Q15
Think about the last time you felt this way for 2 weeks or more in a row. In what month was that?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
    DK, RF
    Go to DEP_END

DEP_Q16
During the past 12 months, was there ever a time lasting 2 weeks or more when you lost interest in most things like hobbies, work or activities that usually give you pleasure?

1. Yes
2. No (Go to DEP_END)
   DK, RF (Go to DEP_END)

DEP_Q17
For the next few questions, please think of the 2-week period during the past 12 months when you had the most complete loss of interest in things. During that 2-week period, how long did the loss of interest usually last?
INTERVIEWER: Read categories to respondent.

1. All day long
2. Most of the day
3. About half of the day (Go to DEP_END)
4. Less than half of a day (Go to DEP_END)
   DK, RF (Go to DEP_END)

DEP_Q18
How often did you feel this way during those 2 weeks?
INTERVIEWER: Read categories to respondent.

1. Every day
2. Almost every day
3. Less often (Go to DEP_END)
   DK, RF (Go to DEP_END)

DEP_Q19
During those 2 weeks did you feel tired out or low on energy all the time?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D19
If DEP_Q19 = 1 (Yes), ^DT_KEYPHRASEQ19 = "Feeling tired".
Otherwise, ^DT_KEYPHRASEQ19 = "null".

DEP_Q20
Did you gain weight, lose weight, or stay about the same?

1. Gained weight
2. Lost weight
3. Stayed about the same (Go to DEP_Q22)
4. Was on a diet (Go to DEP_Q22)
   DK, RF (Go to DEP_END)

DEP_D20A
If DEP_Q20 = 1, ^DT_KEYPHRASEQ20 = "Gaining weight".
If DEP_Q20 = 2, ^DT_KEYPHRASEQ20 = "Losing weight".
Otherwise, ^DT_KEYPHRASEQ20 = "null".

DEP_D20B
If DEP_Q20 = 1, ^DT_WEIGHT = "gain".
Otherwise, ^DT_WEIGHT = "lose".

DEP_Q21A
About how much did you ^DT_WEIGHT?
INTERVIEWER: Enter amount only.

• Weight
  (MIN: 1) (MAX: 99)
  DK, RF
  (Go to DEP_Q22)

DEP_N21A
INTERVIEWER: Was that in pounds or in kilograms?

1. Pounds
2. Kilograms
   (DK, RF are not allowed)

DEP_E21A
An unusual value has been entered. Please confirm.
Note: Trigger soft edit if (DEP_Q21A > 20 and DEP_N21A = 1 or DEP_Q21A > 9 and DEP_N21A = 2).

DEP_Q22
Did you have more trouble falling asleep than you usually do?

1. Yes
2. No (Go to DEP_Q24)
   DK, RF (Go to DEP_END)

DEP_D22
If DEP_Q22 = 1 (Yes), ^DT_KEYPHRASEQ22 = "Trouble falling asleep".
Otherwise, ^DT_KEYPHRASEQ22 = "null".

DEP_Q23
How often did that happen?
INTERVIEWER: Read categories to respondent.

1. Every night
2. Nearly every night
3. Less often
   DK, RF (Go to DEP_END)

DEP_Q24
Did you have a lot more trouble concentrating than usual?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D24
If DEP_Q24 = 1 (Yes), ^DT_KEYPHRASEQ24 = "Trouble concentrating".
Otherwise, ^DT_KEYPHRASEQ24 = "null".

DEP_Q25
At these times, people sometimes feel down on themselves, no good, or worthless. Did you feel this way?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D25
If DEP_Q25 = 1 (Yes), ^DT_KEYPHRASEQ25 = "Feeling down on yourself".
Otherwise, ^DT_KEYPHRASEQ25 = "null".

DEP_Q26
Did you think a lot about death - either your own, someone else’s, or death in general?

1. Yes
2. No
   DK, RF (Go to DEP_END)

DEP_D26
If DEP_Q26 = 1 (Yes), ^DT_KEYPHRASEQ26 = "Thoughts about death".
Otherwise, ^DT_KEYPHRASEQ26 = "null".

DEP_C27
If any "Yes" in DEP_Q19, DEP_Q22, DEP_Q24, DEP_Q25 or DEP_Q26, or DEP_Q20 is "gain" or "lose", go to DEP_R27.
Otherwise, go to DEP_END.

DEP_R27
Reviewing what you just told me, you had 2 weeks in a row during the past 12 months when you lost interest in most things and also had some other things like (^DT_KEYPHRASEQ19, ^DT_KEYPHRASEQ20, ^DT_KEYPHRASEQ22, ^DT_KEYPHRASEQ24, ^DT_KEYPHRASEQ25, ^DT_KEYPHRASEQ26).
INTERVIEWER: Press <Enter> to continue.

DEP_Q27
About how many weeks did you feel this way during the past 12 months?

• Weeks
  (MIN: 2) (MAX: 53)
  DK, RF
  (Go to DEP_END)

DEP_C28
If DEP_Q27 > 51, go to DEP_END.
Otherwise, go to DEP_Q28.

DEP_Q28
Think about the last time you had 2 weeks in a row when you felt this way. In what month was that?

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
    DK, RF

DEP_END

Suicidal thoughts and attempts (SUI)

SUI_BEG
Optional Content (See Appendix 2)

SUI_C1A
If (do SUI block = 2), go to SUI_END.
Otherwise, go to SUI_C1B.

SUI_C1B
If proxy interview or if age < 15, go to SUI_END.
Otherwise, go to SUI_R1.

SUI_R1
The following questions relate to the sensitive issue of suicide.
INTERVIEWER: Press <Enter> to continue.

SUI_Q1
Have you ever seriously considered committing suicide or taking your own life?

1. SUI_1
2. Yes
3. No (Go to SUI_END)
   DK, RF (Go to SUI_END)

SUI_Q2
Has this happened in the past 12 months?

1. Yes
2. No (Go to SUI_END)
   DK, RF (Go to SUI_END)

SUI_Q3
Have you ever attempted to commit suicide or tried taking your own life?

1. Yes
2. No (Go to SUI_END)
   DK, RF (Go to SUI_END)

SUI_Q4
Did this happen in the past 12 months?

1. Yes
2. No (Go to SUI_END)
   DK, RF (Go to SUI_END)

SUI_Q5
Did you see or talk to a health professional following your attempt to commit suicide?
INTERVIEWER: Include both face to face and telephone contacts.

1. Yes
2. No (Go to SUI_END)
   DK, RF (Go to SUI_END)

SUI_Q6
Whom did you see or talk to?

INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Family doctor or general practitioner
2. Psychiatrist
3. Psychologist
4. Nurse
5. Social worker or counsellor
6. Religious or spiritual advisor such as a priest, chaplain or
7. Teacher or guidance counsellor
8. Other
   DK, RF

SUI_END

Access to health care services (ACC)

ACC_BEG
Theme content. Only asked of a sub-sample.

ACC_C1
If (do ACC block = 1), go to ACC_C2.
Otherwise, go to ACC_END.

ACC_C2
If proxy interview or if age < 15, go to ACC_END.
Otherwise, go to ACC_D10.

ACC_D10
If respondent is male, ^DT_SPECIALIST = "urologist".
Otherwise, ^DT_SPECIALIST = "gynaecologist".

ACC_R10
The next questions are about the use of various health care services.

I will start by asking about your experiences getting health care from a medical specialist such as a cardiologist, allergist, ^DT_SPECIALIST or psychiatrist (excluding an optometrist)
INTERVIEWER: Press <1> to continue.

ACC_Q10
In the past 12 months, did you require a visit to a medical specialist for a diagnosis or a consultation?

1. Yes
2. No (Go to ACC_R20)
   DK, RF (Go to ACC_R20)

ACC_Q11
In the past 12 months, did you ever experience any difficulties getting the specialist care you needed for a diagnosis or consultation?

1. Yes
2. No (Go to ACC_R20)
   DK, RF (Go to ACC_R20)

ACC_Q12
What type of difficulties did you experience?

INTERVIEWER: Mark all that apply.

1. Difficulty getting a referral
2. Difficulty getting an appointment
3. No specialists in the area
4. Waited too long - between booking appointment and visit
5. Waited too long - to see the doctor ( i.e. in-office waiting)
6. Transportation - problems
7. Language - problem
8. Cost
9. Personal or family responsibilities
10. General deterioration of health
11. Appointment cancelled or deferred by specialist
12. Still waiting for visit
13. Unable to leave the house because of a health problem
14. Other - Specify (Go to ACC_S12)
    DK, RF
    Go to ACC_R20

ACC_S12
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_R20
The following questions are about any surgery not provided in an emergency that you may have required, such as cardiac surgery, joint surgery, like knee or hip, caesarean sections and cataract surgery, excluding laser eye surgery.
INTERVIEWER: Press <1> to continue.

ACC_Q20
In the past 12 months, did you require any non-emergency surgery?

1. Yes
2. No (Go to ACC_R30)
   DK, RF (Go to ACC_R30)

ACC_Q21
In the past 12 months, did you ever experience any difficulties getting the surgery you needed?

1. Yes
2. No (Go to ACC_R30)
   DK, RF (Go to ACC_R30)

ACC_Q22
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty getting an appointment with a surgeon
2. Difficulty getting a diagnosis
3. Waited too long - for a diagnostic test
4. Waited too long - for a hospital bed to become available
5. Waited too long - for surgery
6. Service not available - in the area
7. Transportation - problems
8. Language - problem
9. Cost
10. Personal or family responsibilities
11. General deterioration of health
12. Appointment cancelled or deferred by surgeon or hospital
13. Still waiting for surgery
14. Unable to leave the house because of a health problem
15. Other - Specify (Go to ACC_S22)
    DK, RF
    Go to ACC_R30

ACC_S22
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_R30
Now some questions about MRIs, CAT Scans and angiographies provided in a non-emergency situation.
INTERVIEWER: Press <1> to continue.

ACC_Q30
In the past 12 months, did you require one of these tests?

1. Yes
2. No (Go to ACC_D40)
   DK, RF (Go to ACC_D40)

ACC_Q31
In the past 12 months, did you ever experience any difficulties getting the tests you needed?

1. Yes
2. No (Go to ACC_D40)
   DK, RF (Go to ACC_D40)

ACC_Q32
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty getting a referral
2. Difficulty getting an appointment
3. Waited too long - to get an appointment
4. Waited too long - to get test ( i.e. in-office waiting)
5. Service not available - at time required
6. Service not available - in the area
7. Transportation - problems
8. Language - problem
9. Cost
10. General deterioration of health
11. Did not know where to go ( i.e. information problems)
12. Still waiting for test
13. Unable to leave the house because of a health problem
14. Other - Specify (Go to ACC_S32)
    DK, RF
    Go to ACC_D40

ACC_S32
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_D40
If one person household then ^DT_YourFamily = " "
If one person household, ^DT_Family = "you"
Else, ^DT_YourFamily = "for yourself or a family member"
Else, ^DT_Family = "you or a family member"

ACC_C40
If If one person household, go to ACC_R40B.
Otherwise go to ACC_R40., go to ACC_R40B.
Otherwise, go to ACC_R40.

ACC_R40
Now I’d like you to think about yourself and family members living in your dwelling.
The next questions are about your experiences getting health information or advice when you needed it for yourself or a family member living in your dwelling.
INTERVIEWER: Press <1> to continue.
Go to ACC_Q40

ACC_R40B
The next questions are about your experiences getting health information or advice when you needed it.
INTERVIEWER: Press <1> to continue.

ACC_Q40
In the past 12 months, have you required health information or advice ^DT_YourFamily?

1. Yes
2. No (Go to ACC_R50)
   DK, RF (Go to ACC_R50)

ACC_Q40A
Who did you contact when you needed health information or advice ^DT_YourFamily?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Doctor’s office
2. Community health centre / CLSC
3. Walk-in clinic
4. Telephone health line (for example, HealthLinks, Telehealth Ontario, Health-Line, TeleCare, Info-Santé)
5. Hospital emergency room
6. Other hospital service
7. Other - Specify (Go to ACC_S40A)
   DK, RF
   Go to ACC_Q41

ACC_S40A
Who did you contact when you needed health information or advice ^DT_YourFamily?
INTERVIEWER: Specify.
DK, RF

ACC_Q41
In the past 12 months, did you ever experience any difficulties getting the health information or advice ^DT_YourFamily?

1. Yes
2. No (Go to ACC_C50)
   DK, RF (Go to ACC_C50)

ACC_Q42
Did you experience difficulties during “regular” office hours (that is, 9:00 am to 5:00 pm, Monday to Friday)?
INTERVIEWER: It is important to make a distinction between "No" (Did not experience problems) and "Did not require at this time".

1. Yes
2. No (Go to ACC_Q44)
3. Not required at this time (Go to ACC_Q44)
   DK, RF (Go to ACC_Q44)

ACC_Q43
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty contacting a physician or nurse
2. Did not have a phone number
3. Could not get through ( i.e. no answer)
4. Waited too long to speak to someone
5. Did not get adequate info or advice
6. Language - problem
7. Did not know where to go / call / uninformed
8. Unable to leave the house because of a health problem
9. Other - Specify (Go to ACC_S43)
   DK, RF
   Go to ACC_Q44

ACC_S43
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_Q44
Did you experience difficulties getting health information or advice during evenings and weekends (that is, 5:00 to 9:00 pm Monday to Friday, or 9:00 am to 5:00 pm, Saturdays and Sundays)?
INTERVIEWER: It is important to make a distinction between "No" (Did not experience problems) and "Did not require at this time".

1. Yes
2. No (Go to ACC_Q46)
3. Not required at this time (Go to ACC_Q46)
   DK, RF (Go to ACC_Q46)

ACC_Q45
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty contacting a physician or nurse
2. Did not have a phone number
3. Could not get through ( i.e. no answer)
4. Waited too long to speak to someone
5. Did not get adequate info or advice
6. Language - problem
7. Did not know where to go / call / uninformed
8. Unable to leave the house because of a health problem
9. Other - Specify (Go to ACC_S45)
   DK, RF
   Go to ACC_Q46

ACC_S45
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_Q46
Did you experience difficulties getting health information or advice during the middle of the night?
INTERVIEWER: It is important to make a distinction between "No" (Did not experience problems) and "Did not require at this time".

1. Yes
2. No (Go to ACC_C50)
3. Not required at this time (Go to ACC_C50)

DK, RF (Go to ACC_C50)

ACC_Q47
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty contacting a physician or nurse
2. Did not have a phone number
3. Could not get through ( i.e. no answer)
4. Waited too long to speak to someone
5. Did not get adequate info or advice
6. Language - problem
7. Did not know where to go / call / uninformed
8. Unable to leave the house because of a health problem
9. Other - Specify (Go to ACC_S47)
   DK, RF
   Go to ACC_C50

ACC_S47
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_C50
If If one person household, go to ACC_R50B
Otherwise, go to ACC_R50, go to ACC_R50B.
Otherwise, go to ACC_R50.

ACC_R50
Now some questions about your experiences when you needed health care services for routine or on-going care such as a medical exam or follow-up for yourself or a family member living in your dwelling.
INTERVIEWER: Press <1> to continue.
Go to ACC_Q50A

ACC_R50B
Now some questions about your experiences when you needed health care services for routine or on-going care such as a medical exam or follow-up.
INTERVIEWER: Press <1> to continue.

ACC_Q50A
Do you have a regular family doctor?

1. Yes
2. No
   DK, RF

ACC_Q50
In the past 12 months, did you require any routine or on-going care ^DT_YourFamily?

1. Yes
2. No (Go to ACC_R60)
   DK, RF (Go to ACC_R60)

ACC_Q51
In the past 12 months, did you ever experience any difficulties getting the routine or on- going ^DT_Family needed?

1. Yes
2. No (Go to ACC_R60)
   DK, RF (Go to ACC_R60)

ACC_Q52
Did you experience difficulties getting such care during "regular" office hours (that is, 9:00 am to 5:00 pm, Monday to Friday)?
INTERVIEWER: It is important to make a distinction between "No" (Did not experience problems) and "Did not require at this time".

1. Yes
2. No (Go to ACC_Q54)
3. Not required at this time (Go to ACC_Q54)
   DK, RF (Go to ACC_Q54)

ACC_Q53
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty contacting a physician
2. Difficulty getting an appointment
3. Do not have personal / family physician
4. Waited too long - to get an appointment
5. Waited too long - to see the doctor ( i.e. in-office waiting)
6. Service not available - at time required
7. Service not available - in the area
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go ( i.e. information problems)
12. Unable to leave the house because of a health problem
13. Other - Specify (Go to ACC_S53)
    DK, RF
    Go to ACC_Q54

ACC_S53
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_Q54
Did you experience difficulties getting such care during evenings and weekends (that is, 5:00 to 9:00 pm, Monday to Friday or 9:00 am to 5:00 pm, Saturdays and Sundays)?
INTERVIEWER: It is important to make a distinction between "No" (Did not experience problems) and "Did not require at this time".

1. Yes
2. No (Go to ACC_R60)
3. Not required at this time (Go to ACC_R60)
   DK, RF (Go to ACC_R60)

ACC_Q55
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty contacting a physician
2. Difficulty getting an appointment
3. Do not have personal / family physician
4. Waited too long - to get an appointment
5. Waited too long - to see the doctor ( i.e. in-office waiting)
6. Service not available - at time required
7. Service not available - in the area
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go ( i.e. information problems)
12. Unable to leave the house because of a health problem
13. Other - Specify (Go to ACC_S55)
    DK, RF
    Go to ACC_R60

ACC_S55
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_R60
The next questions are about situations when ^DT_Family have needed immediate care for a minor health problem such as fever, headache, a sprained ankle, vomiting or an unexplained rash.
INTERVIEWER: Press <1> to continue.

ACC_Q60
In the past 12 months, did ^DT_Famiily require immediate health care services for a minor health problem?

1. Yes
2. No (Go to ACC_END)
   DK, RF (Go to ACC_END)

ACC_Q61
In the past 12 months, did you ever experience any difficulties getting the immediate care needed for a minor health problem ^DT_YourFamily?

1. Yes
2. No (Go to ACC_END)
   DK, RF (Go to ACC_END)

ACC_Q62
Did you experience difficulties getting such care during “regular” office hours (that is, 9:00 am to 5:00 pm, Monday to Friday)?
INTERVIEWER: It is important to make a distinction between "No" (Did not experience problems) and "Did not require at this time".

1. Yes
2. No (Go to ACC_Q64)
3. Not required at this time (Go to ACC_Q64)
   DK, RF (Go to ACC_Q64)

ACC_Q63
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty contacting a physician
2. Difficulty getting an appointment
3. Do not have personal / family physician
4. Waited too long - to get an appointment
5. Waited too long - to see the doctor ( i.e. in-office waiting)
6. Service not available - at time required
7. Service not available - in the area
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go ( i.e. information problems)
12. Unable to leave the house because of a health problem
13. Other - Specify (Go to ACC_S63)
    DK, RF
    Go to ACC_Q64

ACC_S63
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_Q64
Did you experience difficulties getting such care during evenings and weekends (that is, 5:00 to 9:00 pm, Monday to Friday or 9:00 am to 5:00 pm, Saturdays and Sundays)?
INTERVIEWER: It is important to make a distinction between "No" (Did not experience problems) and "Did not require at this time".

1. Yes
2. No (Go to ACC_Q66)
3. Not required at this time (Go to ACC_Q66)
   DK, RF (Go to ACC_Q66)

ACC_Q65
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty contacting a physician
2. Difficulty getting an appointment
3. Do not have personal / family physician
4. Waited too long - to get an appointment
5. Waited too long - to see the doctor ( i.e. in-office waiting)
6. ervice not available - at time required
7. Service not available - in the area
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go ( i.e. information problems)
12. Unable to leave the house because of a health problem
13. Other - Specify (Go to ACC_S65)
    DK, RF
    Go to ACC_Q66

ACC_S65
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_Q66
Did you experience difficulties getting such care during the middle of the night?
INTERVIEWER: It is important to make a distinction between "No" (Did not experience problems) and "Did not require at this time".

1. Yes
2. No (Go to ACC_END)
3. Not required at this time (Go to ACC_END)
   DK, RF (Go to ACC_END)

ACC_Q67
What type of difficulties did you experience?
INTERVIEWER: Mark all that apply.

1. Difficulty contacting a physician
2. Difficulty getting an appointment
3. Do not have personal / family physician
4. Waited too long - to get an appointment
5. Waited too long - to see the doctor ( i.e. in-office waiting)
6. Service not available - at time required
7. Service not available - in the area
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go ( i.e. information problems)
12. Unable to leave the house because of a health problem
13. Other - Specify (Go to ACC_S67)
    DK, RF
    Go to ACC_END

ACC_S67
What type of difficulties did you experience?
INTERVIEWER: Specify.
DK, RF

ACC_END

Labour force (LBS)

LF2_BEG
Core content

LF2_C1A
If (do LF2 block = 1), go to LF2_C1B.
Otherwise, go to LF2_END.

LF2_C1B
If age < 15 or age > 75, go to LF2_END.
Otherwise, go to LF2_R1.

LF2_R1
The next questions concern ^YOUR2 activities in the last 7 days. By the last 7 days, I mean beginning [date one week ago], and ending [date yesterday].
INTERVIEWER: Press <Enter> to continue.

LF2_Q1
Last week, did ^YOU2 work at a job or a business? Please include part-time jobs, seasonal work, contract work, self-employment, baby-sitting and any other paid work, regardless of the number of hours worked.

LBS_01

1. Yes
2. No
3. Permanently unable to work (Go to LF2_END)
   DK, RF (Go to LF2_END)

LF2_E1
A response inconsistent with a response to a previous question has been entered. Please confirm.

Note: Trigger soft edit if GEN_Q08 = 2 (did not work at any time in past 12 months) and LF2_Q1 = 1.

LF2_C2
If LF2_Q1 = 1, go to LF2_Q3.
Otherwise, go to LF2_Q2.

LF2_Q2
Last week, did ^YOU2 have a job or business from which ^YOU1 ^WERE absent?

1. Yes
2. No (Go to LF2_Q4)
   DK, RF (Go to LF2_END)

LF2_Q3
Did ^YOU1 have more than one job or business last week?

1. Yes
2. No
   DK, RF
   Go to LF2_D5

LF2_Q4
In the past 4 weeks, did ^YOU2 do anything to find work?

1. Yes
2. No
   DK, RF
   Go to LF2_END

LF2_D5
(not applicable)

LF2_R5
The next questions are about ^YOUR1 current job or business.
INTERVIEWER: If person currently holds more than one job, report on the job for which the number of hours worked per week is the greatest.
Press <Enter> to continue.

LF2_Q31
^ARE_C ^YOU1 an employee or self-employed?

1. Employee (Go to LF2_Q33)
2. Self-employed
3. Working in a family business without pay (Go to LF2_Q33)
   DK, RF (Go to LF2_Q33)

LF2_Q32
What is the name of ^YOUR1 business?

LF2_32
DK, RF
Go to LF2_Q34

LF2_Q33
For whom ^DOVERB ^YOU1 currently work? (For example: name of business, government department or agency, or person)
DK, RF

LF2_Q34
What kind of business, industry or service is this? (For example: cardboard box , road maintenance, retail shoe store, secondary school, dairy manufacturing

LF2_34
DK, RF

LF2_Q35
What kind of work ^ARE ^YOU1 doing? (For example: babysitting in own home, factory worker, forestry technician)
DK, RF

Note: Use trigram search, source file is PrepSOC.tdf

LF2_D35
SIC_CODE (4 bytes)

Note: Store SOC Code associated with LF2_Q35

LF2_C35
If LF2_D35 = 1 or LF2_D35 = 2 (OtherSpec), go to LF2_S35.
Otherwise, go to LF2_Q36.

LF2_S35
INTERVIEWER: Specify.
DK, RF

LF2_Q36
What are ^YOUR1 most important activities or duties? (For example: caring for children, stamp press machine operator, forest examiner)
DK, RF

LF2_Q5
About how many hours a week ^DOVERB ^YOU1 usually work at ^YOUR1 job or business? If ^YOU2 usually work^S extra hours, paid or unpaid, please include these hours.

LBS_42

• Hours
  (MIN: 1) (MAX: 168; warning after 84)
  DK, RF

LF2_C7
If LF2_Q3 = 1, go to LF2_Q7.
Otherwise, go to LF2_END.

LF2_Q7
You indicated that ^YOU2 ^HAVE more than one job.

LBS_53
About how many hours a week ^DOVERB ^YOU1 usually work at ^YOUR1 other job(s)? If ^YOU2 usually work^S extra hours, paid or unpaid, please include these hours.
INTERVIEWER: Minimum is 1; maximum is [168 - LF2_Q5].

• Hours
  (MIN: 1) (MAX: 168 - LF2_Q5; warning after 30)
  DK, RF

Note: If LF2_Q5 = 168, then maximum = 1.
If LF2_Q5 = DK or RF, then maximum = 168.

LF2_END

Loss of Productivity (LOP)

LOP_BEG
Theme content

External variables required:

• PROXMODE: proxy identifier, from the GR block.
  DOLOP: do block flag, from the sample file.
  GEN_Q08: worked at a job or business in the past 12 month
  Age of respondent

LOP_C010
If (do LOP = 1), go to LOP_C011.
Otherwise, go to LOP__END.

LOP_C011
If proxy interview, go to LOP_END.
Otherwise, go to LOP_C011A.

LOP_C011A
If age < 15 or age > 75, go to LOP_END.
Otherwise, go to LOP_C012.

LOP_C012
If GEN_Q08 = 2 (did not work in the past 12 months), go to LOP_Q020.
Otherwise, go to LOP_Q015.

LOP_Q015
Did you work at a job or a business at any time in the past three months?
INTERVIEWER: Include only paid job or business.

1. Yes (Go to LOP_R030)
2. No
   DK, RF (Go to LOP_END)

LOP_Q020
What is the main reason that you have not worked at a job or business in the past three months?

LOP_020
INTERVIEWER: If respondent wants to report more that one reason, ask for the main one.

1. Chronic physical or mental health condition diagnosed by a health professional
2. Own injury such as broken bone, bad cut, burn or sprain
3. Own infectious disease such as a cold, flu or stomach flu
4. Other reason related to physical or mental health
5. Caring for own children
6. Caring for elderly relative(s)
7. Maternity, paternity or parental leave
8. Education, training or school
9. Temporary lay-off
10. Strike or lockout
11. Retired
12. Other
    DK, RF

LOP_C020
If LOP_Q020 = 01, go to LOP_Q050.
Otherwise, go to LOP_END.

LOP_R030
The next questions are about absence from work because of your OWN health. Please include consultations with health professionals, but exclude absences because of the health of another person.
INTERVIEWER: Press <1> to continue.

LOP_Q030
In the past three months, that is from [date three months ago] to yesterday, have you missed any days at work because of a chronic health condition?
By chronic condition, we mean a long-term physical or mental condition that is expected to last or have already lasted 6 months or more and that has been diagnosed by a health professional.

1. Yes
2. No (Go to LOP_Q060)
   DK, RF (Go to LOP_Q060)

LOP_Q040
How many days of work have you missed because of a chronic condition?
INTERVIEWER: Don't enter days for which time has been made up. Enter 1 day if respondent reports less than one day.

• (MIN: 1) (MAX: 90)
  DK, RF

LOP_Q050
Which chronic condition is this?
INTERVIEWER: If the respondent wants to report more than one condition, probe for the main reason or the one that has required the highest number of days of absence.

1. Arthritis (such as rheumatoid arthirtis, osteoarthritis, lupus or gout)
2. Osteoporosis
3. Cardiovascular disease (including stroke and hypertension)
4. Kidney disease
5. Asthma
6. Chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD)
7. Diabetes
8. Migraine
9. Back problems
10. Cancer
11. Mental illnesses (such as depression bipolar disorder, mania or schizophrenia)
12. Neurological diseases (such as alzheimer, dementia, parkinson's disease, multiple sclerosis, spina bifida)
13. Digestive diseases (such as celiac disease, irritable bowel syndrome, stomach ulcers)
14. Fibromyalgia, chronic fatigue syndrome or multiple chemical sensitivities
15. Other - Specify (Go to LOP_S050)
    DK, RF
    Go to LOP_C060

LOP_S050
INTERVIEWER: Specify.
DK, RF
Go to LOP_C060

LOP_C060
If LOP_Q020 = 1, go to LOP_END.
Otherwise, go to LOP_Q060.

LOP_Q060
In the past three months, have you missed any days at work because of an injury such as a broken bone, a bad cut, a burn or a sprain?

1. Yes
2. No (Go to LOP_Q080)
   DK, RF (Go to LOP_Q080)

LOP_Q070
How many days of work have you missed (because of an injury)?
INTERVIEWER: Don't enter days for which time has been made up. Enter 1 day if respondent reports less than one day.
(MIN: 1) (MAX: 90)
DK, RF

LOP_Q080
In the past three months, have you missed any days at work because of an infectious disease such as a cold, a stomach flu or a respiratory infection?

1. Yes
2. No (Go to LOP_Q090)
   DK, RF (Go to LOP_Q090)

LOP_Q081
Which infectious disease was this?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. Cold
2. Flu or influenza
3. Stomach flu
4. Respiratory infection
5. Other
   DK, RF (Go to LOP_Q090)
   Go to LOP_C082

LOP_C082
If LOP_Q081 = 1, go to LOP_Q082.
Otherwise, go to LOP_C083.

LOP_Q082
How many days of work have you missed because of a cold?
INTERVIEWER: Symptoms of a cold include a runny nose, congestion and a cough. Don't enter days for which time has been made up.

• (MIN: 1) (MAX: 90)
  DK, RF

LOP_C083
If LOP_Q081=2, go to LOP_Q083.
Otherwise, go to LOP_C084.

LOP_Q083
How many days of work have you missed because of a flu or influenza?
INTERVIEWER: Symptoms of influenza include fever, headache and body aches. Don't enter days for which time has been made up.

• (MIN: 1) (MAX: 90)
  DK, RF

LOP_C084
If LOP_Q081=3, go to LOP_Q084.
Otherwise, go to LOP_C085.

LOP_Q084
How many days of work have you missed because of a stomach flu?
INTERVIEWER: Symptoms of stomach flu include nausea, vomitting, stomach cramps and diarrhea. Don't enter days for which time has been made up.

• (MIN: 1) (MAX: 90)
  DK, RF

LOP_C085
If LOP_Q081=4, go to LOP_Q085.
Otherwise, go to LOP_C086.

LOP_Q085
How many days of work have you missed because of another respiratory infection such as pneumonia or bronchitis?
INTERVIEWER: Don't enter days for which time has been made up.

• (MIN: 1) (MAX: 90)
  DK, RF

LOP_C086
If LOP_Q081=5, go to LOP_Q086.
Otherwise, go to LOP_Q090.

LOP_Q086
How many days of work have you missed because of any other infectious disease?
INTERVIEWER: Don't enter days for which time has been made up.

• (MIN: 1) (MAX: 90)
  DK, RF

LOP_Q090
In the past three months, have you been absent from work because of any other reason related to your physical or mental health?

1. Yes (Go to LOP_Q100)
2. No (Go to LOP_END)
   DK, RF (Go to LOP_END)

LOP_Q100
How many days of work have you missed because of another reason related to your own physical or mental health?
INTERVIEWER: Don’t enter days for which time has been made up. Enter 1 day if respondent reports less than one day.

• (MIN: 1) (MAX: 90)
  DK, RF

LOP_END

Socio-demographic characteristics (SDC)

SDC_BEG
Core content

SDC_C1
If (do SDC block = 1), go to SDC_R1.
Otherwise, go to SDC_END.

SDC_D1
Create fields DV_CNTRYTEXT (String 80) = SDC_Q1 and DV_CNTRYCODE (0..9990) = SDC_Q1

SDC_R1
Now some general background questions which will help us compare the health of people in Canada.
INTERVIEWER: Press <1> to continue.

SDC_Q1
In what country ^WERE ^YOU2 born?
INTERVIEWER: Ask the respondent to specify country of birth according to current boundaries. Start typing the name of the country of birth to activate function. Enter (CAN) to select Canada.

Note: Call Trigram Search. Null is not allowed. Don't know and Refusal are allowed. The Search File to be used corresponds to the Excel file "Country_Pays_Look_up_list_Concordance_3_digit_CCHS_all_alphabetical_order.xlsx"  The DV_CNTRYCODE and the DV_CNTRYTEXT are the two fields that should be displayed on the pop-up screen when the Search File is called. However, the corresponding DV_CNTRYCODE also needs to be saved and used as the key to indicate exactly which unique entry in the Search File was selected ( i.e. , it is the code that differentiates between the English, French and other spelling variations of country names).

SDC_C02A
If DV_CNTRYCODE = 124 (Canada) or DK or R, go to SDC_D4.
Otherwise, go to SDC_C02B.

SDC_C02B
If DV_CNTRYCODE = 1 (Other-Specify), go to SDC_S1.
Otherwise, go to SDC_Q2.

SDC_S1
In what country ^WERE ^YOU1 born?
INTERVIEWER: Specify.
DK, RF

SDC_Q2
^WERE_C ^YOU1 born a Canadian citizen?

1. Yes (Go to SDC_D4)
2. No
   DK, RF (Go to SDC_D4)

SDC_Q3
In what year did ^YOU1 first come to Canada to live?
INTERVIEWER: The respondent may have first come to live in Canada on a work or study permit or by claiming refugee status. If the respondent moved to Canada more than once, enter the first year they arrived in Canada (excluding holiday time spent in Canada).

If the respondent cannot give the exact year of arrival in Canada, ask for a best estimate of the year.Minimum is [^Info.YearofBirth]; maximum is [^info.CurrentYear].

• Year
  (MIN: ^Info.YearofBirth) (MAX: ^info.CurrentYear)
  DK, RF

SDC_E3
Year must be between ^Info.YearofBirth and ^Info.CurrentYear. Please return and correct.

Note: Trigger hard edit if SDC_Q3 < [^Info.YearofBirth] or SDC_Q3 > [^Info.CurrentYear].

SDC_D4
(not applicable)

SDC_Q4A
To which ethnic or cultural groups did ^YOUR2 ancestors belong? (For example: French, Scottish, Chinese, East Indian)
INTERVIEWER: Mark all that apply. An ancestor is usually more distant than a grandparent. If "Canadian" is the only response, probe. If the respondent hesitates, do not suggest Canadian. If the respondent answers "Eskimo", enter "20".

1. Canadian
2. French
3. English
4. German
5. Scottish
6. Irish
7. Italian
8. Ukrainian
9. Dutch (Netherlands)
10. Chinese
11. Jewish
12. Polish
13. Portuguese
14. South Asian ( e.g. East Indian, Pakistani, Sri Lankan)
15. Norwegian
16. Welsh
17. Swedish
18. North American Indian
19. Métis
20. Inuit
21. Other - Specify (Go to SDC_S4A)
    DK, RF
    Go to SDC_C04B

SDC_S4A
To which ethnic or cultural groups did ^YOUR2 ancestors belong?
INTERVIEWER: Specify.
DK, RF

SDC_C04B
If SDC_Q1 or DV_CNTRYCODE = Canada, United States, Germany or Greenland, go to SDC_Q4B_1.
Otherwise, go to SDC_D4C.

SDC_Q4B_1
^ARE_C ^YOU1 an Aboriginal person, that is, First nations, Métis or Inuk/Inuit? First Nations includes Status and Non-Status Indians.
INTERVIEWER: The terms "First Nations" and "North American Indian" can be interchanged. Some respondents may prefer one term over the other. "Inuit" is the plural form of "Inuk".

1. Yes
2. No (Go to SDC_D4C)
   DK, RF (Go to SDC_D5A)

SDC_N4B_1
INTERVIEWER: If the respondent has already specified the Aboriginal group(s), select
(^ARE_C ^YOU1 First Nations, Métis or Inuk/Inuit?)

INTERVIEWER: Mark all that apply. First Nations (North American Indian) includes Status and Non-Status Indians. The terms “First Nations” and "North American Indian" can be interchanged. Some respondents may prefer one term over the other. "Inuit" is the plural form of "Inuk".

1. First Nations (North American Indian)
2. Métis
3. Inuk/Inuit
   DK, RF
   Go to SDC_D5A

SDC_D4C
If Proxmode=1, YOU2_C = "FNAME".

SDC_Q4C
^YOU2_C may belong to one or more racial or cultural groups on the following list.
INTERVIEWER: Read categories to respondent and mark up to 4 responses that apply.
If respondent answers "mixed" or "bi-racial", probe for specific groups

1. White
2. South Asian ( e.g. , East Indian, Pakistani, Sri Lankan, etc. )
3. Chinese
4. Black
5. Filipino
6. Latin American
7. Arab
8. Southeast Asian ( e.g. , Vietnamese, Cambodian, Malaysian, Laotian,     etc. )
9. West Asian ( e.g. , Iranian, Afghan, etc. )
10. Korean
11. Japanese
12. Other - Specify (Go to SDC_S4C)
    DK, RF
    Go to SCD_Q5AA

Note: (Help text) All response categories and examples must be read aloud, even if the respondent has already given the interviewer one response.

DO NOT code responses that do not appear on the list of response categories. For example, do not mark "White", if the respondent says "Caucasian". Record

SDC_S4C
YOU2_C may belong to one or more racial or cultural groups on the following list.
^ARE_C ^YOU1...?
INTERVIEWER: Specify.
DK, RF

SDC_D5A_1
Not applicable
Of English or French, which language(s) ^DOVERB ^YOU1 speak well enough to conduct a conversation? Is it...?

SDC_5
INTERVIEWER: Read categories to respondent.

1. English only
2. French only
3. Both English and French
4. Neither English nor French
   DK, RF

SDC_B5B
Call LanguageLookUp block (LLU) a maximum of three times. Always call it the first time; call subsequent items if the previous instances SDC_B5A.LangCode is a response

Note: Pass via parameter (question text, interviewer instruction, help text, instance number):

SDC_E5B1
The answer category "XYZ - No more response" cannot be selected as the first response for this question. If the respondent cannot provide an answer to this question, please select DK or RF.

Note: Trigger hard edit if at the first iteration of the question, the interviewer selects "XYZ-
No more response" DV_LANGCODE = 995

SDC_E5B2
The same language has been selected a second time. Please return and correct.

Note: Trigger hard edit if any two language codes (SDC_B5A.LangCode) are equal.
DV_LANGCODE = 1 is an exception to this edit: multiple other-specify responses are

SDC_D6
(not applicable)

SDC_B6
Call LanguageLookUp block (LLU) a maximum of three times. Always call it the first time; call subsequent items if the previous instances SDC_B6.LangCode is a response other than 9995.

Note: Pass via parameter (question text, interviewer instruction, help text, instance number):

SDC_E6A
The answer category "XYZ - No more response" cannot be selected as the first response for this question. If the respondent cannot provide an answer to this question, please select DK or RF.

Note: Trigger hard edit if at the first iteration of the question, the interviewer selects "XYZ -
No more response" DV_LANGCODE = 995.

SDC_E6B
The same language has been selected a second time. Please return and correct.

Note: Trigger hard edit if any two language codes (SDC_B6.LangCode) are equal.
DV_LANGCODE = 1 is an exception to this edit: multiple other-specify responses are

SDC_R7
Now a question about the dwelling in which you live.
INTERVIEWER: Press <1> to continue.

SDC_Q7
Is the dwelling ...?
DHH_OWN
INTERVIEWER: Read categories to respondent. If the respondent’s household contains both owners and renters, such as a boarder, the dwelling should be considered owned

1. Owned by you or a member of this household, even if it is still being paid for
2. Rented, even if no cash rent is paid

DK, RF
Note: (Help text) Choose ‘Owned’ if the respondent and/or another member of this household own the dwelling in which they live, even if the dwelling is on rented or leased land, or if it is part of a condominium, or if it is still being paid for by the respondent or another member of your household.

Choose ‘Rented’ in all other cases, even if the dwelling occupied by the respondent is provided without cash rent or at a reduced rent (for example, a clergy’s residence or a superintendent’s dwelling in an apartment building), or the dwelling is part of a co-operative.

SDC_C7A
If proxy interview or age < 18 or age > 59, go to SDC_END.
Otherwise, go to SDC_R7A.

SDC_R7A
Now one additional background question which will help us compare the health of people in Canada.
INTERVIEWER: Press <1> to continue.

SDC_Q7A
Do you consider yourself to be...?
INTERVIEWER: Read categories to respondent.

1. heterosexual (sexual relations with people of the opposite
2. homosexual, that is lesbian or gay (sexual relations with people of your own sex)
3. bisexual (sexual relations with people of both sexes)
   DK, RF

SDC_END

Language Lookup (LLU)

LLU_BEG
Content block

• External variables required:
  PROXMODE: proxy identifier, from the GR block.
  FNAME: first name of respondent from household block.
  DOLLU: do block flag, from the sample file.
  PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
  Screen display:
  Display on header bar PE_Q01 and PE_Q02 separated by a space

LLU_Q01
What language ^DOVERB ^YOU1 speak most often at home?

INTERVIEWER: Mark up to three responses. Multiple responses are accepted only if languages are spoken equally often at home. Start typing name of language to activate the search function. Enter “Other-Specify” if the language is not part of the list. Enter “xyz” to select the item which indicates no (more) languages.

Note: Help text: For a person who lives alone, report the language in which the respondent feels most comfortable (this can be the language the respondent would use for talking on the telephone, visiting at home with friends, etc. ).
Some languages like Chinese (Cantonese, Mandarin or other Chinese language) and those used by Jewish communities (such as Hebrew or Yiddish) have regional

LLU_END

Person most knowledgeable about household situation (PMK)

PMK_BEG
Core module

• External variables required:
  PROXMODE
  Age of Proxy respondent
  Do PMK
  HHLD Size
  Province
  Respondent’s name
  GR_N01
  PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
  Screen display:
  Display on header bar PE_Q01 and PE_Q02 separated by a space

PMK_C010
If DOPMK = 1, go to PMK_C015A.
Otherwise, go to PMK_END.

PMK_C015A
If PROXMODE = 1 and age of proxy respondent >15, go to PMK_END.
Otherwise, go to PMK_C015AB.

PMK_C015B
If HHLD size = 1 (respondent lives alone) or if AGE > 15, go to PMK_END.
Otherwise, go to PMK_C15C.

PMK_C015C
If Age<14, go to PMK_R020.
Otherwise, go to PMK_C16A.

PMK_C16A
If province = 24 (Quebec), go to PMK_R16AC.
Otherwise, go to PMK_C16B.

PMK_C16B
If province = 60, 61 or 62 (Yukon, N.W.T. or Nunavut),, go to PMK_R16AB.
Otherwise, go to PMK_R16AA.

PMK_R16AA
Statistics Canada would like your permission to share the information collected in this survey with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada.

Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses, telephone numbers or health numbers will be provided

INTERVIEWER: The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public
Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.
Press <1> to continue.
Go to PMK_Q016

PMK_R16AB
Statistics Canada would like your permission to share the information collected in this survey with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada.

Territorial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses, telephone numbers or health numbers will be provided

INTERVIEWER: The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public

Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.
Press <1> to continue.
Go to PMK_Q016

PMK_R16AC
Statistics Canada would like your permission to share the information collected in this survey with provincial and territorial ministries of health, the « Institut de la Statistique du Québec », Health Canada and the Public Health Agency of Canada.

The « Institut de la Statistique du Québec » and provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses, telephone numbers or health numbers will be provided

INTERVIEWER: The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public Health Agency of Canada. "Provincial ministries of health" includes the territorial ministries of health.
Press <1> to continue.

PMK_Q016
All information will be kept strictly confidential and used only for statistical purposes.
Do you agree to share the information provided?

1. Yes
2. No
   DK, R

PMK_R020
For the last few questions, I would like to speak with someone who would be best able to answer questions about the entire household such as household income, food purchases and insurance coverage.
INTERVIEWER: Press <1> to continue.

PMK_Q020
Who would this person be?
INTERVIEWER: Select most knowledgeable person from the household roster. Allow the respondent to say myself.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20
    (DK, RF are not allowed)

Note: Programmer: Display household members by personID in ascending order so as to ensure that category values match the personID variable.

PMK_E020
An invalid answer has been selected. Please return and correct.

Note: Trigger hard edit if a blank answer is selected.

PMK_D030A
If PMK_Q020 is the respondent then PMKFLAG (Person most knowledgeable) = 2. Else, PMKFLAG = 1.

PMK_C030A
If PMKFLAG=2, go to PMK_D030C.
Otherwise, go to PMK_D030B.

PMK_D030B

• If PMK_Q020 = 1, MEMBERNAME = "MEMBER1".
• If PMK_Q020 = 2, MEMBERNAME = "MEMBER2".
• If PMK_Q020 = 3, MEMBERNAME = "MEMBER3".
• If PMK_Q020 = 4, MEMBERNAME = "MEMBER4".
• If PMK_Q020 = 5, MEMBERNAME = "MEMBER5".
• If PMK_Q020 = 6, MEMBERNAME = "MEMBER6".
• If PMK_Q020 = 7, MEMBERNAME = "MEMBER7".
• If PMK_Q020 = 8, MEMBERNAME = "MEMBER8".
• If PMK_Q020 = 9, MEMBERNAME = "MEMBER9".
• If PMK_Q020 = 10, MEMBERNAME = "MEMBER10".
• If PMK_Q020 = 11, MEMBERNAME = "MEMBER11".
• If PMK_Q020 = 12, MEMBERNAME = "MEMBER12".
• If PMK_Q020 = 13, MEMBERNAME = "MEMBER13".
• If PMK_Q020 = 14, MEMBERNAME = "MEMBER14".
• If PMK_Q020 = 15, MEMBERNAME = "MEMBER15".
• If PMK_Q020 = 16, MEMBERNAME = "MEMBER16".
• If PMK_Q020 = 17, MEMBERNAME = "MEMBER17".
• If PMK_Q020 = 18, MEMBERNAME = "MEMBER18".
• If PMK_Q020 = 19, MEMBERNAME = "MEMBER19".
• If PMK_Q020 = 20, MEMBERNAME = "MEMBER20".

PMK_Q030B
Is ^MEMBERNAME available?

1. Yes
2. No
   (DK, RF are not allowed)

Note: Do not retain data for this variable.

PMK_D030C
PMKFLAG=1 and PMK_Q030B=1 then PMKProxy = 1
Otherwise, PMKProxy = 2

PMK_C040
If PMKProxy=1, go to PMK_R050.
Otherwise, go to PMK_C045.

PMK_C045
If PMKFLAG=2, go to PMK_R040.
Otherwise, go to PMK_R045.

PMK_R040
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time.
INTERVIEWER: Press <1> to continue.
Go to PMK_END

PMK_R045
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time. I would now like to try and find the best time to speak with ^MEMBERNAME.
INTERVIEWER: Press <1> to continue.
Go to PMK_END

PMK_R050
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time. I would now like to speak with ^MEMERNAME.
INTERVIEWER: You should continue with the most knowledgeable person about household. Press < 1> to continue.

PMK_R060
Hello, My name is ... I’ve just completed the main portion of the interview with <Respondent’s name>. At this point I need to finish the interview with a few general questions on your household's situation. <Respondent's name> said you would be the best person to answer these types of questions.
INTERVIEWER: Press <1> to continue.

PMK_END

Home safety (HMS)

HMS_BEG
Optional Content (See Appendix 2)

HMS_C1A
If (do HMS block = 2), go to HMS_END.
Otherwise, go to HMS_C1B.

HMS_C1B
If PMKProxy = 2, go to HMS_END.
Otherwise, go to HMS_R1.

HMS_R1
Now, a few questions about things some people do to make their homes safe.
INTERVIEWER: Press <Enter> to continue.

HMS_Q1
Is there at least 1 working smoke detector installed in your home?

1. Yes
2. No (Go to HMS_Q5)
   DK, RF (Go to HMS_END)

HMS_Q2
Are there smoke detectors installed on every level of your home, including the basement?

1. Yes
2. No
   DK, RF

HMS_Q3
Are the smoke detectors tested each month?

1. Yes
2. No
   DK, RF

HMS_Q4
How often are the batteries changed in your smoke detectors?
INTERVIEWER: Read categories to respondent.

1. At least every 6 months
2. At least every year
3. As needed when the low battery warning chirps
4. Never
5. Not applicable (Hard wired)
   DK, RF

HMS_Q5
Is there an escape plan for getting out of your home in case of a fire?

1. Yes
2. No (Go to HMS_END)
   DK, RF (Go to HMS_END)

HMS_C6
If household size > 1, go to HMS_Q6.
Otherwise, go to HMS_END.

HMS_Q6
Have the members of your household ever discussed this plan?

1. Yes
2. No
   DK, RF

HMS_END

Insurance coverage (INS)

INS_BEG
Optional Content (See Appendix 2)

INS_C1A
If (do INS block = 1), go to INS_C1B.
Otherwise, go to INS_END.

INS_C1B
If PMKProxy=2, go to INS_END.
Otherwise, go to INS_R1.

INS_R1
Now, turning to ^YOUR2 insurance coverage. Please include any private, government or employer-paid plans.
INTERVIEWER: Press <1> to continue.

INS_D1
(not applicable)

INS_Q1
^DOVERB_C ^YOU2 have insurance that covers all or part of the cost of ^YOUR1 prescription medications?

1. Yes
2. No (Go to INS_C2)
   DK (Go to INS_C2)
   RF (Go to INS_END)

INS_Q1A
Is it...?

INTERVIEWER: Read categories to respondent. Mark all that apply.

1. A government-sponsored plan
2. An employer-sponsored plan
3. A private plan
   DK, RF

INS_C2
If (do OH2 block = 1) and not a proxy interview, go to INS_Q3.
Otherwise, go to INS_Q2.

INS_Q2
(^DOVERB_C ^YOU2 have insurance that covers all or part of:)
...^YOUR1 dental expenses?

1. Yes
2. No (Go to INS_Q3)
   DK, RF (Go to INS_Q3)

INS_Q2A
Is it...?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. A government-sponsored plan
2. An employer-sponsored plan
3. A private plan
   DK, RF

INS_Q3
(^DOVERB_C ^YOU2 have insurance that covers all or part of:)
...the costs of eye glasses or contact lenses?

1. Yes
2. No (Go to INS_Q4)
   DK, RF (Go to INS_Q4)

INS_Q3A
Is it...?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. A government-sponsored plan
2. An employer-sponsored plan
3. A private plan
   DK, RF

INS_Q4
(^DOVERB_C ^YOU2 have insurance that covers all or part of:)
...hospital charges for a private or semi-private room?

1. Yes
2. No (Go to INS_END)
   DK, RF (Go to INS_END)

INS_Q4A
Is it...?
INTERVIEWER: Read categories to respondent. Mark all that apply.

1. A government-sponsored plan
2. An employer-sponsored plan
3. A private plan
   DK, RF

INS_END

Food security (FSC)

FSC_BEG
Theme content

FSC_C01A
If (do FSC block = 1), go to FSC_C01AB.
Otherwise, go to FSC_END.

FSC_C01AB
If PMKProxy = 2, go to FSC_END.
Otherwise, go to FSC_D010.

FSC_D010

• If HhldSize = 1, ^DT_YouAndOthers = "you".
• If HhldSize = 1, ^DT_YouAndOthers_C = "You".
• If HhldSize ne 1, ^DT_YouAndOthers = "you and other household members".
• If HhldSize ne 1, ^DT_YouAndOthers_C = "You and other household members".
• If OlderKids + YoungKids = 1, ^DT_ChildFName = "^ChildFName".
• If OlderKids + YoungKids = 1, ^DT_ChildWas = "^ChildFName + was".
• If OlderKids + YoungKids = 1, ^DT_AnyChild = "^ChildFName".
• If OlderKids + YoungKids = 1, ^DT_AnyChilds = "^ChildFName + ’s".
• If OlderKids + YoungKids = 1, ^DT_WasAnyChild = "was + ^ChildFName".
• If OlderKids + YoungKids ne 1, ^DT_ChildFName = "the children".
• If OlderKids + YoungKids ne 1, ^DT_ChildWas = "The children were".
• If OlderKids + YoungKids ne 1, ^DT_AnyChild = "any of the children".
• If OlderKids + YoungKids ne 1, ^DT_AnyChilds = "any of the children’s".
• If OlderKids + YoungKids ne 1, ^DT_WasAnyChild = " were any of the children".
• If (Adults + YoungAdults) = 1, ^DT_YouOtherAdults = "you".
• If (Adults + YoungAdults) = 1, ^DT_YouOtherAdults_C = "You".
• If (Adults + YoungAdults) ne 1, ^DT_YouOtherAdults = "you or other adults in your household".
• If (Adults + YoungAdults) ne 1, ^DT_YouOtherAdults_C = "You or other adults in your
• household".

FSC_R010
The following questions are about the food situation for your household in the past 12 months.
INTERVIEWER: Press <Enter> to continue.

FSC_Q010
Which of the following statements best describes the food eaten in your household in the past 12 months, that is, since [current month] of last year?
INTERVIEWER: Read categories to respondent.

1. ^DT_YouAndOthers_C always had enough of the kinds of food you wanted to eat.
2. ^DT_YouAndOthers_C had enough to eat, but not always the kinds of food you wanted.
3. Sometimes ^DT_YouAndOthers did not have enough to eat.
4. Often ^DT_YouAndOthers didn’t have enough to eat.
   DK, RF (Go to FSC_END)

FSC_R020
Now I’m going to read you several statements that may be used to describe the food situation for a household. Please tell me if the statement was often true, sometimes true, or never true for ^DT_YouAndOthers in the past 12 months.
INTERVIEWER: Press <Enter> to continue.

FSC_Q020
The first statement is: ...^DT_YouAndOthers_C worried that food would run out before you got money to buy more. Was that often true, sometimes true, or never true in the past 12 months?

1. Often true
2. Sometimes true
3. Never true
   DK, RF

FSC_Q030
The food that ^DT_YouAndOthers bought just didn’t last, and there wasn’t any money to get more. Was that often true, sometimes true, or never true in the past 12 months?

1. Often true
2. Sometimes true
3. Never true
   DK, RF

FSC_Q040
^DT_YouAndOthers_C couldn’t afford to eat balanced meals. In the past 12 months was that often true, sometimes true, or never true?

1. Often true
2. Sometimes true
3. Never true
   DK, RF

FSC_C050
If (OlderKids + YoungKids > 0), go to FSC_R050.
Otherwise, go to FSC_C070.

FSC_R050
Now I’m going to read a few statements that may describe the food situation for households with children.
INTERVIEWER: Press <Enter> to continue.

FSC_Q050
^DT_YouOtherAdults_C relied on only a few kinds of low-cost food to feed ^DT_ChildFName because you were running out of money to buy food. Was that often true, sometimes true, or never true in the past 12 months?

1. Often true
2. Sometimes true
3. Never true
   DK, RF

Note: If (OlderKids + YoungKids) = 0 and some members have age = blank then FSC_Q050 = Valid Skip.

FSC_Q060
^DT_YouOtherAdults_C couldn’t feed ^DT_ChildFName a balanced meal, because you couldn’t afford it. Was that often true, sometimes true, or never true in the past 12 months?

1. Often true
2. Sometimes true
3. Never true
   DK, RF

FSC_C070
If ((([FSC_Q020 or FSC_Q030 or FSC_Q040 or FSC_Q050 or FSC_Q060 <= 2) or (FSC_Q010 = 3 or 4)] and ([OlderKids + YoungKids] > 0)), go to FSC_Q070. Else if (([FSC_Q020 or FSC_Q030 or FSC_Q040 or FSC_Q050 or FSC_Q060] <= 2) or (FSC_Q010 = 3 or 4)), go to FSC_R080.
Otherwise, go to FSC_END.

FSC_Q070
^DT_ChildWas not eating enough because ^DT_YouOtherAdults just couldn't afford enough food. Was that often, sometimes, or never true in the past 12 months?

1. Often true
2. Sometimes true
3. Never true
   DK, RF

FSC_R080
The following few questions are about the food situation in the past 12 months for you or any other adults in your household.
INTERVIEWER: Press <Enter> to continue.

FSC_Q080
In the past 12 months, since last [current month] did ^DT_YouOtherAdults ever cut the size of your meals or skip meals because there wasn’t enough money for food?

1. Yes
2. No (Go to FSC_Q090)
   DK, RF (Go to FSC_Q090)

FSC_Q081
How often did this happen---almost every month, some months but not every month, or in only 1 or 2 months?

1. Almost every month
2. Some months but not every month
3. Only 1 or 2 months
   DK, RF

FSC_Q090
In the past 12 months, did you ^Personallyever eat less than you felt you should because there wasn't enough money to buy food?

1. Yes
2. No
   DK, RF

FSC_Q100
In the past 12 months, were you ^Personallyever hungry but didn't eat because you couldn't afford enough food?

1. Yes
2. No
   DK, RF

FSC_Q110
In the past 12 months, did you ^Personally lose weight because you didn't have enough money for food?

1. Yes
2. No
   DK, RF

FSC_C120
If (FSC_Q070 = 1 or 2) or (FSC_Q080 or FSC_Q090 or FSC_Q100 or FSC_Q110 = 1), go to FSC_Q120.
Otherwise, go to FSC_END.

FSC_Q120
In the past 12 months, did ^DT_YouOtherAdults ever not eat for a whole day because there wasn't enough money for food?

1. Yes
2. No (Go to FSC_C130)
   DK, RF (Go to FSC_C130)

FSC_Q121
How often did this happen---almost every month, some months but not every month, or in only 1 or 2 months?

1. Almost every month
2. Some months but not every month
3. Only 1 or 2 months
   DK, RF

FSC_C130
If OlderKids + YoungKids <> 0, go to FSC_R130.
Otherwise, go to FSC_END.

FSC_R130
Now, a few questions on the food experiences for children in your household.
INTERVIEWER: Press <Enter> to continue.

FSC_Q130
In the past 12 months, did ^DT_YouOtherAdults ever cut the size of ^DT_AnyChilds meals because there wasn't enough money for food?

1. Yes
2. No
   DK, RF

FSC_Q140
In the past 12 months, did ^DT_AnyChild ever skip meals because there wasn't enough money for food?

1. Yes
2. No (Go to FSC_Q150)
   DK, RF (Go to FSC_Q150)

FSC_Q141
How often did this happen---almost every month, some months but not every month, or in only 1 or 2 months?

1. Almost every month
2. Some months but not every month
3. Only 1 or 2 months
   DK, RF

FSC_Q150
In the past 12 months, ^DT_WasAnyChild ever hungry but you just couldn't afford more food?

1. Yes
2. No
   DK, RF

FSC_Q160
In the past 12 months, did ^DT_AnyChild ever not eat for a whole day because there wasn't enough money for food?

1. Yes
2. No
   DK, RF

FSC_END

Neurological Conditions (NEU)

NEU_BEG

Theme content

• External variables required:
• Household size
• From roster: MEMBERNAME, Sex and Age
• PROXMODE: proxy identifier, from the GR block.
• FNAME: first name of respondent from household block.
• DONEU: do block flag, from the sample file.
• PE_Q01: first name of specific respondent from USU block
• PE_Q02: last name of specific respondent from USU block
• Screen display:
• Display on header bar PE_Q01 and PE_Q02 separated by a space

NEU_C01
If DONEU = 1, go to NEU_C02.
Otherwise, go to NEU_END.

NEU_C02
If PMKProxy = 2, go to NEU_END.
Otherwise, go to NEU_D010.

NEU_D010
If household size > 1, ^DT_PHRASENEUE = "Now, I’d like you to think about everyone in your household".
Otherwise, ^DT_NOW = "Now,".

NEU_R010
^DT_PHRASENEUE.
^DT_NOW I’d like to ask about neurological conditions, which are conditions that affect the brain, spinal cord, nerves or muscles. Please do not include mental health conditions such as depression, anxiety disorder or schizophrenia.
We are interested in conditions which are expected to last or have already lasted 6 months or more and have been diagnosed by a doctor or other health professional.
INTERVIEWER: Press <1> to continue.

NEU_D015

• If one person household, DT_YOU = "you".
• If one person household, DT_DOES_C = "Do you".
• If one person household, DT_DOES = "do you".
• If one person household, DT_HAS = "Have you".
• If Else, DT_YOU = "you or anyone in your household".
• If Else, DT_DOES_C = "Does MEMBERNAME".
• If Else, DT_DOES = "does MEMBERNAME".
• If Else, DT_HAS = "Has MEMBERNAME".

NEU_C015
If household size = 1, go to NEU_Q020.
Otherwise, go to NEU_Q015.

NEU_Q015
Do ^DT_YOU have migraine headaches?

• 1 Yes
  2 No (Go to NEU_Q020)
  98 RF (Go to NEU_END)
  99 DK (Go to NEU_Q020)

Note: If hhld of 1, this question was asked of the respondent in CCC.

NEU_C016
If one person household, go to NEU_Q020.
Otherwise, go to NEU_Q016.

NEU_Q016
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID.

NEU_E016
An invalid answer has been selected. Please return and correct.

Note: If a blank answer is selected, call NEU_E016.

NEU_Q020
Do ^DT_YOU have multiple sclerosis?

1. Yes
2. No (Go to NEU_Q030)
   DK, RF (Go to NEU_Q030)

Note: In processing, if this is a one-person household and NEU_Q020 = 1, then NEU_Q021A = 1 and NEU_Q021(B - T) = 2.

NEU_C021
If one person household, go to NEU_Q030.
Otherwise, go to NEU_Q021.

NEU_Q021
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID.

NEU_E021
An invalid answer has been selected. Please return and correct.

Note: If a blank answer is selected, call NEU_E021.

NEU_Q030
Do ^DT_YOU have epilepsy?

1. Yes
2. No (Go to NEU_Q040)
   DK, RF (Go to NEU_Q040)

Note: In processing, if this is a one-person household and NEU_Q030 = 1, then NEU_Q031A = 1 and NEU_Q031(B - T) = 2.

NEU_C031
If one person household, go to NEU_Q032.
Otherwise, go to NEU_Q031.

NEU_Q031
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID.

For each valid response ask

NEU_E031
An invalid answer has been selected. Please return and correct.

Note: If a blank answer is selected for NEU_E031.

NEU_C032
If If NEU_Q030=1, go to NEU_Q032.
Otherwise, go to NEU_Q033.

NEU_Q032
^DT_DOES_C currently take medication for epilepsy?

• 1 Yes
  2 No
  99 DK, RF

Note: Call NEU_Q032 and NEU_Q033 for each member of the household when NEU_Q030 = 1 (yes)

NEU_Q033
^DT_HAS had a seizure in the past 5 years?

• 1 Yes
  2 No
  99 DK, RF

NEU_Q040
Do ^DT_YOU have cerebral palsy?

• 1Yes
  2 No (Go to NEU_Q050)
  99 DK, RF (Go to NEU_Q050)

Note: In processing, if this is a one-person household and NEU_Q040 = 1, then NEU_Q041A = 1 and NEU_Q041(B - T) = 2.

NEU_C041
If one person household, go to NEU_Q050.
Otherwise, go to NEU_Q041.

NEU_Q041
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E041.

NEU_E041
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q050
(Do ^DT_YOU have) spina bifida?

1. Yes
2. No (Go to NEU_Q060)
   DK, RF (Go to NEU_Q060)

Note: In processing, if this is a one-person household and NEU_Q050 = 1, then NEU_Q051A = 1 and NEU_Q051(B - T) = 2.

NEU_C051
If one person household, go to NEU_Q060.
Otherwise, go to NEU_Q051.

NEU_Q051
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E051.

NEU_E051
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q060
(Do ^DT_YOU have) hydrocephalus?

• 1 Yes
  2 No (Go to NEU_Q070)
  99 DK, RF (Go to NEU_Q070)

Note: In processing, if this is a one-person household and NEU_Q060 = 1, then NEU_Q061A = 1 and NEU_Q061(B - T) = 2.

NEU_C061
If one person household, go to NEU_Q070.
Otherwise, go to NEU_Q061.

NEU_Q061
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E061.

NEU_E061
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q070
(Do ^DT_YOU have) muscular dystrophy?

• 1 Yes
  2 No (Go to NEU_Q080)
  99 DK, RF (Go to NEU_Q080)

Note: In processing, if this is a one-person household and NEU_Q070 = 1, then NEU_Q071A = 1 and NEU_Q071(B - T) = 2.

NEU_C071
If one person household, go to NEU_Q080.
Otherwise, go to NEU_Q071.

NEU_Q071
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E071.

NEU_E071
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q080
(Do ^DT_YOU have) dystonia?

• 1 Yes
  2 No (Go to NEU_Q090)
  99 DK, RF (Go to NEU_Q090)

Note: In processing, if this is a one-person household and NEU_Q080 = 1, then NEU_Q081A = 1 and NEU_Q081(B - T) = 2.

NEU_C081
If one person household, go to NEU_Q090.
Otherwise, go to NEU_Q081.

NEU_Q081
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E081.

NEU_E081
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q090
(Do ^DT_YOU have) Tourette’s syndrome?

• 1 Yes
  2 No (Go to NEU_Q100)
  99 DK, RF (Go to NEU_Q100)

Note: In processing, if this is a one-person household and NEU_Q090 = 1, then NEU_Q091A = 1 and NEU_Q091(B - T) = 2.

NEU_C091
If one person household, go to NEU_Q100.
Otherwise, go to NEU_Q091.

NEU_Q091
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E091.

NEU_E091
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q100
(Do ^DT_YOU have) Parkinson’s disease?

• 1 Yes
  2 No (Go to NEU_Q110)
  99 DK, RF (Go to NEU_Q110)

Note: In processing, if this is a one-person household and NEU_Q100 = 1, then NEU_Q101A = 1 and NEU_Q101(B - T) = 2.

NEU_C101
If one person household, go to NEU_Q110.
Otherwise, go to NEU_Q101.

NEU_Q101
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E101.

NEU_E101
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q110
(Do ^DT_YOU have) ALS (Lou Gehrig’s disease/ amyotrophic lateral sclerosis)?

• 1 Yes
  2 No (Go to NEU_Q120)
  99 DK, RF (Go to NEU_Q120)

Note: In processing, if this is a one-person household and NEU_Q110 = 1, then NEU_Q111A = 1 and NEU_Q111(B - T) = 2.

NEU_C111
If one person household, go to NEU_Q120.
Otherwise, go to NEU_Q111.

NEU_Q111
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E111.

NEU_E111
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q120
(Do ^DT_YOU have) Huntington’s disease?

• 1 Yes
  2 No (Go to NEU_C130)
  99 DK, RF (Go to NEU_C130)

Note: In processing, if this is a one-person household and NEU_Q120 = 1, then NEU_Q121A = 1 and NEU_Q121(B - T) = 2.

NEU_C121
If one person household, go to NEU_C130.
Otherwise, go to NEU_Q121.

NEU_Q121
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E121.

NEU_E121
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_C130
If household size = 1, go to NEU_C140.
Otherwise, go to NEU_Q130.

NEU_Q130
Do ^DT_YOU suffer from the effects of a stroke?

• 1 Yes
  2 No (Go to NEU_Q140)
  99 DK, RF (Go to NEU_Q140)

Note: In processing, if this is a one-person household and NEU_Q130 = 1, then NEU_Q131A = 1 and NEU_Q131(B - T) = 2.

NEU_C131
If one person household, go to NEU_Q140.
Otherwise, go to NEU_Q131.

NEU_Q131
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E131.

NEU_E131
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID.

NEU_Q140
Do ^DT_YOU have a neurological condition caused by a brain injury?

• 1 Yes
  2 No (Go to NEU_Q150)
  99 DK, RF (Go to NEU_Q150)

Note: In processing, if this is a one-person household and NEU_Q140 = 1, then NEU_Q141A = 1 and NEU_Q141(B - T) = 2.

NEU_C141
If one person household, go to NEU_Q150.
Otherwise, go to NEU_Q141.

NEU_Q141
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E141.

NEU_E141
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q150
(Do ^DT_YOU have) a neurological condition caused by a brain tumour?
INTERVIEWER: Include both malignant and benign tumours.
Include tumours that start in the brain and cancer from elsewhere in the body that has spread to the brain.

• 1 Yes
  2 No (Go to NEU_Q160)
  99 DK, RF (Go to NEU_Q160)

Note: In processing, if this is a one-person household and NEU_Q150 = 1, then NEU_Q151A = 1 and NEU_Q151(B - T) = 2.

NEU_C151
If one person household, go to NEU_Q160.
Otherwise, go to NEU_Q151.

NEU_Q151
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E151.

NEU_E151
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q160
(Do ^DT_YOU have) a neurological condition caused by a spinal cord injury?

• 1 Yes
  2 No (Go to NEU_Q170)
  99 DK, RF (Go to NEU_Q170)

Note: In processing, if this is a one-person household and NEU_Q160 = 1, then NEU_Q161A = 1 and NEU_Q161(B - T) = 2.

NEU_C161
If one person household, go to NEU_Q170.
Otherwise, go to NEU_Q161.

NEU_Q161
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E161.

NEU_E161
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_Q170
(Do ^DT_YOU have) a neurological condition caused by a spinal cord tumour?
INTERVIEWER: Include both malignant and benign tumours.
Include tumours that start in the spinal cord and cancer from elsewhere in the body that has spread to the spinal cord.

• 1 Yes
  2 No (Go to NEU_C180)
  99 DK, RF (Go to NEU_C180)

Note: In processing, if this is a one-person household and NEU_Q170 = 1, then NEU_Q171A = 1 and NEU_Q171(B - T) = 2.

NEU_C171
If one person household, go to NEU_END.
Otherwise, go to NEU_Q171.

NEU_Q171
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E171.

NEU_E171
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_C180
If household size = 1, go to NEU_END.

Otherwise, go to NEU_Q180.

NEU_Q180
(Do ^DT_YOU have) Alzheimer’s Disease or any other dementia?

• 1 Yes
  2 No (Go to NEU_END)
  99 DK, RF (Go to NEU_END)

Note: In processing, if this is a one-person household and NEU_Q180 = 1, then NEU_Q181A = 1 and NEU_Q181(B - T) = 2.

NEU_Q181
Who has this condition?
INTERVIEWER: Mark all that apply.

1. MEMBER1
2. MEMBER2
3. MEMBER3
4. MEMBER4
5. MEMBER5
6. MEMBER6
7. MEMBER7
8. MEMBER8
9. MEMBER9
10. MEMBER10
11. MEMBER11
12. MEMBER12
13. MEMBER13
14. MEMBER14
15. MEMBER15
16. MEMBER16
17. MEMBER17
18. MEMBER18
19. MEMBER19
20. MEMBER20

Note: If a blank answer is selected, call NEU_E181.

NEU_E181
An invalid answer has been selected. Please return and correct.

Note: Programmer displays all household member names, genders, and ages from Household Roster. Show household members in ascending order by personID

NEU_END

Education (EDU)

EDU_BEG
Core content

EDU_C01A
If (do EDU block = 1), go to EDU1_C01B.
Otherwise, go to EDU_END.

EDU_C01B
If PMKProxy =2, go to EDU_END.
Otherwise, go to EDU_C01C.

EDU_C01C
If age of selected respondent < 14, go to EDU_C07A.
Otherwise, go to EDU_B01.

EDU_B01
Call Education Sub Block 1 (EDU1)

EDU_C07A
If there is at least one household member who is >= 14 years of age other than the selected respondent, go to EDU_C07B.
Otherwise, go to EDU_END.

EDU_C07B
If If age of selected respondent < 14, go to EDU_R07B, Otherwise go to EDU_R07A., go to EDU_R07B.
Otherwise, go to EDU_R07A.

EDU_R07A
Now I would like you to think about the rest of your household.
INTERVIEWER: Press <1> to continue.
Go to EDU_B02

EDU_R07B
The following questions are about education.
INTERVIEWER: Press <1> to continue.

EDU_B02
Call Education Sub Block 2 (EDU2)

Note: Ask this block for each household member aged 14 and older other than selected respondent. Maximum of 19 times.

If it is a proxy or PMKproxy interview, begin with the person providing the information and use proxy sex verbs set to non-proxy. Otherwise begin with the first persons rostered and continue in the order the household was rostered.

Otherwise, begin with first person rostered. Continue with household members in the order in which they were rostered.

EDU_END

Education of the respondent (EDU1)

EDU1_BEG
Core content

EDU_R01
The following questions are about education.
INTERVIEWER: Press <1> to continue.

EDU_Q01
What is the highest grade of elementary or high school ^YOU2 ^HAVE ever completed?

1. Grade 8 or lower (Québec: Secondary II or lower) (Go to EDU_Q03)
2. Grade 9 - 10 (Québec: Secondary III or IV, Newfoundland  (Go to EDU_Q03) and Labrador: 1st year of secondary)
3. Grade 11 - 13 (Québec: Secondary V, Newfoundland and Labrador: 2nd to 4th year of secondary)
   DK, RF (Go to EDU_Q03)

Note: In processing, if ANC_AGE < 14 (age of respondent), the variable EDU_Q01 is given the value of "1" and the variable EDU_Q03 is given the value of "2".

EDU_Q02
Did ^YOU1 complete a high school diploma or its equivalent?

1. Yes
2. No
   DK, RF

EDU_Q03
^HAVE_C ^YOU1 received any other education that could be counted towards a degree, certificate, diploma or degree from an educational institution?

1. Yes
2. No (Go to EDU_Q05)
   DK, RF (Go to EDU_Q05)

Note: In processing, if ANC_AGE < 14 (age of respondent), the variable EDU_Q01 is given the value of "1" and the variable EDU_Q03 is given the value of "2".

EDU_Q04A
What is the highest certificate, diploma or degree that ^YOU1 ^HAVE completed?

1. Less than high school diploma or its equivalent
2. High school diploma or a high school equivalency certificate
3. Trade Certificate or Diploma
4. College, cegep or other non-university certificate or diploma (other than trades certificates or diplomas)
5. University certificate or diploma below the bachelor’s level
6. Bachelor’s degree (eg. B.A., B.Sc., LL.B.)
7. University certificate, diploma or degree above the bachelor’s level
   DK, RF

EDU_Q05
^ARE_C ^YOU1 currently attending a school, college, cegep or university?

SDC_8
INTERVIEWER: Ask respondent to include attendance only for courses that can be used as credit towards a certificate, diploma or degree.

1. Yes
2. No (Go to EDU1_END)
   DK, RF (Go to EDU1_END)

EDU_Q06
^ARE_C ^YOU1 enrolled as…?
INTERVIEWER: Read categories to respondent.

1. A full-time student
2. A part-time student
3. Both full-time and part-time student
   DK, RF

EDU1_END

Education of other household members (EDU2)

EDU2_BEG
Core content

EDU2_D07

• If proxymode = NonProxy, YOU7 = "you".
• If proxymode = NonProxy, YOU8 = "you".
• If proxymode = NonProxy, HAVE9_C = "Have".
• If proxymode = NonProxy, HAVE10 = "have".
• Otherwise, YOU7 = "FNAME".
• Otherwise, YOU8 = "he/she".
• Otherwise, HAVE9_C = "Has".
• Otherwise, HAVE10 = "has".

EDU_Q07
What is the highest grade of elementary or high school ^YOU2 ever completed?

1. Grade 8 or lower (Québec: Secondary II or lower) (Go to EDU2_Q03)
2. Grade 9 - 10 (Québec: Secondary III or IV, (Go to EDU2_Q03) Newfoundland and Labrador: 1st year of secondary)
3. Grade 11 - 13 (Québec: Secondary V, Newfoundland and Labrador: 2nd to 4th year of secondary)
   DK, RF (Go to EDU2_Q03)

EDU_Q08
Did ^YOU1 complete high school or its equivalent?

1. Yes
2. No
   DK, RF

EDU_Q09
^HAVE_C ^YOU1 received any other education that could be counted towards a degree, certificate, diploma or degree from an educational institution?

1. Yes
2. No (Go to EDU2_END)
3. DK, RF (Go to EDU2_END)

EDU_Q10A
What is the highest degree, certificate or diploma ^YOU1 ^HAVE completed?

1. Less than high school diploma or its equivalent
2. High school diploma or a high school equivalency certificate
3. Trade Certificate or Diploma
4. College, cegep or other non-university certificate or diploma (other than trades certificates or diplomas)
5. University certificate or diploma below the bachelor’s level
6. Bachelor’s Degree ( e.g. B.A., B.Sc., LL.B.)
7. University certificate, diploma or degree above the bachelor’s level
   DK, RF

EDU2_END

Income (INC)

INC_BEG
Core content

INC_C1A
If do INC block = 1, go to INC_C1B.
Otherwise, go to INC_END.

INC_C1B
If PMKProxy = 2, go to INC_END.
Otherwise, go to INC_R1.

INC_R1
Although many health expenses are covered by health insurance, there is still a relationship between health and income. Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.
INTERVIEWER: Press <1> to continue.

INC_Q1
Thinking about the total income for all household members, from which of the following sources did your household receive any income in the past 12 months?
INTERVIEWER: Read categories to respondent.
Mark all that apply.

1. Wages and salaries
2. Income from self-employment
3. Dividends and interest ( e.g. , on bonds, savings)
4. Employment insurance
5. Worker's compensation
6. Benefits from Canada or Quebec Pension Plan
7. Job related retirement pensions, superannuation and
8. RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
9. Old Age Security and Guaranteed Income Supplement
10. Provincial or municipal social assistance or welfare
11. Child Tax Benefit
12. Child support
13. Alimony
14. Other ( e.g. , rental income, scholarships)
15. None
    DK, RF (Go to INC_END)

INC_E1A
You cannot select "None" and another category. Please return and correct.

Note: Trigger hard edit if INC_Q1 = 15 and any other response selected in INC_Q1.

INC_E1B
Inconsistent answers have been entered. Please confirm.

Note: Trigger soft edit if (INC_Q1 <> 1 or 2) and (LF2_Q1 = 1 or LF2_Q2 = 1).

INC_C2
If more than one source of income is indicated in INC_Q1, go to INC_Q2.
Otherwise, go to INC_Q3.

INC_Q2
What was the main source of household income?

1. Wages and salaries
2. Income from self-employment
3. Dividends and interest ( e.g. , on bonds, savings)
4. Employment insurance
5. Worker's compensation
6. Benefits from Canada or Quebec Pension Plan
7. Job related retirement pensions, superannuation and annuities
8. RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
9. Old Age Security and Guaranteed Income Supplement
10. Provincial or municipal social assistance or welfare
11. Child Tax Benefit
12. Child support
13. Alimony
14. Other ( e.g. , rental income, scholarships)
15. None
    DK, RF

Note: At the time of the data processing, if the respondent reported only one source of income in INC_Q1, the variable INC_Q2 will be given its value.

INC_E2
A blank answer item has been selected. Please return and correct.

Note: Trigger hard edit if the response in INC_Q2 was not selected in INC_Q1.

INC_Q3
What is your best estimate of the total income received by all household members, from all sources, before taxes and deductions, in the past 12 months?
INTERVIEWER: Capital gains should not be included in the household income. Income can come from various sources such as from work, investments, pensions or government. Examples include Employment Insurance, Social Assistance, Child Tax Benefit and other income such as child support, alimony and rental income.

• Income
  (MIN: -9 000 000) (MAX: 9, 000,000)
  DK, RF (Go to INC_Q5A)

Note: At the time of the data processing, responses reported in INC_Q3 will also be recoded into the cascade categories of INC_Q5A to INC_Q5C.

INC_E3
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if INC_Q3 > 150,000.

INC_C5A
If INC_Q3 = 0, go to INC_END.
Otherwise, go to INC_C6A.

INC_Q5A
Can you estimate in which of the following groups your household income falls? Was the total household income in the past 12 months...?
INTERVIEWER: Read categories to respondent.

1. Less than $50,000 include income loss
2. $50,000 and more (Go to INC_Q5C)
   DK, RF (Go to INC_END)

INC_Q5B
Please stop me when I have read the category which applies to ^YOUR1 household. Was it...?
INTERVIEWER: Read categories to respondent.

1. Less than $5,000
2. $5,000 to less than $10,000
3. $10,000 to less than $15,000
4. $15,000 to less than $20,000
5. $20,000 to less than $30,000
6. $30,000 to less than $40,000
7. $40,000 to less than $50,000
   DK, RF
   Go to INC_C6A

INC_Q5C
Please stop me when I have read the category which applies to ^YOUR1 household. Was it...?
INTERVIEWER: Read categories to respondent.

1. $50,000 to less than less than $60,000
2. $60,000 to less than less than $70,000
3. $70,000 to less than less than $80,000
4. $80,000 to less than less than $90,000
5. $90,000 to less than less than $100,000
6. $100,000 to less than less than $150,000
7. $150,000 and over
   DK, RF

INC_C6A
If HHLDSZ > 1, go to INC_C6B.
Otherwise, go to INC_END.

INC_C6B
If age of respondent > 15, go to INC_D6.
Otherwise, go to INC_END.

INC_D6
(not applicable)

INC_Q6
Thinking about ^YOUR2 total personal income, from which of the following sources did ^YOU1 receive any income in the past 12 months?
INTERVIEWER: Read categories to respondent.
Mark all that apply.

1. Wages and salaries
2. Income from self-employment
3. Dividends and interest ( e.g. , on bonds, savings)
4. Employment insurance
5. Worker's compensation
6. Benefits from Canada or Quebec Pension Plan
7. Job related retirement pensions, superannuation and
8. RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
9. Old Age Security and Guaranteed Income Supplement
10. Provincial or municipal social assistance or welfare
11. Child Tax Benefit
12. Child support
13. Alimony
14. Other ( e.g. , rental income, scholarships)
15. None
    DK, RF (Go to INC_END)

INC_E6A
A selected source of personal income is not selected as one of the sources of income for all household members. Please return and correct.

Note: Trigger hard edit if any response other than 15 is selected in INC_Q6 and is not selected in INC_Q1.

INC_E6B
You cannot select "None" and another category. Please return and correct.

Note: Trigger hard edit if INC_Q6 = 15 (None) and any other response selected in INC_Q6.

INC_C7
If more than one source of income is indicated in INC_Q6, go to INC_Q7.
Otherwise, go to INC_Q8A.

INC_Q7
What was the main source of ^YOUR1 personal income?

1. Wages and salaries
2. Income from self-employment
3. Dividends and interest ( e.g. , on bonds, savings)
4. Employment insurance
5. Worker's compensation
6. Benefits from Canada or Quebec Pension Plan
7. Job related retirement pensions, superannuation and annuities
8. RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
9. Old Age Security and Guaranteed Income Supplement
10. Provincial or municipal social assistance or welfare
11. Child Tax Benefit
12. Child support
13. Alimony
14. Other ( e.g. , rental income, scholarships)
15. None
    DK, RF (Go to INC_END)

Note: At the time of the data processing, if the respondent reported only one source of income in INC_Q6, the variable INC_Q7 will be given its value.

INC_E7
A blank answer item has been selected. Please return and correct.

Note: Trigger hard edit if the response in INC_Q7 was not selected in INC_Q6.

INC_Q8A
What is your best estimate of ^YOUR1 total personal income, before taxes and deductions, from all sources in the past 12 months?
INTERVIEWER: Capital gains should not be included in the personal income. Income can come from various sources such as from work, investments, pensions or government. Examples include Employment Insurance, Social Assistance, Child Tax Benefit and other income such as child support, alimony and rental income.

• Income
  (MIN: -9,000 000) (MAX: 9 000,000)
  DK, RF
  (Go to INC_Q8B)
  Go to INC_END

Note: At the time of the data processing, responses reported in INC_Q8A will also be coded into the cascade categories of INC_Q8B to INC_Q8D.

INC_E8A
An unusual value has been entered. Please confirm.

Note: Trigger soft edit if INC_Q8A > $150,000.

INC_Q8B
Can you estimate in which of the following groups ^YOUR1 personal income falls? Was ^YOUR1 total personal income in the past 12 months...?
INTERVIEWER: Read categories to respondent.

1. Less than $30,000 including income loss
2. $30,000 and more (Go to INC_Q8D)
   DK, RF (Go to INC_END)

INC_Q8C
Please stop me when I have read the category which applies to ^YOU2. Was it...?
INTERVIEWER: Read categories to respondent.

1. Less than $5,000
2. $5,000 to less than $10,000
3. $10,000 to less than $15,000
4. $15,000 to less than $20,000
5. $20,000 to less than $25,000
6. $25,000 to less than $30,000
   DK, RF
   Go to INC_END

INC_Q8D
Please stop me when I have read the category which applies to ^YOU2. Was it...?
INTERVIEWER: Read categories to respondent.

1. $30,000 to less than $40,000
2. $40,000 to less than $50,000
3. $50,000 to less than $60,000
4. $60,000 to less than $70,000
5. $70,000 to less than $80,000
6. $80,000 to less than $90,000
7. $90,000 to less than $100,000
8. $100,000 and over
   DK, RF

INC_END

Administration information (ADM)

ADM_BEG
Core content

ADM_C01
If (do ADM block = 1), go to ADM_D01A.
Otherwise, go to ADM_END.

Note: Health Number

ADM_C01A
If If PMKProxy=2, go to ADM_END.
Otherwise, go to ADM_D01A.

ADM_D01A
If province = 60, 61 or 62, DT_PROVTERRE = "territorial".
Otherwise, DT_PROVTERRE = "provincial".

ADM_D01B
If province = 24, DT_STAT = "Statistics Canada, your ^DT_PROVTERR ministry of health and the « Institut de la Statistique du Québec»".
Otherwise, DT_STAT = "Statistics Canada and your ^DT_PROVTERR ministry of health".

ADM_D01C
(not applicable)

ADM_R01
^DT_STAT would like your permission to link information collected during this interview. This includes linking ^YOUR2 survey information to ^YOUR1 past and continuing use of health services such as visits to hospitals, clinics and doctor’s offices.
INTERVIEWER: Press <1> to continue.

ADM_Q01B
This linked information will be kept confidential and used only for statistical purposes. Do we have your permission?

1. Yes
2. No (Go to ADM_D04A)
   DK, RF (Go to ADM_D04A)

ADM_D3A

• If province = 10, ^DT_PROVINCEE = "a Newfoundland and Labrador".
• If province = 11, ^DT_PROVINCEE = "a Prince Edward Island".
• If province = 12, ^DT_PROVINCEE = "a Nova Scotia".
• If province = 13, ^DT_PROVINCEE = "a New Brunswick".
• If province = 24, ^DT_PROVINCEE = "a Quebec".
• If province = 35, ^DT_PROVINCEE = "an Ontario".
• If province = 46, ^DT_PROVINCEE = "a Manitoba".
• If province = 47, ^DT_PROVINCEE = "a Saskatchewan".
• If province = 48, ^DT_PROVINCEE = "an Alberta".
• If province = 59, ^DT_PROVINCEE = "a British Columbia".
• If province = 60, ^DT_PROVINCEE = "a Yukon".
• If province = 61, ^DT_PROVINCEE = "a Northwest Territories".
• If province = 62, ^DT_PROVINCEE = "a Nunavut".
  ADM_D3B (not applicable)

ADM_Q03A
Having a provincial or territorial health number will assist us in linking to this other information.
^DOVERB_C ^YOU2 have ^DT_PROVINCEE health number?

1. Yes (Go to ADM_B03C)
2. No
   DK, RF (Go to ADM_D04A)

ADM_Q03B
For which province or territory is ^YOUR1 health number?

• 10 Newfoundland and Labrador
  11 Prince Edward Island
  12 Nova Scotia
  13 New Brunswick
  24 Quebec
  35 Ontario
  46 Manitoba
  47 Saskatchewan
  48 Alberta
  59 British Columbia
  60 Yukon
  61 Northwest Territories
  62 Nunavut
  88 Does not have a Canadian health number (Go to ADM_D04A)
  DK, R (Go to ADM_D04A)

HN
What is ^YOUR1 health number?
INTERVIEWER: Enter a health number for ^DT_PROVINCEE. Do not insert blanks, hyphens or commas between the numbers.
DK, RF

ADM_D04A
If ADM_Q01B = 1, ^DT_SHARE1 = "names, addresses, telephone numbers and health numbers will not be provided".
Otherwise, ^DT_SHARE1 = "names, addresses and telephone numbers will not be provided".

ADM_C04A
If province = 24 (Quebec), go to ADM_R04AB.
Otherwise, go to ADM_R04AA.

ADM_R04AA
Statistics Canada would like your permission to share the information collected in this survey with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada.

Provincial ministries of health may make this information available to local health authorities, but ^DTSHARE1.
INTERVIEWER: The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public Health Agency of Canada. Provincial ministries of health includes the territorial ministries of health.
Press <1> to continue.
Go to ADM_Q04B

ADM_R04AB
Statistics Canada would like your permission to share the information collected in this survey with provincial and territorial ministries of health, the « Institut de la Statistique du Québec », Health Canada and the Public Health Agency of Canada.

The « Institut de la Statistique du Québec » and provincial ministries of health may make this information available to local health authorities, but ^DTSHARE1.
INTERVIEWER: The personal identifiers (names, addresses, telephone numbers and health numbers) will not be provided to Health Canada or the Public
Health Agency of Canada. Provincial ministries of health includes the territorial ministries of health.
Press <1> to continue.

ADM_Q04B
All information will be kept confidential and used only for statistical purposes.
Do you agree to share the information provided?

1. Yes
2. No
   DK, RF

Note: Frame Evaluation

ADM_B09
Call sub-bloc “Frame Evaluation” (FRE)

ADM_C09
If CATI (Casetype = 1), go to ADM_N10.
Otherwise, go to ADM_N09.

ADM_N09
INTERVIEWER: Was this interview conducted on the telephone or in person?

1. On telephone
2. In person
   (DK, RF are not allowed)

ADM_N10
INTERVIEWER: Was the respondent alone when you asked this health questionnaire?

1. Yes (Go to ADM_N12)
2. No
   DK, RF (Go to ADM_N12)

ADM_N11
INTERVIEWER: Do you think that the answers of the respondent were affected by someone else being there?

1. Yes
2. No
   DK, RF

ADM_N12
INTERVIEWER: Record language of interview

• 01 English
  02 French
  03 Chinese
  04 Italian
  05 Punjabi
  06 Spanish
  07 Portuguese
  08 Polish
  09 German
  10 Vietnamese
  11 Arabic
  12 Tagalog (Filipino)
  13 Greek
  14 Tamil
  15 Cree
  16 Afghan
  17 Cantonese
  18 Hindi
  19 Mandarin
  20 Persian
  21 Russian
  22 Ukrainian
  23 Urdu
  24 Inuktitut
  90 Other - Specify (Go to ADM_S12)
  DK, RF
  Go to ADM_END

ADM_S12
INTERVIEWER: Specify.
DK, RF

ADM_END

CAPI Frame Evaluation - Sub-block (FRE)

FRE_BEG
Content block

• External variables required:
• PROXMODE: proxy identifier, from the GR block.
  FNAME: first name of respondent from household block.
  DOFRE: do block flag, from the sample file.
• PE_Q01: first name of specific respondent from USU block
  PE_Q02: last name of specific respondent from USU block
• Screen display:
• Display on header bar PE_Q01 and PE_Q02 separated by a space

FRE_C1B
If CAPI (Casetype = 0) and FREFLAG = 2 ( i.e. the frame evaluation questions have not been done for the household), go to FRE_R1.
Otherwise, go to FRE_END.

FRE_R1
And finally, a few questions to evaluate the way households were selected for this survey, and to prevent households from being selected more than once for this survey.
INTERVIEWER: Press <1> to continue.

FRE_Q1
Excluding cellular phone numbers and phone numbers used strictly for business purposes, or fax machines, how many telephone numbers are there for your household?

1. 1
2. 2
3. 3 or more
4. None
   DK, RF (Go to FRE_Q5)

FRE_E1
Please confirm with the respondent that, in order to make a telephone call from his/her home the respondent exclusively uses a cellular telephone or if he/she has to leave his/her home to access a telephone.

Note: Trigger soft edit if (FRE_Q1 = 4).

FRE_C2
If FRE_Q1 = 4, go to FRE_Q4.
Otherwise, go to FRE_D2.

FRE_D2
If FRE_Q1 = 1, ^DT_MAIN = "your".
Otherwise, ^DT_MAIN = "your main".

FRE_Q2
What is ^DT_MAIN phone number, including the area code?
INTERVIEWER: Do not include cellular phone numbers, or those used strictly for business or fax machines.
Telephone number: [telnum].

Note: Telephone Block
Code: INTERVIEWER: Enter the area code.
Tel: INTERVIEWER: Enter the telephone number.

FRE_E2
A non-Canadian area code has been entered. Please return and correct.

Note: Trigger hard edit if a non-canadian area code is entered.

FRE_C3A
If Code or Tel = DK, RF, go to FRE_Q5.
Otherwise, go to FRE_C3B.

FRE_C3B
If FRE_Q1 = 1 (1 phone), go to FRE_Q5.
Otherwise, go to FRE_D3.

FRE_D3
If FRE_Q1 = 2, ^DT_PHONE = "your other phone number".
Otherwise, ^DT_PHONE = "another of your phone numbers".

FRE_Q3
What is ^DT_PHONE, including the area code?
INTERVIEWER: Do not include cellular phone numbers, or those used strictly for business or fax machines
Telephone number: [telnum].

Note: Telephone Block

Code: INTERVIEWER: Enter the area code.

Tel: INTERVIEWER: Enter the telephone number.
Go to FRE_Q5

FRE_E3
A non-Canadian area code has been entered. Please return and correct.

Note: Trigger hard edit if a non-canadian area code is entered.

FRE_D4
(not applicable)

FRE_Q4
^DOVERB_C ^YOU2 have a working cellular phone that can place and receive calls?

1. Yes
2. No
   DK, RF
   Go to FRE_END

FRE_Q5
Among all of the telephone numbers for your home, excluding cellular phone numbers and those used strictly for business purposes and fax machines, are any of them listed in the paper or internet telephone book?

1. Yes
2. No
   DK, RF

Note: Administration (Part 1)

FRE_END