I. Health (W10, 1998)



HEALTH10 I1 In general, would you say your health is (Circle one number):


1 Excellent

2 Very Good

3 Good

4 Fair

5 Poor

-9 Missing


I2 What is your current height and weight?

            FEET10 Height in feet
               INCH10 and inches
               WEIGHT10 Weight in pounds
                                        -9 Missing

   


PHYHEA10 I3 During the past 4 weeks, have physical health problems caused you difficulty in doing your work or other regular daily activities?

                                        

                                        1 Not at all

2 Slightly

3 Moderately

4 Quite a bit

5 Extremely

-9 Missing




EMOHEA10 I4  During the past 4 weeks, have emotional problems (such as feeling depressed or anxious) led you to accomplish less than you would like in your work or other daily activities?


1 Not at all

2 Slightly

3 Moderately

4 Quite a bit

5 Extremely

-9 Missing



SOCIAL10 I5 During the past 4 weeks, have physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?


1 Not at all

2 Slightly

3 Moderately

4 Quite a bit

5 Extremely

-9 Missing




PAIN10 I6 How much bodily pain have you had during the past 4 weeks?


1 None

2 Mild

3 Moderate

4 Severe

5 Very severe

-9 Missing




I7 Have you been told by your doctor that you have any of the following:


1 Yes

2 No

-9 Missing


BPRESS10 High blood pressure

HEART10 Heart condition

DIABET10 Diabetes

MENTAL10 Prolonged anxiety, depression or other mental health problems

CANCER10 Cancer

LUNG10 Chronic lung disease (emphysema, asthma, chronic bronchitis)

BONE10 Fractures or broken bones

DIGEST10 Chronic digestive disease (ulcer, colitis, liver problems)

EPILEP10 Epilepsy or a seizure disorder

BACK10 Chronic back problems

DEVELP10 Developmental problems (speech, language, learning)

OTHDIS10 Any other major disease, disability or handicap




CHECKU10 I8 About how long has it been since you last visited a doctor for a routine check-up?


1 Within the past year

2 Within the past two years

3 Within the past five years

4 More than 5 years ago

5 I have never had a routine check-up

-9 Missing




CLINIC10 I9  Is there one particular clinic, health center, doctor's office, or other place that you usually go to if you are sick or need advice about your health?


0 No

1 Yes

                               -9 Missing



BREAKF10 I10 In an average week, how many days do you eat breakfast?


                                        1 None
                                        2 One
                                        3 Two
                                        4 Three
                                        5 Four
                                        6 Five
                                        7 Six
                                        8 Seven
                                        -9 Missing




MODACT10 I11 In an average week, how many days do you participate in moderate physical activities that last at least 30 minutes? (Examples of moderate physical activity include walking, gardening)


                                        1 None
                                        2 One
                                        3 Two
                                        4 Three
                                        5 Four
                                        6 Five
                                        7 Six
                                        8 Seven
                                        -9 Missing




VIGACT10 I12 In an average week, how many days do you participate in vigorous physical activities that last at least 30 minutes? (Examples of vigorous physical activity include jogging, stair master, soccer)


                                        1 None
                                        2 One
                                        3 Two
                                        4 Three
                                        5 Four
                                        6 Five
                                        7 Six
                                        8 Seven
                                        -9 Missing




SLEEP10 I13 How many hours of sleep do you usually get in a 24 hour period?


1 Less than five

2 Six

3 Seven

4 Eight

5 Nine

6 More than nine

-9 Missing




ALCLIF10 I14 On how many occasions have you alcoholic beverages to drink in your lifetime?


1 None (GO TO I17)

2 1-2 times

3 3-5 times

4 6-9 times

5 10-19 times

6 20-39 times

7 40 or more times

-9 Missing




ALCMON10 I15 How many times have you had alcoholic beverages to drink during the past 30 days?


1 None (GO TO 117)

2 1-2 times

3 3-5 times

4 6-9 times

5 10-19 times

6 20-39 times

7 40 or more times

-9 Missing


DRINKS10 I16 Think back over the last two weeks.  How many times have you had five or more drinks in a row? (A "drink" is a glass of wine, a bottle of beer, shot glass of liquor, or a mixed drink).

                                        1 None

2 Once

3 Twice

4 Three to five times

5 Six to nine times

6 Ten or more times

-9 Missing


SMOKE10 I17 Have you ever smoked cigarettes (tobacco)?


0 No (GO TO I22)

1 Yes (GO TO I18)

-9 Missing


CIG10010 I18 Have you smoked at least 100 cigarettes in your lifetime?


0 No 

1 Yes 

                                        -9 Missing


CIGMON10 I19 How often have you smoke cigarettes during the past 30 days?


1 None at all (GO TO 120)

2 Less than 1 cigarette each day (GO TO 122)

3 1 to 5 cigarettes each day (GO TO 122)

4 About a half pack each day (GO TO 122)

5 About 1 pack each day (GO TO 122)

6 About one and a half packs each day (GO TO 122)

7 About 2 packs or more each day (GO TO 122)

-9 Missing (GO TO 122)



I20 On average, when you were smoking, about how many cigarettes a day did you smoke?


                LONUCI10 number low
                HINUCI10 number high
                LT1CIG10 check here if you smoked less than one cigarette a day
                                        -9 Missing



I21 About haw long has it been since you last smoked cigarettes? (Please specify whether this is months or years.)

                LOMOCI10 number of months low
                HIMOCI10 number of months high
                                        -9 Missing



HINSUR10 I22 Do you have health insurance?


0 No (GO TO I23)

1 Yes (GO TO I22A)

-9 Missing




I22A Do you get this insurance through: (Circle all that apply):

                                        0 Not checked

                                        1 Checked

                                        -9 Missing


INSEMP10 Your employer

INSSPS10 Spouse or partnerís employer

INSSCH10 Your school

INSPRT10 Your parents (you are covered by your parents' policy)

INSPUB10 A public program (Medicaid, MN Care, AFDC)

INSYOU10 Yourself (you purchased it)

INSOTH10 Other

OTHSOU10 please specify: ______________________________




LONGLI10 I23 What do you think are the chances that you will live a long and healthy life?


1 Very high

2 High

3 About fifty-fifty

4 Low

5 Very low

-9 Missing








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