I. Health (W11, 1999)

HEALTH11 I1 In general, would you say your health is (Circle one number):

1 Excellent

2 Very Good

3 Good

4 Fair

5 Poor

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PHYHEA11 I2 During the past 4 weeks, have physical health problems caused you difficulty in doing your work or other daily activities?

1 Not at all

2 Slightly

3 Moderately

4 Quite a bit

5 Extremely

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EMOHEA11 I3  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

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SOCIAL11 I4 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

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PAIN11 I5 If you have felt bodily pain in the past 4 weeks, how severe was the pain?

1 I have not felt bodily pain

2 Very mild

3 Mild

4 Moderate

5 Severe

6 Very severe

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I6 During the past month, how much of the time:

1 No time

2 A little time

3 Some time

4 Most of the time

5 All of the time

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STRAIN11 Have you been under any strain, stress, or pressure?

BLUE11 Have you felt downhearted and blue?

MOODY11 Have you been moody or brooded about things?

DEPRES11 Have you felt depressed?

SPIRIT11 Have you been in low or very low spirits?

ALC11 I7 During the past year (since March 1998), have you had any beer, wine, or liquor?

0 No

1 Yes

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ALCMON11 I7A  How many times have you had alcoholic beverages during the past 30 days?

1 None

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

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DRINKS11 I7B 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, a 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

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SMOKE11 I8 During the past year (since March 1998), have you smoked cigarettes (tobacco)?

0 No

1 Yes

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CIGMON11 I8A How many cigarettes have you smoked daily during the past 30 days?

1 None at all

2 Less than 1 cigarette each day

3 1 to 5 cigarettes each day

4 About a half pack each day

5 About 1 pack each day

6 About one and a half packs each day

7 About 2 packs or more each day

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CHECKU11 I9 Did you visit a doctor for a routine checkup during the past year (since March 1998)?

0 No

1 Yes

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CLINIC11 I10 Is there one particular clinic, health center, or doctor’s office that you usually go to if you are sick or need advice about your health?

0 No

1 Yes

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NOHINS11 I11 Was there any time in the past year (since March 1998) that you did not have health insurance?

0 No

1 Yes

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HINSUR11 I12 Do you currently have health insurance?

0 No

1 Yes

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I12A Do you get this insurance through (Circle all that apply):

                                        0 Not checked

                                        1 Checked

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INSEMP11 Your employer

INSSPS11 Your spouse or partner’s employer

INSSCH11 Your school

INSPRT11 Your parents (you are covered by their policy)

INSPUB11 A public program (Medicaid, MN Care, AFDC, etc)

INSYOU11 Yourself (you purchased it)

INSOTH11 Other, please specify: ______________________________

LONGLI11 I13 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

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