K. MYSELF (W12, 2000)

K1 How strongly do you agree or disagree with each of the following statements? (Circle one number for each)

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly Agree

-9 Missing

MEK1A12 I feel I have a number of good qualities.

MEK1B12 I certainly feel useless at times.

MEK1C12 I feel I do not have much to be proud of.

MEK1D12 There is really no way I can solve some of the problems I have.

MEK1E12 I take a positive attitude toward myself.

MEK1F12 On the whole, I am satisfied with myself.

MEK1G12 Sometimes I feel that I'm being pushed around in life.

MEK1H12 I have little control over the things that happen to me.

MEK1I12 I am useful to society.

MEK1J12 I can do just about anything I really set my mind to do.

MEK1K12 I am helpful to others.

MEK1L12 What happens to me in the future mostly depends on me.

MEK1M12 I often feel helpless in dealing with the problems of life.

MEK1N12 There is little I can do to change many of the important things in my life.

MEK1O12 At times I think I am no good at all.

MEK1P12 I wish I could have more respect for myself.

MEK1Q12 I am an active citizen in my community.

K2 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

-9 Missing

MEK2A12 Have you felt that the future looks hopeful and promising?

MEK2B12 Have you been under any strain, stress, or pressure?

MEK2C12 Have you generally enjoyed the things you do?

MEK2D12 Have you felt tired, worn out, or exhausted?

MEK2E12 Have you felt downhearted and blue?

MEK2F12 Have you felt tense or “high strung”?

MEK2G12 Have you felt cheerful, lighthearted?

MEK2H12 Have you felt depressed?

MEK2I12 Have you been in low or very low spirits?

MEK2J12 Have you felt lonely?

MEK2K12 Has your daily life been full of things that are interesting to you?

MEK2L12 Do you wake up feeling fresh and rested?

MEK312 K3 In general, would you say your health is (Circle one number):

1 Excellent

2 Very Good

3 Good

4 Fair

5 Poor

-9 Missing

K4 What is your current height and weight?

Height: TALLFT12 , TALLIN12

Weight: MEFAT12

                            -9 Missing

MEK512 K5 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

-9 Missing

MEK612 K6  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

MEK712 K7 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

MEK812 K8 How much bodily pain have you had during the past 4 weeks?

1 None

2 Very mild

3 Mild

4 Moderate

5 Severe

6 Very severe

-9 Missing

MEK912 K9 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

-9 Missing

MEK1012 K10 How would you describe your sexual identity?

1 Straight

2 Gay

3 Lesbian

4 Bisexual

5 Unsure

6 Other (please specify) MEK10F12

-9 Missing

In an average week, on how many days do you                                                                     Number of Days Per Week

                                        -9 Missing

MEK1412 K14 How many hours of sleep do you usually get in a 24 hour period?

1 Less than five

2 Five

3 Six

4 Seven

5 Eight

6 Nine

7 More than nine

-9 Missing