L. MYSELF (W19, 2011)

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree

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MEL1A19 I feel I have a number of good qualities.

MEL1B19 I certainly feel useless at times.

MEL1C19 I feel I do not have much to be proud of.

MEL1D19 In my community people trust each other.

MEL1E19 There is really no way I can solve some of the problems I have.

MEL1F19 I take a positive attitude toward myself.

MEL1G19 On the whole, I am satisfied with myself.

MEL1H19 Sometimes I feel that I'm being pushed around in life.

MEL1I19 I have little control over the things that happen to me.

MEL1J19 I can do just about anything I really set my mind to.

MEL1K19 What happens to me in the future mostly depends on me.

MEL1L19 I often feel helpless in dealing with the problems of life.

MEL1M19 There is little I can do to change many of the important things in my life.

MEL1N19 At times I think I am no good at all.

MEL1O19 I wish I could have more respect for myself.

MEL219 L2 How successful do you feel in your work life?

1 Not successful at all

2 Somewhat unsuccessful

3 Somewhat successful

4 Very successful

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MEL319 L3 How successful do you feel in your family or personal life?

1 Not successful at all

2 Somewhat unsuccessful

3 Somewhat successful

4 Very successful

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MEL419 L4 How successful do you feel in balancing work and family/personal life?

1 Not successful at all

2 Somewhat unsuccessful

3 Somewhat successful

4 Very successful

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MEL5HE19 L5 In general, would you say your health is?

1 Excellent

2 Very good

3 Good

4 Fair

5 Poor

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L6 What is your current height and weight?

Height: feet-MEL6FE19 and inches-MEL6IN19

MEL7PH19 L7 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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MEL8EM19 L8 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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MEL9SO19 L9 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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MEL1019 L10 How much physical pain have you had during the past 4 weeks?

1 None

2 Very mild

3 Mild

4 Moderate

5 Severe

6 Very Severe

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L11 Have you ever been told by a doctor that you have the following?

0 No

1 Yes

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MEL11A19 High blood pressure

MEL11B19 Ischemic heart disease, heart attack, MI

MEL11C19 Stroke

MEL11D19 Hepatitis/jaundice

MEL11E19 Diabetes

MEL11F19 Prolonged anxiety, depression or other mental health problems

MEL11G19 Cancer

MEL11H19 Chronic Lung Disease (Emphysema, Asthma, Chronic Bronchitis)

MEL11I19 Fractures or broken bones

MEL11J19 Chronic digestive disease (ulcer, colitis, liver problems)

MEL11K19 Epilepsy or a seizure disorder

MEL11L19 A chronic back problem

MEL11M19 A developmental problem

MEL11N19 An allergy

MEL11O19 Any other major disease, disability or handicap

In an average week how many days do you:

Min=0 Max=7 times per week

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MEL1219 L12 Eat breakfast

MEL1319 L13 Do moderate physical activity for at least 30 minutes (e.g. walking, biking)?

MEL1419 L14 Do vigorous physical activities for at least 30 minutes(e.g. running, football, swimming)?

MEL1519 L15 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

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L16 Please indicate below how uch you agree or disagree with the following statements.

1 Definitely disagree

2 Mostly agree

3 Neither agree nor disagree

4 Mostly agree

5 Definitely agree

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MEL16A19 I like my looks jus the way they are

MEL16B19 I check my appearance in the mirror whenever I can

MEL16C19 Before going out, I usually spend a lot of time getting ready

MEL16D19 I use very few beauty or styling products

MEL16E19 I don't care what people think about my appearance

MEL16F19 I am physically unattractive

MEL1719 L17 I have tried to lose weight by fasting or going on diets.

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very often

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MEL1819 L18 I think I am:

1 Very underweight

2 Somwhat underweight

3 Normal weight

4 Somewhat overweight

5 Very overweight

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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

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MEL19A19 Have you felt that the future looks hopeful and promising?

MEL19B19 Have you been under any strain, stress, or pressure?

MEL19C19 Have you been anxious or worried?

MEL19D19 Have you generally enjoyed the things you do?

MEL19E19 Have you felt tired, worn out, or exhausted?

MEL19F19 Have you felt calm and peaceful?

MEL19G19 Have you felt downhearted and blue?

MEL19H19 Have you felt tense or “high strung”?

MEL19I19 Have you felt cheerful or lighthearted?

MEL19J19 Have you been moody or brooded about things?

MEL19K19 Have you felt depressed?

MEL19L19 Have you been in low or very low spirits?

MEL19M19 Have you felt lonely?

MEL19N19 Has your daily life been full of things that are interesting to you?

MEL19O19 Do you wake up feeling fresh and rested?

MEL2019 L20 Do you have issues regarding sadness or other mental health problems that you would like some help with?

0 No

1 Yes

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