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MATERNAL SELF COMPLETION FORM
STRICTLY CONFIDENTIAL
Director: Professor Neville Butler MD, FRCP, FRCOG, DCH
BLOCK CAPITALS PLEASE

Study teenager's Surname

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Study teenager's Forename(s)

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Sex of teenager

1
Male
2
Female

Study teenager's Home Address

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Postcode

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Study teenager's NHS number (if known)

NHS number

Date of birth

Date of birth

Today's Date

Generic date
TO THE MOTHER OR PERSON COMPLETING THIS FORM:
In this form, we are asking your help in telling us about the activities, skills, diet and behaviour of your teenager. This is in strict confidence and no names will ever be divulged under any circumstances whatsoever.
Please note the questions are addressed to the mother; this is for convenience as it will be the mother answering the questions in the vast majority of cases; however, please do not let the actual wording of the questions interfere with the completion of the form, if the person filling in the form is not the actual mother.
If you should have any difficulty in filling in any part of the form, please consult the Health Visitor, School nurse or other Study Representative who gave it to you. Please return the completed form to the person who gave it to you.
PLEASE START HERE
Section A: HEALTH & BEHAVIOUR

Is your teenager well in every possible way? (Include any changes in health, behaviour, education problems, illness, handicaps etc).

1
YES
2
NO
If NO, answer 1(a) and 1(b) below
qc_A1 == 2

What is the matter?

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Does it affect every day life at home or at school?

1
NO
2
YES, slightly
3
YES, quite a lot
4
YES, severely

Has your teenager any present or past difficulty with speech?

1
YES, at present
2
YES, in past only
3
NO, never
4
DON'T KNOW
If YES, please answer 2(a) below
qc_A2 == 1 || qc_A2 == 2

What is/was the difficulty?

1
Severe stammer
2
Slight stammer
3
Cannot say words properly
4
Other difficulty (please describe ...)
Other

Does your teenager have any present or past eating/appetite problems?

1
YES, at present
2
YES, in past only
3
NO, never
4
DON'T KNOW
If YES, please answer (a) and (b) below
qc_A3 == 1 || qc_A3 == 2

What is/was the eating problem?

1
Refuses to eat
2
Not eating enough
3
Over-eating for more than the occasional meal
4
Other eating problem

Please describe

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Does your teenager have any present or past sleeping difficulty?

1
YES, at present
2
YES, in past only
3
NO, never
4
DON'T KNOW
If YES, please answer 4(a)
qc_A4 == 1 || qc_A4 == 2

Which of the following difficulties is/was present?

1
Can't get off to sleep
2
Complains of nightmares/night terrors
3
Other sleeping difficulty (please describe ...)
Other
Below is a series of descriptions of behaviour sometimes shown by young people. Please say whether, in respect of your teenager, the descriptions certainly applies, applied somewhat or doesn't apply.
-

1 - Certainly Applies

2 - Applies Somewhat

3 - Doesn't Apply

Very restless. Often running about or jumping up and down. Hardly ever still
Is squirmy/fidgety
Often destroys others or own belongings
Frequently fights with others
Not much liked by others
Often worried, worries about many things
Tends to do things on own, rather solitary
Irritable. Is quick to fly off the handle
Often appears miserable, unhappy, tearful or distressed
Sometimes takes things belonging to others
Has twitches, mannerisms or tics of the face and body
Frequently sucks thumb or fingers
Frequently bites nails or fingers
Is often disobedient
Cannot settle to anything for more than a few moments
Tends to be fearful or afraid of new things or new situations
Is fussy or overparticular
Often tells lies
Bullies others
Below is a series of further statements which can apply to young people. Please say whether your teenager behaves not at all like each statement, just a little like it, pretty much like it or very much like it.
-

1 - Not at all

2 - Just a little

3 - Pretty much

4 - Very much

Is noticeably clumsy
Trips or falls easily or bumps into objects or other people
Inattentive, easily distracted
Hums or makes other odd noises at inappropriate times
Has difficulty picking up small objects
Drops things which are being carried
Becomes obsessional about unimportant things
Requests must be met immediately, easily frustrated
Shows restless or over-active behaviour
Is implusive, excitable
Interferes with the activity of others
Is sullen or sulky
Fails to finish things he/she starts, short attention span
Given to rhythmic tapping or kicking
Cries for little cause
Changes mood quickly and drastically
Displays outbrusts of temper, explosive or unpredictable behaviour
Has difficulty in using scissors
Has difficulty concentrating on any particular task though may return to it frequently
Section B: THE SCHOOL

Have you or your husband been to your teenager's school since September 1985?

1
YES, my husband
2
YES, myself
3
YES, both of us
4
NO, neither of us
If YES, please answer 1(a) and 1(b) below
qc_B1 == 1 || qc_B1 == 2 || qc_B1 == 3

How many times?

1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9 +

What did you go for?

1
To a Parent Teacher Association
2
To a School function
3
To discuss your teenager's future
4
Other reasons (What? ...)
Other

Since September 1985, other than visits to school, have you received any advice/literature about your teenager's job, career, or further education?

1
NO
2
YES, completed a interst inventory
3
YES, had an interview with careers officer(s)
4
YES, received literature
5
YES, in other ways (What? ...)
Other
How satisfied have you been with your teenager's progress and advice given to him/her in the past 2 years?
-

1 - Very satisfied

2 - Fairly satisfied

3 - Not satisfied

4 - Can't say

With my teenager's school progress
With decisions about exams
With advice/help on getting a job etc.
With the teacher's interest in him/her
With school discipline
With school's readiness to see parents
If you have answered 'Not satisfied' or 'Can't say' to any,
qc_B3_a-f == 3 || qc_B3_a-f == 4

could you expain why it is?

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Which of the following would you like your teenager to do (A), and what do you think he/she will actually do, after this school year? (B)
(A) I would like her/him to do this (B) I think he/she will do this

1 - Tick

1 - Tick

1 - Tick

1 - Tick

1 - Tick

1 - Tick

1 - Tick

1 - Tick

Leave at end of this term
Stay in full-time education and do vocational training
Stay in full-time education and do 'A' levels etc.
Continue some form of full-time education beyond age 18
Other (What? ...)
Don't know

Which of the following would you like your teenager to do (A), and what do you think he/she will actually do, after this school year? (B) Other (What? ...)

Other

During this school year, how much time, if any, has your teenager missed at school because of ill health/emotional disturbance, etc.?

1
Missed none or less than one week in all
2
Over one week and up to one month
3
Over one month and up to three months
4
Over three months
5
Missed school but not known how long
6
Not known if missed school
If has missed over one week schooling answer 5(a).
qc_B5 >= 2 && qc_B5 <= 5

Give the reason(s) why schooling missed

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Section C: THE HOME

Is anyone usually at home when your teenager gets back from school at the end of the day?

1
YES
2
NO
3
Not applicable eg boarder etc.
Right now, how often do you/the family spend time with your teenager? (Of course, you are bound to come into contact will all your children who live at home, but we mean more than that. We mean talking together, doing hobbies and other things together and going out together etc. because you want to.) Please tick how many times each week yourself, your husband or both of you together, have done things with your teenager.
-

1 - Every day

2 - 3-5 times a week

3 - 1-2 times a week

4 - Occasionally

5 - Quite rare

Myself
My husband
As a family
Right now, who would you say your teenager has listened to most for advice?
A Tick all that apply B Put in order 1, 2, 3

1 - Tick

Order

1 - Tick

Order

1 - Tick

Order

1 - Tick

Order
Your husband
Yourself
Brother(s)/Sister(s)
School Teacher(s)
Friend(s) (own)
Someone else (Who? ...)
Nobody

Right now, who would you say your teenager has listened to most for advice? (Who?...)

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On the whole, are you and your husband happy with the way your teenager is turning out?

1
YES, definitely
2
YES, in some ways but not in others
3
NO, not happy
4
CAN'T SAY
If YES, in some ways but not in others or NO, not happy to question C4
qc_C4 == 2 || qc_C4 == 3

Would you like to tell us more?

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If you could bring your teenager up again, would you do anything differently?

1
NO
2
YES, I might/am undecided
3
YES, definitely
4
CAN'T SAY
If YES, please answer 5(a) below.
qc_C5 == 2 || qc_C5 == 3

Would you like to tell us in what way?

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Do you feel that your husband plays a big part in the life of your teenager?

1
My husband takes a big part or an equal part with myself
2
My husband takes a smaller part than myself but I still feel it to be a significant part
3
My husband takes a very small part or leaves it to me
4
Can't say
5
Other answer (Please give details ...)
Other
Section D: YOUR HEALTH
Many mothers find caring for their family difficult if their own health is not very good. Listed below are a number of common symptoms that mothers often describe to doctors. We would like you to say if these happen to you most of the time, some of the time, or rarely/never, as in the examples given below.
-

1 - Most of the time

2 - Some of the time

3 - Rarely or never

Do you have backache?
Do you feel tired?
Do you feel miserable or depressed?
Do you have bad headaches?
Do you get worried about things?
Do you have great difficulty in falling asleep or staying asleep?
Do you wake unnecessarily early in the morning?
Do you wear yourself out worrying about your health?
Do you get into a violent rage?
Do people annoy and irritate you?
Have you at times had a twitching of the face, head or shoulders?
Do you suddenly become scared for no good reason?
Are you scared to be alone when there are no friends near you?
Are you easily upset or irritated?
Are you frightened of going out alone or of meeting people?
Are you keyed up and jittery?
Do you suffer from indigestion?
Do you suffer from an upset stomach?
Is your appetite poor?
Does every little thing get on your nerves and wear you out?
Does your heart race like mad?
Do you have bad pains in your eyes?
Are you troubled with rheumatism or fibrositis?
Have you ever had a nervous breakdown?
Do you have any other health problems worrying you?
If positive to last item
qc_D1$1;25 == 1 || qc_D1$1;25 == 2

please describe the problem(s) in your own words:

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Here are a series of statements about how some people feel. Could you tell us what you think regarding yourself?
-

1 - Yes, I agree a lot

2 - Yes, I agree a little

3 - Not sure

4 - No, I disagree a little

5 - No, I disagree a lot

I can do things as well as most people of my age
I'm a useful person to have around
I haven't got much to be proud of
Sometimes I think I'm no good at all
I feel I'm as good a person as anybody else
I feel I can't do anything right
When I do something I always do it well
I'm not really getting anywhere with my life
Section E: FOOD

Please enter here how often the teenager eats the following:- Breakfast Cereal

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- White Bread

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Wholemeal/Granary Bread

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Ordinary Brown Bread

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Eggs/Egg Dishes

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Ordinary Meat

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Processed Meat

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Chicken/Turkey

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Liver/Kidney

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Fish

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Potatoes (Chips)

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Potatoes (Not Chips)

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Crisps

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Baked Beans

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Peas/Green Beans

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Other Green Vegetables

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Root Vegetables

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Green Salad

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Fresh Fruit

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Margarine

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Butter

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Cheese/Cheese Dishes

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Cake/Buns/Biscuits

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Ice Cream

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Chocolate/Sweets

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Please enter here how often the teenager eats the following:- Puddings

1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day

Which type of milk do you take and which does your teenager drink? I buy

1
Gold Top (Channel Island)
2
Silver Top (include UHT or carton-pasteurised)
3
Semi-skimmed (fresh or UHT)
4
Skimmed (fresh or UHT)
5
Other types of milk (which ...)
6
I do not buy milk
7
Teenager doesn't drink it
Other

Which type of milk do you take and which does your teenager drink? My teenager drinks

1
Gold Top (Channel Island)
2
Silver Top (include UHT or carton-pasteurised)
3
Semi-skimmed (fresh or UHT)
4
Skimmed (fresh or UHT)
5
Other types of milk (which ...)
6
I do not buy milk
7
Teenager doesn't drink it
Other
What type(s) of bread do you buy and what does your teenager eat?
A I buy B My teenager eats Brand

1 - Tick

1 - Tick

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1 - Tick

1 - Tick

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1 - Tick

1 - Tick

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1 - Tick

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1 - Tick

White bread
Wholemeal bread
Granary bread
Ordinary brown bread
Other types of bread (which? ...)

What type(s) of bread do you buy and what does your teenager eat? Other types of bread (which? ...)

Other

Which brand(s) do you usually buy?

Generic text

Which cereals do you buy/does your teenager eat? I buy

1
Cornflakes
2
Weetabix/Shredded Wheat/Bran Flakes
3
All Bran and similar products
4
Muesli/Porridge Oats (exclude instant types)
5
Rice Krispies and similar products
6
Other cereals (what? ...)
Other

Which cereals do you buy/does your teenager eat? My teenager eats

1
Cornflakes
2
Weetabix/Shredded Wheat/Bran Flakes
3
All Bran and similar products
4
Muesli/Porridge Oats (exclude instant types)
5
Rice Krispies and similar products
6
Other cereals (what? ...)
Other

Some people ask for/select lean cuts of meat. What about you?

1
Makes no difference to me
2
I ask for lean meat
3
I prefer meat to have some fat
4
Other answer (what? ...)
Other

Some people trim their meat before cooking In preparing meat for cooking. Do you?

1
Leave it as it is
2
Trim off some fat
3
Try to remove all fat
4
Buy lean meat anyway
5
Other answer (what? ...)
Other
Have you served any of these in the past 4 weeks
A I have bought for family B My teenager eats Brand if known

1 - Tick

1 - Tick

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1 - Tick

1 - Tick

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Meat pies/pasties
Sausages
Faggots, etc
Fish fingers
Burgers
Pizzas
Have your served any of these in the past 4 weeks
A I have bought for family B My teenager eats Brand if known

1 - Tick

1 - Tick

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1 - Tick

1 - Tick

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Fish (and chips)
Chicken (and chips)
Baked potatoes as a meal
Hamburgers/beefburgers
Chinese takeaway
Indian takeaway
Other takeaway

Which type of flour do you use when cooking?

1
White flour
2
Wholemeal flour
3
Mixture of the two
4
Other types(s) of flour (what? ...)
Other

What about fish (other than fish and chips) I have bought in past month

1
White Fish e.g. Plaice, Haddock, Cod
2
Herring, Trout, Mackerel (fresh/frozen)
3
Tinned Fish
4
Smoked Fish
5
Fish fingers/cakes
6
Other types of fish (what? ...)
Other

Do you add salt when cooking? (Don't include salt substitutes and seasonings) Meat/Poultry

1
I usually add salt
2
I sometimes add salt
3
I never add salt

Do you add salt when cooking? (Don't include salt substitutes and seasonings) Fish

1
I usually add salt
2
I sometimes add salt
3
I never add salt

Do you add salt when cooking? (Don't include salt substitutes and seasonings) Egg dishes

1
I usually add salt
2
I sometimes add salt
3
I never add salt

Do you add salt when cooking? (Don't include salt substitutes and seasonings) Potatoes

1
I usually add salt
2
I sometimes add salt
3
I never add salt

Do you add salt when cooking? (Don't include salt substitutes and seasonings) Vegetables

1
I usually add salt
2
I sometimes add salt
3
I never add salt

Do you add salt when cooking? (Don't include salt substitutes and seasonings) Salad

1
I usually add salt
2
I sometimes add salt
3
I never add salt

Do you add salt when cooking? (Don't include salt substitutes and seasonings) Other foods to which you add salt (namely ...)

1
I usually add salt
2
I sometimes add salt
3
I never add salt
Other

Do you add salt when cooking? (Don't include salt substitutes and seasonings) Other foods to which you add salt (namely ...)

1
I usually add salt
2
I sometimes add salt
3
I never add salt
Other
What does your teenager put on bread/toast?
Tick

1 - Usually

2 - Occasionally

3 - Never

Soft margarine
Hard margarine
Low fat spread
Butter

What does your teenager put on bread/toast? Other or doubtful as to type (what? ...)

1
Usually
2
Occasionally
3
Never
Other

For frying, which of the following do you do?

1
I shallow fry
2
I deep fry
3
I use little or no fat/non-stick pan
4
I grill
We would like to find out what sort of fat and oil you use for frying. Put a tick in the correct boxes for the types you use for A and B.
A Shallow Frying B Deep Frying State brand, if known

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

Generic text

1 - Main one

2 - Sometimes used

Soft Margarine (tub)
Hard Margarine
Butter
Dripping
Lard
Solid Vegetable Fat (eg Pura)
Vegetable oil (blended)
Corn Oil
Soya Oil
Sunflower Oil
Sesame Oil
Olive Oil
Other Oil What ?

We would like to find out what sort of fat and oil you use for frying. Put a tick in the correct boxes for the types you use for A and B. Other oil What?

Other

Has your teenager had any puddings in the past 4 weeks?

1
YES, at home
2
YES, outside home
3
NO
If YES, answer 14(a) and 14(b) below.
qc_E14 == 1 || qc_E14 == 2

With how many meals per week does your teenager have puddings?

How many
What sort of puddings has your teenager eaten in the past 4 weeks?
Tick

1 - Not eaten

2 - Sometimes

3 - Often

Milk puddings e.g. rice pudding/semolina
Stewed or cooked fruit
Fresh fruit
Yoghurt
Fruit pie or crumble
Jelly, blancmange, whips
Ice cream
Trifle, gateau, cream cakes, cheesecake
Sponge cakes/puddings
Suet puddings

Has your teenager had any cheese(s) during the past 4 weeks?

1
NO
2
YES
3
DON'T KNOW
If YES, answer 15(a) below.
qc_E15 == 2
What was the type?
A Tick all that apply Brand, if known

1 - Tick

Generic text

1 - Tick

Generic text

1 - Tick

Generic text

1 - Tick

Generic text
Cottage Cheese
Soft chesse (eg Brie, Camembert)
Hard cheese (eg Edam, Cheddar)
Cheese Spread
Other cheese (what? ...)

What was the type? Other cheese (what? ...)

Other

Was the arrangement for your teenager's mid-day meal in the last week that he/she has been at school?

1
Went to school cafeteria
2
Received free school meal(s)
3
Teenager took snack(s) to school
4
Teenager came home for mid-day meal
5
Teenager bought snacks outside school
6
Other type of meal (Please give details: ...)
Other

Has this arrangement changed at any time in the past year, for whatever reason?

Generic text
How many weekdays and how many days at weekends does the family 'sit down together' to eat a meal each week? (Exclude members of household away temporarily/permanently)
A Number of weekdays B Number of days at weekends

1 - 0

2 - 1

3 - 2

4 - 3

5 - 4

6 - 5

1 - 0

2 - 1

3 - 2

1 - 0

2 - 1

3 - 2

4 - 3

5 - 4

6 - 5

1 - 0

2 - 1

3 - 2

1 - 0

2 - 1

3 - 2

4 - 3

5 - 4

6 - 5

1 - 0

2 - 1

3 - 2

1 - 0

2 - 1

3 - 2

4 - 3

5 - 4

6 - 5

1 - 0

2 - 1

3 - 2

Breakfast
Mid-day meal
Evening meal

Does your teenager take any special diet(s) etc.?

1
YES
2
NO
3
DON'T KNOW
If YES, answer 18(a) and 18(b) below.
qc_E18 == 1

Please describe how his/her diet differs from that of the average British teenager of his/her age

Generic text

Why is this?

1
To lose weight
2
For health/medical reasons
3
For religion/culture
4
For other reason(s)
If for health reasons, what are they? (eg diabetes, obesity, cardiac)
qc_qE18_b == 1

What?

Generic text
If for health reasons, what are they? (eg diabetes, obesity, cardiac)
qc_E18_b == 2

What?

Generic text

Why is this? For religion/culture Which?

Generic text

Why is this? for other reasons(s) What?

Other
Section F: ACCOMMODATION

Is your accommodation affected by damp?

1
NO, no damp
2
YES, slight dampness
3
YES, marked dampness
If YES, please answer 1(a), 1(b) and 1(c) below.
qc_F1 == 2 || qc_F1 == 3

How long has this been the case

1
Less than 1 year
2
1-4 years
3
5 years or more

How many room(s) are affected?

1
0
2
1
3
2
4
3
5
4
6
5
7
6

Do you think it is a hazard to health?

1
YES
2
NO
If YES,
qc_F1_c == 1

in what way?

Generic text

Apart from damp problems, has your accommodation deteriorated in any other way? (e.g. subsidence, dilapidations, decayed concrete, etc.)

1
NO, it is in good condition
2
YES, there is a slight problem
3
YES, there is a marked problem
If YES, please answer 2(a) and 2(b)
qc_F2 == 2 || qc_F2 == 3

How long have you experienced problem(s) in your accommodation?

1
Less than one year
2
1-4 years
3
5 years or more

Please describe briefly the problem(s)

Generic text
Section G: YOUR HOUSEHOLD

Are there in your household any of the following? Car or Van

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Telephone

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Television

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Video Recorder

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Video Camera

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Stereo/HiFi

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Radio

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Home Computer

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Double Glazing

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Sewing Machine

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Electric Cooker

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Gas Cooker (Piped)

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Gas Cooker (Bottled)

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Solid Fuel Cooker

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Dishwasher

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Washing Machine

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Tumbler Dryer

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Spin Dryer

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Fridge

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Freezer

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Food Mixer/Blender

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Microwave Oven

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Vacuum Cleaner

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Paraffin Heater

1
We own one
2
We would like one
3
We wouldn't want one

Are there in your household any of the following? Calor Gas (Butane) heater

1
We own one
2
We would like one
3
We wouldn't want one

Do you receive any help with housework? e.g. cleaning the house, washing up, making beds, etc.

1
YES, considerable
2
YES, some
3
YES, a little
4
Almost none
If YES, answer 2(a) below
qc_G2 == 1 || qc_G2 === 2 || qc_G2 === 3

Who usually helps you?

1
My husband
2
My teenager him/herself
3
Others in household
4
Relatives or friends from outside
5
Paid help
6
Other person (Who? ...)
Other
What papers, comics, magazines are regularly at home which your teenager can read?
- Tick all that apply

1 - Tick

Generic text

1 - Tick

Generic text

1 - Tick

Generic text

1 - Tick

Generic text
Comics (please name: ...)
Magazines (please name: ...)
Weekly papers (please name: ...)
Local papers (please name: ...)
Sunday papers (please name: ...)

What papers, comics, magazines are regularly at home which your teenager can read? National daily papers

1
Daily Mail
2
Daily Express
3
The Sun
4
The Times
5
The Guardian
6
Daily Star
7
Daily Mirror
8
Daily Telegraph
9
None of these

Have you a pet in your household?

1
YES
2
NO
If YES, please answer 4(a), 4(b), (c), (d), and (e) below.
qc_G4 == 1

What type of pet?

1
Dog
2
Cat
3
Parrot
4
Budgerigar/Canary
5
Goldfish/Tropical fish
6
Hamster/Gerbil/Mice
7
Other animal(s)/pet(s) (What? ...)
Other

Is anyone in your household sensitive to animal/pets?

1
YES
2
NO
3
DON'T KNOW
If YES, answer 4(c), (d) and (e) below.
qc_4_b == 1

Who is sensitive?

Generic text

To what type of animal/pet?

Generic text

What symptoms are produced by contact or exposure?

Generic text
Did your teenager, yourself or your husband have any difficulty in learning to read or in reading at present?
-

1 - Yes, in learning to read

2 - Yes, in reading now

3 - No, Neither

Teenager
Husband
Myself

Does your teenager, yourself or your husband read books or magazines? Teenager

1
Neither Books nor Magazines
2
Yes reads Books
3
Yes reads Magazines

Does your teenager, yourself or your husband read books or magazines? Husband

1
Neither Books nor Magazines
2
Yes reads Books
3
Yes reads Magazines

Does your teenager, yourself or your husband read books or magazines? Myself

1
Neither Books nor Magazines
2
Yes reads Books
3
Yes reads Magazines
If YES to magazines, answer 6(a)
qc_G6_i == 3 || qc_G6_ii == 3 || qc_G6_iii == 3

Which magazine(s)? Teenager

Generic text

Which magazine(s)? Husband

Generic text

Which magazine(s)? Myself

Generic text
If YES to books, answer 6b
qc_G6_i == 2 || qc_G6_ii == 2 || qc_G6_iii == 2

Which type of book(s)? Teenager

Generic text

Which type of book(s)? Husband

Generic text

Which type of book(s)? Myself

Generic text

Has anyone ever told you that your teenager, your husband, yourself or any relatives were dyslexic? Which, if any, are dyslexic?

1
My teenager
2
Other children in family (who? ...)
3
Other relative(s) (who? ...)
4
Husband (teenager's father)
5
Myself
6
None of above
Other
Other 2

As far as you know how often does your teenager have an alcoholic drink, if at all, and how often do your husband or yourself?

1
Very rarely or never
2
Once a month
3
2 or 3 times a month
4
Once or twice a week
5
3 or 4 times a week
6
Everyday or most days
What is the usual drink, if any, of the teenager, the mother and the father, and what is sometimes consumed?
cs_qG9_A_Y (Other, what? ...) cs_qG9_X cs_qG9 cs_qG9 cs_qG9 cs_qG9

1 - Your teenager

2 - Your husband

3 - Yourself

1 - Your teenager

2 - Your husband

3 - Yourself

1 - Your teenager

2 - Your husband

3 - Yourself

1 - Your teenager

2 - Your husband

3 - Yourself

Doesn't drink 1 A Usual Drink
Doesn't drink 1 B Drink sometimes
Doesn't drink 2 A Usual Drink
Doesn't drink 2 B Drink sometimes
Lager 1 A Usual Drink
Lager 1 B Drink sometimes
Lager 2 A Usual Drink
Lager 2 B Drink sometimes
Beer 1 A Usual Drink
Beer 1 B Drink sometimes
Beer 2 A Usual Drink
Beer 2 B Drink sometimes
Wine 1 A Usual Drink
Wine 1 B Drink sometimes
Wine 2 A Usual Drink
Wine 2 B Drink sometimes
Gin 1 A Usual Drink
Gin 1 B Drink sometimes
Gin 2 A Usual Drink
Gin 2 B Drink sometimes
Whisky 1 A Usual Drink
Whisky 1 B Drink sometimes
Whisky 2 A Usual Drink
Whisky 2 B Drink sometimes
Sherry 1 A Usual Drink
Sherry 1 B Drink sometimes
Sherry 2 A Usual Drink
Sherry 2 B Drink sometimes
Vodka 1 A Usual Drink
Vodka 1 B Drink sometimes
Vodka 2 A Usual Drink
Vodka 2 B Drink sometimes
Martini 1 A Usual Drink
Martini 1 B Drink sometimes
Martini 2 A Usual Drink
Martini 2 B Drink sometimes

PLEASE GIVE A SHORT DESCRIPTION OF YOUR TEENAGER'S DEVELOPMENT SINCE A BABY, MENTIONING THE IMPORTANT EVENTS AT HOME, SCHOOL, IN THE FAMILY WHICH HAVE INFLUENCED HIM/HER AND HIS/HER HEALTH AND DEVELOPMENT.

Long text
Miscellaneous
(Question 1 - Girls only)
qc_intro_iii == 2

What age did your teenage girl have her first menstrual period?

1
Before 11th birthday
2
When aged 11
3
Aged 12
4
Aged 13
5
Aged 14
6
Aged 15 or more
7
Not yet commenced
8
Commenced, but don't know age
If reached puberty, answer 1(a) and 1(b).
qc_1 == 1 || qc_1 == 2 || qc_1 == 3 || qc_1 == 4 || qc_1 == 5 || qc_1 == 6 || qc_1 == 8

Have her periods been regular in past year?

1
Regular
2
Irregular
3
Has missed more than 3 months at any time (Why? ...)
Generic text

When was her last menstrual period? Month ... Year

Generic text
Generic text 2

A lot is spoken these days about early sexual experience of all sorts having an effect on children's development. Is this a thing you've thought about in regard to your teenager?

1
YES, I have thought about it
2
NO, it really doesen't come into it
3
CAN'T SAY
If YES, please answer 2(a).
qc_2 == 1

Would you like to help us form a view on this sort of thing?

Long text

Describe your teenager's health over the past 12 months?

1
Excellent
2
Good
3
Fair
4
Poor
If there is a problem,
qc_3 == 3 || qc_3 == 4

what is it?

Generic text

Do your teenager, yourself or your husband ever do things to keep healthy? Teenager

1
Never
2
Occasionally
3
Regularly

Do your teenager, yourself or your husband ever do things to keep healthy? Myself

1
Never
2
Occasionally
3
Regularly

Do your teenager, yourself or your husband ever do things to keep healthy? Husband

1
Never
2
Occasionally
3
Regularly
If occasionally or regularly answer 4(a).
qc_4_A == 2 || qc_4_A == 3 || qc_4_B == 2 || qc_4_B == 3 || qc_4_C == 2 || qc_4_C == 3

What form of exercise Teenager

1
Go running/jogging
2
Do keep fit exercises
3
Weight-training
4
Go for walks
5
Sauna
6
Other exercise (What? ...)
Other

What form of exercise Myself

1
Go running/jogging
2
Do keep fit exercises
3
Weight-training
4
Go for walks
5
Sauna
6
Other exercise (What? ...)
Other

What form of exercise My Husband

1
Go running/jogging
2
Do keep fit exercises
3
Weight-training
4
Go for walks
5
Sauna
6
Other exercise (What? ...)
Other
Do you think the following should be taught to teenagers at school? Answer questions 1-25 in Section A and tick one of the four boxes in Section A If your answer in Section A is "No" proceed to Section B and tick one of the three boxes to say why you think this should not be given at school.
SECTION A SECTION B If NO, is it because:

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

How the body works
Staying well
Immunisation
Illness and recovery
Talking with Doctors, Nurses and Dentists
Care of hair, teeth, skin
Care of eyes
Care of feet
Human reproduction
Menstruation (periods)
Food and Health
Drinking alcohol
Glue-sniffing
Smoking
Physical fitness
Understanding the needs of handicapped people
Understanding the needs of old people
Health and social services
Safety at home
Safety in traffic
Water safety
First aid
Family life
Separation from parents
Death and bereavement

Which do you consider to be the 3 most important topics from the list above? Please enter topic numbers

Topic 1-25 1
Topic 1-25 2
Topic 1-25 3
Do you think the following should be taught to teenagers at school? (continued) Answer questions 26-49 in section A and tick one of the four boxes in Section A If your answer in Section A is "No" proceed to Section B and tick one of the three boxes to say why you think this should not be given at school.
SECTION A SECTION B If NO, is it because:

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

Stress and relaxation
The difference between boys' behaviour and girl's behaviour
Normal growth and development
Relationships with other boys and girls of the same age
Understanding people of different race or religion
Feelings (love, hate, anger, jealously)
Bullying
Building self-confidence
Making decisions
Honesty
Responsibility for your own behaviour
Spare-time activities
Boredom
Caring for pets
Vandalism
Stealing
Pollution
Conservation
Contraception
Parenthood and child care
Sexually transmitted diseases
Control of body weight
Violence on the television screen
Cancer

Which do you consider to be the 3 most important topics from the list above? Please enter topic numbers.

Topic 26-49 1
Topic 26-49 2
Topic 26-49 3
THANK YOU FOR YOUR HELP
End

bcs_86_msc

MATERNAL SELF COMPLETION FORM
STRICTLY CONFIDENTIAL
Director: Professor Neville Butler MD, FRCP, FRCOG, DCH
BLOCK CAPITALS PLEASE
Study teenager's Surname
Generic text
Study teenager's Forename(s)
Generic text
Sex of teenager
1
Male
2
Female
Study teenager's Home Address
Generic text
Postcode
Generic text
Study teenager's NHS number (if known)
NHS number
Date of birth
Date of birth
Today's Date
Generic date
TO THE MOTHER OR PERSON COMPLETING THIS FORM:
In this form, we are asking your help in telling us about the activities, skills, diet and behaviour of your teenager. This is in strict confidence and no names will ever be divulged under any circumstances whatsoever.
Please note the questions are addressed to the mother; this is for convenience as it will be the mother answering the questions in the vast majority of cases; however, please do not let the actual wording of the questions interfere with the completion of the form, if the person filling in the form is not the actual mother.
If you should have any difficulty in filling in any part of the form, please consult the Health Visitor, School nurse or other Study Representative who gave it to you. Please return the completed form to the person who gave it to you.
PLEASE START HERE

Section A: HEALTH & BEHAVIOUR

Is your teenager well in every possible way? (Include any changes in health, behaviour, education problems, illness, handicaps etc).
1
YES
2
NO
What is the matter?
Generic text
Does it affect every day life at home or at school?
1
NO
2
YES, slightly
3
YES, quite a lot
4
YES, severely
Has your teenager any present or past difficulty with speech?
1
YES, at present
2
YES, in past only
3
NO, never
4
DON'T KNOW
What is/was the difficulty?
1
Severe stammer
2
Slight stammer
3
Cannot say words properly
4
Other difficulty (please describe ...)
Other
Does your teenager have any present or past eating/appetite problems?
1
YES, at present
2
YES, in past only
3
NO, never
4
DON'T KNOW
What is/was the eating problem?
1
Refuses to eat
2
Not eating enough
3
Over-eating for more than the occasional meal
4
Other eating problem
Please describe
Generic text
Does your teenager have any present or past sleeping difficulty?
1
YES, at present
2
YES, in past only
3
NO, never
4
DON'T KNOW
Which of the following difficulties is/was present?
1
Can't get off to sleep
2
Complains of nightmares/night terrors
3
Other sleeping difficulty (please describe ...)
Other

Below is a series of descriptions of behaviour sometimes shown by young people. Please say whether, in respect of your teenager, the descriptions certainly applies, applied somewhat or doesn't apply.

-

1 - Certainly Applies

2 - Applies Somewhat

3 - Doesn't Apply

Very restless. Often running about or jumping up and down. Hardly ever still
Is squirmy/fidgety
Often destroys others or own belongings
Frequently fights with others
Not much liked by others
Often worried, worries about many things
Tends to do things on own, rather solitary
Irritable. Is quick to fly off the handle
Often appears miserable, unhappy, tearful or distressed
Sometimes takes things belonging to others
Has twitches, mannerisms or tics of the face and body
Frequently sucks thumb or fingers
Frequently bites nails or fingers
Is often disobedient
Cannot settle to anything for more than a few moments
Tends to be fearful or afraid of new things or new situations
Is fussy or overparticular
Often tells lies
Bullies others

Below is a series of further statements which can apply to young people. Please say whether your teenager behaves not at all like each statement, just a little like it, pretty much like it or very much like it.

-

1 - Not at all

2 - Just a little

3 - Pretty much

4 - Very much

Is noticeably clumsy
Trips or falls easily or bumps into objects or other people
Inattentive, easily distracted
Hums or makes other odd noises at inappropriate times
Has difficulty picking up small objects
Drops things which are being carried
Becomes obsessional about unimportant things
Requests must be met immediately, easily frustrated
Shows restless or over-active behaviour
Is implusive, excitable
Interferes with the activity of others
Is sullen or sulky
Fails to finish things he/she starts, short attention span
Given to rhythmic tapping or kicking
Cries for little cause
Changes mood quickly and drastically
Displays outbrusts of temper, explosive or unpredictable behaviour
Has difficulty in using scissors
Has difficulty concentrating on any particular task though may return to it frequently

Section B: THE SCHOOL

Have you or your husband been to your teenager's school since September 1985?
1
YES, my husband
2
YES, myself
3
YES, both of us
4
NO, neither of us
How many times?
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9 +
What did you go for?
1
To a Parent Teacher Association
2
To a School function
3
To discuss your teenager's future
4
Other reasons (What? ...)
Other
Since September 1985, other than visits to school, have you received any advice/literature about your teenager's job, career, or further education?
1
NO
2
YES, completed a interst inventory
3
YES, had an interview with careers officer(s)
4
YES, received literature
5
YES, in other ways (What? ...)
Other

How satisfied have you been with your teenager's progress and advice given to him/her in the past 2 years?

-

1 - Very satisfied

2 - Fairly satisfied

3 - Not satisfied

4 - Can't say

With my teenager's school progress
With decisions about exams
With advice/help on getting a job etc.
With the teacher's interest in him/her
With school discipline
With school's readiness to see parents
could you expain why it is?
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Which of the following would you like your teenager to do (A), and what do you think he/she will actually do, after this school year? (B)

(A) I would like her/him to do this (B) I think he/she will do this

1 - Tick

1 - Tick

1 - Tick

1 - Tick

1 - Tick

1 - Tick

1 - Tick

1 - Tick

Leave at end of this term
Stay in full-time education and do vocational training
Stay in full-time education and do 'A' levels etc.
Continue some form of full-time education beyond age 18
Other (What? ...)
Don't know
Which of the following would you like your teenager to do (A), and what do you think he/she will actually do, after this school year? (B) Other (What? ...)
Other
During this school year, how much time, if any, has your teenager missed at school because of ill health/emotional disturbance, etc.?
1
Missed none or less than one week in all
2
Over one week and up to one month
3
Over one month and up to three months
4
Over three months
5
Missed school but not known how long
6
Not known if missed school
Give the reason(s) why schooling missed
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Section C: THE HOME

Is anyone usually at home when your teenager gets back from school at the end of the day?
1
YES
2
NO
3
Not applicable eg boarder etc.

Right now, how often do you/the family spend time with your teenager? (Of course, you are bound to come into contact will all your children who live at home, but we mean more than that. We mean talking together, doing hobbies and other things together and going out together etc. because you want to.) Please tick how many times each week yourself, your husband or both of you together, have done things with your teenager.

-

1 - Every day

2 - 3-5 times a week

3 - 1-2 times a week

4 - Occasionally

5 - Quite rare

Myself
My husband
As a family

Right now, who would you say your teenager has listened to most for advice?

A Tick all that apply B Put in order 1, 2, 3

1 - Tick

Order

1 - Tick

Order

1 - Tick

Order

1 - Tick

Order
Your husband
Yourself
Brother(s)/Sister(s)
School Teacher(s)
Friend(s) (own)
Someone else (Who? ...)
Nobody
Right now, who would you say your teenager has listened to most for advice? (Who?...)
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On the whole, are you and your husband happy with the way your teenager is turning out?
1
YES, definitely
2
YES, in some ways but not in others
3
NO, not happy
4
CAN'T SAY
Would you like to tell us more?
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If you could bring your teenager up again, would you do anything differently?
1
NO
2
YES, I might/am undecided
3
YES, definitely
4
CAN'T SAY
Would you like to tell us in what way?
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Do you feel that your husband plays a big part in the life of your teenager?
1
My husband takes a big part or an equal part with myself
2
My husband takes a smaller part than myself but I still feel it to be a significant part
3
My husband takes a very small part or leaves it to me
4
Can't say
5
Other answer (Please give details ...)
Other

Section D: YOUR HEALTH

Many mothers find caring for their family difficult if their own health is not very good. Listed below are a number of common symptoms that mothers often describe to doctors. We would like you to say if these happen to you most of the time, some of the time, or rarely/never, as in the examples given below.

-

1 - Most of the time

2 - Some of the time

3 - Rarely or never

Do you have backache?
Do you feel tired?
Do you feel miserable or depressed?
Do you have bad headaches?
Do you get worried about things?
Do you have great difficulty in falling asleep or staying asleep?
Do you wake unnecessarily early in the morning?
Do you wear yourself out worrying about your health?
Do you get into a violent rage?
Do people annoy and irritate you?
Have you at times had a twitching of the face, head or shoulders?
Do you suddenly become scared for no good reason?
Are you scared to be alone when there are no friends near you?
Are you easily upset or irritated?
Are you frightened of going out alone or of meeting people?
Are you keyed up and jittery?
Do you suffer from indigestion?
Do you suffer from an upset stomach?
Is your appetite poor?
Does every little thing get on your nerves and wear you out?
Does your heart race like mad?
Do you have bad pains in your eyes?
Are you troubled with rheumatism or fibrositis?
Have you ever had a nervous breakdown?
Do you have any other health problems worrying you?
please describe the problem(s) in your own words:
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Here are a series of statements about how some people feel. Could you tell us what you think regarding yourself?

-

1 - Yes, I agree a lot

2 - Yes, I agree a little

3 - Not sure

4 - No, I disagree a little

5 - No, I disagree a lot

I can do things as well as most people of my age
I'm a useful person to have around
I haven't got much to be proud of
Sometimes I think I'm no good at all
I feel I'm as good a person as anybody else
I feel I can't do anything right
When I do something I always do it well
I'm not really getting anywhere with my life

Section E: FOOD

Please enter here how often the teenager eats the following:- Breakfast Cereal
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- White Bread
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Wholemeal/Granary Bread
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Ordinary Brown Bread
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Eggs/Egg Dishes
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Ordinary Meat
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Processed Meat
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Chicken/Turkey
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Liver/Kidney
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Fish
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Potatoes (Chips)
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Potatoes (Not Chips)
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Crisps
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Baked Beans
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Peas/Green Beans
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Other Green Vegetables
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Root Vegetables
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Green Salad
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Fresh Fruit
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Margarine
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Butter
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Cheese/Cheese Dishes
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Cake/Buns/Biscuits
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Ice Cream
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Chocolate/Sweets
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Please enter here how often the teenager eats the following:- Puddings
1
Never
2
Eats it rarely
3
About once a month
4
About 1 day a week
5
About 2 days a week
6
About 3 days a week
7
About 4 days a week
8
About 5 days a week
9
About 6 days a week
10
Every day
Which type of milk do you take and which does your teenager drink? I buy
1
Gold Top (Channel Island)
2
Silver Top (include UHT or carton-pasteurised)
3
Semi-skimmed (fresh or UHT)
4
Skimmed (fresh or UHT)
5
Other types of milk (which ...)
6
I do not buy milk
7
Teenager doesn't drink it
Other
Which type of milk do you take and which does your teenager drink? My teenager drinks
1
Gold Top (Channel Island)
2
Silver Top (include UHT or carton-pasteurised)
3
Semi-skimmed (fresh or UHT)
4
Skimmed (fresh or UHT)
5
Other types of milk (which ...)
6
I do not buy milk
7
Teenager doesn't drink it
Other

What type(s) of bread do you buy and what does your teenager eat?

A I buy B My teenager eats Brand

1 - Tick

1 - Tick

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1 - Tick

White bread
Wholemeal bread
Granary bread
Ordinary brown bread
Other types of bread (which? ...)
What type(s) of bread do you buy and what does your teenager eat? Other types of bread (which? ...)
Other
Which brand(s) do you usually buy?
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Which cereals do you buy/does your teenager eat? I buy
1
Cornflakes
2
Weetabix/Shredded Wheat/Bran Flakes
3
All Bran and similar products
4
Muesli/Porridge Oats (exclude instant types)
5
Rice Krispies and similar products
6
Other cereals (what? ...)
Other
Which cereals do you buy/does your teenager eat? My teenager eats
1
Cornflakes
2
Weetabix/Shredded Wheat/Bran Flakes
3
All Bran and similar products
4
Muesli/Porridge Oats (exclude instant types)
5
Rice Krispies and similar products
6
Other cereals (what? ...)
Other
Some people ask for/select lean cuts of meat. What about you?
1
Makes no difference to me
2
I ask for lean meat
3
I prefer meat to have some fat
4
Other answer (what? ...)
Other
Some people trim their meat before cooking In preparing meat for cooking. Do you?
1
Leave it as it is
2
Trim off some fat
3
Try to remove all fat
4
Buy lean meat anyway
5
Other answer (what? ...)
Other

Have you served any of these in the past 4 weeks

A I have bought for family B My teenager eats Brand if known

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1 - Tick

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Meat pies/pasties
Sausages
Faggots, etc
Fish fingers
Burgers
Pizzas

Have your served any of these in the past 4 weeks

A I have bought for family B My teenager eats Brand if known

1 - Tick

1 - Tick

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Fish (and chips)
Chicken (and chips)
Baked potatoes as a meal
Hamburgers/beefburgers
Chinese takeaway
Indian takeaway
Other takeaway
Which type of flour do you use when cooking?
1
White flour
2
Wholemeal flour
3
Mixture of the two
4
Other types(s) of flour (what? ...)
Other
What about fish (other than fish and chips) I have bought in past month
1
White Fish e.g. Plaice, Haddock, Cod
2
Herring, Trout, Mackerel (fresh/frozen)
3
Tinned Fish
4
Smoked Fish
5
Fish fingers/cakes
6
Other types of fish (what? ...)
Other
Do you add salt when cooking? (Don't include salt substitutes and seasonings) Meat/Poultry
1
I usually add salt
2
I sometimes add salt
3
I never add salt
Do you add salt when cooking? (Don't include salt substitutes and seasonings) Fish
1
I usually add salt
2
I sometimes add salt
3
I never add salt
Do you add salt when cooking? (Don't include salt substitutes and seasonings) Egg dishes
1
I usually add salt
2
I sometimes add salt
3
I never add salt
Do you add salt when cooking? (Don't include salt substitutes and seasonings) Potatoes
1
I usually add salt
2
I sometimes add salt
3
I never add salt
Do you add salt when cooking? (Don't include salt substitutes and seasonings) Vegetables
1
I usually add salt
2
I sometimes add salt
3
I never add salt
Do you add salt when cooking? (Don't include salt substitutes and seasonings) Salad
1
I usually add salt
2
I sometimes add salt
3
I never add salt
Do you add salt when cooking? (Don't include salt substitutes and seasonings) Other foods to which you add salt (namely ...)
1
I usually add salt
2
I sometimes add salt
3
I never add salt
Other
Do you add salt when cooking? (Don't include salt substitutes and seasonings) Other foods to which you add salt (namely ...)
1
I usually add salt
2
I sometimes add salt
3
I never add salt
Other

What does your teenager put on bread/toast?

Tick

1 - Usually

2 - Occasionally

3 - Never

Soft margarine
Hard margarine
Low fat spread
Butter
What does your teenager put on bread/toast? Other or doubtful as to type (what? ...)
1
Usually
2
Occasionally
3
Never
Other
For frying, which of the following do you do?
1
I shallow fry
2
I deep fry
3
I use little or no fat/non-stick pan
4
I grill

We would like to find out what sort of fat and oil you use for frying. Put a tick in the correct boxes for the types you use for A and B.

A Shallow Frying B Deep Frying State brand, if known

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

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1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

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1 - Main one

2 - Sometimes used

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2 - Sometimes used

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

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2 - Sometimes used

1 - Main one

2 - Sometimes used

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2 - Sometimes used

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2 - Sometimes used

1 - Main one

2 - Sometimes used

1 - Main one

2 - Sometimes used

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2 - Sometimes used

1 - Main one

2 - Sometimes used

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1 - Main one

2 - Sometimes used

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1 - Main one

2 - Sometimes used

Soft Margarine (tub)
Hard Margarine
Butter
Dripping
Lard
Solid Vegetable Fat (eg Pura)
Vegetable oil (blended)
Corn Oil
Soya Oil
Sunflower Oil
Sesame Oil
Olive Oil
Other Oil What ?
We would like to find out what sort of fat and oil you use for frying. Put a tick in the correct boxes for the types you use for A and B. Other oil What?
Other
Has your teenager had any puddings in the past 4 weeks?
1
YES, at home
2
YES, outside home
3
NO
With how many meals per week does your teenager have puddings?
How many

What sort of puddings has your teenager eaten in the past 4 weeks?

Tick

1 - Not eaten

2 - Sometimes

3 - Often

Milk puddings e.g. rice pudding/semolina
Stewed or cooked fruit
Fresh fruit
Yoghurt
Fruit pie or crumble
Jelly, blancmange, whips
Ice cream
Trifle, gateau, cream cakes, cheesecake
Sponge cakes/puddings
Suet puddings
Has your teenager had any cheese(s) during the past 4 weeks?
1
NO
2
YES
3
DON'T KNOW

What was the type?

A Tick all that apply Brand, if known

1 - Tick

Generic text

1 - Tick

Generic text

1 - Tick

Generic text

1 - Tick

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Cottage Cheese
Soft chesse (eg Brie, Camembert)
Hard cheese (eg Edam, Cheddar)
Cheese Spread
Other cheese (what? ...)
What was the type? Other cheese (what? ...)
Other
Was the arrangement for your teenager's mid-day meal in the last week that he/she has been at school?
1
Went to school cafeteria
2
Received free school meal(s)
3
Teenager took snack(s) to school
4
Teenager came home for mid-day meal
5
Teenager bought snacks outside school
6
Other type of meal (Please give details: ...)
Other
Has this arrangement changed at any time in the past year, for whatever reason?
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How many weekdays and how many days at weekends does the family 'sit down together' to eat a meal each week? (Exclude members of household away temporarily/permanently)

A Number of weekdays B Number of days at weekends

1 - 0

2 - 1

3 - 2

4 - 3

5 - 4

6 - 5

1 - 0

2 - 1

3 - 2

1 - 0

2 - 1

3 - 2

4 - 3

5 - 4

6 - 5

1 - 0

2 - 1

3 - 2

1 - 0

2 - 1

3 - 2

4 - 3

5 - 4

6 - 5

1 - 0

2 - 1

3 - 2

1 - 0

2 - 1

3 - 2

4 - 3

5 - 4

6 - 5

1 - 0

2 - 1

3 - 2

Breakfast
Mid-day meal
Evening meal
Does your teenager take any special diet(s) etc.?
1
YES
2
NO
3
DON'T KNOW
Please describe how his/her diet differs from that of the average British teenager of his/her age
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Why is this?
1
To lose weight
2
For health/medical reasons
3
For religion/culture
4
For other reason(s)
What?
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What?
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Why is this? For religion/culture Which?
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Why is this? for other reasons(s) What?
Other

Section F: ACCOMMODATION

Is your accommodation affected by damp?
1
NO, no damp
2
YES, slight dampness
3
YES, marked dampness
How long has this been the case
1
Less than 1 year
2
1-4 years
3
5 years or more
How many room(s) are affected?
1
0
2
1
3
2
4
3
5
4
6
5
7
6
Do you think it is a hazard to health?
1
YES
2
NO
in what way?
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Apart from damp problems, has your accommodation deteriorated in any other way? (e.g. subsidence, dilapidations, decayed concrete, etc.)
1
NO, it is in good condition
2
YES, there is a slight problem
3
YES, there is a marked problem
How long have you experienced problem(s) in your accommodation?
1
Less than one year
2
1-4 years
3
5 years or more
Please describe briefly the problem(s)
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Section G: YOUR HOUSEHOLD

Are there in your household any of the following? Car or Van
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Telephone
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Television
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Video Recorder
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Video Camera
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Stereo/HiFi
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Radio
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Home Computer
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Double Glazing
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Sewing Machine
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Electric Cooker
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Gas Cooker (Piped)
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Gas Cooker (Bottled)
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Solid Fuel Cooker
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Dishwasher
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Washing Machine
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Tumbler Dryer
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Spin Dryer
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Fridge
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Freezer
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Food Mixer/Blender
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Microwave Oven
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Vacuum Cleaner
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Paraffin Heater
1
We own one
2
We would like one
3
We wouldn't want one
Are there in your household any of the following? Calor Gas (Butane) heater
1
We own one
2
We would like one
3
We wouldn't want one
Do you receive any help with housework? e.g. cleaning the house, washing up, making beds, etc.
1
YES, considerable
2
YES, some
3
YES, a little
4
Almost none
Who usually helps you?
1
My husband
2
My teenager him/herself
3
Others in household
4
Relatives or friends from outside
5
Paid help
6
Other person (Who? ...)
Other

What papers, comics, magazines are regularly at home which your teenager can read?

- Tick all that apply

1 - Tick

Generic text

1 - Tick

Generic text

1 - Tick

Generic text

1 - Tick

Generic text
Comics (please name: ...)
Magazines (please name: ...)
Weekly papers (please name: ...)
Local papers (please name: ...)
Sunday papers (please name: ...)
What papers, comics, magazines are regularly at home which your teenager can read? National daily papers
1
Daily Mail
2
Daily Express
3
The Sun
4
The Times
5
The Guardian
6
Daily Star
7
Daily Mirror
8
Daily Telegraph
9
None of these
Have you a pet in your household?
1
YES
2
NO
What type of pet?
1
Dog
2
Cat
3
Parrot
4
Budgerigar/Canary
5
Goldfish/Tropical fish
6
Hamster/Gerbil/Mice
7
Other animal(s)/pet(s) (What? ...)
Other
Is anyone in your household sensitive to animal/pets?
1
YES
2
NO
3
DON'T KNOW
Who is sensitive?
Generic text
To what type of animal/pet?
Generic text
What symptoms are produced by contact or exposure?
Generic text

Did your teenager, yourself or your husband have any difficulty in learning to read or in reading at present?

-

1 - Yes, in learning to read

2 - Yes, in reading now

3 - No, Neither

Teenager
Husband
Myself
Does your teenager, yourself or your husband read books or magazines? Teenager
1
Neither Books nor Magazines
2
Yes reads Books
3
Yes reads Magazines
Does your teenager, yourself or your husband read books or magazines? Husband
1
Neither Books nor Magazines
2
Yes reads Books
3
Yes reads Magazines
Does your teenager, yourself or your husband read books or magazines? Myself
1
Neither Books nor Magazines
2
Yes reads Books
3
Yes reads Magazines
Which magazine(s)? Teenager
Generic text
Which magazine(s)? Husband
Generic text
Which magazine(s)? Myself
Generic text
Which type of book(s)? Teenager
Generic text
Which type of book(s)? Husband
Generic text
Which type of book(s)? Myself
Generic text
Has anyone ever told you that your teenager, your husband, yourself or any relatives were dyslexic? Which, if any, are dyslexic?
1
My teenager
2
Other children in family (who? ...)
3
Other relative(s) (who? ...)
4
Husband (teenager's father)
5
Myself
6
None of above
Other
Other 2
As far as you know how often does your teenager have an alcoholic drink, if at all, and how often do your husband or yourself?
1
Very rarely or never
2
Once a month
3
2 or 3 times a month
4
Once or twice a week
5
3 or 4 times a week
6
Everyday or most days

What is the usual drink, if any, of the teenager, the mother and the father, and what is sometimes consumed?

cs_qG9_A_Y (Other, what? ...) cs_qG9_X cs_qG9 cs_qG9 cs_qG9 cs_qG9

1 - Your teenager

2 - Your husband

3 - Yourself

1 - Your teenager

2 - Your husband

3 - Yourself

1 - Your teenager

2 - Your husband

3 - Yourself

1 - Your teenager

2 - Your husband

3 - Yourself

Doesn't drink 1 A Usual Drink
Doesn't drink 1 B Drink sometimes
Doesn't drink 2 A Usual Drink
Doesn't drink 2 B Drink sometimes
Lager 1 A Usual Drink
Lager 1 B Drink sometimes
Lager 2 A Usual Drink
Lager 2 B Drink sometimes
Beer 1 A Usual Drink
Beer 1 B Drink sometimes
Beer 2 A Usual Drink
Beer 2 B Drink sometimes
Wine 1 A Usual Drink
Wine 1 B Drink sometimes
Wine 2 A Usual Drink
Wine 2 B Drink sometimes
Gin 1 A Usual Drink
Gin 1 B Drink sometimes
Gin 2 A Usual Drink
Gin 2 B Drink sometimes
Whisky 1 A Usual Drink
Whisky 1 B Drink sometimes
Whisky 2 A Usual Drink
Whisky 2 B Drink sometimes
Sherry 1 A Usual Drink
Sherry 1 B Drink sometimes
Sherry 2 A Usual Drink
Sherry 2 B Drink sometimes
Vodka 1 A Usual Drink
Vodka 1 B Drink sometimes
Vodka 2 A Usual Drink
Vodka 2 B Drink sometimes
Martini 1 A Usual Drink
Martini 1 B Drink sometimes
Martini 2 A Usual Drink
Martini 2 B Drink sometimes
PLEASE GIVE A SHORT DESCRIPTION OF YOUR TEENAGER'S DEVELOPMENT SINCE A BABY, MENTIONING THE IMPORTANT EVENTS AT HOME, SCHOOL, IN THE FAMILY WHICH HAVE INFLUENCED HIM/HER AND HIS/HER HEALTH AND DEVELOPMENT.
Long text
Miscellaneous
What age did your teenage girl have her first menstrual period?
1
Before 11th birthday
2
When aged 11
3
Aged 12
4
Aged 13
5
Aged 14
6
Aged 15 or more
7
Not yet commenced
8
Commenced, but don't know age
Have her periods been regular in past year?
1
Regular
2
Irregular
3
Has missed more than 3 months at any time (Why? ...)
Generic text
When was her last menstrual period? Month ... Year
Generic text
Generic text 2
A lot is spoken these days about early sexual experience of all sorts having an effect on children's development. Is this a thing you've thought about in regard to your teenager?
1
YES, I have thought about it
2
NO, it really doesen't come into it
3
CAN'T SAY
Would you like to help us form a view on this sort of thing?
Long text
Describe your teenager's health over the past 12 months?
1
Excellent
2
Good
3
Fair
4
Poor
what is it?
Generic text
Do your teenager, yourself or your husband ever do things to keep healthy? Teenager
1
Never
2
Occasionally
3
Regularly
Do your teenager, yourself or your husband ever do things to keep healthy? Myself
1
Never
2
Occasionally
3
Regularly
Do your teenager, yourself or your husband ever do things to keep healthy? Husband
1
Never
2
Occasionally
3
Regularly
What form of exercise Teenager
1
Go running/jogging
2
Do keep fit exercises
3
Weight-training
4
Go for walks
5
Sauna
6
Other exercise (What? ...)
Other
What form of exercise Myself
1
Go running/jogging
2
Do keep fit exercises
3
Weight-training
4
Go for walks
5
Sauna
6
Other exercise (What? ...)
Other
What form of exercise My Husband
1
Go running/jogging
2
Do keep fit exercises
3
Weight-training
4
Go for walks
5
Sauna
6
Other exercise (What? ...)
Other

Do you think the following should be taught to teenagers at school? Answer questions 1-25 in Section A and tick one of the four boxes in Section A If your answer in Section A is "No" proceed to Section B and tick one of the three boxes to say why you think this should not be given at school.

SECTION A SECTION B If NO, is it because:

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

How the body works
Staying well
Immunisation
Illness and recovery
Talking with Doctors, Nurses and Dentists
Care of hair, teeth, skin
Care of eyes
Care of feet
Human reproduction
Menstruation (periods)
Food and Health
Drinking alcohol
Glue-sniffing
Smoking
Physical fitness
Understanding the needs of handicapped people
Understanding the needs of old people
Health and social services
Safety at home
Safety in traffic
Water safety
First aid
Family life
Separation from parents
Death and bereavement
Which do you consider to be the 3 most important topics from the list above? Please enter topic numbers
Topic 1-25 1
Topic 1-25 2
Topic 1-25 3

Do you think the following should be taught to teenagers at school? (continued) Answer questions 26-49 in section A and tick one of the four boxes in Section A If your answer in Section A is "No" proceed to Section B and tick one of the three boxes to say why you think this should not be given at school.

SECTION A SECTION B If NO, is it because:

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

1 - YES: Should be given at school

2 - YES: Useful if time available

3 - UNDECIDED: Can't say

4 - NO: Should not be given at school

1 - Not important at this age?

2 - Should be covered outside school?

3 - Does more harm than good?

Stress and relaxation
The difference between boys' behaviour and girl's behaviour
Normal growth and development
Relationships with other boys and girls of the same age
Understanding people of different race or religion
Feelings (love, hate, anger, jealously)
Bullying
Building self-confidence
Making decisions
Honesty
Responsibility for your own behaviour
Spare-time activities
Boredom
Caring for pets
Vandalism
Stealing
Pollution
Conservation
Contraception
Parenthood and child care
Sexually transmitted diseases
Control of body weight
Violence on the television screen
Cancer
Which do you consider to be the 3 most important topics from the list above? Please enter topic numbers.
Topic 26-49 1
Topic 26-49 2
Topic 26-49 3
THANK YOU FOR YOUR HELP
Name

BCS70 Age 16 Maternal Self-Completion Form