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STRICTLY CONFIDENTIAL
MRC NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
MRC Unit for Lifelong Health and Ageing
CLINIC STUDY 2008-10
Pre-Assessment Booklet
This is a questionnaire about your lifestyle and some aspects of your health. We will use the information you provide to help us understand the measurements to be taken. We would like you to fill in this questionnaire before you arrive at the clinic because the time at the clinic will be taken up with the health examination. Alternatively if the nurse is visiting you at home, please fill in the questionnaire before she comes.
When completing the questionnaire please use a pen to put a tick in the appropriate box or to circle the appropriate response to each question (i.e. Yes 1 ) and provide further details where requested either in boxes or in the space provided.
Some questions don’t apply to everybody. Where you should skip questions that do not apply to you it tells you which question to go to next at the side of the answer you have circled (i.e. go to Q2). Otherwise please continue through each question in turn.
All information you give us will be treated in the strictest confidence. If you have any queries do not hesitate to telephone us on 020 7670 5702.
When you have finished filling in the questionnaire, please keep it safely and bring it with you when you come to visit us at the clinic. Thank you very much for your time and co-operation.

Please enter the date you completed this questionnaire:

Generic date

In the past year have you been in paid employment or have you done regular, organised voluntary work?

0
No
1
Yes
If No to question 1a go to Q4a
qc_1_a == 0
Else

How many journeys do you make between home and work in an average week? Number of journeys

How many

How far do you walk on each journey?

0
No distance
1
Less than 0.5 miles
2
0.5-1.5 miles
3
1.5-2.5 miles
4
2.5-3.5 miles
5
3.5-5.5 miles
6
More than 5.5 miles

How far do you cycle on each journey?

0
No distance
1
Less than 0.5 miles
2
0.5-1.5 miles
3
1.5-2.5 miles
4
2.5-3.5 miles
5
3.5-5.5 miles
6
5.5-9.5 miles
7
More than 9.5 miles
Now we would like to know about your activity at work.
Please answer questions 2 and 3 for your current, main job.
Read through each of the following categories and circle either 1 for Yes or 0 for No. Then go back through the list and, for each of the activities for which you have ticked yes, record the number of hours per week that you spent on that activity.
cs_q2_Y If you do any other activities at work which we have not included, please list them in the space below and fill in the hours per week column: cs_q2_X cs_No_Yes Hours in week cs_No_Yes Hours in week

0 - No

1 - Yes

0 - No

1 - Yes

Sitting – light work e.g. desk work, or driving a car or truck 1 Have you done each activity at work in the last year?
Sitting – light work e.g. desk work, or driving a car or truck 1 If yes, how many hours per week?
Sitting – light work e.g. desk work, or driving a car or truck 2 Have you done each activity at work in the last year?
Sitting – light work e.g. desk work, or driving a car or truck 2 If yes, how many hours per week?
Sitting – moderate work e.g. working heavy levers or riding a mower or forklift truck 1 Have you done each activity at work in the last year?
Sitting – moderate work e.g. working heavy levers or riding a mower or forklift truck 1 If yes, how many hours per week?
Sitting – moderate work e.g. working heavy levers or riding a mower or forklift truck 2 Have you done each activity at work in the last year?
Sitting – moderate work e.g. working heavy levers or riding a mower or forklift truck 2 If yes, how many hours per week?
Standing – light work e.g. lab technician work or working at a shop counter 1 Have you done each activity at work in the last year?
Standing – light work e.g. lab technician work or working at a shop counter 1 If yes, how many hours per week?
Standing – light work e.g. lab technician work or working at a shop counter 2 Have you done each activity at work in the last year?
Standing – light work e.g. lab technician work or working at a shop counter 2 If yes, how many hours per week?
Standing – light/moderate work e.g. light welding or stocking shelves 1 Have you done each activity at work in the last year?
Standing – light/moderate work e.g. light welding or stocking shelves 1 If yes, how many hours per week?
Standing – light/moderate work e.g. light welding or stocking shelves 2 Have you done each activity at work in the last year?
Standing – light/moderate work e.g. light welding or stocking shelves 2 If yes, how many hours per week?
Standing – moderate work e.g. fast rate assembly line work or lifting up to 50 lbs every 5 minutes for a few seconds at a time 1 Have you done each activity at work in the last year?
Standing – moderate work e.g. fast rate assembly line work or lifting up to 50 lbs every 5 minutes for a few seconds at a time 1 If yes, how many hours per week?
Standing – moderate work e.g. fast rate assembly line work or lifting up to 50 lbs every 5 minutes for a few seconds at a time 2 Have you done each activity at work in the last year?
Standing – moderate work e.g. fast rate assembly line work or lifting up to 50 lbs every 5 minutes for a few seconds at a time 2 If yes, how many hours per week?
Standing – moderate/heavy work e.g. masonry/painting or lifting more than 50 lbs every 5 minutes for a few seconds at a time 1 Have you done each activity at work in the last year?
Standing – moderate/heavy work e.g. masonry/painting or lifting more than 50 lbs every 5 minutes for a few seconds at a time 1 If yes, how many hours per week?
Standing – moderate/heavy work e.g. masonry/painting or lifting more than 50 lbs every 5 minutes for a few seconds at a time 2 Have you done each activity at work in the last year?
Standing – moderate/heavy work e.g. masonry/painting or lifting more than 50 lbs every 5 minutes for a few seconds at a time 2 If yes, how many hours per week?
Walking at work – carrying nothing heavier than a briefcase e.g. moving about a shop 1 Have you done each activity at work in the last year?
Walking at work – carrying nothing heavier than a briefcase e.g. moving about a shop 1 If yes, how many hours per week?
Walking at work – carrying nothing heavier than a briefcase e.g. moving about a shop 2 Have you done each activity at work in the last year?
Walking at work – carrying nothing heavier than a briefcase e.g. moving about a shop 2 If yes, how many hours per week?
Walking – carrying something heavy 1 Have you done each activity at work in the last year?
Walking – carrying something heavy 1 If yes, how many hours per week?
Walking – carrying something heavy 2 Have you done each activity at work in the last year?
Walking – carrying something heavy 2 If yes, how many hours per week?
Moving, pushing heavy objects weighing over 75 lbs 1 Have you done each activity at work in the last year?
Moving, pushing heavy objects weighing over 75 lbs 1 If yes, how many hours per week?
Moving, pushing heavy objects weighing over 75 lbs 2 Have you done each activity at work in the last year?
Moving, pushing heavy objects weighing over 75 lbs 2 If yes, how many hours per week?

At work, how many times a day do you normally climb up a flight of stairs (10 steps)? Number of times each day

How many

At work, how many times a day do you normally climb up a ladder? Number of times each day

How many

Apart from journeys to work, have you made any journeys by foot in the last 7 days?

0
No
1
Yes
If No to question 4a go to Q4c
qc_4_a == 0
Else
Please write in the number of journeys of each distance that you made by foot in the last 7 days.
-
How many
Journeys less than 0.5 miles
Journeys of 0.5 to 1.5 miles
Journeys of 1.5 to 2.5 miles
Journeys of 2.5 to 3.5 miles
Journeys of 3.5 to 5.5 miles
Journeys of more than 5.5 miles

Apart from journeys to work, have you made any journeys by bicycle in the last 7 days?

0
No
1
Yes
If No to question 4c go to Q5a
qc_4_c == 0
Else
Please write in the number of journeys of each distance that you made by bicycle in the last 7 days.
-
How many
Journeys less than 0.5 miles
Journeys of 0.5 to 1.5 miles
Journeys of 1.5 to 2.5 miles
Journeys of 2.5 to 3.5 miles
Journeys of 3.5 to 5.5 miles
Journeys of 5.5 to 9.5 miles
Journeys of more than 9.5 miles

In the last 4 weeks, in your spare time, have you taken part in any sports or vigorous leisure activities or done any exercises, things like badminton, swimming, yoga, press-ups, dancing, football, mountain climbing or jogging?

0
No
1
Yes
If No to question 5a go to Q6a
qc_5_a == 0
Else

On how many occasions in the last month did you do these activities?

How many

On how many of these occasions were you sweaty and/or out of breath?

How many

Did you do any of the activities (swimming, walking, running, cycling) listed in the table below in the last 12 months?

0
No
1
Yes
If yes,
qc_6_a == 1
please indicate how often you did each activity on average over the last 12 months. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line.
Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow manyMinutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow manyMinutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow manyMinutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Swimming – leisurely not laps
Swimming - competitive or laps
Walking for pleasure- do not include walking as a means of transport
Backpacking, hill walking or mountain climbing
Jogging
Competitive running
Cycling for pleasure - do not include cycling as a means of transport
Racing or rough terrain cycling

Did you do any of the activities (gardening, DIY) listed in the table below in the last 12 months?

0
No
1
Yes
If yes,
qc_6_b == 1
please indicate how often you did each activity on average over the last 12 months. For mowing and watering the lawn put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line
Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
Mowing the lawn – during the grass cutting season
Watering the lawn or garden in the summer
Digging, shoveling or chopping wood
Weeding, pruning
DIY e.g. carpentry, home or car maintenance

Did you do any of the activities (aerobics, gym exercises) listed in the table below in the last 12 months

0
No
1
Yes
If yes,
qc_6_c == 1
please indicate how often you did each activity on average over the last 12 months. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line
Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
High impact aerobics, step aerobics
Other aerobics
Exercises with weights
Conditioning exercises e.g. using an exercise bike or rowing machine
Floor exercises e.g. stretching, bending, keep fit

Did you do any of the activities (games, team sports) listed in the table below in the last 12 months?

0
No
1
Yes
If yes,
qc_6_d == 1
please indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, e.g. football and cricket please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line
Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
Snooker, billiards, darts
Bowling – indoor, lawn or ten pin
Tennis or badminton
Squash
Table tennis
Golf
Netball, volleyball, basketball
Football, rugby or hockey (during the season)
Cricket (during the season)

Did you do any of the activities listed in the table below in the last 12 months?

0
No
1
Yes
If yes,
qc_6_e == 1
please indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, e.g. skiing, please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line
Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
Dancing e.g. ballroom
Musical instrument playing, singing
Horse-riding
Fishing
Rowing
Sailing, windsurfing, boating
Ice-skating
Winter sports e.g. skiing
Martial arts, boxing, wrestling

Did you do any of the activities listed in the table below in the last 12 months?

0
No
1
Yes
If yes,
qc_6_f == 1
please indicate how often you did each activity on average over the last 12 months. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line
Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
Preparing food, cooking and washing up
Shopping for food and groceries
Shopping and browsing in shops for other items (e.g. clothes, toys)
Cleaning the house
Doing the laundry and ironing
Caring for children or babies at home (not as paid employment)
Caring for people who are elderly, handicapped or disabled at home (not as paid employment)

Did you do any other physical activities not listed in tables 6a-f in the last 12 months

0
No
1
Yes
If yes,
qc_6_g == 1
please specify the activity and indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line
Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How manyHow manyMinutes in hourHow manyHow manyMinutes in hourHow manyMinutes in hourHow many How manyHow manyMinutes in hourHow manyHow manyMinutes in hourHow manyMinutes in hourHow many How manyHow manyMinutes in hourHow manyHow manyMinutes in hourHow manyMinutes in hourHow many
First activity (please specify)
Second activity (please specify)

please specify the activity and indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line First activity (please specify)

Other

please specify the activity and indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line Second activity (please specify)

Other

At home, how many times a day do you normally climb up a flight of stairs (10 steps)? on a weekday Number of times each day

How many

At home, how many times a day do you normally climb up a flight of stairs (10 steps)? on a weekend day Number of times each day

How many
Please could you say how much time you spent on average during the last year watching TV or videos or using a computer, other than for work?
-

0 - None

1 - Less than 1 hour a day

2 - 1 to 2 hours a day

3 - 2 to 3 hours a day

4 - 3 or 4 hours a day

5 - More than 4 hours a day

TV or video viewing
Using a computer (during leisure time only)
These questions are about your drinking habits.

Have you drunk alcohol in the last year?

0
No
1
Yes, but only on special occasions
2
Yes, more often
If No to question 9 go to Q12
qc_9 == 0
Else

In the last 7 days have you had any of the following drinks? Spirits or liqueurs (e.g. whisky, gin, brandy)

0
No
1
Yes
If yes,
qc_10_a == 1

how many measures? Measures

How many

In the last 7 days have you had any of the following drinks? Wine, sherry, martini, or port

0
No
1
Yes
If yes,
qc_10_b == 1

how many glasses? Glasses

How many

In the last 7 days have you had any of the following drinks? Beer, lager, cider, or stout

0
No
1
Yes
If yes,
qc_10_c == 1

how many 1/2 pints? 1/2 pints

How many

In the last year, have you felt you ought to cut down on your drinking?

0
No
1
Yes

In the last year, have people ever annoyed you by criticising your drinking?

0
No
1
Yes

In the last year, have you ever felt bad or guilty about your drinking?

0
No
1
Yes

In the last year, have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

0
No
1
Yes
These next questions are about your diet.

How many days a week do you usually eat breakfast?

0
None
1
One
2
Two
3
Three
4
Four
5
Five
6
Six
7
Seven
For your main meal of the day, how many times during the week do you usually:
Number of times
How many
Eat out in a restaurant or café (including a fast food restaurant)
Eat a meal from a take-away restaurant
Eat a meal prepared at home
When you have your main meal at home, do you usually eat it….
-

1 - Usually

2 - Sometimes

3 - Rarely/Never

sitting at a table?
watching television?
with other members of the family?
with friends?
alone?

Do you get up in the night to get something to eat or drink?

1
Every night
2
Most nights
3
Sometimes
4
Occasionally
5
Never
If occasionally or more,
qc_15_a >= 1 && qc_15_a <= 4

what do you usually eat or drink?

Generic text

If you are hungry at home between meals, what do you usually eat?

Generic text

If you are thirsty at home between meals, what do you usually drink?

Generic text

What type of bread do you usually eat?

1
White
2
Brown/Granary
3
Wholemeal
4
Don’t often eat bread
5
Other
If other,
qc_16 == 5

please specify type of bread:

Generic text

How often do you eat fruit?

1
I rarely or never have fruit
2
I have fruit some days, not every day
3
I eat fruit everyday or most days
If I rarely or never have fruit to question 17a go to Q17c
qc_17_a == 1
Else

On the days when you eat fruit, how many portions (e.g. an apple, an orange, some grapes) do you eat?

1
One portion a day
2
Two portions a day
3
Three portions a day
4
Four portions a day
5
Five or more portions a day

Is there fruit usually available to eat at home?

0
No
1
Yes

What kind of milk do you usually have at home either as a drink or on cereal?

1
Do not drink/use milk
2
Whole milk
3
Semi-skimmed
4
Skimmed
5
Soya
6
Other
If other,
qc_18 == 6

please specify type of milk:

Generic text
If you don’t use milk at all,
qc_18 == 1

please say why not:

Generic text

What brand name fat spread do you usually use (for example on bread)?

Generic text

What kind of fat is usually used for cooking at home (e.g. butter, margarine, olive oil, sunflower oil, vegetable oil, lard)?

Generic text
How many times per week do you usually eat, either on their own or in mixed dishes, sandwiches etc:
-

1 - 5-7 times

2 - 3-4 times

3 - 1-2 times

4 - Less often/Never

red meat (beef, lamb, pork)
white meat (chicken and turkey)
processed meat (e.g. sausages – including salami, frankfurters, beefburgers, chicken nuggets

Do you have a special diet? (e.g. vegetarian, diet for a health condition)

0
No
1
Yes
If yes,
qc_22 == 1

please say what sort of diet

Generic text

Are there any foods that you always avoid eating?

0
No
1
Yes
If yes,
qc_23 == 1

please say which food or foods:

Generic text

Do you take any dietary supplements? (e.g. vitamin or mineral tablets)

0
No
1
Yes
If yes,
qc_24 == 1
please specify the names/brands of each supplement in table below and indicate how often you use each one in the table below.
Name/brand of supplement (please specify) -
Generic text

1 - Daily

2 - Several times a week

3 - Less often

Generic text

1 - Daily

2 - Several times a week

3 - Less often

Generic text

1 - Daily

2 - Several times a week

3 - Less often

Generic text

1 - Daily

2 - Several times a week

3 - Less often

Supplement 1:
Supplement 2:
Supplement 3:
Supplement 4:
Supplement 5:
Supplement 6:
Supplement 7:
Supplement 8:

Have you broken a bone since you were 25 years old?

0
No
1
Yes
If 'Yes':
qc_25 == 1
please fill in details of each injury, starting with the first, in the table below:
How old were you when you broke the bone? Please give your age in years ... Years Which bone did you break? Please specify in box below and also indicate on the diagram What caused the bone to break? Please specify in box below
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1st broken bone
2nd broken bone
3rd broken bone
4th broken bone
5th broken bone

Please put a cross on the figure below (marked 1,2,3,4 or 5) to show where each break occurred.

We would like ask you about your parents.

Is your natural mother alive?

0
No
1
Yes
If Yes to question 26a go to Q27a
qc_26_a == 1
Else

How old was your mother when she died? Years

Age

What was the date of her death?

Date of death

What was the cause of her death? If you are not sure, do you know what was on the death certificate? Please specify cause:

Generic text

Is your natural father alive?

0
No
1
Yes
If Yes to question 27a go to Q28a
qc_27_a == 1
Else

How old was your father when he died? Years

Age

What was the date of his death?

Date of death

What was the cause of his death? If you are not sure, do you know what was on the death certificate? Please specify cause:

Generic text
These questions are about your social life particularly with friends and relatives who do not live at home with you.

Are there any relatives or friends who do not live in your household with whom you have contact at least once a month, either by visit, telephone, email or letters?

0
No
1
Yes
If No to question 28a go to Q29a
qc_28_a == 0
Else

Thinking of all your relatives or friends, how often do you regularly visit or are visited by these people.

1
Never/almost never
2
Once every few months
3
About once a month
4
About once a week
5
Almost daily

How many relatives or friends do you see once a month or more?

1
None
2
1-2
3
3-5
4
6-10
5
More than 10

Do you think that you have friends, neighbours or relatives who would help you out if a problem or crisis came up?

1
No one to help
2
Would sometimes get help
3
Would often get help
4
Would always get help

Overall do you wish that you had more of a social life, or are things about right for you, or would you prefer to see less of people?

1
Prefer less
2
About right
3
Prefer more
The following statements are about neighbourhoods. Please indicate how strongly you agree or disagree with each statement.
-

1 - Strongly Agree

2 - Agree

3 - Neither Agree or Disagree

4 - Disagree

5 - Strongly Disagree

I feel like I belong to this neighbourhood
The friendships and associations I have with other people in my neighbourhood mean a lot to me
If I needed some advice about something I could go to someone in my neighbourhood
I borrow things and exchange favours with my neighbours
I would be willing to work together with others on something to improve my neighbourhood
I plan to remain a resident of this neighbourhood for a number of years
I like to think of myself as similar to the people who live in this neighbourhood
I regularly stop and talk with people in my neighbourhood
These next questions are about things you have experienced in the last 12 months.

Have you developed, or found out that you have, a serious illness or disability in the last 12 months?

0
No
1
Yes

Have you had an accident or received an injury that has affected you for a month or more in the last 12 months?

0
No
1
Yes

Have you been assaulted, robbed or been a victim of attempted robbery in the last 12 months?

0
No
1
Yes

Have you lost your job or thought you would soon lose your job in the last 12 months?

0
No
1
Yes

Have you had any other crises or serious disappointments in your work or career in general in the last 12 months?

0
No
1
Yes

Have you moved house in the last 12 months?

0
No
1
Yes
If No to question 31f go to Q31h
qc_31_f == 0
Else

Did you move away from the area where most of your friends lived?

0
No
1
Yes

Has your spouse/partner had a serious accident or illness, or received a serious injury, or been assaulted in the last 12 months?

0
No
1
Yes
2
No spouse/partner
If No spouse/partner to question 31h go to Q31l
qc_31_h == 2
Else

Has your spouse/partner lost their job or thought they would soon lose their job in the last 12 months?

0
No
1
Yes

Has your spouse/partner had any other crises or serious disappointments in their work in the last 12 months?

0
No
1
Yes

Have you had any serious disagreements with your spouse/partner or felt betrayed or disappointed by them in the last 12 months?

0
No
1
Yes

Have you had any serious difficulties with any of your children, because of their health or behaviour or for other reasons in the last 12 months?

0
No
1
Yes
2
No children

Has a friend or relative (other than your spouse/partner or children) or someone you know well had a serious accident or illness or received a serious injury in the last 12 months?

0
No
1
Yes

Has a friend or relative (other than your spouse/partner or children) or someone you know well died in the last 12 months?

0
No
1
Yes

Have you fallen out or had a serious disagreement with a friend or relative (other than your spouse/partner or children) or someone you know well or felt betrayed by them in the last 12 months?

0
No
1
Yes

Have you lost contact with a close friend or relative (other than your spouse/partner or children) for any other reason in the last 12 months?

0
No
1
Yes

Have you had any other serious upsets or disappointments in the last 12 months?

0
No
1
Yes
If yes,
qc_31_q == 1

please specify what they were:

Generic text

Is there anyone living with you who is sick, handicapped or elderly whom you look after or give special help to (for example, a sick, handicapped, or elderly relative/husband/wife/friend, etc)?

0
No
1
Yes
If yes,
qc_32_a == 1

please specify who you look after or help:

Generic text

Do you provide some regular service or help for any sick, handicapped or elderly person not living with you?

0
No
1
Yes
If yes,
qc_32_b == 1

please specify who you help:

Generic text
If you answered ‘Yes’ to either question a or b, please answer question c.
qc_32_a == 1 || qc_32_b == 1

In total, how many hours do you spend each week looking after or helping these people?

1
0-4 hours per week
2
5-9 hours per week
3
10-19 hours per week
4
20-34 hours per week
5
35-49 hours per week
6
50-99 hours per week
7
100 or more hours per week/continuous care
8
Varies under 20 hours
9
Varies 20 hours or more
10
Other (please specify)
Other
The following statements are about feelings and thoughts. Please circle one number per line that best describes your experience of each statement over the last 2 weeks.
-

1 - None of the time

2 - Rarely

3 - Some of the time

4 - Often

5 - All of the time

I’ve been feeling optimistic about the future
I’ve been feeling useful
I’ve been feeling relaxed
I’ve been feeling interested in other people
I’ve had energy to spare
I’ve been dealing with problems well
I’ve been thinking clearly
I’ve been feeling good about myself
I’ve been feeling close to other people
I’ve been feeling confident
I’ve been able to make up my own mind about things
I’ve been feeling loved
I’ve been interested in new things
I’ve been feeling cheerful
These questions are about hysterectomy operations and HRT use.

Since January 2003 have you had an operation to remove your uterus (womb) and/ or ovaries.

0
No
1
Yes
If yes,
qc_34 == 1
please give dates of all operations. (Circle 0 (no) or 1 (yes) for a-e). If you cannot remember the month and year, give your age at the time of the operation.
- Month/Year or Age at the time ... yrs
Generic date

0 - No

1 - Yes

AgeGeneric date

0 - No

1 - Yes

Age

0 - No

1 - Yes

AgeGeneric date
Generic date

0 - No

1 - Yes

AgeGeneric date

0 - No

1 - Yes

Age

0 - No

1 - Yes

AgeGeneric date
Generic date

0 - No

1 - Yes

AgeGeneric date

0 - No

1 - Yes

Age

0 - No

1 - Yes

AgeGeneric date
Removal of uterus (womb) and both ovaries (hysterectomy and bilateral oophorectomy)
Removal of uterus (womb) only (hysterectomy)
Removal of uterus (womb) and one ovary (hysterectomy and oophorectomy)
Removal of both ovaries only (bilateral oophorectomy)
Removal of one ovary only (oophorectomy)

Since January 2003 have you had hormone replacement therapy (HRT)

0
No
1
Yes
If No to question 35 go to page 24
qc_35 == 0
Else

Are you currently on HRT?

0
No
1
Yes
If you are currently on HRT,
qc_36_a == 1

what is the name of the HRT preparation? Please specify:

Generic text
Please indicate (by ticking the boxes) which months you used HRT preparations.
Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec

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If you would like to give further details to any questions or make any comments about the questionnaire, please feel free to do so in the space below:

Long text
Thank you very much for the time you have spent filling in this questionnaire. Please bring the completed questionnaire with you to the clinic. If you are being visited at home, please give your completed questionnaire to the nurse.
End

nshd_06_pb

STRICTLY CONFIDENTIAL
MRC NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
MRC Unit for Lifelong Health and Ageing
CLINIC STUDY 2008-10
Pre-Assessment Booklet
This is a questionnaire about your lifestyle and some aspects of your health. We will use the information you provide to help us understand the measurements to be taken. We would like you to fill in this questionnaire before you arrive at the clinic because the time at the clinic will be taken up with the health examination. Alternatively if the nurse is visiting you at home, please fill in the questionnaire before she comes.
When completing the questionnaire please use a pen to put a tick in the appropriate box or to circle the appropriate response to each question (i.e. Yes 1 ) and provide further details where requested either in boxes or in the space provided.
Some questions don’t apply to everybody. Where you should skip questions that do not apply to you it tells you which question to go to next at the side of the answer you have circled (i.e. go to Q2). Otherwise please continue through each question in turn.
All information you give us will be treated in the strictest confidence. If you have any queries do not hesitate to telephone us on 020 7670 5702.
When you have finished filling in the questionnaire, please keep it safely and bring it with you when you come to visit us at the clinic. Thank you very much for your time and co-operation.
Please enter the date you completed this questionnaire:
Generic date
In the past year have you been in paid employment or have you done regular, organised voluntary work?
0
No
1
Yes
How many journeys do you make between home and work in an average week? Number of journeys
How many
How far do you walk on each journey?
0
No distance
1
Less than 0.5 miles
2
0.5-1.5 miles
3
1.5-2.5 miles
4
2.5-3.5 miles
5
3.5-5.5 miles
6
More than 5.5 miles
How far do you cycle on each journey?
0
No distance
1
Less than 0.5 miles
2
0.5-1.5 miles
3
1.5-2.5 miles
4
2.5-3.5 miles
5
3.5-5.5 miles
6
5.5-9.5 miles
7
More than 9.5 miles
Now we would like to know about your activity at work.
Please answer questions 2 and 3 for your current, main job.

Read through each of the following categories and circle either 1 for Yes or 0 for No. Then go back through the list and, for each of the activities for which you have ticked yes, record the number of hours per week that you spent on that activity.

cs_q2_Y If you do any other activities at work which we have not included, please list them in the space below and fill in the hours per week column: cs_q2_X cs_No_Yes Hours in week cs_No_Yes Hours in week

0 - No

1 - Yes

0 - No

1 - Yes

Sitting – light work e.g. desk work, or driving a car or truck 1 Have you done each activity at work in the last year?
Sitting – light work e.g. desk work, or driving a car or truck 1 If yes, how many hours per week?
Sitting – light work e.g. desk work, or driving a car or truck 2 Have you done each activity at work in the last year?
Sitting – light work e.g. desk work, or driving a car or truck 2 If yes, how many hours per week?
Sitting – moderate work e.g. working heavy levers or riding a mower or forklift truck 1 Have you done each activity at work in the last year?
Sitting – moderate work e.g. working heavy levers or riding a mower or forklift truck 1 If yes, how many hours per week?
Sitting – moderate work e.g. working heavy levers or riding a mower or forklift truck 2 Have you done each activity at work in the last year?
Sitting – moderate work e.g. working heavy levers or riding a mower or forklift truck 2 If yes, how many hours per week?
Standing – light work e.g. lab technician work or working at a shop counter 1 Have you done each activity at work in the last year?
Standing – light work e.g. lab technician work or working at a shop counter 1 If yes, how many hours per week?
Standing – light work e.g. lab technician work or working at a shop counter 2 Have you done each activity at work in the last year?
Standing – light work e.g. lab technician work or working at a shop counter 2 If yes, how many hours per week?
Standing – light/moderate work e.g. light welding or stocking shelves 1 Have you done each activity at work in the last year?
Standing – light/moderate work e.g. light welding or stocking shelves 1 If yes, how many hours per week?
Standing – light/moderate work e.g. light welding or stocking shelves 2 Have you done each activity at work in the last year?
Standing – light/moderate work e.g. light welding or stocking shelves 2 If yes, how many hours per week?
Standing – moderate work e.g. fast rate assembly line work or lifting up to 50 lbs every 5 minutes for a few seconds at a time 1 Have you done each activity at work in the last year?
Standing – moderate work e.g. fast rate assembly line work or lifting up to 50 lbs every 5 minutes for a few seconds at a time 1 If yes, how many hours per week?
Standing – moderate work e.g. fast rate assembly line work or lifting up to 50 lbs every 5 minutes for a few seconds at a time 2 Have you done each activity at work in the last year?
Standing – moderate work e.g. fast rate assembly line work or lifting up to 50 lbs every 5 minutes for a few seconds at a time 2 If yes, how many hours per week?
Standing – moderate/heavy work e.g. masonry/painting or lifting more than 50 lbs every 5 minutes for a few seconds at a time 1 Have you done each activity at work in the last year?
Standing – moderate/heavy work e.g. masonry/painting or lifting more than 50 lbs every 5 minutes for a few seconds at a time 1 If yes, how many hours per week?
Standing – moderate/heavy work e.g. masonry/painting or lifting more than 50 lbs every 5 minutes for a few seconds at a time 2 Have you done each activity at work in the last year?
Standing – moderate/heavy work e.g. masonry/painting or lifting more than 50 lbs every 5 minutes for a few seconds at a time 2 If yes, how many hours per week?
Walking at work – carrying nothing heavier than a briefcase e.g. moving about a shop 1 Have you done each activity at work in the last year?
Walking at work – carrying nothing heavier than a briefcase e.g. moving about a shop 1 If yes, how many hours per week?
Walking at work – carrying nothing heavier than a briefcase e.g. moving about a shop 2 Have you done each activity at work in the last year?
Walking at work – carrying nothing heavier than a briefcase e.g. moving about a shop 2 If yes, how many hours per week?
Walking – carrying something heavy 1 Have you done each activity at work in the last year?
Walking – carrying something heavy 1 If yes, how many hours per week?
Walking – carrying something heavy 2 Have you done each activity at work in the last year?
Walking – carrying something heavy 2 If yes, how many hours per week?
Moving, pushing heavy objects weighing over 75 lbs 1 Have you done each activity at work in the last year?
Moving, pushing heavy objects weighing over 75 lbs 1 If yes, how many hours per week?
Moving, pushing heavy objects weighing over 75 lbs 2 Have you done each activity at work in the last year?
Moving, pushing heavy objects weighing over 75 lbs 2 If yes, how many hours per week?
At work, how many times a day do you normally climb up a flight of stairs (10 steps)? Number of times each day
How many
At work, how many times a day do you normally climb up a ladder? Number of times each day
How many
Apart from journeys to work, have you made any journeys by foot in the last 7 days?
0
No
1
Yes

Please write in the number of journeys of each distance that you made by foot in the last 7 days.

-
How many
Journeys less than 0.5 miles
Journeys of 0.5 to 1.5 miles
Journeys of 1.5 to 2.5 miles
Journeys of 2.5 to 3.5 miles
Journeys of 3.5 to 5.5 miles
Journeys of more than 5.5 miles
Apart from journeys to work, have you made any journeys by bicycle in the last 7 days?
0
No
1
Yes

Please write in the number of journeys of each distance that you made by bicycle in the last 7 days.

-
How many
Journeys less than 0.5 miles
Journeys of 0.5 to 1.5 miles
Journeys of 1.5 to 2.5 miles
Journeys of 2.5 to 3.5 miles
Journeys of 3.5 to 5.5 miles
Journeys of 5.5 to 9.5 miles
Journeys of more than 9.5 miles
In the last 4 weeks, in your spare time, have you taken part in any sports or vigorous leisure activities or done any exercises, things like badminton, swimming, yoga, press-ups, dancing, football, mountain climbing or jogging?
0
No
1
Yes
On how many occasions in the last month did you do these activities?
How many
On how many of these occasions were you sweaty and/or out of breath?
How many
Did you do any of the activities (swimming, walking, running, cycling) listed in the table below in the last 12 months?
0
No
1
Yes

please indicate how often you did each activity on average over the last 12 months. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line.

Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow manyMinutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow manyMinutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow manyMinutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Swimming – leisurely not laps
Swimming - competitive or laps
Walking for pleasure- do not include walking as a means of transport
Backpacking, hill walking or mountain climbing
Jogging
Competitive running
Cycling for pleasure - do not include cycling as a means of transport
Racing or rough terrain cycling
Did you do any of the activities (gardening, DIY) listed in the table below in the last 12 months?
0
No
1
Yes

please indicate how often you did each activity on average over the last 12 months. For mowing and watering the lawn put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line

Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
Mowing the lawn – during the grass cutting season
Watering the lawn or garden in the summer
Digging, shoveling or chopping wood
Weeding, pruning
DIY e.g. carpentry, home or car maintenance
Did you do any of the activities (aerobics, gym exercises) listed in the table below in the last 12 months
0
No
1
Yes

please indicate how often you did each activity on average over the last 12 months. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line

Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
High impact aerobics, step aerobics
Other aerobics
Exercises with weights
Conditioning exercises e.g. using an exercise bike or rowing machine
Floor exercises e.g. stretching, bending, keep fit
Did you do any of the activities (games, team sports) listed in the table below in the last 12 months?
0
No
1
Yes

please indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, e.g. football and cricket please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line

Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
Snooker, billiards, darts
Bowling – indoor, lawn or ten pin
Tennis or badminton
Squash
Table tennis
Golf
Netball, volleyball, basketball
Football, rugby or hockey (during the season)
Cricket (during the season)
Did you do any of the activities listed in the table below in the last 12 months?
0
No
1
Yes

please indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, e.g. skiing, please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line

Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
Dancing e.g. ballroom
Musical instrument playing, singing
Horse-riding
Fishing
Rowing
Sailing, windsurfing, boating
Ice-skating
Winter sports e.g. skiing
Martial arts, boxing, wrestling
Did you do any of the activities listed in the table below in the last 12 months?
0
No
1
Yes

please indicate how often you did each activity on average over the last 12 months. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line

Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
How many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hour

0 - Not done in last year

1 - Less than once month

2 - Once a month

3 - 2 to 3 times a month

4 - Once a week

5 - 2 to 3 times a week

6 - 4 to 5 times a week

7 - 6 times a week or every day

Minutes in hourHow many
Preparing food, cooking and washing up
Shopping for food and groceries
Shopping and browsing in shops for other items (e.g. clothes, toys)
Cleaning the house
Doing the laundry and ironing
Caring for children or babies at home (not as paid employment)
Caring for people who are elderly, handicapped or disabled at home (not as paid employment)
Did you do any other physical activities not listed in tables 6a-f in the last 12 months
0
No
1
Yes

please specify the activity and indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line

Number of times you did the activity in the last 12 months Average time per episode Hours Average time per episode Mins
How manyHow manyMinutes in hourHow manyHow manyMinutes in hourHow manyMinutes in hourHow many How manyHow manyMinutes in hourHow manyHow manyMinutes in hourHow manyMinutes in hourHow many How manyHow manyMinutes in hourHow manyHow manyMinutes in hourHow manyMinutes in hourHow many
First activity (please specify)
Second activity (please specify)
please specify the activity and indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line First activity (please specify)
Other
please specify the activity and indicate how often you did each activity on average over the last 12 months. For activities that are seasonal, please put the average frequency during the season when you did the activity. Please indicate the average length of time you spent doing the activity on each occasion. Please complete EACH line Second activity (please specify)
Other
At home, how many times a day do you normally climb up a flight of stairs (10 steps)? on a weekday Number of times each day
How many
At home, how many times a day do you normally climb up a flight of stairs (10 steps)? on a weekend day Number of times each day
How many

Please could you say how much time you spent on average during the last year watching TV or videos or using a computer, other than for work?

-

0 - None

1 - Less than 1 hour a day

2 - 1 to 2 hours a day

3 - 2 to 3 hours a day

4 - 3 or 4 hours a day

5 - More than 4 hours a day

TV or video viewing
Using a computer (during leisure time only)
These questions are about your drinking habits.
Have you drunk alcohol in the last year?
0
No
1
Yes, but only on special occasions
2
Yes, more often
In the last 7 days have you had any of the following drinks? Spirits or liqueurs (e.g. whisky, gin, brandy)
0
No
1
Yes
how many measures? Measures
How many
In the last 7 days have you had any of the following drinks? Wine, sherry, martini, or port
0
No
1
Yes
how many glasses? Glasses
How many
In the last 7 days have you had any of the following drinks? Beer, lager, cider, or stout
0
No
1
Yes
how many 1/2 pints? 1/2 pints
How many
In the last year, have you felt you ought to cut down on your drinking?
0
No
1
Yes
In the last year, have people ever annoyed you by criticising your drinking?
0
No
1
Yes
In the last year, have you ever felt bad or guilty about your drinking?
0
No
1
Yes
In the last year, have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
0
No
1
Yes
These next questions are about your diet.
How many days a week do you usually eat breakfast?
0
None
1
One
2
Two
3
Three
4
Four
5
Five
6
Six
7
Seven

For your main meal of the day, how many times during the week do you usually:

Number of times
How many
Eat out in a restaurant or café (including a fast food restaurant)
Eat a meal from a take-away restaurant
Eat a meal prepared at home

When you have your main meal at home, do you usually eat it….

-

1 - Usually

2 - Sometimes

3 - Rarely/Never

sitting at a table?
watching television?
with other members of the family?
with friends?
alone?
Do you get up in the night to get something to eat or drink?
1
Every night
2
Most nights
3
Sometimes
4
Occasionally
5
Never
what do you usually eat or drink?
Generic text
If you are hungry at home between meals, what do you usually eat?
Generic text
If you are thirsty at home between meals, what do you usually drink?
Generic text
What type of bread do you usually eat?
1
White
2
Brown/Granary
3
Wholemeal
4
Don’t often eat bread
5
Other
please specify type of bread:
Generic text
How often do you eat fruit?
1
I rarely or never have fruit
2
I have fruit some days, not every day
3
I eat fruit everyday or most days
On the days when you eat fruit, how many portions (e.g. an apple, an orange, some grapes) do you eat?
1
One portion a day
2
Two portions a day
3
Three portions a day
4
Four portions a day
5
Five or more portions a day
Is there fruit usually available to eat at home?
0
No
1
Yes
What kind of milk do you usually have at home either as a drink or on cereal?
1
Do not drink/use milk
2
Whole milk
3
Semi-skimmed
4
Skimmed
5
Soya
6
Other
please specify type of milk:
Generic text
please say why not:
Generic text
What brand name fat spread do you usually use (for example on bread)?
Generic text
What kind of fat is usually used for cooking at home (e.g. butter, margarine, olive oil, sunflower oil, vegetable oil, lard)?
Generic text

How many times per week do you usually eat, either on their own or in mixed dishes, sandwiches etc:

-

1 - 5-7 times

2 - 3-4 times

3 - 1-2 times

4 - Less often/Never

red meat (beef, lamb, pork)
white meat (chicken and turkey)
processed meat (e.g. sausages – including salami, frankfurters, beefburgers, chicken nuggets
Do you have a special diet? (e.g. vegetarian, diet for a health condition)
0
No
1
Yes
please say what sort of diet
Generic text
Are there any foods that you always avoid eating?
0
No
1
Yes
please say which food or foods:
Generic text
Do you take any dietary supplements? (e.g. vitamin or mineral tablets)
0
No
1
Yes

please specify the names/brands of each supplement in table below and indicate how often you use each one in the table below.

Name/brand of supplement (please specify) -
Generic text

1 - Daily

2 - Several times a week

3 - Less often

Generic text

1 - Daily

2 - Several times a week

3 - Less often

Generic text

1 - Daily

2 - Several times a week

3 - Less often

Generic text

1 - Daily

2 - Several times a week

3 - Less often

Supplement 1:
Supplement 2:
Supplement 3:
Supplement 4:
Supplement 5:
Supplement 6:
Supplement 7:
Supplement 8:
Have you broken a bone since you were 25 years old?
0
No
1
Yes

please fill in details of each injury, starting with the first, in the table below:

How old were you when you broke the bone? Please give your age in years ... Years Which bone did you break? Please specify in box below and also indicate on the diagram What caused the bone to break? Please specify in box below
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1st broken bone
2nd broken bone
3rd broken bone
4th broken bone
5th broken bone
Please put a cross on the figure below (marked 1,2,3,4 or 5) to show where each break occurred.
We would like ask you about your parents.
Is your natural mother alive?
0
No
1
Yes
How old was your mother when she died? Years
Age
What was the date of her death?
Date of death
What was the cause of her death? If you are not sure, do you know what was on the death certificate? Please specify cause:
Generic text
Is your natural father alive?
0
No
1
Yes
How old was your father when he died? Years
Age
What was the date of his death?
Date of death
What was the cause of his death? If you are not sure, do you know what was on the death certificate? Please specify cause:
Generic text
These questions are about your social life particularly with friends and relatives who do not live at home with you.
Are there any relatives or friends who do not live in your household with whom you have contact at least once a month, either by visit, telephone, email or letters?
0
No
1
Yes
Thinking of all your relatives or friends, how often do you regularly visit or are visited by these people.
1
Never/almost never
2
Once every few months
3
About once a month
4
About once a week
5
Almost daily
How many relatives or friends do you see once a month or more?
1
None
2
1-2
3
3-5
4
6-10
5
More than 10
Do you think that you have friends, neighbours or relatives who would help you out if a problem or crisis came up?
1
No one to help
2
Would sometimes get help
3
Would often get help
4
Would always get help
Overall do you wish that you had more of a social life, or are things about right for you, or would you prefer to see less of people?
1
Prefer less
2
About right
3
Prefer more

The following statements are about neighbourhoods. Please indicate how strongly you agree or disagree with each statement.

-

1 - Strongly Agree

2 - Agree

3 - Neither Agree or Disagree

4 - Disagree

5 - Strongly Disagree

I feel like I belong to this neighbourhood
The friendships and associations I have with other people in my neighbourhood mean a lot to me
If I needed some advice about something I could go to someone in my neighbourhood
I borrow things and exchange favours with my neighbours
I would be willing to work together with others on something to improve my neighbourhood
I plan to remain a resident of this neighbourhood for a number of years
I like to think of myself as similar to the people who live in this neighbourhood
I regularly stop and talk with people in my neighbourhood
These next questions are about things you have experienced in the last 12 months.
Have you developed, or found out that you have, a serious illness or disability in the last 12 months?
0
No
1
Yes
Have you had an accident or received an injury that has affected you for a month or more in the last 12 months?
0
No
1
Yes
Have you been assaulted, robbed or been a victim of attempted robbery in the last 12 months?
0
No
1
Yes
Have you lost your job or thought you would soon lose your job in the last 12 months?
0
No
1
Yes
Have you had any other crises or serious disappointments in your work or career in general in the last 12 months?
0
No
1
Yes
Have you moved house in the last 12 months?
0
No
1
Yes
Did you move away from the area where most of your friends lived?
0
No
1
Yes
Has your spouse/partner had a serious accident or illness, or received a serious injury, or been assaulted in the last 12 months?
0
No
1
Yes
2
No spouse/partner
Has your spouse/partner lost their job or thought they would soon lose their job in the last 12 months?
0
No
1
Yes
Has your spouse/partner had any other crises or serious disappointments in their work in the last 12 months?
0
No
1
Yes
Have you had any serious disagreements with your spouse/partner or felt betrayed or disappointed by them in the last 12 months?
0
No
1
Yes
Have you had any serious difficulties with any of your children, because of their health or behaviour or for other reasons in the last 12 months?
0
No
1
Yes
2
No children
Has a friend or relative (other than your spouse/partner or children) or someone you know well had a serious accident or illness or received a serious injury in the last 12 months?
0
No
1
Yes
Has a friend or relative (other than your spouse/partner or children) or someone you know well died in the last 12 months?
0
No
1
Yes
Have you fallen out or had a serious disagreement with a friend or relative (other than your spouse/partner or children) or someone you know well or felt betrayed by them in the last 12 months?
0
No
1
Yes
Have you lost contact with a close friend or relative (other than your spouse/partner or children) for any other reason in the last 12 months?
0
No
1
Yes
Have you had any other serious upsets or disappointments in the last 12 months?
0
No
1
Yes
please specify what they were:
Generic text
Is there anyone living with you who is sick, handicapped or elderly whom you look after or give special help to (for example, a sick, handicapped, or elderly relative/husband/wife/friend, etc)?
0
No
1
Yes
please specify who you look after or help:
Generic text
Do you provide some regular service or help for any sick, handicapped or elderly person not living with you?
0
No
1
Yes
please specify who you help:
Generic text
In total, how many hours do you spend each week looking after or helping these people?
1
0-4 hours per week
2
5-9 hours per week
3
10-19 hours per week
4
20-34 hours per week
5
35-49 hours per week
6
50-99 hours per week
7
100 or more hours per week/continuous care
8
Varies under 20 hours
9
Varies 20 hours or more
10
Other (please specify)
Other

The following statements are about feelings and thoughts. Please circle one number per line that best describes your experience of each statement over the last 2 weeks.

-

1 - None of the time

2 - Rarely

3 - Some of the time

4 - Often

5 - All of the time

I’ve been feeling optimistic about the future
I’ve been feeling useful
I’ve been feeling relaxed
I’ve been feeling interested in other people
I’ve had energy to spare
I’ve been dealing with problems well
I’ve been thinking clearly
I’ve been feeling good about myself
I’ve been feeling close to other people
I’ve been feeling confident
I’ve been able to make up my own mind about things
I’ve been feeling loved
I’ve been interested in new things
I’ve been feeling cheerful
These questions are about hysterectomy operations and HRT use.
Since January 2003 have you had an operation to remove your uterus (womb) and/ or ovaries.
0
No
1
Yes

please give dates of all operations. (Circle 0 (no) or 1 (yes) for a-e). If you cannot remember the month and year, give your age at the time of the operation.

- Month/Year or Age at the time ... yrs
Generic date

0 - No

1 - Yes

AgeGeneric date

0 - No

1 - Yes

Age

0 - No

1 - Yes

AgeGeneric date
Generic date

0 - No

1 - Yes

AgeGeneric date

0 - No

1 - Yes

Age

0 - No

1 - Yes

AgeGeneric date
Generic date

0 - No

1 - Yes

AgeGeneric date

0 - No

1 - Yes

Age

0 - No

1 - Yes

AgeGeneric date
Removal of uterus (womb) and both ovaries (hysterectomy and bilateral oophorectomy)
Removal of uterus (womb) only (hysterectomy)
Removal of uterus (womb) and one ovary (hysterectomy and oophorectomy)
Removal of both ovaries only (bilateral oophorectomy)
Removal of one ovary only (oophorectomy)
Since January 2003 have you had hormone replacement therapy (HRT)
0
No
1
Yes
Are you currently on HRT?
0
No
1
Yes
what is the name of the HRT preparation? Please specify:
Generic text

Please indicate (by ticking the boxes) which months you used HRT preparations.

Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec

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If you would like to give further details to any questions or make any comments about the questionnaire, please feel free to do so in the space below:
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Thank you very much for the time you have spent filling in this questionnaire. Please bring the completed questionnaire with you to the clinic. If you are being visited at home, please give your completed questionnaire to the nurse.
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2008-2010 Clinic Study Pre-Assessment Booklet