Start
whiii_12_hs
Health Survey
Stress and Health Study
Phase 11: 2012-13
Department of Epidemiology and Public Health
University College London
Thank you for your continuing participation in our study of stress and health. We would be very grateful if you could complete this further questionnaire which will bring us up to date with any changes to your life circumstances, any new illnesses you may have had, and your use of health services.
As always, the answers to these questions will be kept strictly confidential. The study results will never be in a form which can reveal your identity. All the information you provide will be used for research purposes only.
Why repeat the same questions every time?
Some people ask us why the same questions keep appearing in questionnaires. There are several reasons for this.
Some questions are about events – for example, your date of retirement or changes to your marital status – that might happen to people at any time in the study.
Other questions are designed to track changes in your health or personal circumstances over time.
Some questions are about a specific period – for example, the last 4 weeks or the last 14 days. These questions may look familiar but they are specific to that period before filling in the questionnaire.
Some questions don’t apply to everybody. This questionnaire indicates where you need to skip questions, and guides you to the next applicable question.
Repeating these questions means that the questionnaire looks very long. We apologise for this, but do hope that you understand why it’s so important.
Most of the questions can be answered by putting a tick in the box next to the answer that applies to you, or sometimes you have to write a number in the box,
We may contact you to clarify your responses to some questions.
If you have any questions, please call us on freephone
Section 1: About your health

Please enter today's date:

Generic date

In general would you say your health is:

1
Excellent
2
Very good
3
Good
4
Fair
5
Poor

Compared to one year ago, how would you rate your health in general now?

1
Much better now than one year ago
2
Somewhat better now than one year ago
3
About the same as one year ago
4
Somewhat worse than one year ago
5
Much worse than one year ago
The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?
-

1 - Yes, limited a lot

2 - Yes, limited a little

3 - No, not limited at all

1 - Yes, limited a lot

2 - Yes, limited a little

3 - No, not limited at all

1 - Yes, limited a lot

2 - Yes, limited a little

3 - No, not limited at all

1 - Yes, limited a lot

2 - Yes, limited a little

3 - No, not limited at all

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf
Lifting or carrying groceries
Climbing several flights of stairs
Climbing one flight of stairs
Bending, kneeling or stooping
Walking more than one mile
Walking half a mile
Walking one hundred yards
Bathing and dressing yourself

During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Cut down the amount of time you spent on work or other activities?

1
Yes
2
No

During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Accomplished less than you would like

1
Yes
2
No

During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Were limited in the kind of work or other activities you could do

1
Yes
2
No

During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Had difficulty performing your work or other activities (for example, it took extra effort)

1
Yes
2
No

During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Cut down the amount of time you spent on work or other activities

1
Yes
2
No

During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Accomplished less than you would like

1
Yes
2
No

During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Didn't do work or other activities as carefully as usual

1
Yes
2
No

During the past four weeks to what extent have your physical health or emotional problems interfered with your normal social activities with family, friends, neighbours or groups?

1
Not at all
2
Slightly
3
Moderately
4
Quite a bit
5
Extremely

How much bodily pain have you had during the past four weeks?

1
None
2
Very mild
3
Mild
4
Moderate
5
Severe
6
Very severe

During the past four weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

1
Not at all
2
Slightly
3
Moderately
4
Quite a bit
5
Extremely
How much of the time during the past four weeks:
-

1 - All of the time

2 - Most of the time

3 - A good bit of the time

4 - Some of the time

5 - A little bit of the time

6 - None of the time

1 - All of the time

2 - Most of the time

3 - A good bit of the time

4 - Some of the time

5 - A little bit of the time

6 - None of the time

Did you feel full of life?
Have you been a very nervous person?
Have you felt so down in the dumps that nothing could cheer you up?
Have you felt calm and peaceful?
Did you have a lot of energy?
Have you felt downhearted and low?
Did you feel worn out?
Have you been a happy person?
Did you feel tired?

During the past four weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc)?

1
All of the time
2
Most of the time
3
Some of the time
4
A little bit of the time
5
None of the time
Please choose the answer that best describes how true or false each of the following statements is for you:
-

1 - Definitely true

2 - Mostly true

3 - Don't know

4 - Mostly false

5 - Definitely false

1 - Definitely true

2 - Mostly true

3 - Don't know

4 - Mostly false

5 - Definitely false

1 - Definitely true

2 - Mostly true

3 - Don't know

4 - Mostly false

5 - Definitely false

I seem to get sick a little easier than other people
I’m as healthy as anyone I know
I expect my health to get worse
My health is excellent
Medical consultation

How many times have you consulted your GP in the last 12 months?

How many

Do you have any longstanding illnesses, diseases or medical conditions for which you have sought treatment in the last 12 months? (Longstanding means anything that has troubled you over a period of time or that is likely to affect you over a period of time).

1
Yes
2
No
If yes,
qc_14_a == 1

Please list below

Generic text
Generic text 2
Generic text 3
Generic text 4
Generic text 5
Generic text 6
Generic text 7
Generic text 8
Generic text 9
Generic text 10

This question concerns any medicines that you may have taken during the last fourteen days. Have you been taking any medicines, tablets, tonics or pills within the last fourteen days? You may want to check your medicine bottles, pill box or prescription sheet for the exact name.

1
Yes
2
No
If yes,
qc_15_a == 1
_medicines < 8

please list any medicines below

Generic text

Was this prescribed by a doctor?

1
Yes
2
No

And the reasons for taking them

Generic text
Chest pain and other aspects of heart disease

Since January 2008 have you had any pain or discomfort in your chest?

1
Yes
2
No
If yes:
qc_16_a == 1

Do you get this pain or discomfort when you walk uphill or hurry?

1
Yes
2
No

Do you get it when you walk at an ordinary pace on the level?

1
Yes
2
No

When you get any pain or discomfort in your chest, what do you do?

1
Stop
2
Slow down
3
Continue at same pace

Does it go away when you stand still?

1
Yes
2
No
If yes,
qc_16_e == 1

how soon?

1
In 10 minutes or less
2
More than 10 minutes

Where do you get this pain or discomfort? Mark the place(s) with an x on the diagram.

Since January 2008 have you had a severe pain across the front of your chest lasting half an hour or more?

1
Yes
2
No
If yes:
qc_17_a == 1

Did you talk to a doctor about it?

1
Yes
2
No
If yes:
qc_17_b == 1

What did he /she say it was?

Generic text
Tests and Treatments
These questions concern any test(s) or treatment(s) you may have had for chest pain or heart disease.

Since January 2008 have you had any of the following? (Please answer Yes or No to each question) An exercise/stress ECG heart tracing whilst walking or running on a treadmill (not as part of the Stress & Health Study)

1
Yes
2
No
If yes: Please give year, hospital and town for each occasion.
qc_18_a == 1
_ECG < 2

Year since 2008

Year since 2008

Hospital name, Town

Generic text

Since January 2008 have you had any of the following? (Please answer Yes or No to each question) Angiogram or X-ray of your coronary arteries (a dye test of the arteries)

1
Yes
2
No
If yes: Please give year, hospital and town for each occasion.
qc_18_b == 1
_angiogram < 2

Year since 2008

Year since 2008

Hospital name, Town

Generic text

Since January 2008 have you had any of the following? (Please answer Yes or No to each question) Angioplasty of coronary arteries (balloon treatment for angina) or insertion of a stent

1
Yes
2
No
If yes: Please give year, hospital and town for each occasion.
qc_18_c == 1
_angioplasty < 2

Year since 2008

Year since 2008

Hospital name, Town

Generic text

Since January 2008 have you had any of the following? (Please answer Yes or No to each question) Coronary artery bypass graft (CABG) operation

1
Yes
2
No
If yes: Please give year, hospital and town for each occasion.
qc_18_d == 1
_CABG < 2

Year since 2008

Year since 2008

Hospital name, Town

Generic text

Since January 2008 have you had any of the following? (Please answer Yes or No to each question) An admission to hospital with chest pain, angina or heart attack

1
Yes
2
No
If yes: Please give year, hospital and town for each occasion.
qc_18_e == 1
_admission < 2

Year since 2008

Year since 2008

Hospital name, town

Generic text

Since January 2008 have you had any of the following? (Please answer Yes or No to each question) Other heart tests or operations, or admissions to hospital for other heart trouble (not as part of the Stress and Health Study).

1
Yes
2
No
If yes: Please give year, hospital and town for each occasion.
qc_18_f == 1

Year since 2008

Year since 2008

Hospital name, Town

Generic text

If yes to (f), please specify (for example, 24 hour ECG, pacemaker, thallium scan, echocardiogram, or resting ECG not done as part of the Stress & Health study)

Other

Since January 2008 has a doctor told you that you have had angina?

1
Yes
2
No

Since January 2008 has a doctor told you that you have had angina? Month

Month of Year

Since January 2008 has a doctor told you that you have had angina? Year since 2008

Year since 2008

Since January 2008 has a doctor told you that you have had a heart attack (myocardial infarct/coronary thrombosis)?

1
Yes
2
No

Since January 2008 has a doctor told you that you have had a heart attack (myocardial infarct/coronary thrombosis)? Month

Month of Year

Since January 2008 has a doctor told you that you have had a heart attack (myocardial infarct/coronary thrombosis)? Year since 2008

Year since 2008

Since January 2008 have you had any other heart trouble suspected or confirmed? (For example, valve disease, congenital heart disease or irregular heartbeat.)

1
Yes
2
No

Since January 2008 have you had any other heart trouble suspected or confirmed? (For example, valve disease, congenital heart disease or irregular heartbeat.) Month

Month of Year

Since January 2008 have you had any other heart trouble suspected or confirmed? (For example, valve disease, congenital heart disease or irregular heartbeat.) Year since 2008

Year since 2008
If yes,
qc_19ci == 1

please specify

Generic text

Have you been admitted to hospital (including as a day case) in the last 12 months? (this excludes outpatient appointments)

1
Yes
2
No
If yes,
qc_20_a == 1

please specify the number of times:

How many
and the reason for hospitalisation(s) and the dates:
- Month Year
Year since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textMonth of YearYear since 2010Generic textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textMonth of YearYear since 2010 Year since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textMonth of YearYear since 2010Generic textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textMonth of YearYear since 2010 Year since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textMonth of YearYear since 2010Generic textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textMonth of YearYear since 2010
Cause 1
Cause 2
Cause 3
Cause 4

Since January 2008 have you been told by a doctor that you have had a stroke or transient ischaemic attack (mini stroke/TIA)?

1
Yes
2
No
3
Don&#39;t know
If yes,
qc_21_a == 1

was it:

1
Stroke
2
Transient Ischaemic Attack (mini stroke/TIA)
3
Other (please specify)
Other
If yes, please give the month, year, GP practice/hospital name and town
_stroke < 2

Month

Month of Year

Year since 2008

Year since 2008

GP practice/Hospital name and town

Generic text
General health questions
Please read this carefully. We should like to know if you have had any medical complaints, and how your health has been in general over the past few weeks. Please answer ALL questions on the following pages simply by indicating the answer which you think most nearly applies to you. Remember that we want to know about your present and recent complaints, not those you had in the past. It is important that you try to answer ALL the questions.

Have you recently... been able to concentrate on whatever you’re doing?

1
Better than usual
2
Same as usual
3
Rather less than usual
4
Much less than usual

Have you recently... Lost much sleep over worry?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been having restless, disturbed nights?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been managing to keep yourself busy and occupied?

1
More so than usual
2
Same as usual
3
Rather less than usual
4
Much less than usual

Have you recently... Been getting out of the house as much as usual?

1
More so than usual
2
About the same as usual
3
Less than usual
4
Much less than usual

Have you recently... Been managing as well as most people would in your shoes?

1
Better then most
2
About the same
3
Rather less well
4
Much less well

Have you recently... Felt on the whole you were doing things well?

1
Better than usual
2
About the same
3
Less well than usual
4
Much less well

Have you recently... Been satisfied with the way you've carried out your task(s)?

1
More satisfied than usual
2
About the same as usual
3
Less satisfied than usual
4
Much less satisfied

Have you recently... Been able to feel warmth and affection for those near to you?

1
Better than usual
2
About the same as usual
3
Less well than usual
4
Much less well

Have you recently... Been finding it easy to get on with other people?

1
Better than usual
2
About the same as usual
3
Less well than usual
4
Much less well

Have you recently... Spent much time chatting with people?

1
More time than usual
2
About the same as usual
3
Less time than usual
4
Much less than usual

Have you recently... felt that you are playing a useful part in things?

1
More so than usual
2
Same as usual
3
Less useful than usual
4
Much less useful

Have you recently... Felt capable of making decisions about things?

1
More so than usual
2
Same as usual
3
Less so than usual
4
Much less capable

Have you recently... Felt constantly under strain?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Felt you couldn't overcome your difficulties?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been finding life a struggle all the time?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been able to enjoy your normal day-to-day activities?

1
More so than usual
2
Same as usual
3
Less so than usual
4
Much less than usual

Have you recently... Been taking things hard?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been getting scared or panicky for no good reason?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been able to face up to your problems?

1
More so than usual
2
Same as usual
3
Less able than usual
4
Much less able

Have you recently... Found everything getting on top of you?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been feeling unhappy and depressed?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been losing confidence in yourself?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been thinking of yourself as a worthless person?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Felt that life is entirely hopeless?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Been feeling hopeful about your own future?

1
More so than usual
2
About the same as usual
3
Less so than usual
4
Much less hopeful

Have you recently... Been feeling reasonably happy, all things considered?

1
More so than usual
2
About the same as usual
3
Less so than usual
4
Much less than usual

Have you recently... Been feeling nervous and strung-up all the time?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Felt that life isn’t worth living?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Have you recently... Found at times you couldn’t do anything because your nerves were too bad?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Here are a few everyday activities. Please tell us if you have any difficulties with these because of a physical, mental, emotional or memory problem. Exclude any difficulties you expect to last less than three months.
-

1 - Yes

2 - No

Dressing, including putting on shoes and socks
Walking across a room
Bathing or showering
Eating, such as cutting up your food
Getting in or out of bed
Using the toilet, including getting up or down
Using a map to figure out how to get around in a strange place
Preparing a hot meal
Shopping for groceries
Making telephone calls
Taking medication
Doing work around the house or garden
Managing money, such as paying bills and keeping track of expenses
Controlling bowel and bladder completely by yourself
Doing personal laundry completely
Travelling independently on public transport or drive own car
Please indicate how well each of the following describes you.
-

1 - A lot

2 - Some

3 - A little

4 - Not at all

1 - A lot

2 - Some

3 - A little

4 - Not at all

1 - A lot

2 - Some

3 - A little

4 - Not at all

Outgoing
Helpful
Moody
Organised
Self-confident
Friendly
Warm
Worrying
Responsible
Forceful
Lively
Caring
Nervous
Creative
Assertive
Hardworking
Imaginative
Softhearted
Calm
Outspoken
Intelligent
Curious
Active
Careless
Broad-minded
Sympathetic
Talkative
Sophisticated
Adventurous
Dominant

Over the last 12 months would you say your health has been?

1
Very good
2
Good
3
Average
4
Poor
5
Very poor

How many hours of sleep do you have on an average week-night?

1
5 hours or less
2
6 hours
3
7 hours
4
8 hours
5
9 hours or more
How often in the past month did you:
-

1 - Not at all

2 - 1-3 days

3 - 4-7 days

4 - 8-14 days

5 - 15-20 days

6 - 21-31 days

1 - Not at all

2 - 1-3 days

3 - 4-7 days

4 - 8-14 days

5 - 15-20 days

6 - 21-31 days

1 - Not at all

2 - 1-3 days

3 - 4-7 days

4 - 8-14 days

5 - 15-20 days

6 - 21-31 days

Have trouble falling asleep?
Wake up several times per night?
Have trouble staying asleep (including waking far too early)?
Wake up after your usual amount of sleep feeling tired and worn out?
Have disturbed or restless sleep?

Do you doze or take a nap anytime during the day or before you go to bed?

1
Yes
2
No
If yes,
qc_57_a == 1

does this happen:

1
About once a week or less
2
Two or three times per week
3
Once every day
4
Two or more times a day

On average, how long is each nap?

1
15 mins or less
2
30 mins
3
1 hour
4
1.5 hours
5
2 hours or more

Many people leak urine some of the time. We are trying to find out how many people leak urine, and how much this bothers them. We would be grateful if you could answer the following questions, thinking about how you have been, on average over the past four weeks. How often do you leak urine?

1
Never
2
About once a week or less often
3
Two or three times a week
4
About once a day
5
Several times a day
6
All the time
If Never to question 58a Go to 59
qc_58_a == 1
Else

We would like to know how much urine you think leaks. How much urine do you usually leak (whether you wear protection or not)?

1
None
2
Small amount
3
A moderate amount
4
A large amount

Overall, how much does leaking urine interfere with your everyday life?

0
0: Not at all
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10: A great deal
When does urine leak?
-
Never – urine does not leak
Leaks before you can get to the toilet
Leaks when you cough or sneeze
Leaks when you are asleep
Leaks when you are physically active/exercising
Leaks when you have finished urinating and are dressed
Leaks for no obvious reason
Leaks all the time

Is your eyesight (with your glasses if you wear them):

1
Excellent
2
Very good
3
Good
4
Fair
5
Poor

Is your hearing (with your hearing aids if your use them):

1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
To be answered by men only - women please go to Question 61

Over the past six months: How do you rate your confidence that you could get and keep an erection?

1
Very low
2
Low
3
Moderate
4
High
5
Very high
To be answered by everyone
Have you ever been told by a doctor that you have, or have had, any of the following?
- If yes, what was the year?
Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Osteoarthritis (‘wear and tear’ arthritis)
Rheumatoid arthritis
Gout
Osteoporosis
Diabetes

Since January 2006 have you broken/fractured a bone?

1
Yes
2
No
If Yes to question 62a
qc_62_a == 1
Details of bones broken/fractured
Name of bone(s) broken/fractured Year since 2006
Year since 2006Year since 2006Generic textGeneric textYear since 2006Generic textYear since 2006Generic text Year since 2006Year since 2006Generic textGeneric textYear since 2006Generic textYear since 2006Generic text
First injury
Second injury
Third injury
Please specify what caused the bone(s) to break/fracture?
-

1 - Fall from greater than standing height. (For example, from chair or stairs)

2 - Fall from standing height. (For example, walking)

3 - Fall from less than standing height. (For example, getting out of a chair)

4 - Road traffic accident

5 - High energy trauma. (For example, sports injury)

6 - Other (please specify)

1 - Fall from greater than standing height. (For example, from chair or stairs)

2 - Fall from standing height. (For example, walking)

3 - Fall from less than standing height. (For example, getting out of a chair)

4 - Road traffic accident

5 - High energy trauma. (For example, sports injury)

6 - Other (please specify)

1 - Fall from greater than standing height. (For example, from chair or stairs)

2 - Fall from standing height. (For example, walking)

3 - Fall from less than standing height. (For example, getting out of a chair)

4 - Road traffic accident

5 - High energy trauma. (For example, sports injury)

6 - Other (please specify)

First injury
Second injury
Third injury

Please specify what caused the bone(s) to break/fracture? Other (please specify)

Other
Section 2: About your lifestyle
Exercise
We would like to know about your activities in your free time and at work that involve physical activity.

Thinking about the days of the PAST WEEK. (a) On average, for how long did you walk outside your home/workplace? (If you did not walk, please enter zero (‘00’) in the boxes in each row.) On each weekday

Hours in week
Minutes in hour

Thinking about the days of the PAST WEEK. (a) On average, for how long did you walk outside your home/workplace? (If you did not walk, please enter zero (‘00’) in the boxes in each row.) On each weekend day

Hours in week
Minutes in hour

Thinking about the days of the PAST WEEK. On average, for how long did you cycle? (If you did not cycle, please enter zero (‘00’) in the boxes in each row.) On each weekday

Hours in week
Minutes in hour

Thinking about the days of the PAST WEEK. On average, for how long did you cycle? (If you did not cycle, please enter zero (‘00’) in the boxes in each row.) On each weekend day

Minutes in hour
Hours in week
Other physical activities in the PAST FOUR WEEKS
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.
Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Football (including coaching, etc)
Golf
Swimming
Other sports and games activities for example, aerobics, ballroom dancing, keep fit, jogging, tennis. Other, activity 1 (please specify)
Other sports and games activities for example, aerobics, ballroom dancing, keep fit, jogging, tennis. Other, activity 2 (please specify)

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other sports and games activities for example, aerobics, ballroom dancing, keep fit, jogging, tennis. Other, activity 1 (please specify)

Other

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other sports and games activities for example, aerobics, ballroom dancing, keep fit, jogging, tennis. Other, activity 2 (please specify)

Other
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.
Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Weeding, hoeing, pruning (not mowing)
Manual lawn mowing
Other gardening for example, digging, planting, clearing ground, etc

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other gardening for example, digging, planting, clearing ground, etc

Other
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.
Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Carrying heavy shopping
Cooking
Hanging out washing
Other housework for example, dusting, ironing, hoovering Other housework, activity 1 (please specify)
Other housework for example, dusting, ironing, hoovering Other housework, activity 2 (please specify)

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other housework for example, dusting, ironing, hoovering Other housework, activity 1 (please specify)

Other

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other housework for example, dusting, ironing, hoovering Other housework, activity 2 (please specify)

Other
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.
Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Manual car washing
Painting/decorating
Other DIY for example, household repairs, woodwork, bricklaying (please specify)

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other DIY for example, household repairs, woodwork, bricklaying (please specify)

Other
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.
Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Additional/other activity 1 (please specify)
Additional/other activity 2 (please specify)

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Additional/other activity 1 (please specify)

Other

Additional/other activity 2 (please specify)

Other

How many times a week do you engage in vigorous physical activity enough to make you out of breath, and for how long in total? (please specify the activity) Occasions per week (please tick one)

0
None
1
1
2
2
3
3
4
4
5
5
6
6+

How many times a week do you engage in vigorous physical activity enough to make you out of breath, and for how long in total? (please specify the activity)

Other

How many times a week do you engage in vigorous physical activity enough to make you out of breath, and for how long in total? (please specify the activity) Total hours per week (please tick one)

0
None
1
1/2
2
1
3
1 1/2
4
2
5
2 1/2
6
3+
Time spent sitting down in the PAST FOUR WEEKS.

In the last four weeks, how much time did you spend sitting down watching TV (including DVDs and videos)? On each weekday

Hours in week
Minutes in hour

In the last four weeks, how much time did you spend sitting down watching TV (including DVDs and videos)? On each weekend day

Hours in week
Minutes in hour

In the last four weeks, how much time did you spend sitting down doing any other activity? For example reading, studying, drawing, using a computer, playing video games, driving or sitting in a car, travelling by public transport. On each weekday

Hours in week
Minutes in hour

In the last four weeks, how much time did you spend sitting down doing any other activity? For example reading, studying, drawing, using a computer, playing video games, driving or sitting in a car, travelling by public transport. On each weekend day

Hours in week
Minutes in hour
Smoking habits

Do you smoke cigarettes now (that is, not cigars or a pipe)?

1
Yes
2
No
3
Social/Occasional smoker
If Yes or Social/Occasional smoker…
qc_67_a == 1 || qc_67_a == 3

How many cigarettes do you smoke per day?

How many

Do you currently smoke cigars or a pipe?

1
Yes
2
No
Drinking habits

In the past 12 months have you taken an alcoholic drink?

1
Yes
2
No
If No,
qc_69_a == 2

have you always been a non-drinker?

1
Yes
2
No
If always a non-drinker,
qc_69_b == 1
which of the following would best describe your main reason(s) for never drinking?
-

1 - Tick

1 - Tick

No interest in drinking
Religion/moral/social objection
Brought up not to drink
Drinking is not healthy
Family members/friends had alcohol problems
Drinking is a waste of money

Other (please specify)

Other
1
Tick
Please go to question 79 if you have never drunk alcohol.
If Yes to question 69a Go to 70
qc_69_a == 1

Have you had an alcoholic drink in the last seven days?

1
Yes
2
No
If Yes…
qc_70_a == 1

In the last seven days, how many of each of the following drinks have you had? Please remember that a drink poured at home could be equivalent to 2 or 3 pub measures. Spirits (Whisky, gin, rum, brandy, vodka etc) or liqueurs? Measures

How many

In the last seven days, how many of each of the following drinks have you had? Please remember that a drink poured at home could be equivalent to 2 or 3 pub measures. Wine (including sherry, port, vermouth)? Glasses

How many

In the last seven days, how many of each of the following drinks have you had? Please remember that a drink poured at home could be equivalent to 2 or 3 pub measures. Beer (including lager and cider)? Pints

How many

Thinking about the past 12 months: How often do you have a drink containing alcohol?

1
Never
2
Monthly or less
3
2-4 times per month
4
2-3 times per week
5
4+ times per week

Thinking about the past 12 months: How many drinks do you have on a typical day when you are drinking?

1
1-2 drinks
2
3-4 drinks
3
5-6 drinks
4
7-9 drinks
5
10+ drinks

Thinking about the past 12 months: How often do you have six or more drinks in one occasion?

1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
If Yes to question 69a or if No to question 69b Go to 72
qc_69_a == 1 || qc_69_b == 2

Have you given up or reduced your alcohol consumption in the past 10 years?

1
Yes
2
No
If yes,
qc_72_a == 1
what were the main reasons:
-

1 - Tick

1 - Tick

Illness/medication
Health precaution/To prevent illness
I&#39;ve had alcohol problems in the past
Pressure/concern from family/friends
To save money
Fewer social occasions involving alcohol consumption

Other (please specify)

Other
1
Tick

Have you increased your alcohol consumption in the past 10 years?

1
Yes
2
No
If yes,
qc_73_a == 1
what were the main reasons:
-

1 - Tick

1 - Tick

More social occasions involving alcohol
Less responsibilities
Bereavement/loneliness
To get to sleep
To relieve pain
To reduce stress/anxiety/depression

what were the main reasons: Other (please specify)

Other
1
Tick

Have you ever felt that you ought to cut down on your drinking?

1
Yes
2
No

Have people annoyed you by criticising your drinking?

1
Yes
2
No

Have you ever felt bad or guilty about your drinking?

1
Yes
2
No

Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

1
Yes
2
No

How old were you the first time you had a proper alcoholic drink (a whole drink, not just a sip)?

Age
The next sets of questions are about your alcohol consumption across different decades in your life. We realise that these may be difficult for you to answer, but we ask that you try to give the closest approximation as possible. Please complete up to the decade you are currently in and leave the rest blank
How often did you have a drink containing alcohol?
-

1 - Never

2 - Monthly or less

3 - 2-4 times per month

4 - 2-3 times per week

5 - 4+ times per week

1 - Never

2 - Monthly or less

3 - 2-4 times per month

4 - 2-3 times per week

5 - 4+ times per week

16-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80+ years
How many drinks did you have on a typical day when you were drinking?
-

1 - 1-2 drinks

2 - 3-4 drinks

3 - 5-6 drinks

4 - 7-9 drinks

5 - 10+ drinks

1 - 0 drinks / didn&#39;t drink

2 - 1-2 drinks

3 - 3-4 drinks

4 - 5-6 drinks

5 - 7-9 drinks

6 - 10+ drinks

1 - 0 drinks / didn&#39;t drink

2 - 1-2 drinks

3 - 3-4 drinks

4 - 5-6 drinks

5 - 7-9 drinks

6 - 10+ drinks

16-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80+ years
How often did you have six or more drinks on one occasion?
-

1 - Never

2 - Less than monthly

3 - Monthly

4 - Weekly

5 - Daily or almost daily

1 - Never

2 - Less than monthly

3 - Monthly

4 - Weekly

5 - Daily or almost daily

1 - Never

2 - Less than monthly

3 - Monthly

4 - Weekly

5 - Daily or almost daily

16-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80+ years
Food habits

What type of bread do you eat most frequently?

1
White
2
Wholemeal
3
Granary or Wheatmeal
4
Other brown
5
Both Brown and White
6
Do not eat bread

What type of milk do you most often use?

1
Whole milk
2
Semi-skimmed
3
Skimmed/fat free
4
Channel Islands whole milk
5
Dried milk
6
Soya
7
Other (please specify)
8
None
Other

How often do you eat fresh fruit or vegetables?

1
Seldom or never
2
Less than once a month
3
1-3 times a month
4
1-2 times a week
5
3-4 times a week
6
5-6 times a week
7
Once a day
8
2-3 times daily
9
4 or more times daily

Are you trying to lose weight at present?

1
Yes
2
No

Over the past year have you noticed any unexplained weight loss?

1
Yes
2
No

In general, how well are you able to bite or chew food that you eat nowadays? Would you say you have:

1
No difficulty
2
A little difficulty
3
A fair amount of difficulty
4
A great amount of difficulty

How many natural teeth do you have? Please count them and write the number in the box. Please include only natural teeth, not false teeth (dentures).

How many
Food Frequency Questionnaire
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Red meat e.g. beef, beef burgers, pork, lamb Amount: Medium serving/ one beef burger
Chicken or other poultry Amount: Medium serving
Bacon or sausages Amount: Two rashers (bacon)/ Two medium sausages
Ham, corned beef, spam, luncheon meats Amount: One medium thick slice
Liver, liver pate, liver sausages Amount: Medium serving
Fish Amount: One medium fillet or serving
Fried fish in batter Amount: One medium fillet
Fish fingers or fish cakes Amount: Two pieces
Eggs as boiled, fried, scrambled, etc Amount: One
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Refined grain ready to eat cereals Amount: One bowl
Whole grain ready to eat cereals Amount: One bowl
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

White bread and rolls Amount: One slice or roll
Brown/wholemeal bread and rolls Amount: One slice or roll
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

White pasta or white rice Amount: One cup (pasta) Half a cup (rice)
Wholemeal pasta or brown rice Amount: One cup (pasta) Half a cup (rice)
Ready meal with rice or pasta e.g. lasagne Amount: One serving
Boiled, mashed or jacket potatoes Amount: One medium serving
Roast potatoes, chips or french fries Amount: One medium serving
Quiche/pie/pizza Amount: One slice
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Butter Amount: Teaspoon
Margarine or spreads Amount: Teaspoon
Olive oil Amount: Teaspoon
Other oils e.g. sunflower Amount: Teaspoon
Cheese Amount: 1oz or 30g piece (matchbox size)
Full fat milk, double or clotted cream Amount: One pint
Semi-skimmed, skimmed, sterilized, dried milk or single cream or yoghurt Amount: One pint (milk), Teaspoon (dried milk), Tablespoon (cream), Carton (yoghurt)
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Soups (vegetable or meat) Amount: Medium soup bowl
Salad dressing e.g. French vinaigrette, Amount: Tablespoon
Condiments e.g. sauces, tomato ketchup, pickles, marmite Amount: Tablespoon
Salad cream, mayonnaise Amount: Teaspoon
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Wine Amount: Wine glass
Beer, lager or cider Amount: Half pint
Liqueurs, port, sherry and spirits Amount: Liqueurs, port &amp; sherry (50ml). Spirits (25ml)
Tea or coffee Amount: One cup
Cocoa, hot chocolate, chicory, ovaltine Amount: One cup
Fizzy soft drink or fruit squash Amount: Average glass
Low calorie or diet fizzy soft drinks Amount: Average glass
Real fruit juice (100%) e.g. orange, apple juice Amount: Average glass
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Crisps or other packet snacks e.g. wotsits, cheese biscuits Amount: 1 small packet (25g)
Pastries, fruit pies, cakes, tarts, sweet biscuits Amount: Medium slice/serving
Ice cream Amount: One scoop
Chocolate bars, sweets, toffees Amount: One bar or one sweet/ toffee
Jam, marmalade, honey Amount: Teaspoon
Sugar added to tea, coffee, cereal Amount: Teaspoon
For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.
Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Fruits Amount: One medium/ one medium serving
Vegetables Amount: One medium/ one medium serving
Peas and dried legume e.g. beans, peas, baked beans, dried lentils Amount: One medium/ one medium serving
Soya product e.g. tofu, soya meat, vegeburger Amount: Medium serving
Peanuts or other nuts Amount: 10 whole
Section 3: About your life in general

Are you married/cohabiting/in a civil partnership?

1
Yes
2
No
If not married/cohabiting/in a civil partnership,
qc_86_a == 2

are you

1
Single, never married
2
Widowed
3
Divorced
4
Separated
If widowed/divorced/separated or you have lost a partner –
qc_86_b == 2 || qc_86_b == 3 || qc_86_b == 4

what year did this last happen?

Generic date
Friends and relatives

The following questions concern people in your life who you feel close to and from whom you can obtain support (either emotional or practical) including close relatives and good friends. How often do you feel you lack companionship?

1
Hardly ever to never
2
Some of the time
3
Often

The following questions concern people in your life who you feel close to and from whom you can obtain support (either emotional or practical) including close relatives and good friends. How often do you feel isolated from others?

1
Hardly ever to never
2
Some of the time
3
Often

The following questions concern people in your life who you feel close to and from whom you can obtain support (either emotional or practical) including close relatives and good friends. How often do you feel left out?

1
Hardly ever to never
2
Some of the time
3
Often

The following questions concern people in your life who you feel close to and from whom you can obtain support (either emotional or practical) including close relatives and good friends. How often do you feel in tune with the people around you?

1
Hardly ever to never
2
Some of the time
3
Often

Are there any relatives outside your household with whom you have regular contact (either by visit, telephone, e-mail or letters)? (Not necessarily the same person each time)

1
Almost daily
2
About once a week
3
About once a month
4
Once every few months
5
Never/Almost never
6
No relatives outside household
If No relatives to outside household to question 88 Go to 89
qc_88_a == 6
Else

How often do you regularly visit or are visited by these relatives?

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

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

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

Are there friends or acquaintances with whom you have regular contact (either by visit, telephone, e-mail or letters)? (Not necessarily the same person each time)

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

How often do you regularly visit or are visited by these friends or acquaintances

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

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

1
None
2
1-2
3
3-5
4
6-10
5
More than 10
Feelings and life events
The sentences that follow concern your feelings and behaviour over the past week. Please read the statements carefully and tick one box for each statement that best describes how often you felt this way during the past week.
-

1 - Tick

1 - Rarely or none of the time (less than 1 day)

2 - Some or a little of the time (1-2 days)

3 - Occasionally or moderate amount of time (3-4 days)

4 - Most or all of the time (5-7 days)

I was bothered by things that usually don’t bother me
I did not feel like eating, my appetite was poor
I felt that I could not shake off the blues even with help from my family and friends
I felt that I was just as good as other people
I had trouble keeping my mind on what I was doing
I felt depressed
I felt that everything I did was an effort
I felt hopeful about the future
I thought my life had been a failure
I felt fearful
My sleep was restless
I was happy
I talked less than usual
I felt lonely
People were unfriendly
I enjoyed life
I had crying spells
I felt sad
I felt that people disliked me
I could not get going
The following is a list of things that can happen to people. Try to remember if any of these things happened to you and when they happened.
- If yes, please give the years when the events occurred, e.g. 1995

1 - Yes

2 - No

1 - Yes

2 - No

Generic dateYearYear

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

YearGeneric dateYear

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

Generic dateYearYear

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

YearGeneric dateYear

1 - Yes

2 - No

Personal serious illness, injury or operation
Death of a close relative or friend
Serious illness, injury or operation of a close relative or friend
Major financial difficulty
Divorce, separation or break up of a personal intimate relationship
Other marital or family problem
Robbery, mugging or similar criminal event
Activities
In your spare time are you involved in any of the following activities? How often have you taken part in these activities in the last 12 months?
-

1 - Weekly

2 - Monthly

3 - Less often

4 - Never

1 - Weekly

2 - Monthly

3 - Less often

4 - Never

1 - Weekly

2 - Monthly

3 - Less often

4 - Never

Religious activities/observance
Positions of office (for example, school governor, councillor)
Voluntary work
Courses and education/evening classes
Cultural visits to stately homes, galleries, theatres, cinema or live music events
Social indoor games, cards, bingo, chess, etc
Visiting friends and relatives
Going to pubs and social clubs
Individual occupations (for example, reading, listening to music)
Household tasks (for example, DIY, maintenance, decorating)
Practical activities, making things with your hands (for example, pottery, drawing)
Gardening
Using a home computer for leisure
Heating the home

Do you ever have the home colder than you would like during the winter (December to March)?

1
Yes, always
2
Yes, often
3
Yes, sometimes
4
No
If No to question 93 Go to 95
qc_93 == 4
Else
What are the reasons for having your home colder than you would like?
-

1 - Tick

1 - Tick

Trying to keep cost of heating down
Any heat just disappears
I like to have windows open
It is healthy to keep your body cooler
Other household members like it cooler
We only have a heater in one room
I can&#39;t afford to heat it more

What are the reasons for having your home colder than you would like? Other (please specify)

1
Tick
Other

Do you spend more than 10% of your disposable household income on your fuel bills (for gas, electricity, etc.) to heat your home up to an adequate standard of warmth?

1
Yes
2
No
3
Don&#39;t know
If no,
qc_95_a == 2

what is the reason:

1
Fuel bills are less than 10% of my disposable household income
2
I cannot afford to heat my home adequately
3
Other (please specify)
4
Don&#39;t know
Other
Section 4: About your past and present work

Are you still working as a civil servant?

1
Yes
2
No
If No to question 96a Go to 97a
qc_96_a == 2
Else

Which of the following is closest to your current grade in the Civil Service?

1
Administrative Assistant (AA)
2
Administrative Officer (AO)
3
Executive Officer (EO)
4
Higher Executive Officer (HEO)
5
Senior Executive Officer (SEO)
6
Grade 7
7
Grade 6
8
Grade 5
9
Grade 4
10
Grade 3
11
Grade 2
12
Grade 1
Go to 103
If No to question 96a Go to q97a
qc_96_a == 2

When did you leave the civil service? Was it:

1
On or before 31st December 2007
2
On or after 1st January 2008
If On or before 31st December 2007 to question 97a Go to 100
qc_97_a == 1
Else

Please give the date when you left the Civil Service:

Month of Year
Year

Which of the following is closest to your last grade in the Civil Service?

1
Administrative Assistant (AA)
2
Administrative Officer (AO)
3
Executive Officer (EO)
4
Higher Executive Officer (HEO)
5
Senior Executive Officer (SEO)
6
Grade 7
7
Grade 6
8
Grade 5
9
Grade 4
10
Grade 3
11
Grade 2
12
Grade 1

By which route did you leave the Civil Service?

1
Retirement at 60
2
Voluntary Early Retirement
3
Retirement on health grounds
4
Voluntary Compulsory Redundancy
5
Redundancy
6
Transfer to company through privatisation
7
Left to take a post outside the Civil Service
8
Left to become self-employed
9
Other (please specify)
Other

Are you in paid employment NOW (including self-employment or employment after retirement)?

1
Yes
2
No
If you are not currently in paid employment,
qc_100 == 2

would you classify yourself as:

1
Unemployed seeking work
2
Retired
3
Long term sick/disabled
4
Looking after family or home
5
Other (please specify)
Other
Go to 104
If yes to question 100 Go to 102a
qc_100 == 1

What is the exact title of your main paid job, including those of you who are self-employed? (If you have more than one job, the main job is either the one in which the most hours are worked, or if you do equal hours it is the one that is the highest paid.) Please give the full title by which the job is known and give the rank or grade if you have one.

Generic text

What kind of work do you do in it? (list the main things you do in the job)

Generic text

Are you an employee or self-employed?

1
Employee
2
Self-employed
If you are self-employed,
qc_102_c == 2

do you employ other people?

1
Yes
2
No
If No to question 102d Go to 103
qc_102_d == 2
Else

How many people do you employ?

1
1-24
2
25 or more
If you are an employee,
qc_102_c == 1

are you:

1
A manager
2
A foreman or supervisor
3
None of the above
If A manager or A foreman or supervisor Go to question 102f Go to (g)
qc_102_f == 1 || qc_102_f == 2

How many people do you manage or supervise?

1
1-24
2
25 or more

If you are currently in employment. Thinking about your main job, how many hours do you work in a normal week, including work brought home?

How many

This questionnaire was completed…

1
Independently
2
With assistance (for example, if you have trouble writing or have lost your eye sight)
3
By someone else on my behalf

Please use the space below to add any further comments

Long text
Thank you for completing this questionnaire
End

whiii_12_hs

Health Survey
Stress and Health Study
Phase 11: 2012-13
Department of Epidemiology and Public Health
University College London
Thank you for your continuing participation in our study of stress and health. We would be very grateful if you could complete this further questionnaire which will bring us up to date with any changes to your life circumstances, any new illnesses you may have had, and your use of health services.
As always, the answers to these questions will be kept strictly confidential. The study results will never be in a form which can reveal your identity. All the information you provide will be used for research purposes only.
Why repeat the same questions every time?
Some people ask us why the same questions keep appearing in questionnaires. There are several reasons for this.
Some questions are about events – for example, your date of retirement or changes to your marital status – that might happen to people at any time in the study.
Other questions are designed to track changes in your health or personal circumstances over time.
Some questions are about a specific period – for example, the last 4 weeks or the last 14 days. These questions may look familiar but they are specific to that period before filling in the questionnaire.
Some questions don’t apply to everybody. This questionnaire indicates where you need to skip questions, and guides you to the next applicable question.
Repeating these questions means that the questionnaire looks very long. We apologise for this, but do hope that you understand why it’s so important.
Most of the questions can be answered by putting a tick in the box next to the answer that applies to you, or sometimes you have to write a number in the box,
We may contact you to clarify your responses to some questions.
If you have any questions, please call us on freephone

Section 1: About your health

Please enter today's date:
Generic date
In general would you say your health is:
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
Compared to one year ago, how would you rate your health in general now?
1
Much better now than one year ago
2
Somewhat better now than one year ago
3
About the same as one year ago
4
Somewhat worse than one year ago
5
Much worse than one year ago

The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?

-

1 - Yes, limited a lot

2 - Yes, limited a little

3 - No, not limited at all

1 - Yes, limited a lot

2 - Yes, limited a little

3 - No, not limited at all

1 - Yes, limited a lot

2 - Yes, limited a little

3 - No, not limited at all

1 - Yes, limited a lot

2 - Yes, limited a little

3 - No, not limited at all

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf
Lifting or carrying groceries
Climbing several flights of stairs
Climbing one flight of stairs
Bending, kneeling or stooping
Walking more than one mile
Walking half a mile
Walking one hundred yards
Bathing and dressing yourself
During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Cut down the amount of time you spent on work or other activities?
1
Yes
2
No
During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Accomplished less than you would like
1
Yes
2
No
During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Were limited in the kind of work or other activities you could do
1
Yes
2
No
During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Had difficulty performing your work or other activities (for example, it took extra effort)
1
Yes
2
No
During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Cut down the amount of time you spent on work or other activities
1
Yes
2
No
During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Accomplished less than you would like
1
Yes
2
No
During the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Didn't do work or other activities as carefully as usual
1
Yes
2
No
During the past four weeks to what extent have your physical health or emotional problems interfered with your normal social activities with family, friends, neighbours or groups?
1
Not at all
2
Slightly
3
Moderately
4
Quite a bit
5
Extremely
How much bodily pain have you had during the past four weeks?
1
None
2
Very mild
3
Mild
4
Moderate
5
Severe
6
Very severe
During the past four weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
1
Not at all
2
Slightly
3
Moderately
4
Quite a bit
5
Extremely

How much of the time during the past four weeks:

-

1 - All of the time

2 - Most of the time

3 - A good bit of the time

4 - Some of the time

5 - A little bit of the time

6 - None of the time

1 - All of the time

2 - Most of the time

3 - A good bit of the time

4 - Some of the time

5 - A little bit of the time

6 - None of the time

Did you feel full of life?
Have you been a very nervous person?
Have you felt so down in the dumps that nothing could cheer you up?
Have you felt calm and peaceful?
Did you have a lot of energy?
Have you felt downhearted and low?
Did you feel worn out?
Have you been a happy person?
Did you feel tired?
During the past four weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc)?
1
All of the time
2
Most of the time
3
Some of the time
4
A little bit of the time
5
None of the time

Please choose the answer that best describes how true or false each of the following statements is for you:

-

1 - Definitely true

2 - Mostly true

3 - Don&#39;t know

4 - Mostly false

5 - Definitely false

1 - Definitely true

2 - Mostly true

3 - Don&#39;t know

4 - Mostly false

5 - Definitely false

1 - Definitely true

2 - Mostly true

3 - Don&#39;t know

4 - Mostly false

5 - Definitely false

I seem to get sick a little easier than other people
I’m as healthy as anyone I know
I expect my health to get worse
My health is excellent

Medical consultation

How many times have you consulted your GP in the last 12 months?
How many
Do you have any longstanding illnesses, diseases or medical conditions for which you have sought treatment in the last 12 months? (Longstanding means anything that has troubled you over a period of time or that is likely to affect you over a period of time).
1
Yes
2
No
Please list below
Generic text
Generic text 2
Generic text 3
Generic text 4
Generic text 5
Generic text 6
Generic text 7
Generic text 8
Generic text 9
Generic text 10
This question concerns any medicines that you may have taken during the last fourteen days. Have you been taking any medicines, tablets, tonics or pills within the last fourteen days? You may want to check your medicine bottles, pill box or prescription sheet for the exact name.
1
Yes
2
No

_medicines < 8

please list any medicines below
Generic text
Was this prescribed by a doctor?
1
Yes
2
No
And the reasons for taking them
Generic text

Chest pain and other aspects of heart disease

Since January 2008 have you had any pain or discomfort in your chest?
1
Yes
2
No
Do you get this pain or discomfort when you walk uphill or hurry?
1
Yes
2
No
Do you get it when you walk at an ordinary pace on the level?
1
Yes
2
No
When you get any pain or discomfort in your chest, what do you do?
1
Stop
2
Slow down
3
Continue at same pace
Does it go away when you stand still?
1
Yes
2
No
how soon?
1
In 10 minutes or less
2
More than 10 minutes
Where do you get this pain or discomfort? Mark the place(s) with an x on the diagram.
Since January 2008 have you had a severe pain across the front of your chest lasting half an hour or more?
1
Yes
2
No
Did you talk to a doctor about it?
1
Yes
2
No
What did he /she say it was?
Generic text

Tests and Treatments

These questions concern any test(s) or treatment(s) you may have had for chest pain or heart disease.
Since January 2008 have you had any of the following? (Please answer Yes or No to each question) An exercise/stress ECG heart tracing whilst walking or running on a treadmill (not as part of the Stress & Health Study)
1
Yes
2
No

_ECG < 2

Year since 2008
Year since 2008
Hospital name, Town
Generic text
Since January 2008 have you had any of the following? (Please answer Yes or No to each question) Angiogram or X-ray of your coronary arteries (a dye test of the arteries)
1
Yes
2
No

_angiogram < 2

Year since 2008
Year since 2008
Hospital name, Town
Generic text
Since January 2008 have you had any of the following? (Please answer Yes or No to each question) Angioplasty of coronary arteries (balloon treatment for angina) or insertion of a stent
1
Yes
2
No

_angioplasty < 2

Year since 2008
Year since 2008
Hospital name, Town
Generic text
Since January 2008 have you had any of the following? (Please answer Yes or No to each question) Coronary artery bypass graft (CABG) operation
1
Yes
2
No

_CABG < 2

Year since 2008
Year since 2008
Hospital name, Town
Generic text
Since January 2008 have you had any of the following? (Please answer Yes or No to each question) An admission to hospital with chest pain, angina or heart attack
1
Yes
2
No

_admission < 2

Year since 2008
Year since 2008
Hospital name, town
Generic text
Since January 2008 have you had any of the following? (Please answer Yes or No to each question) Other heart tests or operations, or admissions to hospital for other heart trouble (not as part of the Stress and Health Study).
1
Yes
2
No
Year since 2008
Year since 2008
Hospital name, Town
Generic text
If yes to (f), please specify (for example, 24 hour ECG, pacemaker, thallium scan, echocardiogram, or resting ECG not done as part of the Stress & Health study)
Other
Since January 2008 has a doctor told you that you have had angina?
1
Yes
2
No
Since January 2008 has a doctor told you that you have had angina? Month
Month of Year
Since January 2008 has a doctor told you that you have had angina? Year since 2008
Year since 2008
Since January 2008 has a doctor told you that you have had a heart attack (myocardial infarct/coronary thrombosis)?
1
Yes
2
No
Since January 2008 has a doctor told you that you have had a heart attack (myocardial infarct/coronary thrombosis)? Month
Month of Year
Since January 2008 has a doctor told you that you have had a heart attack (myocardial infarct/coronary thrombosis)? Year since 2008
Year since 2008
Since January 2008 have you had any other heart trouble suspected or confirmed? (For example, valve disease, congenital heart disease or irregular heartbeat.)
1
Yes
2
No
Since January 2008 have you had any other heart trouble suspected or confirmed? (For example, valve disease, congenital heart disease or irregular heartbeat.) Month
Month of Year
Since January 2008 have you had any other heart trouble suspected or confirmed? (For example, valve disease, congenital heart disease or irregular heartbeat.) Year since 2008
Year since 2008
please specify
Generic text
Have you been admitted to hospital (including as a day case) in the last 12 months? (this excludes outpatient appointments)
1
Yes
2
No
please specify the number of times:
How many

and the reason for hospitalisation(s) and the dates:

- Month Year
Year since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textMonth of YearYear since 2010Generic textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textMonth of YearYear since 2010 Year since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textMonth of YearYear since 2010Generic textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textMonth of YearYear since 2010 Year since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textGeneric textYear since 2010Month of YearGeneric textYear since 2010Month of YearGeneric textGeneric textGeneric textGeneric textMonth of YearYear since 2010Generic textGeneric textGeneric textGeneric textYear since 2010Month of YearGeneric textMonth of YearYear since 2010
Cause 1
Cause 2
Cause 3
Cause 4
Since January 2008 have you been told by a doctor that you have had a stroke or transient ischaemic attack (mini stroke/TIA)?
1
Yes
2
No
3
Don&#39;t know
was it:
1
Stroke
2
Transient Ischaemic Attack (mini stroke/TIA)
3
Other (please specify)
Other
If yes, please give the month, year, GP practice/hospital name and town

_stroke < 2

Month
Month of Year
Year since 2008
Year since 2008
GP practice/Hospital name and town
Generic text

General health questions

Please read this carefully. We should like to know if you have had any medical complaints, and how your health has been in general over the past few weeks. Please answer ALL questions on the following pages simply by indicating the answer which you think most nearly applies to you. Remember that we want to know about your present and recent complaints, not those you had in the past. It is important that you try to answer ALL the questions.
Have you recently... been able to concentrate on whatever you’re doing?
1
Better than usual
2
Same as usual
3
Rather less than usual
4
Much less than usual
Have you recently... Lost much sleep over worry?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been having restless, disturbed nights?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been managing to keep yourself busy and occupied?
1
More so than usual
2
Same as usual
3
Rather less than usual
4
Much less than usual
Have you recently... Been getting out of the house as much as usual?
1
More so than usual
2
About the same as usual
3
Less than usual
4
Much less than usual
Have you recently... Been managing as well as most people would in your shoes?
1
Better then most
2
About the same
3
Rather less well
4
Much less well
Have you recently... Felt on the whole you were doing things well?
1
Better than usual
2
About the same
3
Less well than usual
4
Much less well
Have you recently... Been satisfied with the way you've carried out your task(s)?
1
More satisfied than usual
2
About the same as usual
3
Less satisfied than usual
4
Much less satisfied
Have you recently... Been able to feel warmth and affection for those near to you?
1
Better than usual
2
About the same as usual
3
Less well than usual
4
Much less well
Have you recently... Been finding it easy to get on with other people?
1
Better than usual
2
About the same as usual
3
Less well than usual
4
Much less well
Have you recently... Spent much time chatting with people?
1
More time than usual
2
About the same as usual
3
Less time than usual
4
Much less than usual
Have you recently... felt that you are playing a useful part in things?
1
More so than usual
2
Same as usual
3
Less useful than usual
4
Much less useful
Have you recently... Felt capable of making decisions about things?
1
More so than usual
2
Same as usual
3
Less so than usual
4
Much less capable
Have you recently... Felt constantly under strain?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Felt you couldn't overcome your difficulties?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been finding life a struggle all the time?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been able to enjoy your normal day-to-day activities?
1
More so than usual
2
Same as usual
3
Less so than usual
4
Much less than usual
Have you recently... Been taking things hard?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been getting scared or panicky for no good reason?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been able to face up to your problems?
1
More so than usual
2
Same as usual
3
Less able than usual
4
Much less able
Have you recently... Found everything getting on top of you?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been feeling unhappy and depressed?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been losing confidence in yourself?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been thinking of yourself as a worthless person?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Felt that life is entirely hopeless?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Been feeling hopeful about your own future?
1
More so than usual
2
About the same as usual
3
Less so than usual
4
Much less hopeful
Have you recently... Been feeling reasonably happy, all things considered?
1
More so than usual
2
About the same as usual
3
Less so than usual
4
Much less than usual
Have you recently... Been feeling nervous and strung-up all the time?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Felt that life isn’t worth living?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual
Have you recently... Found at times you couldn’t do anything because your nerves were too bad?
1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

Here are a few everyday activities. Please tell us if you have any difficulties with these because of a physical, mental, emotional or memory problem. Exclude any difficulties you expect to last less than three months.

-

1 - Yes

2 - No

Dressing, including putting on shoes and socks
Walking across a room
Bathing or showering
Eating, such as cutting up your food
Getting in or out of bed
Using the toilet, including getting up or down
Using a map to figure out how to get around in a strange place
Preparing a hot meal
Shopping for groceries
Making telephone calls
Taking medication
Doing work around the house or garden
Managing money, such as paying bills and keeping track of expenses
Controlling bowel and bladder completely by yourself
Doing personal laundry completely
Travelling independently on public transport or drive own car

Please indicate how well each of the following describes you.

-

1 - A lot

2 - Some

3 - A little

4 - Not at all

1 - A lot

2 - Some

3 - A little

4 - Not at all

1 - A lot

2 - Some

3 - A little

4 - Not at all

Outgoing
Helpful
Moody
Organised
Self-confident
Friendly
Warm
Worrying
Responsible
Forceful
Lively
Caring
Nervous
Creative
Assertive
Hardworking
Imaginative
Softhearted
Calm
Outspoken
Intelligent
Curious
Active
Careless
Broad-minded
Sympathetic
Talkative
Sophisticated
Adventurous
Dominant
Over the last 12 months would you say your health has been?
1
Very good
2
Good
3
Average
4
Poor
5
Very poor
How many hours of sleep do you have on an average week-night?
1
5 hours or less
2
6 hours
3
7 hours
4
8 hours
5
9 hours or more

How often in the past month did you:

-

1 - Not at all

2 - 1-3 days

3 - 4-7 days

4 - 8-14 days

5 - 15-20 days

6 - 21-31 days

1 - Not at all

2 - 1-3 days

3 - 4-7 days

4 - 8-14 days

5 - 15-20 days

6 - 21-31 days

1 - Not at all

2 - 1-3 days

3 - 4-7 days

4 - 8-14 days

5 - 15-20 days

6 - 21-31 days

Have trouble falling asleep?
Wake up several times per night?
Have trouble staying asleep (including waking far too early)?
Wake up after your usual amount of sleep feeling tired and worn out?
Have disturbed or restless sleep?
Do you doze or take a nap anytime during the day or before you go to bed?
1
Yes
2
No
does this happen:
1
About once a week or less
2
Two or three times per week
3
Once every day
4
Two or more times a day
On average, how long is each nap?
1
15 mins or less
2
30 mins
3
1 hour
4
1.5 hours
5
2 hours or more
Many people leak urine some of the time. We are trying to find out how many people leak urine, and how much this bothers them. We would be grateful if you could answer the following questions, thinking about how you have been, on average over the past four weeks. How often do you leak urine?
1
Never
2
About once a week or less often
3
Two or three times a week
4
About once a day
5
Several times a day
6
All the time
We would like to know how much urine you think leaks. How much urine do you usually leak (whether you wear protection or not)?
1
None
2
Small amount
3
A moderate amount
4
A large amount
Overall, how much does leaking urine interfere with your everyday life?
0
0: Not at all
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10: A great deal

When does urine leak?

-
Never – urine does not leak
Leaks before you can get to the toilet
Leaks when you cough or sneeze
Leaks when you are asleep
Leaks when you are physically active/exercising
Leaks when you have finished urinating and are dressed
Leaks for no obvious reason
Leaks all the time
Is your eyesight (with your glasses if you wear them):
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
Is your hearing (with your hearing aids if your use them):
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
Over the past six months: How do you rate your confidence that you could get and keep an erection?
1
Very low
2
Low
3
Moderate
4
High
5
Very high
To be answered by everyone

Have you ever been told by a doctor that you have, or have had, any of the following?

- If yes, what was the year?
Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Generic date

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Osteoarthritis (‘wear and tear’ arthritis)
Rheumatoid arthritis
Gout
Osteoporosis
Diabetes
Since January 2006 have you broken/fractured a bone?
1
Yes
2
No

Details of bones broken/fractured

Name of bone(s) broken/fractured Year since 2006
Year since 2006Year since 2006Generic textGeneric textYear since 2006Generic textYear since 2006Generic text Year since 2006Year since 2006Generic textGeneric textYear since 2006Generic textYear since 2006Generic text
First injury
Second injury
Third injury

Please specify what caused the bone(s) to break/fracture?

-

1 - Fall from greater than standing height. (For example, from chair or stairs)

2 - Fall from standing height. (For example, walking)

3 - Fall from less than standing height. (For example, getting out of a chair)

4 - Road traffic accident

5 - High energy trauma. (For example, sports injury)

6 - Other (please specify)

1 - Fall from greater than standing height. (For example, from chair or stairs)

2 - Fall from standing height. (For example, walking)

3 - Fall from less than standing height. (For example, getting out of a chair)

4 - Road traffic accident

5 - High energy trauma. (For example, sports injury)

6 - Other (please specify)

1 - Fall from greater than standing height. (For example, from chair or stairs)

2 - Fall from standing height. (For example, walking)

3 - Fall from less than standing height. (For example, getting out of a chair)

4 - Road traffic accident

5 - High energy trauma. (For example, sports injury)

6 - Other (please specify)

First injury
Second injury
Third injury
Please specify what caused the bone(s) to break/fracture? Other (please specify)
Other

Section 2: About your lifestyle

Exercise

We would like to know about your activities in your free time and at work that involve physical activity.
Thinking about the days of the PAST WEEK. (a) On average, for how long did you walk outside your home/workplace? (If you did not walk, please enter zero (‘00’) in the boxes in each row.) On each weekday
Hours in week
Minutes in hour
Thinking about the days of the PAST WEEK. (a) On average, for how long did you walk outside your home/workplace? (If you did not walk, please enter zero (‘00’) in the boxes in each row.) On each weekend day
Hours in week
Minutes in hour
Thinking about the days of the PAST WEEK. On average, for how long did you cycle? (If you did not cycle, please enter zero (‘00’) in the boxes in each row.) On each weekday
Hours in week
Minutes in hour
Thinking about the days of the PAST WEEK. On average, for how long did you cycle? (If you did not cycle, please enter zero (‘00’) in the boxes in each row.) On each weekend day
Minutes in hour
Hours in week
Other physical activities in the PAST FOUR WEEKS

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.

Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Football (including coaching, etc)
Golf
Swimming
Other sports and games activities for example, aerobics, ballroom dancing, keep fit, jogging, tennis. Other, activity 1 (please specify)
Other sports and games activities for example, aerobics, ballroom dancing, keep fit, jogging, tennis. Other, activity 2 (please specify)
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other sports and games activities for example, aerobics, ballroom dancing, keep fit, jogging, tennis. Other, activity 1 (please specify)
Other
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other sports and games activities for example, aerobics, ballroom dancing, keep fit, jogging, tennis. Other, activity 2 (please specify)
Other

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.

Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Weeding, hoeing, pruning (not mowing)
Manual lawn mowing
Other gardening for example, digging, planting, clearing ground, etc
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other gardening for example, digging, planting, clearing ground, etc
Other

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.

Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Carrying heavy shopping
Cooking
Hanging out washing
Other housework for example, dusting, ironing, hoovering Other housework, activity 1 (please specify)
Other housework for example, dusting, ironing, hoovering Other housework, activity 2 (please specify)
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other housework for example, dusting, ironing, hoovering Other housework, activity 1 (please specify)
Other
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other housework for example, dusting, ironing, hoovering Other housework, activity 2 (please specify)
Other

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.

Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Manual car washing
Painting/decorating
Other DIY for example, household repairs, woodwork, bricklaying (please specify)
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Other DIY for example, household repairs, woodwork, bricklaying (please specify)
Other

Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable.

Occasions in the past 4 weeks (please tick one) Total hours in the past 4 weeks (please tick one)

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

0 - None

1 - 1/2

2 - 1 - 1 1/2

3 - 2-3

4 - 4-5

5 - 6-10

6 - 11+

0 - None

1 - 1-2

2 - 3-4

3 - 5-10

4 - 11-15

5 - 16-20

6 - 21+

Additional/other activity 1 (please specify)
Additional/other activity 2 (please specify)
Please indicate the number of occasions and total time spent on each of the activities listed. Write in other types of activity not listed, as applicable. Additional/other activity 1 (please specify)
Other
Additional/other activity 2 (please specify)
Other
How many times a week do you engage in vigorous physical activity enough to make you out of breath, and for how long in total? (please specify the activity) Occasions per week (please tick one)
0
None
1
1
2
2
3
3
4
4
5
5
6
6+
How many times a week do you engage in vigorous physical activity enough to make you out of breath, and for how long in total? (please specify the activity)
Other
How many times a week do you engage in vigorous physical activity enough to make you out of breath, and for how long in total? (please specify the activity) Total hours per week (please tick one)
0
None
1
1/2
2
1
3
1 1/2
4
2
5
2 1/2
6
3+
Time spent sitting down in the PAST FOUR WEEKS.
In the last four weeks, how much time did you spend sitting down watching TV (including DVDs and videos)? On each weekday
Hours in week
Minutes in hour
In the last four weeks, how much time did you spend sitting down watching TV (including DVDs and videos)? On each weekend day
Hours in week
Minutes in hour
In the last four weeks, how much time did you spend sitting down doing any other activity? For example reading, studying, drawing, using a computer, playing video games, driving or sitting in a car, travelling by public transport. On each weekday
Hours in week
Minutes in hour
In the last four weeks, how much time did you spend sitting down doing any other activity? For example reading, studying, drawing, using a computer, playing video games, driving or sitting in a car, travelling by public transport. On each weekend day
Hours in week
Minutes in hour

Smoking habits

Do you smoke cigarettes now (that is, not cigars or a pipe)?
1
Yes
2
No
3
Social/Occasional smoker
How many cigarettes do you smoke per day?
How many
Do you currently smoke cigars or a pipe?
1
Yes
2
No

Drinking habits

In the past 12 months have you taken an alcoholic drink?
1
Yes
2
No
have you always been a non-drinker?
1
Yes
2
No

which of the following would best describe your main reason(s) for never drinking?

-

1 - Tick

1 - Tick

No interest in drinking
Religion/moral/social objection
Brought up not to drink
Drinking is not healthy
Family members/friends had alcohol problems
Drinking is a waste of money
Other (please specify)
Other
1
Tick
Please go to question 79 if you have never drunk alcohol.
Have you had an alcoholic drink in the last seven days?
1
Yes
2
No
In the last seven days, how many of each of the following drinks have you had? Please remember that a drink poured at home could be equivalent to 2 or 3 pub measures. Spirits (Whisky, gin, rum, brandy, vodka etc) or liqueurs? Measures
How many
In the last seven days, how many of each of the following drinks have you had? Please remember that a drink poured at home could be equivalent to 2 or 3 pub measures. Wine (including sherry, port, vermouth)? Glasses
How many
In the last seven days, how many of each of the following drinks have you had? Please remember that a drink poured at home could be equivalent to 2 or 3 pub measures. Beer (including lager and cider)? Pints
How many
Thinking about the past 12 months: How often do you have a drink containing alcohol?
1
Never
2
Monthly or less
3
2-4 times per month
4
2-3 times per week
5
4+ times per week
Thinking about the past 12 months: How many drinks do you have on a typical day when you are drinking?
1
1-2 drinks
2
3-4 drinks
3
5-6 drinks
4
7-9 drinks
5
10+ drinks
Thinking about the past 12 months: How often do you have six or more drinks in one occasion?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
Have you given up or reduced your alcohol consumption in the past 10 years?
1
Yes
2
No

what were the main reasons:

-

1 - Tick

1 - Tick

Illness/medication
Health precaution/To prevent illness
I&#39;ve had alcohol problems in the past
Pressure/concern from family/friends
To save money
Fewer social occasions involving alcohol consumption
Other (please specify)
Other
1
Tick
Have you increased your alcohol consumption in the past 10 years?
1
Yes
2
No

what were the main reasons:

-

1 - Tick

1 - Tick

More social occasions involving alcohol
Less responsibilities
Bereavement/loneliness
To get to sleep
To relieve pain
To reduce stress/anxiety/depression
what were the main reasons: Other (please specify)
Other
1
Tick
Have you ever felt that you ought to cut down on your drinking?
1
Yes
2
No
Have people annoyed you by criticising your drinking?
1
Yes
2
No
Have you ever felt bad or guilty about your drinking?
1
Yes
2
No
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
1
Yes
2
No
How old were you the first time you had a proper alcoholic drink (a whole drink, not just a sip)?
Age
The next sets of questions are about your alcohol consumption across different decades in your life. We realise that these may be difficult for you to answer, but we ask that you try to give the closest approximation as possible. Please complete up to the decade you are currently in and leave the rest blank

How often did you have a drink containing alcohol?

-

1 - Never

2 - Monthly or less

3 - 2-4 times per month

4 - 2-3 times per week

5 - 4+ times per week

1 - Never

2 - Monthly or less

3 - 2-4 times per month

4 - 2-3 times per week

5 - 4+ times per week

16-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80+ years

How many drinks did you have on a typical day when you were drinking?

-

1 - 1-2 drinks

2 - 3-4 drinks

3 - 5-6 drinks

4 - 7-9 drinks

5 - 10+ drinks

1 - 0 drinks / didn&#39;t drink

2 - 1-2 drinks

3 - 3-4 drinks

4 - 5-6 drinks

5 - 7-9 drinks

6 - 10+ drinks

1 - 0 drinks / didn&#39;t drink

2 - 1-2 drinks

3 - 3-4 drinks

4 - 5-6 drinks

5 - 7-9 drinks

6 - 10+ drinks

16-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80+ years

How often did you have six or more drinks on one occasion?

-

1 - Never

2 - Less than monthly

3 - Monthly

4 - Weekly

5 - Daily or almost daily

1 - Never

2 - Less than monthly

3 - Monthly

4 - Weekly

5 - Daily or almost daily

1 - Never

2 - Less than monthly

3 - Monthly

4 - Weekly

5 - Daily or almost daily

16-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80+ years

Food habits

What type of bread do you eat most frequently?
1
White
2
Wholemeal
3
Granary or Wheatmeal
4
Other brown
5
Both Brown and White
6
Do not eat bread
What type of milk do you most often use?
1
Whole milk
2
Semi-skimmed
3
Skimmed/fat free
4
Channel Islands whole milk
5
Dried milk
6
Soya
7
Other (please specify)
8
None
Other
How often do you eat fresh fruit or vegetables?
1
Seldom or never
2
Less than once a month
3
1-3 times a month
4
1-2 times a week
5
3-4 times a week
6
5-6 times a week
7
Once a day
8
2-3 times daily
9
4 or more times daily
Are you trying to lose weight at present?
1
Yes
2
No
Over the past year have you noticed any unexplained weight loss?
1
Yes
2
No
In general, how well are you able to bite or chew food that you eat nowadays? Would you say you have:
1
No difficulty
2
A little difficulty
3
A fair amount of difficulty
4
A great amount of difficulty
How many natural teeth do you have? Please count them and write the number in the box. Please include only natural teeth, not false teeth (dentures).
How many
Food Frequency Questionnaire

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Red meat e.g. beef, beef burgers, pork, lamb Amount: Medium serving/ one beef burger
Chicken or other poultry Amount: Medium serving
Bacon or sausages Amount: Two rashers (bacon)/ Two medium sausages
Ham, corned beef, spam, luncheon meats Amount: One medium thick slice
Liver, liver pate, liver sausages Amount: Medium serving
Fish Amount: One medium fillet or serving
Fried fish in batter Amount: One medium fillet
Fish fingers or fish cakes Amount: Two pieces
Eggs as boiled, fried, scrambled, etc Amount: One

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Refined grain ready to eat cereals Amount: One bowl
Whole grain ready to eat cereals Amount: One bowl

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

White bread and rolls Amount: One slice or roll
Brown/wholemeal bread and rolls Amount: One slice or roll

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

White pasta or white rice Amount: One cup (pasta) Half a cup (rice)
Wholemeal pasta or brown rice Amount: One cup (pasta) Half a cup (rice)
Ready meal with rice or pasta e.g. lasagne Amount: One serving
Boiled, mashed or jacket potatoes Amount: One medium serving
Roast potatoes, chips or french fries Amount: One medium serving
Quiche/pie/pizza Amount: One slice

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Butter Amount: Teaspoon
Margarine or spreads Amount: Teaspoon
Olive oil Amount: Teaspoon
Other oils e.g. sunflower Amount: Teaspoon
Cheese Amount: 1oz or 30g piece (matchbox size)
Full fat milk, double or clotted cream Amount: One pint
Semi-skimmed, skimmed, sterilized, dried milk or single cream or yoghurt Amount: One pint (milk), Teaspoon (dried milk), Tablespoon (cream), Carton (yoghurt)

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Soups (vegetable or meat) Amount: Medium soup bowl
Salad dressing e.g. French vinaigrette, Amount: Tablespoon
Condiments e.g. sauces, tomato ketchup, pickles, marmite Amount: Tablespoon
Salad cream, mayonnaise Amount: Teaspoon

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Wine Amount: Wine glass
Beer, lager or cider Amount: Half pint
Liqueurs, port, sherry and spirits Amount: Liqueurs, port &amp; sherry (50ml). Spirits (25ml)
Tea or coffee Amount: One cup
Cocoa, hot chocolate, chicory, ovaltine Amount: One cup
Fizzy soft drink or fruit squash Amount: Average glass
Low calorie or diet fizzy soft drinks Amount: Average glass
Real fruit juice (100%) e.g. orange, apple juice Amount: Average glass

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Crisps or other packet snacks e.g. wotsits, cheese biscuits Amount: 1 small packet (25g)
Pastries, fruit pies, cakes, tarts, sweet biscuits Amount: Medium slice/serving
Ice cream Amount: One scoop
Chocolate bars, sweets, toffees Amount: One bar or one sweet/ toffee
Jam, marmalade, honey Amount: Teaspoon
Sugar added to tea, coffee, cereal Amount: Teaspoon

For each food, please tick the box to indicate how often, on average, you have eaten the specified amount during the past 12 months. Please answer all questions and do not leave any lines blank. If someone helps you with the shopping and cooking you may wish to ask for their help in completing this questionnaire.

Average use in the last 12 months

1 - Never or less than once/mth

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Fruits Amount: One medium/ one medium serving
Vegetables Amount: One medium/ one medium serving
Peas and dried legume e.g. beans, peas, baked beans, dried lentils Amount: One medium/ one medium serving
Soya product e.g. tofu, soya meat, vegeburger Amount: Medium serving
Peanuts or other nuts Amount: 10 whole

Section 3: About your life in general

Are you married/cohabiting/in a civil partnership?
1
Yes
2
No
are you
1
Single, never married
2
Widowed
3
Divorced
4
Separated
what year did this last happen?
Generic date

Friends and relatives

The following questions concern people in your life who you feel close to and from whom you can obtain support (either emotional or practical) including close relatives and good friends. How often do you feel you lack companionship?
1
Hardly ever to never
2
Some of the time
3
Often
The following questions concern people in your life who you feel close to and from whom you can obtain support (either emotional or practical) including close relatives and good friends. How often do you feel isolated from others?
1
Hardly ever to never
2
Some of the time
3
Often
The following questions concern people in your life who you feel close to and from whom you can obtain support (either emotional or practical) including close relatives and good friends. How often do you feel left out?
1
Hardly ever to never
2
Some of the time
3
Often
The following questions concern people in your life who you feel close to and from whom you can obtain support (either emotional or practical) including close relatives and good friends. How often do you feel in tune with the people around you?
1
Hardly ever to never
2
Some of the time
3
Often
Are there any relatives outside your household with whom you have regular contact (either by visit, telephone, e-mail or letters)? (Not necessarily the same person each time)
1
Almost daily
2
About once a week
3
About once a month
4
Once every few months
5
Never/Almost never