Start
alspac_11_foy
Focusing on You
V1 13/05/2013
INTRODUCTION
You are receiving this questionnaire because you are the father or father figure of a young person in our study.
Some questions may seem very similar to each other; this is because the combination of answers gives a clearer picture than one single answer. There may be questions that seem a bit strange and are not applicable to you because they are concerned with specific feelings or problems.
We would be very grateful if you would try to answer all the questions, but we understand that there may be questions that you either prefer not to answer or are unable to answer. We understand that some of the questions are of a sensitive nature, please remember that your answers are confidential and anonymous.
We appreciate the time and effort required to complete the questionnaire and thank you for your continued support. The success of the study is entirely dependent on the support and goodwill of the participating families
FILLING IN THE QUESTIONNAIRE
Please use black pen. To answer questions simply put a cross in the box which is most accurate in your opinion,
If you make a mistake, shade the box in then cross the correct box.
If you are answering questions which ask you to give further details, please make sure you write inside the boxes.
If you do not want to answer a question or if it does not apply to you, leave it blank. There are no right or wrong answers. Just tell us what is true for you.
THANK YOU FOR YOUR HELP
Section A: Your Home Life
Your Household
('Household' is the people living with you in your house or flat)

When did you move to your present address?

Generic date

Is your home (Please mark one box only).

1
Owned - with mortgage
2
Being bought from council
3
Owned - with no mortgage to pay
4
Rented from council
5
Rented from private landlord - furnished
6
Rented from private landlord -unfurnished
7
Rented from housing association
8
Other (please mark & describe):
Other

If you know your council tax band (A, B, C, etc.) please write it here:

Tax Band
How many people live in your household now (including yourself)?
-
How many
Adults (18 years and older)
Young adults (16-17 years)
Older children (14-15 years)
Younger children (less than 14 years)

What is your present marital/relationship status? (Mark one only)

1
Never married
2
Widowed
3
Divorced
4
Separated
5
Married (once only)
6
Married for second time
7
Married for third time or more
8
Living as married
9
Civil partnership

Do you currently have a partner who lives with you?

1
Yes
2
No
If no, go to A7 on page 6
qc_A5_b == 2
Else
Below are attitudes and behaviours which people reveal in their close relationships. Please rate your spouse's/partner's attitudes and behaviour towards you in recent times and mark the most appropriate box for each item.
-

1 - Very true

2 - Moderately true

3 - Somewhat true

4 - Not at all true

Is very considerate of me
Wants me to take his/her side in an argument
Wants to know exactly what I'm doing and where I am
Is a good companion
Is affectionate to me
Is clearly hurt if I don't accept his/ her views
Tends to try and change me
Confides closely in me
Tends to criticise me over small issues
Understands my problems and worries
Tends to order me about
Insists I do exactly as I'm told
Is physically gentle and considerate
Makes me feel needed
Wants me to change in small ways
Is very loving to me
Seeks to dominate me
Is fun to be with
Wants to change me in big ways
Tends to control everything I do
Shows his/her appreciation of me
Is critical of me in private
Is gentle and kind to me
Speaks to me in a warm and friendly voice
How difficult does your household find it at the moment to afford each of the following? (Please mark one box on each line).
-

1 - Very difficult

2 - Fairly difficult

3 - Slightly difficult

4 - Not difficult

5 - Paid by Government (e.g. DSS/LEA)

6 - Don't pay for this

Food
Clothing
Heating
Rent/mortgage
Things you need for your children
Costs of educational resources for your study teenager (music lessons/school trips/ school uniform)
Medical or dental care
Childcare
Your family life

There is very little commotion in our home

1
True
2
False

We can usually find things when we need them

1
True
2
False

We almost always seem to be rushed

1
True
2
False

We are usually able to stay on top of things

1
True
2
False

No matter how hard we try, we always seem to be running late

1
True
2
False

It's a real zoo in our home

1
True
2
False

At home we can talk to each other without being interrupted

1
True
2
False

There is often a fuss going on at our home

1
True
2
False

No matter what our family plans, it usually doesn't seem to work out

1
True
2
False

You can't hear yourself think in our home

1
True
2
False

I often get drawn into other people's arguments at home

1
True
2
False

Our home is a good place to relax

1
True
2
False

The telephone takes up a lot of our time at home

1
True
2
False

The atmosphere in our home is calm

1
True
2
False

First thing in the day, we have a regular routine at home

1
True
2
False
Section B: Your Neighbourhood, Family and Friends
Where you live
Here is a list of some things that can be a problem in people's homes or in the neighbourhood. How much of a problem are the following for you and your family? (Please mark one box on each line)
-

1 - Serious problem

2 - Minor problem

3 - Not a problem

4 - No opinion

Noise from other homes
Noise from outside in the street
Rubbish or litter dumped around your neighbourhood
Dog dirt on pavement/walkways
Worry about vandalism
Worry about burglaries
Worry about muggings or attacks
Disturbance from teenagers or youths
Traffic
Parking
How often do the other people in your neighbourhood do each of the following?

(Please mark one box on each line):

-

1 - Never

2 - Rarely

3 - Sometimes

4 - Often

5 - Always

Visit your home
Argue with you
Look after your children
Keep to themselves
How often do you do each of the following?
-

1 - Never

2 - Rarely

3 - Sometimes

4 - Often

5 - Always

Visit the home of your neighbours
Argue with your neighbours
Look after your neighbours' children
Keep to yourself

What do you think of your neighbourhood as a place to live?

1
A very good place to live
2
A fairly good place to live
3
Not a very good place to live
4
Not at all a good place to live

How heavy is the traffic on the street where you live?

1
Very heavy
2
Quite heavy
3
Not very heavy
4
Hardly any traffic
Your friends and family
Please mark one box on each line:

How many of your relatives and your partner's relatives do you see at least twice a year?

1
None
2
One
3
Two to four
4
More than 4

About how many friends do you have?

1
None
2
One
3
Two to four
4
More than 4

How many people are there that you can talk to about personal problems?

1
None
2
One
3
Two to four
4
More than 4

How many people talk to you about their personal problems or their private feelings?

1
None
2
One
3
Two to four
4
More than 4

If you have to make an important decision, how many people are there with whom you can discuss it?

1
None
2
One
3
Two to four
4
More than 4

How many people are there among your family and friends from whom you could borrow £200 if you needed to?

1
None
2
One
3
Two to four
4
More than 4

How many of your family and friends would help you in times of trouble?

1
None
2
One
3
Two to four
4
More than 4

During the last month, how many times did you get together with one or more friends?

1
None
2
One
3
Two to four
4
More than 4

During the last month, how many times did you get together with one or more of your relatives or your partner's relatives?

1
None
2
One
3
Two to four
4
More than 4

Overall, would you say you belong to a close circle of friends?

1
Yes
2
No
Section C: Your Employment
Your job

Are you currently (please mark all that apply)?

1
Employed in a paid job (full or part-time)
2
Retired
3
Unemployed and seeking work
4
Unable to work through sickness/disability
5
Full/part-time student
6
Doing voluntary work
7
Looking after family/home
8
Self employed
9
Other, please describe:
Other

In your job, do you have any formal responsibility for supervising the work of other employees? Do not include supervising children e.g. teachers.

1
Yes
2
No
If yes,
qc_C2_a == 1

how many people do you supervise?

1
1-24
2
25+

How many people work for your employer in the place where you work? We mean the actual building/branch or part of a building.

1
1-9
2
10-24
3
25-499
4
500 or more
If self employed,

do you work on your own or do you have employees?

1
On own or with partner but no employees
2
With employees

Do you work from home?

1
Yes, all of the time
2
Yes, some of the time
3
No
(Use precise terms such as Primary Teacher, Laboratory Technician, Care Assistant, Mortgage Adviser, Bus Driver, Software Developer, Call Centre Operator. If the occupation is known by a special name, please use that name. If in HM Forces, give the rank in addition to the actual job. Please also describe the type of industry or service given and give details of what is made, materials used or services given).

Please describe your current or most recent job. What is the job title?

(If you have more than one job, please describe your main role)

Generic text

Please describe your current or most recent job. What is the business/ industry?

(If you have more than one job, please describe your main role)

Generic text

Please describe your current or most recent job. Please describe the main things you do in this job.

(If you have more than one job, please describe your main role)

Generic text

Please describe your current or most recent job. Which one best describes your current position at work?

(If you have more than one job, please describe your main role) (*Total number in the company, not just those of who you are in charge)

1
Self employed (25 or more employees*)
2
Self employed (less than 25 employees*)
3
Self employed (no employees)
4
Manager (25 or more employees*)
5
Manager (less than 25 employees*)
6
Supervisor
7
Employee

Please describe your current or most recent job. When did you start this job?

(If you have more than one job, please describe your main role)

Generic date
If not current,

Please describe your current or most recent job. when did you end this job?

(If you have more than one job, please describe your main role)

Generic date
This next question concerns your finances. If you would rather not answer it, please leave it blank.

What is the individual total take-home pay each month of yourself/your partner (after tax and national insurance are removed as appropriate)? If possible, please refer to a recent payslip. If this is not possible, please estimate. Please mark only one box for each person. Yourself:

1
Up to £399
2
£400-£599
3
£600-£899
4
£900-£1149
5
£1150-£1499
6
£1500-£1899
7
£1900-£2249
8
£2250-£2749
9
£2750-£3299
10
£3300 and above
11
Not doing paid work

What is the individual total take-home pay each month of yourself/your partner (after tax and national insurance are removed as appropriate)? If possible, please refer to a recent payslip. If this is not possible, please estimate. Please mark only one box for each person. Your partner:

1
Up to £399
2
£400-£599
3
£600-£899
4
£900-£1149
5
£1150-£1499
6
£1500-£1899
7
£1900-£2249
8
£2250-£2749
9
£2750-£3299
10
£3300 and above
11
Not doing paid work

How many hours do you work in a usual week? ... hours

Hours in week

How many hours does your partner work in a usual week? ... hours

Hours in week

Have you or your partner started a new job in the last five years? Please mark one box only.

1
Yes, I have
2
Yes, my partner has
3
Yes, we both have
4
No, neither of us has
Section D: How you cope with life
Below are some statements. Please say how true they are of you.
-

1 - Almost always true

2 - Often true

3 - Sometimes true

4 - Seldom true

5 - Never true

I feel that I am a person of worth, at least equal to others
I feel I have a number of good qualities
I am able to do things as well as most other people
I feel I do not have much to be proud of
I take a positive attitude towards myself
Sometimes I think I am no good at all
I am a useful person to have around
I feel I cannot do anything right
When I do a job I do it well
I feel that my life is not very useful
I am unlucky
Your outlook on life:

Did getting good marks at school mean a great deal to you?

1
Yes
2
No

Are you often blamed for things that just are not your fault?

1
Yes
2
No

Do you feel that most of the time it does not pay to try hard because things never turn out right anyway?

1
Yes
2
No

Do you feel that if things start out well in the morning then it's going to be a good day no matter what you do?

1
Yes
2
No

Do you believe that whether or not people like you depends on how you act?

1
Yes
2
No

Do you believe that when bad things are going to happen they are just going to happen no matter what you try to do to stop them?

1
Yes
2
No

Do you feel that when good things happen they happen because of hard work?

1
Yes
2
No

Do you feel that when someone does not like you there is little you can do about it?

1
Yes
2
No

Did you usually feel that it was almost useless to try in school because most other children were cleverer than you?

1
Yes
2
No

Are you the kind of person who believes that planning ahead makes things turn out better?

1
Yes
2
No

Most of the time, do you feel that you have little to say about what your family decides to do?

1
Yes
2
No

Do you think it's better to be clever than to be lucky?

1
Yes
2
No
The questions in this section ask you about your feelings and the way you behave. You may have answered these questions in other questionnaires, but you might be feeling differently now.
Your feelings in the past week.

I have been able to laugh and see the funny side of things:

1
As much as I always could
2
Not quite so much now
3
Definitely not so much now
4
Not at all

I have looked forward with enjoyment to things:

1
As much as I ever did
2
Rather less than I used to
3
Definitely less than I used to
4
Hardly at all

I have blamed myself unnecessarily when things went wrong:

1
Yes, most of the time
2
Yes, some of the time
3
Not very often
4
Never

I have been anxious or worried for no good reason:

1
No, not at all
2
Hardly ever
3
Yes, sometimes
4
Yes, often

I have felt scared or panicky for no good reason:

1
Yes, quite a lot
2
Yes, sometimes
3
No, not much
4
No, not at all

Things have been getting on top of me:

1
Yes, most of the time I haven't been able to cope
2
Yes, sometimes I haven't been coping as well as usual
3
No, most of the time I have coped quite well
4
No, I have been coping as well as ever

I have been so unhappy that I have had difficulty sleeping:

1
Yes, most of the time
2
Yes, sometimes
3
Not very often
4
No, not at all

I have felt sad or miserable:

1
Yes, most of the time
2
Yes, sometimes
3
Not very often
4
No, not at all

I have been so unhappy that I have been crying:

1
Yes, most of the time
2
Yes, quite often
3
Only occasionally
4
Never

The thought of harming myself has occurred to me:

1
Yes, quite often
2
Sometimes
3
Hardly ever
4
Never

I avoid saying what I think for fear of being rejected.

1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me

If others knew the real me they would not like me.

1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me

If other people knew what I am really like they would think less of me.

1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me

I always expect criticism.

1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me

I don't like people to really know me.

1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me

My value as a person depends enormously on what others think of me.

1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me
Events in your life
Listed below are a number of events which may have brought changes in your life. Have any of these occurred in the last year?

In the last year: Your partner died

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: One of your children died

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: A friend or relative died

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: One of your children was ill

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your partner was ill

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: A friend or relative was ill

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You were admitted to hospital

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You were in trouble with the law

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You were divorced

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You were very ill

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your partner lost their job

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your partner had problems at work

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You had problems at work

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You lost your job

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your partner went away

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your partner was in trouble with the law

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You and your partner separated

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: Your income was reduced

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You argued with your partner

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You argued with your family and friends

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You moved house

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: Your partner was physically cruel to you

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You became homeless

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You had a major financial problem

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You got married

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: Your partner was physically cruel to your children

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You were physically cruel to your children

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You attempted suicide

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You were convicted of an offence

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You started a new job

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You returned to work

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year:: You took an examination

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your partner was emotionally cruel to you

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your partner was emotionally cruel to your children

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You were emotionally cruel to your children

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your house or car was burgled

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You found a new partner

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: One of your children started school

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: Your partner started a new job

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: A pet died

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen

In the last year: You had an accident (please mark and describe):

1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
Generic text
Section E: Your Physical Activity and Your Lifestyle

Which of the following forms of transport do you use most often? (Please mark one box only)

1
Car
2
Motorbike
3
Public transport
4
Cycle
5
Walk
7
Not applicable

Do you make regular journeys every day or most days either walking or cycling?

1
No
2
I walk
3
I cycle
4
Both

Which of the following best describes your walking pace?

1
Slow
2
Steady average
3
Fairly brisk
4
Fast (at least 4miles/hr)
If you cycle regularly,

how long do you spend cycling in an average week? ... Hours/week

Hours in week

Do you take part in physical activity (e.g. running, swimming, dancing, golf, tennis, squash, jogging, bowls)?

1
No
2
Occasionally (less than monthly)
3
Frequently (once a month or more)
If frequently go to E5b below
qc_E5_a == 3

How many times on average do you take part in these activities? Summer ... times per week

How many

How many times on average do you take part in these activities? Winter ... times per week

How many
In a typical week during the past year, how many hours did you spend each week in the following activities? (Please write 00 in the boxes if you did not do this activity).
Summer (hours/week) Winter (hours/week)
Hours in weekHours in weekHours in weekHours in week Hours in weekHours in weekHours in weekHours in week
Walking to work, shopping or leisure
Cycling, including to work and leisure
Gardening, light e.g. pruning, watering
Gardening, heavy e.g. digging, mowing
Physical exercise e.g. fitness, sports
DIY e.g. on house or car
Household activities, light e.g. cooking, washing up
Household activities, heavy e.g. hoovering, cleaning windows

In a typical week in the last year, did you do any of these activities vigorously enough to cause breathlessness, sweating or a faster heartbeat?

1
Yes
2
No
If no, go to E8 on the next page
If yes,
qc_E7_a == 1

For how many minutes each week did you perform vigorous activity? ... minutes/week

Minutes in week

In a typical weekday in the last year, how many flights of stairs did you climb? ... flights per day

How many

Compared with your activity level two years ago, are you doing?

1
More
2
Same
3
Less
If not the same,
qc_E9_a != 2

Please give a reason:

Generic text

Compared with other people your age, are you?

1
Much more active
2
More active
3
Similar
4
Less active
5
Much less active
You and gambling
For the next set of questions about gambling (by "gambling" we mean all gambling for money including bingo, scratch cards and the lottery), please indicate the extent to which each one has applied to you in the last 12 months. Please mark one box for each question:

In the last 12 months, have you ever gambled for money?

1
Yes
2
No
If no, go to E21 on page 27
qc_E11 == 2
Else

How often have you bet more than you could really afford to lose?

1
Never
2
Sometimes
3
Most of the time
4
Almost always

How often have you needed to gamble with larger amounts of money to get the same excitement?

1
Never
2
Sometimes
3
Most of the time
4
Almost always

How often have you gone back to try to win back the money you'd lost?

1
Never
2
Sometimes
3
Most of the time
4
Almost always

How often have you borrowed money or sold anything to get money to gamble?

1
Never
2
Sometimes
3
Most of the time
4
Almost always

How often have you felt that you might have a problem with gambling?

1
Never
2
Sometimes
3
Most of the time
4
Almost always

How often have you felt that gambling has caused you any health problems, including stress or anxiety?

1
Never
2
Sometimes
3
Most of the time
4
Almost always

How often have people criticised your betting, or told you that you have a gambling problem, whether or not you thought it is true?

1
Never
2
Sometimes
3
Most of the time
4
Almost always

How often have you felt your gambling has caused financial problems for you or your household?

1
Never
2
Sometimes
3
Most of the time
4
Almost always

How often have you felt guilty about the way you gamble or what happens when you gamble?

1
Never
2
Sometimes
3
Most of the time
4
Almost always
Smoking

Are you currently a smoker (cigarettes or tobacco)?

1
Yes
2
No
If no, go to E31 on the next page
qc_E21 == 2
Else

Do you smoke every day?

1
Yes
2
No
If no, go to E31 on the next page
If yes,
qc_E22 == 1

How old were you when you started smoking regularly (at least one cigarette or equivalent per day)? ... years old

Age

How many cigarettes do you usually smoke each day? ... cigarettes

How many
If hand-rolled,

how much tobacco do you use per week? ... oz OR ... grams

Ounces
Grams

How soon after you wake up do you smoke your first cigarette?

1
Within 5 minutes
2
6-30 minutes
3
31-60 minutes
4
After 60 minutes

Do you find it difficult to refrain from smoking in places where it is forbidden, e.g. at work, restaurants, cinema and other public places.?

1
Yes
2
No

In the UK, smoking is now banned in many public places. Has this affected how much you smoke?

1
Yes, smoke less than before
2
No, smoke same amount
3
Yes, smoke more than before

Do you smoke more frequently during the first hours after waking than during the rest of the day?

1
Yes
2
No

Do you smoke if you are so ill that you are in bed most of the day?

1
Yes
2
No

Which cigarette would you hate most to give up?

1
The first one in the morning
2
Any other
Now go to E36 on the next page
For non-smokers only:
qc_E21 == 2

Have you ever smoked in the past?

1
Yes
2
No
If no, go to E36 on the next page
qc_E31 == 2
Else

When you smoked in the past did you smoke every day?

1
Yes
2
No
If no, go to E36 on the next page
If yes,
qc_E32 == 1

How old were you when you started smoking regularly (at least one cigarette or equivalent per day)? ... years old

Age

How many cigarettes did you usually smoke each day? ... cigarettes

How many
If hand-rolled,

how much tobacco did you use per week? ... oz OR ... grams

Ounces
Grams

How long ago did you stop smoking? If you can't remember give your age at the time you stopped. ... years ... months ago OR ... years old

Years Months
Age
Alcohol
In this question COUNT ONE DRINK AS APPROXIMATELY HALF A PINT OF BEER, A SMALL GLASS OF WINE OR A SINGLE PUB MEASURE OF SPIRITS ETC. PLEASE SEE OUR DRINKOGRAM FOR MORE INFORMATION.

How often do you have a drink containing alcohol?

1
Never
2
Monthly or less
3
2 to 4 times a month
4
2 to 3 times a week
5
4 or more times a week
If Never to question E36a Go to Section F on page 31
qc_E36_a == 1
Else

How many drinks containing alcohol do you have on a typical day when you are drinking?

1
1 or 2
2
3 or 4
3
5 or 6
4
7, 8 or 9
5
10 or more

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

1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily

How often during the last year have you found that you were not able to stop drinking once you had started?

1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily

How often during the last year have you failed to do what was normally expected from you because of drinking?

1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily

How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily

How often during the last year have you had a feeling of guilt or remorse after drinking?

1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily

How often during the last year have you been unable to remember what happened the night before because you had been drinking?

1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily

Have you or someone else been injured as a result of your drinking?

1
Yes, during the last year
2
Yes, but not in the last year
3
No

Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

1
Yes, during the last year
2
Yes, but not in the last year
3
No
Section F: Your Health
The following questions ask for your views about your health and how you feel about life in general. If you are unsure about how to answer any question, try and think about your overall health and give the best answer you can. Do not spend too much time answering, as your immediate response is likely to be the most accurate.

In general, would you say your health is: (Please mark one box)

1
Excellent
2
Very good
3
Good
4
Fair
5
Poor

Compared to 3 months ago, how would you rate your health in general now?

(Please mark one box).

1
Much better than 3 months ago
2
Somewhat better than 3 months ago
3
About the same
4
Somewhat worse now than 3 months ago
5
Much worse now than 3 months ago
The following questions are about activities you might do during a typical day. Does your health limit you in these activities? If so, how much? (Please mark one box on each line).
-

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, 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 a mile
Walking half a mile
Walking 100 yards
Bathing and dressing yourself
During the past 2 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health? (Please mark one box on each line)
-

1 - All of the time

2 - Most of the time

3 - Some of the time

4 - A little of the time

5 - None of the time

Cut down on the amount of time you spent on work or other activities
Accomplished less than you would like
Were limited in the kind of work or other activities
Had difficulty performing the work or other activities (e.g. it took more effort)
During the past 2 weeks, how much of the time 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)? (Please mark one box on each line)
-

1 - All of the time

2 - Most of the time

3 - Some of the time

4 - A little of the time

5 - None of the time

Cut down on the amount of time you spent on work or other activities
Accomplished less than you would like
Didn't do work or other activities as carefully as usual

During the past 2 weeks, to what extent have your physical health or emotional problems interfered with your normal social activities with family, neighbours or groups? (Please mark one box.)

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

How much bodily pain have you had during the past 2 weeks? (Please mark one box).

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

During the past 2 weeks, how much did pain interfere with your normal work, including both outside the home and housework? (Please mark one box.)

1
Not at all
2
Slightly
3
Moderately
4
Quite a bit
5
Extremely
These questions are about how you feel and how things have been with you during the past 2 weeks. For each question please give one answer that comes closest to the way you have been feeling. (Please mark one box on each line.)
-

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 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 would 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 2 weeks, how much of your time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)? (Please mark one box).

1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
How TRUE or FALSE is each of the following statements for you? (Please mark one box on each line)
-

1 - Definitely true

2 - Mostly true

3 - Not sure

4 - Mostly false

5 - Definitely false

I seem to get ill more easily than other people
I am as healthy as anybody I know
I expect my health to get worse
My health is excellent
Other Health Issues
Have you ever been told that you have had any of the following conditions? Please mark one box for each answer.
- If yes, please give the year of most recent diagnosis

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year

1 - Yes

2 - No

Year
Heart attack (coronary thrombosis or myocardial infarction)
Heart failure
Angina
Other heart trouble
Aortic aneurysm
Narrowing or hardening of the arteries in the leg (including claudication)
High blood pressure
High cholesterol
Pulmonary embolism (PE)
Deep vein thrombosis (DVT)

Have you ever been told by a doctor that you have had a stroke?

1
Yes
2
No
If no, go to F14 below
If yes,
qc_F13 == 1

Please give year of most recent stroke: ... Year

Generic date

Did the symptoms last more than 24 hours?

1
Yes
2
No

Have you made a complete recovery from your stroke?

1
Yes
2
No

Have you ever been told by a doctor that you have cancer?

1
Yes
2
No
If no, go to F15 on the next page
If yes,
qc_F14 == 1
_cancer < 3 && _cancer < 4 _cancer < 3 && _cancer < 4

What type of cancer(s)? Please write in the space below starting with the most recent: ... Year of diagnosis?

Generic text
Year

Have you ever been told by a doctor that you have arthritis?

1
Yes
2
No
If no, go to F16 below
If yes,
qc_F15 == 1

What year was it diagnosed?

Generic date

Please give the type of arthritis if known (mark one box only):

1
Osteoarthritis
2
Rheumatoid arthritis
3
Other (please give details):
Other

Have you had a fall in the last 12 months?

1
Yes
2
No
If no, go to F17 on the next page
If yes,
qc_F16 == 1

How many times have you fallen? ... times

How many

Did you seek medical attention?

1
Yes
2
No

Have you ever had a fracture (broken a bone)?

1
Yes
2
No
If no, go to F18 below
If yes,
qc_F17 == 1

What did you fracture?

Generic text

Are you troubled by shortness of breath when hurrying on level ground or walking up a slight hill?

1
Yes
2
No
3
Unable to walk

Do you get short of breath walking with other people of your own age on level ground?

1
Yes
2
No
3
Unable to walk

In the past twelve months, have you at any time been awoken at night by an attack of shortness of breath?

1
Yes
2
No

Have you ever been told by a doctor that you have chronic bronchitis or emphysema?

1
Yes
2
No

Have you ever been told by a doctor that you have asthma?

1
Yes
2
No

Have you ever been told by a doctor that you have diabetes?

1
Yes
2
No
If no, go to F24a) below
If yes,
qc_F23_a == 1

What year was this first diagnosed?

Generic date
How is your diabetes controlled? (Please mark all that apply).
-

1 - Yes

Diet
Tablets
Insulin

Do you ever have any pain or discomfort in your chest?

1
Yes
2
No
If no, go to F30 on page 41
If yes,
qc_F24_a == 1

Where do you get this pain or discomfort?

Please mark the appropriate boxes underneath the diagram.

1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13

When you walk at an ordinary pace on the level does this produce the pain?

1
Yes
2
No
3
Unable to walk

When you walk uphill or hurry does this produce the pain?

1
Yes
2
No
3
Unable to walk

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

1
Stop
2
Slow down
3
Continue at same pace
7
Not applicable

Does the pain or discomfort in your chest go away if you stand still?

1
Yes
2
No

How long does it take to go away?

1
10 minutes or less
2
More than 10 minutes

Have you ever had a PSA (Prostate-Specific Antigen) test? This is a blood test to find out if you might have early prostate cancer.

1
Yes
2
No
If no go to F32 on the next page
If yes,
qc_F30_a == 1

when was this?

If you have had more than one tell us the latest one. If you are not sure please give us your best guess and tick the guess box

Generic date
1
guess

I am not sure when it was

1
Yes

Where did you have this ?

1
GP/local health centre
2
Hospital
3
Other place please specify
Other
Why did you have the test? (please mark all that apply)
-

1 - Yes

Part of hospital management
GP ordered it
I requested screening
Private insurance check-up
Going abroad
Family member was diagnosed with prostate cancer
Other
Don't know
If yes to question F31g
qc_F31_a-h$1;7 == 1

specify

Other
The following questions are about urinary symtoms, sexual feelings and activity. These obviously change as we get older and we are interested to find out about how things are at the moment. if you do not wish to answer any specific question then it is fine to simply leave it blank and go onto the next question.
During the last month or so, how often have you :
-

1 - Not at all

2 - Less than 1 time in 5

3 - Less than half the time

4 - About half the time

5 - More than half the time

6 - Almost always

Had a sensation of not emptying your bladder completely after urinating?
Had to urinate again less than two hours after you had urinated?
Stopped and started, several times when you urinated?
Found it difficult to postpone urination?
Had a weak urinary stream?
Had to push or strain to urinate?

How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?

1
None
2
One time
3
Two times
4
Three times
5
Four times
6
Five times or more

Which statement best describes your circumstances

1
I have been living with my wife
2
I have been living with my partner
3
I have a sexual partner but we did not live together
4
I do not have a sexual partner

How often do you think about sex? This includes times of just being interested in sex, daydreaming or fantasizing about sex, as well as times when you wanted to have sex.

0
Not at all
1
Once in the last month
2
2-3 times in the last month
3
Once a week
4
2-3 times a week
5
4-6 times a week
6
Once a day
7
More than once a day

Are you worried or distressed by your current level of sexual drive/desire?

1
Not at all worried or distressed
2
A little bit worried or distressed
3
Moderately worried or distressed
4
Very worried or distressed
5
Extremely worried or distressed

Compared with a year ago, has your sexual drive/desire changed?

1
Increased a lot
2
Increased moderately
3
Neither increased or decreased
4
Decreased moderately
5
Decreased a lot
If you did NOT have a sexual partner in the LAST MONTH please go to F40.
Else

How many times have you attempted sexual intercourse?

0
Not at all
1
Once in the last month
2
2-3 times in the last month
3
Once a week
4
2-3 times a week
5
4-6 times a week
6
Once a day
7
More than once a day

Apart from when you attempted sexual intercourse, how frequently did you engage in activities such as kissing, fondling, petting etc?

0
Not at all
1
Once in the last month
2
2-3 times in the last month
3
Once a week
4
2-3 times a week
5
4-6 times a week
6
Once a day
7
More than once a day

How often do you masturbate?

0
Not at all
1
Once in the last month
2
2-3 times in the last month
3
Once a week
4
2-3 times a week
5
4-6 times a week
6
Once a day
7
More than once a day

Are you worried or distressed by the overall frequency of your sexual activities (including intercourse, kissing etc and masturbation)?

0
Not at all worried or distressed
1
A little bit worried or distressed
2
Moderately worried or distressed
3
Very worried or distressed
4
Extremely worried or distressed
If Not at all worried or distressed to question F41 go to F42 below
qc_F41 == 0

If you are worried or distressed by the current frequency of your sexual activities, do you consider it to be

1
Too frequent
2
Not frequent enough

Compared with a year ago, has the overall frequency of your sexual activities changed?

1
Increased a lot
2
Increased moderately
3
Neither increases or decreased
4
Decreased moderately
5
Decreased a lot

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: You are:

1
Always able to keep an erection which would be good enough for sexual intercourse
2
Usually able to get and keep an erection which would be good enough for sexual intercourse
3
Sometimes able to get and keep an erection which is good enough for sexual intercourse
4
Never able to get and keep an erection which would be good enough for sexual intercourse

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: Are you worried or distressed by your current ability to have an erection?

1
Not at all worried or distressed
2
A little bit worried or distressed
3
Moderately worried or distressed
4
Very worried or distressed
5
Extremely worried or distressed

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: Compared with a year ago, has your ability to have an erection changed?

1
Increased a lot
2
Increased moderately
3
Neither increased or decreased
4
Decreased moderately
5
Decreased a lot

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: When you had sexual stimulation, how often did you have the feeling of orgasm or climax?

1
No sexual intercourse/masturbation
2
Almost never/never
3
A few times (much less than half the time)
4
Sometimes (about half the time)
5
Most of the time (much more than half the time)
6
Almost always/always

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: Are you worried or distressed by your current orgasmic experience?

1
Not at all worried or distressed
2
A little bit worried or distressed
3
Moderately worried or distressed
4
Very worried or distressed
5
Extremely worried or distressed

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: Compared with a year ago, has the enjoyment of your orgasmic experience changed?

1
Increased a lot
2
Increased moderately
3
Neither increased or decreased
4
Decreased moderately
5
Decreased a lot

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH:How frequently did you awaken with full erection?

0
Not at all
1
Once in the last month
2
2-3 times in the last month
3
Once a week
4
2-3 times a week
5
4-6 times a week
6
Once a day
7
More than once a day

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: Are you worried or distressed by the frequency of your morning erections?

1
Not at all worried or distressed
2
A little bit worried or distressed
3
Moderately worried or distressed
4
Very worried or distressed
5
Extremely worried or distressed

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: Compared with a year ago, has the frequency of your morning erections changed?

1
Increased a lot
2
Increased moderately
3
Neither increased or decreased
4
Decreased moderately
5
Decreased a lot

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: How satisfied have you been with your overall sex life?

1
Very dissatisfied
2
Moderately dissatisfied
3
About equally satisfied and dissatisfied
4
Moderately satisfied
5
Very satisfied

It is common for men to experience erectile problems. This may mean that one is not always able to get or keep an erection that is rigid enough for satisfactory activity (including sexual intercourse and masturbation). In the LAST MONTH: How satisfied have you been with your general (non-sexual) relationship with your partner?

1
Very dissatisfied
2
Moderately dissatisfied
3
About equally satisfied and dissatisfied
4
Moderately satisfied
5
Very satisfied
Your medications

Do you currently take any regular medication?

1
Yes
2
No
In the last 2 years how often have you taken the following?
-

1 - Every day

2 - Often

3 - Sometimes

4 - Not at all

Sleeping pills
Vitamins
Cannabis/marijuana
Tranquillisers
Pills for depression
Antibiotics
Cocaine
Aspirin, acylpyrin
Paracetamol
Other painkillers
Amphetamines, ecstasy or other stimulants
Heroin, methadone, crack, other hard drug
Anticonvulsants
About You

What colour eyes do you have?

1
Blue
2
Green
3
Brown
4
Grey
5
Other

What is your natural hair colour? (i.e. when you were aged 20)

1
Blond
2
Light brown
3
Dark brown
4
Black
5
Ginger/red

Please give your present weight and measurements if you know them. Height ... metres ... centimetres OR ... feet ... inches OR Don't know

Metres
Centimetres in metre
Feet
Inches in foot
9
Don't know

Please give your present weight and measurements if you know them. Weight ... kg OR ... st ... lbs

Kilograms
Stones
Pounds in stone
9
Don't know

Please give your present weight and measurements if you know them. Chest ... cm OR ... inches OR Don't know

Centimetres
Inches
9
Don't know

Please give your present weight and measurements if you know them. Hips ... cm OR ... inches OR Don't know

Centimetres
Inches
9
Don't know

Please give your present weight and measurements if you know them. Waist ... cm OR ... inches OR Don't know

Centimetres
Inches
9
Don't know
Section G:

This questionnaire was completed by:

1
study young person's biological father
2
study young person's father figure
3
someone else (please mark box and describe below):
Other

If you have a partner/spouse are they:

1
study young person's biological mother
2
study young person's mother figure
3
someone else (please mark box and describe below):
Other

Did you live in the same house as the study young person when they were born?

1
Yes
2
No
If yes, go to G4a
If no, go to G3b
qc_G3_a == 2

If no, what was their age when you/they moved in?

Age

Do you still live in the same house as the study young person?

1
Yes
2
No
If yes, go to G4c
If no, go to G4b
qc_G4_a == 2

What was their age when either they or you moved out of the family home?

(Ignore any periods when you/they may have temporarily moved out of the house for less than a year)

Age

During the period you lived with the study young person, did you or they ever move out and back into the family home?

(Ignore any periods when you/they may have temporarily moved out of the house for less than a year)

1
Yes
2
No
If no, go to G5
If yes,
qc_G4_c == 1

how old were they when this occured? Please indicate up to two occasions when this occured. period 1 age moved in

Age

how old were they when this occured? Please indicate up to two occasions when this occured. period 1 age moved out

Age

how old were they when this occured? Please indicate up to two occasions when this occured. period 2 age moved in

Age

how old were they when this occured? Please indicate up to two occasions when this occured. period 2 age moved out

Age

On what date did you complete this questionnaire?

Generic date

Please give your date of birth:

Date of birth

Please give your study young person's date of birth:

Date of birth
THANK YOU VERY MUCH FOR YOUR HELP

Space for any additional comments you would like to make

Generic text
NB: Please remember we cannot reply to any comment unless you sign it.
When completed, please send this back to: Freepost () Children of the 90s Oakfield House
End

alspac_11_foy

Focusing on You
V1 13/05/2013
INTRODUCTION
You are receiving this questionnaire because you are the father or father figure of a young person in our study.
Some questions may seem very similar to each other; this is because the combination of answers gives a clearer picture than one single answer. There may be questions that seem a bit strange and are not applicable to you because they are concerned with specific feelings or problems.
We would be very grateful if you would try to answer all the questions, but we understand that there may be questions that you either prefer not to answer or are unable to answer. We understand that some of the questions are of a sensitive nature, please remember that your answers are confidential and anonymous.
We appreciate the time and effort required to complete the questionnaire and thank you for your continued support. The success of the study is entirely dependent on the support and goodwill of the participating families
FILLING IN THE QUESTIONNAIRE
Please use black pen. To answer questions simply put a cross in the box which is most accurate in your opinion,
If you make a mistake, shade the box in then cross the correct box.
If you are answering questions which ask you to give further details, please make sure you write inside the boxes.
If you do not want to answer a question or if it does not apply to you, leave it blank. There are no right or wrong answers. Just tell us what is true for you.
THANK YOU FOR YOUR HELP

Section A: Your Home Life

Your Household

('Household' is the people living with you in your house or flat)
When did you move to your present address?
Generic date
Is your home (Please mark one box only).
1
Owned - with mortgage
2
Being bought from council
3
Owned - with no mortgage to pay
4
Rented from council
5
Rented from private landlord - furnished
6
Rented from private landlord -unfurnished
7
Rented from housing association
8
Other (please mark & describe):
Other
If you know your council tax band (A, B, C, etc.) please write it here:
Tax Band

How many people live in your household now (including yourself)?

-
How many
Adults (18 years and older)
Young adults (16-17 years)
Older children (14-15 years)
Younger children (less than 14 years)
What is your present marital/relationship status? (Mark one only)
1
Never married
2
Widowed
3
Divorced
4
Separated
5
Married (once only)
6
Married for second time
7
Married for third time or more
8
Living as married
9
Civil partnership
Do you currently have a partner who lives with you?
1
Yes
2
No

Below are attitudes and behaviours which people reveal in their close relationships. Please rate your spouse's/partner's attitudes and behaviour towards you in recent times and mark the most appropriate box for each item.

-

1 - Very true

2 - Moderately true

3 - Somewhat true

4 - Not at all true

Is very considerate of me
Wants me to take his/her side in an argument
Wants to know exactly what I'm doing and where I am
Is a good companion
Is affectionate to me
Is clearly hurt if I don't accept his/ her views
Tends to try and change me
Confides closely in me
Tends to criticise me over small issues
Understands my problems and worries
Tends to order me about
Insists I do exactly as I'm told
Is physically gentle and considerate
Makes me feel needed
Wants me to change in small ways
Is very loving to me
Seeks to dominate me
Is fun to be with
Wants to change me in big ways
Tends to control everything I do
Shows his/her appreciation of me
Is critical of me in private
Is gentle and kind to me
Speaks to me in a warm and friendly voice

How difficult does your household find it at the moment to afford each of the following? (Please mark one box on each line).

-

1 - Very difficult

2 - Fairly difficult

3 - Slightly difficult

4 - Not difficult

5 - Paid by Government (e.g. DSS/LEA)

6 - Don't pay for this

Food
Clothing
Heating
Rent/mortgage
Things you need for your children
Costs of educational resources for your study teenager (music lessons/school trips/ school uniform)
Medical or dental care
Childcare

Your family life

There is very little commotion in our home
1
True
2
False
We can usually find things when we need them
1
True
2
False
We almost always seem to be rushed
1
True
2
False
We are usually able to stay on top of things
1
True
2
False
No matter how hard we try, we always seem to be running late
1
True
2
False
It's a real zoo in our home
1
True
2
False
At home we can talk to each other without being interrupted
1
True
2
False
There is often a fuss going on at our home
1
True
2
False
No matter what our family plans, it usually doesn't seem to work out
1
True
2
False
You can't hear yourself think in our home
1
True
2
False
I often get drawn into other people's arguments at home
1
True
2
False
Our home is a good place to relax
1
True
2
False
The telephone takes up a lot of our time at home
1
True
2
False
The atmosphere in our home is calm
1
True
2
False
First thing in the day, we have a regular routine at home
1
True
2
False

Section B: Your Neighbourhood, Family and Friends

Where you live

Here is a list of some things that can be a problem in people's homes or in the neighbourhood. How much of a problem are the following for you and your family? (Please mark one box on each line)

-

1 - Serious problem

2 - Minor problem

3 - Not a problem

4 - No opinion

Noise from other homes
Noise from outside in the street
Rubbish or litter dumped around your neighbourhood
Dog dirt on pavement/walkways
Worry about vandalism
Worry about burglaries
Worry about muggings or attacks
Disturbance from teenagers or youths
Traffic
Parking

How often do the other people in your neighbourhood do each of the following?

-

1 - Never

2 - Rarely

3 - Sometimes

4 - Often

5 - Always

Visit your home
Argue with you
Look after your children
Keep to themselves

How often do you do each of the following?

-

1 - Never

2 - Rarely

3 - Sometimes

4 - Often

5 - Always

Visit the home of your neighbours
Argue with your neighbours
Look after your neighbours' children
Keep to yourself
What do you think of your neighbourhood as a place to live?
1
A very good place to live
2
A fairly good place to live
3
Not a very good place to live
4
Not at all a good place to live
How heavy is the traffic on the street where you live?
1
Very heavy
2
Quite heavy
3
Not very heavy
4
Hardly any traffic

Your friends and family

Please mark one box on each line:
How many of your relatives and your partner's relatives do you see at least twice a year?
1
None
2
One
3
Two to four
4
More than 4
About how many friends do you have?
1
None
2
One
3
Two to four
4
More than 4
How many people are there that you can talk to about personal problems?
1
None
2
One
3
Two to four
4
More than 4
How many people talk to you about their personal problems or their private feelings?
1
None
2
One
3
Two to four
4
More than 4
If you have to make an important decision, how many people are there with whom you can discuss it?
1
None
2
One
3
Two to four
4
More than 4
How many people are there among your family and friends from whom you could borrow £200 if you needed to?
1
None
2
One
3
Two to four
4
More than 4
How many of your family and friends would help you in times of trouble?
1
None
2
One
3
Two to four
4
More than 4
During the last month, how many times did you get together with one or more friends?
1
None
2
One
3
Two to four
4
More than 4
During the last month, how many times did you get together with one or more of your relatives or your partner's relatives?
1
None
2
One
3
Two to four
4
More than 4
Overall, would you say you belong to a close circle of friends?
1
Yes
2
No

Section C: Your Employment

Your job

Are you currently (please mark all that apply)?
1
Employed in a paid job (full or part-time)
2
Retired
3
Unemployed and seeking work
4
Unable to work through sickness/disability
5
Full/part-time student
6
Doing voluntary work
7
Looking after family/home
8
Self employed
9
Other, please describe:
Other
In your job, do you have any formal responsibility for supervising the work of other employees? Do not include supervising children e.g. teachers.
1
Yes
2
No
how many people do you supervise?
1
1-24
2
25+
How many people work for your employer in the place where you work? We mean the actual building/branch or part of a building.
1
1-9
2
10-24
3
25-499
4
500 or more
do you work on your own or do you have employees?
1
On own or with partner but no employees
2
With employees
Do you work from home?
1
Yes, all of the time
2
Yes, some of the time
3
No
(Use precise terms such as Primary Teacher, Laboratory Technician, Care Assistant, Mortgage Adviser, Bus Driver, Software Developer, Call Centre Operator. If the occupation is known by a special name, please use that name. If in HM Forces, give the rank in addition to the actual job. Please also describe the type of industry or service given and give details of what is made, materials used or services given).
Please describe your current or most recent job. What is the job title?
Generic text
Please describe your current or most recent job. What is the business/ industry?
Generic text
Please describe your current or most recent job. Please describe the main things you do in this job.
Generic text
Please describe your current or most recent job. Which one best describes your current position at work?
1
Self employed (25 or more employees*)
2
Self employed (less than 25 employees*)
3
Self employed (no employees)
4
Manager (25 or more employees*)
5
Manager (less than 25 employees*)
6
Supervisor
7
Employee
Please describe your current or most recent job. When did you start this job?
Generic date
Please describe your current or most recent job. when did you end this job?
Generic date
This next question concerns your finances. If you would rather not answer it, please leave it blank.
What is the individual total take-home pay each month of yourself/your partner (after tax and national insurance are removed as appropriate)? If possible, please refer to a recent payslip. If this is not possible, please estimate. Please mark only one box for each person. Yourself:
1
Up to £399
2
£400-£599
3
£600-£899
4
£900-£1149
5
£1150-£1499
6
£1500-£1899
7
£1900-£2249
8
£2250-£2749
9
£2750-£3299
10
£3300 and above
11
Not doing paid work
What is the individual total take-home pay each month of yourself/your partner (after tax and national insurance are removed as appropriate)? If possible, please refer to a recent payslip. If this is not possible, please estimate. Please mark only one box for each person. Your partner:
1
Up to £399
2
£400-£599
3
£600-£899
4
£900-£1149
5
£1150-£1499
6
£1500-£1899
7
£1900-£2249
8
£2250-£2749
9
£2750-£3299
10
£3300 and above
11
Not doing paid work
How many hours do you work in a usual week? ... hours
Hours in week
How many hours does your partner work in a usual week? ... hours
Hours in week
Have you or your partner started a new job in the last five years? Please mark one box only.
1
Yes, I have
2
Yes, my partner has
3
Yes, we both have
4
No, neither of us has

Section D: How you cope with life

Below are some statements. Please say how true they are of you.

-

1 - Almost always true

2 - Often true

3 - Sometimes true

4 - Seldom true

5 - Never true

I feel that I am a person of worth, at least equal to others
I feel I have a number of good qualities
I am able to do things as well as most other people
I feel I do not have much to be proud of
I take a positive attitude towards myself
Sometimes I think I am no good at all
I am a useful person to have around
I feel I cannot do anything right
When I do a job I do it well
I feel that my life is not very useful
I am unlucky

Your outlook on life:

Did getting good marks at school mean a great deal to you?
1
Yes
2
No
Are you often blamed for things that just are not your fault?
1
Yes
2
No
Do you feel that most of the time it does not pay to try hard because things never turn out right anyway?
1
Yes
2
No
Do you feel that if things start out well in the morning then it's going to be a good day no matter what you do?
1
Yes
2
No
Do you believe that whether or not people like you depends on how you act?
1
Yes
2
No
Do you believe that when bad things are going to happen they are just going to happen no matter what you try to do to stop them?
1
Yes
2
No
Do you feel that when good things happen they happen because of hard work?
1
Yes
2
No
Do you feel that when someone does not like you there is little you can do about it?
1
Yes
2
No
Did you usually feel that it was almost useless to try in school because most other children were cleverer than you?
1
Yes
2
No
Are you the kind of person who believes that planning ahead makes things turn out better?
1
Yes
2
No
Most of the time, do you feel that you have little to say about what your family decides to do?
1
Yes
2
No
Do you think it's better to be clever than to be lucky?
1
Yes
2
No
The questions in this section ask you about your feelings and the way you behave. You may have answered these questions in other questionnaires, but you might be feeling differently now.

Your feelings in the past week.

I have been able to laugh and see the funny side of things:
1
As much as I always could
2
Not quite so much now
3
Definitely not so much now
4
Not at all
I have looked forward with enjoyment to things:
1
As much as I ever did
2
Rather less than I used to
3
Definitely less than I used to
4
Hardly at all
I have blamed myself unnecessarily when things went wrong:
1
Yes, most of the time
2
Yes, some of the time
3
Not very often
4
Never
I have been anxious or worried for no good reason:
1
No, not at all
2
Hardly ever
3
Yes, sometimes
4
Yes, often
I have felt scared or panicky for no good reason:
1
Yes, quite a lot
2
Yes, sometimes
3
No, not much
4
No, not at all
Things have been getting on top of me:
1
Yes, most of the time I haven't been able to cope
2
Yes, sometimes I haven't been coping as well as usual
3
No, most of the time I have coped quite well
4
No, I have been coping as well as ever
I have been so unhappy that I have had difficulty sleeping:
1
Yes, most of the time
2
Yes, sometimes
3
Not very often
4
No, not at all
I have felt sad or miserable:
1
Yes, most of the time
2
Yes, sometimes
3
Not very often
4
No, not at all
I have been so unhappy that I have been crying:
1
Yes, most of the time
2
Yes, quite often
3
Only occasionally
4
Never
The thought of harming myself has occurred to me:
1
Yes, quite often
2
Sometimes
3
Hardly ever
4
Never
I avoid saying what I think for fear of being rejected.
1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me
If others knew the real me they would not like me.
1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me
If other people knew what I am really like they would think less of me.
1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me
I always expect criticism.
1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me
I don't like people to really know me.
1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me
My value as a person depends enormously on what others think of me.
1
Very like me
2
Moderately like me
3
Moderately unlike me
4
Very unlike me

Events in your life

Listed below are a number of events which may have brought changes in your life. Have any of these occurred in the last year?
In the last year: Your partner died
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: One of your children died
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: A friend or relative died
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: One of your children was ill
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your partner was ill
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: A friend or relative was ill
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You were admitted to hospital
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You were in trouble with the law
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You were divorced
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You were very ill
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your partner lost their job
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your partner had problems at work
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You had problems at work
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You lost your job
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your partner went away
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your partner was in trouble with the law
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You and your partner separated
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: Your income was reduced
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You argued with your partner
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You argued with your family and friends
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You moved house
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: Your partner was physically cruel to you
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You became homeless
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You had a major financial problem
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You got married
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: Your partner was physically cruel to your children
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You were physically cruel to your children
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You attempted suicide
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You were convicted of an offence
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You started a new job
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You returned to work
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year:: You took an examination
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your partner was emotionally cruel to you
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your partner was emotionally cruel to your children
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You were emotionally cruel to your children
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your house or car was burgled
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You found a new partner
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: One of your children started school
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: Your partner started a new job
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: A pet died
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
In the last year: You had an accident (please mark and describe):
1
Yes & affected me a lot
2
Yes, moderately affected
3
Yes, mildly affected
4
Yes, but did not affect me at all
5
No, did not happen
Generic text

Section E: Your Physical Activity and Your Lifestyle

Which of the following forms of transport do you use most often? (Please mark one box only)
1
Car
2
Motorbike
3
Public transport
4
Cycle
5
Walk
7
Not applicable
Do you make regular journeys every day or most days either walking or cycling?
1
No
2
I walk
3
I cycle
4
Both
Which of the following best describes your walking pace?
1
Slow
2
Steady average
3
Fairly brisk
4
Fast (at least 4miles/hr)
how long do you spend cycling in an average week? ... Hours/week
Hours in week
Do you take part in physical activity (e.g. running, swimming, dancing, golf, tennis, squash, jogging, bowls)?
1
No
2
Occasionally (less than monthly)
3
Frequently (once a month or more)
How many times on average do you take part in these activities? Summer ... times per week
How many
How many times on average do you take part in these activities? Winter ... times per week
How many

In a typical week during the past year, how many hours did you spend each week in the following activities? (Please write 00 in the boxes if you did not do this activity).

Summer (hours/week) Winter (hours/week)
Hours in weekHours in weekHours in weekHours in week Hours in weekHours in weekHours in weekHours in week
Walking to work, shopping or leisure
Cycling, including to work and leisure
Gardening, light e.g. pruning, watering
Gardening, heavy e.g. digging, mowing
Physical exercise e.g. fitness, sports
DIY e.g. on house or car
Household activities, light e.g. cooking, washing up
Household activities, heavy e.g. hoovering, cleaning windows
In a typical week in the last year, did you do any of these activities vigorously enough to cause breathlessness, sweating or a faster heartbeat?
1
Yes
2
No
If no, go to E8 on the next page
For how many minutes each week did you perform vigorous activity? ... minutes/week
Minutes in week
In a typical weekday in the last year, how many flights of stairs did you climb? ... flights per day
How many
Compared with your activity level two years ago, are you doing?
1
More
2
Same
3
Less
Please give a reason:
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Compared with other people your age, are you?
1
Much more active
2
More active
3
Similar
4
Less active
5
Much less active

You and gambling

For the next set of questions about gambling (by "gambling" we mean all gambling for money including bingo, scratch cards and the lottery), please indicate the extent to which each one has applied to you in the last 12 months. Please mark one box for each question:
In the last 12 months, have you ever gambled for money?
1
Yes
2
No
How often have you bet more than you could really afford to lose?
1
Never
2
Sometimes
3
Most of the time
4
Almost always
How often have you needed to gamble with larger amounts of money to get the same excitement?
1
Never
2
Sometimes
3
Most of the time
4
Almost always
How often have you gone back to try to win back the money you'd lost?
1
Never
2
Sometimes
3
Most of the time
4
Almost always
How often have you borrowed money or sold anything to get money to gamble?
1
Never
2
Sometimes
3
Most of the time
4
Almost always
How often have you felt that you might have a problem with gambling?
1
Never
2
Sometimes
3
Most of the time
4
Almost always
How often have you felt that gambling has caused you any health problems, including stress or anxiety?
1
Never
2
Sometimes
3
Most of the time
4
Almost always
How often have people criticised your betting, or told you that you have a gambling problem, whether or not you thought it is true?
1
Never
2
Sometimes
3
Most of the time
4
Almost always
How often have you felt your gambling has caused financial problems for you or your household?
1
Never
2
Sometimes
3
Most of the time
4
Almost always
How often have you felt guilty about the way you gamble or what happens when you gamble?
1
Never
2
Sometimes
3
Most of the time
4
Almost always

Smoking

Are you currently a smoker (cigarettes or tobacco)?
1
Yes
2
No
Do you smoke every day?
1
Yes
2
No
If no, go to E31 on the next page
How old were you when you started smoking regularly (at least one cigarette or equivalent per day)? ... years old
Age
How many cigarettes do you usually smoke each day? ... cigarettes
How many
how much tobacco do you use per week? ... oz OR ... grams
Ounces
Grams
How soon after you wake up do you smoke your first cigarette?
1
Within 5 minutes
2
6-30 minutes
3
31-60 minutes
4
After 60 minutes
Do you find it difficult to refrain from smoking in places where it is forbidden, e.g. at work, restaurants, cinema and other public places.?
1
Yes
2
No
In the UK, smoking is now banned in many public places. Has this affected how much you smoke?
1
Yes, smoke less than before
2
No, smoke same amount
3
Yes, smoke more than before
Do you smoke more frequently during the first hours after waking than during the rest of the day?
1
Yes
2
No
Do you smoke if you are so ill that you are in bed most of the day?
1
Yes
2
No
Which cigarette would you hate most to give up?
1
The first one in the morning
2
Any other
Now go to E36 on the next page
Have you ever smoked in the past?
1
Yes
2
No
When you smoked in the past did you smoke every day?
1
Yes
2
No
If no, go to E36 on the next page
How old were you when you started smoking regularly (at least one cigarette or equivalent per day)? ... years old
Age
How many cigarettes did you usually smoke each day? ... cigarettes
How many
how much tobacco did you use per week? ... oz OR ... grams
Ounces
Grams
How long ago did you stop smoking? If you can't remember give your age at the time you stopped. ... years ... months ago OR ... years old
Years Months
Age

Alcohol

In this question COUNT ONE DRINK AS APPROXIMATELY HALF A PINT OF BEER, A SMALL GLASS OF WINE OR A SINGLE PUB MEASURE OF SPIRITS ETC. PLEASE SEE OUR DRINKOGRAM FOR MORE INFORMATION.
How often do you have a drink containing alcohol?
1
Never
2
Monthly or less
3
2 to 4 times a month
4
2 to 3 times a week
5
4 or more times a week
How many drinks containing alcohol do you have on a typical day when you are drinking?
1
1 or 2
2
3 or 4
3
5 or 6
4
7, 8 or 9
5
10 or more
How often do you have six or more drinks on one occasion?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
How often during the last year have you found that you were not able to stop drinking once you had started?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
How often during the last year have you failed to do what was normally expected from you because of drinking?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
How often during the last year have you had a feeling of guilt or remorse after drinking?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
Have you or someone else been injured as a result of your drinking?
1
Yes, during the last year
2
Yes, but not in the last year
3
No
Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
1
Yes, during the last year
2
Yes, but not in the last year
3
No

Section F: Your Health

The following questions ask for your views about your health and how you feel about life in general. If you are unsure about how to answer any question, try and think about your overall health and give the best answer you can. Do not spend too much time answering, as your immediate response is likely to be the most accurate.
In general, would you say your health is: (Please mark one box)
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
Compared to 3 months ago, how would you rate your health in general now?
1
Much better than 3 months ago
2
Somewhat better than 3 months ago
3
About the same
4
Somewhat worse now than 3 months ago
5
Much worse now than 3 months ago

The following questions are about activities you might do during a typical day. Does your health limit you in these activities? If so, how much? (Please mark one box on each line).

-

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, 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 a mile
Walking half a mile
Walking 100 yards
Bathing and dressing yourself

During the past 2 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health? (Please mark one box on each line)

-

1 - All of the time

2 - Most of the time

3 - Some of the time

4 - A little of the time

5 - None of the time

Cut down on the amount of time you spent on work or other activities
Accomplished less than you would like
Were limited in the kind of work or other activities
Had difficulty performing the work or other activities (e.g. it took more effort)

During the past 2 weeks, how much of the time 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)? (Please mark one box on each line)

-

1 - All of the time

2 - Most of the time

3 - Some of the time

4 - A little of the time

5 - None of the time

Cut down on the amount of time you spent on work or other activities
Accomplished less than you would like
Didn't do work or other activities as carefully as usual
During the past 2 weeks, to what extent have your physical health or emotional problems interfered with your normal social activities with family, neighbours or groups? (Please mark one box.)
1
Not at all
2
Slightly
3
Moderately
4
Quite a bit
5
Extremely
How much bodily pain have you had during the past 2 weeks? (Please mark one box).
1
None
2
Very mild
3
Mild
4
Moderate
5
Severe
6
Very severe
During the past 2 weeks, how much did pain interfere with your normal work, including both outside the home and housework? (Please mark one box.)
1
Not at all
2
Slightly
3
Moderately
4
Quite a bit
5
Extremely

These questions are about how you feel and how things have been with you during the past 2 weeks. For each question please give one answer that comes closest to the way you have been feeling. (Please mark one box on each line.)

-

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 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 would 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 2 weeks, how much of your time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)? (Please mark one box).