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ADULT SELF-COMPLETION QUESTIONNAIRE (AGED 16+)
Completing the questionnaire
Please answer questions by ticking the box next to the answer, as in the example below. Some questions have instructions that show which question to answer next. If there are no instructions, just answer the next question.
Please tick only one box for each question.
Returning the questionnaire
If the interviewer is still in your home when you have completed the questionnaire, please hand it back to them. If not, please return the completed questionnaire in the pre-paid envelope as soon as you possibly can.
Now please go to Q1 and start filling in your answers

Please write in your date of birth:

Date of birth

Are you male or female?

1
Male
2
Female
For each of the following questions, please tick the one box that best describes your answer.

In general, would you say your health is?

1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
The following questions 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

Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Climbing several flights of stairs
During the past 4 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?
-

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

Accomplished less than you would like
Were limited in the kind of work or other activities
During the past 4 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)?
-

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

Accomplished less than you would like
Did work or other activities less carefully than usual

During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

1
Not at all
2
A little bit
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 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks...
-

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

Have you felt calm and peaceful?
Did you have a lot of energy?
Have you felt downhearted and depressed?

During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?

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
Here are some questions regarding the way you have been feeling over the last few weeks. For each question please tick the box next to the answer that best describes the way you have felt.

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

1
Better than usual
2
Same as usual
3
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... ...felt that you were playing a useful part in things?

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

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 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 able to face up to problems?

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

Have you recently... ...been feeling unhappy or 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
Not 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... ...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
We'd like to know how important various things are to your sense of who you are. Please think about each of the following and tick the box that indicates whether you think it is very important, fairly important, not very important or not at all important to your sense of who you are. Please tick one answer on each line.
-

1 - Very important to my sense of who I am

2 - Fairly important to my sense of who I am

3 - Not very important to my sense of who I am

4 - Not at all important to my sense of who I am

5 - Don't know/doesn't apply

Your profession?
Your level of education?
Your ethnic or racial background?
Your political beliefs?
Your family?
Your gender?
Your age and life stage?

How old were you the first time you ever had an alcoholic drink, that is, a whole drink not just a sip? Do not include non-alcoholic or low alcohol drinks but do include shandy. Write in how old you were then ... years old

Age
1
Have never had an alcoholic drink
If Have never had an alcoholic drink to question 23
qc_23 == 1
Else

Thinking now about all kinds of drinks, how often have you had an alcoholic drink of any kind during the last 12 months?

1
Almost every day
2
Five or six days a week
3
Three or four days a week
4
Once or twice a week
5
Once or twice a month
6
Once every couple of months
7
Once or twice a year
8
Not at all in the last 12 months
If Almost every day or Five or six days a week or Three or four days a week or Once or twice a week or Once or twice a month or Once every couple of months or Once or twice a year
qc_24 == 1 || qc_24 == 2 || qc_24 == 3 || qc_24 == 4 || qc_24 == 5 || qc_24 == 6 || qc_24 == 7

Did you have an alcoholic drink in the seven days ending yesterday?

1
Yes
2
No
If Yes to question 25
qc_25 == 1

In the last seven days, on how many days did you have an alcoholic drink? Tick one box only.

1
One day
2
Two days
3
Three days
4
Four days
5
Five days
6
Six days
7
Seven days
Please think about the day on which you drank the most in the last seven days (if you drank the same amount on more than one day, please answer about the most recent of those days).

On the day you drank the most, how many pints of beer, lager, stout or cider did you have? If none, please enter '0'. ... pints

How many

On the day you drank the most, how many measures of spirits or liqueurs, such as gin, whisky, rum, brandy, vodka or cocktails did you have? Drinks poured at home may be larger than a pub single measure - please estimate the number of single measures. If none, please enter '0'. ... single measures

How many

On the day you drank the most, how many glasses of wine did you have? Include sherry, port or vermouth. If none, please enter '0'. ... glasses

How many

On the day you drank the most, how many 'alcopops' did you have? Include pre-mixed alcoholic drinks such as Bacardi Breezer, WKD or Smirnoff Ice. If none, please enter '0'. ... bottles

How many
Here are some questions about how you feel about your life. Please tick the number which you feel best describes how dissatisfied or satisfied you are with the following aspects of your current situation.
-

1 - Completely dissatisfied

2 - Mostly dissatisfied

3 - Somewhat dissatisfied

4 - Neither satisfied nor dissatisfied

5 - Somewhat satisfied

6 - Mostly satisfied

7 - Completely satisfied

Your health
The income of your household
The amount of leisure time you have
Your life overall
Please say how much you agree or disagree with the following statements. Tick one box on each line.
-

1 - Strongly agree

2 - Moderately agree

3 - Slightly agree

4 - Slightly disagree

5 - Moderately disagree

6 - Strongly disagree

At home, I feel I have control over what happens in most situations
I feel that what happens in life is often determined by factors beyond my control
In general, I have different demands on me that are hard to combine
In general, I have enough time to do everything
Considering the things I have to do at home, I have to work very fast

Do you have a husband, wife or partner with whom you live?

1
Yes
2
No
If Yes to question 33
qc_33 == 1
We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement.
-

1 - A lot

2 - Somewhat

3 - A little

4 - Not at all

How much do they really understand the way you feel about things?
How much can you rely on them if you have a serious problem?
How much can you open up to them if you need to talk about your worries?
How much do they criticise you?
How much do they let you down when you are counting on them?
How much do they get on your nerves?

Do you have any immediate family, for example, any children, brothers or sisters, parents, cousins, aunts, uncles, grandparents or grandchildren? Please do not consider deceased persons when answering.

1
Yes
2
No
If Yes to question 35
qc_35 == 1
We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement.
-

1 - A lot

2 - Somewhat

3 - A little

4 - Not at all

How much do they really understand the way you feel about things?
How much can you rely on them if you have a serious problem?
How much can you open up to them if you need to talk about your worries?
How much do they criticise you?
How much do they let you down when you are counting on them?
How much do they get on your nerves?

Do you have any friends?

1
Yes
2
No
If Yes to question 37
qc_37 == 1
We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement.
-

1 - A lot

2 - Somewhat

3 - A little

4 - Not at all

How much do they really understand the way you feel about things?
How much can you rely on them if you have a serious problem?
How much can you open up to them if you need to talk about your worries?
How much do they criticise you?
How much do they let you down when you are counting on them?
How much do they get on your nerves?

Please think of the person you can best share your private feelings and concerns with. Is this person male or female?

1
Male
2
Female
3
Have no-one to share my feelings with
If Male or Female to question 39
qc_39 == 1 || qc_39 == 2

What is this person's relationship to you? Tick one box only.

1
Husband/wife or partner
2
Son or Daughter
3
Mother or Father
4
Brother or Sister
5
Grandparent
6
Grandchild
7
Aunt/Uncle or Cousin
8
Other relative
9
Friend
Here are some questions about family life. Do you personally agree or disagree...
-

1 - Strongly agree

2 - Agree

3 - Neither agree nor disagree

4 - Disagree

5 - Strongly disagree

A pre-school child is likely to suffer if his or her mother works
All in all, family life suffers when the woman has a full-time job
Both the husband and wife should contribute to the household income
A husband's job is to earn money; a wife's job is to look after the home and family
Employers should make special arrangements to help mothers combine jobs and childcare

If there is anything else you would like to tell us, please write in the space below. We would be very interested in reading what you have to say.

Long text
Thank you very much for taking the time to answer our questions.
Please place the questionnaire in the envelope and hand it back to your interviewer
Or please return to the address below: National Centre for Social Research
End

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ADULT SELF-COMPLETION QUESTIONNAIRE (AGED 16+)
Completing the questionnaire
Please answer questions by ticking the box next to the answer, as in the example below. Some questions have instructions that show which question to answer next. If there are no instructions, just answer the next question.
Please tick only one box for each question.
Returning the questionnaire
If the interviewer is still in your home when you have completed the questionnaire, please hand it back to them. If not, please return the completed questionnaire in the pre-paid envelope as soon as you possibly can.
Now please go to Q1 and start filling in your answers
Please write in your date of birth:
Date of birth
Are you male or female?
1
Male
2
Female
For each of the following questions, please tick the one box that best describes your answer.
In general, would you say your health is?
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor

The following questions 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

Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Climbing several flights of stairs

During the past 4 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?

-

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

Accomplished less than you would like
Were limited in the kind of work or other activities

During the past 4 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)?

-

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

Accomplished less than you would like
Did work or other activities less carefully than usual
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
1
Not at all
2
A little bit
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 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks...

-

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

Have you felt calm and peaceful?
Did you have a lot of energy?
Have you felt downhearted and depressed?
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
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
Here are some questions regarding the way you have been feeling over the last few weeks. For each question please tick the box next to the answer that best describes the way you have felt.
Have you recently... ...been able to concentrate on whatever you're doing?
1
Better than usual
2
Same as usual
3
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... ...felt that you were playing a useful part in things?
1
More so than usual
2
Same as usual
3
Less so than usual
4
Much less than usual
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 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 able to face up to problems?
1
More so than usual
2
Same as usual
3
Less able than usual
4
Much less able
Have you recently... ...been feeling unhappy or 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
Not 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... ...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

We'd like to know how important various things are to your sense of who you are. Please think about each of the following and tick the box that indicates whether you think it is very important, fairly important, not very important or not at all important to your sense of who you are. Please tick one answer on each line.

-

1 - Very important to my sense of who I am

2 - Fairly important to my sense of who I am

3 - Not very important to my sense of who I am

4 - Not at all important to my sense of who I am

5 - Don't know/doesn't apply

Your profession?
Your level of education?
Your ethnic or racial background?
Your political beliefs?
Your family?
Your gender?
Your age and life stage?
How old were you the first time you ever had an alcoholic drink, that is, a whole drink not just a sip? Do not include non-alcoholic or low alcohol drinks but do include shandy. Write in how old you were then ... years old
Age
1
Have never had an alcoholic drink
Thinking now about all kinds of drinks, how often have you had an alcoholic drink of any kind during the last 12 months?
1
Almost every day
2
Five or six days a week
3
Three or four days a week
4
Once or twice a week
5
Once or twice a month
6
Once every couple of months
7
Once or twice a year
8
Not at all in the last 12 months
Did you have an alcoholic drink in the seven days ending yesterday?
1
Yes
2
No
In the last seven days, on how many days did you have an alcoholic drink? Tick one box only.
1
One day
2
Two days
3
Three days
4
Four days
5
Five days
6
Six days
7
Seven days
Please think about the day on which you drank the most in the last seven days (if you drank the same amount on more than one day, please answer about the most recent of those days).
On the day you drank the most, how many pints of beer, lager, stout or cider did you have? If none, please enter '0'. ... pints
How many
On the day you drank the most, how many measures of spirits or liqueurs, such as gin, whisky, rum, brandy, vodka or cocktails did you have? Drinks poured at home may be larger than a pub single measure - please estimate the number of single measures. If none, please enter '0'. ... single measures
How many
On the day you drank the most, how many glasses of wine did you have? Include sherry, port or vermouth. If none, please enter '0'. ... glasses
How many
On the day you drank the most, how many 'alcopops' did you have? Include pre-mixed alcoholic drinks such as Bacardi Breezer, WKD or Smirnoff Ice. If none, please enter '0'. ... bottles
How many

Here are some questions about how you feel about your life. Please tick the number which you feel best describes how dissatisfied or satisfied you are with the following aspects of your current situation.

-

1 - Completely dissatisfied

2 - Mostly dissatisfied

3 - Somewhat dissatisfied

4 - Neither satisfied nor dissatisfied

5 - Somewhat satisfied

6 - Mostly satisfied

7 - Completely satisfied

Your health
The income of your household
The amount of leisure time you have
Your life overall

Please say how much you agree or disagree with the following statements. Tick one box on each line.

-

1 - Strongly agree

2 - Moderately agree

3 - Slightly agree

4 - Slightly disagree

5 - Moderately disagree

6 - Strongly disagree

At home, I feel I have control over what happens in most situations
I feel that what happens in life is often determined by factors beyond my control
In general, I have different demands on me that are hard to combine
In general, I have enough time to do everything
Considering the things I have to do at home, I have to work very fast
Do you have a husband, wife or partner with whom you live?
1
Yes
2
No

We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement.

-

1 - A lot

2 - Somewhat

3 - A little

4 - Not at all

How much do they really understand the way you feel about things?
How much can you rely on them if you have a serious problem?
How much can you open up to them if you need to talk about your worries?
How much do they criticise you?
How much do they let you down when you are counting on them?
How much do they get on your nerves?
Do you have any immediate family, for example, any children, brothers or sisters, parents, cousins, aunts, uncles, grandparents or grandchildren? Please do not consider deceased persons when answering.
1
Yes
2
No

We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement.

-

1 - A lot

2 - Somewhat

3 - A little

4 - Not at all

How much do they really understand the way you feel about things?
How much can you rely on them if you have a serious problem?
How much can you open up to them if you need to talk about your worries?
How much do they criticise you?
How much do they let you down when you are counting on them?
How much do they get on your nerves?
Do you have any friends?
1
Yes
2
No

We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement.

-

1 - A lot

2 - Somewhat

3 - A little

4 - Not at all

How much do they really understand the way you feel about things?
How much can you rely on them if you have a serious problem?
How much can you open up to them if you need to talk about your worries?
How much do they criticise you?
How much do they let you down when you are counting on them?
How much do they get on your nerves?
Please think of the person you can best share your private feelings and concerns with. Is this person male or female?
1
Male
2
Female
3
Have no-one to share my feelings with
What is this person's relationship to you? Tick one box only.
1
Husband/wife or partner
2
Son or Daughter
3
Mother or Father
4
Brother or Sister
5
Grandparent
6
Grandchild
7
Aunt/Uncle or Cousin
8
Other relative
9
Friend

Here are some questions about family life. Do you personally agree or disagree...

-

1 - Strongly agree

2 - Agree

3 - Neither agree nor disagree

4 - Disagree

5 - Strongly disagree

A pre-school child is likely to suffer if his or her mother works
All in all, family life suffers when the woman has a full-time job
Both the husband and wife should contribute to the household income
A husband's job is to earn money; a wife's job is to look after the home and family
Employers should make special arrangements to help mothers combine jobs and childcare
If there is anything else you would like to tell us, please write in the space below. We would be very interested in reading what you have to say.
Long text
Thank you very much for taking the time to answer our questions.
Please place the questionnaire in the envelope and hand it back to your interviewer
Or please return to the address below: National Centre for Social Research
Name

Wave 2 Adult Self-Completion Questionnaire