Statistics Canada
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Canadian Health Measures Survey, Cycle 1
2007 to 2009
Household Questionnaire

Table of contents

Introduction
Contact (CN)
Interviewer Introduction (II)
Initial Contact (IC)
Language Of Preference (LP)
Survey Introduction (INT)
Dwelling Type (DW)
Collective Dwelling (COLL)
Tenure (TN)
Mortgage (MTGE)
Number Of Bedrooms (BD)
Roster Introduction (RS)
Usual Roster (USU)
Temp Roster (TEM)
Other Roster 1 (OTH1)
Demographic Introduction (DM)
Age With Confirmation (AWC)
Sex (SEX)
Marital Status With Confirmation (MSWC)
Education (ED)
Canadian Forces (CAF)
Relationship With Confirmation (RWC)
Person Providing Demographics (PPD)
Person Providing Information (PPI)
General Health (GEN)
Pregnancy (PRS)
Sleep (SLP)
Height And Weight (HWT)
Weight Change (WTC)
Meat And Fish Consumption (MFC)
Milk And Dairy Product Consumption (MDC)
Grains, Fruits And Vegetables Consumption (GFV)
Dietary Fat Consumption (DFC)
Water And Soft Drink Consumption (WSD)
Salt Consumption (SLT)
Physical Activities (PAC)
Children’s Physical Activity (CPA)
Sedentary Activities (SAC)
Sun Exposure (SEB)
Oral Health (OHM)
Chronic Conditions (CCC)
Phlegm (PLM)
Family Medical History (FMH)
Hepatitis (HEP)
Medication Use (MED)
Health Utility Index (HUI)
Request For Parent To Leave (RPL)
Smoking (SMK)
Alcohol Use (ALC)
Illicit Drug Use (IDU)
Sexual Behaviour (SXB)
Breastfeeding (MBF)
Request For Parent To Return (RPR)
Request For Child To Leave (RCL)
Pregnancy Information (PRG)
Birth Information (BIR)
Breastfeeding Information (BRI)
Strengths And Difficulties (SDQ)
Request For Child To Return (RCR)
Exposure To Second-Hand Smoke (ETS)
Housing Characteristics (HSC)
Hobbies (HOB)
Grooming Product Use (GPU)
Labour Force Activity (LBF)
Sociodemographic Characteristics (SDC)
Education (EDU)
Income (INC)
Administration (ADM)
Thank You (TY)

Introduction

  1. Question text in bold font is read to the respondent. Text in normal font is not read to the respondent. Interviewer instructions are prefaced by the word “ INTERVIEWER ”, and are not read aloud.
  2. Question text in bold font enclosed by brackets () is read to the respondent at the discretion of the person asking the questions.
  3. In this text, the use of the masculine is generic and applies to both men and women.  Please note that during the actual interview, the questions were personalized to be appropriate to the gender of the respondent.
  4. Question text enclosed in square brackets [] is dynamic and in most cases will vary depending on the age and sex of the respondent.
  5. The options “Don’t Know” (DK) and “Refusal” (RF) are allowed on every question unless otherwise stated. However, the response categories are shown in this document only when the flow from these responses is not to the next question.

Contact (CN)

CN_N01

  • Interviewer: Record method of interview.
    1. Telephone
    2. Personal
  • Note: Don’t Know and Refused are not allowed.

CN_N02

  • Interviewer: Have you made contact?
    1. Yes
    2. No (Go to CN_END)
  • Note: Don’t Know and Refused are not allowed.

CN_END

Interviewer Introduction (II)

II_R01
Hello, I’m from Statistics Canada. My name is …

  • Interviewer: Introduce yourself using both your given and last names.
    Press <Enter> to continue.
  • Note: Don’t Know and Refused are not allowed.
II_END

Initial Contact (IC)

IC_R01
I’m calling regarding the Canadian Health Measures Survey. All information collected in this survey will be kept strictly confidential.

  • Interviewer: Press <Enter> to continue.
  • Note: Don’t Know and Refused are not allowed.
IC_END

Language Of Preference (LP)

LP_Q01
Would you prefer to be interviewed in English or in French?

  1. English (Go to LP_END)
  2. French (Go to LP_END)
  3. Other
    Note: Don’t Know and Refused are not allowed.

LP_N02

  • Interviewer: Select respondent’s preferred non-official language.
  • If necessary, ask: (What language would you prefer?)
    • 03 Chinese
    • 04 Italian
    • 05 Punjabi
    • 06 Spanish
    • 07 Portuguese
    • 08 Polish
    • 09 German
    • 10 Vietnamese
    • 11 Arabic
    • 12 Tagalog
    • 13 Greek
    • 14 Tamil
    • 15 Cree
    • 16 Afghan
    • 17 Cantonese
    • 18 Hindi
    • 19 Mandarin
    • 20 Persian (Farsi)
    • 21 Russian
    • 22 Ukrainian
    • 23 Urdu
    • 24 Inuktitut
    • 25 Hungarian
    • 26 Korean
    • 27 Serbo-Croatian
    • 28 Gujarati
    • 29 Dari
    • 90 Other – Specify
  • Note: Don’t Know and Refused are not allowed.
  • If LP_N02 <> 90 (Other – Specify), go to LP_END.

LP_S02

  • Interviewer: Specify. (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know, Refused and EMPTY are not allowed.

LP_END


Survey Introduction (INT)

INT_R01
The survey will collect information on Canadians’ health and health habits. The first part of the survey is this home interview, which includes questions on many health-related topics. The second part of the survey involves a visit to a clinic to collect direct physical measures such as blood pressure, height and weight, and fitness levels.

  • Interviewer: Press <Enter> to continue.
  • Note: Don’t Know and Refused are not allowed.

INT_R02
Your answers will be kept strictly confidential and used only for statistical purposes. While participation is voluntary, your cooperation is important to ensure the information collected in this survey is as accurate and as comprehensive as possible. (Registration#: STC/HLT-084-75364)

  • Interviewer: Press <Enter> to continue.
  • Note: Don’t Know and Refused are not allowed.
INT_END

Dwelling Type (DW)

DW_N02

  • Interviewer: Select the dwelling type.

    01. Single detached
    02. Double
    03. Row or Terrace
    04. Duplex
    05. Low-rise apartment (fewer than 5 stories) or flat
    06. High-rise apartment (5 stories or more)
    07. Institution
    08. Hotel; rooming/lodging house; camp
    09. Mobile home
    10. Other - Specify

  • If DW_N02 <> 10 “Other -Specify”, go to DW_END.

DW_S02

  • Interviewer: Specify. (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know, Refused and EMPTY are not allowed.
DW_END

Collective Dwelling (COLL)

COLL_N01

  • Interviewer: Specify the type of collective dwelling (e.g., lodging/rooming house, hotel, motel, hostel, tourist home, hospital, staff residence, working camp, etc.)
  • If necessary, ask: (Please specify the type of dwelling.)
  • (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know, Refused and EMPTY are not allowed.

COLL_Q02
What is the total number of people living here?

  • (insert respondent answer between 1 and 995)
COLL_END

Tenure (TN)

TN_Q01
Is this dwelling owned by a member of this household?

  1. Yes
  2. No

TN_END


Mortgage (MTGE)

MTGE_Q01
Is there a mortgage on this dwelling?

  1. Yes
  2. No
MTGE_END

Number Of Bedrooms (BD)

BD_Q01
How many bedrooms are there in this dwelling? 

  • Interviewer: Enter “0” if no separate, enclosed bedroom.
  • (insert respondent answer between 0 and 20)
BD_END

Roster Introduction (RS)

RS_R01
The next few questions ask for important basic information about the people in your household.

  • Interviewer: Press <Enter> to continue.
  • Note: Don’t Know and Refused are not allowed.
RS_END

Usual Roster (USU)

USU_Q01
What are the names of all persons who usually live here?

  • First Name
  • Interviewer: Begin with adults who have responsibility for the care or support of the family.
  • Enter the first name.
  • Last Name
  • Interviewer: Begin with adults who have responsibility for the care or support of the family.
  • Enter the last name.

USU_END


Temp Roster (TEM)

RS_Q02
Is anyone staying here temporarily?

  1. Yes
  2. No (Go to TEM_END)
    Don’t Know, Refused (Go to TEM_END)

TEM_Q01
What are the names of all persons who are staying here temporarily?

  • First Name
  • Interviewer: Add a person only if he has no other usual residence elsewhere.
  • Enter the first name.
  • Last Name
  • Interviewer: Add a person only if he has no other usual residence elsewhere.
  • Enter the last name.

TEM_END

Other Roster 1 (OTH1)

RS_Q04
Are there any other persons who usually live here but are now away at school, in hospital, or somewhere else?

  1. Yes
  2. No (Go to OTH1_END)
    Don’t Know, Refused (Go to OTH1_END)

OTH1_Q01
What are the names of the other people who live or stay here?

  • First Name
    Interviewer: Add a person only if he has no other usual residence elsewhere.
    Enter the first name.

  • Last Name
    Interviewer: Add a person only if he has no other usual residence elsewhere.
    Enter the last name.
OTH1_END

Demographic Introduction (DM)

DM_N01
  • Interviewer: The following questions collect the demographic information for all household members.
  • For new household members collect all demographic information.
  • For other household members collect any missing demographic information, or update/correct existing demographic information as needed.
  • Press <Page Down> to go to the first unanswered demographic question, or to go to the next question series once all the demographic information has been collected.
  • Note: Don’t Know and Refused are not allowed.

DM_END


Age With Confirmation (AWC)

AWC_Q02
What is [Respondent Name]’s date of birth?

  • Day
    • Interviewer: Enter the day.
    • If necessary, ask: (What is the day?)
    • (insert respondent answer between 1 and 31)  
  • Month
    • Interviewer: Select the month.
    • If necessary, ask: (What is the month?)
    • 01 January
    • 02 February
    • 03 March
    • 04 April
    • 05 May
    • 06 June
    • 07 July
    • 08 August
    • 09 September
    • 10 October
    • 11 November
    • 12 December
  • Year
    • Interviewer: Enter a four-digit year.
    • If necessary, ask: (What is the year?)
    • (insert respondent answer between 1900 and 2009)

AWC_Q03
So [Respondent Name]’s age on [Interview Date] was [Calculated Age].
Is that correct?

  • Interviewer: Date of birth is [Month of Birth, Day of Birth, Year of Birth].
    1. Yes (Go to AWC_END)
    2. No, return and correct date of birth
    3. No, collect age
  • Note: Don’t Know and Refused are not allowed.

AWC_Q04
What is [Respondent Name]’s age?

  • (insert respondent answer between 0 and 130)
  •  Note: Don’t Know and Refused are not allowed.
AWC_END

Sex (SEX)

  • SEX_Q01
    • Interviewer: Enter [Respondent Name]’s sex.
    • If necessary, ask: (Is [Respondent Name] male or female?)
      1. Male
      2. Female
  • Note: Don’t Know and Refused are not allowed.

SEX_END


Marital Status With Confirmation (MSWC)

MSWC_Q02
What is [Respondent Name]’s marital status? Is he:

  • Interviewer: Read categories to respondent.
    • 01 ...married?
    • 02 ...living common-law?
    • 03 ...widowed?
    • 04 ...separated?
    • 05 ...divorced?
    • 06 ...single, never married?

MSWC_END

Education (ED)

ED_Q01
What is the highest grade of elementary or high school [Respondent Name] ever completed?

  1. Grade 8 or lower (Québec: Secondary II or lower) (Go to ED_Q03)
  2. Grade 9 - 10 (Québec: Secondary III or IV, Newfoundland and Labrador: 1st year of secondary) (Go to ED_Q03)
  3. Grade 11 - 13 (Québec: Secondary V, Newfoundland and Labrador: 2nd to 4th year of secondary)
    Don’t Know, Refused (Go to ED_Q03)

ED_Q02
Did [Respondent Name] graduate from high school (secondary school)?

  1. Yes
  2. No

ED_Q03
Has [Respondent Name] received any other education that could be counted towards a degree, certificate or diploma from an educational institution?

  1. Yes
  2. No (Go to ED_END)
    Don’t Know, Refused (Go to ED_END)

ED_Q04
What is the highest degree, certificate or diploma [Respondent Name] has obtained?

01. No post-secondary degree, certificate or diploma
02. Tade certificate or diploma from a vocational school or apprenticeship training
03. Non-university certificate or diploma from a community college, CEGEP, school of nursing, etc.
04. certificate below bachelor’s level
05. Bachelor’s degree
06. University degree or certificate above bachelor’s degree

ED_END


Canadian Forces (CAF)

CAF_Q01
Is [Respondent Name] a full time member of the regular Canadian Armed Forces?

  1. Yes
  2. No
    Note: Don’t Know and Refused are not allowed.

CAF_END

Relationship With Confirmation (RWC)

RWC_Q2
What is the relationship

  • of: Respondent Name1] (Age1, Sex1E)
  • to: [Respondent Name2]? (Age2, Sex2E)
  • 01 Husband/Wife
  • 02 Common-law partner
  • 03 Father/Mother (Go to RWC_Q3A)
  • 04 Son/Daughter (Go to RWC_Q3B)
  • 05 Brother/Sister (Go to RWC_Q3C)
  • 06 Foster father/mother
  • 07 Foster son/daughter
  • 08 Grandfather/mother
  • 09 Grandson/daughter
  • 10 In-law (Go to RWC_Q3D)
  • 11 Other related (Go to RWC_Q3E)
  • 12 Unrelated

RWC_Q3A
What is the relationship

  • of: [Respondent Name1] (Age1, Sex1E)
  • to: [Respondent Name2] (Age2, Sex2E)

Is that a(n):

  1. ...birth father/mother?
  2. ...step father/mother?
  3. ...adoptive father/mother?

RWC_Q3B
What is the relationship

  • of: [RespondentName1] (Age1, Sex1E)
  • to: [RespondentName2] (Age2, Sex2E)

Is that a(n):

  1. ...birth son/daughter?
  2. ...step son/daughter?
  3. ...adopted son/daughter?

RWC_Q3C
What is the relationship

  • of: [RespondentName1] (Age1, Sex1E)
  • to: [RespondentName2] (Age2, Sex2E)

Is that a(n):

  1. ...full brother/sister?
  2. ...half brother/sister?
  3. ...step brother/sister?
  4. ...adopted brother/sister?
  5. ...foster brother/sister?

RWC_Q3D
What is the relationship

  • of: [RespondentName1] (Age1, Sex1E)
  • to: [RespondentName2] (Age2, Sex2E)

Is that a:

  1. ...father/mother-in-law?
  2. ...son/daughter-in-law?
  3. ...brother/sister-in-law?
  4. ...other in-law?

RWC_Q3E
What is the relationship

  • of: [RespondentName1] (Age1, Sex1E)
  • to: [RespondentName2] (Age2, Sex2E)

Is that a(n):

  1. ...uncle/aunt?
  2. ...cousin?
  3. ...nephew/niece?
  4. ...other relative?

RWC_END


Person Providing Demographics (PPD)

PPD_N01

  • Interviewer: Select the person who is providing the information. If the person is not on the list, select “Non-household member”.
  • Note: Don’t Know and Refused are not allowed.

PPD_END

Person Providing Information (PPI)

PPI_N01

  • Interviewer: Select the person who is providing the information. If the person is not on the list, select “Non-household member”.
  • Note: A list of household members over 12 years of age is available to choose from. It includes category “88” (Non-household member).
  • Note: Don’t Know and Refused are not allowed.
  • If non-proxy interview, go to PPI_END.

PPI_N02

  • Interviewer: Is the person providing the information a parent or guardian of [Respondent Name]?
    1. Yes
    2. No (Go to PPI_END)
  • Note: Don’t Know and Refused are not allowed.

PPI_N03

  • Interviewer: Is the person providing the information a birth or biological parent of [Respondent Name]?
    1. Yes
    2. No
  • Note: Don’t Know and Refused are not allowed.

PPI_END


General Health (GEN)

GEN_R11
This survey deals with various aspects of your health. I’ll be asking about such things as physical activity, nutrition, environment and health status. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

GEN_Q11
To start, in general, would you say your health is:

Interviewer: Read categories to respondent.

  1. ...excellent?
  2. ...very good?
  3. ...good?
  4. ...fair?
  5. ...poor?
    All respondents

GEN_Q12
Compared to one year ago, how would you say your health is now? Is it:

Interviewer: Read categories to respondent.

  1. ...much better now than 1 year ago?
  2. ...somewhat better now (than 1 year ago)?
  3. ...about the same as 1 year ago?
  4. ...somewhat worse now (than 1 year ago)?
  5. ...much worse now (than 1 year ago)?

If proxy interview or if age < 15, go to GEN_Q20.

All respondents

GEN_Q13
How satisfied are you with your life in general?

  • Interviewer: Read categories to respondent.
    1. Very satisfied
    2. Satisfied
    3. Neither satisfied nor dissatisfied
    4. Dissatisfied
    5. Very dissatisfied

Non-proxy respondents aged 15 and over

GEN_Q14
In general, would you say your mental health is:

  • Interviewer: Read categories to respondent.
    1. ...excellent?
    2. ...very good?
    3. ...good?
    4. ...fair?
    5. ...poor?

Non-proxy respondents aged 14 and over

GEN_Q15
Thinking about the amount of stress in your life, would you say that most days are:

  • Interviewer: Read categories to respondent.
    1. ...not at all stressful?
    2. ...not very stressful?
    3. ...a bit stressful?
    4. ...quite a bit stressful?
    5. ...extremely stressful?

Non-proxy respondents aged 15 and over
If age < 15 or age > 75, go to GEN_Q18.

GEN_Q16
Have you worked at a job or business at any time in the past 12 months?

  1. Yes
  2. No (Go to GEN_Q18)
    Don’t Know, Refused (Go to GEN_Q18)

Non-proxy respondents aged 15 to 75

GEN_Q17
The next question is about your main job or business in the past 12 months.

Would you say that most days at work were:

  • Interviewer: Read categories to respondent.
    1. ...not at all stressful?
    2. ...not very stressful?
    3. ...a bit stressful?
    4. ...quite a bit stressful?
    5. ...extremely stressful?

Non-proxy respondents aged 15 to 75 who worked at a job or business at any time in the past 12 months [GEN_Q16 = 1]

GEN_Q18
How would you describe your sense of belonging to your local community? Would you say it is:

  • Interviewer: Read categories to respondent.
    1. ...very strong?
    2. ...somewhat strong?
    3. ...somewhat weak?
    4. ...very weak?

Non-proxy respondents aged 15 and over

GEN_Q19
Would you rate your quality of life as:

  • Interviewer: Read categories to respondent.
    1. ...excellent?
    2. ...very good?
    3. ...good?
    4. ...fair?
    5. ...poor?

Non-proxy respondents aged 15 and over

GEN_Q20
Do you have a regular medical doctor?

  1. Yes
  2. No

All respondents

GEN_END


Pregnancy (PRS)

If sex = male or age < 14 or age > 59, go to PRS_END.

PRS_Q11
It is important to know when analyzing health whether or not the person is pregnant. Are you pregnant?

  1. Yes
  2. No
    Female respondents aged 14 to 59

PRS_END

Sleep (SLP)

SLP_R11
Now a few questions about your sleep.

SLP_Q11
How many hours do you usually spend sleeping in a 24 hour period, excluding time spent resting?

Interviewer: Enter number of hours per 24 hour period. Record to the nearest half hour.
(insert respondent answer between 0.5 and 24)
Don’t Know, Refused (Go to SLP_END)

All respondents

SLP_Q12
How often do you have trouble going to sleep or staying asleep?

  • Interviewer: Read categories to respondent.
    1. Never (Go to SLP_Q14)
    2. Rarely (Go to SLP_Q14)
    3. Sometimes (Go to SLP_Q14)
    4. Most of the time
    5. All of the time
      Don’t Know, Refused (Go to SLP_Q14)

Respondents who provided number of hours of sleep [SLP_Q11 ≤ 24]

SLP_Q13
How long have you had this trouble?

  1. Less than 2 weeks
  2. 2 weeks to less than 6 months
  3. 6 months to less than one year
  4. 1 year to less than 2 years
  5. 2 years or more

Respondents who have trouble sleeping most or all of the time [SLP_Q12 = (4, 5)]

SLP_Q14
How often do you find your sleep refreshing?

  • Interviewer: Read categories to respondent.
    1. Never
    2. Rarely
    3. Sometimes (Go to SLP_Q16)
    4. Most of the time (Go to SLP_Q16)
    5. All of the time (Go to SLP_Q16)
      Don’t Know, Refused (Go to SLP_Q16)

Respondents who provided number of hours of sleep [SLP_Q11 ≤ 24]

SLP_Q15
How long has your sleep not been refreshing?

  1. Less than 2 weeks
  2. 2 weeks to less than 6 months
  3. 6 months to less than one year
  4. 1 year to less than 2 years
  5. 2 years or more

Respondents who never or rarely find their sleep refreshing [SLP_Q14 = (1, 2)]

SLP_Q16
How often do you find it difficult to stay awake during your normal waking hours when you want to?

  • Interviewer: Read categories to respondent.
    1. Never (Go to SLP_END)
    2. Rarely (Go to SLP_END)
    3. Sometimes (Go to SLP_END)
    4. Most of the time
    5. All of the time
      Don’t Know, Refused (Go to SLP_END)

Respondents who provided number of hours of sleep [SLP_Q11 ≤ 24]

SLP_Q17
How long have you had difficulty staying awake when you want to?

  1. Less than 2 weeks
  2. 2 weeks to less than 6 months
  3. 6 months to less than one year
  4. 1 year to less than 2 years
  5. 2 years or more

Respondents who have difficulty staying awake when they want to, most or all of the time [SLP_Q16 = (4, 5)]

SLP_END


Height And Weight (HWT)

HWT_Q2
The next questions are about height and weight. How tall are you without shoes on?

  • 0  Less than 1’ / 12” (less than 29.2 cm)
  • 1  1’0” to 1’11” / 12” to 23” (29.2 to 59.6 cm)
  • 2  2’0” to 2’11” / 24” to 35” (59.7 to 90.1 cm) (Go to HWT_N2B)
  • 3  3’0” to 3’11” / 36” to 47” (90.2 to 120.6 cm) (Go to HWT_N2C)
  • 4  4’0” to 4’11” / 48” to 59” (120.7 to 151.0 cm) (Go to HWT_N2D)
  • 5  5’0” to 5’11” (151.1 to 181.5 cm) (Go to HWT_N2E)
  • 6  6’0” to 6’11” (181.6 to 212.0 cm) (Go to HWT_N2F)
  • 7  7’0” and over (212.1 cm and over) (Go to HWT_N2G)
    Don’t Know, Refused (Go to HWT_B3)
    All respondents

HWT_N2A

  • Interviewer: Select the exact height.
    • 0  1’0” / 12” (29.2 to 31.7 cm)
    • 1  1’1” / 13” (31.8 to 34.2 cm)
    • 2  1’2” / 14” (34.3 to 36.7 cm)
    • 3  1’3” / 15” (36.8 to 39.3 cm)
    • 4  1’4” / 16” (39.4 to 41.8 cm)
    • 5  1’5” / 17” (41.9 to 44.4 cm)
    • 6  1’6” / 18” (44.5 to 46.9 cm)
    • 7  1’7” / 19” (47.0 to 49.4 cm)
    • 8  1’8” / 20” (49.5 to 52.0 cm)
    • 9  1’9” / 21” (52.1 to 54.5 cm)
    • 10  1’10 / 22” (54.6 to 57.1 cm)
    • 11  1’11” / 23” (57.2 to 59.6 cm)

Respondents between 1’ 0” and 1’ 11” tall without shoes on [HWT_Q2 = 1]
Go to HWT_B3.

HWT_N2B

  • Interviewer: Select the exact height.
    • 0  2’0” / 24” (59.7 to 62.1 cm)
    • 1  2’1” / 25” (62.2 to 64.7 cm)
    • 2  2’2” / 26” (64.8 to 67.2 cm)
    • 3  2’3” / 27” (67.3 to 69.8 cm)
    • 4  2’4” / 28” (69.9 to 72.3 cm)
    • 5  2’5” / 29” (72.4 to 74.8 cm)
    • 6  2’6” / 30” (74.9 to 77.4 cm)
    • 7  2’7” / 31” (77.5 to 79.9 cm)
    • 8  2’8” / 32” (80.0 to 82.5 cm)
    • 9  2’9” / 33” (82.6 to 85.0 cm)
    • 10  2’10” / 34” (85.1 to 87.5 cm)
    • 11  2’11” / 35” (87.6 to 90.1 cm)

Respondents between 2’ 0” and 2’ 11” tall without shoes on [HWT_Q2 = 2]
Go to HWT_B3.

HWT_N2C

  • Interviewer: Select the exact height.
    • 0  3’0” / 36” (90.2 to 92.6 cm)
    • 1 3’1” / 37” (92.7 to 95.2 cm)
    • 2  3’2” / 38” (95.3 to 97.7 cm)
    • 3 3’3” / 39” (97.8 to 100.2 cm)
    • 4 3’4” / 40” (100.3 to 102.8 cm)
    • 5 3’5” / 41” (102.9 to 105.3 cm)
    • 6 3’6” / 42” (105.4 to 107.9 cm)
    • 7 3’7” / 43” (108.0 to 110.4 cm)
    • 8 3’8” / 44” (110.5 to 112.9 cm)
    • 9 3’9” / 45” (113.0 to 115.5 cm)
    • 10  3’10” / 46” (115.6 to 118.0 cm)
    • 11  3’11” / 47” (118.1 to 120.6 cm)

Respondents between 3’ 0” and 3’ 11” tall without shoes on [HWT_Q2 = 3]
Go to HWT_B3.

HWT_N2D

  • Interviewer: Select the exact height.
    • 0  4’0” / 48” (120.7 to 123.1 cm)
    • 1 4’1” / 49” (123.2 to 125.6 cm)
    • 2 4’2” / 50” (125.7 to 128.2 cm)
    • 3 4’3” / 51” (128.3 to 130.7 cm)
    • 4 4’4” / 52” (130.8 to 133.3 cm)
    • 5  4’5” / 53” (133.4 to 135.8 cm)
    • 6 4’6” / 54” (135.9 to 138.3 cm)
    • 7 4’7” / 55” (138.4 to 140.9 cm)
    • 8 4’8” / 56” (141.0 to 143.4 cm)
    • 9  4’9” / 57” (143.5 to 146.0 cm)
    • 10  4’10” / 58” (146.1 to 148.5 cm)
    • 11  4’11” / 59” (148.6 to 151.0 cm)

Respondents between 4’ 0” and 4’ 11” tall without shoes on [HWT_Q2 = 4]
Go to HWT_B3.

HWT_N2E

  • Interviewer: Select the exact height.
    • 0  5’0” (151.1 to 153.6 cm)
    • 1  5’1” (153.7 to 156.1 cm)
    • 2  5’2” (156.2 to 158.7 cm)
    • 3  5’3” (158.8 to 161.2 cm)
    • 4  5’4” (161.3 to 163.7 cm)
    • 5  5’5” (163.8 to 166.3 cm)
    • 6  5’6” (166.4 to 168.8 cm)
    • 7  5’7” (168.9 to 171.4 cm)
    • 8  5’8” (171.5 to 173.9 cm)
    • 9  5’9” (174.0 to 176.4 cm)
    • 10  5’10” (176.5 to 179.0 cm)
    • 11  5’11” (179.1 to 181.5 cm)

Respondents between 5’ 0” and 5’ 11” tall without shoes on [HWT_Q2 = 5]
Go to HWT_B3.

HWT_N2F

  • Interviewer: Select the exact height.
    • 0  6’0” (181.6 to 184.1 cm)
    • 1  6’1” (184.2 to 186.6 cm)
    • 2  6’2” (186.7 to 189.1 cm)
    • 3  6’3” (189.2 to 191.7 cm)
    • 4  6’4” (191.8 to 194.2 cm)
    • 5  6’5” (194.3 to 196.8 cm)
    • 6  6’6” (196.9 to 199.3 cm)
    • 7  6’7” (199.4 to 201.8 cm)
    • 8  6’8” (201.9 to 204.4 cm)
    • 9  6’9” (204.5 to 206.9 cm)
    • 10  6’10” (207.0 to 209.5 cm)
    • 11  6’11” (209.6 to 212.0 cm)

Respondents between 6’ 0” and 6’ 11” tall without shoes on [HWT_Q2 = 6]
Go to HWT_B3.

HWT_N2G

  • Interviewer: Select the exact height.
    • 0  7’0” (212.1 to 214.6 cm)
    • 1  7’1” (214.7 to 217.1 cm)
    • 2  7’2” (218.0 to 220.5 cm)
    • 3  7’3” (220.6 to 223.1 cm)
    • 4  7’4” (223.2 to 225.7 cm)
    • 5  7’5” (225.8 to 228.3 cm)
    • 6  7’6” (228.4 to 230.9 cm)
    • 7  7’7” (231.0 to 233.5 cm)
    • 8  7’8” (233.6 to 236.1 cm)
    • 9  7’9” (236.2 to 238.7 cm)
    • 10  7’10” (238.8 to 241.3 cm)
    • 11  7’11” (241.4 to 243.8 cm)

Respondents between 7’ 0” and 7’ 11” tall without shoes on [HWT_Q2 = 7]

HWT_B3

How much do you weigh?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 1 and 575)
    Don’t Know, Refused (Go to HWT_END.)
  • Interviewer: Was that in pounds or kilograms?
    1. Pounds
    2. Kilograms
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who provided weight
  • If proxy interview, go to HWT_END.

HWT_Q4
Do you consider yourself:

  • Interviewer: Read categories to respondent.
    1. ...overweight?
    2. ...underweight?
    3. ...just about right?
  • Respondents who provided weight

HWT_END


Weight Change (WTC)

If age < 18, go to WTC_END.

WTC_R11
The next questions are about changes over time in your weight. If you don’t remember your exact weight, please provide an estimate. (If you were pregnant at the time, please think about your weight just before the pregnancy.)

WTC_B11
How much did you weigh a year ago?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 1 and 575)
     Don’t Know, Refused
  • Interviewer: Was that in pounds or kilograms?
    1. Pounds
    2. Kilograms
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 18 and older
  • If there was a change of at least 10 pounds/4 kilograms between current weight and weight one year ago, go to WTC_Q12. Otherwise If age < 27 or age = 35, go to WTC_B23.)

WTC_Q12
Was the change between your current weight and your weight a year ago intentional?

  1. Yes
  2. No
  • Respondents aged 18 and over with a change of at least 10 pounds / 4 kilograms between their current weight and their weight one year ago
  • If age < 27 or age = 35, go to WTC_B23.

WTC_B21
How much did you weigh 10 years ago?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 1 and 575)
    Don’t Know, Refused (If age < 27 or age = 35, go to WTC_B23)
  • Interviewer: Was that in pounds or kilograms?
    1. Pounds
    2. Kilograms
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 28 and over
  • If age < 27 or age = 35, go to WTC_B23.

WTC_B22
How much did you weigh at age 25?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 1 and 575)
  • Don’t Know, Refused (Go to WTC_B23)
  • Interviewer: Was that in pounds or kilograms?
    1. Pounds
    2. Kilograms
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 27 and over, except respondents aged 35

WTC_B23
What is the most you have ever weighed excluding during pregnancy?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 1 and 575)
  • Don’t Know, Refused (Go to WTC_END)
  • Interviewer: Was that in pounds or kilograms?
    1. Pounds
    2. Kilograms
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 18 and over

WTC_Q24
How old were you when you first weighed this amount?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 0 and 79)
  • Respondents aged 18 and over
  • If age < 19, go to WTC_END.

WTC_B25
What is the least you have ever weighed since age 18?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 1 and 575)
  • Don’t Know, Refused (Go to WTC_Q26)
  • Interviewer: Was that in pounds or kilograms?
    1. Pounds
    2. Kilograms
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 19 and over

WTC_Q26
How old were you when you first weighed this amount?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 18 and 79)
  • Respondents aged 19 and over

WTC_R27
Now, I'm going to ask you about weight changes that you may have had since age 18. By "weight change" we mean a gain or a loss of at least 10 pounds or 4 kilograms in a single year. Please think about all the times this has happened to you since age 18. Please do not include weight gain during pregnancy.

WTC_Q27
Since age 18, has your weight increased or decreased by 10 pounds or 4 kilograms or more in a single year?

  1. Yes
  2. No (Go to WTC_END)
    Don’t Know, Refused (Go to WTC_END)
    Respondents aged 19 and over

WTC_Q28
How many times has this happened (gaining or losing 10 pounds or 4 kilograms or more in a single year)?

  • Interviewer: Enter number of times.
  • (insert respondent answer between 1 and 995)
  • Respondents aged 19 and over with a weight increase or decrease of 10 pounds / 4 kilograms or more in a single year [WTC_Q27 = 1]

WTC_END


Meat And Fish Consumption (MFC)

Note to users: Please note that the purpose of the headings is to facilitate the interview process for respondents, and not for estimating food group consumption. The foods listed in the questionnaire are in support of the nutrition biomarkers only.

MFC_R11
The next questions are about the foods you usually eat or drink. Think about all the foods you eat, both meals and snacks, at home and away from home.

MFC_B11
How often do you usually eat red meat, such as beef, hamburger, pork or lamb?  (For example: twice a day, three times a week, once a month)

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused(Go to MFC_B12)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B12
How often do you usually eat:
... liver (including all types of liver such as beef, veal, pork or chicken, but excluding liverwurst and liver pâté)?

  • Interviewer: Enter amount only.
  • (respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B13)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B13
How often do you usually eat:
... other organ meats such as kidneys, heart or giblets?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B14)
    Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B14
How often do you usually eat:
… beef or pork hot dogs?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B15)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B15
How often do you usually eat:
… sausage or bacon (including all types of sausages such as breakfast, pepperoni and Kielbassa but excluding low-fat, light or turkey varieties)?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B16)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B16
How often do you usually eat:
… salt water fish such as salmon, tuna or fish sticks?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B17)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B17
How often do you usually eat:
… fresh water fish such as trout, walleye or pickerel?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B18)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B18
How often do you usually eat:
… shellfish, such as shrimp, mussels, scallops, lobster, clams, oysters or crab?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B19)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B19
How often do you usually eat:
… eggs and egg dishes including the yolk (excluding all egg dishes made with only egg whites)?  Egg dishes could include such things as eggs, omelette, frittata or quiche.

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B20)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B20
How often do you usually eat:
… cooked dried beans, such as refried beans, baked beans, pea soup or kidney beans, excluding green and yellow beans?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused (Go to MFC_B21)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_B21
How often do you usually eat:
… peanuts, walnuts, seeds, or other nuts, excluding nut butters such as peanut butter?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
  • 0, Don’t Know, Refused  (Go to MFC_END)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MFC_END


Milk And Dairy Product Consumption (MDC)

Note to users: Please note that the purpose of the headings is to facilitate the interview process for respondents, and not for estimating food group consumption. The foods listed in the questionnaire are in support of the nutrition biomarkers only.

MDC_R11
Now, some questions about your consumption of milk and other dairy products. Remember, think about all the foods you eat and drink, both meals and snacks, at home and away from home.

MDC_B11
How often do you drink milk or enriched milk substitutes or use them on cereal?  (For example: twice a day, three times a week, once a month)

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to MDC_B13)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MDC_Q12
What kind of milk do you usually drink or use on cereal?

  • Interviewer: Mark all that apply.
    1. 3.25% (Whole or homo)
    2. 2%
    3. 1%
    4. 0.5%
    5. Skim or Non-Fat (including powdered milk)
    6. Flavoured milk beverages (such as Chocolate milk and flavoured milks such as Oh Henry!®)
    7. Rice (enriched)
    8. Soya (enriched)
    9. Other - Specify

 Respondents who drink milk or enriched milk substitutes, or use them on cereal [MDC_B11 > 0]
If MDC_Q12 = 9 (Other), go to MDC_S12. Otherwise, go to MDC_B13.

MDC_S12

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who drink milk or enriched milk substitutes, or use them on cereal [MDC_Q12 = 9]

MDC_B13
How often do you usually eat cottage cheese?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to MDC_B14)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MDC_B14

How often do you usually eat:
… yogurt, excluding frozen yogurt?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to MDC_B15)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MDC_B15

How often do you usually eat:
… ice cream or frozen yogurt?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to MDC_END)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

MDC_END


Grains, Fruits and Vegetables Consumption (GFV)

Note to users: Please note that the purpose of the headings is to facilitate the interview process for respondents, and not for estimating food group consumption. The foods listed in the questionnaire are in support of the nutrition biomarkers only.

GFV_R11
Now, a few questions about grains, fruits and vegetables. Remember, think about all the foods you eat, both meals and snacks, at home and away from home.

GFV_B11
How often do you usually eat hot or cold cereal?  (For example: twice a day, three times a week, once a month)

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B12)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B12
How often do you usually eat:
brown bread, including bagels, rolls, pita bread or tortillas?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B13)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B13
How often do you usually eat:
white bread, including bagels, rolls, pita bread or tortillas?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B14)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B14
How often do you usually eat:
… any kind of pasta (including spaghetti, noodles, macaroni & cheese or pasta salad)?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B15)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B15
How often do you usually eat:
… any kind of rice?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (If GFV_B15 = 0, go to GFV_B17. Otherwise, go to GFV_B16)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B16
How often do you usually eat:
… instant, seasoned or wild rice (such as Minute Rice®, Dainty®, Rice-a-Roni®)?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B17)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
    Respondents who eat any kind of rice [GFV_B15 > 0]

GFV_B17
How often do you usually eat:
… fruit (fresh, frozen or canned)?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B18)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B18
How often do you usually eat:
… tomatoes or tomato sauce, including salsa, tomato soup and spaghetti sauce but excluding tomato paste, ketchup or pizza sauce?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B19)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B19
How often do you usually eat:
… lettuce or green leafy salad with or without other vegetables?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B20)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B20
How often do you usually eat:
… spinach, mustard greens or collards excluding kale?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B21)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B21
How often do you usually eat:
… french fries, home fries, or hash brown potatoes?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B22)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B22
How often do you usually eat:
… other potatoes including baked, boiled, mashed or in potato salad, but excluding sweet potatoes?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_B23)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_B23
How often do you usually eat:
… all other types of vegetables, excluding those already mentioned?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to GFV_END)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

GFV_END


Dietary Fat Consumption (DFC)

Note to users: Please note that the purpose of the headings is to facilitate the interview process for respondents, and not for estimating food group consumption. The foods listed in the questionnaire are in support of the nutrition biomarkers only.

DFC_R11
Remember, think about all the foods you eat, both meals and snacks, at home and away from home.

DFC_B11
How often do you usually eat regular-fat salad dressing or mayonnaise (including on salads and sandwiches)?  (For example: twice a day, three times a week, once a month)

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to DFC_B12)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

DFC_B12
How often do you usually eat:
… regular-fat potato chips, tortilla chips or corn chips (excluding low fat chips and pretzels)?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to DFC_END)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

DFC_END


Water and Soft Drink Consumption (WSD)

Note to users: Please note that the purpose of the headings is to facilitate the interview process for respondents, and not for estimating food group consumption. The foods listed in the questionnaire are in support of the nutrition biomarkers only.

WSD_R11
Next, some questions about your drink consumption. Think about all the things you drink, both at home and away from home.

WSD_B11
How often do you usually drink regular soft drinks?  (For example: twice a day, three times a week, once a month)

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to WSD_B12)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

WSD_B12
How often do you usually drink:
… diet soft drinks?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to WSD_B13)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

WSD_B13
How often do you usually drink:
… sport drinks, such as Gatorade® or Powerade®?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to WSD_R14)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

WSD_R14
The next two questions are about the different kinds of juice or fruit flavoured drinks you usually drink. When we say fruit juice, we mean 100% pure fruit juices such as apple, orange or grapefruit juice, whether or not they are made from concentrate. When we say fruit flavoured drinks, we mean drinks such as Sunny Delight®, fruit punch, or Kool-Aid®.

WSD_B14
How often do you usually drink fruit juices?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to WSD_B15)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

WSD_B15
How often do you usually drink:
… fruit flavoured drinks?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to WSD_B16)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

WSD_B16
How often do you usually drink:
… vegetable juices?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to WSD_B21)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

WSD_B21
How often do you usually drink:
… water?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to WSD_Q22)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

WSD_Q22
When you drink water at home or away from home, what is your primary source of drinking water?

  1. Tap water
  2. Bottled water
  3. Other – Specify
  • All respondents
  • If WSD_Q22 = 3 (Other), go to WSD_S22. Otherwise, If two persons selected in the household and age of current respondent > 11, go to WSD_END

WSD_S22

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who selected 'Other' as their primary source of drinking water at home or away from home [WSD_Q22 = 3]
  • If two persons selected in the household and age of current respondent > 11, go to WSD_END.

WSD_Q23
What is the source of the tap water in this home?

  • Interviewer: Read categories to respondent.
    1. Municipally treated water
    2. Private well
    3. Surface source such as natural spring, lake, river, lagoon or dugout
    4. Other - Specify
      Don’t Know, Refused (Go to WSD_END)
  • One respondent per household
  • If WSD_Q23 = 4 (Other), go to WSD_S23. Otherwise, go to WSD_Q24.

WSD_S23

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who selected 'Other' as the source of the tap water in their home [WSD_Q23 = 4]

WSD_Q24
Is the water in this home treated using:

  • Interviewer: Read categories to respondent. Mark all that apply.
    1. ...a filter, for example a Brita® filter?
    2. ...a water softener?
    3. ...an ultraviolet system?
    4. ...reverse osmosis?
    5. Other - Specify
    6. No treatment
  • One respondent per household
  • If WSD_Q24 = 5 (Other), go to WSD_S24. Otherwise, go to WSD_END.

WSD_S24

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Respondents who selected 'Other' as the method of treatment for the tap water in their home [WSD_Q24 = 5]
  • Note: Don’t Know and Refused are not allowed.

WSD_END


Salt Consumption (SLT)

Note to users: Please note that the purpose of the headings is to facilitate the interview process for respondents, and not for estimating food group consumption. The foods listed in the questionnaire are in support of the nutrition biomarkers only.

SLT_Q11
How often do you usually add salt to your food, excluding during cooking?

  • Interviewer: Read categories to respondent.
    1. Always
    2. Often
    3. Sometimes
    4. Rarely
    5. Never
      Don’t Know, Refused (If two persons selected in the household and age of current respondent > 11, go to SLT_END)
  • All respondents

    (If two persons selected in the household and age of current respondent > 11, go to SLT_END)

SLT_Q12
What type of salt is usually used?

  • Interviewer: Read categories to respondent.
    1. Ordinary table salt
    2. Sea, Kosher, seasoned, or other flavoured salt
    3. Light salt
    4. Salt substitute
    5. Other - Specify 
      Respondents who add salt to their food, excluding during cooking [SLT_Q11 = (1, 2, 3, 4)]
      If SLT_Q12 = 5 (Other), go to SLT_S12. Otherwise, If two persons selected in the household and age of current respondent > 11, go to SLT_END.

SLT_S12

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know, Refused, and EMPTY are not allowed.
  • Respondents who selected 'Other' as the type of salt usually used [SLT_Q12 = 5]
  • If two persons selected in the household and age of current respondent > 11, go to SLT_END.

SLT_Q13
How often is ordinary table salt added during the cooking or preparation of foods in this household?

  • Interviewer: Read categories to respondent.
    1. Always
    2. Often
    3. Sometimes
    4. Rarely
    5. Never
  • One respondent per household

SLT_END


Physical Activities (PAC)

If age < 12, go to PAC_END.

PAC_R11
Now I’d like to ask you about some of your physical activities. To begin with, I’ll be dealing with physical activities not related to work, that is, leisure time activities.

PAC_Q11
Have you done any of the following in the past 3 months, that is, from [date three months ago] to yesterday?

  • Interviewer: Read categories to respondent. Mark all that apply.
    1. Walking for exercise
    2. Gardening or yard work
    3. Swimming
    4. Bicycling
    5. Popular or social dance
    6. Home exercises
    7. Ice hockey
    8. Ice skating
    9. In-line skating or rollerblading
    10. Jogging or running
    11. Golfing
    12. Exercise class or aerobics
    13. Downhill skiing or snowboarding
    14. Bowling
    15. Baseball or softball
    16. Tennis
    17. Weight-training
    18. Fishing
    19. Volleyball
    20. Basketball
    21. Soccer
    22. Any other
    23. No physical activity (Go to PAC_R21)
  • Don’t Know, Refused (Go to PAC_END)
  • Respondents aged 12 and over
  • If “Any other” is chosen as a response, go to PAC_S11V. Otherwise, go to PAC_Q12.

PAC_S11V
What was this activity?

  • Interviewer: Enter one activity only.
  • (insert respondent answer to a maximum of 80 characters)
    Don’t Know, Refused (Go to PAC_Q12 )
  • Respondents aged 12 and over who selected 'Any Other' as the form of physical activity they participated in [PAC_Q11 = 22]

PAC_Q11X
In the past 3 months, did you do any other physical activity for leisure?

  1. Yes
  2. No (Go to PAC_Q12)
    Don’t Know, Refused (Go to PAC_Q12 )
  • Respondents aged 12 and over

PAC_S11X
What was this activity?

  • Interviewer: Enter one activity only.
  • (insert respondent answer to a maximum of 80 characters)
    Don’t Know, Refused (Go to PAC_Q12 )
  • Respondents aged 12 and over

PAC_Q11Y
In the past 3 months, did you do any other physical activity for leisure?

  1. Yes
  2. No (Go to PAC_Q12 )
    Don’t Know, Refused (Go to PAC_Q12 )
  • Respondents aged 12 and over

PAC_S11Y
What was this activity?

  • Interviewer: Enter one activity only.
  • (insert respondent answer to a maximum of 80 characters)
    Don’t Know, Refused (Go to PAC_Q12 )
  • Respondents aged 12 and over
  • For each activity identified in PAC_Q11, PAC_S11V, PAC_S11X and PAC_S11Y, ask PAC_Q12 and PAC_Q13.

PAC_Q12
In the past 3 months, how many times did you [participate in identified activity]?

  • (insert respondent answer between 1 and 95)
  • for each activity except the following:
    • Walking: MAX = 270
    • Bicycling: MAX = 200
    • Other activities: MAX = 200
  • Don’t Know, Refused (Go to next activity)
  • Respondents aged 12 and over who indicated that they participated in an activity [PAC_Q11 < 23]

PAC_Q13
About how much time did you spend on each occasion?

  1. 1 to 15 minutes
  2. 16 to 30 minutes
  3. 31 to 60 minutes
  4. More than one hour
  • Respondents aged 12 and over who indicated that they participated in an activity [PAC_Q11 < 23]

PAC_R21
Next, some questions about the amount of time spent in the past 3 months on physical activity at work, while doing daily chores around the house, or doing errands, but not leisure time activity.

PAC_Q21
In a typical week in the past 3 months, how many hours did you usually spend walking to work or to school or while doing errands?

  1. None
  2. Less than 1 hour
  3. From 1 to 5 hours
  4. From 6 to 10 hours
  5. From 11 to 20 hours
  6. More than 20 hours
  • Respondents aged 12 and over

PAC_Q22 
(In a typical week in the past 3 months,) How many hours did you usually spend bicycling to work or to school or while doing errands?

  1. None
  2. Less than 1 hour
  3. From 1 to 5 hours
  4. From 6 to 10 hours
  5. From 11 to 20 hours
  6. More than 20 hours
  • Respondents aged 12 and over

PAC_Q23
Thinking back over the past 3 months, which of the following best describes your usual daily activities or work habits?

  • Interviewer: Read categories to respondent.
    1. Usually sit during the day and don’t walk around very much
    2. Stand or walk quite a lot during the day but don’t have to carry or lift things very often
    3. Usually lift or carry light loads, or have to climb stairs or hills often
    4. Do heavy work or carry very heavy loads
  • Respondents aged 12 and over

PAC_END


Children’s Physical Activity (CPA)

If age > 11, go to CPA_END.

CPA_R11A
Physical activity is any activity that increases your heart rate and makes you get out of breath some of the time. It can be done in sports, school activities, playing with friends, or walking to school.

CPA_R11B
Some examples of physical activity are running, brisk walking, dancing, swimming, rollerblading, skateboarding, biking, soccer, basketball and football.

For these next two questions, add up all the time [he] spends in physical activity each day.

CPA_Q11
Over the past 7 days, on how many days was he physically active for a total of at least 60 minutes per day?

  • Interviewer: Read categories to respondent.
    1. None (zero days)
    2. 1 day
    3. 2 to 3 days
    4. 4 days or more
  • Respondents aged 11 and under

CPA_Q12
Over a typical or usual week, on how many days is he physically active for a total of at least 60 minutes per day?

  • Interviewer: Read categories to respondent.
    1. None (zero days)
    2. 1 day
    3. 2 to 3 days
    4. 4 days or more
  • Respondents aged 11 and under

CPA_Q13
About how many hours a week does he usually take part in physical activity (that makes him out of breath or warmer than usual) in
his free time at school (for example, at lunch)?

  • Interviewer: Read categories to respondent.
    1. Never
    2. Less than 2 hours per week
    3. 2 to 3 hours per week
    4. 4 to 6 hours per week
    5. 7 or more hours per week
  • Respondents aged 11 and under

CPA_Q14
About how many hours a week does he usually take part in physical activity (that makes him out of breath or warmer than usual) in his class time at school?

  • Interviewer: Read categories to respondent.
    1. Never
    2. Less than 2 hours per week
    3. 2 to 3 hours per week
    4. 4 to 6 hours per week
    5. 7 or more hours per week
  • Respondents aged 11 and under

CPA_Q15
About how many hours a week does he usually take part in physical activity (that makes him out of breath or warmer than usual):
outside of school while participating in lessons or league or team sports?

  1. Never
  2. Less than 2 hours per week
  3. 2 to 3 hours per week
  4. 4 to 6 hours per week
  5. 7 or more hours per week
  • Respondents aged 11 and under

CPA_Q16
About how many hours a week does he usually take part in physical activity (that makes him out of breath or warmer than usual):
outside of school while participating in unorganized activities, either on his own or with friends?

  1. Never
  2. Less than 2 hours per week
  3. 2 to 3 hours per week
  4. 4 to 6 hours per week
  5. 7 or more hours per week
  • Respondents aged 11 and under

CPA_Q17
On average, about how many hours a day does [he] watch TV or videos or play video games?

  1. Doesn’t watch TV or videos or play video games
  2. Less than 1 hour a day
  3. 1 to 2 hours a day
  4. 3 to 4 hours a day
  5. 5 to 6 hours a day
  6. 7 or more hours a day
  • Respondents aged 11 and under

CPA_Q18
On average, about how many hours a day does he spend on a computer (working, playing games, e-mailing, chatting, surfing the Internet, etc.)?

  1. Doesn’t use a computer
  2. Less than 1 hour a day
  3. 1 to 2 hours a day
  4. 3 to 4 hours a day
  5. 5 to 6 hours a day
  6. 7 or more hours a day
  • Respondents aged 11 and under

CPA_END


Sedentary Activities (SAC)

If age < 12, go to SAC_END.

SAC_R11
Now, a few additional questions about activities you do in your leisure time, that is, activities not at work or at school.

SAC_Q11
In a typical week in the past 3 months, how much time did you usually spend on a computer, including using the Internet, playing computer games, e-mailing or chatting on-line?

  • Interviewer: Do not include time spent at work or at school.
    1. None
    2. Less than 1 hour
    3. 1 to 2 hours
    4. 3 to 5 hours
    5. 6 to 10 hours
    6. 11 to 14 hours
    7. 15 to 20 hours
    8. More than 20 hours
      Don’t Know, Refused (Go to SAC_END)
  • Respondents aged 12 and over

SAC_Q12
In a typical week in the past 3 months, how much time did you usually spend:
... playing video games, such as XBOX, Nintendo and Playstation?

  1. None
  2. Less than 1 hour
  3. 1 to 2 hours
  4. 3 to 5 hours
  5. 6 to 10 hours
  6. 11 to 14 hours
  7. 15 to 20 hours
  8. More than 20 hours
  • Respondents aged 12 and over

SAC_Q13
In a typical week in the past 3 months, how much time did you usually spend:
... watching television, DVD’s or videos?

  1. None
  2. Less than 1 hour
  3. 1 to 2 hours
  4. 3 to 5 hours
  5. 6 to 10 hours
  6. 11 to 14 hours
  7. 15 to 20 hours
  8. More than 20 hours
    Respondents aged 12 and over

SAC_Q14
In a typical week in the past 3 months, how much time did you usually spend:
... reading, not counting at work or at school?

  • Interviewer: Include books, magazines, newspapers, homework.
    1. None
    2. Less than 1 hour
    3. 1 to 2 hours
    4. 3 to 5 hours
    5. 6 to 10 hours
    6. 11 to 14 hours
    7. 15 to 20 hours
    8. More than 20 hours
  • Respondents aged 12 and over

SAC_END


Sun Exposure (SEB)

SEB_R11
The next few questions are about your exposure to the sun.

SEB_R12
For the next questions, think about a typical weekend or day off from work or school in the summer months.

SEB_Q12
About how much time each day do you spend in the sun between 11 am and 4 pm?

  1. None (Go to SEB_END)
  2. Less than 30 minutes (Go to SEB_END)
  3. 30 to 59 minutes
  4. 1 hour to less than 2 hours
  5. 2 hours to less than 3 hours
  6. 3 hours to less than 4 hours
  7. 4 hours to less than 5 hours
  8. 5 hours
    Don’t Know, Refused (Go to SEB_END)
    All respondents

SEB_Q13
In the summer months, on a typical weekend or day off, when you are in the sun for 30 minutes or more, how often do you use sunscreen?

  1. Always
  2. Often
  3. Sometimes
  4. Rarely
  5. Never
  • Respondents who spend 30 minutes or more in the sun on a typical weekend or day off [SEB_Q12 = (3, 4, 5, 6, 7, 8)]

SEB_END


Oral Health (OHM)

OHM_R11
Next, some questions about the health of your mouth, including your teeth or dentures, tongue, gums, lips and jaw joints.

OHM_Q11
In general, would you say the health of your mouth is:

  • Interviewer: Read categories to respondent.
    1. ...excellent?
    2. ...very good?
    3. ...good?
    4. ...fair?
    5. ...poor?
  • All respondents

OHM_Q12
How satisfied are you with the appearance of your teeth and/or dentures?

  • Interviewer: Read categories to respondent.
    1. Very satisfied
    2. Satisfied
    3. Neither satisfied nor dissatisfied
    4. Dissatisfied
    5. Very dissatisfied
  • All respondents

OHM_Q21
In the past 12 months, that is, from [date one year ago] to yesterday, how often have you found it uncomfortable to eat any food because of problems with your mouth?

  • Interviewer: Read categories to respondent.
    1. Often
    2. Sometimes
    3. Rarely
    4. Never
  • All respondents

OHM_Q22
(In the past 12 months,) How often have you avoided eating particular foods because of problems with your mouth?

  • Interviewer: Read categories to respondent.
    1. Often
    2. Sometimes
    3. Rarely
    4. Never
  • All respondents

OHM_Q23
Remember, by mouth we mean teeth or dentures, tongue, gums, lips and jaw joints.
In the past 12 months, how often have you had any other persistent or on-going pain anywhere in your mouth?

  • Interviewer: Read categories to respondent.
    1. Often
    2. Sometimes
    3. Rarely
    4. Never
  • All respondents

OHM_Q24
(In the past 12 months,) Have you taken time away from work, school or your normal activitiesfor dental check-ups or treatments or because of problems with your mouth?

  1. Yes
  2. No (Go to OHM_Q31)
    Don’t Know, Refused (Go to OHM_Q31)
    All respondents

OHM_Q25
(In the past 12 months,) How many hours were you away from your normal activities?

  • Interviewer: Record to the nearest 0.5 hour.
  • (insert respondent answer between 0.5 and 95.5)
  • Respondents who have taken time away from work, school, or normal activities for dental check-ups or treatments or because of problems with their mouth [OHM_Q24 = 1]

OHM_Q31
Now a few questions about your regular dental care habits.
How often do you usually brush your teeth and/or dentures? (For example: twice a day, three times a week, once a month)

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    If OHM_Q31 = 0, Don’t Know or Refused, go to OHM_Q32.
  • All respondents

OHM_N31

  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who brush their teeth and/or dentures [OHM_Q31 > 0]

OHM_Q32
How often do you usually floss your teeth?

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    If OHM_Q32 = 0, Don’t Know or Refused, go to OHM_Q33.
  • All respondents

OHM_N32

  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
    5. Never
    6. Full set of dentures
  • Note: Don’t Know and Refused are not allowed.
  • All respondents

OHM_Q33
Do you usually see a dental professional:

  • Interviewer: Read categories to respondent.
    1. more than once a year for check-ups or treatment?
    2. about once a year for check-ups or treatment?
    3. less than once a year for check-ups or treatment?
    4. only for emergency care?
    5. never? (Go to OHM_R41)
      Don’t Know, Refused (Go to OHM_R41)
  • All respondents

OHM_Q34
When was the last time you saw a dental professional?

  1. Less than 1 year ago
  2. 1 year to less than 2 years ago
  3. 2 years to less than 3 years ago
  4. 3 years to less than 4 years ago
  5. 4 years to less than 5 years ago
  6. 5 or more years ago
  • Respondents who usually see a dental professional [OHM_Q33 = (1, 2, 3, 4)]

OHM_R41
Now a few questions about the cost of your dental care.  (It is important that we get this information from each individual that we interview, even those in the same family.)

OHM_Q41
In the past 12 months, have you avoided going to a dental professional because of the cost of dental care?

  1. Yes
  2. No
    All respondents

OHM_Q42
(In the past 12 months,) Have you avoided having all the dental treatment that was recommended because of the cost?

  1. Yes
  2. No
    All respondents

OHM_Q43
Do you have insurance or a government program that covers all or part of your dental expenses?

  1. Yes
  2. No (Go to OHM_END)
    Don’t Know, Refused (Go to OHM_END)
    All respondents

OHM_Q44
Is it:

  • Interviewer: Read categories to respondent. Mark all that apply.
    1. ...an employer-sponsored plan?
    2. ...a provincial program for children or seniors?
    3. ...a private plan?
    4. ...a government program for social service (welfare) clients?
    5. ...a government program for First Nations and Inuit?
  • Respondents who have insurance or a government program that covers all or part of their dental expenses [OHM_Q43 = 1]

OHM_END


Chronic Conditions (CCC)

CCC_R11
Now I’d like to ask about certain chronic health conditions which you may have. We are interested in “long-term conditions” which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.

CCC_Q11
Do you have asthma?

  1. Yes
  2. No (Go to CCC_Q21)
  • Don’t Know (Go to CCC_Q21)
  • Refused (Go to CCC_END)
  • All respondents
  • If age < 12 go to CCC_Q41

CCC_Q12
How old were you when this was first diagnosed?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 0 and 79)
    Respondents who have asthma [CCC_Q11 = 1]

CCC_Q13
Have you had any asthma symptoms or asthma attacks in the past 12 months?

  1. Yes
  2. No
  • Respondents aged 12 and over who have asthma [CCC_Q11 = 1]

CCC_Q21
Do you have fibromyalgia?

  1. Yes
  2. No
    Respondents aged 12 and over

CCC_Q22
Do you have arthritis or rheumatism, excluding fibromyalgia?

  1. Yes
  2. No (Go to CCC_Q24)
  • Don’t Know, Refused (Go to CCC_Q24)
  • Respondents aged 12 and over

CCC_Q23
What kind of arthritis do you have?

  1. Rheumatoid arthritis
  2. Osteoarthritis
  3. Rheumatism
  4. Other - Specify
  • Respondents aged 12 and over who have arthritis or rheumatism, excluding fibromyalgia [CCC_Q22 = 1]
  • If CCC_Q23 = 4 (Other), go to CCC_S23. Otherwise, go to CCC_Q24.

CCC_S23

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 12 and over who have arthritis or rheumatism, excluding fibromyalgia [CCC_Q23 = 4]

CCC_Q24
Do you have back problems, excluding fibromyalgia and arthritis?

  1. Yes
  2. No
    Respondents aged 12 and over

CCC_Q31
Remember, we’re interested in conditions diagnosed by a health professional.
Do you have high blood pressure?

  1. Yes
  2. No
    Respondents aged 12 and over

CCC_Q32
In the past month have you taken any medicine for high blood pressure?

  1. Yes
  2. No
    Respondents aged 12 and over

CCC_Q33
Have you ever had your blood cholesterol measured?

  1. Yes
  2. No (Go to CCC_Q41)
  • Don’t Know, Refused (Go to CCC_Q41)
  • Respondents aged 12 and over

CCC_Q34
Have you ever been told by a health professional that your blood cholesterol was high?

  1. Yes
  2. No
  • Respondents aged 12 and over who have had their blood cholesterol measured [CCC_Q33 = 1]

CCC_Q41
Remember, we’re interested in conditions diagnosed by a health professional.
Do you have chronic bronchitis?

  1. Yes
  2. No (Go to CCC_Q43)
  • Don’t Know, Refused (Go to CCC_Q43)
  • All respondents
  • If age < 30, go to CCC_Q51

CCC_Q42
How old were you when this was first diagnosed?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 0 and 79)
  • Respondents who have chronic bronchitis [CCC_Q41 = 1]

CCC_Q43
Do you have emphysema?

  1. Yes
  2. No (Go to CCC_Q45)
    Don’t Know, Refused (Go to CCC_Q45)
    Respondents aged 30 and over

CCC_Q44
How old were you when this was first diagnosed?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 0 and 79)
  • Respondents aged 30 and over who have emphysema [CCC_Q43 = 1]

CCC_Q45
Do you have chronic obstructive pulmonary disease (COPD)?

  1. Yes
  2. No (Go to CCC_Q51)
    Don’t Know, Refused (Go to CCC_Q51)
    Respondents aged 30 and over

CCC_Q46
How old were you when this was first diagnosed?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 0 and 79)
  • Respondents aged 30 and over who have chronic obstructive pulmonary disease (COPD) [CCC_Q45 = 1]

CCC_Q51
Remember, we’re interested in conditions diagnosed by a health professional.
Do you have diabetes?

  1. Yes
  2. No (Go to CCC_Q61)
    Don’t Know, Refused (Go to CCC_Q61)
    All respondents

CCC_Q52
Were you diagnosed with:

  • Interviewer:  Read categories to respondent. Mark all that apply.
    1. ...insulin dependent diabetes (Type 1)?
    2. ...non-insulin dependent diabetes (Type 2)?
    3. ...gestational diabetes?
  • If CCC_Q52 = 3, go to CCC_Q61
    Respondents who have diabetes [CCC_Q51 = 1]

CCC_Q53
How old were you when this was first diagnosed?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 0 and 79)
  • Respondents who have Type 1 or Type 2 diabetes [CCC_Q52 = 1 or 2]

CCC_Q61
Do you have heart disease?

  1. Yes
  2. No (Go to CCC_Q63)
    Don’t Know, Refused (Go to CCC_Q63)
    All respondents

CCC_Q62
How old were you when this was first diagnosed?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 0 and 79)
  • Respondents who have heart disease [CCC_Q61 = 1]

CCC_Q63
Have you ever been told by a health professional that you have had a heart attack?

  1. Yes
  2. No
    All respondents

CCC_Q71
Remember, we’re interested in conditions diagnosed by a health professional.
Do you have cancer?

  1. Yes (Go to CCC_Q73)
  2. No
    Don’t Know, Refused (Go to CCC_Q81)
    All respondents

CCC_Q72
Have you ever been diagnosed with cancer?

  1. Yes
  2. No (Go to CCC_Q81)
    Don’t Know, Refused (Go to CCC_Q81)
    Respondents aged 12 and over who do not currently have cancer [CCC_Q71 = 2]

CCC_Q73
How old were you when this was first diagnosed?

  • Interviewer: Maximum is age.
  • (insert respondent answer between 0 and 79)
    Respondents aged 12 and over who have ever been diagnosed with cancer [CCC_Q71 = 1 or CCC_Q72 = 1]
    If sex = male, go to CCC_Q75.

CCC_Q74
What type of cancer did you / do you have?

  • Interviewer: Mark all that apply.
    1. Breast
    2. Colorectal
    3. Skin - Melanoma
    4. Skin - Non-melanoma
    5. Other - Specify
  • Female respondents aged 12 and over who have ever been diagnosed with cancer [CCC_Q71 = 1 or CCC_Q72 = 1]
  • If CCC_Q74 = 5 (Other), go to CCC_S74. Otherwise, go to CCC_Q81.

CCC_S74 

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Female respondents aged 12 and over who have ever been diagnosed with cancer [CCC_Q74 = 5]
  • Go to CCC_Q83

CCC_Q75
What type of cancer did you / do you have?

  • Interviewer: Mark all that apply.
    1. Prostate
    2. Colorectal
    3. Skin - Melanoma
    4. Skin - Non-melanoma
    5. Other - Specify
  • Male respondents aged 12 and over who have ever been diagnosed with cancer [CCC_Q71 = 1 or CCC_Q72 = 1]
  • If CCC_Q75 = 5 (Other), go to CCC_S75. Otherwise, go to CCC_Q81.

CCC_S75

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Male respondents aged 12 and over who have ever been diagnosed with cancer [CCC_Q75 = 5]

CCC_Q81
Remember, we’re interested in conditions diagnosed by a health professional.
Do you suffer from the effects of a stroke?

  1. Yes
  2. No
    Respondents aged 12 and over

CCC_Q82
Do you have a thyroid condition?

  1. Yes
  2. No
    Respondents aged 12 and over

CCC_Q83
Do you have a mood disorder such as depression, bipolar disorder, mania or dysthymia?

  • Interviewer: Include manic depression.
    1. Yes
    2. No
  • All respondents

CCC_Q84
Do you have a learning disability?

  1. Yes
  2. No (Go to CCC_Q91)
    Don’t Know, Refused (Go to CCC_Q91)
    All respondents

CCC_Q85
What kind of learning disability do you have?

  • Interviewer: Mark all that apply.
    1. Attention Deficit Disorder, no hyperactivity (ADD)
    2. Attention Deficit Hyperactivity Disorder (ADHD)
    3. Dyslexia
    4. Other - Specify
  • Respondents who have a learning disability [CCC_Q84 = 1]
  • If CCC_Q85 = 4 (Other), go to CCC_S85. Otherwise, go to CCC_Q91.

CCC_S85

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who have a learning disability [CCC_Q85 = 4]

CCC_Q91
Remember, we’re interested in conditions diagnosed by a health professional.
Do you have an eating disorder such as anorexia or bulimia?

  1. Yes
  2. No
    All respondents
    If age < 12 go to CCC_Q95.

CCC_Q92
Do you suffer from kidney dysfunction or disease?

  1. Yes
  2. No
    Respondents aged 12 and over

CCC_Q93
Do you have liver disease or gallbladder problems?

  1. Yes
  2. No (Go to CCC_Q95)
    Don’t Know, Refused (Go to CCC_Q95)
    Respondents aged 12 and over

CCC_Q94
What kind of liver disease or gallbladder problem do you have?

  • Interviewer: Mark all that apply.
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
    4. Jaundice
    5. Cirrhosis
    6. Gall Stones
    7. Other - Specify
  • Respondents aged 12 and over who have liver disease or gallbladder problems [CCC_Q93 = 1]
  • If CCC_Q94 = 7 (Other), go to CCC_S94. Otherwise, If CCC_Q94 = 1 or CCC_Q94 = 2 or CCC_Q94 =3, go to CCC_Q101.

CCC_S94

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 12 and over who have liver disease or gallbladder problems [CCC_Q94 = 7]
  • If CCC_Q94 = 1 or CCC_Q94 = 2 or CCC_Q94 =3, go to CCC_Q101.

CCC_Q95
Do you have hepatitis?

  1. Yes
  2. No (Go to CCC_Q101)
    Don’t Know, Refused (Go to CCC_Q101)
    Respondents who had not previously indicated that they have hepatitis

CCC_Q96
What type of hepatitis do you have?

  • Interviewer: Read categories to respondent. Mark all that apply.
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  • Respondents who answered yes to the direct question regarding hepatitis [CCC_Q95 = 1]

CCC_Q101
Do you have any other long-term physical or mental health condition that has been diagnosed by a health professional?

  1. Yes
  2. No
    All respondents
    If CCC_Q101 = 1 (Yes), go to CCC_S101. Otherwise, go to CCC_END.

CCC_S101

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who have any other long-term physical or mental health condition that has been diagnosed by a health professional [CCC_Q101 = 1]

CCC_END


Phlegm (PLM)

PLM_R11
We asked you earlier about “long-term conditions” that have been diagnosed by a health professional. Now, a few questions about conditions that do not need to have been diagnosed by a health professional and that have lasted 3 months or more.

PLM_Q11
During the past year, that is, from [date one year ago] to yesterday, have you had a cough where you brought up phlegm that lasted 3 months or more?

  1. Yes
  2. No (Go to PLM_END)
    Don’t Know, Refused (Go to PLM_END)
    All respondents

PLM_Q12
During the previous year, that is, from [date two years ago] to [date one year ago],  did you have a cough where you brought up phlegm that lasted 3 months or more?

  1. Yes
  2. No
    Respondents who, in the past year, have had a cough that lasted 3 months or more where they brought up phlegm [PLM_Q11 = 1]

PLM_END

Family Medical History (FMH)

If there is only one person selected in the household then go to FMH_R11. If there are two people selected for the household and age of current respondent is less than 12 or greater than 19 go to FMH_R11. If there are two people selected for the household and age of current respondent is between 12 and 19 and the relationship between the two selected respondents is not a birth sibling go to FMH_R11. Otherwise go to FMH_END.

FMH_R11
The next set of questions is about the medical history of your immediate family members.  (It is important that we get this information from each individual that we interview, even those in the same family.)

By immediate family, we mean only your birth parents, birth siblings and birth children - alive or deceased. We are only interested in conditions diagnosed by a health professional.

FMH_Q11
Has anyone in your immediate family ever been diagnosed with heart disease (including heart attack or angina)?

  1. Yes
  2. No (Go to FMH_Q13)
    Don’t Know, Refused (Go to FMH_Q13)
    One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question

FMH_Q12
What is the youngest age at which a member of your immediate family was first diagnosed with heart disease?

  • Interviewer: If diagnosed at death, then use age at death.
  • (insert respondent answer between 0 and 130)
  • One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question, and a member of the respondent’s immediate family had ever been diagnosed with heart disease [FMH_Q11 = 1]

FMH_Q13
Has anyone in your immediate family ever had a stroke?

  1. Yes
  2. No (Go to FMH_Q15)
    Don’t Know, Refused (Go to FMH_Q15)
    One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question

FMH_Q14
What is the youngest age at which a member of your immediate family had a stroke?

  • Interviewer: If diagnosed at death, then use age at death.
  • (insert respondent answer between 0 and 130)
  • One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question, and a member of the respondent’s immediate family ever had a stroke [FMH_Q13 = 1]

FMH_Q15
Has anyone in your immediate family ever had high blood pressure, excluding during pregnancy?

  1. Yes
  2. No (Go to FMH_Q17)
    Don’t Know, Refused (Go to FMH_Q17)
    One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question

FMH_Q16
What is the youngest age at which a member of your immediate family was first diagnosed with high blood pressure?

  • Interviewer: If diagnosed at death, then use age at death.
  • (insert respondent answer between 0 and 130)
  • One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question, and a member of the respondent’s immediate family ever had high blood pressure (excluding during pregnancy) [FMH_Q15 = 1]

FMH_Q17
Has anyone in your immediate family ever had arthritis?

  1. Yes
  2. No (Go to FMH_Q19)
    Don’t Know, Refused (Go to FMH_Q19)
    One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question

FMH_Q18
What is the youngest age at which a member of your immediate family was first diagnosed with arthritis?

  • Interviewer: If diagnosed at death, then use age at death.
  • (insert respondent answer between 0 and 130)
  •  One respondent per household, unless two unrelated household members are selected to complete the interview and both have a member of their immediate family who was diagnosed with arthritis in which case both respondents would answer the question. [FMH_Q17 = 1]

FMH_Q19
Has anyone in your immediate family ever had diabetes, excluding during pregnancy?

  1. Yes
  2. No (Go to FMH_Q23)
    Don’t Know, Refused (Go to FMH_Q23)
    One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question

FMH_Q21
Was this:

  • Interviewer:  Read categories to respondent.
    1. ...insulin dependent diabetes (Type 1)?
    2. ...non-insulin dependent diabetes (Type 2)?
    3. ...both?
  • One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question, and a member of the respondent’s immediate family ever had diabetes (excluding during pregnancy) [FMH_Q19 = 1]

FMH_Q22
What is the youngest age at which a member of your immediate family was first diagnosed with diabetes?

  • Interviewer: If diagnosed at death, then use age at death.
  • (insert respondent answer between 0 and 130)
  • One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question, and a member of the respondent’s immediate family ever had diabetes (excluding during pregnancy) [FMH_Q19 = 1]

FMH_Q23
Has anyone in your immediate family ever had asthma?

  1. Yes
  2. No (Go to FHM_END)
    Don’t Know, Refused (Go to FHM_END)
    One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question

FMH_Q24
Was it one of your parents that was diagnosed with asthma?

  1. Yes
  2. No
    One respondent per household, unless two unrelated household members are selected to complete the interview in which case both respondents would answer the question, and a member of the respondent’s immediate family ever had asthma [FMH_Q23 = 1]

FMH_END


Hepatitis (HEP)

HEP_R11
The next questions are about hepatitis vaccinations you may have had.

HEP_Q11
Have you ever received a hepatitis A vaccination? This vaccine is given to people who travel outside of Canada. It has been available since the mid 1990s.

  1. Yes
  2. No
    Refused (Go to HEP_END)
    All respondents

HEP_Q12
Hepatitis B vaccinations usually come in a 2 or 3 dose series. Have you received a complete series of hepatitis B vaccines?

  1. Yes
  2. No
    Respondents who did not refuse to the question regarding receipt of a hepatitis A vaccination
    If age < (Reference Year – 1985) go to HEP_END.

HEP_Q13
Did you receive a blood transfusion in Canada between 1978 and 1985?

  1. Yes
  2. No
    Respondents who did not refuse to the question regarding receipt of a hepatitis A vaccination, and whose age is not less than (Reference Year – 1985) [Respondents born before 1986]

HEP_END

Medication Use (MED)

MED_R100
Now I’d like to ask a few questions about your use of medications, including prescriptions, over-the-counter medications and herbal products and remedies. We will be collecting the names, drug identification numbers (DINs) and dosages of all the different kinds of medications you are currently taking. It would help us record this information more quickly if you would go and get all the bottles and containers for these products now.

MED_Q100A
In the past month, that is, from [date last month] to yesterday, did you take any prescription medications? Prescribed medications could include such things as insulin, nicotine patches and birth control (pills, patches or injections).

  1. Yes
  2. No (Go to MED_Q200A)
    Don’t Know (Go to MED_Q200A)
    Refused (Go to MED_END)
    All respondents

MED_Q100B
How many different prescribed medications did you take?

  • (insert respondent answer between 1 and 95)
    Don’t Know, Refused (Go to MED_Q200A)
  • Respondents who took prescription medications during the past month [MED_Q100A = 1]
  • For the first 15 prescription medications identified in MED_Q100B, ask MED_B101A through MED_B101F.

MED_B101A
Is a Drug Identification Number (DIN) available for the medication?

  • Interviewer: If necessary, help the respondent to find the DIN on the bottle, tube or box.
    1. Yes
    2. No (Go to MED_B101D)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took prescription medications during the past month [MED_Q100B > 0]

MED_B101B
What is the DIN of the medication?

  • Interviewer: Record DIN from the bottle, tube or box. Be sure to use eight digits; use leading zeros to fill the field if necessary (e.g., 00012345).
  • (insert Drug Identification Number between 00000001 and 99999995)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took prescription medications during the past month [MED_Q100B > 0]
  • Use trigram search.
  • If DIN found in DIN_Database, set medication name from DIN_Database.
  • Otherwise go to MED_B101D.

MED_B101C

  • Interviewer: The name associated with DIN [number] is [name]. Please confirm.
    1. Yes (Go to MED_B101F)
    2. No
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took prescription medications during the past month [MED_Q100B > 0]

MED_B101D
What is the exact name and dosage of the medication?

  • Interviewer: Record the exact name and dosage of the medication from the bottle, tube or box.
  • (insert medication information to a maximum of 80 characters)
  • Respondents who took prescription medications during the past month [MED_Q100B > 0]
  • If MED_B101D = Other - Specify, go to MED_B101E. Otherwise, go to MED_B101F.

MED_B101E

  • Interviewer: Record the exact name and dosage of the medication from the bottle, tube or box.
  • (insert medication information to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took prescription medications during the past month [MED_Q100B > 0]

MED_B101F
When was the last time that you took that medication?

  • Interviewer: Read categories to respondent.
    1. Today
    2. Yesterday
    3. Within the last week
    4. Within the last month
    5. More than one month ago
  • Respondents who took prescription medications during the past month [MED_Q100B > 0]

MED_Q200A
In the past month did you take any over-the-counter medications? Over-the-counter medications could include such things as pain killers, antacids, allergy pills and hydrocortisone creams.

  1. Yes
  2. No (Go to MED_Q300A)
    Don’t Know, Refused (Go to MED_Q300A)
    All respondents

MED_Q200B
How many different over-the-counter medications did you take?

  • (insert respondent answer between 1 and 95)
    Don’t Know, Refused(Go to MED_Q300A)
  • Respondents who took over-the-counter medications during the past month [MED_Q200A = 1]
  • For the first 15 over-the-counter medications identified in MED_Q200B, ask MED_B201A through MED_B201F.

MED_B201A
Is a Drug Identification Number (DIN) available for the medication?

  • Interviewer: If necessary, help the respondent to find the DIN on the bottle, tube or box.
    1. Yes
    2. No (Go to MED_B201D)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took over-the-counter medications during the past month [MED_Q200B > 0]

MED_B201B
What is the DIN of the medication?

  • Interviewer: Record DIN from the bottle, tube or box. Be sure to use eight digits; use leading zeros to fill the field if necessary (e.g., 00012345).
  • (insert Drug Identification Number between 00000001 and 99999995)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took over-the-counter medications during the past month [MED_Q200B > 0]
  • Use trigram search.
  • If DIN found in DIN_Database, set medication name from DIN_Database.  Otherwise go to MED_B201D.

MED_B201C

  • Interviewer: The name associated with DIN [number] is [name]. Please confirm.
    1. Yes(Go to MED_B201F)
    2. No
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took over-the-counter medications during the past month [MED_Q200B > 0]

MED_B201D
What is the exact name and dosage of the medication?

  • Interviewer: Record the exact name and dosage of the medication from the bottle, tube or box.
  • (insert medication information to a maximum of 80 characters)
  • Respondents who took over-the-counter medications during the past month [MED_Q200B > 0]
  • If MED_B201D = Other - specify, go to MED_B201E. Otherwise, go to MED_B201F.

MED_B201E

  • Interviewer: Record the exact name and dosage of the medication from the bottle, tube or box.
  • (insert medication information to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took over-the-counter medications during the past month [MED_Q200B > 0]

MED_B201F
When was the last time that you took that medication?

  • Interviewer: Read categories to respondent.
    1. Today
    2. Yesterday
    3. Within the last week
    4. Within the last month
    5. More than one month ago
  • Respondents who took over-the-counter medications during the past month [MED_Q200B > 0]

MED_Q300A
There are also many health products and herbal remedies such as vitamins, minerals, fish oils and other oils, and botanical or homeopathic preparations which people use to prevent illness or to improve or maintain their health.
In the past month did you take any health products or herbal remedies?

  1. Yes
  2. No (Go to MED_END)
    Don’t Know, Refused (Go to MED_END)
    All respondents

MED_Q300B
How many different health products or herbal remedies did you take?

  • (insert respondent answer between 1 and 95)
    Don’t Know, Refused (Go to MED_END)
  • Respondents who took health products or herbal remedies during the past month [MED_Q300A = 1]
  • For the first 15 health products identified in MED_Q300B, ask MED_B301A through MED_B301F.

MED_B301A
Is a Drug Identification Number (DIN) available for the health product or herbal remedy?

  • Interviewer: If necessary, help the respondent to find the DIN on the bottle, tube or box.
    1. Yes
    2. No (Go to MED_B301D)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took health products or herbal remedies during the past month [MED_Q300B > 0]

MED_B301B
What is the DIN of the health product or herbal remedy?

  • Interviewer: Record DIN from the bottle, tube or box. Be sure to use eight digits; use leading zeros to fill the field if necessary (e.g., 00012345).
  • (insert Drug Identification Number between 00000001 and 99999995)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took health products or herbal remedies during the past month [MED_Q300B > 0]
  • Use trigram search.
  • If DIN found in DIN_Database, set medication name from DIN_Database. Otherwise go to MED_B301D.

MED_B301C

  • Interviewer: The name associated with DIN [number] is [name]. Please confirm.
    1. Yes (Go to MED_B301F)
    2. No
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took health products or herbal remedies during the past month [MED_Q300B > 0]

MED_B301D
What is the exact name and dosage of the health product or herbal remedy?

  • Interviewer: Record the exact name and dosage of the health product or herbal remedy from the bottle, tube or box.
  • (insert health product information to a maximum of 80 characters)
  • Respondents who took health products or herbal remedies during the past month [MED_Q300B > 0]
  • If MED_B301D = Other - specify, go to MED_B301E. Otherwise, go to MED_B301F.

MED_B301E

  • Interviewer: Record the exact name and dosage of the health product or herbal remedy from the bottle, tube or box.
  • (insert health product information to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who took health products or herbal remedies during the past month [MED_Q300B > 0]

MED_B301F
When was the last time that you took that health product or herbal remedy?

  • Interviewer: Read categories to respondent.
    1. Today
    2. Yesterday
    3. Within the last week
    4. Within the last month
    5. More than one month ago
  • Respondents who took health products or herbal remedies during the past month [MED_Q300B > 0]

MED_END


Health Utility Index (HUI)

HUI_R01
The next set of questions asks about your day-to-day health. The questions are not about illnesses like colds that affect people for short periods of time. They are concerned with a person’s usual abilities.

You may feel that some of these questions do not apply to you, but it is important that we ask the same questions of everyone.

HUI_Q01
Are you usually able to see (clearly, and without distortion, the words in a book/well enough to read ordinary newsprint) without glasses or contact lenses?

  1. Yes (Go to HUI_Q04)
  2. No
    Don’t Know, Refused (Go to HUI_END)
    All respondents

HUI_Q02
Are you usually able to see (clearly, and without distortion, the words in a book/well enough to read ordinary newsprint) with glasses or contact lenses?

  1. Yes (Go to HUI_Q04)
  2. No
    Respondents unable to see clearly without glasses or contact lenses [HUI_Q01 = 2]

HUI_Q03
Are you able to see at all?

  1. Yes
  2. No (Go to HUI_Q06)
    Don’t Know, Refused (Go to HUI_Q06)
    Respondents unable to see clearly without glasses or contact lenses [HUI_Q01 = 2]

HUI_Q04
Are you able to see well enough to recognize a friend on the other side of the street without glasses or contact lenses?

  1. Yes (Go to HUI_Q06)
  2. No
    Don’t Know, Refused (Go to HUI_Q06)
    All respondents except those who are unable to see at all [HUI_Q01 = 1 or HUI_Q02 = 1 or HUI_Q03 = 1]

HUI_Q05
Are you usually able to see well enough to recognize a friend on the other side of the street with glasses or contact lenses?

  1. Yes
  2. No
    All respondents (except those who are unable to see at all) who are unable to recognize a friend on the other side of the street without glasses or contact lenses [HUI_Q04 = 2]

HUI_Q06
Are you usually able to hear what is said in a group conversation with at least 3 other people without a hearing aid?

  1. Yes (Go to HUI_Q10)
  2. No
    Don’t Know, Refused (Go to HUI_Q10)
    All respondents

HUI_Q07
Are you usually able to hear what is said in a group conversation with at least 3 other people with a hearing aid?

  1. Yes (Go to HUI_Q08)
  2. No
    Respondents unable to hear what is said in a group conversation without a hearing aid [HUI_Q06 = 2]

HUI_Q07A
Are you able to hear at all?

  1. Yes
  2. No (Go to HUI_Q10)
    Don’t Know, Refused (Go to HUI_Q10)
    Respondents unable to hear what is said in a group conversation with a hearing aid [HUI_Q07 = 2]

HUI_Q08
Are you usually able to hear what is said in a conversation with one other person in a quiet room without a hearing aid?

  1. Yes (Go to HUI_Q10)
  2. No
    Refused (Go to HUI_Q10)
    All respondents except those who are unable to hear at all [HUI_Q07 = 1 or HUI_Q07A = 1]

HUI_Q09
Are you usually able to hear what is said in a conversation with one other person in a quiet room with a hearing aid?

  1. Yes
  2. No
    All respondents (except those who are unable to hear at all) who are unable to hear what is said in a conversation with one other person in a quiet room without a hearing aid [HUI_Q08 = (2, RF)]

HUI_Q10
Are you usually able to be understood completely when speaking with strangers in your own language?

  1. Yes (Go to HUI_Q14)
  2. No
    Refused (Go to HUI_Q14)
    All respondents

HUI_Q11
Are you able to be understood partially when speaking with strangers?

  1. Yes
  2. No
    Respondents unable to be understood completely when speaking with strangers in their own language [HUI_Q10 = 2]

HUI_Q12
Are you able to be understood completely when speaking with those who know you well?

  1. Yes (Go to HUI_Q14)
  2. No
    Refused (Go to HUI_Q14)
    Respondents unable to be understood completely when speaking with strangers in their own language [HUI_Q10 = 2]

HUI_Q13
Are you able to be understood partially when speaking with those who know you well?

  1. Yes
  2. No
    Respondents unable to be understood completely when speaking with those they know well [HUI_Q12 = 2]

HUI_Q14
Are you usually able to walk around the neighbourhood without difficulty and without mechanical support such as braces, a cane or crutches?

  1. Yes (Go to HUI_Q21)
  2. No
    Don’t Know, Refused (Go to HUI_Q21)
    All respondents

HUI_Q15 
Are you able to walk at all?

  1. Yes
  2. No (Go to HUI_Q18)
    Don’t Know, Refused (Go to HUI_Q18)
    Respondents unable to walk around the neighbourhood without difficulty and without mechanical support [HUI_Q14 = 2]

HUI_Q16
Do you require mechanical support such as braces, a cane or crutches to be able to walk around the neighbourhood?

  1. Yes
  2. No
    Respondents able to walk, but unable to walk around the neighbourhood without difficulty and without mechanical support [HUI_Q15 = 1]

HUI_Q17
Do you require the help of another person to be able to walk?

  1. Yes
  2. No
    Respondents able to walk, but unable to walk around the neighbourhood without difficulty and without mechanical support [HUI_Q15 = 1]

HUI_Q18
Do you require a wheelchair to get around?

  1. Yes
  2. No (Go to HUI_Q21)
    Don’t Know, Refused (Go to HUI_Q21)
    Respondents able to walk but, unable to walk around the neighbourhood without difficulty and without mechanical support [HUI_Q14 = 2]

HUI_Q19
How often do you use a wheelchair?

  • Interviewer: Read categories to respondent.
    1. Always
    2. Often
    3. Sometimes
    4. Never
  • Respondents who require the use of a wheelchair [HUI_Q18 = 1]

HUI_Q20
Do you need the help of another person to get around in the wheelchair?

  1. Yes
  2. No
    Respondents who require the use of a wheelchair [HUI_Q18 = 1]

HUI_Q21
Are you usually able to grasp and handle small objects such as a pencil or scissors?

  1. Yes (Go to HUI_Q25)
  2. No
    Don’t Know, Refused (Go to HUI_Q25)
    All respondents

HUI_Q22
Do you require the help of another person because of limitations in the use of hands or fingers?

  1. Yes
  2. No (Go to HUI_Q24)
    Don’t Know, Refused (Go to HUI_Q24)
    Respondents unable to grasp and handle small objects [HUI_Q21 = 2]

HUI_Q23
Do you require the help of another person with:

  • Interviewer: Read categories to respondent.
    1. ...some tasks?
    2. ...most tasks?
    3. ...almost all tasks?
    4. ...all tasks?
  • Respondents who require the help of another person because of limitations in the use of their hands or fingers [HUI_Q22 = 1]

HUI_Q24
Do you require special equipment, for example, devices to assist in dressing, because of limitations in the use of hands or fingers?

  1. Yes
  2. No
    Respondents unable to grasp and handle small objects, or who require the help of another person because of limitations in the use of their hands or fingers [HUI_Q21 = 2]

HUI_Q25
Would you describe yourself as being usually:

  • Interviewer: Read categories to respondent.
    1. ...happy and interested in life?
    2. ...somewhat happy?
    3. ...somewhat unhappy?
    4. ...unhappy with little interest in life?
    5. ...so unhappy that life is not worthwhile?
  • All respondents

HUI_Q26
How would you describe your usual ability to remember things?

  • Interviewer: Read categories to respondent.
    1. Able to remember most things
    2. Somewhat forgetful
    3. Very forgetful
    4. Unable to remember anything at all
  • All respondents

HUI_Q27
How would you describe your usual ability to think and solve day-to-day problems?

  • Interviewer: Read categories to respondent.
    1. Able to think clearly and solve problems
    2. Having a little difficulty
    3. Having some difficulty
    4. Having a great deal of difficulty
    5. Unable to think or solve problems
  • All respondents

HUI_Q28
Are you usually free of pain or discomfort?

  1. Yes (Go to HUI_END)
  2. No
    Don’t Know, Refused (Go to HUI_END)
    All respondents

HUI_Q29
How would you describe the usual intensity of your pain or discomfort?

  • Interviewer: Read categories to respondent.
    1. Mild
    2. Moderate
    3. Severe
  • Respondents who are not usually free of pain or discomfort [HUI_Q28 = 2]

HUI_Q30
How many activities does your pain or discomfort prevent?

  • Interviewer: Read categories to respondent.
    1. None
    2. A few
    3. Some
    4. Most
  • Respondents who are not usually free of pain or discomfort [HUI_Q28 = 2]

HUI_END


Request for parent to leave (RPL)

If age < 12 or age > 19, go to RPL_END.

RPL_N11

  • Interviewer: Is the parent or guardian in the room with the youth?
    1. Yes
    2. No (Go to RPL_END)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents between 12 and 19 years of age

RPL_R12
The next set of questions deal with some sensitive topics such as smoking, drug use and sexual behaviour. To obtain honest and accurate answers, it is best when these questions are answered in private.

RPL_Q13

  • Interviewer:  Read to parent or guardian.

Would you please leave the room for a few minutes? We will let you know when we have finished these questions and you will be welcome to return.

  • Interviewer: Is the selected respondent now alone?
    1. Yes
    2. No
  • Note: Don’t Know and Refused are not allowed.
  • Parent or guardian of respondents between 12 and 19 years of age
RPL_END

Smoking (SMK)

If age < 12, go to SMK_END.

SMK_R11
Now, I am going to ask you about cigarette smoking. By cigarettes, we mean both ready-made cigarettes and ones you roll yourself, excluding cigars, cigarillos, marijuana or pipes.

SMK_Q11
In your lifetime, have you smoked a total of 100 or more cigarettes (about 4 packs)?

  1. Yes
  2. No
    Respondents aged 12 and over

SMK_Q12
At the present time, do you smoke cigarettes daily, occasionally or not at all?

  1. Daily
  2. Occasionally
  3. Not at all
  • Respondents aged 12 and over
  • If SMK_Q11 = 2 (No) and SMK_Q12 = 3 (Not at all), go to SMK_Q60.
  • If SMK_Q11 = (Don’t Know or Refused) and SMK_Q12 = (Don’t Know or Refused), go to SMK_Q60.

SMK_R21
The next questions are about your smoking history. To begin, a question about when you started smoking. You may find it helpful to think back to what you were doing or who you were with when you started smoking.

SMK_Q21
At what age did you smoke your first whole cigarette?

  • Interviewer: Minimum is 5; maximum is age.
  • (insert respondent answer between 5 and 79)
  • Respondents aged 12 and over who have smoked a total of 100 or more cigarettes during their lifetime, or who are smoking daily or occasionally at the present time [Age > 11 + SMK_Q11 = 1 or SMK_Q12 = (1, 2) or (SMK_Q11 = (DK, RF) and SMK_Q12 = (1, 2, 3))]

SMK_R22
Now I’d like to know about changes in your smoking pattern from the time you smoked your first whole cigarette until today.

SMK_Q22
How old were you when you started smoking at least 1 cigarette a month?

  • Interviewer: Minimum is [age smoked first whole cigarette]; maximum is age.
  • If the respondent never smoked at least one cigarette a month, enter “0”.
  • (insert respondent answer between 0 and 79)
  • Respondents aged 12 and over who have smoked a total of 100 or more cigarettes during their lifetime, or who are smoking daily or occasionally at the present time [Age > 11 + SMK_Q11 = 1 or SMK_Q12 = (1, 2) or (SMK_Q11 = (DK, RF) and SMK_Q12 = (1, 2, 3))]
  • If SMK_Q22 = 0, Don’t Know or Refused, go to SMK_Q60.

SMK_Q23
When you were [age started smoking one cigarette a month] years old, how many days in a typical month did you smoke at least one cigarette?

  • Interviewer: If the respondent smoked every day or daily, enter “31”.
  • If the respondent smoked 30 days in a month, ask if this means every day. If so, enter “31”. If not, enter “30”.
  • (insert respondent answer between 1 and 31)
  • Respondents aged 12 and over who have smoked a total of 100 or more cigarettes during their lifetime, or who are smoking daily or occasionally at the present time, who smoke at least one cigarette a month [Age > 11 + SMK_Q22 > 0]

SMK_Q24
(When you were [age started smoking one cigarette a month] years old,) [How many cigarettes did you usually smoke each day/On the days you smoked, how many cigarettes did you usually smoke]?

  • (insert respondent answer between 1 and 95)
  • Respondents aged 12 and over who have smoked a total of 100 or more cigarettes during their lifetime, or who are smoking daily or occasionally at the present time, who smoke at least one cigarette a month [Age > 11 + SMK_Q22 > 0]
  • If SMK_Q12 = 1 (Daily) or SMK_Q12 = 2 (Occasionally), go to SMK_R25. Otherwise, If SMK_Q12 = 1 (Daily), go to SMK_Q31. Otherwise, If SMK_Q12 = 2, go to SMK_Q41. Otherwise, go to SMK_Q51.

SMK_R25
Next, a question about cigarette brand names. By brand name I mean the name on the package of cigarettes, including size and strength, such as King Size, Regular, Mild or Extra Mild.

SMK_Q25
What brand of cigarettes do you currently smoke?

  • Interviewer: If necessary, probe for cigarette strength and size.
  • (insert respondent answer to a maximum of 80 characters)
  • Respondents aged 12 and over who are smoking daily or occasionally at the present time [Respondents aged 12 and over who answered SMK_Q12 = (1, 2) and SMK_Q22 > 0]
  • Use trigram search.

SMK_D25
Cigarette brand code

  • If SMK_D25 = Other, go to SMK_S25. Otherwise, If SMK_Q12 = 1 (Daily), go to SMK_Q31. Otherwise, If SMK_Q12 = 2, go to SMK_Q41. Otherwise, go to SMK_Q51..

SMK_S25

  • Interviewer: Specify
  • (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 12 and over, who are smoking daily or occasionally at the present time [Age > 11 + SMK_Q25 = Other]
  • If SMK_Q12 = 1 (Daily), go to SMK_Q31. Otherwise, If SMK_Q12 = 2, go to SMK_Q41. Otherwise, go to SMK_Q51.

SMK_Q31
How many cigarettes do you smoke each day now?

  • (insert respondent answer between 1 and 95)
  • Respondents aged 12 and over who are smoking daily at the present time [Age > 11 + SMK_Q12 = 1 and SMK_Q22 > 0]
  • Go to SMK_Q60.
  • If SMK_Q12 = 2, go to SMK_Q41. Otherwise, go to SMK_Q51.

SMK_Q41
On the days that you smoke, how many cigarettes do you usually smoke?

  • (insert respondent answer between 1 and 95)
  • Respondents aged 12 and over who are smoking occasionally at the present time [Age > 11 + SMK_Q12 = 1 and SMK_Q22 > 0]

SMK_Q42
In the past month, on how many days have you smoked 1 or more cigarettes?

  • (insert respondent answer between 0 and 31)
  • Respondents aged 12 and over who are smoking occasionally at the present time [Age > 11 + SMK_Q12 = 1 and SMK_Q22 > 0]

SMK_Q51
Have you ever smoked cigarettes daily?

  1. Yes
  2. No (Go to SMK_ Q60)
    Don’t Know, Refused (Go to SMK_ Q60)
    Respondents aged 12 and over who have smoked a total of 100 or more cigarettes during their lifetime, or who are smoking  occasionally at the present time [Age > 11 + SMK_Q12 = (2, 3) and SMK_Q22 > 0]

SMK_Q52
At what age did you begin to smoke (cigarettes) daily?

  • Interviewer: Minimum is [age started smoking at least 1 cigarette a month]; maximum is age.
  • (insert respondent answer between 5 and 79)
  • Respondents aged 12 and over who have smoked a total of 100 or more cigarettes during their lifetime, or who are smoking  occasionally at the present time, who have ever smoked cigarettes daily [Age > 11 + SMK_Q51 = 1]

SMK_Q53
How many cigarettes did you usually smoke each day?

  • (insert respondent answer between 1 and 95)
  • Respondents aged 12 and over who have smoked a total of 100 or more cigarettes during their lifetime, or who are smoking  occasionally at the present time, who have ever smoked cigarettes daily [Age > 11 + SMK_Q51 = 1]

SMK_Q54
At what age did you stop smoking cigarettes [daily/completely]?

  • Interviewer: Minimum is [age started smoking daily/age started smoking at least 1 cigarette a month]; maximum is age.
  • (insert respondent answer between 5 and 79)
  • Respondents aged 12 and over who have smoked a total of 100 or more cigarettes during their lifetime, or who are smoking  occasionally at the present time, who have ever smoked cigarettes daily [Age > 11 + SMK_Q51 = 1]

SMK_Q60
In the past month, have you smoked cigars or a pipe or used snuff or chewing tobacco?

  1. Yes
  2. No
    Respondents aged 12 and over

SMK_END


Alcohol Use (ALC)

If age < 12, go to ALC_END.

ALC_R11
Now, some questions about your alcohol consumption.
When we use the word “drink” it means:

  • one bottle or can of beer or a glass of draft
  • one glass of wine or a wine cooler
  • one drink or cocktail with 1 and a 1/2 ounces of liquor.

ALC_Q11
During the past 12 months, that is, from [date one year ago] to yesterday, have you had a drink of beer, wine, liquor or any other alcoholic beverage?

  1. Yes
  2. No (Go to ALC_Q17)
    Don’t Know, Refused (Go to ALC_END)
    Respondents aged 12 and over

ALC_Q12
During the past 12 months, how often did you drink alcoholic beverages?

  1. Less than once a month
  2. Once a month
  3. 2 to 3 times a month
  4. Once a week
  5. 2 to 3 times a week
  6. 4 to 6 times a week
  7. Every day
    Respondents aged 12 and over who have had a drink of beer, wine, liquor, or any other alcoholic beverage during the past 12 months [Age > 11 + ALC_Q11 = 1]

ALC_Q13
How often in the past 12 months have you had 5 or more drinks on one occasion?

  1. Never
  2. Less than once a month
  3. Once a month
  4. 2 to 3 times a month
  5. Once a week
  6. More than once a week
    Respondents aged 12 and over who have had a drink of beer, wine, liquor, or any other alcoholic beverage during the past 12 months [Age > 11 + ALC_Q11 = 1]

ALC_Q14
Thinking back over the past week, that is, from [date last week] to yesterday, did you have a drink of beer, wine, liquor or any other alcoholic beverage?

  1. Yes
  2. No (Go to ALC_Q19)
    Don’t Know, Refused (Go to ALC_Q19)
    Respondents aged 12 and over who have had a drink of beer, wine, liquor, or any other alcoholic beverage during the past 12 months [Age > 11 + ALC_Q11 = 1]

ALC_Q15
(Starting with yesterday, that is) [day name], how many drinks did you have?

  1. Sunday? (insert respondent answer between 0 and 95)
  2. Monday? (insert respondent answer between 0 and 95)
  3. Tuesday? (insert respondent answer between 0 and 95)
  4. Wednesday? (insert respondent answer between 0 and 95)
  5. Thursday? (insert respondent answer between 0 and 95)
  6. Friday? (insert respondent answer between 0 and 95)
  7. Saturday? (insert respondent answer between 0 and 95)
  • Ask ALC_Q15 seven times, once for each day of the week, working backwards from yesterday.
  • Respondents aged 12 and over who have had a drink of beer, wine, liquor, or any other alcoholic beverage during the past week [Age > 11 + ALC_Q14 = 1]
  • If Refused on first day, go to ALC_Q19.

ALC_Q16
Is the amount you drank over the last week more, about the same, or less compared to most weeks?

  1. More
  2. About the same
  3. Less
    Go to ALC_Q19
    Respondents aged 12 and over who have had a drink of beer, wine, liquor, or any other alcoholic beverage during the past week [Age > 11 + ALC_Q14 = 1 and ALC_Q15 <> RF]

ALC_Q17
Have you ever had a drink?

  1. Yes
  2. No (Go to ALC_END)
    Don’t Know, Refused (Go to ALC_END)
    Respondents aged 12 and over who have not had a drink of beer, wine, liquor, or any other alcoholic beverage during the past 12 months [Age > 11 + ALC_Q11 = 2]

ALC_Q18
Did you ever regularly drink more than 12 drinks a week?

  1. Yes
  2. No
    Respondents aged 12 and over who have ever had a drink, but who have not had a drink of beer, wine, liquor, or any other alcoholic beverage during the past 12 months [Age > 11 + ALC_Q17 = 1]

ALC_Q19
Not counting small sips, how old were you when you started drinking alcoholic beverages?

  • Interviewer: Drinking does not include having a few sips of wine for religious purposes.
  • Minimum is 5; maximum is age.
  • (insert respondent answer between 5 and 79)
  • Respondents aged 12 and over who have ever had a drink [Age > 11 + ALC_Q11 = 1 or ALC_Q17 = 1]

ALC_END


Illicit Drug Use (IDU)

If age < 14 or proxy interview, go to IDU_END.

IDU_R11
Now I am going to ask you some questions about your use of drugs and other substances for recreational purposes. I would like to remind you that everything you say will remain strictly confidential.

IDU_Q11
Have you ever used or tried marijuana, cannabis or hashish?

  1. Yes
  2. No
  • Refused (Go to IDU_END)
  • Non-proxy respondents aged 14 and over

IDU_Q12 
Have you ever used prescription drugs for recreational purposes?

  1. Yes
  2. No
    Non-proxy respondents aged 14 and over

IDU_Q13
Have you ever used or tried street drugs such as cocaine, speed, solvents or steroids?

  1. Yes
  2. No (Go to IDU_END)
  • Don’t Know, Refused (Go to IDU_END)
  • Non-proxy respondents aged 14 and over

IDU_Q14
Have you ever injected drugs?

  1. Yes
  2. No (Go to IDU_END)
  • Don’t Know, Refused (Go to IDU_END)
  • Non-proxy respondents aged 14 and over who have used or tried street drugs [Age > 13 + IDU_Q13 = 1]

IDU_Q15
Have you ever lent injection equipment to another person?

  1. Yes
  2. No
  • Refused (Go to IDU_END)
  • Non-proxy respondents aged 14 and over who have used or tried street drugs, who have ever injected drugs [Age > 13 + IDU_Q14 = 1]

IDU_Q16
Have you ever borrowed injection equipment from another person (excluding needle exchange programs)?

  1. Yes
  2. No
    Non-proxy respondents aged 14 and over who have used or tried street drugs, who have ever injected drugs [Age > 13 + IDU_Q14 = 1]

IDU_END

Sexual Behaviour (SXB)

If age < 14 or proxy interview, go to SXB_END.

SXB_R11
I would like to ask you a few questions about sexual behaviour. We ask these questions because sexual behaviours can have very important and long-lasting effects on personal health. You can be assured that anything you say will remain confidential.

SXB_Q11
Have you ever had sexual intercourse?

  1. Yes
  2. No (Go to SXB_END)
    Don’t Know, Refused (Go to SXB_END)
    Non-proxy respondents aged 14 and over

SXB_Q12
In the past 12 months, have you had sexual intercourse?

  1. Yes
  2. No (Go to SXB_Q21)
  • Don’t Know, Refused (Go to SXB_END)
  • Non-proxy respondents aged 14 and over who have ever had sexual intercourse [Age > 13 + SXB_Q11 = 1]

SXB_Q13
With how many different partners?

  1. 1 partner
  2. 2 partners
  3. 3 partners
  4. 4 or more partners
    Non-proxy respondents aged 14 and over who have had sexual intercourse during the past 12 months [Age > 13 + SXB_Q12 = 1]

SXB_Q21
Have you ever been diagnosed with a sexually transmitted disease?

  1. Yes
  2. No
  • (If SXB_Q12 = 1 (Go to SXB_END.)
  • Don’t Know, Refused  (Go to SXB_END.)
  • Non-proxy respondents aged 14 and over who have ever had sexual intercourse [Age > 13 + SXB_Q12 = (1, 2)]

SXB_Q22
Which sexually transmitted disease[s] have you been diagnosed with?

  • Interviewer: Mark all that apply.
    1. HIV (Human Immunodeficiency Virus)
    2. AIDS (Acquired Immunodeficiency Syndrome)
    3. Chlamydia
    4. Genital Herpes (Herpes Simplex Type II)
    5. Syphilis
    6. Gonorrhoea
    7. Genital Warts (Human Papilloma Virus or HPV)
    8. Venereal disease
    9. Hepatitis B
    10. Other - Specify
  • Non-proxy respondents aged 14 and over who have ever had sexual intercourse, who have been diagnosed with a sexually transmitted disease [Age > 13 + SXB_Q21 = 1]
  • If SXB_Q22 = 10 (Other), go to SXB_S22. Otherwise, go to SXB_END.

SXB_S22

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Non-proxy respondents aged 14 and over who have ever had sexual intercourse, who have been diagnosed with a sexually transmitted disease [Age > 13 + SXB_Q22 = 10]
  • If MSWC_Q02 = [1 (Married) or 2 (Common-law)] and SXB_Q13 = 1 (one partner), go to SXB_END.

SXB_Q23
Did you or your partner use a condom the last time you had sexual intercourse?

  1. Yes
  2. No
    Non-proxy respondents aged 14 and over who have had sexual intercourse with more than one partner in the past 12 months [Age > 13 + SXB_Q12 = 1]

SXB_Q24
Do you or your partner usually use a condom when you have sexual intercourse?

  1. Yes
  2. No
    Non-proxy respondents aged 14 and over who have had sexual intercourse with more than one partner in the past 12 months [Age > 13 + SXB_Q12 = 1]

SXB_END


Breastfeeding (MBF)

If age < 14 or SEX = male or SXB_Q11 = 2 (never had sexual intercourse) or proxy interview, go to MBF_END.

MBF_R11
Now some questions about giving birth and breastfeeding experiences.

MBF_Q11
Have you ever given birth?

  1. Yes
  2. No (Go to MBF_END)
  • Don’t Know, Refused (Go to MBF_END)
  • Female non-proxy respondents aged 14 and over who have had sexual intercourse [Sex = 2 + Age > 13 + SXB_Q11 = 1]

MBF_Q12
How many live births have you had (excluding stillborns and miscarriages)?

  • Interviewer: Enter number of births.
  • (insert respondent answer between 0 and 15)
  • Female non-proxy respondents aged 14 and over who have given birth [Sex = 2 + Age > 13 + MBF_Q11 = 1]
  • If MBF_Q12 = 0, Don’t Know or Refused go to MBF_END.
  • For each birth identified in MBF_Q12, ask MBF_Q21 and MBF_Q22.

MBF_Q21
Did you breastfeed your baby?

  1. Yes
  2. No (Go to MBF_END)
  • Don’t Know, Refused (Go to MBF_END)
  • Female non-proxy respondents aged 14 and over who have given birth [Sex = 2 + Age > 13 + MBF_Q12 > 0]

MBF_Q22
For how long did you breastfeed your baby?

  1. Less than 1 week
  2. 1 to 2 weeks
  3. 3 to 4 weeks
  4. 5 to 8 weeks
  5. 9 weeks to less than 12 weeks
  6. 3 months (12 weeks to less than 16 weeks)
  7. 4 months (16 weeks to less than 20 weeks)
  8. 5 months (20 weeks to less than 24 weeks)
  9. 6 months (24 weeks to less than 28 weeks)
  10. 7 to 9 months
  11. 10 to 12 months
  12. More than 1 year
    Female non-proxy respondents aged 14 and over who breastfed their baby [Sex = 2 + Age > 13 + MBF_Q21 = 1]
MBF_END

Request for Parent to Return (RPR)

If age < 12 or age > 19 or RPL_Q13 = 2 (respondent not alone), go to RPR_END.

RPR_R11
We have now finished the sensitive questions. If your parent or guardian is available, please ask him or her to [rejoin/join] us now.

RPR_N11

  • Interviewer: Is the parent or guardian in the room?
    1. Yes
    2. No
  • Note: Don’t Know and Refused are not allowed.

RPR_END

Request for Child to Leave (RCL)

If age > 17 or RPR_N11 = 2 (parent or guardian not in the room), go to RCL_END.

RCL_N11

  • Interviewer: Is the child in the room?
    1. Yes
    2. No (Go to RCL_END)
  • Note: Don’t Know and Refused are not allowed.

RCL_R12

  • If proxy interview Interviewer: Read to parent or guardian.
  • It is best when this next set of questions is answered by an adult in private.
  • Else
  • Interviewer: Read to respondent.
  • This next set of questions deals with topics that are best answered by your parent or guardian in private. Is your parent or guardian available to answer the next set of questions?

RCL_N12

  • Interviewer: Is the parent or guardian available to answer the next questions?
    1. Yes
    2. No (Go to RCL_END)
  • Note: Don’t Know and Refused are not allowed.

RCL_Q13

  • If proxy interview
  • Could [Respondent Name] please leave the room while we complete these questions?  We will let him know when we have finished these questions and he may return.
  • Interviewer: Has the child left the room?
    1. Yes
    2. No
  • Else
  • Would you please leave the room so that your parent or guardian may answer these questions in private?  We will let you know when we have finished these questions and at that time we would like you to return.
  • Interviewer: Is the parent or guardian now alone?
    1. Yes
    2. No
  • Note: Don’t Know and Refused are not allowed.

RCL_END


Pregnancy Information (PRG)

If age > 11 or Person Providing Information is not a birth or biological parent, go to PRG_END.

PRG_R11
Next some questions about your pregnancy with [Respondent Name] .

PRG_Q11
Did you smoke during your pregnancy with [Respondent Name]?

  1. Yes
  2. No (Go to PRG_END)
    Don’t Know, Refused (Go to PRG_END)
    Birth or biological parent of child respondent less than 12 years of age

PRG_Q12
How many cigarettes per day did you smoke?

  • Interviewer: Enter number of cigarettes.
  • (insert respondent answer between 1 and 95)
  • Birth or biological parent of child respondent less than 12 years of age who's biological mother smoked while pregnant with respondent

PRG_Q13
At what stage in your pregnancy did you smoke [this amount]?

  • Interviewer: Mark all that apply.
    1. During the first three months
    2. During the second three months
    3. During the third three months
    4. Throughout
  • Birth or biological parent of child respondent less than 12 years of age who's biological mother smoked while pregnant with respondent

PRG_END

Birth Information (BIR)

If age > 11 or if Person Providing Information is not a parent/guardian, go to BIR_END.

BIR_R11
The following questions concern [Respondent Name]’s birth.

BIR_Q11
How much did he weigh at birth?

  • Interviewer: Record the reporting unit.
    1. Pounds and Ounces
    2. Grams (Go to BIR_N14)
      Don’t Know, Refused (Go to BIR_Q21)
      Parent or guardian of child respondent less than 12 years of age

BIR_N12

  • Interviewer: Enter pounds only
  • (insert respondent answer between 0 and 20)
  • Note: Don’t Know and Refused are not allowed.
  • Parent or guardian of child respondent less than 12 years of age giving weight of respondent in pounds and ounces

BIR_N13

  • Interviewer: Enter ounces only
  • (insert respondent answer between 0 and 15)
  • Note: Don’t Know and Refused are not allowed.
  • Go to BIR_Q21.
  • Parent or guardian of child respondent less than 12 years of age giving weight of respondent in pounds and ounces

BIR_N14

  • Interviewer: Enter grams.
  • (insert respondent answer between 0 and 9995)
  • Note: Don’t Know and Refused are not allowed.
  • Parent or guardian of child respondent less than 12 years of age giving weight of respondent in grams

BIR_Q21
Was he born before, after or on the due date?

  1. Before the due date
  2. After the due date
  3. On the due date (Go to BIR_Q23)
    Don’t Know, Refused (Go to BIR_Q23)
    Parent or guardian of child respondent less than 12 years of age

BIR_Q22
How many days [before/after] the due date was he born?

  • Interviewer: If less than one day, enter “0”.
  • (insert respondent answer between 0 and 105)
  • Parent or guardian of child respondent less than 12 years of age, born before or after the due date

BIR_Q23
Was this a single birth, or was it twins or triplets?

  1. Single birth
  2. Twins
  3. Triplets
  4. More than triplets
    Parent or guardian of child respondent less than 12 years of age

BIR_Q24
Was [Respondent Name] admitted to a special neonatal unit or an intensive care unit immediately following birth, before he left the hospital?

  1. Yes
  2. No (Go to BIR_Q26)
    Don’t Know, Refused (Go to BIR_Q26)
    Parent or guardian of child respondent less than 12 years of age

BIR_Q25
For how many days, in total, was this care received?

  • Interviewer: If less than one day, enter “0”.
  • (insert respondent answer between 0 and 995)
  • Parent or guardian of child respondent less than 12 years of age who was admitted to a special neonatal unit or an intensive care unit immediately following birth

BIR_Q26
How old were you when [Respondent Name] was born?

  • Interviewer: Minimum is 12; maximum is 59.
  • (insert respondent answer between 12 and 59)
  • Parent or guardian of child respondent less than 12 years of age

BIR_END


Breastfeeding Information (BRI)

If age > 11 or Person Providing Information is not a birth or biological parent, go to BRI_END.

BRI_Q11
Did you breastfeed [Respondent Name] as an infant, even if only for a short period of time?

  1. Yes
  2. No (Go to BRI_END)
    Don’t Know, Refused (Go to BRI_END)
    Birth or biological parent of child respondent less than 12 years of age

BRI_Q12
For how long did you breastfeed?

  1. Less than one week
  2. 1 to 2 weeks
  3. 3 to 4 weeks
  4. 5 to 8 weeks
  5. 9 to less than 12 weeks
  6. 3 to 6 months
  7. 7 to 9 months
  8. 10 to 12 months
  9. More than 1 year
    Birth or biological parent of child respondent less than 12 years of age who was breastfed by his/her biological mother as an infant

BRI_Q13
For how long was [Respondent Name] fed only breast milk?

  • Interviewer: Water, tea, juice or other liquids are not to be included. Medication and vitamins can be included.
    1. Less than one week
    2. 1 to 2 weeks
    3. 3 to 4 weeks
    4. 5 to 8 weeks
    5. 9 to less than 12 weeks
    6. 3 to 6 months
    7. More than 6 months
  • Birth or biological parent of child respondent less than 12 years of age who was breastfed by his/her biological mother as an infant

BRI_END

Strengths and Difficulties (SDQ) © Robert Goodman

If age > 17 or (age > 11 and age < 18 and (RPR_N11 = 2 (parent or guardian not in the room) or RCL_N12 = 2 (parent/guardian not available to answer questions)), go to SDQ_END.

For some questions, the question text changes slightly if the respondent is a “youth” (i.e., they are aged between 12 and 17).

SDQ_R11
Now I’m going to read a series of statements. Please tell me if the statement is “Not true”, “Somewhat true” or “Certainly true”. It would help us if you answered all of the questions as best you can even if you are not absolutely certain. Please give your answers on the basis of your child’s behaviour over the last six months.

SDQ_Q11
[Respondent Name] is considerate of other people’s feelings.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Refused  (Go to SDQ_END)
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q12
He is restless, overactive, cannot stay still for long.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q13
He often complains of headaches, stomach aches or sickness.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q14
He shares readily with other children, for example toys, treats, pencils. / He shares readily with other youth, for example CD’s, games, food.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q15
He often loses his temper.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q16
[[Respondent Name] is rather solitary, prefers to play alone. / [Respondent  Name] would rather be alone than with other youth.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q17
He is generally well behaved, usually does what adults request.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q18
He has many worries or often seems worried.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q19
He is helpful if someone is hurt, upset, or feeling ill.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q20
He is constantly fidgeting or squirming.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q21
[Respondent Name] has at least one good friend.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q22
He often fights with other children or bullies them. / He often fights with other youth or bullies them.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q23
He is often unhappy, depressed or tearful.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q24
He is generally liked by other children. /He is generally liked by other youth.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q25
He is easily distracted, his concentration wanders.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q26
[[Respondent Name] is nervous or clingy in new situations, easily loses confidence. / [Respondent Name] is nervous in new situations, easily loses confidence.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q27
He is kind to younger children.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q28
He often lies or cheats.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q29
He is picked on or bullied by other children. / He is picked on or bullied by other youth.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q30
He often offers to help others (parents, teachers, other children).

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q31
[Respondent Name] thinks things out before acting.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q32
He steals from home, school or elsewhere.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q33
He gets along better with adults than with other children. / He gets along better with adults than with other youth.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q34
He has many fears, is easily scared.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_Q35
He has a good attention span, sees chores or homework through to the end.

  1. Not true
  2. Somewhat true
  3. Certainly true
    Parent or guardian of child respondent aged 6 to 17

SDQ_END


Request for Child to Return (RCR)

If age > 17 or RCL_N12 = 2 (parent/guardian not available to answer questions), go to RCR_END.

RCR_R11
We have now finished this set of questions.

  • If proxy interview
  • [Respondent Name] may return now if he wishes. He may help answer the remaining questions.
  • Else
  • [Respondent Name] should return now to answer the remaining questions in the survey. You may wish to remain in the room or close by to provide assistance to [Respondent Name] if needed.

RCR_N11

  • Interviewer:  Has the child returned to the room?
    1. Yes
    2. No
  • Note: Don’t Know and Refused are not allowed.
RCR_END

Exposure to Second-Hand Smoke (ETS)

ETS_R11
The next questions are about exposure to second-hand smoke. Second-hand smoke includes the smoke that smokers exhale and the smoke from burning cigarettes.

If two persons selected in the household and age of current respondent > 11, go to ETS_Q13.

ETS_Q11
Including both household members and regular visitors, does anyone smoke inside this home, every day or almost every day?

  • Interviewer: Include cigarettes, cigars and pipes.
    1. Yes
    2. No (Go to ETS_Q14)
      Don’t Know, Refused (Go to ETS_END)
      One respondent per household

ETS_Q12
How many people smoke inside this home every day or almost every day?

  • Interviewer: Include household members and regular visitors.
  • (insert respondent answer between 1 and 15)
  • One respondent per household, in a home where someone smokes every day or almost every day [ETS_Q11 = 1]

ETS_Q13
Overall, excluding your own smoking, in the past month were you exposed to second-hand smoke inside this home:

  • Interviewer:  Read categories to respondent.
    1. ...every day?
    2. ...almost every day?
    3. ...at least once a week?
    4. ...at least once in the past month?
    5. ...never?
  • One respondent per household. [ETS_Q11 = 1]

ETS_Q14 
In the past month, were you exposed to second-hand smoke, every day or almost every day, in a car or other private vehicle?

  1. Yes
  2. No
    One respondent per household [ETS_Q11 = (1,2)]

ETS_Q15
(In the past month, ) Were you exposed to second-hand smoke, every day or almost every day, in public places (such as bars, restaurants, shopping malls, arenas, bingo halls, bowling alleys)?

  1. Yes
  2. No
    One respondent per household [ETS_Q11 = (1, 2)]
    If GEN_Q16 = 1 (worked in past 12 months), go to ETS_Q16. Otherwise, go to ETS_Q17.

ETS_Q16
(In the past month,) Were you exposed to second-hand smoke every day or almost every day at your place of work?

  1. Yes
  2. No
    One respondent per household, in a home where someone smokes every day or almost every day [GEN_Q16 = 1 and ETS_Q11 = (1, 2)]

ETS_Q17
Overall, excluding your own smoking and excluding inside your own home, in the past month were you exposed to second-hand smoke:

  • Interviewer:  Read categories to respondent.
    1. ...every day?
    2. ...almost every day?
    3. ...at least once a week?
    4. ...at least once in the past month?
    5. ...never?
  • All respondents [ETS_Q11 = (1, 2)]

ETS_END


Housing Characteristics (HSC)

HSC_R11
Now I’m going to ask you some questions about this home.

If two persons selected in the household and age of current respondent > 11 go to HSC_Q12.

HSC_Q11
How old is this home? Is it:

  • Interviewer: Read categories to respondent. If necessary state: (If you do not know the exact age, please provide an estimate.)
    1. ...less than 10 years old?
    2. ...10 years old to less than 20?
    3. ...20 years old to less than 30?
    4. ...30 years old to less than 40?
    5. ...40 years old to less than 50?
    6. ...50 or more years old?
      Refused (Go to HSC_END)
  • One respondent per household

HSC_Q12
How long have you lived in this home?

  • Interviewer: Minimum is 0; maximum is age.
  • If less than one year enter “0”.
  • (insert respondent answer between 0 and 79)
  • All respondents
  • If two persons selected in the household and age of current respondent > 11 go to HSC_END.

HSC_Q13
What is the main source of heat in this home?

  • Interviewer: Mark all that apply.
    1. Oil furnace
    2. Gas furnace
    3. Electric heat
    4. Wood-burning stove
    5. Wood-burning fireplace
    6. Gas fireplace
    7. Other – Specify
  • One respondent per household
  • If HSC_Q13 = 7 (Other), go to HSC_S13. Otherwise, go to HSC_Q31.

HSC_S13

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • One respondent per household [Respondents who answered HSC_Q13 = 7]

HSC_Q31
In the past month, that is from [date last month] to yesterday, were any chemicals used to treat this home to control roaches, ants or termites, or were any insecticides used on indoor house plants?

  1. Yes
  2. No (Go to HSC_Q37)
    Don’t Know, Refused (Go to HSC_Q37)
    One respondent per household

HSC_Q33
In which area(s) of this home were these products used?

  • Interviewer: Mark all that apply.
    1. Living room
    2. Family room
    3. Dining room
    4. Kitchen
    5. Bathroom(s)
    6. Bedroom(s)
    7. Other rooms (den, play room, rec room, etc.)
    8. Outside (foundation of building)
    9. Entire home
  • One respondent per household where chemicals were used to treat the home to control roaches, ants or termites, or where insecticides were used on indoor house plants [HSC_Q31 = 1]

HSC_Q34
(In the past month,) When these chemical products were used to treat this home, how many times did someone living in this home personally apply these products?

  • Interviewer: Minimum is 0; maximum is 30.
  • (insert respondent answer between 0 and 30)
  • One respondent per household where chemicals were used to treat the home to control roaches, ants or termites, or where insecticides were used on indoor house plants [HSC_Q31 = 1]

HSC_Q35
(In the past month, when these chemical products were used to treat this home,) How many times did a professional exterminator apply these products?

  • Interviewer: Minimum is 0; maximum is 30.
  • (insert respondent answer between 0 and 30)
  • One respondent per household where chemicals were used to treat the home to control roaches, ants or termites, or where insecticides were used on indoor house plants [HSC_Q31 = 1]

HSC_Q36
(In the past month, when these chemical products were used to treat this home,) How many times did someone other than a professional or household member apply these products? (For example: a neighbour or relative living outside this home)

  • Interviewer: Minimum is 0; maximum is 30.
  • (insert respondent answer between 0 and 30)
  • One respondent per household where chemicals were used to treat the home to control roaches, ants or termites, or where insecticides were used on indoor house plants [HSC_Q31 = 1]

HSC_Q37
In the past month, were any chemicals used in this home to control head lice on family members or fleas on pets?

  1. Yes
  2. No
    One respondent per household

HSC_Q41
(In the past month,) Did anyone treat the lawn or yard of this home, or the surrounding fields, woods or orchards with chemical products to kill insects or weeds, or to control plant diseases?

  1. Yes
  2. No (Go to HSC_END)
    Don’t Know, Refused (Go to HSC_END)
    One respondent per household

HSC_Q42
(In the past month,) When these chemical products were used to treat the area around this home, how many times did someone living in this home personally apply these products?

  • Interviewer: Minimum is 0; maximum is 30.
  • (insert respondent answer between 0 and 30)
  • One respondent per household where the lawn, surrounding fields, woods or orchards were treated with chemical products to kill insects or weeds, or to control plant diseases [HSC_Q41 = 1]

HSC_Q43
(In the past month, when these chemical products were used to treat the area around this home,) How many times did a professional apply these products?

  • Interviewer: Minimum is 0; maximum is 30.
  • (insert respondent answer between 0 and 30)
  • One respondent per household where the lawn, surrounding fields, woods or orchards were treated with chemical products to kill insects or weeds, or to control plant diseases [HSC_Q41 = 1]

HSC_Q44
(In the past month, when these chemical products were used to treat the area around this home,) How many times did someone other than a professional or household member apply these products? (For example: a neighbour or relative living outside this home)

  • Interviewer: Minimum is 0; maximum is 30.
  • (insert respondent answer between 0 and 30)
  • One respondent per household where the lawn, surrounding fields, woods or orchards were treated with chemical products to kill insects or weeds, or to control plant diseases [HSC_Q41 = 1]

HSC_END


Hobbies (HOB)

HOB_R11
Now some questions about activities you may have done recently.

HOB_Q11
If the respondent is between 6 and 11:

  • In the past 3 months, that is from [date three months ago] to yesterday, have you done any of the following in your leisure time or at school?  For children this can include watching or helping a relative as well as participating themselves.
  • If the respondent is between 12 and 19:
  • In the past 3 months, that is from [date three months ago] to yesterday, have you done any of the following in your leisure time or at school?
  • Else:
  • In the past 3 months, that is from [date three months ago] to yesterday, have you done any of the following in your leisure time, that is outside of work?
  • Interviewer: Read categories to respondent. Mark all that apply.
    1. Arts using paints, glazes, finger paints, water colours, crayons
    2. Pottery and ceramics using a kiln
    3. Model making using glues, solders, paints or metals
    4. Making fishing sinkers or weights
    5. Welding or soldering
    6. Auto repairs
    7. Electronics assembly, repairs of components
    8. Plumbing
    9. Refinishing furniture
    10. Woodworking 
    11. None (Go to HOB_END)
      Don’t Know, Refused (Go to HOB_END)
  • All respondents
  • For each activity identified in HOB_Q11, ask HOB_Q12 and HOB_Q13.

HOB_B12
(In the past three months,) How often did you usually [identified activity]? (For example: twice a day, three times a week, once a month)

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to next activity)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who participated in a leisure time activity during the past 3 months [Respondents who answered HOB_Q11 = (1, 2, 3, 4, 5, 6, 7, 8, 9, 10)]

HOB_Q12
About how much time did you spend on each occasion?

  1. Less than 30 minutes
  2. 30 to 60 minutes
  3. 61 to 90 minutes
  4. More than an hour and a half
    Respondents who participated in a leisure time activity during the past 3 months [Respondents who answered HOB_Q11 = (1, 2, 3, 4, 5, 6, 7, 8, 9, 10)]

HOB_END


Grooming Product Use (GPU)

GPU_R11 
Now some questions about your use of grooming and cosmetic products [including “dress-up” use]. Some of these questions may not apply to you, but we need to ask them to all respondents.

GPU_Q11
In the past 3 months, that is from [date three months ago] to yesterday, have you used any of the following:

  • Interviewer: Read categories to respondent. Mark all that apply.
    1. ...fragrance (including perfumes, cologne and aftershave)?
    2. ...eye make-up?
    3. ...lipstick (including lip gloss)?
    4. ... hair dye?
    5. ...hair style products (including hair spray, gel, mousse and other hair styling products)?
    6. ...manicure preparations?
    7. ...scented body products (including lotion, cream and body wash)?
    8. None (Go to GPU_END)
      Don’t Know, Refused (Go to GPU_END)
  • All respondents
  • For each type of product identified GPU_Q11, ask GPU_Q12.

GPU_Q12
How often do you usually use [identified product]? (For example: twice a day, three times a week, once a month)

  • Interviewer: Enter amount only.
  • (insert respondent answer between 0 and 500)
    0, Don’t Know, Refused (Go to next product)
  • Interviewer: Select the reporting period.
    1. Per day
    2. Per week
    3. Per month
    4. Per year
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who used grooming or cosmetic products [GPU_Q11 = (1, 2, 3, 4, 5, 6, 7)]

GPU_END

Labour Force Activity (LBF)

If age < 15 or age > 75, go to LBF_END. Otherwise, go to LBF_R01.

LBF_R01
The next few questions concern your activities in the last 7 days. By the last 7 days, I mean beginning [date one week ago] and ending [date yesterday].

LBF_Q01
Last week, did you work at a job or a business? Please include part-time jobs, seasonal work, contract work, self-employment, baby-sitting and any other paid work, regardless of the number of hours worked.

  1. Yes (Go to LBF_Q03)
  2. No
  3. Permanently unable to work (Go to LBF_R21)
    Don’t Know, Refused (Go to LBF_END)
    Respondents aged 15 to 75

LBF_Q02
Last week, did you have a job or business from which you were absent?

  1. Yes
  2. No (Go to LBF_Q11)
    Don’t Know, Refused (Go to LBF_END)
    Respondents aged 15 to 75 who were not employed during the previous week [LBF_Q01 = 2]

LBF_Q03
Did you have more than one job or business last week?

  1. Yes
  2. No
  • Go to LBF_R31
  • Respondents aged 15 to 75 who were employed during the previous week [Respondents who answered LBF_Q01 = 1 or LBF_Q02 = 1]

LBF_Q11
In the past 4 weeks, did you do anything to find work?

  1. Yes (Go to LBF_R21)
  2. No
    Don’t Know, Refused (Go to LBF_R21)
    Respondents aged 15 to 75 who were not employed during the previous week [LBF_Q02 = 2]

LBF_Q13
What is the main reason that you are not currently working at a job or business?

  1. Own illness or disability
  2. Caring for - own children
  3. Caring for - elder relatives
  4. Pregnancy (Females only)
  5. Other personal or family responsibilities
  6. Vacation
  7. School or educational leave
  8. Retired
  9. Believes no work available (in area or suited to skills)
  10. Other - Specify
  • Respondents aged 15 to 75 who were not employed during the previous week and who did nothing to find work during the previous 4 weeks [LBF_Q11 = 2]
  • If LBF_Q13 = 10 (Other), go to LBF_S13. Otherwise, If LBF_Q13 = 1 (Own illness or disability), go to LBF_Q14. Otherwise, go to LBF_R21.

LBF_S13 

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 15 to 75 who were not employed during the previous week and who did nothing to find work during the previous 4 weeks and gave a reason of 'Other' as the main reason that they were not currently working at a job or business [LBF_Q13 = 10]
  • If LBF_Q13 = 1 (Own illness or disability), go to LBF_Q14. Otherwise, go to LBF_R21.

LBF_Q14
Is this due to your physical health, to your emotional or mental health, to your use of alcohol or drugs, or to another reason?

  1. Physical health
  2. Emotional or mental health (including stress)
  3. Use of alcohol or drugs
  4. Another reason
    Respondents aged 15 to 75 who were not employed during the previous week and who did nothing to find work during the previous 4 weeks because of their own illness or disability [LBF_Q13 = 1]

LBF_R21
Now some questions about jobs or employment which you have had during the past 12 months, that is, from [date one year ago] to yesterday.

LBF_Q21
Did you work at a job or a business at any time in the past 12 months? Please include part-time jobs, seasonal work, contract work, self-employment, baby-sitting and any other paid work, regardless of the number of hours worked.

  1. Yes (Go to LBF_Q23)
  2. No
  • Respondents aged 15 to 75 who were permanently unable to work or who were not employed during the previous week [LBF_Q01 = 3 or LBF_Q02 = 2]
  • If LBF_Q11 = 1 (looked for work), go to LBF_Q71. Otherwise, go to LBF_Q22.

LBF_Q22
During the past 12 months, did you do anything to find work?

  1. Yes (Go to LBF_Q71)
  2. No (Go to LBF_END)
    Don’t Know, Refused (Go to LBF_END)
    Respondents aged 15 to 75 who were not employed during the previous 12 months and who did not try to find work during the previous 4 weeks [Respondents who answered LBF_21 <> 1, excluding those who answered LBF_Q11 = 1]

LBF_Q23
During that 12 months, did you work at more than one job or business at the same time?

  1. Yes
  2. No
    Respondents aged 15 to 75 who were permanently unable to work, or who were not employed during the previous week, but were employed at some point during the previous 12 months [LBF_Q21 = 1]

LBF_R31
The next questions are about your [current job or business/most recent job or business].

  • If person currently holds more than one job or if the last time he worked it was at more than one job:
  • Interviewer:  Report on the job for which the number of hours worked per week is the greatest.
  • Note: Don’t Know and Refused are not allowed.

LBF_Q31
[Are/Were] you an employee or self-employed?

  1. Employee (Go to LBF_Q33)
  2. Self-employed
  3. Working in a family business without pay (Go to LBF_Q33)
    Don’t Know, Refused (Go to LBF_Q33)
    Respondents aged 15 to 75 who were employed during the previous week, or who were employed at some point during the previous 12 months [LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q21 = 1]

LBF_Q31A
[Do/Did] you have any employees?

  1. Yes
  2. No
    Respondents aged 15 to 75 who were self-employed during the previous week or who were self-employed at some point during the previous 12 months [Respondents who answered LBF_Q31 = 2]

LBF_Q32
What [is/was] the name of your business?

  • (insert respondent answer to a maximum of 50 characters)
  • Respondents aged 15 to 75 who were self-employed during the previous week or who were self-employed at some point during the previous 12 months.
  • Go to LBF_Q34.

LBF_Q33
For whom [do/did] you work? (For example: name of business, government department or agency, or person)

  • (insert respondent answer to a maximum of 50 characters)
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months and are/were an employee or working in a family business without pay

LBF_Q34
What kind of business, industry or service [is/was] this? (For example: cardboard box manufacturing, road maintenance, retail shoe store, secondary school, dairy farm, municipal government)

  • (insert respondent answer to a maximum of 50 characters)
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months

LBF_Q35
What kind of work [are/were] you doing? (For example: babysitting in own home, factory worker, forestry technician)

  • (insert respondent answer to a maximum of 50 characters)
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months
  • If LBF_Q35 = Other, go to LBF_S35. Otherwise, go to LBF_Q36.

LBF_S35

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months and who selected "Other" for the kind of work they are/were doing

LBF_Q36
What [are/were] your most important activities or duties? (For example: caring for children, stamp press machine operator, forest examiner)

  • (insert respondent answer to a maximum of 50 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months

LBF_Q36A
[Is/Was] your [job/business] permanent, or [is/was] there some way that it [is/was] not permanent? (For example: seasonal, temporary, term, casual)

  1. Permanent (Go to LBF_Q37)
  2. Not permanent
    Don’t Know, Refused (Go to LBF_Q37)
    Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months [LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q21 = 1]

LBF_Q36B
In what way [is/was] your [job/business] not permanent?

  1. Seasonal
  2. Temporary, term or contract
  3. Casual job
  4. Work done through a temporary help agency
  5. Other
    Respondents aged 15 to 75 who were employed at a a non-permanent job or business during the previous week, or who were employed at some point during the previous 12 months at a non-permanent job or business [LBF_Q36A = 2]

LBF_Q37
At your place of work, what [are/were] the restrictions on smoking?

  • Interviewer: Read categories to respondent.
    1. Restricted completely
    2. Allowed in designated areas
    3. Restricted only in certain places
    4. Not restricted at all
  • If LBF_Q02 = 1 (Had a job), go to LBF_Q41. Otherwise, go to LBF_Q42.
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months [LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q21 = 1]

LBF_Q41
What was the main reason you were absent from work last week?

  1. Own illness or disability
  2. Caring for – own children
  3. Caring for – elder relatives
  4. Maternity leave (Females only)
  5. Other personal or family responsibilities
  6. Vacation
  7. Labour dispute (strike or lockout)
  8. Temporary layoff due to business conditions (Employees only)
  9. Seasonal layoff (Employees only)
  10. Casual job, no work available (Employees only)
  11. Work schedule (e.g., shift work)  (Employees only)
  12. Self-employed, no work available (Self-employed only)
  13. Seasonal business (Excluding employees)
  14. School or educational leave
  15. Other - Specify
  • Respondents aged 15 to 75 who were employed during the previous week but had been absent from work [LBF_Q02 = 1]
  • If LBF_Q41 = 15 (Other), go to LBF_S41. Otherwise, If LBF_Q41 = 1 (Own illness or disability), go to LBF_Q41A. Otherwise, go to LBF_Q42.

LBF_S41

  • Interviewer: Specify (insert respondent answer to a maximum of 80 spaces)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents 15 to 75 years of age who were employed but had been absent the previous week and gave "Other" as the reason for being absent [LBF_Q41 = 15]
  • If LBF_Q41 = 1 (Own illness or disability), go to LBF_Q41A. Otherwise, go to LBF_Q42.

LBF_Q41A
Was that due to your physical health, to your emotional or mental health, to your use of alcohol or drugs, or to another reason?

  1. Physical health
  2. Emotional or mental health (including stress)
  3. Use of alcohol or drugs
  4. Another reason
    Respondents aged 15 to 75 who were employed during the previous week but had been absent from work because of their own illness or disability [Respondents who answered LBF_Q41 = 1]

LBF_Q42
About how many hours a week [do/did] you usually work at your [job/business]? If you usually [work/worked] extra hours, paid or unpaid, please include these hours.

  • (insert respondent answer between 1 and 168)
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months [LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q21 = 1]

LBF_Q44
Which of the following best describes the hours you usually [work/worked] at your [job/business]?

  • Interviewer: Read categories to respondent.
    1. Regular - daytime schedule or shift(Go to LBF_Q46)
    2. Regular - evening shift
    3. Regular - night shift
    4. Rotating shift (change from days to evenings to nights)
    5. Split shift
    6. On call
    7. Irregular schedule
    8. Other - Specify
      Don’t Know, Refused (Go to LBF_Q46)
  • Respondents aged 15 to 75 who were employed during the previous week, or who were employed at some point during the previous 12 months [LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q21 = 1]
  • If LBF_Q44 = 8 (Other), go to LBF_S44. Otherwise, go to LBF_Q45.

LBF_S44

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents 15 to 75 years of age who were employed during the previous week or who were employed at some point during the previous 12 months and who described their regular work hours as "Other" [LBF_Q44 = 8]

LBF_Q45
What is the main reason that you [work/worked] this schedule?

  1. Requirement of job/no choice
  2. Going to school
  3. Caring for - own children
  4. Caring for - other relatives
  5. To earn more money
  6. Likes to work this schedule
  7. Other - Specify
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months and did not work a regular daytime schedule or shift [LBF_Q44 <> 1]
  • If LBF_Q45 = 7 (Other), go to LBF_S45. Otherwise, go to LBF_Q46.

LBF_S45

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents 15 to 75 years of age who were employed during the previous week or who were employed at some point during the previous 12 months and who gave a reason of "Other" for why they do/did not work a regular daytime schedule or shift [LBF_Q45 = 7]

LBF_Q46
[Do/Did] you usually work on weekends at this [job/business]?

  1. Yes
  2. No
  • Respondents aged 15 to 75 who were employed during the previous week or who were employed at some point during the previous 12 months [LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q21 = 1]
  • If LBF_Q03 = 1 (More than 1 job past week) or LBF_Q23 = 1 (More than 1 job past 12 months), go to LBF_Q51. Otherwise, go to LBF_Q61.

LBF_Q51
You indicated that you [have/had] more than one job. For how many weeks in a row [have/did] you work at more than one job (in the past 12 months)?

  • Interviewer: Obtain best estimate.
  • (insert respondent answer between 1 and 52)
  • Respondents aged 15 to 75 who were employed at more than one job or business during the previous week, or who were employed at more than one job or business at some point during the previous 12 months [LBF_Q03 = 1 or LBF_Q23 = 1]

LBF_Q52
What is the main reason that you [work/worked] at more than one job?

  1. To meet regular household expenses
  2. To pay off debts
  3. To buy something special
  4. To save for the future
  5. To gain experience
  6. To build up a business
  7. Enjoys the work of the second job
  8. Other - Specify
  • Respondents aged 15 to 75 who were employed at more than one job or business during the previous week, or who were employed at more than one job or business at some point during the previous 12 months [LBF_Q03 = 1 or LBF_Q23 = 1]
  • If LBF_Q52 = 8 (Other), go to LBF_S52. Otherwise, go to LBF_Q53.

LBF_S52

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 15 to 75 who were employed at more than one job or business during the previous week, or who were employed at more than one job or business at some point during the previous 12 months, and gave a reason of 'Other' as the main reason that they work/worked at more than one job [Respondents who answered LBF_Q52 = 8]

LBF_Q53
About how many hours a week [do/did] you usually work at your other job[s]? If you usually [work/worked] extra hours, paid or unpaid, please include these hours.

  • Interviewer: Minimum is 1; maximum is 168.
  • (insert respondent answer between 1 and 168)
  • Respondents aged 15 to 75 who were employed at more than one job or business during the previous week, or who were employed at more than one job or business at some point during the previous 12 months [LBF_Q03 = 1 or LBF_Q23 = 1]

LBF_Q54
[Do/Did] you usually work on weekends at your other job[s]?

  1. Yes
  2. No
    Respondents aged 15 to 75 who were employed at more than one job or business during the previous week, or who were employed at more than one job or business at some point during the previous 12 months [LBF_Q03 = 1 or LBF_Q23 = 1]

LBF_Q61
During the past 52 weeks, how many weeks did you do any work at a job or a business? (Include paid vacation leave, paid maternity leave, and paid sick leave.)

  • (insert respondent answer between 1 and 52)
  • Respondents aged 15 to 75 who were employed at a job or business during the previous week, or who were employed at a job or business at some point during the previous 12 months [LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q21 = 1]
  • If LBF_Q61 = 52, go to LBF_END. If LBF_Q61 = 51, go to LBF_Q71A.

LBF_Q71
[During the past 52 weeks / That leaves [52 - LBF_Q61] weeks. During those [52 - LBF_Q61] weeks], how many weeks were you looking for work?

  • Interviewer: Minimum is 0; maximum is 52.
  • (insert respondent answer between 0 and 52)
  • Respondents aged 15 to 75 who were employed for less than 52 weeks during the previous 52 weeks, or who tried to find work during the previous 12 months, or who were not employed during the previous 12 months and tried to find work during the previous 4 weeks [LBF_Q61 <> 52 or LBF_Q22 = 1 or LBF_Q21 <> 1 and LBF_Q11 = 1]
  • If LBF_Q61 = (DK or RF) or LBF_Q71 = (DK or RF), go to LBF_END. If LBF_Q61 + LBF_Q71 = 52, go to LBF_END. If LBF_Q61 and LBF_Q71 were answered, [WEEKS] = [52 - (LBF_Q61 + LBF_Q71)]. If LBF_Q61 was not answered, [WEEKS] = (52 - LBF_Q71).

LBF_Q71A
That leaves 1 week. During that week, did you look for work?

  1. Yes (set LBF_Q71 = 1)
  2. No (set LBF_Q71 = 0)
  • Respondents 15 to 75 years of age who were employed during the previous week,or who were employed at some point during the previous 12 months for 51 of 52 weeks
  • If LBF_Q61 = (Don’t Know or Refused) or LBF_Q71 = (Don’t Know or Refused), go to LBF_END. If LBF_Q61 + LBF_Q71 = 52, go to LBF_END. If LBF_Q61 and LBF_Q71 were answered, [WEEKS] = [52 - (LBF_Q61 + LBF_Q71)]. If LBF_Q61 was not answered, [WEEKS] = (52 - LBF_Q71).

LBF_Q72
That leaves [# Weeks] week[s] during which you were neither working nor looking for work. Is that correct?

  1. Yes
  2. No
  • Respondents 15 to 75 years of age who, during the last 52 weeks, have a certain number weeks during which they were neither working nor looking for work. [(LBF_Q61 < 52 and LBF_Q71 < (52 - LBF_Q61)) or ((LBF_Q22 = 1 or LBF_Q21 <> 1 and LBF_Q11 = 1) and LBF_Q71 < 52)]
  • If (LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q11 = 1), go to LBF_Q73. Otherwise, go to LBF_END.

LBF_Q73
What is the main reason that you were not looking for work?

  • Interviewer: If more than one reason, choose the one that explains the most number of weeks.
    1. Own illness or disability
    2. Caring for - own children
    3. Caring for - elder relatives
    4. Pregnancy (Females only)
    5. Other personal or family responsibilities
    6. Vacation
    7. Labour dispute (strike or lockout)
    8. Temporary layoff due to business conditions
    9. Seasonal layoff
    10. Casual job, no work available
    11. Work schedule (e.g., shift work)
    12. School or educational leave
    13. Retired
    14. Believes no work available (in area or suited to skills)
    15. Other - Specify
  • Respondents aged 15 to 75 who were employed during the previous week, or who tried to find work during the previous 4 weeks, or who were neither working nor looking for work during the time period they were not employed [Respondents who answered (LBF_Q01 = 1 or LBF_Q02 = 1 or LBF_Q11 = 1) and LBF_Q72 <> 2]
  • If LBF_Q73 = 15 (Other), go to LBF_S73. Otherwise, If LBF_Q73 = 1 (Own illness or disability), go to LBF_Q74. Otherwise, go to LBF_END.

LBF_S73

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents 15 to 75 years of age who were employed during the previous week or who were employed at some point during the previous 12 months but had a period when they were neither working nor looking for work and stated "Other" as the main reason they did not look for work [LBF_Q73 = 15]
  • If LBF_Q73 = 1 (Own illness or disability), go to LBF_Q74. Otherwise, go to LBF_END.

LBF_Q74
Was that due to your physical health, to your emotional or mental health, to your use of alcohol or drugs, or to another reason?

  1. Physical health
  2. Emotional or mental health (including stress)
  3. Use of alcohol or drugs
  4. Another reason
    Respondents aged 15 to 75 who were not looking for work because of their own illness or disability [LBF_Q73 = 1]

LBF_END


Sociodemographic Characteristics (SDC)

SDC_R11
Now some general background questions which will help us compare the health of people in Canada. (It is important that we get this information from each individual that we interview, even those in the same family.)

SDC_Q11
In what country were you born?

  1. Canada   (Go to SDC_Q21)
  2. China
  3. France
  4. Germany
  5. Greece
  6. Guyana
  7. Hong Kong
  8. Hungary
  9. India
  10. Italy
  11. Jamaica
  12. Netherlands / Holland
  13. Philippines
  14. Poland
  15. Portugal
  16. United Kingdom
  17. United States
  18. Vietnam
  19. Sri Lanka
  20. Other - Specify
    Don’t Know, Refused (Go to SDC_Q21)
  • All respondents
  • If SDC_Q11 = 20, go to SDC_S11. Otherwise, go to SDC_Q12.

SDC_S11

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who selected ‘Other’ as the country of their birth [SDC_Q11 = 20]

SDC_Q12
Were you born a Canadian citizen?

  1. Yes (Go to SDC_Q21)
  2. No
    Don’t Know, Refused (Go to SDC_Q21)
    Respondents born outside Canada [SDC_Q11 > 1]

SDC_Q13
In what year did you first come to Canada to live?

  • Interviewer: Minimum is [year of birth]; maximum is [current year].
  • (insert respondent answer between year of birth and current year)
  • Respondents born outside Canada who were not born as a Canadian citizen [SDC_Q12 = 2]

SDC_Q21
To which ethnic or cultural groups did your ancestors belong? (For example: French, Scottish, Chinese, East Indian)

  • Interviewer: Mark all that apply.
  • If “Canadian” is the only response, probe. If the respondent hesitates, do not suggest Canadian. If the respondent answers “Eskimo”, enter “20”.
    1. Canadian
    2. French
    3. English
    4. German
    5. Scottish
    6. Irish
    7. Italian
    8. Ukrainian
    9. Dutch (Netherlands)
    10. Chinese
    11. Jewish
    12. Polish
    13. Portuguese
    14. South Asian (e.g. East Indian, Pakistani, Sri Lankan)
    15. Norwegian
    16. Welsh
    17. Swedish
    18. North American Indian
    19. Métis
    20. Inuit
    21. Other - Specify
  • All respondents
  • If SDC_Q21 = 21 (Other), go to SDC_S21. Otherwise, go to SDC_Q22.

SDC_S21

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who selected 'Other' for the ethnic or cultural group that their ancestors belonged to [SDC_Q21 = 21]

SDC_Q22
Are you an Aboriginal person, that is, North American Indian, Métis or Inuit?

  1. Yes
  2. No (Go to SDC_Q24)
    Don’t Know, Refused (Go to SDC_Q31)
    All respondents

SDC_Q23
Are you:

  • Interviewer: Read categories to respondent. Mark all that apply.
  • If respondent answers “Eskimo”, enter “3”.
    1. ...North American Indian?
    2. ...Métis?
    3. ...Inuit?
  • Respondents who are Aboriginal persons [SDC_Q22 = 1]
  • Go to SDC_Q31.

SDC_Q24
People living in Canada come from many different cultural and racial backgrounds.  Are you:

  • Interviewer: Read categories to respondent. Mark all that apply.
    1. ...White?
    2. ...Chinese?
    3. ...South Asian (e.g., East Indian, Pakistani, Sri Lankan)?
    4. ...Black?
    5. ...Filipino?
    6. ...Latin American?
    7. ...Southeast Asian (e.g., Cambodian, Indonesian, Laotian, Vietnamese)?
    8. ...Arab?
    9. ...West Asian (e.g., Afghan, Iranian)?
    10. ...Japanese?
    11. ...Korean?
    12. Other - Specify
  • Respondents who are not Aboriginal persons [SDC_Q22 = 2]
  • If SDC_Q24 = 12 (Other), go to SDC_S24. Otherwise, go to SDC_Q31.

SDC_S24

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who selected 'Other' for their cultural and racial background [Respondents who answered SDC_Q24 = 12]

SDC_Q31
In what languages can you conduct a conversation?

  • Interviewer: Mark all that apply.
    1. English
    2. French
    3. Arabic
    4. Chinese
    5. Cree
    6. German
    7. Greek
    8. Hungarian
    9. Italian
    10. Korean
    11. Persian (Farsi)
    12. Polish
    13. Portuguese
    14. Punjabi
    15. Spanish
    16. Tagalog (Pilipino)
    17. Ukrainian
    18. Vietnamese
    19. Dutch
    20. Hindi
    21. Russian
    22. Tamil
    23. Other - Specify
  • All respondents
  • If SDC_Q31 = 23 (Other), go to SDC_S31. Otherwise, go to SDC_Q32.

SDC_S31

  • Interviewer: Specify
  • (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who selected 'Other' as a language in which they are able to conduct a conversation [SDC_Q31 = 23]

SDC_Q32
What language do you speak most often at home?

  1. English
  2. French
  3. Arabic
  4. Chinese
  5. Cree
  6. German
  7. Greek
  8. Hungarian
  9. Italian
  10. Korean
  11. Persian (Farsi)
  12. Polish
  13. Portuguese
  14. Punjabi
  15. Spanish
  16. Tagalog (Pilipino)
  17. Ukrainian
  18. Vietnamese
  19. Dutch
  20. Hindi
  21. Russian
  22. Tamil
  23. Other - Specify
  • All respondents
  • If SDC_Q32 = 23 (Other), go to SDC_S32. Otherwise, go to SDC_Q33.

SDC_S32

  • Interviewer: Specify
  • (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who selected 'Other' as the language that they speak most often at home [Respondents who answered SDC_Q32 = 23]

SDC_Q33
What is the language that you first learned at home in childhood and can still understand?

  • Interviewer: Mark all that apply.
  • If person can no longer understand the first language learned, mark the second.
    1. English
    2. French
    3. Arabic
    4. Chinese
    5. Cree
    6. German
    7. Greek
    8. Hungarian
    9. Italian
    10. Korean
    11. Persian (Farsi)
    12. Polish
    13. Portuguese
    14. Punjabi
    15. Spanish
    16. Tagalog (Pilipino)
    17. Ukrainian
    18. Vietnamese
    19. Dutch
    20. Hindi
    21. Russian
    22. Tamil
    23. Other - Specify
  • All respondents
  • If SDC_Q33 = 23 (Other), go to SDC_S33. Otherwise, go to SDC_END.

SDC_S33

  • Interviewer: Specify
  • (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who selected 'Other' as the language that they first learned at home in childhood and can still understand [SDC_Q33 = 23]

SDC_END


Education (EDU)

If age < 15, go to EDU_END. Otherwise, go to EDU_R01.

EDU_R01
Next, education.

EDU_Q01
Are you currently attending a school, college or university?

  1. Yes
  2. No (Go to EDU_END)
    Don’t Know, Refused (Go to EDU_END)
    Respondents aged 15 and over

EDU_Q02
Are you enrolled as a full-time student or as a part-time student?

  1. Full-time
  2. Part-time
    Respondents aged 15 and over who are currently attending a school, college or university [EDU_Q01 = 1]

EDU_END

Income (INC)

If two persons selected in the household and age of current respondent > 11 and age of current respondent <15, go to INC_END.

INC_R11
Although many health expenses are covered by [provincial/territorial] health insurance, there is still a relationship between health and income. Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.

INC_Q11
Thinking about the total income for all household members, from which of the following sources did your household receive any income in the past 12 months?

  • Interviewer: Read categories to respondent. Mark all that apply.
    1. Wages and salaries
    2. Income from self-employment
    3. Dividends and interest (e.g., on bonds, savings)
    4. Employment insurance
    5. Worker’s compensation
    6. Benefits from Canada or Quebec Pension Plan
    7. Retirement pensions, superannuation and annuities
    8. Old Age Security and Guaranteed Income Supplement
    9. Child Tax Benefit
    10. Provincial or municipal social assistance or welfare
    11. Child support
    12. Alimony
    13. Other (e.g., rental income, scholarships)
    14. None (Go to INC_Q21)
      Don’t Know, Refused (Go to INC_END)
  • One adult respondent per household
  • If more than one source of income is indicated, go to INC_Q12. Otherwise, go to INC_Q21.

INC_Q12
What was the main source of income?

  1. Wages and salaries
  2. Income from self-employment
  3. Dividends and interest (e.g., on bonds, savings)
  4. Employment insurance
  5. Worker’s compensation
  6. Benefits from Canada or Quebec Pension Plan
  7. Retirement pensions, superannuation and annuities
  8. Old Age Security and Guaranteed Income Supplement
  9. Child Tax Benefit
  10. Provincial or municipal social assistance or welfare
  11. Child support
  12. Alimony
  13. Other (e.g., rental income, scholarships)
    One adult respondent in a household that has reported more than one source of household income

INC_Q21
What is your best estimate of the total income, before taxes and deductions, of all household members from all sources in the past 12 months?

  • (insert respondent answer between 0 and 500,000)(Go to INC_END)
    0 (Go to INC_END)
  • Don’t Know, Refused (Go to INC_Q22)
  • One adult respondent in a household that has reported household income

INC_Q22
Can you estimate in which of the following groups your household income falls? Was the total household income less than $20,000 or $20,000 or more?

  1. Less than $20,000
  2. $20,000 or more (Go to INC_Q26)
  3. No income (Go to INC_END)
    Don’t Know, Refused (Go to INC_END)
    One adult respondent in a household that has reported household income where the amount was unspecified

INC_Q23
Was the total household income from all sources less than $10,000 or $10,000 or more?

  1. Less than $10,000
  2. $10,000 or more (Go to INC_Q25)
    Don’t Know, Refused (If age < 15, go to INC_END)
    One adult respondent in a household that has reported an unspecified household income amount of less than $20,000 [INC_Q22 = 1]

INC_Q24
Was the total household income from all sources less than $5,000 or $5,000 or more?

  1. Less than $5,000
  2. $5,000 or more
    One adult respondent in a household that has reported an unspecified household income amount of less than $10,000 [INC_Q23 = 1]
    If age < 15, go to INC_END.

INC_Q25
Was the total household income from all sources less than $15,000 or $15,000 or more?

  1. Less than $15,000
  2. $15,000 or more
    One adult respondent in a household that has reported an unspecified household income amount greater than $10,000 and less than $20,000 [INC_Q23 = 2]
    If age < 15, go to INC_END

INC_Q26
Was the total household income from all sources less than $40,000 or $40,000 or more?

  1. Less than $40,000
  2. $40,000 or more (Go to INC_Q28)
    Don’t Know, Refused (If age < 15, go to INC_END)
    One adult respondent in a household that has reported an unspecified household income amount greater than $20,000 [INC_Q22 = 2]

INC_Q27
Was the total household income from all sources less than $30,000 or $30,000 or more?

  1. Less than $30,000
  2. $30,000 or more
    If age < 15, go to INC_END
    One adult respondent in a household that has reported an unspecified household income amount greater than $20,000 and less than $40,000 [INC_Q26 = 1]

INC_Q28
Was the total household income from all sources:

  • Interviewer: Read categories to respondent.
    1. ...less than $50,000?
    2. ...$50,000 to less than $60,000?
    3. ...$60,000 to less than $80,000?
    4. ...$80,000 to less than $100,000?
    5. ...$100,000 or more?
  • One adult respondent in a household that has reported an unspecified household income amount greater than $40,000 [INC_Q26 = 2]
  • If age < 15, go to INC_END.

INC_Q31
What is your best estimate of your total personal income, before taxes and other deductions, from all sources in the past 12 months?

  • (insert respondent answer between 0 and 500,000) (Go to INC_END)
    0 (Go to INC_END)
    Don’t Know, Refused (Go to INC_Q32)
  • Respondents aged 15 and over [Age > 14 + INC_Q22 = (1, 2)]

INC_Q32
Can you estimate in which of the following groups your personal income falls? Was your total personal income less than $20,000 or $20,000 or more?

  1. Less than $20,000
  2. $20,000 or more (Go to INC_Q36)
  3. No income (Go to INC_END)
    Don’t Know, Refused (Go to INC_END)
    Respondents aged 15 and over who have reported an unspecified personal income amount [Age > 14 + INC_Q22 = (1, 2)]

INC_Q33
Was your total personal income less than $10,000 or $10,000 or more?

  1. Less than $10,000
  2. $10,000 or more (Go to INC_Q35)
    Don’t Know, Refused (Go to INC_END)
    Respondents aged 15 and over who have reported an unspecified personal income amount less than $20,000 [Age > 14 + INC_Q32 = 1]

INC_Q34
Was your total personal income less than $5,000 or $5,000 or more?

  1. Less than $5,000
  2. $5,000 or more
    Respondents aged 15 and over who have reported an unspecified personal income amount less than $10,000 [Age > 14 +answered INC_Q33 = 1]
    Go to INC_END.

INC_Q35
Was your total personal income less than $15,000 or $15,000 or more?

  1. Less than $15,000
  2. $15,000 or more
    Respondents aged 15 and over who have reported an unspecified personal income amount greater than $10,000 and less than $20,000 [Age > 14 + INC_Q33 = 2]
    Go to INC_END.

INC_Q36
Was your total personal income less than $40,000 or $40,000 or more?

  1. Less than $40,000
  2. $40,000 or more (Go to INC_Q38)
    Don’t Know, Refused (Go to INC_END)
    Respondents aged 15 and over who have reported an unspecified personal income amount greater than $20,000 [Age > 14 + INC_Q32 = 2]

INC_Q37
Was your total personal income less than $30,000 or $30,000 or more?

  1. Less than $30,000
  2. $30,000 or more
    Respondents aged 15 and over who have reported an unspecified personal income amount greater than $20,000 and less than $40,000 [Age > 14 + INC_Q36 = 1]
    Go to INC_END.

INC_Q38
Was your total personal income:

  • Interviewer: Read categories to respondent.
    1. ...less than $50,000?
    2. ...$50,000 to less than $60,000?
    3. ...$60,000 to less than $80,000?
    4. ...$80,000 to less than $100,000?
    5. ...$100,000 or more?
  • Respondents aged 15 and over who have reported an unspecified personal income amount greater than $40,000 [Age > 14 + INC_Q36 = 2]

INC_END


Administration (ADM)

ADM_N31

  • Interviewer: Is this a fictitious name for the respondent?
    1. Yes
    2. No (Go to ADM_N35)
      Don’t Know (Go to ADM_N35)
  • Note: Refused is not allowed.
  • All respondents

ADM_N32

  • Interviewer: Remind respondent about the importance of getting correct names.
  • Do you want to make corrections to:
    1. first name only?
    2. last name only? (Go to ADM_N34)
    3. both names?
    4. no corrections? (Go to ADM_N35)
  • Note: Don’t Know, Refused are not allowed.
  • Respondents who used a fictitious name during the interview

ADM_N33

  • Interviewer: Enter the first name only.
  • (insert respondent answer to a maximum of 25 characters)
  • Note: Don’t Know, Refused are not allowed.
  • If ADM_N32 does not equal “both names”, go to ADM_N35.
  • Respondents who used a fictitious first name, or first and last name, during the interview

ADM_N34

  • Interviewer: Enter the last name only.
  • (insert respondent answer to a maximum of 25 characters)
  • Note: Don’t Know, Refused are not allowed.
  • Respondents who used a fictitious last name, or first and last name, during the interview

ADM_N35

  • Interviewer: Was this interview conducted on the telephone or in person?
    1. On telephone
    2. In person
    3. Both
  • Note: Don’t Know and Refused are not allowed.
  • All respondents
  • If age < 12, go to ADM_N38.

ADM_N36

  • Interviewer: Was the respondent alone when you asked the health component questions?
    1. Yes (Go to ADM_N38)
    2. No
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 12 and over

ADM_N37

  • Interviewer: Do you think that the answers of the respondent were affected by someone else being there?
    1. Yes
    2. No
  • Note: Don’t Know and Refused are not allowed.
  • Respondents aged 12 and over who were not alone when asked the health component questions

ADM_N38

  • Interviewer: Select the language of interview.
    1. English
    2. French
    3. Chinese
    4. Italian
    5. Punjabi
    6. Spanish
    7. Portuguese
    8. Polish
    9. German
    10. Vietnamese
    11. Arabic
    12. Tagalog
    13. Greek
    14. Tamil
    15. Cree
    16. Afghan
    17. Cantonese
    18. Hindi
    19. Mandarin
    20. Persian (Farsi)
    21. Russian
    22. Ukrainian
    23. Urdu
    24. Inuktitut
    25. Hungarian
    26. Korean
    27. Serbo-Croatian
    28. Gujarati
    29. Dari
    30. Other - Specify
  • Note: Don’t Know and Refused are not allowed.
  • All respondents
  • If ADM_N38 does not equal 90, go to ADM_END.

ADM_S38

  • Interviewer: Specify (insert respondent answer to a maximum of 80 characters)
  • Note: Don’t Know and Refused are not allowed.
  • Respondents who were interviewed in a language other than those listed [Respondents who answered ADM_N38 = 90]

ADM_END

Thank You (TY)

TY_R01
Thank you for your participation in the Canadian Health Measures Survey.

  • Interviewer: Press <Enter> to continue.
  • Note: Don’t Know and Refused are not allowed.
TY_END