Canadian Health Measures Survey

2009 to 2011

Household Questionnaire

Explanatory notes for this document
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 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)
Chronic conditions (CCC)
Phlegm (PLM)
Family medical history (FMH)
Hepatitis (HEP)
Human Papillomavirus Vaccine (HPV)
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)
Pap Smear Questions (PAP)
Maternal 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) © Robert Goodman
Request for child to return (RCR)
Exposure to second-hand smoke (ETS)
Housing characteristics (HSC)
Hobbies (HOB)
Labour force (LBF)
Socio-demographic characteristics (SDC)
Education (EDU)
Income (INC)
Administration information (ADM)

Explanatory notes for this document

The “Contact (CN)” through “Person providing information (PPI)” entries in the Table of Contents represent the roster modules. The roster modules provide basic demographic information about the household and its occupants, and select the respondents for the health interview portion of the survey. The other entries in the Table of Contents, starting with “General health (GEN)”, represent the main health modules of the household interview component of the Canadian Health Measures Survey (CHMS).
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.
Question text in bold font enclosed by brackets () is read to the respondent at the discretion of the person asking the questions.
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.
Question text enclosed in square brackets [ ] is dynamic and in most cases will vary depending on the age and sex of the respondent.
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.
In this document, the flow direction from a given response is not provided when it is to the next immediate 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?

English (Go to LP_END)
French (Go to LP_END)
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 does not equal 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

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.
1. Single detached
2. Double
3. Row or Terrace
4. Duplex
5. Low-rise apartment (fewer than 5 stories) or flat
6. High-rise apartment (5 stories or more)
7. Institution
8. Hotel; rooming/lodging house; camp
9. Mobile home
10. Other - Specify
If DW_N02 does not equal 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?

TN_END

Mortgage (MTGE)

MTGE_Q01
Is there a mortgage on this dwelling?

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?

Yes
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?

Yes
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, and 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.
1. … married?
2. … living common-law?
3. … widowed?
4. … separated?
5. … divorced?
6. … single, never married?

MSWC_END

Education (ED)

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

Grade 8 or lower (Québec: Secondary II or lower) (Go to ED_Q03)
Grade 9 - 10 (Québec: Secondary III or IV, Newfoundland and Labrador: 1st year of secondary) (Go to ED_Q03)
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)?

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

Yes
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?

No post-secondary degree, certificate or diploma
Trade certificate or diploma from a vocational school or apprenticeship training
Non-university certificate or diploma from a community college, CEGEP, school of nursing, etc.
University certificate below bachelor’s level
Bachelor’s degree
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?

Yes
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):

… birth father/mother?
… step father/mother?
… adoptive father/mother?

RWC_Q3B
What is the relationship

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

Is that a(n):

… birth son/daughter?
… step son/daughter?
… adopted son/daughter?

RWC_Q3C
What is the relationship

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

Is that a(n):

… full brother/sister?
… half brother/sister?
… step brother/sister?
… adopted brother/sister?
… foster brother/sister?

RWC_Q3D
What is the relationship

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

Is that a:

… father/mother-in-law?
… son/daughter-in-law?
… brother/sister-in-law?
… other in-law?

RWC_Q3E
What is the relationship

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

Is that a(n):

… uncle/aunt?
… cousin?
… nephew/niece?
… 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)?
All respondents
If proxy interview, go to GEN_Q15

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

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

GEN_Q15
If AGE is less than 15 and it is a proxy interview, go to GEN_Q20.
Otherwise, if AGE is less than 15 and it is a non-proxy interview, go to GEN_Q18.

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?
If proxy interview, go to GEN_Q20.
Otherwise, if AGE is less than 15 or AGE is greater than 75, go to GEN_Q18.
Respondents aged 15 and over

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

Yes
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

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

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

GEN_Q20
Do you have a regular medical doctor?

Yes
No
All respondents

GEN_END

Pregnancy (PRS)

If SEX is male or AGE is less than 14 or greater than 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?

Yes
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 24.0)
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 indicated the number of hours they slept

SLP_Q13
How long have you had this trouble?

Less than 2 weeks
2 weeks to less than 6 months
6 months to less than one year
1 year to less than 2 years
2 years or more

Respondents who have trouble sleeping most or all of the time

SLP_Q14
If AGE is less than 6, go to SLP_Q16.

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 aged 6 and over who indicated the number of hours they slept

SLP_Q15
How long has your sleep not been refreshing?

Less than 2 weeks
2 weeks to less than 6 months
6 months to less than one year
1 year to less than 2 years
2 years or more

Respondents aged 6 and over who never or rarely find their sleep refreshing

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.

Never (Go to SLP_END)
Rarely (Go to SLP_END)
Sometimes (Go to SLP_END)
Most of the time
All of the time
Don’t Know, Refused (Go to SLP_END)

Respondents who indicated the number of hours they slept

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

Less than 2 weeks
2 weeks to less than 6 months
6 months to less than one year
1 year to less than 2 years
2 years or more

Respondents who find it difficult to stay awake most or all of the time

SLP_END

Height and weight (HWT)

HWT_Q1
The next questions are about height and weight. How tall are you without shoes on?

Interviewer: Is that in feet and inches or in centimetres?
1. Feet and inches
2. Centimetres (Go to HWT_N1C)
  Don’t Know, Refused (Go to HWT_B3)

All respondents

HWT_N1A

Interviewer: Enter feet only.

(insert respondent answer between 0 and 7)
Note: Don’t Know and Refused are not allowed.
Respondents who provided height in feet and inches

HWT_N1B

Interviewer: Enter inches only, to the nearest quarter of an inch.
(insert respondent answer between 0 and 95.75)
Note: Don’t Know and Refused are not allowed.
Respondents who provided height in feet and inches

HWT_N1C

Interviewer: Record the height to the nearest half centimetre.
(insert respondent answer between 40.0 and 244.0)
Note: Don’t Know and Refused are not allowed.
Respondents who provided height in centimetres

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)
All respondents
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?
Non-proxy respondents who provided weight

HWT_END

Weight change (WTC)

If AGE is less than 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_Q11
How much did you weigh a year ago?

Interviewer: Enter amount only.
(insert respondent answer between 1 and 575)
Don’t Know, Refused (Go to WTC_Q21)
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_Q12
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 go to WTC_Q21.

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

Yes
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

WTC_Q21
If AGE is less than 28, go to WTC_Q22.

How much did you weigh 10 years ago?

Interviewer: Enter amount only.
(Insert respondent answer between 1 and 575)
Don’t Know, Refused (Go to WTC_Q22)
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

WTC_Q22
If AGE is less than 27 or equal to 35, go to WTC_Q23.

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_Q23)
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_Q23
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_Q24)
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)
Don’t Know, Refused (Go to WTC_Q25)
Respondents aged 18 and over

WTC_Q25
If AGE is less than 19, go to WTC_END.

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.

If WTC_Q12 is equal to 1 or 2, go to WTC_Q28.

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

Yes
No (Go to WTC_END)
Don’t Know, Refused (Go to WTC_END)
Respondents aged 19 and over who have not had a weight change of at least 10 pounds (4 kilograms) between their current weight and their weight one year ago

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 who have had a weight change of at least 10 pounds (4 kilograms) between their current weight and their weight one year ago

WTC_END

Meat 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.
(insert 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_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)

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 (Go to MDC_S12)
Go to MDC_B13.
Respondents who consume milk or enriched milk substitutes

MDC_S12

Interviewer: Specify.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
Respondents who consume milk or enriched milk substitutes and answered “other” for kind of milk they usually drink or use on cereal

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)

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 is equal to 0, go to GFV_B17.
If GFV_B15 is equal to “Don’t Know” or “Refused”, 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 rice

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)

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)

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
If WSD_B21 is equal to 0, go to WSD_ Q23.
If WSD_B21 is equal to “Don’t Know” or “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?

Interviewer: Read categories to respondent.
1. Tap water
2. Bottled water
3. Other – Specify (Go to WSD_S22)
Go to WSD_Q23.
Respondents who drink water

WSD_S22

Interviewer: Specify.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
Respondents who drink water and answered “other” for primary source of drinking water

WSD_Q23
If two persons selected in the household and age of current respondent is greater than 11, go to WSD_END.

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 (Go to WSD_S23)
  Don’t Know, Refused (Go to WSD_END)
  Go to WSD_Q24.
  One respondent per household

WSD_S23
Interviewer: Specify.

(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
One respondent per household who answered “other” for source of tap water in this home

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. … boiling?
6. … distilling?
7. Other – Specify (Go to WSD_S24)
8. No treatment
  go to WSD_END.
  One respondent per household

WSD_S24
Interviewer: Specify.

(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
One respondent per household who answered “other” for the method of water treatment in this home

WSD_END

Salt consumption (SLT)

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 (Go to SLT_Q13)
Don’t Know, Refused (Go to SLT_Q13)
All respondents

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 (Go to SLT _S12)
  Go to SLT_Q13.
Respondents who consume salt

SLT_S12

Interviewer: Specify.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
Respondents who consume salt and who answered “other” for type of salt usually used

SLT_Q13
If two persons selected in the household and age of current respondent is greater than 11, go to SLT_END.

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 is less than 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 (Go to PAC_S11V)
23. No physical activity (Go to PAC_R21)
Don’t Know, Refused (Go to PAC_END)
Go to PAC_Q12.
Respondents aged 12 and over

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 did at least one other physical activity

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

Yes
No (Go to PAC_Q12)
Don’t Know, Refused (Go to PAC_Q12)
Respondents aged 12 and over who did at least one other physical activity

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 who did two other physical activities

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

Yes
No (Go to PAC_Q12)
Don’t Know, Refused (Go to PAC_Q12)
Respondents aged 12 and over who did two other physical activities

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)
For each activity identified in PAC_Q11, PAC_S11V, PAC_S11X and PAC_S11Y, ask PAC_Q12 and PAC_Q13.
Respondents aged 12 and over who did three other physical activities

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 participated in physical activities

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

1 to 15 minutes
16 to 30 minutes
31 to 60 minutes
More than one hour
Respondents aged 12 and over who participated in physical activities

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?

None
Less than 1 hour
From 1 to 5 hours
From 6 to 10 hours
From 11 to 20 hours
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?

None
Less than 1 hour
From 1 to 5 hours
From 6 to 10 hours
From 11 to 20 hours
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 is greater than 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 [your child] spent 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
If AGE is less than 6, go to CPA_Q15.
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 6 to 11

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. 7or more hours per week
Respondents aged 6 to 11

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?

Never
Less than 2 hours per week
2 to 3 hours per week
4 to 6 hours per week
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?

Never
Less than 2 hours per week
2 to 3 hours per week
4 to 6 hours per week
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?

Doesn’t watch TV or videos or play video games
Less than 1 hour a day
1 to 2 hours a day
3 to 4 hours a day
5 to 6 hours a day
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.)?

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

CPA_END

Sedentary activities (SAC)

If AGE is less than 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. Enter time in hours to the nearest half hour.
(insert respondent answer between 0 and 95.5)
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?
Interviewer: Enter time in hours to the nearest half hour.
(insert respondent answer between 0 and 95.5)
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, DVDs or videos?
Interviewer: Enter time in hours to the nearest half hour.
(insert respondent answer between 0 and 95.5)
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, and homework. Enter time in hours to the nearest half hour.
(insert respondent answer between 0 and 95.5)
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?

None (Go to SEB_END)
Less than 30 minutes (Go to SEB_END)
30 to 59 minutes
1 hour to less than 2 hours
2 hours to less than 3 hours
3 hours to less than 4 hours
4 hours to less than 5 hours
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?

Always
Often
Sometimes
Rarely
Never
Respondents who spent 30 minutes or more in the sun on a typical weekend or day off

SEB_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?

Yes
No (Go to CCC_Q21)
Don’t Know (Go to CCC_Q21)
Refused (Go to CCC_END)
All respondents

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_Q13
Have you had any asthma symptoms or asthma attacks in the past 12 months?

Yes
No
Respondents who have asthma

CCC_Q21
If AGE is less than 6, go to CCC_Q41.
If AGE is between 6 and 11, go to CCC_Q31.

Do you have fibromyalgia?

Yes
No
Respondents aged 12 and over

CCC_Q22
Do you have arthritis or rheumatism, excluding fibromyalgia?

Yes
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?

Rheumatoid arthritis
Osteoarthritis
Rheumatism
Other - Specify (Go to CCC_S23)
Go to CCC_Q24.
Respondents aged 12 and over who have arthritis excluding fibromyalgia

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 excluding fibromyalgia

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

Yes
No
If AGE is between 12 and 39, go to CCC_Q31.
Respondents aged 12 and over

CCC_Q25
Do you have osteoporosis?

Yes
No
Respondents aged 40 and over

CCC_Q31
Remember, we’re interested in conditions diagnosed by a health professional.

Do you have high blood pressure?

Yes
No
Respondents aged 6 and over

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

Yes
No
Respondents aged 6 and over

CCC_Q33
Have you ever had your blood cholesterol measured?

Yes
No (Go to CCC_Q41)
Don’t Know, Refused (Go to CCC_Q41)
Respondents aged 6 and over

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

Yes
No
Respondents aged 6 and over who have had their blood cholesterol measured

CCC_Q41
Remember, we’re interested in conditions diagnosed by a health professional.

Do you have chronic bronchitis?

Yes
No (Go to CCC_Q43)
Don’t Know, Refused (Go to CCC_Q43)
All respondents

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_Q43
If AGE is less than 30, go to CCC_Q51.

Do you have emphysema?

Yes
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_Q45
Do you have chronic obstructive pulmonary disease (COPD)?

Yes
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

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

Yes
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 is equal to 3, go to CCC_Q61.
Respondents who have diabetes

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_Q61
Do you have heart disease?

Yes
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_Q63
Have you ever been told by a health professional that you have had a heart attack?

Yes
No
All respondents

CCC_Q71
Remember, we’re interested in conditions diagnosed by a health professional.

Do you have cancer?

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

CCC_Q72
Have you ever been diagnosed with cancer?

Yes
No (Go to CCC_Q81)
Don’t Know, Refused (Go to CCC_Q81)
Respondents who do not currently have cancer

CCC_Q73
How old were you when this was first diagnosed?

Interviewer: Maximum is AGE.
(insert respondent answer between 0 and 79)
If SEX is male, go to CCC_Q75.
Respondents who have ever been diagnosed with cancer

CCC_Q74
What type of cancer do/did you have?

Interviewer: Mark all that apply.
1. Breast
2. Colorectal
3. Skin - Melanoma
4. Skin - Non-melanoma
5. Ovarian
6. Cervical
7. Uterine
8. Other - Specify (Go to CCC_S74)
Go to CCC_Q81.
Female respondents who have ever been diagnosed with cancer

CCC_S74

Interviewer: Specify.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
Go to CCC_Q81.
Female respondents who have ever been diagnosed with cancer

CCC_Q75

What type of cancer do / did you have?

Interviewer: Mark all that apply.
1. Prostate
2. Colorectal
3. Skin - Melanoma
4. Skin - Non-melanoma
  Other - Specify (Go to CCC_S75)
  Go to CCC_Q81
Male respondents who have ever been diagnosed with cancer

CCC_S75

Interviewer: Specify.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
Male respondents who have ever been diagnosed with cancer

CCC_Q81
If AGE is less than 12, go to CCC_Q83.
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?

Yes
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?

Yes
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 (Go to CCC_S85)
  Go to CCC_Q91.
Respondents who have a learning disability

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_Q91
AGE is less than 6, go to CCC_Q95.
Remember, we’re interested in conditions diagnosed by a health professional.
Do you have an eating disorder such as anorexia or bulimia?

Yes
No
Respondents aged 6 and over

CCC_Q92
If AGE is less than 12, go to CCC_Q95.
Do you suffer from kidney dysfunction or disease?

Yes
No
Respondents aged 12 and over

CCC_Q93
Do you have liver disease or gallbladder problems?

Yes
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. If respondent says gall bladder was removed and no other response to this question is provided, return to CCC_Q93 and enter "No".
1. Hepatitis A (Go to CCC_Q101)
2. Hepatitis B (Go to CCC_Q101)
3. Hepatitis C (Go to CCC_Q101)
4. Jaundice
5. Cirrhosis
6. Gall Stones
7. Other - Specify (Go to CCC_S94)
Go to CCC_Q95.
Respondents aged 12 and over who have liver disease or gallbladder problems

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_Q95
Do you have hepatitis?

Yes
No (Go to CCC_Q101)
Don’t Know, Refused (Go to CCC_Q101)
All respondents

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 have hepatitis

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

Yes
No (Go to CCC_END)
All respondents

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

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?

Yes
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?

Yes
No
Respondents who, in the past year, had a cough that lasted 3 months or more where it brought up phlegm

PLM_END

Family medical history (FMH)

If there is only one person selected for 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 12 to 19 and the two selected respondents are not birth siblings 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)?

Yes
No (Go to FMH_Q13)
Don’t Know, Refused (Go to FMH_Q13)
All respondents, excluding where two household members are selected and the respondent is aged 12 to 19 and the two selected respondents are birth siblings

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)
Respondents who reported that a member of their immediate family has ever been diagnosed with heart disease

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

Yes
No (Go to FMH_Q15)
Don’t Know, Refused (Go to FMH_Q15)
All respondents, excluding where two household members are selected and the respondent is aged 12 to 19 and the two selected respondents are birth siblings

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)
Respondents who reported that a member of their immediate family has ever had a stroke

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

Yes
No (Go to FMH_Q17)
Don’t Know, Refused (Go to FMH_Q17)
All respondents, excluding where two household members are selected and the respondent is aged 12 to 19 and the two selected respondents are birth siblings

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)
Respondents who reported that a member of their immediate family has ever had high blood pressure (excluding during pregnancy)

FMH_Q17
Has anyone in your immediate family ever had arthritis?

Yes
No (Go to FMH_Q19)
Don’t Know, Refused (Go to FMH_Q19)
All respondents, excluding where two household members are selected and the respondent is aged 12 to 19 and the two selected respondents are birth siblings

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)
Respondents who reported that a member of their immediate family has ever had arthritis

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

Yes
No (Go to FMH_Q23)
Don’t Know, Refused (Go to FMH_Q23)
All respondents, excluding where two household members are selected and the respondent is aged 12 to 19 and the two selected respondents are birth siblings

FMH_Q21
Was this:

Interviewer: Read categories to respondent.
1. … insulin dependent diabetes (Type 1)?
2. … non-insulin dependent diabetes (Type 2)?
3. … both?
Respondents who reported that a member of their immediate family has ever had diabetes (excluding during pregnancy)

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)
Respondents who reported that a member of their immediate family has ever had diabetes (excluding during pregnancy)

FMH_Q23
Has anyone in your immediate family ever had asthma?

Yes
No (Go to FMH_END)
Don’t Know, Refused (Go to FMH_END)
All respondents, excluding where two household members are selected and the respondent is aged 12 to 19 and the two selected respondents are birth siblings

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

Yes
No
Respondents who reported that a member of their immediate family has ever had asthma

FMH_END

Hepatitis (HEP)

HEP_R11
The next questions are about hepatitis.

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

Yes
No
If AGE is less than or equal to (Reference Year – 1990) go to HEP_END.
All respondents

HEP_Q13B
Did you receive a blood transfusion in Canada before 1990?

Yes
No
Respondents aged 20 and over at the start of cycle 2 collection

HEP_END

Human Papillomavirus Vaccine (HPV)

SEX is male or AGE is less than 9 or greater than 39, go to HPV_END.

HPV_R11
The next few questions are about the human papillomavirus or HPV vaccine.

If AGE is greater than 13, go to HPV_Q12.

HPV_R12
An HPV vaccine is offered to girls in many schools across Canada, as early as age 9.

HPV_Q12
Have you ever received the HPV vaccine?

Yes
No (Go to HPV_END)
Don’t Know, Refused (Go to HPV_END)
Female respondents aged 9 to 39

HPV_Q13
HPV vaccinations usually come in a 3 dose series. How many doses have you received?

1 dose
2 doses
3 doses
Female respondents aged 9 to 39 who have received the HPV vaccine

HPV_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 one month ago] 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).

Yes
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)
For the first 15 prescription medications identified in MED_Q100B, ask MED_B101A through MED_B101F.
Respondents who took prescription medications during the past month

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_B101B
What is the DIN of the medication?

Interviewer: Record DIN from the bottle, tube or box.
(insert Drug Identification Number between 00000001 and 99999995)
Note: Don’t Know and Refused are not allowed.
Respondents who took prescription medication during the past month
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_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
Use trigram search.
If an entry on the source file is found, save the DIN in MED_B101B.
MED_B101D is equal to “Don’t Know” or “Refused”, go to next medication.
If MED_B101D is equal to “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_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_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.

Interviewer: Do not include vitamins and minerals here.
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)
For the first 15 over-the-counter medications identified in MED_Q200B, ask MED_B201A through MED_B201F.
Respondents who took over-the-counter medications during the past month

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_B201B
What is the DIN of the medication?

Interviewer: Record DIN from the bottle, tube or box.
(insert Drug Identification Number between 00000001 and 99999995)
Note: Don’t Know and Refused are not allowed.
Use trigram search.
If DIN found in DIN_Database, set medication name from DIN_Database. Otherwise go to MED_B201D.
Respondents who took over-the-counter medications during the past month

MED_B201C
Interviewer: The name associated with DIN [number] is [name]. Please confirm.

Yes (Go to MED_B201F)
No

Note: Don’t Know and Refused are not allowed.
Respondents who took over-the-counter medications during the past month

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)
Use trigram search.
If an entry on the source file is found, save the DIN in MED_B201B.
If MED_B201D is equal to “Don’t Know” or “Refused”, go to next medication.
If MED_B201D is equal to “Other – specify”, go to MED_B201E. Otherwise, go to
MED_B201F.
Respondents who took over-the-counter medications during the past month

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_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_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?

Yes
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)
For the first 15 health products identified in MED_Q300B, ask MED_B301A through MED_B301F.
Respondents who took health products or herbal remedies during the past month

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_B301B
What is the DIN of the health product or herbal remedy?

Interviewer: Record DIN from the bottle, tube or box.
(insert Drug Identification Number between 00000001 and 99999995)
Note: Don’t Know and Refused are not allowed.
Use trigram search.
If DIN found in DIN_Database, set medication name from DIN_Database. Otherwise go to MED_B301D.
Respondents who took health products or herbal remedies during the past month

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_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)
Use trigram search.
If an entry on the source file is found, save the DIN in MED_B301B.
If MED_B301D is equal to “Don’t Know” or “Refused”, go to next medication.
If MED_B301D is equal to “Other – specify”, go to MED_B301E. Otherwise, go to MED_B301F.
Respondents who took health products or herbal remedies during the past month

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_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_END

Health utility index (HUI)

If AGE is less than 6, go to HUI_END.

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?

Yes (Go to HUI_Q04)
No
Don’t Know, Refused (Go to HUI_END)
Respondents aged 6 and over

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?

Yes (Go to HUI_Q04)
No
Respondents aged 6 and over who are not able to read without glasses or contact lenses

HUI_Q03
Are you able to see at all?

Yes
No (Go to HUI_Q06)
Don’t Know, Refused (Go to HUI_Q06)
Respondents aged 6 and over who are not able to read with glasses or contact lenses

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?

Yes (Go to HUI_Q06)
No
Don’t Know, Refused (Go to HUI_Q06)
Respondents aged 6 and over

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?

Yes
No
Respondents aged 6 and over who are not able to recognize a friend on the other side of the street without glasses or contact lenses

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?

Yes (Go to HUI_Q10)
No
Don’t Know, Refused (Go to HUI_Q10)
Respondents aged 6 and over

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?

Yes (Go to HUI_Q08)
No
Respondents aged 6 and over who are not able to hear what is said in a group conversation without a hearing aid

HUI_Q07A
Are you able to hear at all?

Yes
No (Go to HUI_Q10)
Don’t Know, Refused (Go to HUI_Q10)
Respondents aged 6 and over who are not able to hear what is said in a group conversation with a hearing aid

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?

Yes (Go to HUI_Q10)
No
Refused (Go to HUI_Q10)
Respondents aged 6 and over with limited hearing

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?

Yes
No
Respondents aged 6 and over with limited hearing who are not able to hear what is said in a conversation in a quiet room without a hearing aid

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

Yes (Go to HUI_Q14)
No
Refused (Go to HUI_Q14)
Respondents aged 6 and over

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

Yes
No
Respondents aged 6 and over who are not able to be understood completely when speaking with strangers

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

Yes (Go to HUI_Q14)
No
Refused (Go to HUI_Q14)
Respondents aged 6 and over who are not able to be understood completely when speaking with strangers

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

Yes
No
Respondents aged 6 and over who are not able to be understood completely when speaking with those who know them well

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

Yes (Go to HUI_Q21)
No
Don’t Know, Refused (Go to HUI_Q21)
Respondents aged 6 and over

HUI_Q15
Are you able to walk at all?

Yes
No (Go to HUI_Q18)
Don’t Know, Refused (Go to HUI_Q18)
Respondents aged 6 and over who are not able to walk without difficulty or mechanical support

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

Yes
No
Respondents aged 6 and over who walk with difficulty

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

Yes
No
Respondents aged 6 and over who walk with difficulty

HUI_Q18
Do you require a wheelchair to get around?

Yes
No (Go to HUI_Q21)
Don’t Know, Refused (Go to HUI_Q21)
Respondents aged 6 and over who walk with difficulty

HUI_Q19
How often do you use a wheelchair?

Interviewer: Read categories to respondent.
1. Always
2. Often
3. Sometimes
4. Never
Respondents aged 6 and over who require a wheelchair to get around

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

Yes
No
Respondents aged 6 and over who require a wheelchair to get around

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

Yes (Go to HUI_Q25)
No
Don’t Know, Refused (Go to HUI_Q25)
Respondents aged 6 and over

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

Yes
No (Go to HUI_Q24)
Don’t Know, Refused (Go to HUI_Q24)
Respondents aged 6 and over who are not able to grasp and handle small objects

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 aged 6 and over who require the help of another person because of limitations in the use of hands or fingers

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

Yes
No
Respondents aged 6 and over who are not able to grasp and handle small objects

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?
Respondents aged 6 and over

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
Respondents aged 6 and over

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
Respondents aged 6 and over

HUI_Q28
Are you usually free of pain or discomfort?

Yes (Go to HUI_END)
No
Don’t Know, Refused (Go to HUI_END)
Respondents aged 6 and over

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 aged 6 and over who are not usually free of pain or discomfort

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 aged 6 and over who are not usually free of pain or discomfort

HUI_END

Request for parent to leave (RPL)

If AGE is less than 12 or greater than 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 aged 12 to 19

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 aged 12 to 19

RPL_END

Smoking (SMK)

If AGE is less than 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)?

Yes
No
Respondents aged 12 and over

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

Daily
Occasionally
Not at all
Respondents aged 12 and over
If SMK_Q11 is equal to 2 (No) and SMK_Q12 is equal to 3 (Not at all), go to SMK_Q60.
If SMK_Q11 is equal to “Don’t Know” or “Refused” and SMK_Q12 is equal to “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 100 or more cigarettes in their lifetime or are currently smoking

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 [SMK_Q21]; 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 100 or more cigarettes in their lifetime or are currently smoking
If SMK_Q22 is equal to 0, “Don’t Know” or “Refused”, go to SMK_Q60.

SMK_Q23
When you started smoking, 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 100 or more cigarettes in their lifetime or are currently smoking

SMK_Q24
(When you started smoking,) how many cigarettes did you usually smoke each day?

(insert respondent answer between 1 and 95)
Respondents aged 12 and over who have smoked 100 or more cigarettes in their lifetime or are currently smoking
If SMK_Q12 is equal to 1 (Daily) or 2 (Occasionally), go to SMK_R25.
Otherwise, go to SMK_Q31.

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)
Note: Use trigram search
Respondents aged 12 and over who are currently smoking daily or occasionally
If SMK_Q25 is equal to “Other”, go to SMK_S25.
Otherwise, go to SMK_Q31.

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 currently smoking daily or occasionally

SMK_Q31
If SMK_Q12 does not equal 1 (Daily), go to SMK_Q41.

How many cigarettes do you smoke each day now?
(insert respondent answer between 1 and 95)
Respondents aged 12 and over who currently smoke daily
If SMK_Q31 does not equal "EMPTY", go to SMK_Q51. If SMK_Q12 is equal to 2 (occasionally), 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 currently smoke daily or occasionally

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 currently smoke daily or occasionally

SMK_Q51
If SMK_Q12 is equal to 1 (daily) and SMK_Q23 is equal to 31 (number of days in a month), go to SMK_Q54. Otherwise, if SMK_Q12 is equal to 1 (daily) and SMK_Q23 is less than 31 (number of days in a month), go to SMK_Q52.

Have you ever smoked cigarettes daily?

Yes
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 currently smoking occasionally

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

Interviewer: Minimum is SMK_Q22; 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 currently smoking occasionally

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 currently smoking occasionally

SMK_Q54
If SMK_Q12 is equal to 1 (daily), go to SMK_Q60.

At what age did you stop smoking cigarettes completely / daily?
(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 currently smoking occasionally

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

Yes
No
Respondents aged 12 and over

SMK_END

Alcohol use (ALC)

If AGE is less than 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?

Yes
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?

Less than once a month
Once a month
2 to 3 times a month
Once a week
2 to 3 times a week
4 to 6 times a week
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

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

Never
Less than once a month
Once a month
2 to 3 times a month
Once a week
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

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

Yes
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

ALC_Q15
Starting with yesterday, how many drinks did you have?

Sunday? (insert respondent answer between 0 and 95)
Monday? (insert respondent answer between 0 and 95)
Tuesday? (insert respondent answer between 0 and 95)
Wednesday? (insert respondent answer between 0 and 95)
Thursday? (insert respondent answer between 0 and 95)
Friday? (insert respondent answer between 0 and 95)
Saturday? (insert respondent answer between 0 and 95)
Note: Ask ALC_Q15 seven times, once for each day of the week, working backwards from yesterday (for example Monday, Sunday, etc.).
Respondents aged 12 and over who have had a drink of beer, wine, liquor or any other alcoholic beverage during the past week
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?

More
About the same
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

ALC_Q17
Have you ever had a drink?

Yes
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

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

Yes
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

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.
(insert respondent answer between 5 and 79)
Respondents aged 12 and over who have ever had a drink of beer, wine, liquor or any other alcoholic beverage

ALC_END

Illicit drug use (IDU)

If proxy interview or AGE is less than 14, 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?

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

IDU_Q12
Have you ever used prescription drugs for recreational purposes?

Yes
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?

Yes
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?

Yes
No (Go to IDU_END)
Don’t Know, Refused (Go to IDU_END)
Non-proxy respondents aged 14 and over who have ever used or tried street drugs

IDU_Q15
Have you ever lent injection equipment to another person?

Yes
No
Refused (Go to IDU_END)
Non-proxy respondents aged 14 and over who have ever used or tried street drugs, who have ever injected drugs

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

Yes
No
Non-proxy respondents aged 14 and over who have ever used or tried street drugs, who have ever injected drugs

IDU_END

Sexual behaviour (SXB)

If AGE is less than 14 or if 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?

Yes
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?

Yes
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

SXB_Q13
With how many different partners?

1 partner
2 partners
3 partners
4 or more partners
Non-proxy respondents aged 14 and over who have had sexual intercourse during the past 12 months

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

Yes
No (Go to SXB_Q23)
Don’t Know, Refused (Go to SXB_Q23)
Non-proxy respondents aged 14 and over who have ever had sexual intercourse

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 (Go to SXB_S22)
Non-proxy respondents aged 14 and over who have ever been diagnosed with a sexually transmitted disease

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 been diagnosed with a sexually transmitted disease

SXB_Q23
If SXB_Q12 does not equal 1 or if MSWC_Q02 is equal to (1 (Married) or 2 (Common-law)) and SXB_Q13 is equal to 1 (one partner), go to SXB_END.

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

Yes
No
Non-proxy respondents aged 14 and over who have had sexual intercourse with more than one partner in the past 12 months

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

Yes
No
Non-proxy respondents aged 14 and over who have had sexual intercourse with more than one partner in the past 12 months

SXB_END

Pap Smear Questions (PAP)

If proxy interview or SEX_Q01 is male or AGE is less than 14, go to PAP_END.

PAP_Q11
Now a few questions about PAP tests.

Have you ever had a PAP smear test?
1. Yes
2. No (Go to PAP_Q13)
  Don’t Know, Refused (Go to PAP_END)
  Non-proxy female respondents aged 14 and over

PAP_Q12
When was the last time?

Less than 6 months ago (Go to PAP_END)
6 months to less than 1 year ago (Go to PAP_END)
1 year to less than 3 years ago (Go to PAP_END)
3 years to less than 5 years ago
5 or more years ago
Don’t Know, Refused (Go to PAP_END)
Non-proxy female respondents aged 14 and over who have ever had a pap smear test

PAP_Q13
What are the reasons that you have not had a PAP smear test in the past 3 years?

Interviewer: Mark all that apply.
1. Have not gotten around to it
2. Respondent - did not think it was necessary
3. Doctor - did not think it was necessary
4. Personal or family responsibilities
5. Not available - at time required
6. Not available - at all in the area
7. Waiting time was too long
8. Transportation - problems
9. Language - problem
10. Cost
11. Did not know where to go/uninformed
12. Fear (e.g. painful, embarrassing, find something wrong)
13. Have had a hysterectomy
14. Hate/dislike having one done
15. Unable to leave the house because of a health problem
16. Other - Specify (Go to PAP_S13)
Non-proxy female respondents aged 14 and over who have never had a pap smear test or who have not had a test in the past 3 years

Go to PAP_END

PAP_S13

Interviewer: Specify
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
Non-proxy female respondents aged 14 and over who have never had a pap smear test or who have not had a test in the past 3 years

PAP_END

Maternal breastfeeding (MBF)

If AGE is less than 14 or SEX is male or SXB_Q11 is equal to 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?

Yes
No (Go to MBF_END)
Don’t Know, Refused (Go to MBF_END)
Non-proxy female respondents aged 14 and over who have had sexual intercourse

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)
Non-proxy female respondents aged 14 and over who have given birth
If MBF_Q12 is equal to 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?

Yes
No (Go to MBF_END)
Don’t Know, Refused (Go to MBF_END)
Non-proxy female respondents aged 14 and over who have had a live birth

MBF_Q22
For how long did you breastfeed your baby?

Less than 1 week
1 to 2 weeks
3 to 4 weeks
5 to 8 weeks
9 weeks to less than 12 weeks
3 months (12 weeks to less than 16 weeks)
4 months (16 weeks to less than 20 weeks)
5 months (20 weeks to less than 24 weeks)
6 months (24 weeks to less than 28 weeks)
7 to 9 months
10 to 12 months
More than 1 year
Non-proxy female respondents aged 14 and over who breastfed their baby

MBF_END

Request for parent to return (RPR)

If AGE is less than 12 or greater than 19 or if RPL_Q13 is equal to 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 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.
Respondents aged 12 to 19 whose parent or guardian is not in the room

RPR_END

Request for child to leave (RCL)

If AGE is greater than 17 or (RPL_N11 is equal to 1 and RPR_N11 is equal to 2), 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. Please ask your parent or guardian to come and answer these next questions.
If AGE is less than 12, go to RCL_Q13.

RCL_N12

Interviewer: Is the parent or guardian available to answer the next questions?
1. Yes
2. No (Go to RCL_END)
Respondents aged 12 to 17

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.
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: Has the child left the room?
1. Yes
2. No
Note: Don’t Know and Refused are not allowed.
Parent or guardian of child respondent aged 6 to 17

RCL_END

Pregnancy information (PRG)

If AGE is greater than 11 or Person Providing Information is not a birth or biological parent, go to PRG_END.

PRG_R11
Next some question about your pregnancy with your child.

PRG_Q11
Did you smoke during your pregnancy with him?

Yes
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 whose 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 whose biological mother smoked while pregnant with respondent

PRG_END

Birth information (BIR)

If AGE is greater than 11 or person providing information is not a parent or guardian of the respondent, go to BIR_END.

BIR_R11
The following questions concern your child’s birth.

BIR_Q11
How much did he weigh at birth?

Interviewer: Record the reporting unit.
1. Pounds and Ounces
2. 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.

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

BIR_N14

Interviewer: Enter grams.
(insert respondent answer between 0 and 9995)
Note: Don’t Know and Refused are not allowed.

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

1 Before the due date
After the due date
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 or after the due date was he born?

Interviewer: If less then 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 due date

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

Single birth
Twins
Triplets
More than triplets
Parent or guardian of child respondent less than 12 years of age

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

Yes
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 whose child was admitted to a special neonatal unit or an intensive care unit immediately following birth

BIR_Q26
How old were you when he 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 is greater than 11 or person providing the information is not a birth or biological parent of the respondent, go to BRI_END.

BRI_Q11
Did you breastfeed him as an infant, even if only for a short period of time?

Yes
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?

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

BRI_Q13
For how long was he 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 whose child was breastfed by his/her biological mother as an infant

If AGE is between 6 and 11, or (if AGE is between 12 and 17 and (RCL_N11 is equal to 2 or RCL_N12 is equal to 1)), go to SDQ_R11. Otherwise, go to SDQ_END.

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
He is considerate of other people’s feelings.

Not true
Somewhat true
Certainly true
Refused (Go to SDQ_END)
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q15
He often loses his temper.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q16
He is rather solitary child, prefers to play alone. /He would rather be alone than with other youth.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q18
He has many worries or often seems worried.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17
He is helpful if someone is hurt, upset, or feeling ill.

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q20
He is constantly fidgeting or squirming.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q21
He has at least one good friend.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q23
He is often unhappy, depressed or tearful.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q24
He is generally liked by other children/youth.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q25
He is easily distracted, his concentration wanders.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q26
He is nervous or clingy in new situations, easily loses confidence.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q27
He is kind to younger children.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q28
He often lies or cheats.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q31
He thinks things out before acting.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q32
He steals from home, school or elsewhere.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_Q34
He has many fears, is easily scared.

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

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

Not true
Somewhat true
Certainly true
Parent of guardian of child respondent aged 6 to 17

SDQ_END

Request for child to return (RCR)

If AGE is less than 18 and RCL_N11 is equal to 1 and RCL_Q13 is equal to 1, go to RCR_R11. Otherwise, go to RCR_END.

RCR_R11
We have now finished this set of questions.

If AGE is less than 12:
He 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 him 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.Parent of guardian of child respondent aged 6 to 17

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 is greater than 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_Q12B
Which of the following tobacco products are smoked inside this home?

Interviewer: Read categories to respondent. Mark all that apply.
1. ...cigarettes
2. ...cigarillos or little cigars
3. ...all other types of cigars
4. ...pipes
Don’t Know, Refused (Go to ETS_Q13)
One respondent per household in a home where someone smokes every day or almost every day

ETS_Q12C
If ETS_Q12B does not equal 1, go to ETS_Q12D.
On a typical day, how many cigarettes are smoked inside this home?

Interviewer: There are about 20 cigarettes in a pack
(insert respondent answer between 0 and 995)
One respondent per household in a home where someone smokes every day or almost every day who indicated that cigarettes are smoked inside the home

ETS_Q12D
If ETS_Q12B does not equal 2, go to ETS_Q12E.
On a typical day, how many cigarillos or little cigars are smoked inside this home?

Interviewer: There are about 20 cigarillos/little cigars in a pack.
(insert respondent answer between 0 and 995)
One respondent per household in a home where someone smokes every day or almost every day who indicated that cigarillos or little cigars are smoked inside the home

ETS_Q12E
If ETS_Q12B does not equal 3, go to ETS_Q12F.
On a typical day, how many cigars are smoked inside this home?

(insert respondent answer between 0 and 995)
One respondent per household in a home where someone smokes every day or almost every day who indicated that cigars are smoked inside the home

ETS_Q12F
If ETS_Q12B does not equal 4, go to ETS_Q13.
On a typical day, what is the total period of time that at least one person is smoking a pipe inside this home?

Interviewer: Include the time only once even if more than one person is smoking a pipe at the same time.
1. Less than 1 hour
2. 1 to 2 hours
3. 3 to 5 hours
4. More than 5 hours
One respondent per household in a home where someone smokes every day or almost every day who indicated that pipes are smoked inside the home

ETS_Q13
Overall, in the past month were you exposed to second-hand smoke inside this home? If you are a smoker, do not consider your own 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?
Respondents in a home where someone smokes every day or almost every day

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?

Yes
No
All respondents

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)?

Yes
No
All respondents
If GEN_Q16 is equal to 1 (worked at a job or business during the 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?

Yes
No
Respondents who worked at a job or a business during the past 12 months

ETS_Q17
Overall, excluding inside your own home, in the past month were you exposed to second-hand smoke? If you are a smoker, do not consider your own 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_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 is greater than 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)
If two persons selected in the household and age of current respondent is greater than 11 go to HSC_END.
All respondents

HSC_Q12B
Excluding the basement and garage, what is the approximate area of this home in square feet or square metres? Would you say it is...?

Interviewer: Read categories to respondent.
1. 600 sq. ft (55 square metres) or less
2. 601 to 1,000 sq. ft (56 to 95 square metres)
3. 1,001 to 2,000 sq. ft (96 to 185 square metres)
4. 2,001 to 3,000 sq. ft (186 to 280 square metres)
5. 3,001 to 4,000 sq. ft (281 to 371 square metres)
6. 4,001 sq. ft (372 square metres) or more
One respondent per household

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 (Go to HSC_S13)
Go to HSC_Q31.
One respondent per household

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

HSC_Q31
In the past month, that is from [date one month ago] 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?

Yes
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_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_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_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_Q37
In the past month, were any chemicals used in this home to control head lice on family members or fleas on pets?

Yes
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?

Yes
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_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_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_END

Hobbies (HOB)

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

HOB_Q11
If the respondent is less than 12:

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)
For each activity identified in HOB_Q11, ask HOB_B12 and HOB_Q12.
All respondents

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 an activity during the past 3 months

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

Less than 30 minutes
30 to 60 minutes
61 to 90 minutes
More than an hour and a half
Respondents who participated in an activity during the past 3 months

HOB_END

Labour force (LBF)

AGE is less than 15 or greater than 75, go to LBF_END.

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 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.

Yes (Go to LBF_Q03)
No
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?

Yes
No (Go to LBF_Q11)
Don’t Know, Refused (Go to LBF_END)
Respondents aged 15 to 75 who did not work at a job or business during the previous week

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

Yes
No
Go to LBF_R31
Respondents aged 15 to 75 who worked at a job or business during the previous week

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

Yes (Go to LBF_R21)
No
Don’t Know, Refused (Go to LBF_R21)
Respondents aged 15 to 75 who did not work at a job or business during the previous week

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

Own illness or disability
Caring for - own children
Caring for - elder relatives
Pregnancy (females only)
Other personal or family responsibilities
Vacation
School or educational leave
Retired
Believes no work available (in area or suited to skills)
Other - Specify (Go to LBF_S13)
Go to LBF_Q14.
Respondents aged 15 to 75 who did not work at a job or business during the previous week and who did nothing to find work in the previous 4 weeks

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 did not work at a job or business during the previous week and who did nothing to find work in the previous 4 weeks who stated “other” as the main reason they are not currently working at a job or business

LBF_Q14
If LBF_Q13 does not equal 1 (Own illness or disability), go to LBF_R21.

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

Physical health
Emotional or mental health (including stress)
Use of alcohol or drugs
Another reason
Respondents aged 15 to 75 who did not work at a job or business during the previous week and who did nothing to find work in the previous 4 weeks and stated the main reason as own illness or disability

LBF_R21
Now some questions about jobs or employment which you have hadduring 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.

Yes (Go to LBF_Q23)
No
Respondents aged 15 to 75 who were permanently unable to work or who did not work at a job or business during the previous week

LBF_Q22
If LBF_Q11 is equal to 1, go to LBF_Q71.

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

Yes (Go to LBF_Q71)
No
Respondents aged 15 to 75 who did not work at a job or business at any time during the previous 12 months and who did not try to find work during the previous 4 weeks

Go to LBF_END

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

Yes
No
Respondents aged 15 to 75 who were permanently unable to work, or who did not work at a job or business during the previous week, but were employed at some point during the previous 12 months

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

If the respondent 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.

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

Employee (Go to LBF_Q33)
Self-employed
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 worked at a job or business during the previous week or who worked at a job or business any time during the previous 12 months

LBF_Q31A
[Do/Did] you have any employees?

Yes
No
Respondents aged 15 to 75 who were self employed during the previous week or who were self employed at any time during the previous 12 months

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 any time 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 worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months who 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 worked at a job or business during the previous week or who worked at a job or business at any time 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 80 characters)
Use trigram search, source file is SOC_Database
Respondents aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months
If LBF_Q35 is equal to “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 worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months who stated “other” as 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)
Respondents aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time 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)

Permanent (Go to LBF_Q37)
Not permanent
Don’t Know, Refused (Go to LBF_Q37)
Respondents aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months

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

Seasonal
Temporary, term or contract
Casual job
Work done through a temporary help agency
Other
Respondents aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months whose job/business was not permanent

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
Respondents aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months
If LBF_Q02 does not equal 1, go to LBF_Q42.

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

Own illness or disability
Caring for - own children
Caring for - elder relatives
Maternity leave (Females only)
Other personal or family responsibilities
Vacation
Labour dispute (strike or lockout)
Temporary layoff due to business conditions (Employees only)
Seasonal layoff (Employees only)
Casual job, no work available (Employees only)
Work schedule (e.g., shift work) (Employees only)
Self-employed, no work available (Self-employed only)
Seasonal business (Excluding employees)
School or educational leave
Other – Specify
(Go to LBF_S41)
Respondents aged 15 to 75 who worked at a job or business during the previous week from which they were absent

LBF_S41

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 worked at a job or business during the previous week from which they were absent who stated “other” as the main reason for being absent

LBF_Q41A

If LBF_Q41 does not equal 1 (Own illness or disability), go to LBF_Q42.

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

Physical health
Emotional or mental health (including stress)
Use of alcohol or drugs
Another reason
Respondents aged 15 to 75 who worked at a job or business during the previous week from which they were absent due to their own illness or disability

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 worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months

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

Interviewer: Read categories to respondent.

Regular - daytime schedule or shift (Go to LBF_Q46)
Regular - evening shift
Regular - night shift
Rotating shift (change from days to evenings to nights)
Split shift
On call
Irregular schedule
Other - Specify (Go to LBF_S44)
Don’t Know, Refused (Go to LBF_Q46)
Respondents aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months

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 aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months who stated “other” to best describe hours worked

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

Requirement of job / no choice
Going to school
Caring for - own children
Caring for - other relatives
To earn more money
Likes to work this schedule
Other - Specify (Go to LBF_S45)
Respondents aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months who did not work a regular day time schedule or shift

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 aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months who stated “other” as the main reason they did not work a regular daytime schedule of shift

LBF_Q46
[Do/Did] you usually work on weekends at this [job/business]?

Yes
No
Respondents aged 15 to 75 who worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months
If LBF_Q03 is equal to 1 or if LBF_Q23 is equal to 1, 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 [worked/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 indicated they worked more than 1 job during the previous week or that they worked more than 1 job during the previous 12 months

LBF_Q52
What is the main reason that you [work/worked] at more than one job?

To meet regular household expenses
To pay off debts
To buy something special
To save for the future
To gain experience
To build up a business
Enjoys the work of the second job
Other – Specify (Go to LBF_S52)
Respondents aged 15 to 75 who indicated they worked more than 1 job during the previous week or that they worked more than 1 job during the previous 12 months
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 indicated they worked more than 1 job during the previous week or that they worked more than 1 job during the previous 12 months who stated “other” as the main reason they worked at more than 1 job

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 indicated they worked more than 1 job during the previous week or that they worked more than 1 job during the previous 12 months

LBF_Q54
[Do/Did] you usually work on weekends at your other job(s)?

Yes
No
Respondents aged 15 to 75 who indicated they worked more than 1 job during the previous week or that they worked more than 1 job during the previous 12 months

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 worked at a job or business during the previous week or who worked at a job or business at any time during the previous 12 months
If LBF_Q61 is equal to 52, go to LBF_END.
If LBF_Q61 is equal to 51, go to LBF_Q71A.
Otherwise, go to LBF_Q71.

LBF_Q71
During the past 52 weeks, how many weeks were you looking for work?

Interviewer: Minimum is 0; maximum is 52.
(insert respondent answer between 1 and 52)
Respondents aged 15 to 75 who worked at a job or business for less than 51 weeks during the previous 52 weeks, or who tried to find work during the previous 12 months, or who did not work at a job or business during the previous 12 months and tried to find work during the previous 4 weeks
Go to LBF_Q72.

LBF_Q71A
That leaves 1 week. During that week, did you look for work?

Yes
No
Respondents aged 15 to 75 who worked at a job or business during the previous week or worked at a job or business at any time during the previous 12 months who worked 51 of the previous 52 weeks

LBF_Q72
If LBF_Q61 is equal to NONRESPONSE or if LBF_Q71 is equal to NONRESPONSE, go to LBF_END.

If LBF_Q61 and LBF_Q71 are equal to 52, go to LBF_END.

That leaves some week(s) during which you were neither working nor looking for work. Is that correct?

Yes
No
Respondents 15 to 75 years of age who, during the last 52 weeks, have a certain number of weeks during which they were neither working nor looking for work
If LBF_Q01, LBF_Q02 or LBF_Q11 are equal to 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 (Go to LBF_Q74)
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 (Go to LBF_S73)
  Respondents aged 15 to 75 who worked at a job or business 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 working

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 aged 15 to 75 who worked at a job or business 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 working

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?

Physical health
Emotional or mental health (including stress)
Use of alcohol or drugs
Another reason
Respondents aged 15 to 75 who were not looking for work because of their ownillness or disability

LBF_END

Socio-demographic 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?

Canada (Go to SDC_Q21)
China
France
Germany
Greece
Guyana
Hong Kong
Hungary
India
Italy
Jamaica
Netherlands / Holland
Philippines
Poland
Portugal
United Kingdom
United States
Vietnam
Sri Lanka
Other - Specify (Go to SDC_S11)
Don’t Know, Refused (Go to SDC_Q21)
All respondents
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 their country of birth

SDC_Q12
Were you born a Canadian citizen?

Yes (Go to SDC_Q21)
No
Don’t Know, Refused (Go to SDC_Q21)
Respondents born outside Canada

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 a Canadian citizen

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
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 groups to which their ancestors belonged

SDC_Q22
Are you an Aboriginal person, that is, North American Indian, Métis or Inuit?

Yes
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
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 (Go to SDC_S24)
Respondents who are not Aboriginal persons
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 are not Aboriginal persons and who selected “other” for their cultural and racial background

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 (Filipino)
17. Ukrainian
18. Vietnamese
19. Dutch
20. Hindi
21. Russian
22. Tamil
23. Other - Specify (Go to SDC_S31)
All respondents
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” for a language in which they are able to conduct a conversation

SDC_Q32
What language do you speak most often at home?

English
French
Arabic
Chinese
Cree
German
Greek
Hungarian
Italian
Korean
Persian (Farsi)
Polish
Portuguese
Punjabi
Spanish
Tagalog (Filipino)
Ukrainian
Vietnamese
Dutch
Hindi
Russian
Tamil
Other - Specify (Go to SDC_S32)
All respondents 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” for the language they speak most often at home

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 (Filipino)
17. Ukrainian
18. Vietnamese
19. Dutch
20. Hindi
21. Russian
22. Tamil
23. Other - Specify (Go to SDC_S33)
All respondents
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” for the language that they first learned at home in childhood and can still understand

SDC_END

Education (EDU)

If AGE is less than 15, go to EDU_END.

EDU_R01
Next, education.

EDU_Q01
Are you currently attending a school, college or university?

Yes
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?

Full-time
Part-time
Respondents aged 15 and over who are currently attending a school, college, or university

EDU_END

Income (INC)

If two respondents have been selected and the Income block has already been completed by the first respondent and the first respondent is more than 19 years old, then go to INC_Q31. Otherwise go to INC_R11.

If two respondents have been selected and the Income block has not been completed for either respondent and the first respondent is greater than 15 and less than 19 years old, then go to INC_Q31. Otherwise go to INC_R11.

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?

Wages and salaries
Income from self-employment
Dividends and interest (e.g., on bonds, savings)
Employment insurance
Worker’s compensation
Benefits from Canada or Quebec Pension Plan
Retirement pensions, superannuation and annuities
Old Age Security and Guaranteed Income Supplement
Child Tax Benefit
Provincial or municipal social assistance or welfare
Child support
Alimony
Other (e.g., rental income, scholarships)
One adult respondent per household who 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 999995) (Go to INC_Q31)
0 (Go to INC_END)
Don’t Know, Refused (Go to INC_Q22)
One adult respondent per household who has reported a 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?

Less than $20,000
$20,000 or more (Go to INC_Q26)
No income (Go to INC_END)
Don’t Know, Refused (Go to INC_END)
One adult respondent per household who has reported a 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?

Less than $10,000
$10,000 or more (Go to INC_Q25)
Don’t Know, Refused (Go to INC_Q31)
One respondent per household who has reported an unspecified household income amount of less than $20,000

INC_Q24
Was the total household income from all sources less than $5,000 or $5,000 or more?

Less than $5,000
$5,000 or more
One respondent per household who has reported an unspecified household income amount of less than $10,000
Go to INC_Q31

INC_Q25
Was the total household income from all sources less than $15,000 or $15,000 or more?

Less than $15,000
$15,000 or more
One adult respondent per household who has reported an unspecified household income amount greater than $10,000 and less than $20,000
Go to INC_Q31

INC_Q26
Was the total household income from all sources less than $40,000 or $40,000 or more?

Less than $40,000
$40,000 or more (Go to INC_Q28)
Don’t Know, Refused (Go to INC_Q31)
One adult respondent per household who has reported an unspecified household income amount greater than $20,000

INC_Q27
Was the total household income from all sources less than $30,000 or $30,000 or more?

Less than $30,000
$30,000 or more
One adult respondent per household who has reported an unspecified household income amount greater than $20,000 and less than $40,000
Go to INC_Q31

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 per household who has reported an unspecified household income amount greater than $40,000

INC_Q31
If AGE of current respondent is less than 15, go to INC_END.

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 999995) (Go to INC_END)
0 (Go to INC_END)
Don’t Know, Refused (Go to INC_Q32)
Respondents aged 15 and over who have reported a household income

INC_Q32
Can you estimate in which of the following groups yourpersonal income falls? Was your total personal income less than $20,000 or $20,000 or more?

Less than $20,000
$20,000 or more (Go to INC_Q36)
No income (Go to INC_END)
Don’t Know, Refused (Go to INC_END)
Respondents aged 15 and over who have reported an unspecified amount for personal income

INC_Q33
Was your total personal income less than $10,000 or $10,000 or more?

Less than $10,000
$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

INC_Q34
Was your total personal income less than $5,000 or $5,000 or more?

Less than $5,000
$5,000 or more
Respondents aged 15 and over who have reported an unspecified personal income amount less than $10,000
Go to INC_END

INC_Q35
Was your total personal income less than $15,000 or $15,000 or more?

Less than $15,000
$15,000 or more
Respondents aged 15 and over who have reported an unspecified personal income amount greater than $10,000
Go to INC_END

INC_Q36
Was your total personal income less than $40,000 or $40,000 or more?

Less than $40,000
$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

INC_Q37
Was your total personal income less than $30,000 or $30,000 or more?

Less than $30,000
$30,000 or more
Respondents aged 15 and over who have reported an unspecified personal income amount less than $40,000
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

INC_END

Administration information (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 and 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 and Refused are not allowed
Respondents who used fictitious first name, or first and last name, during the interview
If ADM_N32 does not equal 3 (both names), go to ADM_N35.

ADM_N34

Interviewer: Enter the last name only.
(insert respondent answer to a maximum of 25 characters)
Note: Don’t Know and 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 proxy interview, 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.
01 English
02 French
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 (Go to ADM_S38)
(Don’t Know, Refused are not allowed)
All respondents
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 selected “other” for the language of the interview

ADM_END

Canadian Health Measures Survey - Cycle 2

Archived information

2009 to 2011

Household Questionnaire