Question frequency on surveys subject to change
Health
Q. Please imagine a ladder with steps numbered from zero at the bottom to ten at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time?
Q. On which step do you think you will stand about five years from now?
Q. Are you satisfied or dissatisfied with your health?
Q. Please rate your physical health today, on a zero-to-ten scale, where 0 is the worst possible physical health and 10 is the best possible physical health.
Q. Now, using the same zero-to-ten scale, please rate your emotional health today.
Q. Do you have any health problems that prevent you from doing any of the things people your age normally can do?
Q. During the past 30 days, for about how many days did poor health keep you from doing your usual activities?
Q. Have you ever been told by a physician or nurse that you have any of the following, or not?
- High blood pressure
- High cholesterol
- Diabetes
- Depression
- Heart attack
- Asthma
- Cancer
Q. Do you have other health problems or conditions?
Q. How many other health problems do you have? In the last 12 months, have you had any of the following, or not? How about?
- Neck or back condition that caused recurring pain
- Knee or leg condition that caused recurring pain
- Other condition that caused recurring pain
Q. Have you visited a dentist in the last 12 months?
Q. In the last 12 months, have any of the following helped you improve or maintain your health, or not?
- A coworker or supervisor at work
- A physician
- A nurse or any other healthcare professional
- Someone from a religious organization
- A friend or family member
- The media, such as TV, radio, magazines, or newspapers
- A Web site on the Internet
- A lifestyle counselor or advice coach
- A community leader
Q. In the next 12 months, are you confident you will have access to quality medical care?
Q. Has your doctor prescribed any medications that you are currently supposed to be taking?
Q. Do you smoke?
Q. In the last seven days, on how many days did you?
- Exercise for 30 or more minutes
- Have five or more servings of fruits and vegetables
- Consume at least ___ drinks containing alcohol
Q. Do you have a personal doctor?
Q. Do you have health insurance coverage?
Q. Is your primary health insurance coverage through an employer or union, through Medicare, Medicaid, military or Veteran's coverage, or something else?
Q. Do you currently help care for an elderly or disabled family member, relative, or friend, or not?
Q. How many children, under the age of 18, are living in your household?
Q. Did this child eat healthy all day yesterday?
Q. In the last seven days, on how many days did this child
- Exercise for 30 minutes
- Have five or more servings of fruits and vegetables
Standard of living
Q. Are you satisfied or dissatisfied with your standard of living, all the things you can buy and do?
Q. Right now, do you feel your standard of living is getting better or getting worse?
Q. Have there been times in the past 12 months when you did not have enough money
- To buy food that you or your family needed
- To provide adequate shelter or housing for you and your family
- To pay for health care and/or medicines that you or your family needed
Q. If you were in trouble, do you have relatives or friends you can count on to help you whenever you need them, or not?
Q. Do you currently have a job or work (either paid or unpaid work)?
Q. Is this a paid full-time job, a paid part-time job, or is it unpaid?
Q. Please tell me whether each of the following applies to you, or not. Are you?
- A full-time student
- RetiredDisabled
- Self-employed or make money or barter by working for yourself by doing domestic work, farm work, odd jobs, or working for your own business
- Doing full-time housework, caring for children or others, but are not paid for it
Q. Please respond to the following for what you consider to be your "primary" job or the one where you spend the most time.
- Approximately, how many minutes does it take you to get to work?
- Are you satisfied or dissatisfied with your job or the work you do?
- At work, do you get to use your strengths to do what you do best every day, or not?
- Does your supervisor at work treat you more like he or she is your boss or your partner?
- Does your supervisor always create an environment that is trusting and open, or not?
Q. Now thinking more generally about the company or business you work for, including all of its employees. Based on what you know or have seen, would you say that, in general, your company or employer is
- Hiring new people and expanding the size of its workforce
- Not changing the size of its workforce (or)
- Letting people go and reducing the size of its workforce
Q. Have you made an active effort to find work within the last four weeks?
Q. Would you have been able to begin work had you been offered a job within the last seven days?
Q. Are you unemployed and on an official layoff from which you expect to be recalled by your employer?
Q. Now, please think about yesterday, from the morning until the end of the day. Think about where you were, what you were doing, who you were with, and how you felt.
- Did you feel well-rested yesterday?
- Were you treated with respect all day yesterday?
- Did you smile or laugh a lot yesterday?
- Did you learn or do something interesting yesterday?
Q. Did you worry about money yesterday?
Q. Did you have enough energy to get things done yesterday?
Q. Did you eat healthy all day yesterday?
Q. Did you experience the following feelings during A LOT OF THE DAY yesterday? How about?
- Enjoyment
- Physical Pain
- Worry
- Sadness
- Stress
- Anger
- Happiness
Q. Approximately, how many hours did you spend, socially, with friends or family yesterday? Please include telephone or e-mail or other online communication.
Q. Were you sick with any of the following yesterday?
- The flu
- A cold
- A headache
Q. Although it's not very likely that you did, could you tell me if you happened to purchase or lease a motor vehicle yesterday, such as a car, truck, or SUV?
Q. What was the total purchase price?
Q. Next, we'd like you to think about your spending yesterday, not counting the purchase of a home, motor vehicle, or your normal household bills. How much money did you spend or charge yesterday on all other types of purchases you may have made, such as at a store, restaurant, gas station, online, or elsewhere?
Q. Are you satisfied or dissatisfied with the city or area where you live?
Q. Is the city or area where you live getting better or getting worse as a place to live?
Q. In the city or area where you live, is it easy or not easy to get
- Clean and safe water
- Affordable fresh fruits and vegetables
- Medicine
- A safe place to exercise
Q. Do you feel safe walking alone at night in the city or area where you live?
Q. Is religion an important part of your daily life?
Q. How would you rate economic conditions in this country today -- as excellent, good, only fair, or poor?
Q. Right now, do you think that economic conditions in the country as a whole are getting better or getting worse? |
