individual questionnaire for adults chestionar … filechestionar individual pentru adul ... the...

Institutul Naţional de Statistică CIA/1Bd. Libertăţii nr. 16, sector 5, Bucureşti - cod 050706

CCHHEESSTTIIOONNAARR IINNDDIIVVIIDDUUAALL PPEENNTTRRUU AADDUULLŢŢII

Strictly confidential

The data in this questionnaire are used for statistical purposes only.

IDENTIFICATION OF THE PERSON RESULT OF THE INTERVIEW

The data are taken from the CG questionnaire

Center code ....................... ... ...…|__|__|__|__|__| CENTR Dwelling code….............................|__|__|__|__|__| LOC Current no. of the household

within the dwelling....................................... |__| NOG

Persons’s code from the CG questionnaire .........................................|__|__| CP Last name and first name of the person:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Birth date: year |__|__|__|__| month |__|__| day |__|__| ANN LUN ZIN

The interview took place 1

The interview did not took place because the person: Is not able to respond and there is no other person who can respond 2

Refuses the interview . 3 Is temporarily absent and there is no other person who can respond 4

Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5

RI

Date when the individual interview took place day |__|__|month|__|__| 2008 ZII LNI ANI

According to Government Ordinance No. 9/1992 on the organization of official statistics, republished, with subsequent amendments and completions, which stipulates: "the individuals are obliged to provide to the official statistical departments personal data and data on household and economic activity, necessary to carry out statistical surveys and censuses”.

Mark the answers with X in the closed cells , with figures in the open cells |__|__| or text on the discontinuous line _ _ _ _ _ _ _. After marking the answers in the corresponding cells, for some questions there is the „ ”sign followed by:

• R and a figure: meaning the rule to be followed (the number indicates the question number);

• a figure: meaning go to the question (without following any rule). In case the marked cell is not followed by the sign, go to the next question. For questions followed by the sign multiple answers can be registered. The symbols marked below or beside the code cells are for data processing only.

The questionnaire will be filled-in only for persons aged 15 and more (including persons born before 30th April 1993).

IINNDDIIVVIIDDUUAALL QQUUEESSTTIIOONNNNAAIIRREE FFOORR AADDUULLTTSS

CIA/2

GENERAL INFORMATION General information about the respondent

1. What is your legal marital status?

• Single (never married) 1

• Married 2 3

• Widowed and not remarried 3

• Divorced and not remarried 4

SCIV Rules for the interviewer:

Check in the CG questionnaire if there are other persons of the opossite sex of the respondent

• If YES continue (question 2)

• If NO question 3

Register or ask: 2. Are you living with someone in this household as a

couple?

• YES, on a legal basis 1

• Yes, without a legal basis 2

• NO 3

CUPL Socio-economic activity

Read this!Read this!Now I'm going to ask you some questions about your current labour situation.

3. How would you define your current labour status?

• Working for pay or profit (including an apprenticeship, currently not at work due to sick leave, holidays, maternity or parental) 1

5

• Unemployed 2

• Pupil, student, further training, unpaid work experience 3

• In retirement or early retirement or has given up business – excluding retirement due to disability or sickness 4

• Permanently disabled (including longstanding illness, disability or other health problem) 5

• Fulfilling domestic tasks 6

• Other. Please specify: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 7

TXULST ULST 4. Have you ever worked for pay or profit?

• YES............................................................ 1

• NO ............................................................ 2 10 LUCR

Read this!Read this!Think about your job (your last job)

5. What was (were) your professional status?

• Employee 1

• Employer or self-employed 2

• Working without payment as a family worker 3

• Member of an agricultural co-operative 4

• Member of a non-agricultural co-operative 5

7

EXLU

6. In this latter job, you have (had) an employment contract for an unlimited duration or you are (have been) temporarily employed?

• Permanent job/work contract of unlimited duration 1

• Temporary job/work contract of limited duration 2

• Other 3

CONM

7. In your (main) job do (did) you work full-time or part-time?

• full-time 1

• part-time 2

TIMPL 8. What is (was) your occupation in this job (last job)?

(Profession or specialty currently practiced) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Describe what do (did) you mainly do in your job:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Occupation |__|__|__|__| OCUP (occupation code from Annex 2)

9. What does (did) the business/organisation mainly produce or do at the place where you work (worked) (e.g. fishing, agriculture, wholesale/retail trade, constructions, textile manufacturing, health, education, public administration etc.)?

(specify the activity name)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Activity |__|__|__|__| ACTP (activity code from Annex 3)

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HEALTH STATUS Perception of health

Read this! I would now like to talk to you about your health.

10. How is your health in general?

• Very good ………………………........................... 1

• Good ………………………………....................... 2

• Fair ………………………..................................... 3

• Bad ……………………………............................. 4

• Very bad ………………………............................. 5

• Don't know……………………….......................... 8

• Refusal …………………………........................... 9

SAN

11. Do you have any chronic disease or a health problem which have lasted, or is expected to last for a long time? Please do not take into consideration less serious problems (e.g. cold, cough, headache, toothache, anxiety etc.).

• YES ………………..…......………................... 1

• NO ……………..…....…………...................... 2

• Don't know ...........………........…..................... 8

• Refusal …………...……………....................... 9 CRON

12. For at least the past 6 months, have you been limited because of a health problem in activities you usually do?

• YES, severely limited .....………...................... 1

• YES, limited but not severely.......................... 2

• NO………………………………….................. 3

• Don't know ...........………........…..................... 8

• Refusal …………...……………....................... 9 ALIM

Longstanding illnesses

Rules for the interviewer: Hand SHOWCARD 3 (LONGSTANDING ILLNESSES) to the respondent and fill-in the table LONGSTANDING ILLNESSES with the answers for questions 13, 14 and 15.

Read this! Look at this list of longstanding illnesses and please answer to the following 3 questions:

Questions 14 and 15 shall only refer to the diseases mentioned at question 13 and coded with 1 13. Do you have or have

you ever had any of the following diseases or conditions?

14. The disease has been diagnosed by a doctor?

15. Have you suffered in the last 12 months of this disease?

Name of the longstanding illness

Yes No DK R Yes No DK R Yes No DK R 1. Asthma (allergic asthma included)................. 1 2 8 9 1 2 8 9 1 2 8 9 2. Chronic bronchitis, chronic obstructive pulmonary

disease, emphysema.................................................. 1 2 8 9 1 2 8 9 1 2 8 9 3. Myocardial infarction...................................... 1 2 8 9 1 2 8 9 1 2 8 9 4. Coronary heart disease (angina pectoris)........ 1 2 8 9 1 2 8 9 1 2 8 9 5. High blood pressure (hypertension)................ 1 2 8 9 1 2 8 9 1 2 8 9 6. Stroke (cerebral haemorrhage, cerebral

thrombosis)...................................................... 1 2 8 9 1 2 8 9 1 2 8 9 7. Rheumatoid arthritis (inflammation of the

joints).............................................................. 1 2 8 9 1 2 8 9 1 2 8 9 8. Osteoarthritis (arthrosis, joint degeneration).. 1 2 8 9 1 2 8 9 1 2 8 9 9. Low back disorder or other chronic back

defect............................................................... 1 2 8 9 1 2 8 9 1 2 8 9 10. Chronic neck defect........................................ 1 2 8 9 1 2 8 9 1 2 8 9 11. Diabetes......................................................... 1 2 8 9 1 2 8 9 1 2 8 9 12. Allergy, such as rhinitis, eye inflammation,

dermatitis, food allergy or other (allergic asthma excluded)............................................ 1 2 8 9 1 2 8 9 1 2 8 9

13. Stomach ulcer (gastric or duodenal ulcer)...... 1 2 8 9 1 2 8 9 1 2 8 9 (continuation of the table)

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Questions 14 and 15 shall only refer to the diseases mentioned in question 13 and coded with 1 13. Do you have or have

you ever had any of the following diseases or conditions?

14. The disease has been diagnosed by a doctor?

15. Have you suffered in the last 12 months of this disease?

Name of the longstanding illness

Yes No DK R Yes No DK R Yes No DK R 14. Cirrhosis of the liver, other chronic diseases of

the liver................................................................. 1 2 8 9 1 2 8 9 1 2 8 9 15. Cancer (malignant tumour, also including

leukaemia and lymphoma) .................................. 1 2 8 9 1 2 8 9 1 2 8 9 16. Severe headache such as migraine.................. 1 2 8 9 1 2 8 9 1 2 8 9 17. Urinary incontinence, problems in

controlling the bladder ................................... 1 2 8 9 1 2 8 9 1 2 8 9 18. Chronic anxiety............................................... 1 2 8 9 1 2 8 9 1 2 8 9 19. Chronic depression.......................................... 1 2 8 9 1 2 8 9 1 2 8 9 20. Other mental health problems......................... 1 2 8 9 1 2 8 9 1 2 8 9 21. Thyroid gland defect....................................... 1 2 8 9 1 2 8 9 1 2 8 9 22. Biliary lithiasis, cholecystis............................ 1 2 8 9 1 2 8 9 1 2 8 9 23. Renal lithiasis.................................................. 1 2 8 9 1 2 8 9 1 2 8 9 24. Cataract, glaucoma.......................................... 1 2 8 9 1 2 8 9 1 2 8 9 25. Parkinson, Alzheimer, epilepsy, memory loss 1 2 8 9 1 2 8 9 1 2 8 9 26. Permanent injury or defect caused by an

accident........................................................... 1 2 8 9 1 2 8 9 1 2 8 9 27. Other chronic disease _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 2 8 9 1 2 8 9 1 2 8 9 TXBOALA BOALA DIAG BAN

Accidents

Rules for the interviewer: Hand SHOWCARD 4 (TYPES OF ACCIDENTS), then ask:

Rules for the interviewer:

Ask the following question if you earned at least one positive answer (code 1 – YES) for one of the variants of the previous question and register the answer for eah type of accident with a positive answer, if not R. 18

16. In the past 12 months, have you had any of the following type of accidents resulting in injury (external or internal)? 17. Did you visit a doctor, a nurse or an emergency

department of a hospital as a result of this accident? Type of accident

Yes No DK R

Yes, I visited a doctor or

nurse

Yes, I went to an

emergency department

No consultation or intervention was necessary

DK R

A. Road traffic accident...................... 1 2 8 9 1 2 3 8 9 B. Accident at work..................................... 1 2 8 9 1 2 3 8 9 C. Accident at school.......................... 1 2 8 9 1 2 3 8 9 D. Home and leisure accident............. 1 2 8 9 1 2 3 8 9 ACCID CONSULT

CIA/6

R. 18 Rules for the interviewer: Check the answers to questions 3 and 4. Next question is to be asked only for respondents who are currently working or having worked in the past (code 1 to questions 3 or 4), otherwise R.21.

18. Is any of the diseases you had in the past 12 months caused or made worse by your job or by work you have done in the past?

• No, I had no disease in the past 12 months........................ 1 • I had one or more disease in the past 12 months,

but they were not caused or made worse by my job......... 2 • Yes, I had at least one disease in the past 12 months

which was caused or made worse by my job.................... 3 • Don't know………………………..................................... 8

• Refusal …………………………...................................... 9 BOLIM

R.19 Rules for the interviewer: Next question is to be asked only for respondents currently working (code 1 to question 3). For the others R.21

19. In the past 12 months, have you been absent from work for reasons of health problems? Take into account all kind of diseases, injuries and other health problems that you had and which resulted in your absence from work

• YES ………………..…………....................... 1 • NO ……………..…....…………..................... 2 • Don't know ...........………........…................... 8 • Refusal …………...……………..................... 9

R.21

ABS 20. In the past 12 months, how many days in total were

you absent from work for reasons of health problems?

Interviewer prompt only if necessary "an estimate is acceptable".

|__|__|__| days

• Don't know ...........………........….......................... 998

• Refusal …………...……………............................ 999 ZILABS

Physical and sensory functional limitations R. 21 Read this!

Now I would like you to think about situations you may face in everyday life. Please ignore any temporary problems.

Rules for the interviewer: If the respondent is blind, mark code 3 to the next question and R.24

21. Do you wear glasses or contact lenses? (Take into consideration also the reading glasses).

• YES………………………………………..... 1

• NO ……………………........…………….…. 2

• I'm blind…………………………….…......... 3 R.24

• Don't know ……………………........……..... 8

• Refusal ………………………...……...……. 9 OCH

R.22 Read this! Please answer the following two questions according to your normal use -or not- of glasses or contact lenses. Take into consideration also the reading glasses.

22. Can you see newspaper print?

• YES, with no difficulty………........................... 1

• With some difficulty………............................... 2

• With a lot of difficulty………............................ 3

• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal……….................................................... 9

VAD 23. Can you see the face of someone 4 metres away (across

a road)?

• YES, with no difficulty………........................... 1

• With some difficulty……….............................. 2


• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal……….................................................... 9

VDS

R. 24 Rules for the interviewer: If the respondent is deaf mark code 3 to next question and 28

24. Do you wear a hearing aid?

• YES ………........................................................ 1

• NO………........................................................... 2

• I am profoundly deaf……….............................. 3 28

• Don't know……….............................................. 8

• Refusal……….................................................... 9 APAUD

R.25 Read this! Please answer the following three questions according to your normal use -or not- of your hearing aid.

25. Can you hear what is said in a conversation with several people?

• Yes, with no difficulty………............................ 1



• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal……….................................................... 9 AUZ

CIA/7

26. How much difficulty do you have hearing what is said in a conversation with one other person in a noisy room where there are several other conversations going on?

• No difficulty………........................................... 1 28

• A little difficulty………..................................... 2

• A lot of difficulty……….................................... 3

• Unable……….................................................... 4

• Don't know ………............................................ 8

• Refusal ………................................................... 9 DIALOG

27. How much difficulty do you have hearing what is said in a conversation with one other person in a quiet room?

• No difficulty………............................................ 1

• A little difficulty………..................................... 2

• A lot of difficulty……….................................... 3

• Unable……….................................................... 4

• Don't know……….............................................. 8

• Refusal……….................................................... 9

CONV

28. Do you use any aids or equipment for walking or moving around?

• YES 1

• NO 2 30

• I do not walk at all, I’m bed bound 3 33

• Don't know 8

• Refusal 9

30

MERS

29. Which types of aids or medical equipment do you

use?

• Someone’s assistance……….............................. 01 • Walking stick……….......................................... 02 • Walker………..................................................... 03 • Crutches……….................................................. 04 • Orthopaedic shoes………................................... 05 • Wheelchair……….............................................. 06 • Prothesis (artificial leg) ……….......................... 07 • Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 08

33

TXDISPM

• Don't know ………............................................. 98

• Refusal ………................................................... 99 DISPM

30. Can you walk 500 metres on a flat terrain without a

stick or other walking aid or assistance?

• Yes, with no difficulty……................................. 1

• With some difficulty………................................ 2

• With a lot of difficulty………............................. 3

• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal………..................................................... 9 MERSJ 31. Can you walk up and down a flight of stairs without a

stick, other walking aid, assistance or using the banister?




• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal………..................................................... 9

URCETJ

32. Can you bend and kneel down without any aid or assistance (e.g. to pick something on the floor)?




• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal………..................................................... 9

APLEC

33. Using your arms, can you carry a shopping bag weighing 5 kilos for at least 10 metres without any aid or assistance?




• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal………..................................................... 9

CARKG

34. Can you use your fingers to grasp or handle a small object like a pen without any aid?




• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal………..................................................... 9 DEGET 35. Can you bite and chew on hard foods such as a firm

apple without any aid (for example, denture)?

CIA/8




• Not at all……….................................................. 4

• Don't know……….............................................. 8

• Refusal………..................................................... 9 MUSC 36. How much difficulty do you have to remember

important things? • No difficulty........................................................ 1

• A little difficulty.................................................. 2

• A lot of difficulty................................................ 3

• Unable ................................................................ 4

• Don't know.......................................................... 8 • Refusal.................................................................. 9 AMINT

Personal care Rules for the interviewer:

Hand SHOWCARD 5 (PERSONAL CARE ACTIVITIES) Read this!

Now I would like you to think about everyday personal care. Have a look at this list of activities and for each one tell me if you have difficulties in doing it by yourself. Again, please ignore temporary problems.

37. Do you usually have difficulty doing any of these activities by yourself?

No diffi-culty

Yes, some diffi-culty

Yes, a lot of diffi-culty

I can't achieve it by myself

DK R

A. Feeding yourself?... 1 2 3 4 8 9

B. Getting in and out of a bed or chair? ..............

1

2

3

4

8

9

C. Dressing and undressing..................

1

2

3

4

8

9

D. Using toilets?........ 1 2 3 4 8 9E. Bathing or showering?.................... 1 2 3 4 8 9 INGPER

Rules for the interviewer: If for any of the 5 activities the answer is marked 2, 3 or 4, please continue. Otherwise R.41

38. Do you usually have help? • Yes, at least for one activity What type of help?

1

• Personal assistance.............................. 2

• Technical aids .................................... 3

• Housing adaptation ............................ 4

• No, I do all these activities by myself........... 5 • Don't know.................................................... 8 • Refusal........................................................... 9

40

AJUTIP

39. Do you have enough help?

• Yes............................................................... 1 R41

• No, for at least one activity......................... 2

What type of help you don't have enough?

• Personal assistance..................... 3

• Technical aids ........................... 4 R41

• Housing adaptation ................... 5

• Don't know.................................................... 8

• Refusal........................................................... 9 R41

SUFIN 40. Would you need help?

• Yes, for at least one activity ........................ 1

What type of help you would need?

• Personal assistance ............................ 2

• Technical aids .................................... 3


• No.................................................................. 5

• Don't know.................................................... 8

• Refusal........................................................... 9 NEVAIN

Household activities

R.41 Rules for the interviewer: Hand SHOWCARD 6 (HOUSEHOLD ACTIVITIES)

Read this! Now I would like you to think about some household activities. Please ignore any temporary health problems which causes you difficulties. Also, do not take into consideration that another family member is usually doing this type of activities:

41. Do you usually have difficulty doing any of these activities by yourself?

No diffi-culty

Yes, some diffi-culty

Yes, a lot of

diffi-culty

I can't achieve

it by myself

DK R

A. Preparing meals................. 1 2 3 4 8 9 B. Using the telephone........... 1 2 3 4 8 9

C. Shopping...... 1 2 3 4 8 9 D. Managing medication......... 1 2 3 4 8 9 E. Light housework......... 1 2 3 4 8 9 F. Occasional heavy housework......... 1 2 3 4 8 9 G. Taking care of finances and everyday administrative tasks................... 1 2 3 4 8 9 CASN

CIA/9


Ask the following question for each activity coded 2, 3, 4. For the others R.46

42. Why do you have difficulties doing these activities by yourself?

Mainly, because of health state, disability or

old age

Mainly, because of

other reasons (never tried to

do it, etc.) DK R

A. Preparing meals.................1 2 8 9

B. Using the telephone...........1 2 8 9

C. Shopping ......................... .1 2 8 9

D. Managing medication........1 2 8 9

E. Light housework............... 1 2 8 9

F. Occasional heavy housework........................ 1 2 8 9

G. Taking care of finances and everyday administrative tasks......1 2 8 9 DIFCAS


If you marked 1 at question 42 for at least one activity, continue. For the others R.46

Read this!

Think about all household activities where you have difficulty in doing them by yourself.

43. Do you usually have help? • Yes, for at least one activity What type of help?

1


• Technical aids .................................... 3


• No, I do all these activities by myself............ 5

• Don't know..................................................... 8

• Refusal........................................................... 9

45

AJCASN

44. Do you have enough help?

• Yes.............................................................. 1 R.46

• No, at least for one activity........................ 2

What type of help you don't have enough?

• Personal assistance ................ 3

• Technical aids ........................ 4 R46

• Housing adaptation ................. 5

• Don't know.................................................... 8

• Refusal........................................................... 9

R46

NEVCAS

45. Would you need help?

• Yes, at least for one activity 1 What type of help you would need?


• Technical aids ................................... 3

• Housing adaptation ........................... 4

• No................................................................. 5

• Don't know.................................................... 8

• Refusal.......................................................... 9 SUFCAS

Physical pain R.46 Rules for the interviewer:

Hand SHOWCARD 6A (PHYSICAL PAIN) Read this!

Next question is about any physical pain you have had during the past 4 weeks.

46. Overall during the past four weeks, how much physical pain or physical discomfort did you have?

• None.................................................................. 1

• Mild................................................................... 2

• Moderate........................................................... 3

• Severe................................................................ 4

• Extreme............................................................. 5

• Don't know........................................................ 8

• Refusal.............................................................. 9 DURFIZ

CIA/10

Mood Rules for the interviewer:

Hand SHOWCARD 7 (MOOD), then ask: Read this!

I would like to ask you about how you feel and how things have been with you during the past 4 weeks. For each question, please give the answer that come closest to the way you have been feeling.

47. How much of the time, during the past 4 weeks: All of

the time Most of the time

Some of the time

A little of the time

None of the

time

Don't know Refusal

A. Did you feel full of life? .......................................... 1 2 3 4 5 8 9

B. Have you been very nervous? .................................. 1 2 3 4 5 8 9 C. Have you felt so down in the dumps that nothing

could cheer you up? ............................................... 1 2 3 4 5 8 9

D. Have you felt calm and peaceful? ............................. 1 2 3 4 5 8 9

E. Did you have a lot of energy? ............................... 1 2 3 4 5 8 9

F. Have you felt down-hearted and depressed?......... 1 2 3 4 5 8 9

G. Did you feel worn out? ......................................... 1 2 3 4 5 8 9

H. Have you been happy? .......................................... 1 2 3 4 5 8 9

I. Did you feel tired? ................................................ 1 2 3 4 5 8 9 SUF

USE OF MEDICAL SERVICES AND MEDICINES CONSUMPTION

Hospitalisation

Read this! The next set of questions is about time spent in hospital. You should take into consideration all types of hospitals, but not the visit to an emergency or day care department of a hospital. Do not take into account the time spent in sanatoriums or disabled persons care centers. Also, the time spent in a hospital for nursing a sick person should not be included.

Rules for the interviewer: For women up to age 50 years, add:

Read this! Also, the time spent in hospital for giving birth should NOT be included.

48. During the past 12 months have you been in hospital as an inpatient, that is overnight or longer?

• YES .......................................................... 1

• NO ............................................................ 2

• Don't know / I’m not sure......................... 8 53

• Refusal ..................................................... 9

INTERN

49. How many separate stays in hospital as an inpatient have you had during the past 12 months? Count all the stays that ended in this period.

stays |__|__| SPIT

• Don't know / I’m not sure........................... 98

• Refusal ....................................................... 99 50. Thinking of this/these inpatient stay(s) during the

past 12 months how many nights in total did you spend in hospital?

nights |__|__|__| NOPTI

• Don't know / I’m not sure........................... 998

• Refusal ....................................................... 999 51. What was the reason you have been in hospital as

an inpatient last time?

• wound/injury or accident............................ 1 • other, please specify the disease or health

problem_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 |__|__|__|

TXMBO (Annex 4) MBO

• Don't know / I’m not sure............................ 8

• Refusal ......................................................... 9

MOTINT

CIA/11

52. In which department were you in hospital as an inpatient last time?

• Internal diseases.................................................... 01

• Cardiology ............................................................ 02

• Pneumology, phtisiology....................................... 03

• Otorhinolaryngology............................................. 04

• Ophthalmology...................................................... 05

• Surgery.................................................................. 06

• Endocrinology, diabetology.................................. 07

• Rheumatology.................................................….. 08

• Gastro-enterology.................................................. 09

• Urology, nephrology ............................................ 10

• Gynecology (obstetrics). ...................................... 11

• Oncology .............................................................. 12

• Dermatology.......................................................... 13

• Orthopedy.............................................................. 14

• Gerontology........................................................... 15

• Neurology.............................................................. 16

• Psychiatry.............................................................. 17

• Infectious diseases................................................. 18 • Other_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 19 TXSECT

• Don't know ............................................................. 98

• Refusal .................................................................... 99 SECTSP

53. During the past 12 months have you been admitted to hospital as a day patient, that is admitted to a hospital bed, but not required to remain overnight?

• YES .......................................................... 1

• NO ........................................................... 2

• Don't know / I’m not sure......................... 8 56

• Refusal ..................................................... 9

INTAMB

54. How many days have you been admitted as a day patient during the past 12 months?

days...…………………|__|__|__| NAMB

• Don't know / I’m not sure......................... 998 • Refusal..................................................... 999

55. What was the reason you have been admitted last time as a day patient, that is admitted to a hospital bed, but not required to remain overnight?

• Wound/injury or accident............................. 1 • Other, please specify the disease or health

problem_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 |__|__|__|

TXAMBO (Annex 4) AMBO

• Don't know / I’m not sure............................ 8

• Refusal ......................................................... 9 MOTINTZ 56. During the past 12 months, was there any time when

you really needed to be hospitalised following a recommendation from a doctor, either as an inpatient or a day patient, but did not?

• YES, there was at least one occasion 1

• NO, there was no occasion 2

• Don't know/ I’m not sure 8 R.58

• Refusal 9

NEVI 57. What was the main reason for not being hospitalised? • Could not afford to (too expensive or not covered

by the insurance fund) 1

• Not enough beds (I have made an appointment) 2

• Could not take time because of work, care for children or for others 3

• Too far to travel / no means of transportation 4

• Fear of surgery / treatment 5

• Other reason _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 6

TXINTM

• Don't know 8

• Refusal 9

INTM Visits to dentist

R.58 Read this!

The next set of questions is about visits to dentist, (orthodontist or dental care specialist). Do not refer to contacting a dentist for a surgery problem. Do not take into consideration an appointmentfor a consultation wich did not took place yet. Also, accompanying another person, child, spouse should not be included.

58. When was the last time you visited a dentist or orthodontist on your own behalf (that is, not while only accompanying a child, spouse etc.)?

• Less than 12 months ago 1

• 12 months ago or longer 2

• Never 3

• Don't know/ I’m not sure 8

• Refusal............................................. 9

R.63

UVSTOM

CIA/12

59. During the past 12 months, how many times did you visit a dentist or orthodontist?

number of visits |__|__| VSTAN

• Don't know ....................................................... 98

• Refusal............................................................... 99 60. During the past four weeks (ending yesterday), how

many times did you visit a dentist or orthodontist on your own behalf?

number of visits . |__|__|

VST If „none” fill-in code 0

• Don't know / I’m not sure 98

• Refusal 99

61. What was the main reason you visited last time a dentist or orthodontist?

• Pain …………………………………………........... 1

• Extraction………………………………................... 2

• Treatment (fill the cavities, tartar removal)............... 3

• Routine control ......................................................... 4

• Lucrare dentara.……………………..…………...... 5

• Periodontosis………………………..…………...... 6

• Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 7 TXMST

• Don't know ............................................................. 8

• Refusal.................................................................... 9 MOTSTOM

62. The dentist or orthodontist you visited last time was working within the …

• Public sector ……………..……......................…… 1

• Private sector ……………..……….....................… 2

• Don't know ……………..…………………….…. 8

• Refusal……………..………………………….… 9 STAPAR

Visits to doctor (except dentist) R.63 Read this!

The next set of questions is about visits to doctor (except dentist) on your own behalf. Consider the medical examinations you had in the doctors’ office, in an outpatient or emergency department, any kind of medical examinations, besides those you had during hospitalisation, at home, at phone. You should refer to medical examinations you had during the holiday or travels countrywide or abroad. Do not take into consideration an appointment for a consultation wich did not took place yet. Also, medical examinations made by a nurse or a pharmacist should not be included.

Now I am going to ask you about the visit to the family doctor or a GP (general practitioner).

63. During the past 12 months did you contact the family doctor in order to accomplish the medical tests carried out within the „National programme for the evaluation of health status”?

• YES ……................………..………… 1

• NO ……………..….................……… 2

• Don't know ……………..……....…… 8 65

• Refusal ……………..……...........…… 9

PNES

64. Did you accomplish the medical tests recommended within this programme?

• YES.................................................... 1

month............................... |__|__| (1..12) LUNPN

• NO ..................................................... 2

• Don't know …….....………..………... 8

• Refusal ……………..……...............… 9

PNANZ

65. Apart from the „National programme for the evaluation of health status”, when was the last time you consulted the family doctor or when you ask for a consultation, last time, to a GP (general practitioner) on your own behalf?

• Less than 12 months ago……………........… 1

• 12 months ago or longer……………..…….. 2

• Never ……………..…………....................... 3

• Don't know/ I’m not sure……………..…..... 8

• Refusal……………..…………..................... 9

R.70

UMED

66. During the past 12 months how many times did you consult the family doctor or the GP (general practitioner) on your own behalf?

number of visits to the family doctor |__|__| MFAM

• Don't know ………………………………… 98

• Refusal……………..…………………….... 99 67. During the past 4 weeks (ending yesterday), how

many times did you consult the family doctor or a GP (general practitioner) on your own behalf?

number of visits to the family doctor |__|__|

VMF If „none” fill-in code 0

• Don't know/ I’m not sure…………....…. 98

• Refusal……………..…………............... 99

CIA/13

68. What was the main reason you visited last time the family doctor or the GP (general practitioner)?

• Accident or injure/wound ……………….. …..... 1

• Disease or health problem …………………... 2

• Routine control (no disease or health problem) 3

• Medical examination or prevention test 4

• Rewrite a medical prescription 5

• Administrative proceedings……………………… 6

• Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 7 TXMF

• Don't know/ Don’t remember 8

• Refusal 9 MOTMF

69. Following the consultation did you received a referral letter?

• YES……………..………………………………… 1 Where?

• To a medical specialist ……………..………… 2

• To a clinical laboratory ……………..……… 3

• To a radiology or diagnostic imaging centre… 4

• To a hospital, for hospitalisation …………….. 5

• Other institution _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 6

TXTRIM

• NO ……………………………………………......... 7

• Don't know/Don’t remember ……………..……...… 8

• Refusal……………..…………................................. 9 TRIM

R.70 Read this!

Next questions are about consultations with medical (or surgical specialists). Please include visits to doctors as outpatient or emergency departments, and also visits to doctors at the workplace or school.

Do not include contact while in hospital as an in-patient or day-patient or contact with a nurse, physiotherapist etc.

70. When was the last time you consulted a medical or surgical specialist on your own behalf?

• Less than 12 months ago.......................... 1

• 12 months ago or longer........................... 2

• Never ....................................................... 3

• Don't know/ I’m not sure.......................... 8

• Refusal...................................................... 9

76

USPEC

71. During the past 12 months how many times did you consult a medical or surgical specialist on your own behalf?

number of visits |__|__| NMES

• Don't know 98

• Refusal 99 72. During the past 4 weeks how many times did you

consult a medical or surgical specialist on your own behalf?

number of visits |__|__| VSP

If „none” fill-in code 0

• Don't know/ I’m not sure 98

• Refusal 99

73. What was the speciality of the doctor you consulted last time?

• Internist ………………………….........………….. 01

• Cardiologist………………………......………… 02

• Pneumologist, phtisiologist……........……………. 03

• Otorhinolaryngologist........................................... 04

• Ophthalmologist.................................................... 05

• Surgeon.................................................................. 06

• Dental surgeon....................................................... 07

• Endocrinologist, diabetologist.. ............................ 08

• Rheumatologist................................................….. 09

• Gastro-enterologist................................................ 10

• Urologist, nephrologist ......................................... 11

• Gynecologist (obstetrician). ................................. 12

• Oncologist............................................................. 13

• Dermatologist........................................................ 14

• Orthopaedist.......................................................... 15

• Gerontologist......................................................... 16

• Neurologist............................................................ 17

• Psychiatrist............................................................ 18

• Occupational health specialist...........………....... 19 • Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ TXSPECM

20

• Don't know/ Don’t remember ................................. 98

• Refusal..................................................................... 99 SPECM

CIA/14

74. What was the main reason you consulted last time a medical or surgical specialist?

• Accident or injure/wound ………………................. 1

• Disease or health problem …………………............ 2

• Routine control (no disease or health problem)........ 3

• Medical examination or prevention test ................. 4

• Rewrite a medical prescription ............................. 5

• Administrative proceedings…………………......… 6

• Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 7 TXMOTSP

• Don't know ……………........................................... 8

• Refusal…………….................................................. 9

MOTSP 75. The doctor you visited last time was working within the …

• Public sector ……………................................… 1

• Private sector ……………...............................… 2

• Don't know ……………................................… 8

• Refusal……………........................................… 9

APARTS

76. Was there any time during the past 12 months when you really needed to consult a medical or surgical specialist but did not?

• YES, there was at least one occasion.….. 1

• NO, there was no occasion…………..….. 2

• Don't know/ I’m not sure……………...… 8 78

• Refusal……………...............................… 9

NEVS

77. What was the main reason for not consulting a medical or surgical specialist?

• Could not afford to (too expensive or not covered by the insurance fund) ............................................ 01

• I have made an appointment.................................... 02

• Don't have the referral letter from the family doctor ..................................................................... 03

• Could not take time because of work, care for children or for others ............................................. 04

• Too far to travel / no means of transportation......... 05

• Fear of doctor / hospitals / examination / treatment...... 06

• Wanted to wait and see if problem got better on its own................................................................... 07

• Didn’t know any good medcial or surgical specialist ................................................................. 08

• Other reason:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 09

TXSPMOT

• Don't know/ I’m not sure....................................... 98

• Refusal................................................................... 99 SPMOT

Visits to other medical services and alternative medicine

78. During the past 12 months have you visited on your own

behalf a…?

YES NO DK R A. Medical laboratory, radiology centre

or diagnostic imaging centre............. 1 2 8 9

B. Physiotherapist / kinesitherapist ..... 1 2 8 9 C. Nurse, midwife (excluding when

being hospitalised, for home care services or in a medical laboratory, radiology centre or diagnostic imaging centre)...............................

1

2

8

9

D. Dietician, nutrition specialist.......... 1 2 8 9

E. Speech therapist.............................. 1 2 8 9

F. Chiropractor, manual therapist....... 1 2 8 9

G. Occupational therapist.................... 1 2 8 9

H. Psychologist or psychotherapist...... 1 2 8 9

I. Other paramedics............................ 1 2 8 9

ALT

79. During the past 12 months have you visited on your own behalf a …?

YES NO DK R

A. Homeopath.............................. 1 2 8 9

B. Acupuncturist.......................... 1 2 8 9

C. Phytotherapist / herbalist........ 1 2 8 9

D. Other paramedics................... 1 2 8 9

NAT

80. During the past 12 months, have you yourself used any of the following care services?

YES NO DK R

A. Home care service provided by a nurse or midwife ........... 1 2 8 9

B. Home help for the housework or for elderly people..................................... 1 2 8 9

C. "Meals on wheels"................. 1 2 8 9

D. Transport service................... 1 2 8 9

E. Other home care services....... 1 2 8 9 DOM

CIA/15

Use of medicines

Read this! I’d now like to ask about your use of medicines or dietary supplements in the past 2 weeks. First, I will ask you about the medicines that were prescribed or recommended by a doctor or a dentist and which you have used during this period. Medicines recommended by a pharmacist should not be included.

81. During the past 2 weeks (ending yesterday), have you used any medicines that were prescribed or recommended for you by a doctor (or a dentist)? Please include also contraceptive pills or other hormones, dietary supplements (herbal medicines or vitamins) recommended for you by a doctor.

• YES ................................................................. 1

• NO ................................................................... 2

• Don't know/ I’m not sure................................. 8

• Refusal............................................................. 9

83

MCP

82. Were these medicines for…

YES NO DK R

A. Asthma? .................................... 1 2 8 9 B. Chronic bronchitis, chronic

obstructive pulmonary disease, emphysema? ............................ 1 2 8 9

C. High blood pressure?................. 1 2 8 9 D. Lowering the blood cholesterol

level?......................................... 1 2 8 9 E. Other cardiovascular disease,

such as stroke and heart attack? 1 2 8 9 F. Pain in the joints (arthrosis,

arthritis)?................................... 1 2 8 9

G. Pain in the neck or back?........... 1 2 8 9

H. Headache or migraine?.............. 1 2 8 9

I. Other pain?................................. 1 2 8 9

J. Diabetes?.................................... 1 2 8 9 K. Allergic symptoms (eczema,

rhinitis, hay fever)?................... 1 2 8 9

L. Stomach troubles? ..................... 1 2 8 9

M. Cancer (chemotherapy)?............ 1 2 8 9

N. Depression?................................ 1 2 8 9

O. Tension or anxiety?.................... 1 2 8 9

Have you used other types of medicines that were prescribed to you, such as …:

P. Sleeping tablets? ........................... 1 2 8 9 Q. Antibiotics such as penicillin,

ampicillin? .................................. 1 2 8 9

Rules for the interviewer: For women 50 years or younger For men T

Check the year of birth (age) in the CG

R. Contraceptive pills? ..................... 1 2 8 9 Rules for the interviewer:

For women 45 years or older Check the year of birth (age) in the CG

S. Hormones for menopause?.......... 1 2 8 9 Rules for the interviewer:

For all the respondents (men and women) T. Some other medicines prescribed

by a doctor................................. What type of medicines?

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

1

2

8

9

TXP DMCP

Read this! Next questions are about the medicines or dietary supplements which you used during the past 2 weeks, not prescribed or recommended by a doctor.

83. During the past 2 weeks (ending yesterday), have you used any medicines or dietary supplement (herbal medicines or vitamins) not prescribed or recommended by a doctor?

• YES ......................................................... 1

• NO .......................................................... 2

• Don't know .............................................. 8 R.85

• Refusal..................................................... 9 MCN


Hand SHOWCARD 8 (USE OF NOT PRESCRIBED MEDICINES), then ask the respondent to read out all categories for answering to the following question.

84. Were these medicines or supplements for… YES NO DK R • A. Pain in the joints (arthrosis, • arthritis)? ..................................... 1 2 8 9

• B. Headache or migraine? ............... 1 2 8 9

• C. Other pain? ................................. 1 2 8 9

• D. Cold, flu or sore throat? ............. 1 2 8 9 • E. Allergic symptoms (eczema, • rhinitis, hay fever)? .................... 1 2 8 9

• F. Stomach trouble? ....................... 1 2 8 9 • G. Or were they vitamins, minerals • or tonics? .................................. 1 2 8 9 • H. Or some other type or medicine • or supplement?

The medicine was for: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

1

2

8

9

TXNP DMCN

CIA/16

Preventive care, tests and medical examinations

R.85 Read this! Now I would like to ask you some questions about flu vaccination.

85. Have you ever been vaccinated against flu?

• YES ............................................................ 1

• NO ............................................................. 2

• Don't know ................................................. 8

• Refusal......................................................... 9

R.88

VAC 86. When were you last time vaccinated against flu?

• This year (2008) ................................... 1

• Last year (2007) ................................... 2

• Before last year...................................... 3

• Don't know ................................................. 8

• Refusal......................................................... 9

R.88

UVAC 87. Can I just check, what month was that? month |__|__| (1..12) LVAC

• Don't know ...................................................... 98

• Refusal.............................................................. 99 R.88 Read this!

Now I would like to ask you some questions about your blood pressure.

88. Has your blood pressure ever been measured by a health professional?

• YES .......................................................... 1

• NO ........................................................... 2

• Don't know .............................................. 8 R.90

• Refusal...................................................... 9

TENS 89. When was the last time that your blood pressure was

measured by a health professional?

• Within the past 12 months........................ 1

• 1-5 years ago............................................. 2

• More than 5 years ago.............................. 3

• Don't know............................................... 8

• Refusal...................................................... 9

UTENS

R.90 Read this! Now I would like to ask you some questions about your blood cholesterol. 90. Has your blood cholesterol ever been measured?

• YES .......................................................... 1

• NO ........................................................... 2

• Don't know .............................................. 8 R.92

• Refusal...................................................... 9 COLS

91. When was the last time that your blood cholesterol was measured?

• Within the past 12 months....................... 1

• 1-5 years ago............................................ 2

• More than 5 years ago.............................. 3

• Don't know............................................... 8

• Refusal...................................................... 9 UCOLS

R.92 Read this! Now I would like to ask you some questions about your blood sugar (glycaemia).

92. Has your blood sugar ever been measured? • YES ........................................................... 1 • NO ............................................................. 2 • Don't know ................................................ 8 R.94

• Refusal....................................................... 9 GLIC 93. When was the last time that your blood sugar was

measured?

• Within the past 12 months........................ 1 • 1-5 years ago............................................ 2 • More than 5 years ago.............................. 3 • Don't know............................................... 8 • Refusal...................................................... 9 UGLIC

R.94 Rules for the interviewer: For men R.100 Next questions are for women.

Read this! The next questions are about mammography.

94. Have you ever had a mammography, which is an X-ray of one or both of your breasts?

• YES ........................................................... 1

• NO ............................................................. 2

• Don't know ................................................ 8 R.97

• Refusal....................................................... 9

MAM

95. When was the last time you had a mammography (breast X-ray)?

• Within the past 12 months.......................... 1

• More than 1 year, but not more than 2 years............................................................ 2

• More than 2 years, but not more than 3 years............................................................ 3

• Not within the past 3 years.......................... 4

• Don't know.................................................. 8

• Refusal ..................................................... 9

UMAM

CIA/17

96. What was the reason for this last mammography?

• Myself or my GP/family doctor or a specialist

noticed something not quite right in my breast (e.g a lump) .......................................................... 1

• My GP/family doctor or a specialist advised me to have it without there being something wrong.. 2

• Because of breast cancer in my family................ 3

• Invitation from a national or local screening programme............................................................ 4

• Other reason_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ALTMOTM

5

• Don't know........................................................... 8

• Refusal................................................................. 9

MOTM R.97 Read this!

Now I would like to ask you some questions about cervical smear tests.

97. Have you ever had a cervical smear test? (including Babeş-Papanicolau test)?

• YES........................................................... 1

• NO ........................................................... 2

• Don't know................................................ 8 R.100

• Refusal...................................................... 9

PAP

98. When was the last time you had a cervical smear test?

• Within the past 12 months........................ 1

• More than 1 year, but not more than 2 years.......................................................... 2

• More than 2 years, but not more than 3 years.......................................................... 3

• Not within the past 3 years....................... 4

• Don't know................................................ 8

• Refusal ................................................... 9

UPAP

99. What was the reason for this last cervical smear test?

• Because of symptoms............................... 1

• Because I visited a gynaecologist............. 2

• Invitation from a national or local screening programme............................... 3

• Other medical reason................................ 4

• For another reason (not especially medical) ................................................... 5

• Don't know................................................ 8

• Refusal...................................................... 9

ULTC

R.100 Read this! The next questions are about colon cancer (faecal occult blood test).

100. Have you ever had a faecal occult blood test?

• YES ........................................................... 1

• NO ............................................................ 2

• Don't know ................................................ 8 R.102

• Refusal....................................................... 9 FEC

101. When was the last time you had a faecal occult blood test?

• Within the past 12 months........................ 1 • More than 1 year, but not more than 2

years........................................................... 2 • More than 2 years, but not more than 3

years........................................................... 3 • Not within the past 3 years........................ 4

• Don't know................................................ 8

• Refusal .............................................. 9 UFEC

Satisfaction with the health care system

R. 102 Rules for the interviewer: Hand SHOWCARD 9 (SATISFACTION WITH THE HEALTH CARE SYSTEM), then ask the respondent to read out all categories for answering to the following question.

Read this! Now I would like to ask you some questions about your satisfaction with the health care system.

102. In general, concerning the services provided by the following health care providers, would you say you are:

Fair

ly

satis

fied

Satis

fied

So-s

o

Dis

satis

fied

Ver

y di

ssat

isfie

d

Don

't kn

ow

Ref

usal

A. Hospitals (including emergency departments)...... 1 2 3 4 5 8 9

B. Dentists (including orthodontists and dental care specialists)......... 1 2 3 4 5 8 9

C. Medical or surgical specialists.......... 1 2 3 4 5 8 9

D. Family doctors or GPs............... 1 2 3 4 5 8 9

E. Home care services.............. 1 2 3 4 5 8 9

SIS

CIA/18

HEALTH STATUS DETERMINANTS Height and weight

Read this! Now I'm going to ask you about your height and weight.

103. How tall are you without shoes (in cm)? height |__|__|__| cm INALT

• Don’t know 998

• Refusal 999

104. How much do you weigh without clothes and shoes? (for pregnant women the weight before pregnancy)

weight |__|__|__| kg GREUT

• Don’t know 998

• Refusal 999

Physical activity Read this!

Now I am going to ask you about the time you spent being physically active in the past 7 days. Please answer each question, even if you do not consider yourself to be an active person. Think about the activities you do at work, as part of your house and gardenind, geting from place to place, and in your spare time for recreation, exercise or sport.

I will ask you separately about the vigorous physical activities, then the moderate physical effort and walking. Let's talk first about the vigorous physical activities.

Vigorous activities resides in vigorous physical activity and make you breathe much harder than normal. Is consisting of: heavy lifting, digging, cutting woods, construction work, walking up and down the stairs as part of the work, aerobics, or fast bicycling.

Think only about those physical activities that you did for at least 10 minutes at a time.

105. During the past 7 days, on how many days did you do vigorous physical activities?

total days spent doing vigorous physical activities |__| days/week

For „none” fill-in code 0 and R.107

• Don't know/ I’m not sure........................... 8

• Refusal....................................................... 9 R.107

AFI 106. During the past 7 days, how much time did you

spend doing vigorous physical activities?


If the respondent answers the time spent doing vigorous physical activity vary from day to day prompt "an estimate is acceptable".

total time spent doing vigorous physical activities / week |__|__| hours |__|__| minutes / week HINT MINT


• Refusal....................................................... 99

R. 107 Read this! Now think about the time spent doing activities which take moderate physical effort. Moderate physical activities make you breathe somewhat harder than normal and may include carrying light loads, sweeping, washing the windows, bicycling at a regular pace, doubles tennis or swimming. Do not include walking. Think only about those moderate physical activities that you did for at least 10 minutes at a time.

107. During the past 7 days, on how many days did you do moderate physical activities?

total days moderate physical activity ....|__| days / week


• Don't know/ I’m not sure............. 8

• Refusal......................................... 9 R.109

AFM

108. During the past 7 days, how much time did you spend doing moderate physical activities?


If the respondent answers the time spent doing moderate physical activity vary from day to day prompt "an estimate is acceptable".

total time spent with moderate physical activities / week

|__|__| hours |__|__| minutes / week

HMOD MMOD

• Don't know/ I’m not sure............................ 98

• Refusal........................................................ 99

R. 109 Read this!

Now let’s talk about the time you spent walking.

Walking is a separate activity and includes walking from/to work/school, from place to place, and any other walking that you might do solely for recreation, sport, exercise, or leisure.

Think only about the walking that you did for at least 10 minutes at a time.

109. During the past 7 days, on how many days did you walk for at least 10 minutes at a time?

total days walking........................................... |__| days / week


• Don't know/ I’m not sure......................... 8

• Refusal..................................................... 9 R.111

PL

CIA/19

110. During the past 7 days, how much time did you spend walking?


If the respondent answers the time spent walking vary from day to day prompt "an estimate is acceptable".

total time spent walking/day |__|__| hours |__|__| minutes / day HPL MPL


• Refusal....................................................... 99

Consumption of fruits and vegetables. Diet

R.111 Read this!

Next questions concern your daily feeding. 111. How often do you eat fruits (excluding juice)?

• Twice a day or more...................................... 1

• Once a day..................................................... 2

• Less than once a day, but at least 4 times a week............................................................... 3

• Less than 4 times a week, but at least once a week............................................................... 4

• Less than once a week................................... 5

• Never............................................................. 6

• Don't know..................................................... 8

• Refusal........................................................... 9

FRU

112. How often do you eat vegetables or salad (excluding juice and potatoes)?

• Twice a day or more...................................... 1

• Once a day..................................................... 2




• Never............................................................. 6

• Don't know..................................................... 8

• Refusal........................................................... 9

LEG

113. How often do you drink fruit - or vegetable - juice? • Twice a day or more...................................... 1

• Once a day..................................................... 2




• Never............................................................. 6

• Don't know..................................................... 8

• Refusal ................................................... .... 9 SUC 114. Do you/did you keep a diet?

• YES.............................................................. 1

• YES, I did.................................................... 2

• NO .............................................................. 3

• Don't know................................................... 8

• Refusal......................................................... 9

R.117

REALIM

115. Was the diet:

• Recommended for you by a doctor?.............. 1

• From your own initiative?........................... 2

• Other situation _ _ _ _ _ _ _ _ _ _ _ _ _ _ TXREGIM

3

• Don't know................................................... 8

• Refusal.......................................................... 9

REGIM

116. Was the diet about:

• Consumption of salt? .................................. 1

• Consumption of calories? ........................... 2

• Consumption of fats? .................................. 3

• Consumption of sugar? ............................... 4

• Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ TXREREG

5 R.119

• Don't know................................................... 8

• Refusal.......................................................... 9 REREG 117. Did you received a recommendation of a doctor to

change your diet? • YES ............................................................. 1

• NO ............................................................... 2

• Don't know................................................... 8

• Refusal......................................................... 9

R.119

RECOM

CIA/20

118. What is the main reason for not keeping the diet at present?

• No more ill .................................................. 1

• Improvement of the health status ................ 2

• Financial reasons ........................................ 3

• Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4

TXMODR

• Don't know................................................... 8

• Refusal.......................................................... 9

MODR

Environment and social relations R. 119 Read this!

Next questions concern the environment where you live and work and social support.


Hand SHOWCARD 10 (EXTENSION OF EXPOSURE)

119. Thinking about the past 12 months, when you were at home, to what extent were you exposed to any of the following conditions?

Seve

rely

ex

pose

d

Som

ewha

t ex

pose

d

Not

exp

osed

Don

't kn

ow

Ref

usal

A. Noise (as road traffic, train traffic, airplane traffic, factories, neighbours, animals, restaurants / bars / disco) .................................. 1 2 3 8 9

B. Air pollution (fine dust, grime, dust, fume, ozone)..... 1 2 3 8 9

C. Bad smells (from the industry, from the agriculture, sewer, waste).....

1 2 3 8 9

EXP


Leave the SHOWCARD 10 (EXTENSION OF EXPOSURE)to the respondent.

120. Thinking about the past 12 months, to what extent were you exposed to crime, violence or vandalism at home or in the area where you live?

Seve

rely

ex

pose

d

Som

ewha

t ex

pose

d

Not

exp

osed

Don

't kn

ow

Ref

usal

Crime, violence or vandalism in the area................................................ 1 2 3 8 9

EXPACT


Check the answer to question 3. If the respondent works (code 01) continue and ask the respondent to use SHOWCARD 10 (EXTENSION OF EXPOSURE). Otherwise 122

121. At your workplace, to what extent are you exposed to …?

Seve

rely

ex

pose

d

Som

ewha

t ex

pose

d

Not

exp

osed

Don

't kn

ow

Ref

usal

A. Harassment or bullying.......... 1 2 3 8 9 B. Discrimination........................ 1 2 3 8 9 C. Violence or threat of violence

1 2 3 8 9 D. Time pressure or overload of work............................................ 1 2 3 8 9 E. Chemicals, dust, fumes, smoke or gases........................... 1 2 3 8 9 F. Noise or vibration.................. 1 2 3 8 9 G. Difficult work postures, work movements or handling of heavy loads................................. 1 2 3 8 9 H. Risk of accidents................... 1 2 3 8 9 EXLM

122. How many people are so close to you that you can count on them if you have serious personal problem?

• None................................................................... 1

• 1 or 2.................................................................. 2

• 3 to 5.................................................................. 3

• More than 5........................................................ 4

• Don't know......................................................... 8

• Refusal............................................................... 9

PRIT

DISABILITIES AND SOCIAL INTEGRATION

Mobility and transport Read this!

Next questions are about the possibility of getting out of the house when and where you feel like it.

123. Do you go out when you would like to?

• YES .............................................................. 1

• NO................................................................ 2

• Don’t know................................................... 8

• Refusal.......................................................... 9

ICAS

CIA/21

124. Do you go out where you would like to?

• YES .............................................................. 1

• NO................................................................ 2

• Don’t know................................................... 8

• Refusal.......................................................... 9 UMER

Rules for the interviewer: If the answer is coded 2 for any of the last 2 questions (123 and 124) hand SHOWCARD 11 (MOBILITY), then continue. Otherwise 126

125. What prevents you from going out more often, when or where you want to?

• A health problem or condition ............................ 01

• A disability / invalidity ..................................... 02

• Work/family/too busy/not enough time.............. 03

• Financial reasons/lack of money/can’t afford to. 04

• Problems with public transport............................ 05

• Lack of mobility equipment................................. 06

• Lack of help/support/personal assistance............ 07

• Lack of companionship/someone to go about with...................................................................... 08

• Worry/anxiety/lack of confidence/embarrassed about going out.................................................... 09

• Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10

MOTX

• Don’t know......................................................... 98

• Refusal................................................................. 99 MOT

126. Do you (or anyone else in your household) have a car or van?

• YES .............................................................. 1

• NO................................................................ 2

• Don’t know................................................... 8 130

• Refusal.......................................................... 9 AMMAS

127. Do you yourself drive the car or van?

• YES .............................................................. 1 130

• NO................................................................ 2

• Don’t know................................................... 8

• Refusal.......................................................... 9 CONDMA

128. Do you go out in the car or van?

• YES .............................................................. 1 130

• NO................................................................ 2

• Don’t know................................................... 8

• Refusal.......................................................... 9 130

DEPLMA

Rules for the interviewer: Hand SHOWCARD 12 (TRANSPORTATION), then ask:

129. What prevents you from going out in the car or van

(even if somebody else is driving)?

• A health problem or disability......................... 1

• A disability / invalidity .................................... 2

• No-one to take me out / drive the car............... 3

• Car not suitable/adapted................................... 4

• Do not want to travel by car............................. 5

• Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 6

DEPTX

• Don’t know...................................................... 8

• Refusal............................................................. 9 DEPMOT

130. Do you use public transport?

• YES .............................................................. 1

• NO................................................................ 2

• Don’t know................................................... 8

• Refusal.......................................................... 9 TRANSPC

131. Would you like to use public transport (more often

than you do)?

• YES .............................................................. 1

• NO................................................................ 2

• Don’t know................................................... 8

• Refusal.......................................................... 9

R.133

VREAUTC

CIA/22

Rules for the interviewer: Hand SHOWCARD 13 (PUBLIC TRANSPORT), then ask:

132. What prevents you from using public transport (more often)?

• A health problem or disability ............................. 01

• A disability, invalidity ......................................... 02

• Prefer to use my own transport............................. 03

• Financial reasons/lack of money/can’t afford to... 04

• Too crowded/claustrophobic................................. 05

• No public transport close by................................. 06

• Not frequent enough/timetable unsuitable............ 07

• Hard to get on/get off/find a seat.......................... 08

• No help with bags/pushchairs/wheelchairs........... 09

• Worry/anxiety/lack of confidence/embarrassed about using public transport................................. 10

• Other reasons_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 11

TCMX

• Don’t know........................................................... 98

• Refusal.................................................................. 99 TCMOT

R.133 Read this!

I'd now like to ask some questions about your access to the Internet even if just to send an e-mail.

133. Does your household have access to the Internet from home?

• YES .............................................................. 1

• NO................................................................ 2

• Don’t know................................................... 8 135

• Refusal.......................................................... 9

AMNET

134. May I just check, in the past 3 months have you ever used the Internet at home?

• YES .............................................................. 1

• NO................................................................ 2

• Don’t know................................................... 8

• Refusal.......................................................... 9 FOLNET

135. In the past 3 months have you ever used the Internet from any other place?

• YES .............................................................. 1

• NO................................................................ 2

• Don’t know................................................... 8

• Refusal.......................................................... 9

FOLNETA

Accessibility in buildings

Read this! Next 2 questions are about how well buildings are designed for use by everyone.

136. Thinking about all the buildings that you want to

visit – public buildings, offices, shops, and people’s homes – do you ever find that you have difficulty...

Ver

y of

ten

Qui

te o

ften

Occ

asio

nally

Not

at a

ll

Bed

bou

nd

Don

’t k

now

Ref

usal

A. Getting to the building? 1 2 3 4 5 8 9

B. Getting into the building? 1 2 3 4 5 8 9

C. Going through the building? 1 2 3 4 5 8 9

D. Using the facilities in the building 1 2 3 4 5 8 9

ACLD

Rules for the interviewer: If for any variant from A to D the code is 1 or 2, continue. Otherwise, R.138

137. Why do you have difficulty with access or use of some

buildings?

• Because they are not designed or adapted for people with health problems or disabilities...... 1

• Other reason _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2

ACCTMX

• Don’t know................................................... 8

• Refusal.......................................................... 9

MOTACC

CIA/23

Managing routine activities R.138 Read this!

Here are some questions about how well you feel you plan and manage normal days.

138. Thinking about all the routine activities people do or have to do in an average day, how often do you find that you manage to do what you have planned? Would you say you manage...

• Very well.................................................... 1

• Quite well .................................................. 2 140

• Not very well ............................................. 3

• Not well at all ............................................ 4

• Don’t know................................................ 8

• Refusal ..................................................... 9 140

DESCURC


Hand SHOWCARD 14 (OBSTACLES ENCOUNTERD IN MANAGING ROUTINE ACTIVITIES), then ask:

139. What prevents you from doing what you planned to do?

• A health problem or disability.................... 1

• A disability, invalidity ................................ 2

• Factors that I have no control over.............. 3

• Too many things to do................................ 4

• Take on too much....................................... 5

• Not enough help......................................... 6

• Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 7

DESCTX

• Don’t know................................................. 8

• Refusal........................................................ 9 DESCMOT

140. In general, how well do you cope with stress?

• Very well.................................................... 1

• Quite well................................................... 2 R.142

• Not at all well............................................. 3

• I can not cope the stress at all.................... 4

• Don’t know................................................ 8

• Refusal ...................................................... 9 R.142

STRES


Hand SHOWCARD 15 (DIFFICULTIES AND STRESS), then ask:

141. Why do you have some difficulty coping with stress?

• A health problem.............................................. 1

• A disability, invalidity .................................... 2

• Do not know what to do................................... 3

• Do not have the help I need.............................. 4 • Other reasons_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5 STRESX

• Don’t know....................................................... 8

• Refusal.............................................................. 9

MOTSTRES

Focusing attention, ability to read and write R.142 Read this!

I am now going to ask you a few simple questions about important skills involved in gaining and using knowledge. We are asking these questions of everyone taking part in the survey. Please pick an answer from this card.

Rules for the interviewer: Hand SHOWCARD 16 (ATTENTION), then read the questions from this section (142-146)

142. Can you watch a TV programme when there are other things going on which could distract you?

• Yes, with no difficulty at all............................. 1

• Yes, but with some difficulty ........................... 2

• Yes, but with a lot of difficulty......................... 3

• No, not at all ..................................................... 4

• Don’t know....................................................... 8

• Refusal ............................................................. 9

ATTV

143. Can you read and understand a short article in a newspaper?




• No, not at all ..................................................... 4

• Don’t know....................................................... 8

• Refusal ............................................................. 9

ZIAR

CIA/24

144. Can you write a short letter to someone without help?




• No, not at all ..................................................... 4

• Don’t know....................................................... 8

• Refusal ............................................................. 9

SCRIS

Settling disputes and taking decisions 145. Could you settle a minor disagreement between two

people?




• No, not at all ..................................................... 4

• Don’t know....................................................... 8

• Refusal ............................................................. 9

DISC

146. Can you decide what socks you want to buy when there are lots to choose from?




• No, not at all ..................................................... 4

• Don’t know....................................................... 8

• Refusal ............................................................. 9

HOT

Major life areas Read this!

Thinking now about taking part in different areas of life and the opportunities and barriers that present themselves to you.

147. Do you feel that you have access to all the learning opportunities that you would like to? By learning opportunities I mean learning new arts and crafts, vocational training as well as school and higher education courses?

• YES ........................................................... 1 R.149

• NO.............................................................. 2

• Don’t know................................................ 8

• Refusal....................................................... 9 R.149

ACED

Rules for the interviewer: Hand SHOWCARD 17 (LIMITS IN ACCESS TO EDUCATION), then ask:

148. What limits your opportunity to learn new things?

• A health problem.......................................................... 01

• A disability / invalidity .............................................. 02

• Financial reasons/lack of money/can’t afford to.......... 03

• Difficulty getting a place/refused a place..................... 04

• Lack of confidence....................................................... 05

• None close by/problems with transport........................ 06

• Not frequent enough/timetable unsuitable................... 07

• Family don’t want it/discourage it............................... 08

• Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 09

EDTX

• Don’t know.................................................................. 98

• Refusal......................................................................... 99 MOTED

R.149 Rules for the interviewer: Check the answer to question 3 (Labour status). If the respondent declared:

• Paid employment (code 1) – continue

Otherwise:

• (code 2) – unemployed 151

• (code 5, 6, 7) - fulfilling domestic tasks +other situation+permanently disabled 153

• (code 3, 4) – in retirement, pupil or student 154


Only for subjects currently working (see filter R.149)

149. Are you limited in the type or amount of work that you do?

• YES ................................................... 1

• NO...................................................... 2

• Don’t know........................................ 8 R.154

• Refusal............................................... 9 MLIM

CIA/25

Rules for the interviewer: Hand SHOWCARD 18 (LIMITATION OF WORK), then ask:

150. Why are you limited in the type or amount of work that you do?

• A health problem or disability............... 01

• A disability, invalidity ......................... 02

• Family responsibilities........................... 03

• Transport problems................................ 04

• Access problems.................................... 05

• Employers lack of flexibility................. 06

• Lack of qualifications/experience......... 07

• Affects receipt of benefits.................... 08

• Lack of job opportunities...................... 09 • Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10

BARMTX

• Don’t know........................................... 98 • Refusal.................................................. 99

R.154

BARM Rules for the interviewer:

Question for unemployed persons only (see filter R.149) 151. Are you limited in the type or amount of work that

you could do? • YES ......................................................... 1

• NO............................................................ 2 • Don’t know.............................................. 8

• Refusal..................................................... 9

R.154

SLIM Rules for the interviewer:

Hand SHOWCARD 18 (LIMITATION OF WORK), then ask:

152. Why are you limited in the type or amount of work that you could do?

• A health problem or disability.................. 01

• A disability, invalidity ............................. 02

• Family responsibilities............................. 03

• Transport problems.................................. 04

• Access problems....................................... 05

• Employers lack of flexibility.................... 06

• Lack of qualifications/experience............ 07

• Affects receipt of benefits........................ 08

• Lack of job opportunities......................... 09

• Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ 10 SBARTX • Don’t know.............................................. 98 • Refusal..................................................... 99

R.154

SBAR


Only for subjects not in paid employment and not seeking work and neither a student nor retired (based on employment question in recruitment questionnaire) (see filter R.149) Hand SHOWCARD 18 (LIMITATION OF WORK), then ask:

153. There are lots of valid reasons why people do not do paid work or choose not to look for work. May I ask, why are you not looking for paid work at the moment?

• A health problem or disability....................... 01

• A disability, invalidity ................................. 02

• Family responsibilities................................... 03

• Transport problems........................................ 04

• Access problems............................................ 05

• Employers lack of flexibility......................... 06

• Lack of qualifications/experience.................. 07

• Affects receipt of benefits.............................. 08

• Lack of job opportunities............................... 09

• Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10

TXMUN

• Don’t know.................................................... 98 • Refusal........................................................... 99

MUNCMOT

Managing financially R.154 Read this!

The next questions are about how you manage financially. 154. Can you manage with the money you have to spend

each week? • YES, I can manage with the money I have

to spend ..................................................... 1 R.156 • No, I can not manage with the money I

have to spend each week............................ 2

• Don’t know................................................ 8• Refusal....................................................... 9

R.156 GB


Hand SHOWCARD 19 (MANAGING FINANCIALLY), then ask:

155. What is the main reason for needing to borrow money?

• A health problem restricts what I earn......................... 1 • A disability restricts what I earn.................................. 2

• Everything is more expensive these days..................... 3 • I have difficulty in budgeting with the money I have.. 4 • Other reasons_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5 IBTX • Don’t know.................................................................. 8 • Refusal......................................................................... 9

IB

CIA/26

Spending leisure time

R.156 Read this! I would now like to ask you about how you spend your leisure time.

Rules for the interviewer: Hand SHOWCARD 20 (LEISURE TIME), then ask:

156. I am going to read out a list of activities. Please look at this card and for each activity can you tell me which of the three statements on the card applies to you.

I w

ould

like

to d

o m

ore

of t

hese

act

iviti

es

I am

con

tent

with

how

muc

h tim

e I s

pend

on

thes

e ac

tiviti

es

I do

not d

o an

y of

thes

e ac

tiviti

es a

nd d

o

not w

ish

to

Don

’t k

now

Ref

usal

• Any sporting activity......... 1 2 3 8 9

• Charitable or voluntary work .................................. 1 2 3 8 9

• Meeting other people with similar hobbies or interests 1 2 3 8 9

• Going to the cinema, theatre, opera or a concert . 1 2 3 8 9

• Going to a museum or art gallery................................ 1 2 3 8 9

• Going to cafes, restaurants or pubs............................... 1 2 3 8 9

• Visiting family or friends for a chat or a meal........... 1 2 3 8 9

• Family or friends visiting you for a chat or a meal..... 1 2 3 8 9

• Attending family gatherings or social events 1 2 3 8 9

• Sightseeing, going on holiday............................... 1 2 3 8 9

• Voting in general or local elections............................. 1 2 3 8 9

• Attending religious services.............................. 1 2 3 8 9

ACTIVI

Rules for the interviewer: If for at least one of the variants A to L from the last question the answer is coded 1, hand SHOWCARD 21 (LIMITATION OF SOCIAL ACTIVITIES), then continue. Otherwise 158

157. You have said that you would prefer to do more (READ ACTIVITIES CODED 1). What is stopping you from doing more of these activities?

• A health problem ............................................................ 1

• A disability, invalidity ................................................... 2

• Too busy with family/work; no time to ......................... 3

• Can not afford to do it more often................................... 4

• Can not get there/transport problems.............................. 5

• Accessibility to buildings is a problem........................... 6

• Feel that I am not welcome............................................. 7

• Don’t know..................................................................... 8

• Refusal............................................................................ 9 ACTMO

158. Overall, how much choice would you say you have over how you spend your leisure time? Do you feel you have…

• An unlimited choice........................................................ 1

• A lot of choice................................................................. 2

• Some choice ................................................................... 3

• No choice at all............................................................... 4

• Don’t know..................................................................... 8

• Refusal............................................................................ 9 PAL

Social interaction Read this!

The next few questions are about people you feel close to, including relatives and friends.

159. Thinking about all of the people you feel close to but do not live with you, how many did you meet or speak with in the past week?

• None................................................................................ 1

• 1 or 2 .............................................................................. 2

• 3, 4 or 5........................................................................... 3

• 6 or more......................................................................... 4

• Don’t know.................................................................... 8

• Refusal............................................................................ 9 APR

CIA/27

Respect and consideration 160. Thinking about how other people tend to respond to

you, would you say that you get respect and consideration from other people?

• Very often.................................................. 1

• Quite often ................................................ 2 162

• Not very often............................................ 3

• Never or hardly ever.................................. 4

• Don’t know................................................ 8

• Refusal ..................................................... 9 162

RESPECT 161. Why do you feel that you do not often get respect or

consideration?

• My health problem ................................... 1

• Because I am disabled............................... 2

• Other reasons _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3 TXTMOT

• Don’t know................................................ 8

• Refusal ..................................................... 9 MOTRESP

Control of emotions

162. How often do you lose control of your emotions in your relationships with members of your family?

• Very often ................................................. 1

• Quite often ................................................. 2

• Not very often............................................ 3

• Never or hardly ever................................. 4

• SPONTANEOUS RESPONSE: no family 5 164

• Don’t know................................................ 8

• Refusal....................................................... 9 EMO

Rules for the interviewer: Hand SHOWCARD 22 (EMOTIONS), then ask:

163. What do you do when you lose control of your emotions in your relationships with members of your family?

• Laugh........................................................... 1

• Cry............................................................... 2

• Shout........................................................... 3

• Swear........................................................... 4

• Rip, break or throw things........................... 5

• Hit out and injure yourself or others........... 6

• Something else _ _ _ _ _ _ _ _ _ _ _ _ _ _ 7

RADTX • Don’t know.................................................. 8

• Refusal ........................................................ 9

Rules for the interviewer: Leave SHOWCARD 22 (EMOTIONS) to the respondent until the end of section.

164. How often do you lose control of your emotions in your relationships with people outside of your family?

• Very often ................................................. 1

• Quite often ................................................. 2

• Not very often............................................ 3

• Never or hardly ever.................................. 4

• Don’t know................................................ 8

• Refusal ..................................................... 9

166

CEM 165. What do you do when you lose control of your

emotions in your relationships with people outside of your family?

• Laugh......................................................... 1

• Cry.............................................................. 2

• Shout.......................................................... 3

• Swear.......................................................... 4

• Rip, break or throw things.......................... 5

• Hit out and injure yourself or others.......... 6

• Something else _ _ _ _ _ _ _ _ _ _ _ _ _ 7

TIPTX

• Don’t know................................................ 8

• Refusal ..................................................... 9

TIP

Discrimination Rules for the interviewer:

Hand SHOWCARD 23 (DISCRIMINATION), then ask:

166. Finally, a question about discrimination. Do you feel that you personally are subjected to discrimination in everyday life for any of the reasons shown on this card, or for any other reason?

YES NO DK R

A. Age............................................. 1 2 8 9

B. Sex............................................. 1 2 8 9

C. Disability, invalidity ............... 1 2 8 9

D. Ethnicity or race........................ 1 2 8 9

E. Religion..................................... 1 2 8 9

F. Sexual orientation..................... 1 2 8 9

G. Other reasons_ _ _ _ _ _ _ _ _ _ 1 2 8 9

TXDISCR DISCR

CIA/28

Rules for the interviewer: Continue only if for variant C the answer is coded 1. Otherwise 168. Hand SHOWCARD 24 (SOURCES OF DISCRIMINATION), then ask:

167. Can you look at the list on the card and tell me who subjects you to discrimination?

• Employers............................................................ 01

• Shops and shop keepers....................................... 02

• Cinemas and theatres........................................... 03

• Galleries and museums........................................ 04

• Gyms and sports/leisure centres.......................... 05

• Transport providers.............................................. 06

• Health services..................................................... 07

• Social services..................................................... 08

• Council/local government.................................... 09

• Insurance companies............................................ 10

• Strangers on the street.......................................... 11

• Travel agencies.................................................... 12

• Friends and acquaintances.................................. 13

• Others _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 14 TXDISC

• Don’t know.......................................................... 98

• Refusal ................................................................ 99

DISCRIMI


The answer to the following question should be filled-in by you, according to the situation encountered!

168. Who answered the questions?

The subject him/herself.......................... 1

Other person .......................................... 2 RASP

Code of the person CP from the CG |__|__| CPR

169. Duration of filling-in the individual questionnaire in minutes…........…. |__|__| DCIA


If the interview is conducted with the head of the household, continue with the next section, if not hand the self-completion questionnaire.

THE FOLLOWING QUESTIONS ARE ONLY FOR

THE HEAD OF THE HOUSEHOLD

GENERAL INFORMATION ABOUT THE DWELLING

170. Type of the building

• Individual house ……...………………...... 1

• Building with many flats (block of flats, villa) ................................................................ 2

• Other type of building ……………….. 3

TL 171. Is there a lift in the building?

• YES …………………………………….. 1

• NO………………………………………... 2 LF

172. Has the building (block/villa) an access plaltform for the wheelchairs?

• YES……………………………………….. 1

• NO ………………………………………... 2 RM

173. The type of water supply • Inside the building, public water-supply or

own system ..................................................... 1

• Outside the dwelling, but inside the building 2

• Outside the building, but from the public water-supply or other source........................... 3

AA 174. Type of hot water supply

• Public water-supply …………………............ 1

• Own system …………………...……............. 2

• Has no hot water …………………………… 3

AC

175. Location of the bathroom

• Inside the dwelling. ........................................ 1

• Outside the dwelling....................................... 2

• Has no bathroom ............................................ 3

LB 176. Location of the lavatory (WC)

• Inside the dwelling. ........................................ 1

• Outside the dwelling....................................... 2

• Has no lavatory .............................................. 3

GS

CIA/29

Read this! Next set of questions are about the monthly income of your household.

Rules for the interviewer: Hand SHOWCARD 1 (SOURCES OF INCOME).

177. This card shows various possible sources of income. Can you please tell me which kinds of income you and the other members of your household receive?

• Income from work (as employee, self-

employed or employer) .................................... 01

• Unemployment benefits.................................... 02

• Old-age or survivor's benefits........................... 03

• Sickness or disability benefits.......................... 04

• Family/children related allowances.................. 05

• Housing allowances.......................................... 06

• Education-related allowance............................. 07

• Other regular benefits: _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ 08

TXSV • No source of income......................................... 09

• Don’t know....................................................... 98

• Refusal.............................................................. 99

SV

178. Thinking of the sources you have mentioned before for you and the other members of your household, do you know what is your household's total net monthly income (that is after deductions for tax, insurances etc.)?

• YES ......................................................... 1

• NO........................................................... 2

• Don’t know.............................................. 8

• Refusal..................................................... 9

R.180

DV

179. What was your household's total net income in March (after deductions for tax, insurances etc.)?

• Total monthly net income / household |__|__|__|__|__|__|__|__| RON

VTN

R.181

• Don’t know.............................................. 8

• Refusal..................................................... 9 VN

Rules for the interviewer: Interviewer prompt only if necessary "an estimate is acceptable.

R. 180 Rules for the interviewer: Hand SHOWCARD 2 (GROUPS OF RANGE FOR THE NET INCOME IN MARCH), then ask the respondent to read out only the categories that apply to him/her, in order to answer to the following question.

180. Can you provide the approximate group range which

represents your household's total net monthly income (after deductions for income tax, insurances etc.)?

• Under 300 lei….…….….01 • 301 –350 lei ....................02 • 351 – 400 lei ...................03 • 401 – 450 lei ...................04 • 451 – 500 lei ...................05 • 501 – 550 lei ...................06 • 551 – 600 lei ...................07 • 601 – 650 lei ...................08 • 651 – 700 lei ...................09 • 701 – 750 lei ...................10 • 751 – 800 lei ...................11 • 801 – 850 lei ...................12 • 851 – 900 lei ...................13 • 901 – 950 lei ...................14 • 951 – 1000 lei .................15 • 1001 – 1050 lei .................16 • 1051 – 1100 lei .................17 • 1101 – 1150 lei .................18 • 1151 – 1200 lei .................19 • 1201 – 1250 lei .................20 • 1251 – 1300 lei .................21 • 1301 – 1400 lei .................22 • 1401 – 1500 lei .................23 • 1501 – 1600 lei .................24 • 1601 – 1700 lei .................25 • 1701 – 1800 lei .................26 • 1801 – 1900 lei .................27 • 1901 – 2000 lei .................28 • 2001 – 2500 lei .................29 • 2501 – 3000 lei..................30 • 3001 – 3500 lei .................31 • 3501 – 4000 lei .................32 • 4001 – 4500 lei .................33 • 4501 – 5000 lei .................34 • 5001 – 5500 lei .................35 • 5501 – 6000 lei .................36 • 6001 – 6500 lei .................37 • 6501 – 7000 lei .................38 • 7001 – 7500 lei .................39 • Peste 7500 lei ....................40 • Don’t know........................98 • Refusal...............................99

IV R. 181 Rules for the interviewer:

After filling-in this section, please hand the self-completion questionnaire – AC.

END OF THE INTERVIEW!

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