1970 BRITISH COHORT STUDY: SURVEY

Transcription

1 1970 BRITISH COHORT STUDY: SURVEY Self-completion Questionnire HOW TO FILL IN THE QUESTIONNAIRE Plese complete the questionnire using blck or blue ink. The questionnire will be red by scnner, so plese mrk your nswers by putting cross in the pproprite box x. If you mke mistke or chnge your mind plese completely fill the box to show the mistke [ ] nd then cross the correct nswer. Some you will be sked to write number in box like this: 10. Plese keep your nswer within the boxes. Your nswers will be treted in the strictest confidence nd ll findings will be mde nonymous in the reporting of results so tht responses cnnot be trced bck to individuls. When you hve completed the questionnire plese sel it inside the envelope provided nd hnd it bck to the nurse / interviewer when they visit. INTERVIEWER TO ENTER: Interviewer ID Number Prticipnt First Nme Prticipnt Seril Number Prticipnt Gender Prticipnt Dte of Birth BCS70_MSR_PAPERSC_V1

2 1 Below re some sttements bout feelings nd thoughts. For ech sttement, plese choose the option tht best describes your experience of ech over the lst 2 s. None of the time Rrely Some of the time Often All of the time ) I ve been feeling optimistic bout the future b) I ve been feeling useful c) I ve been feeling relxed d) I ve been feeling interested in other people e) I ve hd energy to spre f) I ve been deling with problems well g) I ve been thinking clerly h) I ve been feeling good bout myself i) I ve been feeling close to other people j) I ve been feeling confident k) I ve been ble to mke up my own mind bout things l) I ve been feeling loved m) I ve been interested in new things n) I ve been feeling cheerful 2

3 2 The following items re bout ctivities you might do during typicl dy. Does your helth limit you in these ctivities? If so, how much? ) Vigorous ctivities, such s running, lifting hevy objects, prticipting in strenuous sports Yes, limited lot Yes, limited little No, not limited t ll b) Moderte ctivities, such s moving tble, pushing vcuum clener, bowling, or plying golf c) Lifting or crrying groceries d) Climbing severl flights of stirs e) Climbing one flight of stirs f) Bending, kneeling or stooping g) Wlking more thn one mile h) Wlking hlf mile i) Wlking 100 yrds j) Bthing or dressing yourself 3 During the pst 4 s, hve you hd ny of the following problems with your work or other regulr dily ctivities s result of your physicl helth? Hve you... Yes No ) Cut down the mount of time you spent on work or other ctivities? b) Been limited in the kind of work or other ctivities you were ble to do? c) Accomplished less thn you would like? d) Hd difficulty performing work or other ctivities (for exmple, it took extr effort)? 3

4 4 During the pst 4 s, hve you hd ny of the following problems with your work or other regulr dily ctivities s result of ny emotionl problems (such s feeling depressed or nxious)? Hve you Yes No ) Cut down the mount of time you spent on work or other ctivities? b) Accomplished less thn you would like? c) Not done your work or other ctivities s crefully s usul? 5 During the pst 4 s, to wht extent hs your physicl helth or emotionl problems interfered with your norml socil ctivities with fmily, friends, neighbours, or groups? CROSS (X) ONE BOX Not t ll Slightly Modertely Quite bit Extremely 6 How much bodily pin hve you hd during the pst 4 s? CROSS (X) ONE BOX None Very mild Mild Moderte Severe Very severe 4

5 7 During the pst 4 s, how much did pin interfere with your norml work (including both work outside the home nd housework)? CROSS (X) ONE BOX Not t ll Slightly Modertely Quite bit Extremely 8 These questions re bout how you feel nd how things hve been with you during the pst 4 s. For ech question, plese give the one nswer tht comes closest to the wy you hve been feeling. How much time during the pst four s All of the time Most of the time Some of the time A good bit of the time A little of the time None of the time ) Did you feel full of life? b) Hve you been very nervous person? c) Hve you felt so down in the dumps nothing could cheer you up? d) Hve you felt clm nd cheerful? e) Did you hve lot of energy? f) Hve you felt downherted nd low? g) Did you feel worn out? h) Hve you been hppy person? i) Did you feel tired? j) Hs your helth limited your socil ctivities (like visiting friends, reltives, etc.)? 5

6 9 For ech of the following sttements plese choose one nswer tht best describes how true or flse it is for you. Definitely true Mostly true Don t know Mostly flse Definitely flse ) I seem to get ill little esier thn other people b) I m s helthy s nybody I know c) I expect my helth to get worse d) My helth is excellent PHYSICAL ACTIVITIES The next set of questions re designed to find out bout your physicl ctivity in your everydy life. HOME ACTIVITIES 10 GETTING UP AND GOING TO BED PLEASE PUT A TIME IN EACH BOX AND TICK WHETHER AM OR PM. MIDDAY IS 12:00 PM. MIDNIGHT IS 12:00 AM. On dy ) At wht time do you normlly get up? ENTER TIME BELOW TICK AM OR PM Hour Minute AM PM : b) At wht time do you normlly go to bed? : On end dy c) At wht time do you normlly get up? ENTER TIME BELOW TICK AM OR PM Hour Minute AM PM : d) At wht time do you normlly go to bed? : 6

7 GETTING ABOUT Aprt from getting to work 11 Which form of trnsport do you use most often prt from your journey to nd from work? USUAL FORM OF TRANSPORT DISTANCE OF JOURNEYS Cr Wlk Public Trnsport Cycle ) Less thn one mile b) 1 5 miles c) More thn 5 miles WATCHING TV, COMPUTER USE AND READING 12 How mny hours do you spend wtching television progrmmes, videos, DVDs or Blu-ry? Plese include time spent wtching progrmmes or films on computer. None Less thn 1 to 2 n hour hours hours 3 to 4 hours More thn 4 hours ) On typicl dy b) On typicl dy t the end 13 How mny hours do you spend plying electronic gmes on computer or gmes system, such s Wii, Nintendo D-S, X-Box or PlySttion? Plese lso include time spent plying gmes on smrtphones or tblets. None Less thn 1 to 2 n hour hours hours 3 to 4 hours More thn 4 hours ) On typicl dy b) On typicl dy t the end 7

8 14 How mny hours do you spend using the internet t home? Include time spent using the internet on tblets, smrtphones nd other mobile devices s well s computers nd lptops. Plese include time spent on socil networking sites such s Fcebook or Twitter. None Less thn 1 to 2 n hour hours hours 3 to 4 hours More thn 4 hours ) On typicl dy b) On typicl dy t the end 15 How mny hours do you spend reding books (including in electronic formt, e.g. Kindle) t home? None Less thn 1 to 2 n hour hours hours 3 to 4 hours More thn 4 hours ) On typicl dy b) On typicl dy t the end 16 STAIR CLIMBING AT HOME Number of you climb up flight of stirs (pprox 10 steps) ech dy t home None 1 to 5 6 to to to 20 More thn 20 ) On dy b) On end dy 8

9 17 ACTIVITIES IN AND AROUND THE HOME Approximte number of hours ech None Less thn 1 hour 1 to 3 hours 3 to 6 hours 6 to 10 hours 10 to 15 hours More thn 15 hours ) Prepring food, cooking nd wshing up b) Shopping for food nd groceries c) Shopping nd browsing in shops for other items (e.g. clothes, toys) d) Clening the house e) Doing the lundry nd ironing f) Cring for pre-school children or bbies t home (not s pid employment) g) Cring for hndicpped, elderly or disbled people t home (not s pid employment) ACTIVITY AT WORK 18 Do you currently hve job? Plese include pid employment, self-employment, voluntry work nd employment trining schemes. Yes No IF YES, GO TO Q19 IF NO, GO TO Q25 9

10 19 We would like to know the types nd mount of physicl ctivity involved in your work. Which of the following best corresponds to your present ctivities? CROSS (X) ONE BOX Sitting occuption Stnding occuption Physicl work Hevy mnul work 20 STAIR OR STEP CLIMBING AT WORK ) Number of you climb up flight of stirs (pprox 10 steps) t work None 1 to 5 6 to to to 20 More thn 20 b) Number of you climb up ldder t work 21 KNEELING AND SQUATTING AT WORK In n verge working dy do you: Yes No ) Kneel for more thn one hour in totl? b) Squt for more thn one hour in totl? c) Get up from kneeling or squtting more thn 30? 10

11 TRAVEL TO AND FROM WORK THE NEXT QUESTIONS ASK ABOUT HOW YOU TRAVEL TO YOUR JOB. IF YOU HAVE MORE THAN ONE JOB PLEASE THINK ABOUT YOUR MAIN JOB, I.E. THE ONE WHERE YOU WORK MOST HOURS. 22 Roughly how mny miles is it from home to your job? WRITE NUMBER IN BOX. IF YOU WORK FROM HOME PLEASE WRITE 0 23 How mny do you trvel from home to your job? WRITE NUMBER IN BOX. IF YOU WORK FROM HOME PLEASE WRITE 0 24 How often do you use ech of the following methods of trnsport to trvel to your job? Alwys Usully Occsionlly Never ) Cr b) Public trnsport c) Bicycle d) Wlking 11

12 RECREATION 25 The following questions sk bout how you hve spent your leisure time. Plese indicte how often you did ech ctivity on verge over the lst 12 s AND the verge length of time you spent doing the ctivity on ech occsion. FOR ACTIVITIES THAT ARE SEASONAL, E.G. CRICKET OR MOWING THE LAWN, PLEASE PUT THE AVERAGE FREQUENCY DURING THE SEASON WHEN YOU DID THE ACTIVITY. AND FOR EACH ACTIVITY YOU HAVE DONE RECORD THE AVERAGE LENGTH OF TIME SPENT DOING THE ACTIVITY ON EACH OCCASION HERE : ) Swimming - competitive None Less thn once Once Once 4 to 5 6 or more Hours Mins b) Swimming - leisurely c) Bckpcking or mountin climbing d) Wlking for plesure - you should not include wlking s mens of trnsporttion s this ws included erlier e) Rcing or rough terrin cycling f) Cycling for plesure - you should not include cycling s mens of trnsporttion g) Mowing the lwn - during the grss cutting seson h) Wtering the lwn or grden in the summer i) Digging, shovelling or chopping wood j) Weeding or pruning k) DIY e.g. crpentry, home or cr mintennce Continue > 12

13 AND FOR EACH ACTIVITY YOU HAVE DONE RECORD THE AVERAGE LENGTH OF TIME SPENT DOING THE ACTIVITY ON EACH OCCASION HERE : l) High impct erobics or step erobics m) Other types of erobics n) Exercises with weights o) Conditioning exercises e.g. using n exercise bike or rowing mchine p) Floor exercises e.g. stretching, bending, keep fit or yog q) Dncing e.g. bllroom or disco r) Competitive running s) Jogging t) Bowling - indoor, lwn or 10 pin u) Tennis or bdminton None Less thn once Once Once 4 to 5 6 or more Hours Mins v) Sqush w) Tble tennis x) Golf y) Footbll, rugby or hockey (during the seson) z) Cricket (during the seson) ) Rowing bb) Netbll, volleybll or bsketbll cc) Fishing Continue > 13

14 AND FOR EACH ACTIVITY YOU HAVE DONE RECORD THE AVERAGE LENGTH OF TIME SPENT DOING THE ACTIVITY ON EACH OCCASION HERE : dd) Horse-riding ee) Snooker, billirds or drts None Less thn once Once Once 4 to 5 6 or more Hours Mins ff) Musicl instrument plying or singing gg) Ice-skting hh) Siling, windsurfing or boting ii) Mrtil rts, boxing or wrestling 26 Are you currently member of ny orgnistions, clubs or societies? PLEASE INCLUDE POLITICAL PARTIES, TRADE UNIONS OR ENVIRONMENTAL GROUPS; TENANTS GROUPS, RESIDENT GROUPS, NEIGHBOURHOOD WATCH; CHURCH, CHARITABLE ORGANISATIONS; EDUCATION, ARTS OR MUSIC GROUPS OR EVENING CLASSES; SOCIAL CLUBS, SPORTS CLUBS, GYMS, EXERCISE CLASSES. Yes No IF YES, GO TO Q27 IF NO, GO TO Q28 27 How often do you prticipte in the meetings, events or ctivities of ny of these orgnistions, clubs or societies? CROSS (X) ONE BOX At lest once At lest once Severl yer At lest once yer Less often Never 14

15 28 The next questions re bout your feelings generlly. Yes No ) Do you feel tired most of the time? b) Do you often feel miserble or depressed? c) Do you often get worried bout things? d) Do you often get in violent rge? e) Do you often suddenly become scred for no good reson? f) Are you esily upset or irritted? g) Are you constntly keyed up nd jittery? h) Does every little thing get on your nerves nd wer you out? i) Does your hert often rce like md? 29 Generlly speking, would you sy tht most people cn be trusted, or tht you cn t be too creful in deling with people? Most people cn be trusted CROSS (X) ONE BOX Cn t be too creful It depends THANK YOU FOR COMPLETING THIS QUESTIONNAIRE. Plese now sel it inside the envelope provided nd hnd it bck to the nurse / interviewer when they visit. 15

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