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1/33 A1005-3
REGIONAL HEALTH AND WELL-BEING STUDY, ATH 2010 Please respond to this questionnaire as soon as possible, preferably within 10 days. Return your response in the enclosed envelope; no stamp is needed. You may also fill in the questionnaire online at www.thl.fi/ath/2010. To log in, you will need the form code – the number at the top of this page. Your password is in the covering letter.
INSTRUCTIONS TO RESPONDENTS
Answer the questions as follows:
Read the question carefully before answering.
Circle the number of the best alternative or write the information required in the space given.
You should only circle one best alternative for each question unless it is specifically stated
that you may circle more than one.
There are further instructions for some questions.
Remember to answer all questions. Enter negative answers by circling the ‘no’ alternative
or by writing ‘0’ (zero) in the space given.
EXAMPLE 1. EXAMPLE 2. How would you evaluate your state Give your present height of health at present? and weight
1 very good height | __ | __ | __| cm 2 fairly good 3 fair weight | __ |__ |__ | kg4 fairly poor 5 poor
For further information about the study, please contact Pirkko Alha, tel. 020 610 8764 (8.00-10.30), e-mail: [email protected] or Risto Kaikkonen, researcher in charge, tel. 020 610 8176, e-mail: [email protected]
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BACKGROUND INFORMATION1. Gender
1. male2. female
2. Year of birth 19 |__|__|
3. Marital status
1. married or in a registered relationship 2. cohabiting3. separated or divorced 4. widowed5. single 4. How many years altogether have you attended school or studied full time? Including primary and comprehensive school.
|__|__| years
5. Where do you live?
1. In the centre of the city/town2. In an inner-city area or suburb3. In a central municipal village or other conurbation4. In a sparsely populated rural area or a rural village
6. What is your form of accommodation at the moment?
1. A dwelling owned by you (or by a member of the family living in that dwelling) 2. Right-of-occupancy dwelling or part ownership dwelling3. A rental dwelling owned by a local authority or a community interest company (e.g. Sato, VVO)4. A privately owned rental dwelling5. An employer-provided dwelling or other housing benefit dwelling6. Sheltered accommodation, rehabilitation home or home for elderly people?7. A care institution (nursing home, hospital for long-term care)8. Other, please specify: __________________________________________________________
7. How many rooms are there in your home? |__|__| rooms, do not include the kitchen/kitchenette 8. How many years have you lived continuously in your present community of residence?
|__|__| years If you have lived here for less than a year continuously, please enter 0.
9. How many people belong to your household including yourself?
|__|__| people
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10. How many of the people living in your household, including yourself, are:
1 2 3 4 5+
under the age of 7 1 2 3 4 5+
aged 7 to 17 1 2 3 4 5+aged 18 to 24 1 2 3 4 5+aged 25 to 64 1 2 3 4 5+aged 65 to 74 1 2 3 4 5+
aged 75+ 1 2 3 4 5+
11. Currently, are you pregnant or is your spouse/partner pregnant
1. no2. yes
12. At present, are you principally/mainly
1. working2. on part retirement – partly working, partly retired( Receiving a part-time retirement pension)3. retired on an old age pension 4. laid off5. unemployed6. on switch leave7. a student8. in an employment relationship but on family leave/ on family leave (related the birth of a child), with continuing employment relationship9. housewife or -husband, no current paid employment 10. on long-term sick leave (more than 6 months)11. receiving a disability pension or rehabilitation benefit12. other, please specify: ________________________________________
13. What is/was your most recent occupational position/form of work?
1. wage earner2. agricultural entrepreneur (farmer)3. other entrepreneur 4. self-employed or freelance5. unpaid employment in a family member’s business6. I have never had a full-time occupation7. other, please specify:_________________________________________
14. Have you been unemployed or laid off over the past 12 months? Take into account periods when you have been completely away from work, including your present unemployment or laid off period.
1. not at all 2. 0–3 months3. 4–11 months4. 12 months (the entire year)5. I am not in the labour market (retired, studying, etc.)
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LIVING CONDITIONS, WORKING CONDITIONS AND WELL-BEING 15. A household may have different sources of income, and more than one of the people living in it may have an income. Considering the total income of your household, how difficult or easy is it to cover your costs?
1. very difficult2. difficult3. fairly difficult4. fairly easy5. easy6. very easy
16. Have you within the past 12 months ever
no yes
feared that you will run out of food before you can get money to buy more? 1 2
been unable to buy medicines because you did not have any money 1 2
not visited a doctor because you did not have any money 1 2
17. Do you receive financial assistance from any of the following?
no yes
family members living elsewhere 1 2
other relatives 1 2
friends or neighbours 1 2
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18. Do any of the following occur near your home, and if so, to what extent do they bother you?
no yes, but does not bother me
bothers me slightly
bothers me a lot
dangerous intersections and/or traffic routes 1 2 3 4
slippery footpaths in winter 1 2 3 4
poorly lit traffic routes/roads and paths 1 2 3 4
vandalism, crime or threat of same 1 2 3 4
traffic noise, smell or dust 1 2 3 4
industrial noise, smell or dust 1 2 3 4long distances to services (e.g. shops) 1 2 3 4
poor public transport 1 2 3 4litter 1 2 3 4buildings in poor condition 1 2 3 4unattractive housing district 1 2 3 4threat of dangerous wild animals/ predators 1 2 3 4
other, please specify: _________ 1 2 3 4
19. How satisfied are you with the following characteristics of your present dwelling?
very satisfied fairly satisfiedneither
satisfied nor dissatisfied
fairly dissatisfied
very dissatisfied
size of the dwelling 1 2 3 4 5
equipment of the dwelling 1 2 3 4 5
condition of the dwelling 1 2 3 4 5
housing costs 1 2 3 4 5safety of the area/neigh-bourhood 1 2 3 4 5
neighbours 1 2 3 4 5
location of the dwelling 1 2 3 4 5
20. Does your household have an Internet connection?
1. no 2. yes
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21. Do you use the Internet for the following?
no yes
e-transactions (online banking, social insurance institution [KELA], tax office, ticket sales, local public services, etc.) 1 2
finding information (timetables, health information, etc.) 1 2
communication (e-mail, discussion groups, etc.) 1 2
games or other entertainment (computer games, online magazines/newspapers, music, etc.) 1 2
studying (online courses or self-study, etc.) 1 2
22. Do you have a mobile phone?
1. no (please go to question 24)2. yes
23. Do you use your mobile phone for the following?
no yes
phone calls 1 2
sending text messages 1 2
Internet browsing 1 2
sending e-mails 1 2
24. How often are you in contact in the following ways with your friends and relatives who do not live in the same household with you?
almost daily 1–2 times a week
1–3 times a month
less often than once a month
never
meeting in person 1 2 3 4 5
by phone 1 2 3 4 5
over the Internet (e-mail, chat, Skype, Facebook, etc.) 1 2 3 4 5
by letter 1 2 3 4 5
25. Do you participate in the activities of any club, association, hobby group or religious or spiritual community (sports club, residents’ association, political party, choir, parish)?
1. no 2. yes, actively3. yes, occasionally
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26. How often have you participated in the activities of the following kinds of organisation , asso-ciation, society, etc. in the past 12 months?
3 or more times a week
1–2 times a week
1–3 times a month
a few times in the year
I have not participated
fitness or sports club 1 2 3 4 5
folk high school, workers’ institu-te and other schools 1 2 3 4 5
cultural association or society 1 2 3 4 5pensioners’ association or club 1 2 3 4 5
public health or patient organi-sation (e.g. Finnish Red Cross, Heart Association)
1 2 3 4 5
other association or society 1 2 3 4 5congregation 1 2 3 4 5
informal hobby group 1 2 3 4 5
27. Please estimate how you would expect to receive help from the following when you need help or support. You may circle one or more alternatives on each line.
spouse, partner
other next of kin
close friend
close colleague
close neighbour
other per-son close
to youno one
who do you believe truly cares about you, whatever may hap-pen?
1 2 3 4 5 6 7
who will provide practical help when you need it?
1 2 3 4 5 6 7
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28. Have you yourself in your free time over the past 12 months helped someone not belonging to your household in any of the following matters? Whom? You may circle more than one alternative on each line.
no, I have not
yes, my own or my
spouse’s parents
yes, my own or my
spouse’s grandpar-
ents
yes, my children or grandchil-
dren
yes, other
persons
renovation, construction, moving, etc. 1 2 3 4 5
house and garden work (cooking, cleaning, gardening, etc.) 1 2 3 4 5
shopping, banking and other similar matters 1 2 3 4 5
health and hygiene (dressing, washing, medication, etc.) 1 2 3 4 5
child care 1 2 3 4 5
listening or supporting in difficult times (mental support) 1 2 3 4 5
financial support 1 2 3 4 5
29. How often have you yourself helped someone who does not live in your household over the past 12 months? Please circle only one alternative on each line.
neveronce or a few times in the
year
once or twice a month
once or twice a week
every day or most days
my own or my spouse’s parents 1 2 3 4 5
my own or my spouse’s grandparents 1 2 3 4 5
children or grandchildren 1 2 3 4 5
other persons 1 2 3 4 5
30. Do you regularly help someone living in your household who has limited functional capacity, or is ill, to cope at home? You may circle more than one alternative on each line.
1. no2. yes, my spouse3. yes, my child or grandchild4. yes, my own or my spouse’s parents5. yes, my own or my spouse’s grandparents6. yes, some other person; please specify: ___________________________________________
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31. Have you yourself received help in any of the following chores and actions over the past 12 months? From whom? You may circle more than one alternative on each line
I have needed and received help:
I can manage without
help
no, from no one,
although I would
have needed it
yes, from family
members living in
the same house-
hold with me
yes, from family
members living in another house-
hold
yes, from relatives, friends or
neigh-bours
yes, from the local authority
(home care,
transport service,
etc.)
yes, from a private service
provider
yes, from someo-ne else (e.g. a
volunteer organisa-
tion)
renovation, construction, moving, etc.
1 2 3 4 5 6 7 8
house and gar-den work (coo-king, cleaning, gardening, etc.)
1 2 3 4 5 6 7 8
shopping, ban-king and other similar chores
1 2 3 4 5 6 7 8
health and hy-giene (dressing, washing, medi-cation, etc.)
1 2 3 4 5 6 7 8
child care 1 2 3 4 5 6 7 8
listening or supporting in difficult times (mental support)
1 2 3 4 5 6 7 8
financial support 1 2 3 4 5 6 7 8
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32. How often do you receive help from the above persons and parties in the mentioned chores and actions?
not at all several times a day
every day or most
days
once or twice
a week
once or twice
a month
once or a few times in
the year
family members living in the same household 1 2 3 4 5 6
family members not living in the same household with you
1 2 3 4 5 6
relatives, friends or neighbours 1 2 3 4 5 6
local authority 1 2 3 4 5 6
private service provider 1 2 3 4 5 6
some one else (e.g. a volunteer organisation) 1 2 3 4 5 6
altogether from all of the above 1 2 3 4 5 6
The following questions are about your work.
33. What is/was your most recent job like?
light fairly light a bit strenuous
quite strenuous
very strenuous
I have never been in paid employment
physically 1 2 3 4 5 6
mentally 1 2 3 4 5 6
34. How satisfied are you with your present work/were you with your most recent job?
1. very satisfied2. fairly satisfied3. neither satisfied nor dissatisfied4. fairly dissatisfied5. very dissatisfied6. I have never been in paid employment
35. How many fixed-term employment relationships have you had over the past two (2) years? Include all new fixed-term/temporary/time limited employment relationships and all continuations of old ones. A fixed-term employment relationship is one that has a fixed end date. total: |__|__|
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36. In which of the following is your present occupational health care provided? Occupational health care is organised and paid for by the employer as a legal obligation. It includes such things as health checks and occupational health care visits to the workplace as well as prevention of illnesses linked to work.
1. occupational health care centre at your company or place of work or local authority2. occupational health care centre at municipal health centre3. occupational health care at private doctor’s clinic4. employers’ joint occupational health centre, usually Työterveys ry5. organised somewhere else, where? please specify:___________6. is organised, but I do not know where7. not organised at all8. don’t know9. I am not in paid employment
37. How satisfied overall are you with the occupational health service at your workplace? Is your current occupational health care’s work
1. excellent2. good3. satisfactory4. adequate5. bad6. don’t know7. I am not in paid employment
38. Are the following statements about home and work accurate for you? Please circle one alternative on each line.
completely accurate fairly accurate fairly
inaccuratecompletely inaccurate
don’t know/not applicable
when I come home, I stop thinking about my work. 1 2 3 4 5
I feel I am neglecting do-mestic issues because of my work.
1 2 3 4 5
I sometimes neglect my family when I am wholly absorbed in my work.
1 2 3 4 5
I often find it difficult to concentrate on my work because of domestic issues.
1 2 3 4 5
I have more energy to be with the children when I also go to work.
1 2 3 4 5
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39. Did you vote in the most recent elections?
no yes don’t remember
local election 1 2 3Parliament election 1 2 3presidential election 1 2 3European Parliament election 1 2 3
40. How much do you trust the following parties or what they do? On each line, circle a number that matches your opinion on a scale of 1 to 5 (1 = no trust, 5 = complete trust).
I do not trust them at all
I trust them completely
public health care 1 2 3 4 5
public social welfare (social services, social assistance, etc.)
1 2 3 4 5
courts of law 1 2 3 4 5
Parliament 1 2 3 4 5
the police 1 2 3 4 5
local media 1 2 3 4 5
national media 1 2 3 4 5
decision-making in your municipality 1 2 3 4 5
decision-making in your municipal federation or region
1 2 3 4 5
decision-making in the EU 1 2 3 4 5
HEALTH
41. How tall are you? (to the nearest centimetre) |__|__|__| cm
42. How much do you weigh when wearing light clothing? (to the nearest kilogramme) |__|__|__| kg
43. How would you describe your state of health at present?
1. good2. rather good3. moderate4. rather poor5. poor
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44. Have you had any of the following conditions diagnosed or treated by a doctor over the past 12 months?
no yes
high blood pressure, hypertension 1 2
(cerebral) stroke 1 2
high blood cholesterol 1 2
coronary thrombosis, myoardial infarction 1 2
coronary disease, angina pectoris (=chest pain under physical strain) 1 2
cancer 1 2
rheumatoid arthritis or other inflammatory arthritis 1 2
arthrosis of the back, sciatica, low back pain or other back condition 1 2
chronic bronchitis, emphysema 1 2
depression 1 2
other mental health problem 1 2
asthma 1 2
pollen allergy, hay fever 1 2
lactose intolerance (sensitivity to lactose = milk sugar) 1 2
food allergy to milk (not lactose intolerance)or allergy to egg, fish or wheat or other grain 1 2
food allergy to raw vegetables or fruit (e.g. peas, carrots, apples) 1 2
45. Has a doctor ever diagnosed you as having diabetes?
1. no 2. no, but elevated blood sugar values or latent diabetes3. yes, type 1 (juvenile) diabetes4. yes, type 2 (adult-type) diabetes5. yes, but I do not know which type of diabetes6. yes, gestational diabetes (pregnant women only)
46. If you have been diagnosed with elevated cholesterol, were you given dietary advice for lo-wering your cholesterol level?
1. I have not been diagnosed with high cholesterol2. no3. yes
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47. Have you had any of the following infections over the past 12 months? You may circle more than one alternative on each line.
noyes, during the past 30
days
yes, during the past 1–12
months
influenza (acute high temperature, muscular pain, coughing, sore throat) 1 2 3
pneumonia 1 2 3
otitis (ear infection) 1 2 3
sinusitis 1 2 3
gastroenteritis (stomach flu; acute diarrhoea and/or vomiting) 1 2 3
urinary tract infection 1 2 3
48. Have you been vaccinated against influenza over the past 12 months?
1. no2. yes
49. Have you had any of the following symptoms or troubles over the past 30 days?
no yes
fever (temperature over 38°C) 1 2
headache 1 2
cough 1 2
diarrhoea (at least three times a day on at least one day) 1 2
vomiting 1 2
joint ache 1 2
back pain, back ache 1 2
toothache 1 2
chest pain under physical strain 1 2
insomnia 1 2
stomach pain 1 2
incontinence 1 2
tinnitus (ringing in the ears) 1 2
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50. Have you used any of the following types of medicines over the past 7 days? You may circle more than one alternative on each line.
noyes, non-
prescription drugs
yes, prescripti-on drugs
painkillers 1 2 3
vitamin and/or mineral supplements 1 2 3
antihypertensive medicines 1 2 3
cholesterol lowering medicines 1 2 3
insulin or other diabetes medication 1 2 3
medicines for an upset stomach 1 2 3
asthma medication 1 2 3
hay fever medication 1 2 3
sedatives 1 2 3
sleeping pills 1 2 3
anti-depressants 1 2 3
menopausal or post-menopausal hormone therapy medication (women) 1 2 3
medicines to improve sexual potency (men) 1 2 3
medicines to relieve memory loss/dementia 1 2 3
51. When have you last had the following measurements taken by a health care professional? Please circle one alternative on each line.
during the past
12 months
1 to 5 years ago
more than 5 years ago never don’t know
blood pressure 1 2 3 4 5
blood cholesterol level 1 2 3 4 5
blood sugar level 1 2 3 4 5
waist circumference 1 2 3 4 5
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The next five (5) questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please circle the one answer that comes closest to the way you have been feeling.
52. Over the past 4 weeks, for how much of the time have you felt: Please circle one alternative on each line.
All of the time
most of the time
a good bit of the
time
some of the time
a little of the time
None of the time
very nervous 1 2 3 4 5 6
so down in the dumps that nothing could cheer you up 1 2 3 4 5 6
calm and peaceful 1 2 3 4 5 6
downhearted and sad 1 2 3 4 5 6
happy 1 2 3 4 5 6
53. Do you ever feel lonely?
1. never2. very rarely3. sometimes4. fairly often5. all the time
54. Over the past 12 months, have you ever had a period of two weeks or more when for most of the time you have felt:
no yes
down, melancholic or depressed 1 2
that you have lost your interest in most things that usually give you pleasure (hobbies, work, and other doings) 1 2
The following two questions deal with thoughts and feelings regarding harming yourself. Some people experience difficulties in their lives that prompt such thoughts and feelings.
no yes
have you thought about suicide over the past 12 months? 1 2
have you attempted suicide over the past 12 months? 1 2
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FUNCTIONAL AND WORKING CAPACITY
55. Can you usually perform the following actions?
yes, no problem
yes, with some difficulty
yes, but with great difficulty
no, I cannot
run a short distance (about 100 m) 1 2 3 4
run a long distance (more than 500 m) 1 2 3 4
walk about 500 m without stopping to rest 1 2 3 4
walk up one flight of stairs without stopping to rest 1 2 3 4
move about outdoors in summer 1 2 3 4
move about outdoors in winter 1 2 3 4
use public transport 1 2 3 4
56. Can you usually perform the following everyday chores and actions?
yes, no problem
yes, with some difficulty
yes, but with great difficulty
no, I cannot
light housework (vacuuming, washing dishes, making beds, doing laundry, etc.)
1 2 3 4
minor repairs (replacing a light bulb or a smoke alarm battery, etc.)
1 2 3 4
day-to-day financial transactions (paying bills, withdrawing cash, etc.)
1 2 3 4
shopping for food 1 2 3 4
reading ordinary newspaper print (with or without spectacles) 1 2 3 4
following a conversation between several people (with or without a hearing aid)
1 2 3 4
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57. The following questions concern memory, learning and concentration.
very well well adequately poorly very poorly
how well does your memory work? 1 2 3 4 5
how easily do you learn new information and new things to do?
1 2 3 4 5
how well can you concentrate on things? 1 2 3 4 5
58. If your functional capacity is impaired, do you need and do you get help for your everyday actions?
1. I do not need help and do not get it 2. I would need help but do not get it3. I get help, but not enough4. I get enough help5. I get more help than I need
59. Assuming that the best working capacity you have ever had would score 10 on a scale of 0 to 10, how would you score your working capacity at present? A score of 0 would mean that you are completely unable to work at present.score: |__|__|
60. How do you assess your current working capacity?If you are not employed at present, please answer as for your most recent job.
very good fairly good fair fairly poor very poorI have never been in paid employment
considering the physical demands of your work
1 2 3 4 5 6
considering the mental demands of your work
1 2 3 4 5 6
61. Do you think that, as far as your health is concerned, you could continue in your present oc-cupation until the retirement age/you could have continued in your most recent occupation until the retirement age?
1. no2. probably not3. probably yes4. yes5. I am retired
62. Regardless of whether you are in paid employment at present, please describe your current working capacity. Are you:
1. completely fit for to work 2. partly disabled3. completely disabled
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FOOD
63. How often have you eaten and drunk the following types of food or drink over the past 7 days?
never on 1–2 days on 3–5 days on 6–7 days
fatty cheeses (e.g. Edam, Emmental, Oltermanni) 1 2 3 4
low-fat cheeses (e.g. Polar-15, Edam 17, cottage cheese) 1 2 3 4
fish 1 2 3 4
fresh vegetables or green salad 1 2 3 4
cooked vegetables (excluding potatoes) 1 2 3 4
fruit or berries 1 2 3 4
hamburgers, pizza, savoury pies 1 2 3 4
buns, Danish pastry, biscuits, cakes, etc. 1 2 3 4
chocolate or other sweets 1 2 3 4
juices with added sugar or soft drinks 1 2 3 4
dark bread (rye bread, rye crispbread, etc.) 1 2 3 4
vegetable oil or liquid margarine (e.g. Flora Culinesse) 1 2 3 4
butter or butter-margarine mixture (e.g. Oivariini) 1 2 3 4
skimmed milk or buttermilk 1 2 3 4
64. Do you usually eat breakfast?
1. no2. yes
65. Can you have a meal at the canteen at your workplace or educational institution?
1. yes2. no3. I am not employed and not studying
66. Where do you usually have lunch (between 10 a.m. and 3 p.m.) on weekdays?
1. at home 2. at a restaurant, diner or fast-food place 3. in the canteen at my workplace or educational institution 4. at a sheltered home or day centre5. I have a packed lunch6. somewhere else than the above 7. I do not eat lunch
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BRUSHING YOUR TEETH
67. How many of your own teeth do you have left?
1. none2. 1 to 9 own teeth3. 10 to 19 own teeth4. 20+ own teeth
68. Do you wear dental prostheses?
1. full prostheses (no own natural teeth or roots)2. (partial) prostheses and some own teeth3. no detachable dental prostheses, several own teeth4. no detachable dental prostheses nor any naturalteeth
69. How often do you usually brush your teeth/dental prostheses?
1. more than twice a day2. twice a day 3. once a day4. not every day5. never
EXERCISE
The following questions concern how you get exercise at work, on the way to work and in your free time. If you exercise in different ways at different times of the year, please circle the alternative that best descri-bes your average situation.
70. How physically strenuous is your work? Please circle the alternative that best fits your situation. 1. I am not employed; or, my work is mainly done sitting down, and I do not walk a lot2. I walk quite a lot in my work but do not have to lift or carry heavy loads3. I have to lift and carry a lot in my work or walk up stairs or up hills4. my work is physically heavy; I have to lift and carry heavy loads or dig, shovel, chop, etc.
71. How many minutes of exercise, e.g. on foot or by bicycle, do you get each day on your way to work or your place of study? Add up the journeys to and from work/study.1. I am not employed; or, I work at home2. I commute wholly by motor vehicle3. less than 15 minutes a day4. 15–29 minutes a day5. 30–60 minutes a day6. more than an hour a day
72. How often do you engage in leisure exercise for a period of at least 20 minutes after which you are at least slightly out of breath and sweating? Exercise on the way to and from work/study not included.1. 5 or more times a week2. 4 times a week3. 3 times a week4. 1–2 times a week5. less often than once a week6. I cannot exercise because of an illness or injury
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73. How often do you go for a walk outdoors for at least 20 minutes?
1. 5 or more times a week2. 4 times a week3. 3 times a week4. 1–2 times a week5. less often than once a week6. I cannot exercise because of an illness or injury
74. How much do you exercise and strain yourself physically in your free time? Please circle the alternative that best fits your situation.
1. I read, watch TV and do things that are not very strenuous physically2. I walk, cycle or do light housework and gardening, etc., several hours a week3. I engage in exercise or sport such as running, skiing, swimming or ball games, several hours a week
75. How many hours do you spend sitting on an average weekday? If you never sit, please enter 0.
hours
during the working day at the office, etc. |__|__|
in free time watching the TV or listening to the radio |__|__|
in free time at the computer |__|__|in free time reading books, magazines or newspapers, or with handicrafts |__|__|
in transport (car, bus, etc.) |__|__|
elsewhere |__|__|
SMOKING
76. Have you ever smoked?
1. no (please go to question 81) 2. yes
77. Have you ever smoked daily for a period of at least one year? For how many years altoget-her?
1. I have never smoked daily2. I have smoked daily for a total of |__|__| years
78. Do you smoke now (cigarettes, cigars or pipe)?
1. yes, daily2. occasionally3. not at all
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79. How much do you smoke now per day on average, or how much did you smoke before quitting? Please enter a response on each line.
per day
factory-made cigarettes |__|__|
self-rolled cigarettes |__|__|
cigars |__|__|
pipe |__|__| times
80. When did you last smoke? If you smoke daily, please circle 1.1. yesterday or today2. between 2 days and 1 month ago3. between 1 and 6 months ago4. between 6 months and 1 year ago5. between 1 and 5 years ago 6. between 5 and 10 years ago 7. more than 10 years ago
81. Have you used nicotine therapy over the past 12 months to help you quit smokings?This includes things like chewing gum, patches, pills, etc.1. I have never used nicotine replacements2. not during the past 12 months3. yes, to help me quit smoking4. yes, for other reasons
ALCOHOL AND DRUGS
82. Have you drunk alcoholic beverages over the past 12 months?
1. no (please go to question 87) 2. yes
83. How often do you have a drink containing alcohol? Include the times when you only had a small amount, e.g. a bottle of medium beer or a sip of wine. Please circle the alternative that best fits your situation. 1. never2. monthly or less 3. 2 to 4 times a month 4. 2 to 3 times a week 5. 4 or more times a week
84. How many drinks containing alcohol do you have on a typical day when you are drinking? Please refer to the adjacent box. 1. 1 or 2 2. 3 or 4 3. 5 or 6 4. 7, 8, or 9 5. 10 or more units
ONE UNIT OF ALCOHOL IS EQUAL TO:1 bottle (33 cl) of medium strength beer or cider, or1 glass (12 cl) of usual mild wine, or1 small glass (8 cl) of fortified wine, orA standard drink (4 cl) of strong spirits
EXAMPLES:0.5 l (‘pint’) of medium beer or cider = 1.5 units0.5 l (‘pint’) of stronger A beer or strong cider = 2 units0.75 l bottle of table wine (12%) = 6 units0.5 l bottle of spirits = 13 units
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85. How often do you have six or more drinks on one occasion?
1. never 2. less than monthly 3. monthly 4. weekly 5. daily or almost daily
86. How many glasses, bottles or restaurant servings of the following types of alcoholic beverage have you consumed over the past 7 days? If you have consumed none, please enter 0.
during the past 7 days
medium strength (III) beer, medium cider or long drinks (sold in food shops, alcohol content 2.9% to 4.7%)
|__|__| bottles (1/3 l each)
Stronger A beer, strong cider or long drinks(only sold in Alko shops, alcohol content over 4.7%) |__|__| bottles (1/3 l each)
wine |__|__| glasses (1 glass = about 12 cl)
spirits or other strong drinks |__|__| restaurant servings (1 serving = 4 cl)
87. Have you used cannabis (hashish, marijuana) over the past 12 months?
1. I have never used2. no3. yes
In the following, GAMING concerns money games – lotteries such as Lotto or Keno, slot machines such as fruit machines, scratchcard lotteries, betting on sports and horse races, games run by Veikkaus, casino games and Internet gambling such as online poker.
88. How often have you felt over the past 12 months that gaming may be a problem for you?
1. never2. sometimes3. often4. almost always5. I do not play money games
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CHANGES OF LIFESTYLE
89. Has any of the persons mentioned below encouraged you to do any of the following over the past 12 months? You may circle more than one alternative on each line.
no onedoctor
or dentist
nurse or oc-cupational
health nurse
family member
someone else
exercise more 1 2 3 4 5
change your dietary habits for health reasons 1 2 3 4 5
lose weight 1 2 3 4 5
drink less alcohol 1 2 3 4 5
quit smoking 1 2 3 4 5
SLEEP
90. How many hours do usually sleep during one night?
|__|__| hours on average
91. Do you usually sleep also during daytime?
1. yes, |__|__| hours on average 2. I do not usually sleep in the daytime
92. Do you feel that you get enough sleep?
1. yes, almost always2. yes, often3. rarely or hardly ever4. don’t know
ACCIDENTS
93. Have you sustained injuries in a traffic accident over the past 12 months? Whatkind of treat-ment did you receive? You may circle more than one alternative.
no
yes,home
treatment
yes,treatment by a nurse
yes,treatment
by a doctor
yes, treatment
in a hospital
as a pedestrian 1 2 3 4 5
riding a bicycle 1 2 3 4 5
riding a moped or motorcycle 1 2 3 4 5
in a car 1 2 3 4 5
in some other vehicle (tractor, ATV, ski-doo, etc.) 1 2 3 4 5
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94. Have you sustained injuries in some other accident over the past 12 months? Where/how did the accident occur, and what treatment did you receive? You may circle more than one alternative.
no
yes,home
treatment
yes,treatment by a nurse
yes,treatment
by a doctor
yes, treatment
in a hospital
in working hours, outside the home 1 2 3 4 5
in free time, indoors at home 1 2 3 4 5
in free time, in the yard/garden at home 1 2 3 4 5
in free time, while exercising outside the home 1 2 3 4 5
in some other context, please specify: 1 2 3 4 5
95. Do you use the following personal protectors or protective equipment?
always often sometimes not at all
not applicable
helmet when riding a bicycle 1 2 3 4 5
safety belt on the back seat of a car 1 2 3 4 5
life jacket or other flotation device in a boat 1 2 3 4 5
studded footwear or crampons when walking outdoors in slippery conditions
1 2 3 4 5
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VIOLENCE
96. Has anyone behaved violently towards you over the past 12 months? You may circle more than one alternative on each line.
no oneunknown person
or casual ac-quaintance
present spouse, cohabitee or
partner
other person well known to
you (other fam-ily member, ex-spouse, friend, close acquain-
tance, colleague)
threats of physical harm made over the phone, by letter, by e-mail or by text message
1 2 3 4
threats of physical harm made in person 1 2 3 4
obstruction of movement, grabbing hold, pushing or shoving
1 2 3 4
slapping 1 2 3 4
hitting with a fist or a hard object, kicking, strangling or using a weapon
1 2 3 4
forced sexual intercourse 1 2 3 4
forced other sexual activity 1 2 3 4
attempt at forced sexual intercourse or other sexual activity
1 2 3 4
other violent behaviour, please describe in one word: 1 ___________ ___________ ___________
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97. If you have experienced violence over the past 12 months, has it caused you any physical injuries? If you have not experienced violence over the past 12 months, please go to question 99.
Violence by unknown person
or casual acquaintance
Violence by present spouse,
cohabitee or partner
Violence by other person well
known to you
no injuries 1 2 3bruises 1 2 3cut or wound 1 2 3sprain, rupture 1 2 3bone fracture 1 2 3dental injury 1 2 3miscarriage of pregnancy (women) 1 2 3internal injury (e.g. damage to internal organ) 1 2 3concussion 1 2 3
other injury or condition, please describe in one word: ___________ ___________ ___________
98. If you were injured as a result of violence over the past 12 months, what treatment did you receive? You may circle more than one alternative.
Violence by un-known person or casual acquain-
tance
Violence by present spouse,
cohabitee or partner
Violence by other person well
known to you
I received no treatment 1 2 3
treatment by domestic ways 1 2 3
treatment by a public health nurse/nurse 1 2 3
treatment by a doctor 1 2 3
treatment in a hospital 1 2 3
99. Has anyone demanded money or property from you by threats or extortion over the past 12 months? You may circle more than one alternative.
1. no one2. unknown person or casual acquaintance3. present spouse, cohabitee or partner4. other person well known to you (other family member, ex-spouse, friend, close acquaintance, colleague)
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SERVICES
100. How many times over the past 12 months have you seen a doctor or nurse in a surgery or seen a doctor or nurse at your home because of an illness you yourself have or had (or because of pregnancy or childbirth)? If you have not seen a doctor or nurse at all, please enter 0. This does not include any times when you have been admitted to a hospital as an inpatient.
I saw a doctor I saw a nurse
in occupational health care |__|__| times |__|__| times
at a health centre |__|__| times |__|__| times
at a private health clinic |__|__| times |__|__| times
at a hospital outpatient clinic |__|__| times |__|__| times
on a house call by a doctor or nurse |__|__| times |__|__| times
elsewhere, please specify: |__|__| times |__|__| times
101. How many times over the past 12 months have you had contact by phone with the follo-wing because of an illness you yourself have or had (or pregnancy or childbirth)? If you have not had contact with a doctor or nurse at all, please enter 0.
with a doctor |__|__| timeswith a nurse |__|__| times
102. Over the past 12 months, have you visited or met any of the following:
no yes
a dentist at a health centre 1 2
a dentist in private practice 1 2
other dentist (university, hospital, etc.) 1 2
dental technician 1 2
the surgery of a dental assistant or dental hygienist 1 2
103. Have you over the past 12 months been admitted as an inpatient to a ward in a hospital?
1. no 2. yes, how many days of hospitalisation altogether? |__|__|__| days
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104. Have you had any of the following screenings or examinations over the past 5 years? You may circle more than one alternative on each line.
no yes, during the past 1 year
yes, during the past 1–5 years
colorectal cancer screening 1 2 3
mammography (women) 1 2 3
Papa test, cervical cancer screening (women) 1 2 3
PSA screening from blood sample related to prostate examination (men) 1 2 3
105. Have you regularly participated in a group for promoting your health and well-being over the past 12 months? Individual one-off lectures or discussions do not count.
no yes
dieting or weight control group or course, or other group aiming at changes in dietary and exercise habits 1 2
neck or back exercise group 1 2
group or course for quitting smoking 1 2
group for quitting the use of alcohol (e.g. AA) 1 2
group for quitting the use of some other intoxicant (e.g. NA) 1 2
gambling addiction group 1 2
patient self-help group (e.g. group of cardiac patients, diabetics or mental health patients) 1 2
mental well-being group (e.g. bereavement therapy, separation therapy or other discussion group) 1 2
106. Do you feel you have received enough information on the municipal services over the past 12 months?
no need not enough information
enough information
health care services 1 2 3
daycare services 1 2 3
social services 1 2 3
education services 1 2 3
library services 1 2 3
cultural services 1 2 3
physical activity services 1 2 3
services for youth 1 2 3
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107. Do you feel you have been adequately provided with the following social and health care services over the past 12 months? Please note services provided by the local authority and/or private service providers.
no needwould have
needed, but ser-vice not received
have used, ser-vice was inad-
equate
have used, service was ad-
equate
health centre physician’s surgery 1 2 3 4nurse’s surgery at a health centre 1 2 3 4dental care 1 2 3 4physiotherapy 1 2 3 4occupational health care 1 2 3 4mental health services 1 2 3 4services for the disabled 1 2 3 4
services for drug abusers 1 2 3 4social worker’s surgery 1 2 3 4social ombudsman’s services 1 2 3 4patient advocate’s services 1 2 3 4
children’s dental care 1 2 3 4child guidance clinics and family counselling clinics 1 2 3 4
children’s municipal daycare 1 2 3 4afternoon care for school-children 1 2 3 4
home services for families with children, family work 1 2 3 4
school health care 1 2 3 4student health care 1 2 3 4pupil counselling (school counsellor, school psychologist) 1 2 3 4
mental health services for children and adolescents 1 2 3 4
child welfare services 1 2 3 4
social assistance 1 2 3 4
support for caring relatives 1 2 3 4
financial and debt counselling 1 2 3 4
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108. Do you feel you have been adequately provided with the following services in your home municipality over the past 12 months?
no needwould have
needed, but ser-vice not received
have used, ser-vice was
inadequate
have used, service was adequate
library services 1 2 3 4
indoors sports facilities (swim-ming baths, gym, etc.) 1 2 3 4
outdoors sports facilities (sports fields, outdoor exercise routes, etc.)
1 2 3 4
cultural services (cinema, theatre, concerts, exhibitions, etc.) 1 2 3 4
folk and workers high schools 1 2 3 4
youth services, youth facilities 1 2 3 4
children’s playgrounds or parks 1 2 3 4
109. How often have you used the following cultural services over the past 12 months?
1 or more times a week
1–3 times a month
a few times in the year
not during the past 12 months
theatre, dance, circus or other performing arts 1 2 3 4
concert of classical music 1 2 3 4
concert of popular or rock music 1 2 3 4
museum or art exhibition 1 2 3 4
library services 1 2 3 4
cinema 1 2 3 4
spectator at a sports or fitness event 1 2 3 4
spectator at some other cultural event 1 2 3 4
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110. Do you yourself practice any of the following cultural activities?
I practice this 3 or more times a
week
I practice this 1–2 times
a week
I practice this 1–3 times a month
not during the past 12 months
writing (literature, blogs) 1 2 3 4
reading (not related to profession) 1 2 3 4
music (listening, playing an instrument or singing) 1 2 3 4
acting (amateur drama, etc.) 1 2 3 4
painting, drawing or other visual art 1 2 3 4
crafts and other practical skills 1 2 3 4
photography or video 1 2 3 4
other, please specify: 1 2 3 4
The following twelve (12) questions concerning the quality of life form part of the quality of life project of the World Health Organisation (WHO), WHOQOL-BREF, which is available in several languages and provides internationally comparable data. We ask you to think about your life in the past four weeks. Please answer the following questions.
111. How would you rate your quality of life?
1. very good 2. good 3. neither poor nor good 4. poor 5. very poor
112. How satisfied are you with:
very satisfied satisfiedneither
satisfied nor dissatisfied
dissatisfied very dissatisfied
your health 1 2 3 4 5
your ability to perform your daily living activities 1 2 3 4 5
your work 1 2 3 4 5
yourself 1 2 3 4 5
your personal relationships 1 2 3 4 5
the conditions of your living place 1 2 3 4 5
your transport 1 2 3 4 5
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113. Do you have:
completely mostly moderately a little not at all
enough energy for everyday life 1 2 3 4 5
enough money to meet your needs 1 2 3 4 5
opportunity for leisure activities 1 2 3 4 5
114. To what extent do you feel your life to be meaningful?
1. not at all2. a little3. a moderate amount4. very much5. an extreme amount
115. Did you fill in this form alone, or did someone assist you?
1. I filled it in alone2. I filled it in together with my spouse3. I filled it in together with another family member4. I filled it in together with a nurse or home care helper5. I was assisted by someone else. Please specify: ____________________________
THANK YOU FOR YOUR TIME!
You can see the results of the survey at www.thl.fi/ATH
