Adventist Religion & Health Study Follow-Up (PDF)
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Three years ago you were one of over 10,000 people who filled out the first questionnaire in the Adventist Religion & Health Study, a substudy of the Adventist Health Study-2. We greatly appreciate your participation. Now we ask that you fill out the questionnaire once again. BAR This will give us important information about how Please return your completed questionnaire CODE changes in your life may have affected your in the envelope health. provided to: AREA LOMA LINDA U NIVERSITY Adventist Health Studies in partnership with OAKWOOD Evans Hall, Room 203 COLLEGE and the Seventh-day Loma Linda University Adventist Churches of North America Loma Linda CA 92350 PLEASE DO NOT WRITE IN THIS AREA SERIAL # 6232301 Please read all the instructions carefully. Each of the questions on the following pages has a number of bubbles like this next to them. 1. Please fill in one bubble for each question unless otherwise directed. Take care that the mark fills the circle and does not stray near other Shade bubbles like this bubbles. Not like this ✓ ✗ 2. Erase cleanly any answer you wish to change. A. Your Religious and Social Environment Which of the following categories best describes your religious belief now and, if you are married, describes your spouse’s religious belief now. For SDA No office Other formal Not use Inactive Active Catholic Jewish Other Don't only Protestant religion know married 1. Your belief now 1 2. Your spouse's belief now 2 Under 26 to 51 to 101 to 201 to 401 to 601 to Over 25 50 100 200 400 600 1000 1000 3. About how many people are members of the church you usually attend? 3 5 or None 1234more 4. How many Seventh-day Adventists churches are there within 20 miles of 4 your home? On a scale from zero to 10, where 10 is the most religious and zero the least, how religious are you and, if you are married, how religious is your spouse? (mark one bubble) 5. You Not religious at all 012345678910Strongly religious 5 6. Your spouse Not religious at all 012345678910Strongly religious 6 More Once a than once Once a A few times A few times year or Never a week week a month a year less 7. How often do you attend church or other religious meetings? 7 8. How often does your spouse attend church or other religious meetings? 8 1 5 7 9 11 more About how many people.... None 3 than or 2 or 4 or 6 to 8 to 10 to 15 15 9. do you regularly socialize with 9 10. do you regularly work with 10 11. are your close friends 11 12. live in your house 12 13. live in your house who are ACTIVE Seventh-day Adventists 13 14. live in your house who are INACTIVE Seventh-day Adventists 14 15. live in your house who are NOT Seventh-day Adventists 15 Page 1 6232302 For office For each type of person below, about what use percent (%) are Seventh-day Adventists? only 5% or 95% less 10% 20% 30% 40% 50% 60% 70% 80% 90% or more 16. People you regularly socialize with 16 17. People you regularly work with 17 18. People who live in your immediate neighborhood 18 19. People who are close friends 19 6 or None 1 2345 20. How many children do you have? more 20 Social Support In the past month, how often did the people you know (spouse, family, friends, relatives etc.)... Never Seldom Occasionally Often Very Often 21. offer helpful advice when you needed to make important decisions? 21 22. suggest ways that you could deal with problems you were having? 22 23. provide you with aid and assistance? 23 24. help you with an important task or something that you could not do on your own? 24 25. do or say things that were kind or considerate toward you? 25 26. include you in things they were doing? 26 27. interfere or meddle in your personal matters? 27 28. question or doubt your decisions? 28 29. let you down when you needed help? 29 30. ask you for too much help? 30 31. forget or ignore you? 31 32. fail to spend enough time with you? 32 33. do things that were thoughtless or inconsiderate? 33 34. act angry or upset with you? 34 35. provide you with good company and companionship? 35 36. [In the past month] how often did you discuss personal matters or concerns with someone you know? 36 For office B. Your Health use only This section of the survey asks for your views about your health. Answer every question by selecting the answer as indicated. If you are unsure about how to answer a question, please give the best answer you can. Excellent Very good Good Fair Poor 1. In general, would you say your health is: 37 Much better Somewhat About the Somewhat worse Much worse now than one better same as one now than one now than year ago year ago year ago one year ago 2. Compared to one year ago, how would you 38 rate your health in general now? PLEASE DO NOT WRITE IN THIS AREA Page 2 SERIAL # 6232303 For 3. The following questions are about activities office use you might do during a typical day. Does only your health now limit you in these activities? If so, how much? Yes, limited Yes, limited No, not limited a lot a little at all a. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports 39 b. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf 40 c. Lifting or carrying groceries 41 d. Climbing several flights of stairs 42 e. Climbing one flight of stairs 43 f. Bending, kneeling, or stooping 44 g. Walking more than a mile 45 h. Walking several hundred yards 46 i. Walking one hundred yards 47 j. Bathing or dressing yourself 48 4. During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your All of Most of Some of A little of None of the time the time the time the time the time physical health? a. Accomplished less than you would like 49 b. Were limited in the kind of work or other activities 50 5. During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of any All of Most of Some of A little of None of the time the time the time the time the time emotional problems (such as feeling depressed or anxious)? a. Accomplished less than you would like 51 b. Did work or activities less carefully than usual 52 Not at all A little bit Moderately Quite a bit Extremely 6. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? 53 7. On the scale below 0 indicates no pain and 10 represents pain as intense as you can imagine. During the past 4 weeks, typically how intense was your pain? No pain012345678910 Pain as intense as you can imagine. 8. These questions are about how you feel and how things have been with you during the past 4 weeks. For each All of Most of Some of A little of None of question, please give the one answer that comes closest the time the time the time the time the time to the way you have been feeling. How much of the time during the past 4 weeks... a. Have you felt calm and peaceful? 54 b. Did you have a lot of energy? 55 c. Have you felt downhearted and depressed? 56 Page 3 6232304 For All of Most of Some of A little of None of office 9. During the past 4 weeks, how much of the time has use the time the time the time the time the time only your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, 57 etc.)? 10. How TRUE or FALSE is each of the following Definitely Mostly Don't Mostly Definitely TRUE know FALSE FALSE statements for you? TRUE a. I seem to get sick a little easier than other people 58 b. I am as healthy as anybody I know 59 c. I expect my health to get worse 60 d. My health is excellent 61 Almost Rarely or Sometimes Often During the past 4 weeks, how often would you say you never every day have had any of these problems related to your sleep? 11. Trouble falling asleep 62 12. Waking up in the middle of the night and finding it hard to get back to sleep. 63 13. Waking up very early and can't get back to sleep. 64 14. How many hours do you usually sleep per night? Please mark the answer that is closest to the average number of hours you sleep 3 hours or less 5 hours 7 hours 9 hours 4 hours 6 hours 8 hours 10 hours or more 65 For office C. Your Feelings use only This set of questions consists of a number of words and phrases that describe different feelings and emotions. Mark a bubble to show to what extent you have felt this way during the past year.