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Including yourself how many people aged 16 years and over live in this household?
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How many children (including babies) under 16 years live in your household?
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In which country [were you / was child’s name] born?
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In general, would you say [your] health is:
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Excellent ; Very good; Good; Fair; Poor
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In the last 12 months, how many times have you used a general practitioner in South Australia?
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Have you ever been told by a doctor that you have diabetes?
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Have you ever been told by a doctor that you have asthma?
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Have you ever been told by a doctor that you have had any of the following conditions?
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Heart attack; Angina; Heart disease; Stroke; None of the above
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Have you ever been told by a doctor that you have arthritis?
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Yes, Osteoarthritis; Yes, Rheumatoid Arthritis; Yes, Juvenile Rheumatoid Arthritis (JRA); Yes, other (specify); No, don’t have arthritis; Yes, don’t know type
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Have you ever been told by a doctor that you have osteoporosis?
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Have you ever been told by a doctor or a nurse that you have high blood pressure?
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Have you ever been told by a doctor or a nurse that you have high cholesterol?
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What is your height without shoes? (Centimetres or Feet : Inches)
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What is your weight? (Undressed in the morning)? (Kilograms (Kg) or Stones : Pounds)
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In the last week, how many times have you walked continuously, for at least 10 minutes, for recreation, exercise or to get to or from places?
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What do you estimate was the total time that you spent walking in this way in the last week?
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The following questions are about tobacco smoking. This includes cigarettes, cigars and pipes. Which of the following best describes your home situation?
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My home is smoke free (includes smoking is allowed outside); People occasionally smoke in the house; People frequently smoke in the house
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Which of the following best describes your smoking status?
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I smoke daily; I smoke occasionally; I don’t smoke now but I used to; I’ve tried it a few times but never smoked regularly; I’ve never smoked
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How often do you usually drink alcohol?
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A Standard Drink is equivalent to a schooner or midi of full strength beer, a glass of wine or a nip of spirits. On a day when you drink alcohol, how many drinks do you usually have?
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How many serves of vegetables [do you] usually eat each day? A ‘serve’ is ½ cup cooked vegetables or 1 cup of salad.
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How many serves of fruit [do you] usually eat each day? A ‘serve’ is 1 medium piece or 2 small pieces of fruit or 1 cup of diced pieces.
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