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2011
February
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In general, would you say your health is:
Excellent
Very good
Good
Fair
Poor
The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?
Yes,limited a lot
Yes,limited a little
No, not limited at all
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Lifting or carrying groceries
Climbing several flights of stairs
Climbing one flight of stairs
Bending, kneeling, or stooping
Walking more than a mile
Walking several hundred yards
Walking one hundred yards
Bathing or dressing yourself
Compared to one year ago, how would you rate your health in general now?
Much better now than one year ago
Somewhat better now than one year ago
About the same as one year ago
Somewhat worse now than one year ago
Much worse now than one year ago
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 physical health?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
Cut down on the amount of time you spent on work or other activities
Accomplished less than you would like
Were limited in the kind of work or other activities
Had difficulty performing the work or other activities (for example, it took extra effort)
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 emotional problems (such as feeling depressed or anxious)?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
Cut down on the amount of time you spent on work or other activities
Accomplished less than you would like
Did work or activities less carefully than usual
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?
Not at all
Slightly
Moderately
Quite a bit
Extremely
How much bodily pain have you had during the past 4 weeks?
None
Very mild
Mild
Moderate
Severe
Very severe
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
Not at all
A little bit
Moderately
Quite a bit
Extremely
These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling.
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
Did you feel full of life?
Have you been very nervous?
Have you felt so down in the dumps that nothing could cheer you up?
Have you felt calm and peaceful?
Did you have a lot of energy?
Have you felt downhearted and depressed?
Did you feel worn out?
Have you been happy?
Did you feel tired?
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
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