NPHS Supplementary Questions

INFORMATION QUESTIONS

POPULATION	NON PROXY 12 YEARS OF AGE AND OVER. IF PROXY, GO TO END; IF AGE<12, GO TO END. CORE SAMPLE ONLY.

SINFO-I1	We are now going to ask you some questions sponsored by Health Canada. One of the goals of Health Canada is to educate Canadians about health and health care. The questions you answer in these next sections will tell Health Canada how effective their work has been and will give you the chance to tell Health Canada your attitudes about health and health care.

SINFO-I2	First, we would like to find out about where people get information on health and health care services. For instance, many people get information from doctors, nurses, friends or family; or from magazines, television or books; or from attending specialized groups or classes.

SINFO-Q1	What are your most important sources of information about nutrition?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SINFO-Q1	DOCTORS OR NURSES

NUTRITIONIST, DIETICIAN

FAMILY

FRIENDS

PAMPHLETS/MAGAZINES/BOOKS

TV, RADIO, NEWSPAPER

WEIGHT LOSS CLINIC

CANADA'S FOOD GUIDE

OTHER (SPECIFY)

NONE OF THE ABOVE

SINFO-Q2	What are your most important sources of information about health risks from smoking and tobacco use?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SINFO-Q2	DOCTORS OR NURSES

OTHER HEALTH PROFESSIONALS

FAMILY

FRIENDS

PAMPHLETS/MAGAZINES/BOOKS

TV, RADIO, NEWSPAPER

SCHOOL

OTHER (SPECIFY)

NONE OF THE ABOVE

SINFO-C3	IF FEMALE BIRTH PARENT IN HHLD-Q4 AND CHILD LESS THAN 5 YEARS OF AGE GO TO SINFO-Q3, OTHERWISE GO TO SINFO-Q5.

SINFO-Q3	What are your most important sources of information about breast feeding and its importance to the health of children?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SINFO-Q3	DOCTORS OR NURSES

MIDWIVES, PRENATAL EDUCATORS

FAMILY

FRIENDS

PAMPHLETS/MAGAZINES/BOOKS

TV, RADIO, NEWSPAPER

BREAST-FEEDING SUPPORT GROUP

OTHER (SPECIFY)

NONE OF THE ABOVE

SINFO-Q4	What are your most important sources of information about alcohol use during pregnancy?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SINFO-Q4	DOCTORS OR NURSES

MIDWIVES OR PRENATAL EDUCATORS

FAMILY

FRIENDS

PAMPHLETS/MAGAZINES/BOOKS

TV, RADIO, NEWSPAPER

ADDICTION AGENCIES

FAMILY AND CHILDREN'S SERVICE AGENCIES

OTHER (SPECIFY)

NONE OF THE ABOVE

SINFO-Q5	What are your most important sources of information for finding or choosing health care services (For example, finding a new doctor, or choosing a health care clinic)?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SINFO-Q5	DOCTORS OR NURSES

OTHER HEALTH PROFESSIONALS

FAMILY

FRIENDS

PAMPHLETS/MAGAZINES/BOOKS

TV, RADIO, NEWSPAPER

YELLOW PAGES (TELEPHONE BOOK)

OTHER (SPECIFY)

NONE OF THE ABOVE

SINFO-C6	PARENTS IN HHLD-Q4 (BIRTH PARENT, STEP PARENT, FOSTER PARENT) OF CHILDREN LESS THAN 12 YEARS OF AGE GO TO SINFO-Q6, OTHERWISE GO TO SINFO-STOP.

SINFO-Q6	I am going to read five health problems which can cause death in young children after their first birthday. Please tell me which one you think is the leading cause of death.

(READ LIST, MARK ONE ONLY)

SINFO-Q6	Cancer

Injuries

Cystic Fibrosis

Meningitis

Heart disease

SINFO-C7A	PARENTS IN HHLD-Q4 (BIRTH PARENT, STEP PARENT, FOSTER PARENT) OF CHILDREN LESS THAN 6 YEARS OF AGE, GO TO SINFO-Q7A; OTHERWISE GO TO SINFO-Q7C

TREAT REFUSALS AND DON'T KNOW AS "NO" IN THIS SET OF SINFO-Q7 QUESTIONS (SINFO-Q7A TO SINFO-Q7R)

SINFO-Q7A	Have you ever looked for information about how to correctly use a car safety seat?

YESNO	YES

NO	GO TO SINFO-Q7C

SINFO-Q7B	Were you able to find enough information to satisfy your needs?

YESNO	YES

NO

SINFO-Q7C	Have you have ever looked for information about teaching children about traffic safety?

YESNO	YES

NO	GO TO SINFO-Q7E

SINFO-Q7D	Were you able to find enough information to satisfy your needs?

YESNO	YES

NO

SINFO-Q7E	Have you have ever looked for information about safety in the home (such as preventing falls, preventing scalds and burns, preventing poisoning)?

YESNO	YES

NO	GO TO SINFO-Q7I

SINFO-Q7F	Were you able to find enough information to satisfy your needs?

YESNO	YES

NO

SINFO-Q7I	Have you have ever looked for information about how to treat a child who is choking?

YESNO	YES

NO	GO TO SINFO-Q7K

SINFO-Q7J	Were you able to find enough information to satisfy your needs?

YESNO	YES

NO

SINFO-Q7K	Have you have ever looked for information about swimming safety?

YESNO	YES

NO	GO TO SINFO-Q7M

SINFO-Q7L	Were you able to find enough information to satisfy your needs?

YESNO	YES

NO

SINFO-Q7M	Have you have ever looked for information about bicycle safety?

YESNO	YES

NO	GO TO SINFO-Q7Q

SINFO-Q7N	Were you able to find enough information to satisfy your needs?

YESNO	YES

NO

SINFO-Q7Q	Have you have ever looked for information about how to prevent sports injuries?

YESNO	YES

NO	GO TO SINFO-Q8

SINFO-Q7R	Were you able to find enough information to satisfy your needs?

YESNO	YES

NO

SINFO-Q8	If you wanted or needed information on preventing or treating childhood injuries, which of the following sources would you find helpful?

(READ LIST, MARK ALL THAT APPLY)

SINFO-Q8	Educational pamphlets displayed in convenient places

Educational pamphlets distributed through schools

Counselling with health professionals

Childhood safety information in the media

Videotapes about safety available in public libraries and video stores

A telephone hotline giving safety information

None of the above

SINFO-STOP

NUTRITION

POPULATION	NON-PROXY 12 YEARS OF AGE AND OVER; IF PROXY GO TO SNUTRITION-STOP

SNUTRITION-I1	The following questions are about the food you eat and your eating habits. When answering these questions think about the kinds of foods you eat, how often you eat them and what amounts you eat.

SNUTRITION-Q1	In general would you say that your eating habits are excellent, very good, good, fair, or poor?

(DO NOT READ LIST, MARK ONE ONLY)

SNUTRITION-Q1	EXCELLENT

VERY GOOD

GOOD

FAIR

POOR

SNUTRITION-Q2	Which of the following foods do you eat more now than you did twelve months ago?

(READ LIST, MARK ALL THAT APPLY)

SNUTRITION-Q2	grain products (bread, pasta, rice, cereals)?

vegetables and fruit (fresh, frozen, canned)?

milk products (milk, cheese, yogurt)?

meat, poultry, or fish?

meat alternatives (dried beans, lentils)?

other foods such as candy, chips, butter, tea/coffee?

NONE OF THE ABOVE

SNUTRITION-Q3	Starch and fibre are important to the Canadian diet. Are you concerned about getting enough starch and fibre in the foods you eat?

YESNO	YES

NO	(Go to SNUTRITION-Q4C)

SNUTRITION-Q4	Are you taking any steps to increase the amount of starch and fibre in the foods you eat?

YESNO	YES

NO	(Go to SNUTRITION-Q4C)

SNUTRITION-Q4A	Are you taking any of the following steps ...?

(READ LIST. MARK ALL 'YES' RESPONSES.)

SNUTRITION-Q4A	Eating vegetables or fruit at most meals and snacks

Using meat alternatives (dried beans, lentils)

Eating meals which have less meat (e.g. pasta, rice, vegetable dishes)

Eating whole grain products (e.g. whole wheat bread, brown rice,

oatmeal muffins)

Using whole wheat flour and bran in baking

Choosing foods that are high in fibre (bran cereals, muffins)

OTHER (specify)

SNUTRITION-Q4B	Do you find it easy to increase the amount of starch and fibre in the foods you eat?

YESNO	YES

NO

SNUTRITION-Q4C	I'm going to read you some statements about starch and fibre in foods. For each statement, please tell me if it is true or false.

(READ LIST. MARK ALL "TRUE" RESPONSES.)

SNUTRITION-Q4C	Grain products do not taste good.

Grain products are too expensive.

Grain products are not readily available.

Grain products are fattening.

You don't know what grain products are.

NONE OF THE ABOVE

SNUTRITION-Q5	Are you concerned about the amount of fat in the foods you eat?

YESNO	YES

NO	GO TO SNUTRITION-Q8

SNUTRITION-E5

REFUSAL OR DON'T KNOW TO SNUTRITION-Q5, GO TO SNUTRITION-Q8

SNUTRITION-Q6	Are you taking any steps to reduce the amount of fat in the foods you eat?

SNUTRITION-Q6	YES

NO, (DOING NOTHING)	GO TO SNUTRITION-Q8

SNUTRITION-E6

REFUSAL OR DON'T KNOW TO SNUTRITION-Q6, GO TO SNUTRITION-Q8

SNUTRITION-Q6A	Are you taking any of the following steps ...

(READ LIST, MARK ALL YES RESPONSES)

SNUTRITION-Q6A	Using less butter, oil or salad dressings

Cutting down on high-fat milk products

Eating less fried or deep fried foods

Cutting down on nuts and seeds

Eating fewer snacks such as chips and chocolate bars

Using lower-fat milk products

Eating leaner meats, poultry, fish

Eating meat alternatives

Choosing foods with lower fat contents

Baking, broiling or microwaving your food

OTHER STEPS (SPECIFY)

SNUTRITION-Q7	Do you find it easy to reduce the amount of fat in the foods you eat?

YESNO	YES

NO

SNUTRITION-Q8	I'm going to read you some statements about fat in food. For each statement, please tell me if it is true or false.

(READ LIST, MARK ALL "TRUE" RESPONSES.)

SNUTRITION-Q8	Low fat food choices are readily available

Low fat foods are expensive

Low fat foods taste good

Low fat foods are easy to prepare

Food labels show the amount of fat content

NONE OF THE ABOVE

SNUTRITION-Q9	Are you presently trying to lose weight?

YESNO	YES

NO

SNUTRITION-E9	IF NO IN SNUTRITION-Q9 GO TO SNUTRITION-STOP

SNUTRITION-Q10	How much would you like to weigh?

SNUTRITION-Q10	_____

SNUTRITION-Q11	TO BE PROGRAMMED THE SAME WAY AS NPHS POUNDS/KILOGRAMS QUESTION IS PROGRAMMED.

SNUTRITION-Q11	pounds or kilograms?

POUNDS

KILOGRAMS

SNUTRITION-STOP

SMOKING

POPULATION	NON PROXY 12 YEARS OF AGE AND OVER:, IF PROXY GO TO SSMOK-STOP

SSMOK-I1	The next questions are about your awareness of the information on cigarette packaging, attitudes toward smoking and quitting smoking. Your answers will allow Health Canada to measure the effectiveness of their programs.

SSMOK-Q1	Have you ever seen health warning messages on cigarette packages?

YESNO	YES

NO	GO TO SSMOK-Q5

SSMOK-Q2	What are the health warning messages you have seen?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SSMOK-Q2	SMOKING REDUCES LIFE EXPECTANCY.

SMOKING IS THE MAJOR CAUSE OF LUNG CANCER.

SMOKING IS A MAJOR CAUSE OF HEART DISEASE.

SMOKING DURING PREGNANCY CAN HARM THE BABY.

CIGARETTES ARE ADDICTIVE.

TOBACCO SMOKE CAN HARM YOUR CHILDREN.

CIGARETTES CAUSE FATAL LUNG DISEASE.

CIGARETTES CAUSE CANCER.

CIGARETTES CAUSE STROKES AND HEART DISEASE.

SMOKING CAN KILL YOU.

TOBACCO SMOKE CAUSES FATAL LUNG DISEASE IN NON-SMOKERS.

ANY OTHER MESSAGE, (SPECIFY)

SSMOK-Q3	Do you agree or disagree with cigarette packages having health warning messages?

(DO NOT READ LIST, MARK ONE ONLY)

SSMOK-Q3	AGREE

DISAGREE

NO OPINION

SSMOK-Q4	How often do you read these health warning messages?

(DO NOT READ, MARK ONE ONLY)

SSMOK-Q4	NEVER

LESS OFTEN THAN ONCE A WEEK

ABOUT ONCE A WEEK

ONCE EVERY TWO OR THREE DAYS

ABOUT ONCE A DAY

MORE THAN ONCE A DAY

SSMOK-C5	IF SMOK-Q1=1, GO TO SSMOK-Q5. OTHERWISE, GO TO SSMOK-C6.

SSMOK-Q5	How many of the people living in your household smoke cigarettes regularly inside the home, including yourself.

SSMOK-Q5	__ People

SSMOK-C6	IF "NOT AT ALL" IN SMOK-Q2 AND "NO" IN SMOK-Q5 GO TO SSMOK-I6.

IF "NOT AT ALL" IN SMOK-Q2 AND "YES" IN SMOK-Q5, THEN GO TO SSMOK-I9.

IF "DON'T KNOW" OR "REFUSAL" IN SMOK-Q2 OR SMOK-Q5, THEN GO TO SMOK-STOP.

OTHERWISE GO TO SSMOK-Q12.

SSMOK-I6	You said earlier that you used to smoke cigarettes, but never smoked daily.

SSMOK-Q7	At what age did you first begin to smoke (even if it wasn't every day)?

SSMOK-Q7	__ AGE

SSMOK-E7	RESPONDENT COULD NOT BEGIN TO SMOKE AT AN AGE OLDER THAN HIS/HER CURRENT AGE.

SSMOK-Q8	At what age did you quit smoking?

SSMOK-Q8	__ AGE

SSMOK-E8	STOP AGE FOR SMOKERS NOT BEFORE --- AND NOT AFTER CURRENT AGE.

SSMOK-E8A

GO TO SSMOK-Q9

SSMOK-I9	We would like to ask some questions of people who have stopped smoking. You said earlier that you used to smoke cigarettes daily.

SSMOK-Q9A	Why did you first begin smoking cigarettes?

(DO NOT READ LIST. MARK ALL THAT APPLY.)

SSMOK-Q7A	EVERYONE AROUND ME SMOKED

ALL MY FRIENDS SMOKED

MY PARENT(S) SMOKED

CURIOSITY

TO BE "COOL"

TO CONTROL BODY WEIGHT

TO CONTROL STRESS, ANXIETY OR ANGER

TO COMBAT BOREDOM

PRICE

AVAILABILITY (LOOSE CIGARETTES, CONTRABAND)

OTHER (SPECIFY)

SSMOK-E9A	IF MORE THAN ONE RESPONSE SELECTED IN SSMOK-Q9A, GO TO SSMOK-Q9B. OTHERWISE, GO TO SSMOK-Q9.

SSMOK-Q7B	What was the most important reason you began smoking?

(DO NOT READ LIST. MARK ONE ONLY.)

SSMOK-Q9B	EVERYONE AROUND ME SMOKED

ALL MY FRIENDS SMOKED

MY PARENT(S) SMOKED

CURIOSITY

TO BE "COOL"

TO CONTROL BODY WEIGHT

TO CONTROL STRESS, ANXIETY OR ANGER

TO COMBAT BOREDOM

PRICE

AVAILABILITY (LOOSE CIGARETTES, CONTRABAND)

OTHER

SSMOK-E9B	RESPONSE SELECTED IN SSMOK-Q9B MUST BE ONE OF THE RESPONSES SELECTED IN SSMOK-Q9A. IF NOT ASK INTERVIEWER TO CHECK RESPONSES TO SSMOK-Q9A AND - Q9B.

SSMOK-Q9	Why did you quit smoking?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SSMOK-Q9	CONCERN ABOUT FUTURE HEALTH EFFECTS

PHYSICIAN ADVICE

AFFECTING PRESENT HEALTH

PREGNANCY

SOCIAL/FAMILY PRESSURES

RESTRICTIONS

COST

ANY OTHER REASON (SPECIFY)

SSMOK-Q10	What method did you use to quit smoking?

(DO NOT READ LIST. MARK ONE ONLY.)

SSMOK-Q10	COLD TURKEY

SELF-HELP PROGRAM (VIDEO, CASSETTE, BOOK)

NICOTINE PATCH

ADDICTION COUNSELLING

ORGANIZED STOP-SMOKING PROGRAM

NICORETTE

ACUPUNCTURE

HYPNOSIS

OTHER (SPECIFY)

SSMOK-E10

GO TO SSMOK-STOP

SSMOK-Q12	Why did you first begin smoking cigarettes?

(DO NOT READ LIST. MARK ALL THAT APPLY.)

SSMOK-Q7A	EVERYONE AROUND ME SMOKED

ALL MY FRIENDS SMOKED

MY PARENT(S) SMOKED

CURIOSITY

TO BE "COOL"

TO CONTROL BODY WEIGHT

TO CONTROL STRESS, ANXIETY OR ANGER

TO COMBAT BOREDOM

PRICE

AVAILABILITY (LOOSE CIGARETTES, CONTRABAND)

OTHER (SPECIFY)

SSMOK-E12	IF MORE THAN ONE RESPONSE SELECTED IN SSMOK-Q12, GO TO SSMOK-Q12A. OTHERWISE, GO TO SSMOK-Q12C.

SSMOK-Q12A	What was the most important reason you began smoking?

(DO NOT READ LIST. MARK ONE ONLY.)

SSMOK-Q7B	EVERYONE AROUND ME SMOKED

ALL MY FRIENDS SMOKED

MY PARENT(S) SMOKED

CURIOSITY

TO BE "COOL"

TO CONTROL BODY WEIGHT

TO CONTROL STRESS, ANXIETY OR ANGER

TO COMBAT BOREDOM

PRICE

AVAILABILITY (LOOSE CIGARETTES, CONTRABAND)

OTHER

SSMOK-E12A	RESPONSE SELECTED IN SSMOK-Q12A MUST BE ONE OF THE RESPONSES SELECTED IN SSMOK-Q12. IF NOT ASK INTERVIEWER TO CHECK RESPONSES TO SSMOK-Q12 AND - Q12A.

SSMOK-Q12C	Why do you continue to smoke now?

(DO NOT READ LIST. MARK ALL THAT APPLY.)

SSMOK-Q12C	HABIT

STIMULANT

RELAXANT

ADDICTION

PLEASURE

WEIGHT CONTROL

SOCIAL ACCEPTABILITY

OTHER (SPECIFY)

SSMOK-Q13	Have you tried to quit smoking in the last twelve months?

YESNO	YES

NO

SSMOK-Q16	Are you smoking less now than you were twelve months ago?

YESNO	YES

NO	GO TO SSMOK-Q18

SSMOK-E16

DON'T KNOW OR REFUSAL TO SSMOK-Q16, GO TO SSMOK-Q18

SSMOK-Q17	Why are you smoking less?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SSMOK-Q17	CONCERN ABOUT FUTURE HEALTH EFFECTS

PHYSICIAN ADVICE

AFFECTING PRESENT HEALTH

PREGNANCY

SOCIAL/FAMILY PRESSURES

RESTRICTIONS

COST

TRYING TO QUIT

ANY OTHER REASON (SPECIFY)

SSMOK-Q18	Nowadays there are many restrictions on where people are allowed to smoke. In your day to day activities, where do you find you have restrictions on your smoking?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SSMOK-Q18	AT HOME

AT THE HOME OF FRIENDS OR RELATIVES

IN PUBLIC PLACES (SHOPPING CENTRES, CHURCH, HOSPITAL)

AT WORK

AT SCHOOL

AT AN ENTERTAINMENT OR SPORTS ACTIVITY

TRANSPORTATION

ANY OTHER PLACES (SPECIFY)

NONE OF THE ABOVE

SSMOK-C18A	IF SMOK-Q2=2 (occasionally) GO TO SSMOK-Q18A. OTHERWISE GO TO SSMOK-Q19.

SSMOK-Q18A	You said earlier that you smoke occassionally. On what types of occasions do you smoke?

(READ LIST. MARK ALL THAT APPLY.)

SSMOK-Q18A	When you are drinking

When you attend parties / social situations

When you are alone

When you are with friends

When you feel stressed

Other (specify)

SSMOK-Q19	Do you usually smoke the same brand of cigarettes?

YESNO	YES	GO TO SSMOK-Q21

NO	GO TO SSMOK-Q20

SSMOK-E19

REFUSAL OR DON'T KNOW IN SSMOK-Q19 GO TO SSMOK-STOP.

SSMOK-Q20	Why not?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SSMOK-Q20	LOWER TAR

TASTE PREFERENCE

ADVERTISEMENT

NO PARTICULAR PREFERENCE FOR ONE BRAND

REDUCE NEGATIVE HEALTH EFFECTS

SSMOK-E20

GO TO SSMOK-STOP.

SSMOK-Q21	What brand do you usually smoke? (specify size and type for example, regular, kingsize, filter-tip, plain, etc.)

_______________________________

SSMOK-E21

REFUSAL OR DON'T KNOW IN SSMOK-Q21 GO TO SSMOK-STOP.

SSMOK-Q22	During the past 12 months, have you switched brands?

YESNO	YES

NO	GO TO SSMOK-Q24

SSMOK-E22

REFUSAL OR DON'T KNOW IN SSMOK-Q22 GO TO SSMOK-STOP

SSMOK-Q23	Why?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SSMOK-Q23	CONCERN ABOUT FUTURE HEALTH EFFECTS

PHYSICIAN ADVICE

AFFECTING PRESENT HEALTH

SOCIAL/FAMILY PRESSURES

RESTRICTIONS

COST

TAR CONTENT

NICOTINE CONTENT

SIZE OF PACKAGE

PREGNANCY

FILTER

ADVERTISING/PACKAGING

TASTE

ANY OTHER REASON (SPECIFY)

SSMOK-Q24	Often people are not sure how much tar, nicotine and carbon monoxide is in their cigarettes. Without looking at your cigarette package, how much tar would you say is in one of your cigarettes?

(READ LIST, MARK ONE ONLY)

SSMOK-Q24	More than 15 mgs

11-15 mgs

6-10 mgs

Less than 6 mgs

SSMOK-Q25	How much nicotine would you say is in one of your cigarettes?

(READ LIST, MARK ONE ONLY)

SSMOK-Q24	More than 15 mgs

11-15 mgs

6-10 mgs

Less than 6 mgs

SSMOK-Q26	How much carbon monoxide would you say is in one of your cigarettes?

(READ LIST, MARK ONE ONLY)

SSMOK-Q24	More than 15 mgs

11-15 mgs?

6-10 mgs

Less than 6 mgs

SSMOK-Q27	Would you like this type of information on tar, nicotine and carbon monoxide displayed more prominently on your cigarette package?

YESNO	YES

NO

SSMOK-STOP

INJURY PREVENTION

POPULATION	NON PROXY 12 YEARS OF AGE AND OVER:, IF PROXY GO TO END

SINJ-I1	The following questions are about safety and the prevention of injuries.

SINJ-C1	IF "BICYCLING" WAS INDICATED AS AN ACTIVITY IN PHYS-Q1 OR ANY RESPONSE OF "LESS THAN ONE HOUR", "FROM ONE TO FIVE HOURS", "FROM SIX TO TEN HOURS", "FROM 11 TO 20 HOURS", "MORE THAN 20 HOURS" IN PHYS-Q4B, AND RESPONSE OF "MOST OF THE TIME", "RARELY", OR "NEVER" IN PHYS-Q5 GO TO SINJ-Q1, OTHERWISE GO TO SINJ-Q2.

SINJ-Q1	You mentioned that you don't always wear a helmet when you ride a bicycle. What is the main reason why you don't wear a helmet all the time?

(DO NOT READ LIST, MARK ONE ONLY)

SINJ-Q1	DON'T HAVE ONE

AREN'T EFFECTIVE

AREN'T NECESSARY/DON'T NEED ONE

COSTS TOO MUCH

UNCOMFORTABLE TO WEAR/HELMET DOESN'T FIT/DON'T LIKE THEM

WOULD BE LAUGHED AT/WOULD BE SILLY

ONLY RIDES IN SAFE AREAS

INTERFERES WITH RIDING

FRIENDS DON'T WEAR THEM

INCONVENIENT/DIFFICULT TO STORE (EG. AT SCHOOL)

ANY OTHER REASON (SPECIFY)

SINJ-Q2	How often do you use a seat belt when riding in a car, truck or van?

(READ LIST, MARK ONE ONLY)

SINJ-Q2	Always GO TO SINJ-Q4

Nearly always

Sometimes

Rarely

Never

NOT APPLICABLE (DON'T RIDE IN CAR, TRUCK OR VAN)

SINJ-E2

REFUSAL OR DON'T KNOW GO TO SINJ-Q4

SINJ-C3A	FOR SINJ-Q3: RESPONSE "PREGNANT" VALID ONLY IF SEX OF RESPONDENT IS FEMALE AND > OR = 16 YEARS OF AGE.

SINJ-C3B	FOR SINJ-Q3: RESPONSE "INTERFERES WITH DRIVING" VALID ONLY IF RESPONDENT IS > OR = 16 YEARS OF AGE.

SINJ-Q3	What is the main reason you don't wear a seat belt all the time?

(DO NOT READ LIST, MARK ONE ONLY)

SINJ-Q3	AREN'T EFFECTIVE

AREN'T NECESSARY/DON'T NEED ONE

NOT IN VEHICLE

SEAT BELT DOESN'T WORK

WOULD BE LAUGHED AT/WOULD BE SILLY

ONLY RIDES IN SAFE AREAS

FRIENDS DON'T WEAR THEM

INCONVENIENT/UNCOMFORTABLE

TOO TIME CONSUMING

PREGNANT

INTERFERES WITH DRIVING

ANY OTHER REASON (SPECIFY)

NOT APPLICABLE

SINJ-E4	BEGIN ROSTER IF RESPONDENT HAS ANY CHILDREN AGE < 13; OTHERWISE GO TO SINJ-STOP.

SINJ-I4	I am now going to ask you about your child(ren)'s safety.

SINJ-Q4	Does %FNAME% ride a bicycle (INCLUDING TRICYCLES)?

YESNO	YES

NO	GO TO SINJ-Q7

SINJ-Q5	When riding on a bicycle how often does %FNAME% wear a helmet?

(DO NOT READ LIST, MARK ONE ONLY)

SINJ-Q5	ALWAYS	GO TO SINJ-Q7

MOST OF THE TIME

RARELY

NEVER

SINJ-Q6	What is the main reason %FNAME% doesn't wear a helmet all the time?

(DO NOT READ LIST, MARK ONE ONLY)

SINJ-Q6	DOESN'T HAVE ONE

AREN'T EFFECTIVE

AREN'T NECESSARY/DOESN'T NEED ONE

COSTS TOO MUCH

UNCOMFORTABLE TO WEAR/DOESN'T LIKE ONE

WOULD BE LAUGHED AT/WOULD BE SILLY

ONLY RIDES IN SAFE AREAS

INTERFERES WITH RIDING

FRIENDS DON'T WEAR THEM

INCONVENIENT/DIFFICULT TO STORE (EG. AT SCHOOL)

ANY OTHER REASON, (SPECIFY)

SINJ-Q7	How often does %FNAME% use a child safety seat or seat belt when riding in a car, truck or van?

(READ LIST, MARK ONE ONLY)

SINJ-Q2	Always

Nearly always

Sometimes

Rarely

Never

NOT APPLICABLE (DOESN'T RIDE IN CAR, TRUCK OR VAN)

SINJ-E7	IF RESPONSE "ALWAYS" OR "DON'T KNOW" OR "REFUSAL" IN SINJ-Q7 AND MORE CHILDREN AGE <13, GO TO SINJ-Q4 FOR NEXT CHILD. IF RESPONSE "ALWAYS" OR "DON'T KNOW" OR "REFUSAL" IN SINJ-Q7 AND NO MORE CHILDREN GO TO SINJ-STOP. OTHERWISE (IE. RESPONSE 2,3,4 OR 5 IN SINJ-Q7) GO TO SINJ-Q8.

SINJ-Q8	What is the main reason %FNAME% doesn't wear a seat belt or use a child safety seat all the time?

(DO NOT READ LIST, MARK ONE ONLY)

SINJ-Q8	AREN'T EFFECTIVE

AREN'T NECESSARY/DON'T NEED ONE

NOT IN VEHICLE

SEAT BELT DOESN'T WORK

WOULD BE LAUGHED AT/WOULD BE SILLY

ONLY RIDES IN SAFE AREAS

FRIENDS DON'T WEAR THEM

INCONVENIENT/UNCOMFORTABLE

TOO TIME CONSUMING

TOO DIFFICULT TO INSTALL SEAT

TOO EXPENSIVE

CHILD UNCOOPERATIVE

DON'T HAVE A SAFETY SEAT

ANY OTHER REASON (SPECIFY)

SINJ-E8	IF MORE CHILDREN AGE <13, GO TO SINJ-Q4 FOR NEXT CHILD. IF NO MORE CHILDREN GO TO SINJ-STOP.

END ROSTER

SINJ-STOP

BREAST-FEEDING

POPULATION	NON PROXY , BIRTH MOTHER IN LAST FIVE YEARS, OTHERWISE GO TO SBF-STOP.

SBF-C1	TO BE ASKED OF BIOLOGICAL MOTHERS WITH BIRTHS IN THE LAST 5 YEARS. THIS IS THE BEGINNING OF ROSTER TO BE COMPLETED FOR EACH BIOLOGICAL CHILD, YOUNGEST TO OLDEST UP TO FIVE YEARS OF AGE.

SBF-I11	The next few questions are about breast-feeding practices and how these practices may change over time.

SBF-C12	IF %FNAME% LESS THAN ONE YEAR OLD GO TO SBF-Q1A, OTHERWISE GO TO SBF- Q1B.

SBF-Q1A	Are you currently breast-feeding %FNAME%?

YESNO	YES	GO TO SBF-Q3

NO

SBF-E1A

IF REFUSAL OR DON'T KNOW TO SBF-Q1A GO TO SBF-STOP.

SBF-Q1B	Did you breast-feed or try to breast-feed %FNAME% even if only for a short time?

SBF-Q1B	YES

STILL BREAST-FEEDING	GO TO SBF-Q3

NO	GO TO SBF-Q4

SBF-E1B

IF REFUSAL OR DON'T KNOW TO SBF-Q1B GO TO SBF-STOP.

SBF-Q1C	For how long did you breast-feed %FNAME%?

(DO NOT READ LIST, MARK ONE ONLY)

SBF-Q1C	< 1 WEEK

1 - 4 WEEKS

5 - 8 WEEKS

9 - 12 WEEKS

3 - 6 MONTHS

7 - 9 MONTHS

10 - 12 MONTHS

MORE THAN ONE YEAR

SBF-Q2	What was the main reason you stopped breast-feeding %FNAME%?

(DO NOT READ LIST; MARK ALL THAT APPLY)

SBF-Q2	NOT ENOUGH MILK/HUNGRY BABY

INCONVENIENCED/FATIGUE

DIFFICULTY WITH BF TECHNIQUES

SORE NIPPLES/ENGORGED BREAST

MOTHER'S ILLNESS

PLANNED TO STOP AT THIS TIME

CHILD WEANED HIM/HERSELF

PHYSICIAN TOLD ME TO STOP

RETURNED TO WORK/SCHOOL

PARTNER/FATHER WANTED ME TO STOP

FORMULA FEEDING PREFERABLE

WANTED TO DRINK ALCOHOL

OTHER (SPECIFY)

SBF-Q3	Why did you choose to breast-feed %FNAME%?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SBF-Q3	BETTER FOR MY BABY

MORE CONVENIENT

LESS COSTLY

NATURAL

BETTER FOR ME

BREAST-FED OTHER / PREVIOUS CHILDREN

OTHER (SPECIFY)

SBF-E3

GO TO SBF-Q5B

SBF-Q4	Why did you choose not to breast-feed %FNAME%?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SBF-Q4	BOTTLE-FEEDING EASIER

FORMULA AS GOOD AS BREAST-MILK

BREAST-FEEDING IS UNAPPEALING/DISGUSTING

FATHER/PARTNER DIDN'T WANT ME TO

RETURNED TO WORK/SCHOOL EARLY

C-SECTION

MEDICAL CONDITION - BABY

PREMATURE BIRTH

MEDICAL CONDITION - MOTHER

MULTIPLE BIRTHS (EG. TWINS ETC.)

WANTED TO DRINK ALCOHOL

OTHER (SPECIFY)

SBF-Q5A	Who helped you to decide not to breast-feed %FNAME%?

(DO NOT READ LIST; MARK ALL THAT APPLY)

SBF-Q5	HEALTH PROFESSIONAL

MY MOTHER / SISTER / RELATIVE

BABY'S FATHER / HUSBAND / PARTNER

FRIEND

BREAST-FEEDING SUPPORT GROUP

EDUCATIONAL/PROMOTIONAL MATERIALS

NO ONE

OTHER (SPECIFY)

SBF-E5A	IF MORE CHILDREN UNDER THE AGE OF 5 GO TO SBF-Q1B FOR NEXT OLDEST CHILD, OTHERWISE GO TO SBF-STOP

SBF-Q5B	Who helped you to decide to breast-feed %FNAME%?

(DO NOT READ LIST; MARK ALL THAT APPLY)

SBF-Q5	HEALTH PROFESSIONAL

MY MOTHER / SISTER / RELATIVE

BABY'S FATHER / HUSBAND / PARTNER

FRIEND

BREAST-FEEDING SUPPORT GROUP

EDUCATIONAL/PROMOTIONAL MATERIALS

NO ONE

OTHER (SPECIFY)

SBF-E5B	IF MORE CHILDREN UNDER THE AGE OF 5 GO TO SBF-Q1B FOR NEXT OLDEST CHILD, OTHERWISE GO TO SBF-STOP

END OF ROSTER

SBF-STOP

ALCOHOL CONSUMPTION DURING PREGNANCY

POPULATION	NON PROXY, BIRTH MOTHER IN LAST FIVE YEARS, OTHERWISE GO TO SALC-STOP.

SALC-C1	TO BE ASKED OF NON PROXY BIOLOGICAL MOTHERS WITH BIRTHS IN THE LAST 5 YEARS. THIS IS THE BEGINNING OF ROSTER TO BE COMPLETED FOR EACH BIOLOGICAL CHILD, YOUNGEST TO OLDEST UP TO FIVE YEARS OF AGE.

SALC-I1	The next questions are about mothers' attitudes toward the use of alcohol and drugs during pregnancy, and how these attitudes change over time.

SALC-Q1	How often did you drink alcohol during your pregnancy with %FNAME% ... (e.g. beer, wine, hard liquor, liqueurs)?

(DO NOT READ LIST, MARK ONE ONLY)

SALC-Q1	NEVER GO TO SALC-Q5

LESS THAN ONCE A MONTH

1 - 3 TIMES A MONTH

ONCE A WEEK

2 - 3 TIMES A WEEK

4 - 6 TIMES A WEEK

EVERY DAY

SALC-E1

REFUSAL OR DON'T KNOW TO SALC-Q1 GO TO SALC-STOP.

SALC-Q2	On the days that you drank, how many drinks did you usually have?

(DO NOT READ LIST, MARK ONE ONLY)

SALC-Q2	1 - 2

3 - 4

5 or more

SALC-E2

REFUSAL OR DON'T KNOW TO SALC-Q2 GO TO SALC-STOP.

SALC-Q3	At what stage in your pregnancy did you consume this quantity:

(READ LIST. MARK ALL THAT APPLY)

SALC-Q3	Before realizing you were pregnant;

During the first three months;

During the second three months;

During the third three months; or

Throughout your pregnancy.

SALC-E3A	IF THE SECOND TO FOURTH RESPONSES ARE ALL MARKED, CHANGE THOSE RESPONSES TO BLANK AND MARK THROUGHOUT.

IF THROUGHOUT IS MARKED, CHANGE ALL OTHER RESPONSES TO BLANK.

SALC-Q4	For each of the following statements, please indicate if it is true or false ...

(READ LIST, MARK ALL TRUE RESPONSES)

I continued to drink after I became pregnant with %FNAME% because ...

SALC-Q4	I was pressured to have a drink.

Nobody told me NOT to have a drink

My doctor said an occasional drink would not harm the baby

I did not think it would harm the baby

NONE OF THE ABOVE

SALC-Q5	During your pregnancy with %FNAME%, did you take any medications or drugs prescribed by a doctor?

YESNO	YES

NO	(GO TO SALC-Q7)

(Refused, DK go to SALC-Q7)

SALC-Q6A	At what stage in your pregnancy did you take these prescription medications?

(READ LIST. MARK ALL THAT APPLY)

SALC-Q3	Before realizing you were pregnant;

During the first three months;

During the second three months;

During the third three months; or

Throughout your pregnancy.

SALC-E5A	IF THE SECOND TO FOURTH RESPONSES ARE ALL MARKED, CHANGE THOSE RESPONSES TO BLANK AND MARK THROUGHOUT.

IF THROUGHOUT IS MARKED, CHANGE ALL OTHER RESPONSES TO BLANK.

SALC-Q7	Did you take any medications which can be bought without a doctor's prescription (ie. over-the-counter medications) during your pregnancy with %FNAME%?

YESNO	YES

NO	(GO TO SALC-Q9)

(Refused, DK go to SALC-Q9)

SALC-Q8A	At what stage in your pregnancy did you take these medications?

(READ LIST. MARK ALL THAT APPLY)

SALC-Q3	Before realizing you were pregnant;

During the first three months;

During the second three months;

During the third three months; or

Throughout your pregnancy.

SALC-E6A	IF THE SECOND TO FOURTH RESPONSES ARE ALL MARKED, CHANGE THOSE RESPONSES TO BLANK AND MARK THROUGHOUT.

IF THROUGHOUT IS MARKED, CHANGE ALL OTHER RESPONSES TO BLANK.

SALC-Q9	Did you take any other drugs such as marijuana, LSD or cocaine during your pregnancy with %FNAME%?

YESNO	YES

NO	(GO TO SALC-E8)

(Refused, DK go to SALC-E8)

SALC-Q10A	Which drugs did you take?

(DO NOT READ LIST. MARK ALL THAT APPLY.)

SALC-Q7A	MARIJUANA / HASHISH / CANNABIS

LSD

COCAINE

OTHER (specify ___)

SALC-Q11B	At what stage in your pregnancy did you take these drugs?

(READ LIST. MARK ALL THAT APPLY)

SALC-Q3	Before realizing you were pregnant;

During the first three months;

During the second three months;

During the third three months; or

Throughout your pregnancy.

SALC-E7B	IF THE SECOND TO FOURTH RESPONSES ARE ALL MARKED, CHANGE THOSE RESPONSES TO BLANK AND MARK THROUGHOUT.

IF THROUGHOUT IS MARKED, CHANGE ALL OTHER RESPONSES TO BLANK.

SALC-E8	IF MORE CHILDREN UNDER AGE 5, GO TO SALC-Q1 FOR NEXT OLDEST CHILD; OTHERWISE GO TO SALC-STOP

SALC-STOP

SEXUAL HEALTH

POPULATION	NON PROXY AGE 15-45; OTHERWISE GO TO SSH-STOP

SSH-E1

REFUSAL OR DON'T KNOW TO SSH-Q1 GO TO SSH-Q3.

SSH-I1	With the growing crisis of sexually transmitted diseases such as AIDS, it is important that Health Canada measure Canadians' knowledge and attitudes about preventive measures. It is also important to find out how many Canadians have been affected by sexually transmitted diseases since this information has never before been collected in a national survey. Please be assured that anything you tell me will remain confidential.

SSH-Q1	How many sexual partners have you had within the past twelve months?

SSH-Q1	__	00	(GO TO SSH-Q3)

01

02-99

SSH-E1	DON'T KNOW OR REFUSAL GO TO SSH-STOP. IF SSH-Q1=1 AND MARITAL STATUS=MARRIED OR COMMON-LAW OR DIVORCED OR WIDOWED, GO TO SSH-Q3; OTHERWISE GO TO SSH-Q2.

SSH-Q2	In the past year, when you have had sexual intercourse, did you / your partner use a condom ... (READ LIST, MARK ONE ONLY)

SSH-Q2	each time?	GO TO SSH-Q3

some, but not all, of the times; or

never?	GO TO SSH-Q2B

SSH-Q2A	When you do use condoms, is it ...

(READ LIST; MARK ALL THAT APPLY)

SSH-Q2A	when you meet a new person?

when you are with someone other than your regular partner?

(males only: ) when your partner asks you to use one?

or some other reason? (specify)

SSH-Q2B	What is your main reason for not using condoms each time you have sexual intercourse?

(DO NOT READ LIST; MARK ALL THAT APPLY)

SSH-Q2B	DON'T ALWAYS HAVE ONE AVAILABLE

WANT TO HAVE A CHILD

CONDOMS ARE NOT NATURAL

CONDOMS DON'T FEEL GOOD / DON'T FIT

TOO EMBARRASSED TO BUY THEM

TOO EXPENSIVE

USE OTHER METHOD OF CONTRACEPTION

INTERRUPTS LOVEMAKING / SPOILS THE MOOD

AGAINST RELIGION TO USE CONTRACEPTION

(males only:) PARTNER DOES NOT ASK ME TO USE ONE

OTHER (SPECIFY)

SSH-Q3	In the past two years have you been told by a doctor that you had a sexually transmitted disease?

YESNO	Yes	GO TO SSH-Q4

No	GO TO SSH-Q5

SSH-E3

REFUSAL OR DON'T KNOW GO TO SSH-STOP.

SSH-Q4	In the past two years have you had, or do you currently have, any of the following sexually transmitted diseases?

(READ LIST; MARK ALL THAT APPLY)

SSH-Q4	Chlamydia

Gonorrhea

Syphilis

Genital warts

Genital herpes

Hepatitis B

HIV / AIDS

NONE OF THE ABOVE

SSH-E4	IF HIV/AIDS IS INDICATED IN SSH-Q4, GO TO SSH-Q6. IF REFUSED OR DON'T KNOW IN SSH-Q4, GO TO SSH-STOP. OTHERWISE GO TO SSH-Q5.

SSH-Q5	Has your blood ever been tested for HIV?

YESNO	YES	GO TO SSH-Q6

NO	GO TO SSH-STOP

SSH-Q6	Where was the (most recent) HIV testing done? Was it ...

(READ LIST; MARK ONE ONLY)

SSH-Q6	At a doctor' office

At a blood bank

At a clinic for sexually transmitted diseases

At a voluntary HIV testing site

At a hospital; or

At some other location?

SSH-Q7	Was the respondent alone when you asked the questions in this section?

YESNO	YES	GO TO SSH-STOP

NO	GO TO SSH-Q7A

DON'T KNOW OR REFUSAL GO TO SSH-STOP

SSH-Q7A	Were the answers of the respondent affected by someone else being there?

YESNO	YES	GO TO SSH-STOP

NO	GO TO SSH-STOP

DON'T KNOW OR REFUSAL GO TO SSH-STOP

SSH-STOP

HEALTH CARE SERVICES

SHCS-START	SELECTED RESPONDENT 20 YRS+, OTHERWISE GO TO END

SHCS-I1	In this last set of questions, we are interested in hearing your opinions on health care services, and the quality of health care you receive, and the Canadian health care system.

SHCS-Q1	Are you given enough information by doctors when you need ...

(READ LIST, MARK ALL 'YES' RESPONSES)

SHCS-Q1	advice on how to stay healthy

treatment for common illnesses

treatment for more serious illnesses

a referral to a specialist

to visit an out-patient clinic or hospital

to stay in hospital

surgery

NONE OF THE ABOVE (DOESN'T WANT OR NEED HEALTH INFORMATION)

SHCS-C1	IF ANSWERED "NONE OF THE ABOVE" TO UTIL-Q2 (IN NPHS BACKGROUND), OR DIDN'T MARK "A GENERAL PRACTITIONER OR FAMILY PHYSICIAN" OR "ANOTHER MEDICAL DOCTOR", SKIP TO SHCS-Q5. (THESE PEOPLE HAVE NOT CONSULTED A DOCTOR IN PAST 12 MONTHS)

SHCS-Q2	Think about the most recent reason for consulting a doctor regarding your own health during the last 12 months. Which of the following statements best describes the relationship between yourself and the doctor at the time?

(READ LIST, MARK ONE ONLY)

SHCS-Q2	The doctor told you what to do and you followed his/her advice.

The doctor offered options for care and you chose one.

You and the doctor discussed the options and agreed on the best one

You and the doctor did not agree on what was best for you.

NONE OF THE ABOVE

SHCS-Q3	In the last 12 months when you saw a doctor or nurse was there an occasion when you did not have a say in the treatment being offered?

YESNO	YES

NO	GO TO SHCS-Q5

SHCS-E3	DON'T KNOW OR REFUSAL IN SHCS-Q3 GO TO SHCS-Q5

SHCS-Q4	Thinking about the most recent time when you did not have a say in the treatment, what did you do?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SHCS-Q4	SAW ANOTHER DOCTOR

DID NOTHING

DID WHAT YOU THOUGHT WORKED BEST FOR YOU

FOLLOWED THE DOCTOR'S ADVICE

ANYTHING ELSE (SPECIFY)

SHCS-Q5	When you have a health problem, do you go to the same family doctor ... always, sometimes, rarely or never?

(DO NOT READ LIST, MARK ONE ONLY)

SHCS-Q5	ALWAYS

SOMETIMES

RARELY

NEVER

SHCS-Q6	When you need a prescription filled, do you go to the same pharmacy ... always, sometimes, rarely or never?

(DO NOT READ LIST, MARK ONE ONLY)

SHCS-Q5	ALWAYS

SOMETIMES

RARELY

NEVER

SHCS-Q6A	Has your doctor prescribed any medication for you in the past 12 months?

YESNO	YES

NO	(GO TO SHCS-Q9A)

(Refused, DK: go to SHCS-Q9A)

SHCS-Q7	When your doctor prescribed a medication for you in the past 12 months, did he/she usually tell you ...

(READ LIST. MARK ALL 'YES' RESPONSES.)

SHCS-Q7	what the medication was for?

what the medication should do?

what were the possible side effects?

how much to take and when to take it?

what you should not eat, drink or take with it?

what activities you should avoid while taking the medication?

NONE OF THE ABOVE

SHCS-Q8	When you had a prescription filled in the past 12 months, did your pharmacist usually tell you ...

(READ LIST. MARK ALL 'YES' RESPONSES.)

SHCS-Q8	what the medication was for?

what the medication should do?

what were the possible side effects?

how much to take and when to take it?

what you should not eat, drink or take with it?

what activities you should avoid while taking the medication?

how to store the medication?

what you should take with the medication (e.g. food, water, milk)?

NONE OF THE ABOVE

SHCS-Q9A	When you go to the family doctor, do you take your medications or a list (of them) with you ... always, sometimes, rarely or never?

(DO NOT READ LIST, MARK ONE ONLY)

SHCS-Q5	ALWAYS

SOMETIMES

RARELY

NEVER

SHCS-Q9B	When you go to the pharmacy with a prescription to be filled, do you take your medications or a list (of them) with you ... always, sometimes, rarely or never?

(DO NOT READ LIST, MARK ONE ONLY)

SHCS-Q5	ALWAYS

SOMETIMES

RARELY

NEVER

SHCS-I10A	Health Canada would like to know people's attitudes about receiving health care from different sources.

SHCS-Q10A	Would you go to a health care clinic, rather than a hospital or private doctor's office, for a routine physical exam?

YESNO	YES

NO

SHCS-E10A	IF YES TO SHCS-Q10A GO TO SHCS-Q10A1, OTHERWISE GO TO SHCS-Q10B.

SHCS-Q10A1	Would you allow a nurse to give you a routine physical exam?

YESNO	YES

NO

SHCS-Q10B	Would you go to a health care clinic rather than a hospital or private doctor's office to receive shots (immunization)?

YESNO	YES

NO

SHCS-E10B	IF YES TO SHCS-Q10B GO TO SHCS-Q10B1, OTHERWISE GO TO SHCS-Q10C.

SHCS-Q10B1	Would you allow a nurse rather than a doctor to give you immunization shots?

YESNO	YES

NO

SHCS-C10C	IF SEX=1 (MALE), GO TO SHCS-Q10E.

SHCS-Q10C	Would you go to a birthing centre, rather than go to a hospital to have a baby?

SHCS-Q10C	YES

NO

NOT APPLICABLE (DO NOT WANT TO HAVE CHILDREN)

SHCS-E10C	IF "NOT APPLICABLE (DO NOT WANT TO HAVE CHILDREN)" IN SHCS-Q10C GO TO SHCS- Q10E. IF "YES" TO SHCS-E10C GO TO SHCS-Q10C1. OTHERWISE GO TO SHCS-Q10E.

SHCS-Q10C1	Would you allow a nurse or midwife rather than a doctor to deliver your baby?

YESNO	YES

NO

SHCS-Q10D	Would you go to a health care clinic or birthing centre rather than a private doctor's office to receive postpartum care?

SHCS-Q10C	YES

NO

NOT APPLICABLE (DO NOT WANT TO HAVE CHILDREN)

SHCS-E10D	IF "YES" TO SHCS-E10D GO TO SHCS-Q10D1, OTHERWISE GO TO SHCS-Q10E

SHCS-Q10D1	Would you allow a nurse or midwife rather than a doctor to give you postpartum care?

YESNO	YES

NO

SHCS-Q10E	Would you go to a health care clinic or a sports centre to receive advice on health subjects such as eating, exercise, or smoking.

YESNO	YES

NO

SHCS-E10E	IF "YES" TO SHCS-E10E GO TO SHCS-Q10E1, OTHERWISE GO TO SHCS-Q10F

SHCS-Q10E1	Would you allow a nurse, dietician, nutritionist or physical education teacher, rather than a doctor to give you advice on health subjects such as eating, exercise, or smoking?

YESNO	YES

NO

SHCS-Q10F	Are you aware of how much health care costs per year in your province?

YESNO	YES

NO

SHCS-Q10G	Are you aware of how much it costs your provincial health care system for individual services such as doctor visits, xrays, laboratory tests, or hospital stays?

YESNO	YES	GO TO SHCS-Q11B

NO	GO TO SHCS-Q11A

SHCS-E10G	DON'T KNOW OR REFUSAL IN SHCS-Q10G, GO TO SHCS-Q12

SHCS-Q11A	Would an awareness of the cost of these types of services cause you to change how you use them?

YESNO	YES

NO

SHCS-E11A	GO TO SHCS-Q12

SHCS-Q11B	Has an awareness of the cost of these types of services caused you to change how you use them?

YESNO	YES

NO

SHCS-Q12	Overall how would you rate health care in Canada?

(READ LIST. MARK ONE ONLY.)

SHCS-Q12	excellent

good

fair

poor

SHCS-Q13	How would you rate the health care system in your province?

(READ LIST. MARK ONE ONLY.)

SHCS-Q12	excellent

good

fair

poor

SHCS-Q14	How would you rate the quality of health care that you personally have received in the past 12 months?

(READ LIST. MARK ONE ONLY.)

SHCS-Q14	excellent

good

fair

poor

DID NOT RECEIVE HEALTH CARE IN THE LAST 12 MONTHS

SHCS-Q15	What do you think are the main strengths of Canada's health care systems?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SHCS-Q15	NO COST / LOW COST

ACCESS (URBAN/RURAL)

QUALITY OF CARE

UNIVERSALITY (AVAILABLE TO RICH AND POOR)

PORTABILITY (AVAILABLE WHEN VISITING OTHER PROVINCE)

FREE TO CHOOSE DOCTOR AND LOCATION OF TREATMENT

RANGE OF SERVICES AVAILABLE

ANY OTHER STRENGTH, (SPECIFY)

NONE

SHCS-Q16	What do you think are the main weaknesses of Canada's health care systems?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SHCS-Q16	TOO LONG BETWEEN CALL AND APPOINTMENT OR VISIT.

QUALITY OF CARE

LACK OF AVAILABLE SERVICES

COST OF SYSTEM

LACK OF TECHNOLOGY/EQUIPMENT/TESTS

ANY OTHER WEAKNESS (SPECIFY)

TOO EASY TO MISUSE/ABUSE

NONE

SHCS-Q17A	Do you think there is misuse in Canada's health care systems?

YESNO	YES

NO GO TO SHCS-STOP

SHCS-Q17B	In which area(s) do you think there is misuse?

(DO NOT READ LIST, MARK ALL THAT APPLY)

SHCS-Q17B	NUMBER OF DOCTOR VISITS FOR MINOR AILMENTS

NUMBER OF DIAGNOSTIC TESTS

NUMBER OF DRUGS PRESCRIBED

HOSPITALIZATIONS INSTEAD OF OUT-PATIENT OR HOMECARE

LENGTH OF STAY IN HOSPITAL

OTHER AREA OF MISUSE (SPECIFY)

SHCS-Q18	Who do you think should be responsible for reducing or stopping the misuse?

(DO NOT READ LIST, MARK ALL THAT APPLY.)

SHCS-Q18	INDIVIDUAL CANADIANS USING THE SERVICES

DOCTORS

MEDICAL ASSOCIATIONS

HOSPITALS

GOVERNMENTS (LOCAL/MUNICIPAL, PROVINCIAL, FEDERAL)

ANY OTHER (SPECIFY)

SHCS-STOP

H07-SHARE	To avoid duplication Statistics Canada intends to share the information from this survey with provincial ministries of health, Health Canada, Human Resources Development Canada, and Canadian Institute for Health Information. These organizations have undertaken to keep this information confidential and use it only for statistical purposed. Do you agree to share the information you have provided?

YESNO	YES

NO