After you left the hospital following your [Fill in (heart attack) if "yes" to Q3a or Q3a and Q3c; fill in (stroke) if "Yes" to Q3c and "No" to Q3a], did you go to any kind of outpatient rehabilitation? This is sometimes called "rehab."

At what age did you have your first stroke?

At what age did you have your first heart attack?

Do you have a health problem or condition that makes taking aspirin unsafe for you?
If "Yes," ask "Is this a stomach condition?" [Code upset stomach as stomach problems]

Do you take aspirin daily or every other day?

Has a doctor ever told you that you had any of the following?

• Heart attack or myocardial infarction
• Angina or coronary heart disease
• Stroke
• Heart failure

Has a doctor, nurse or other health professional ever told you that you had any of the following?
... A heart attack, also called a myocardial infarction

(Has a doctor, nurse or other health professional ever told you that you had any of the following?)
... Angina or coronary heart disease

(Has a doctor, nurse or other health professional ever told you that you had any of the following?)
.... A stroke

Have you ever had any of the following medical procedures?

• Heart bypass surgery
• Angioplasty (balloon surgery)

To lower your risk of developing heart disease or stroke, are you.
a. Eating fewer high fat or high cholesterol foods?

(To lower your risk of developing heart disease or stroke, are you.)
b. Eating more fruits and vegetables?

(To lower your risk of developing heart disease or stroke, are you.)
c. More physically active?

Why do you take aspirin.
a. To relieve pain?

(Why do you take aspirin.)
b. To reduce the chance of a heart attack?

(Why do you take aspirin.)
c. To reduce the chance of a stroke?

Within the past 12 months, has a doctor, nurse, or other health professional told you to.
a. Eat fewer high fat or high cholesterol foods?

(Within the past 12 months, has a doctor, nurse, or other health professional told you to.)
b. Eat more fruits and vegetables?

(Within the past 12 months, has a doctor, nurse, or other health professional told you to.)
c. Be more physically active?

After you left the hospital following your heart attack did you go to any kind of outpatient rehabilitation? This is sometimes called "rehab."

After you left the hospital following your stroke did you go to any kind of outpatient rehabilitation? This is sometimes called "rehab."

Do you take aspirin daily or every other day?

Do you have a health problem or condition that makes taking aspirin unsafe for you?
If "Yes," ask "Is this a stomach condition?" Code upset stomach as stomach problems.

There are situations where people provide regular care or assistance to a family member or friend who is elderly or has a long-term illness or disability. During the past month, did you provide any such care or assistance to a family member or friend who is 60 years of age or older?

Who would you call to arrange short or long-term care in the home for an elderly relative or friend who was no longer able to care for themselves?

How many of the children ages 0 to 4, living in your household have ever had chickenpox?

The varicella vaccine is a vaccine given to children to prevent chickenpox. How many of the children ages 1 to 4, living in your household have had the varicella vaccine (or chickenpox vaccine)?

Has a doctor, nurse, or other health professional ever that [Fill: he/she] has any of the following health problems?

Read each problem listed below:

• Asthma
• Lung problems, other than asthma
• Heart problems
• Diabetes
• Kidney problems
• Weakened immune system caused by a chronic illness, such as cancer or HIV/AIDS, or medicines, such as steroids
• Must take aspirin every day
• Sickle cell anemia or other anemia

Does [Fill: he/she] still have (this/any of these) problem(s)?

If child is less than 6 months old, go to next module otherwise ask: During the past 12 months, has [Fill: he/she] had a flu shot? A flu shot is a flu vaccine injected in a child's arm or thigh.

During the past 12 months, has [Fill: he/she] had a flu vaccine sprayed in the nose? The flu vaccine that is sprayed in the nose is FluMist™ .

During what month and year did [Fill: he/she] receive the most recent flu vaccination? If "Yes" to both Question 3 and Question 4, also say: "The most recent flu vaccination may have been either the flu shot or the flu spray."

What is the MAIN reason [Fill: he/she] has not received a flu vaccination for this current flu season? [Interviewer note: The current flu season = Sept. '04 - Mar. '05]

If Random Child Selection Question 1 date is 06/2003 to present, go to next module; if Question 5 is 09/2003 to 03/2005 go next module, otherwise continue.: Did [Fill: he/she] get the flu vaccine during the 'last flu season' in other words during the months of September 2003 through March 2005?

Do any of the children under age 5 in your household regularly visit a residence built before 1978?

Do you live in a residence built before 1950?

Does your residence have peeling or chipping paint, or has it undergone any remodeling within the past 6 months?

Has any health care provider ever talked to you about childhood lead poisoning?

Have any of the children in your household ever been tested for lead poisoning?

Were the results of the test normal?

Where was the lead testing done?

What is the birth month and year of the “Xth” child?

Is the child a boy or a girl?

Is the child Hispanic or Latino?

Which one or more of the following would you say is the race of the child?
[Check all that apply]

Which one of these groups would you say best represents the child's race?

How are you related to the child?

During the past 30 days, how often did the [randomly selected child] ride in the back seat?

During the past 30 days, how often did the [randomly selected child] use a child safety seat, booster seat, or seat belt when riding in a car, van, sports utility vehicle, or truck?

During that time, did the [randomly selected child] use: a child safety seat?

(During that time, did the [randomly selected child] use): a booster seat?

(During that time, did the [randomly selected child] use): a seat belt only?

How often does the [fill in age]-year-old child in your household use a... car safety seat [for child under 5] or seatbelt [for child 5 or older] ...when they ride in a car?

How often does the oldest child (of children under age 15) in your household use a... car safety seat [for child under 5] or seatbelt [for child 5 or older] ...when they ride in a car?

Next, I have a few questions related to children’s health issues. In general, do you feel a child between 4 and 8 years of age is safer in a seat belt, child safety seat, booster seat, or without a restraining device while riding in a vehicle?

Previously, you indicated there were [number from core] children under age 18 in your household. What is the age of the [randomly selected -- oldest, second oldest, etc.] child?

What is the gender of this child?

About how long has it been since you last had your blood cholesterol checked?

Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked?

Have you ever been told by a doctor or other health professional that your blood cholesterol is high?

How many months or years ago did those joint symptoms first begin?

Were those symptoms present on most days for at least one month?

Over the past 7 days, how many days have you had pain, aching, or stiffness from arthritis or joint symptoms?

On a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it could be, over the past 7 days, how bad was your joint pain or aching ON AVERAGE.

Tell me which joints are affected?
Note to Interviewer: check all that apply - [Do not read]: list. Notice list of joints below goes from top of body to bottom.

• Neck
• Shoulder
• Elbow
• Wrist
• Hand
• Fingers/thumb
• Back
• Hip
• Knee
• Ankle
• Foot
• Toes
• Other Joint (specify)

Have you taken any prescription or non-prescription medication for these joint symptoms in the past 7 days?

Earlier you said you had never seen a doctor about your joint symptoms.
Please tell me why you did not see a doctor about your joint symptoms?

• not that bad/ not serious/ not important
• costs too much/ no insurance
• don't like doctors/ didn't want to go
• self treatment works
• just occurred/ going to doctor soon
• no transportation/ too far
• other specify _______________

Earlier you said you had seen a doctor for your joint symptoms. What did the doctor say was the cause of your joint symptoms?

• injury/ work-related
• bursitis/ tendonitis/ tennis elbow/ carpal tunnel
• bone spurs
• doctor didn't say/ doctor didn't know
• cartilage
• body weight
• age
• other specify ________

Do you suffer from any type of chronic pain, that is pain that occurs constantly or flares up frequently?

Is this pain caused by cancer of any type?

How long have you been experiencing this type of pain?

About how often do you experience this pain? Would you say...

[Please read]:

• It is constant, always there
• At least once a day
• At least once a week
• Not ever week, but at least once a month
• Less often

Using a 1 to 10 scale where 1 means no pain at all and 10 means the worst pain imaginable, how severe would you say your pain has been on average over the past three months?

Have you ever seen or talked to your doctor about your pain?

How satisfied are you with how your doctor is helping you manage your pain?

Have you ever been told by a doctor or health professional that you have chronic obstructive pulmonary disease (COPD), emphysema or chronic bronchitis?

A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit?

A digital rectal exam is when a doctor or other health professional inserts a finger in the rectum to check for cancer or other health problems. Have you ever had this exam?

A sigmoidoscopy or colonoscopy is when a tube is inserted in the rectum to view the bowel for signs of cancer and other health problems. Have you ever had this exam?

A sigmoidoscopy or proctoscopy is when a tube is inserted in the rectum to view the bowel for signs of cancer and other health problems. Have you ever had this exam?

A proctoscopic exam is when a tube is inserted in the rectum to check for cancer and other health problems. Have you ever had this exam?

How long has it been since you had your last blood stool test using a home kit?

How long has it been since you had your last sigmoidoscopy or colonoscopy?

I also previously asked you whether or not you have had tests for colorectal cancer. Has a doctor or other health professional ever talked to you about getting tested for colorectal cancer, or cancer of the bowel?

Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the bowel for signs of cancer or other health problems. Have you ever had either of these exams?

When did you have your last blood stool test using a home kit?

When did you have your last digital rectal exam?

When did you have your last sigmoidoscopy or colonoscopy?

When did you have your last sigmoidoscopy or proctoscopy?

When did you have your last proctoscopis exam?

During the past 5 years, have you been active in a coalition or civic group which attempted to address one or more community problems?

How long have you lived in the community in which you now live?

How would you rate your community as a place to live?

(How would you rate your community on its)... Availability of effective leadership for solving community problems?

(How would you rate your community on its)... Availability of people in the community with skills to solve community problems?

(How would you rate your community on its)... Community decision making shared among community members and among community organizations?

(How would you rate your community on its)... Community investment of financial resources in community problem-solving?

(How would you rate your community on its)... Cooperation and communication between community organizations, including government, civic organizations, and social agencies?

(How would you rate your community on its)... Past history of community success at problem solving?

(How would you rate your community on its)... People sharing a sense of belonging to the community?

(How would you rate your community on its)... Self-honesty and ability to learn from mistakes?

(How would you rate your community on its)... Shared values and vision among community citizens?

How would you rate your community on it's... Willingness of citizens to become involved in community issues?