Health and Behaviour Survey

Health and Behaviour Survey

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This survey is designed to find out about behaviours and attitudes related to health. It consists of a number of sections in which you will be asked about various aspects of your lifestyle. Please be as honest as possible; there are no right or wrong answers. All the replies we receive will be anonymous and confidential, and will be used for research purposes only.

SECTION A

This section of the survey concerns various aspects of your lifestyle. Please read each question carefully, and put a tick or cross in the box next to the answer that is right for you.

Age: __________________	Male / Female
How tall are you ?	__________________
How much do you weigh ?	__________________
What is your main field of study ?	__________________
Are you married?	[ ] YES [ ] NO
Do you have any children ?	[ ] YES [ ] NO
During college term time, do you live	[ ] At home with your parents or family? [ ] In college accommodation, or a rented room or apartment? [ ] Other (please specify)
In general, would you say that your health is	[ ] Excellent [ ] Very good [ ] Good [ ] Fair [ ] Poor
All things considered, how satisfied are you with your life as a whole?	[ ] Very satisfied [ ] Moderately satisfied [ ] No feelings either way [ ] Moderately dissatisfied [ ] Very dissatisfied

Smoking

1. Please read all the following statements carefully and tick the box next to the one that best describes you.

a)	I have never smoked a cigarette, not even a puff	[ ]
b)	I have only ever tried one or two cigarettes	[ ]
c)	I used to smoke sometimes, but I don't now	[ ]
d)	I don't smoke cigarettes, but smoke a pipe or cigars	[ ]
e)	I smoke cigarettes, but not as many as one per day	[ ]
f)	I usually smoke between 1 and 10 cigarettes per day	[ ]
g)	I usually smoke between 10 and 20 cigarettes per day	[ ]
h)	I usually smoke more than 20 cigarettes per day	[ ]
	Would you like to reduce the amount you smoke?	[ ] YES [ ] NO

Eating

2.	How often do you eat breakfast?	[ ] Almost every day [ ] Sometimes [ ] Rarely or never
3.	How many meals do you eat each day? How many between-meal snacks do you eat each day?	_______________ _______________
4.	How often do you eat a meal that includes meat (beef, pork, lamb, veal, bacon, hamburgers, sausages etc) ?	[ ] At least once a day [ ] Every 2 or 3 days [ ] About once a week [ ] Less than once a week [ ] Never
5.	How often do you eat fruit ?	[ ] At least once a day [ ] Every 2 or 3 days [ ] About once a week [ ] Less than once a week [ ] Never
6.	Do you add salt to your meals?	[ ] Usually [ ] Sometimes [ ] Very occasionally [ ] Never
7.	Do you make a conscious effort to avoid eating foods that contain fat and cholesterol? If 'YES' what foods do you try to avoid ? _________________________________________________	[ ] YES [ ] NO
8.	Do you make a conscious effort to eat foods that are high in fibre? If 'YES' what foods do you try to eat ? _________________________________________________	[ ] YES [ ] NO
9.	Are you trying to lose weight ?	[ ] YES [ ] NO
10.	Are you dieting to lose weight ?	[ ] YES [ ] NO
11.	Do you consider yourself to be	[ ] Very overweight [ ] Slightly overweight [ ] About right [ ] Slightly underweight [ ] Very underweight

Sleep

12.

On average, how many hours of sleep do you get in a 24 hour period ?

__________________

Alcohol

13. The next questions are about drinking alcohol, including beer, wine, spirits and any other alcoholic drink

Would you describe yourself as	[ ] A non-drinker [ ] A very occasional drinker (special occasions only) [ ] An occasional drinker [ ] A regular drinker
If you are an "occasional" or "regular" drinker:
On how many days over the past two weeks (14 days) did you have a drink ?	__________________
On the days that you did drink, how many drinks did you have, on average ?	__________________
Would you like to reduce the amount that you drink ?	[ ] YES [ ] NO

Physical activity

14. Over the past 2 weeks (14 days), have you taken any exercise, (eg sport, physically active pastime)?	[ ] YES [ ] NO
If 'YES', what activity did you do? ___________________________________________________
How many times over the past 2 weeks did you take exercise ?	__________________
Would you like to increase the amount that you exercise ?	[ ] YES [ ] NO

Other behaviours

15.	When driving or riding in the front seat of a car do you wear a seat belt?	[ ] All of the time [ ] Some of the time [ ] Never [ ] I don't ride in cars
16.	If you do drive a car, do you travel within the speed limit?	[ ] All of the time [ ] Most of the time [ ] Some of the time [ ] Little of the time
17.	Over the last year, how many times did you drive when you felt that you had perhaps had too much to drink ?	[ ] Never ………. times
18.	Do you brush your teeth?	[ ] Twice or more a day [ ] About once a day [ ] Less than once a day [ ] Seldom or never
19.	Do you suffer from any health problems that have led you to visit a doctor or health clinic in the past four weeks? If 'YES', please give details:____________________________________________ ____________________________________________	[ ] YES [ ] NO
20.	Have you taken any treatment (pills or medicines) over the past four weeks? (Eg. Painkillers for headache, vitamins, antibiotics)	[ ] YES, prescribed by a doctor [ ] YES, bought in a shop [ ] NO

21. WOMEN only to answer question 21

Do you know how to examine your own breasts for lumps ?	[ ] YES [ ] NO
If 'YES', about how many times a year do you examine your breasts for lumps?	[ ] Never [ ] 1-2 times per year [ ] 3-10 times per year [ ] More than 10 times
How long has it been since you had a cervical (Pap) smear test?	[ ] I have never had a smear test [ ] Less than one year [ ] 1 - 3 years [ ] More than 3 years

22. MEN only to answer question 22

Do you know how to examine your own testicles for lumps?	[ ] YES [ ] NO
If 'YES', about how many times a year do you examine your testicles for lumps?	[ ] Never [ ] 1-2 times per year [ ] 3-10 times per year [ ] More than 10 times

SECTION B

In this section, we are interested in how important you feel the following health measures are. Please circle the appropriate number.

Of very low
importance

Of very great
importance

1.	To take regular exercise	1	2	3	4	5	6	7	8	9	10
2.	Not to eat too much animal fat	1	2	3	4	5	6	7	8	9	10
3.	To eat enough fibre	1	2	3	4	5	6	7	8	9	10
4.	To keep your body weight within the normal range	1	2	3	4	5	6	7	8	9	10
5.	To eat enough fruit	1	2	3	4	5	6	7	8	9	10
6.	Not to smoke	1	2	3	4	5	6	7	8	9	10
7.	Not to add too much salt	1	2	3	4	5	6	7	8	9	10
8.	To eat breakfast almost every day	1	2	3	4	5	6	7	8	9	10
9.	To get seven or eight hours sleep on most nights	1	2	3	4	5	6	7	8	9	10
10.	To brush your teeth regularly	1	2	3	4	5	6	7	8	9	10
11.	To wear a seatbelt when travelling in a car	1	2	3	4	5	6	7	8	9	10
12.	Never to drive after drinking alcohol	1	2	3	4	5	6	7	8	9	10
13.	To drive within the speed limit most of the time	1	2	3	4	5	6	7	8	9	10
14.	Not to drink too much alcohol	1	2	3	4	5	6	7	8	9	10
15.	To use sunscreen when you sunbathe	1	2	3	4	5	6	7	8	9	10
16.	To lose weight	1	2	3	4	5	6	7	8	9	10
17.	To make deliberate efforts to control or Avoid stress	1	2	3	4	5	6	7	8	9	10
19.	For women to examine their breasts at least once a month for possible signs of cancer	1	2	3	4	5	6	7	8	9	10
20.	For women to have a regular cervical smear test	1	2	3	4	5	6	7	8	9	10
21.	For men to examine their testicles at least once a month for possible signs of cancer	1	2	3	4	5	6	7	8	9	10

These questions concern your feelings about your life in general

Strongly Disagree

Strongly Agree

These questions are about your background

What is your religion?

[ ] Buddhist
[ ] Christian (Catholic)
[ ] Christian (Protestant)
[ ] Hindu
[ ] Jewish
[ ] Moslem
[ ] Sikh
[ ] Other …………………
[ ] No religion

2. Would you describe your family background as:

[]	Wealthy	(within the highest 25% in your country in terms of wealth)
[]	Quite well-off	(within the 50 - 75 % range for your country)
[]	Not very well off	(within the 25 - 50 % range for your country)
[]	Quite poor	(within the lowest 25% in your country in terms of wealth)

Does your family have

[ ] No car
[ ] One car
[ ] More than one car

4. Please give us an idea about the education of your mother and father:

Mother:

[ ]
[ ]
[ ]
[ ]
[ ]

No education
Primary school
High school
College/University
I do not know

Father:

[ ]
[ ]
[ ]
[ ]
[ ]

No education
Primary school
High school
College/University
I do not know

SECTION C

This section concerns what you know about various health problems. Across the page you will see a series of illnesses or health problems. Down the page are listed some factors that might influence them. For each health problem, put a cross in the box if you believe that it is influenced by the factor shown. For example, if you believe that heart disease is influenced by smoking, you should put a cross into the first box on the first line.

	Heart Disease	Lung cancer	Mental illness	Breast cancer	High blood pressure
Smoking	[ ]	[ ]	[ ]	[ ]	[ ]
Alcohol	[ ]	[ ]	[ ]	[ ]	[ ]
Exercise	[ ]	[ ]	[ ]	[ ]	[ ]
Stress	[ ]	[ ]	[ ]	[ ]	[ ]
Heredity	[ ]	[ ]	[ ]	[ ]	[ ]
Eating fat	[ ]	[ ]	[ ]	[ ]	[ ]
Being overweight	[ ]	[ ]	[ ]	[ ]	[ ]
Eating fibre	[ ]	[ ]	[ ]	[ ]	[ ]

	Follow @UCL_BSH on Twitter
	Read our "Health Chatter" blog
	Learn more about our charity Weight Concern
	GDPR Transparency Notice

There is little I can do to change many of the important things in my life

I often feel helpless in dealing with the problems in my life

Whether or not I am able to get what I want is in my own hands

What happens to me in the future mostly depends on me

I have little control over the things that happen to me

I can do just about anything I really set my mind to