[Q_AGESCREENER]
How old are you?
NUM
VRF:range(0,99)
Values: 0-99
[Q_PROVINCE]
Which province/territory do you currently live in?
RAD
Values: 1-14
- 1 - Ontario
- 2 - Quebec
- 3 - British Columbia
- 4 - Alberta
- 5 - Manitoba
- 6 - Saskatchewan
- 7 - Nova Scotia
- 8 - New Brunswick
- 9 - Newfoundland and Labrador
- 10 - Prince Edward Island
- 11 - Northwest Territories
- 12 - Yukon
- 13 - Nunavut
- 14 - I do not live in Canada
[Q_COMMUNITY]
Please indicate which best describes where you live.
RAD
Values: 1-5
- 1 - Urban/city centre
- 2 - Large population centre
- 3 - Medium population centre
- 4 - Small population centre
- 5 - Rural area
Q_CONDITION
Which of the following health conditions, if any, do you currently suffer from?
CHE
SHF(r)
ATL:1
Values: 0-1
- 0 - Unchecked
- 1 - Checked
- [Q_CONDITIONr1] - Difficulty falling asleep
- [Q_CONDITIONr2] - Fatigue/ lack of energy
- [Q_CONDITIONr3] - High blood pressure/ Hypertension
- [Q_CONDITIONr4] - Insomnia/ Difficulty staying asleep
- [Q_CONDITIONr5] - Joint problems/ stiffness
- [Q_CONDITIONr6] - Stress/ anxiety
- [Q_CONDITIONr7] - Oral/ Dental/ Tooth problems
- [Q_CONDITIONr8] - Weight concerns
- [Q_CONDITIONr9] - Glaucoma, cataracts, or other vision-related ailments
- [Q_CONDITIONr10] - Digestive complications
- [Q_CONDITIONr11] - Heart condition
- [Q_CONDITIONr12] - Respiratory condition
- [Q_CONDITIONr13] - High cholesterol
- [Q_CONDITIONr14] - Chronic pain
- [Q_CONDITIONr15] - Diabetes
- [Q_CONDITIONr16] - Some other condition(s)
- [Q_CONDITIONr98] - None of the above
[Q_GENDER]
Are you...?
RAD
Values: 1-100
- 1 - Male
- 2 - Female
- 100 - Other
[Q_PARENTS]
Do you have children under the age of 18 living at home?
RAD
Values: 1-2
Q_PREVENTION
Which of the following health conditions, if any, are you concerned about preventing in the future?
CHE
SHF(r)
ATL:1
Values: 0-1
- 0 - Unchecked
- 1 - Checked
- [Q_PREVENTIONr1] - Diabetes
- [Q_PREVENTIONr2] - High blood pressure/ Hypertension
- [Q_PREVENTIONr3] - Joint problems/ stiffness
- [Q_PREVENTIONr4] - General illness - cold, flu, etc.
- [Q_PREVENTIONr5] - Difficulty falling asleep
- [Q_PREVENTIONr6] - Fatigue/ lack of energy
- [Q_PREVENTIONr7] - Insomnia/ Difficulty staying asleep
- [Q_PREVENTIONr8] - Stress/ anxiety
- [Q_PREVENTIONr9] - Oral/ Dental/ Tooth problems
- [Q_PREVENTIONr10] - Weight concerns
- [Q_PREVENTIONr11] - Glaucoma, cataracts, or other vision-related ailments
- [Q_PREVENTIONr12] - Digestive complications
- [Q_PREVENTIONr13] - Heart condition
- [Q_PREVENTIONr14] - Respiratory condition
- [Q_PREVENTIONr15] - High cholesterol
- [Q_PREVENTIONr16] - Chronic pain
- [Q_PREVENTIONr17] - Some other condition(s)
- [Q_PREVENTIONr98] - None of the above
Q_STATEMENTS
For each statement, please indicate your agreement on a scale of 1-7, where 1 means 'disagree completely' and 7 means 'agree completely'.
RAD
SHF(r)
Values: 1-7
- 1 - Disagree completely1
- 2 - 2
- 3 - 3
- 4 - 4
- 5 - 5
- 6 - 6
- 7 - Agree completely7
- [Q_STATEMENTSr1] - Exercise is an essential part of my day
- [Q_STATEMENTSr2] - Friends and family often come to me for advice about how to eat well and/or be healthier
- [Q_STATEMENTSr3] - Health and wellness are important to me, but it can be overwhelming to try to do everything I should do
- [Q_STATEMENTSr4] - I am happy with my current life stage
- [Q_STATEMENTSr5] - I am trying to "fight" aging by staying healthy
- [Q_STATEMENTSr6] - I consider myself to be living a healthy lifestyle
- [Q_STATEMENTSr7] - I don't stress over my nutrition or fitness level
- [Q_STATEMENTSr8] - I eat what I want and don't pay attention to health benefits
- [Q_STATEMENTSr9] - I feel depressed about my current health status
- [Q_STATEMENTSr10] - I focus on getting the most out of every day
- [Q_STATEMENTSr11] - Life is complicated. I need simple solutions for my nutritional and health needs
- [Q_STATEMENTSr12] - My stress level has a negative impact on my daily life
- [Q_STATEMENTSr13] - Social media impacts what I eat and drink