Questionnaire for Women

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1、SAX45andUpStudyFemaleScanning.qxd:Layout120/6/082:26PMPage345andUpStudyQuestionnaireforWomenThe45andUpStudyreliesonthewillingnessofpeopleinNewSouthWalestoshareinformationabouttheirlivesandexperiences,toprovideknowledgethatwillhelppeoplelivehealthyandfulfillinglivesforaslongaspossible.P

2、articipationiscompletelyvoluntary,andyouarefreetowithdrawfromtheStudyatanytime.Totakepart,pleasereadtheparticipantinformationleaflet,thencompletethequestionnaireandconsentformandreturnthemintheenvelopeprovided.Weverymuchhopeyouwillbeabletotakepart.Anyquestionsorcomments?PleasecalltheSt

3、udyhelpline:1300451145orgotowww.45andUp.org.auAuspicedbyIncollaborationwithYouranswersandexperiencesareimportanttous.Pleaseputacrossintheappropriatebox(es)YesNoTohelpusreadyouranswers,pleasewriteasclearlyORputnumbersintheappropriatebox,e.g.21stJune1945aspossibleusingaBLACKorBLUEpen,and

4、besure21061945age62tocompletethequestionnaireasshown:Generalquestionsaboutyoudaymonthyear8.Whatyeardidyoufirstcometolivein1.WhatisyourAustraliaforoneyearormore?(e.g.1970)19dateofbirth?daymonthyear9.Whatisyourancestry?(pleasecrossupto2boxes)2.WhatisAustralianEnglishIrishChinese20today’s

5、date?ItalianGreekScottishGermanLebaneseDutchMaltesePolish3.HowtallareyoucmORfeetinchesFilipinoIndianCroatianVietnamesewithoutshoes?other(pleasespecify)__________________________________________________________(pleasegivetothenearestcmorinch)10.DoyouspeakalanguageotherthanEnglishathome?

6、4.Abouthowmuchdoyouweigh?kgORstonelbsYesNo5.Whatisthehighestqualificationyouhavecompleted?11.Haveyoueverbeenaregularsmoker?(pleaseputacrossinthemostappropriatebox)Yes▼NoIfNo–pleasegotoquestion12noschoolcertificateorotherqualificationsHowoldwereyouwhenyoustartedyearsoldschoolorintermedi

7、atecertificate(orequivalent)SAMPLEONLYsmokingregularly?higherschoolorleavingcertificate(orequivalent)Areyouaregularsmokernow?YesNotrade/apprenticeship(e.g.hairdresser,chef)IfNo–howoldwereyouwhenyouyearsoldcertificate/diploma(e.g.childcare,technician)stoppedsmokingregularly?university