How often do you get the social and emotional support you need?

In general, how satisfied are you with your life?

Things like dust, mold, smoke, and chemicals inside the home or office can cause poor indoor air quality. In the past 12 months have you had an illness or symptom that you think was caused by something in the air inside a home, office, or other building?

Read if necessary: If you are experiencing an illness or symptom within the past 12 months that was caused by something in the air you encountered over 12 months ago, the answer is "Yes".

Things like smog, automobile exhaust, and chemicals can cause outdoor air pollution. In the past 12 months have you had an illness or symptom that you think was caused by pollution in the air outdoors?

Read if necessary: This question does not refer to natural agents like pollen or dust in outdoor air. If respondent is experiencing an illness or symptom within the past 12 months that was caused by something in the air they encountered over 12 months ago, the answer is "Yes".

Have you ever been told by a doctor that you have a seizure disorder or epilepsy?

And when you took part in this activity, for how many minutes or hours did you usually keep at it?

And when you took part in this activity, for how many minutes or hours did you usually keep at it?

And when you took part in this activity, for how many minutes or hours did you usually keep at it? (ACTIVTY 1)

And when you took part in this activity, for how many minutes or hours did you usually keep at it? (ACTIVTY 2)

During the past month, how many times per week or per month did you do physical activities or exercises to STRENGTHEN your muscles? Do NOT count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands.

During the past month, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?

During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?

During the past 30 days, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise?

How many times per week or per month did you take part in this activity during the past month? (ACTIVTY 1)

How many times per week or per month did you take part in this activity during the past month? (ACTIVTY 2)

How far did you usually walk/run/jog/swim?

How many times per week or per month did you take part in this activity during the past month?

How many times per week or per month did you take part in this activity?

How many times per week or per month did you take part in this activity during the past month?

Was there another physical activity or exercise that you participated in during the last month?

What type of physical activity or exercise did you spend the most time doing during the past month?

What other type of physical activity gave you the next most exercise during the past month?

What type of physical activity or exercise did you spend the most time doing during the past month? [See Coding List A] (ACTIVTY 1)

INTERVIEWER INSTRUCTION: If the respondent's activity is not included in the Coding List A, choose the option listed as "Other ".

INTERVIEWER NOTE: Housework may be included as a physical activity or exercise spent and can be coded as "Other".

What type of physical activity or exercise did you spend the most time doing during the past month? [See Coding List A] (ACTIVTY 2)

INTERVIEWER INSTRUCTION: If the respondent's activity is not included in the Coding List A, choose the option listed as "Other ".

INTERVIEWER NOTE: Housework may be included as a physical activity or exercise spent and can be coded as "Other".

About how many years ago did this person die?

Did this person’s health care provider prescribe any medications to help control pain?

Did the person receive any psychological or spiritual counseling to help them cope with dying?

During the last three months this person was alive, did this person experience any of the following medical problems?
a. confusion, delirium or other altered mental states

During the last three months this person was alive, did this person experience any of the following medical problems?
b. bed sores

During the last three months this person was alive, did this person experience any of the following medical problems?
c. loss of bowel control

During the last three months this person was alive, did this person experience any of the following medical problems?
d. loss of kidney or bladder control

During the last three months this person was alive, did this person experience any of the following medical problems?
e. severe fatigue

During the last three months this person was alive, did this person experience any of the following medical problems?
f. mouth sores

During the last three months this person was alive, did this person experience any of the following medical problems?
g. depression that was treated with medicine

During the last three months this person was alive, did this person experience any of the following medical problems?
h. open wounds other than bed or mouth sores

During the last three months this person was alive, did this person receive care through a hospice?

During the last three months this person was alive, what was the specialty of the physician providing most of the care for this person?

During the past five years, were you involved in the care of a friend or a close family member who died of cancer?

Have you prepared any legal documents such as a living will that would help your family make health care decisions for you if you were unable to make them for yourself?

How would you rate the medical care this person received to ease their suffering?

On average, how much pain did this person have during the last three months they were alive?

Were there any prescribed pain medications that this person was supposed to use, but:
a. did not get because of the cost?

Were there any prescribed pain medications that this person was supposed to use, but:
b. used less often than prescribed in order to stretch them out because of the cost?

Were there any prescribed pain medications that this person was supposed to use, but:
c. did not use as prescribed because of the side effects?

Were there any prescribed pain medications that this person was supposed to use, but:
d. did not use as prescribed because they were afraid of getting addicted or hooked?

Where did the patient live for most of the time during the last three months of life?

Where did this person die?