ࡱ>  <?/0123456789:; bjbj -xx:T`LL$$(((tg)g)g)/* ;-$g)f_<_<F<<<WF^WzW$g T"(WFNWWW"$$<<% [[[W$*<(<[W[[2': < !T5yg)Y..э0]HYT]\ ]( WW[WWWWW""ZWWWWWWW]WWWWWWWWWL U#:  91Ƭ, Johannesburg Developmental Pathways for Health Research Unit Department of Paediatrics and Child Health BIRTH TO TWENTY PLUS - YOUNG ADULT SURVEY CORE QUESTIONNAIRE - 2012      Consent Table (Initial the appropriate column) ComponentsYesNoCore QuestionnaireMedical & Pregnancy History QuestionnaireFood Frequency QuestionnaireSelf-Complete QuestionnaireResidential Moves QuestionnaireSchooling History QuestionnaireAnthropometric MeasurementsDXAUltra SoundRoutine Blood SamplesDNA CollectionHIV Rapid Test  HISTORICAL BIOLOGICAL SAMPLE & DNA CONSENT The information around the blood and DNA samples taken from me in the past is clear and that the purpose is for me to inform the study what they can or cannot do with these samples. I acknowledge that all procedure/tests on the stored blood and DNA samples have been approved by the Human Research Ethics Committee of the 91Ƭ. YES NO I am in agreement that my DNA may be stored and used for the purposes described above. YES NO I am in agreement that the data generated from my DNA may be made available as stated above. YES NO I agree that a small bit of my DNA may be sent out of the country if the research cannot easily be done in South Africa. YES NO I understand that every time a new study is done on my DNA, permission will be obtained from the ethics committee for the study to make sure that it is used only for the purposes stated above. YES NO I understand that I will not benefit directly from the research done on my DNA. YES NO I understand that I may withdraw from the study at any time. YES NO PARTICIPANT/S: Printed Name Signature/Mark or Thumbprint Date and Time RESEARCH ASSISTANT: _________________________________________________________________________ Printed name Signature/Mark or Thumbprint Date and Time WITNESS: Printed Name Signature/Mark or Thumbprint Date and Time PARTICIPATION IN BIRTH TO TWENTY PLUS CONSENT I agree to myself being a participant in Birth to Twenty Plus study The goals and methods of the study are clear to me. I understand that the study will involve interviews. All the details and purposes of this study have been explained to me. I understand that I have the right to refuse to participate in the study. I agree to participation in Birth to Twenty Plus study on condition that: 1. I can withdraw from the study at any time voluntarily and that no adverse consequences will follow on withdrawal from the study. 2. I have the right not to answer any or all questions posed in the interviews and not to participate in any or all of the procedures / assessments. 3. The 91Ƭ Human Ethics committee has approved the study protocol and procedures. 4. All results will be treated with the strictest confidentiality. 5. Only group results, and not my individual results, will be published in scientific journals and in the media. 6. The study scientific team are committed to treating participants with respect and privacy through interviews conducted in private and follow-up counselling available on request. 7. I will receive a referral note to a health service if any result is out of the normal range or a problem is detected in the course of the study. PARTICIPANT: Printed Name Signature / Mark or Thumbprint Date and Time RESEARCH ASSISTANT: Printed Name Signature Date and Time SURVEY CONSENT I agree to myself being a participant in the study The goals and methods of the study are clear to me. I understand that the study will involve interviews. All the details and purposes of this study have been explained to me. I understand that I have the right to refuse to participate in the study. I agree to participation in the study on the condition that: 1. I can withdraw from the study at any time voluntarily and that no adverse consequences will follow on withdrawal from the study. 2. I have the right not to answer any or all questions posed in the interviews and not to participate in any or all of the procedures / assessments. 3. The 91Ƭ Human Ethics committee has approved the study protocol and procedures. 4. All results will be treated with the strictest confidentiality. 5. Only group results, and not my individual results, will be published in scientific journals and in the media. 6. The study scientific team are committed to treating participants with respect and privacy through interviews conducted in private and follow-up counselling available on request. 7. I will receive a referral note to a health service if any result is out of the normal range or a problem is detected in the course of the study. PARTICIPANT Printed Name Signature / Mark or Thumbprint Date and Time RESEARCH ASSISTANT: Printed Name Signature Date and Time SECTION 1: Education, Employment and Job Search Education The first few questions ask about your experiences with schooling and education. Have you successfully completed grade 12 (passed matric, obtained matric certificate? Yes (Skip to Q4)No If no, what is your highest grade successfully completed? (tick one) Grade 5 or lowerGrade 6Grade 7Grade 8Grade 9Grade 10Grade 11 Are you currently enrolled full time at high school? Yes (Skip to Q6)No Are you currently doing any studies, or registered with any educational institution (including training through employment or correspondence)? Yes, full time (Skip to Q6)Yes, part time (Skip to Q6)No If no, please tell us the main reason that you are not currently registered? (Do NOT read out options; tick one only) ReasonTick oneCodeFinancial constraints1Family responsibilities (i.e. Pregnant or Looking after children/family/relatives)2Completed educational goals3Employed4Taking a planned break from my studies5Results not good enough6Other (specify) 7During the past six months, have you been doing any studies, or attempted to enrol for any studies? Yes (Answer the questions below)No (Skip to Q7) Has the following happened to you in the past 6 months? (answer all questions) YesNoYou failed a courseYou had conflict with school/university/college officialsYou dropped out of your training programmeYou had financial problems paying for school, college, university, or your training programme If you are still in formal full time schooling, skip to the next section (Employment) Since leaving formal full time schooling, have you ever done any studies or been registered with any educational institution (including any training through employment and correspondence)? YesNo (skip to employment section) Please complete the table below for any studies other than full time high school. Please include the 5 most recent courses. Start with the current/most recent course, and then move to older courses. ABCDEFGHIJKInstitution NameInstitution Type (USE KEY)Location of Campus (Suburb, province)Course NameQualification (USE KEY)Is the course full time or part time? (As defined by the institution)When did you start the course? (Month & Year)What is the duration of the course? (USE KEY)Are you still enrolled in this course? (USE KEY)How is the course funded? (USE KEY & GIVE ALL THAT APPLY)What was the main reason for your choice of study? (USE KEY)1FTPT2FTPT3FTPT4FTPT5FTPT Notes12345 Occupation/ Employment/ Income Have you ever had a job? By job we mean any work done to earn money or to gain skills. This includes casual/informal work & volunteer work. Yes No (Skip to Q3) Do you currently have a job? By job we mean any work done to earn money or to gain skills. This includes casual/informal work & volunteer work. Yes (Skip to Q5)No Are you currently looking for a job? Yes (Skip to Q5)No If no, what is the main reason? (tick one) ReasonTick oneCodeI am at school / studying1I am too busy or dont have time 2Family responsibilities (i.e. Pregnant or Looking after children/family/relatives)3I dont need money4I am not skilled or experienced enough/ my level of education is not high enough5Its too expensive to look6I am sick / disabled7Other (specify) 8 YesNo5. Have you been unemployed and seeking work for a month or more during the past 6 months? 6. Have you had any job during the past 6 months? Yes (Answer questions below)No (Skip to Q7) Has the following happened to you in the past 6 months? (Answer all questions) YesNoa. You have had trouble or disagreements with your boss, supervisor or fellow workersb. You felt your work environment was abusivec. You were fired If you have ever had a job, complete the Table in relation to your five most recent jobs, including any current work. By job we mean any work done to earn money or gain skills, including casual, informal and volunteer work, as well as internships and learnerships. Start with any current work, and move backwards. ABCDEFGHIJob (describe in one or two words)How did you get the job? (USE CODE BELOW)When did you start this job? (Month & Year)Are you still doing this job?If no, when did you last do this job? (Month & Year)Who is/was your employer? (USE CODE BELOW)Are/were you being paid for the work? Is the job full time, part time, or occasional?Is the job permanent, on contract or casual?1YNYNFTPTOCPermContCas2YNYNFTPTOCPermContCas3YNYNFTPT OCPermContCas4YNYNFTPTOCPermContCas5YNYNFTPTOCPermContCas Notes12345 Preparedness for independence Do you currently have the following? (answer all questions) ItemYesNoa. Birth certificateb.ID bookc.Learners licensed.Drivers licensee.Bank or savings accountf.Credit card accountg.Proof of address in your own name (utility bill, telephone account, bank account, affidavit)h.Passporti.CVj.Your own number where you can always be contacted on (cell phone)?k.Your own email address that you are able to check regularlyl.Someone to act as a reference (not a family member)m.A reference letter or testimonial from school or an employern.Formal insurance policies in your name (eg: life/car/home/disability/funeral)o.Contributions you are making to a formal savings schemep.Medical aid that covers youq.Informal insurance or savings eg: stokvel, community savings scheme, funeral schemer.Grants that come to you (eg. child support, disability) Have you ever used the following? (answer all questions) Computer and cell phone experienceComputerCell phonea.The internetYNYNb.EmailYNYNc.Facebook/ TwitterYNYNd.Microsoft WindowsYNYNe.Microsoft WordYNYNf.Microsoft ExcelYNYNg.Mxit/ WhatsApp/BBMYNh.Instant messenger (Yahoo chat, MSN chat, Google chat)YNYN Financial support We are interested in asking about the individual for this section not the household. What has been your main source of financial support (over the past 12 months)? (dont read out list; tick one) Financial supportTick oneCodeSelf generated (from employment or scholarship/bursary)1Family member or friend (parent, grandparent, sibling, boyfriend/girlfriend/ partner)2Grant in your own right (child support, disability)3Own loans4Other (specify) 5 Do you have any debts? (answer all questions) DebtsYesNoa.Money owed to banks or financial institutions (legal and documented loans)b.Money owed to money lenders (loan sharks, community money-lenders)c.Money owed to family or friendsd.Money owed to shops/ private companies/ municipality/hospitals/unpaid bills/accounts/ store accounts (eg Jet or Edgars) Who has usually paid for the following expenses for you over the past 12 months: (answer all questions) ExpenseWho pays? USE CODES BELOWa.Food b.Transport c.Housing & utilitiesd.Educatione.Clothingf.Medical expensesg.Cell phone air time or contract Code1I pay for this with my own funds2Family members pay for this3Partner pays for this4Someone else pays for this: specifyNANot applicable YesNoCellphones: Do you currently have a cellphone? YesNoIf yes, was this phone provided to you by Birth to Twenty? If not, what phone do you have now? Make: _________________ Model: _____________________ On contractPay as you goIs your phone If your phone is on contract, what is the cost per month? ______ If your phone is pay as you go, what amount was the last airtime voucher you bought? _______ Households The following set of questions refers to your current living arrangements, at the place where you spent most nights in the past 3 months. Note: if participant lives in a university/employment residence, the following questions refer only to their room or apartment in the residence. Do you live alone? By alone, we mean that you either stay on your own in your home, or that you stay in a hostel/residence or do not share your room/apartment with anybody. Yes (skip to Q4)No If no, how many people (including yourself) live in your current home (have stayed most nights in your home over the past 3 months)?  Can you list the other people who have stayed most nights in your home over the past 3 months (Do not include yourself) Relationship to yourself (USE CODES BELOW)AgeSex (M/F)a.b.c.d.e.f.g.h.i.j.k.l.m.n.o. Relationship Codes: 1=parent 2=grandparent 3=your own child 4=sibling 5=other relative (including other children, in laws, etc) 6=spouse/partner 7=friend 8=housemate/flatmate/roommate 9=other: specify What is your current marital status? (tick one) Marital StatusTick oneCodeSingle1Not married and not living together but in a committed relationship/partnership2Not married but living together3Married (including traditional or customary)4Divorced or separated5Widow/widower6 How would you describe the home you are living in? (tick one) Home typeTick oneCodeShack/Zozo1Flat/Cottage2House3Room/Garage4Residence (attached to education or employment)5Hostel6Other 7 How many rooms for sleeping are there in your current home? Include outside rooms if they are used by household members, but not if rented out. Include any rooms that are used for sleeping, even kitchens, lounges etc.  How would you describe your access to the following facilities? (Please tick only the box for the best available access for each facility) Water FacilityTick OneCodeIndoor water (sole use for your household only)1Indoor water (shared between multiple households)2Outdoor water (sole use for your household only) 3Outdoor water (shared between multiple households)4 Toilet FacilityTick OneCodeIndoor toilet (sole use for your household only)1Indoor toilet (shared between multiple households)2Outdoor toilet (sole use for your household only) 3Outdoor toilet (shared between multiple households)4 Which of the following do you have in your current home (place where you spent most nights in the past three months)? It does not matter who owns/pays for these things. (answer all questions) ItemIn current homeYesNoa.Electricityb.Motor vehiclec.Fridged.Microwavee.Washing machinef.Landline telephoneg.Cell phoneh.Televisioni.Radioj.Video machine/DVD playerk.MNet/DSTV/Satellitel.Computer/laptop m.Internet access  How safe do you feel walking around in your neighbourhood (the area about 20 minutes walk from your home) during the day and at night? ResponseDuring the day (tick one)During the night (tick one)CodeVery unsafe1Unsafe2Safe3Very safe4 In your opinion, how much crime is there in your neighborhood (the area about 20 minutes walk from your home)? ResponseTick oneCodeA lot1Some2Not much3None4 Do you belong to any of the following: (answer all questions) ItemYesNo a.A political partyb.A church or religious groupc.A uniond.A charitable or community organizationf.Other (specify)  SECTION 2: GLOBAL PHYSICAL ACTIVITY QUESTIONNAIRE (Modified STEPs Core data set) Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. This includes vigorous intensity activities that cause large increases in breathing or heart rate such that you would not be able to hold a conversation with someone, as well as moderate-intensity activities which are activities that require moderate physical effort and cause small increases in breathing or heart rate, and during which you are able to talk to someone. Please answer these questions even if you do not consider yourself to be a physically active person. Activity at workThink first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, study/training, household chores, childcare, or seeking employment. 1Does your work involve vigorous-intensity activity that causes large increases in breathing or heart rate like carrying or lifting heavy loads, digging or construction work for at least 10 minutes continuously? (USE SHOWCARDS)YES 1 NO 2 %%42In a typical week, how many days do you do vigorous-intensity activities as part of your work? DAYS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3How much time do you spend doing vigorous-intensity activities at work on a typical day?HOURS________ MINUTES___________ 4Does your work involve moderate-intensity activities that cause small increases in breathing or heart rate such as brisk walking or carrying light loads for at least 10 minutes continuously? (USE SHOWCARDS)YES 1 NO.2 %%75In a TYPICAL week, how many days do you do moderate-intensity activities as part of your work? DAYS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 6How much time do you spend doing moderate-intensity activities at work on a typical day?HOURS________MINUTES________ Travel to and from placesThe next questions exclude the physical activities at work that you have already mentioned. Now I would like to ask you about the usual way you travel to and from places. For example to work, for shopping, to market, or to church.7Do you walk or use a bicycle for at least 10 minutes continuously to get to and from places?YES 1 NO 2 %%108In a typical week, how many days do you walk or bicycle for at least 10 minutes to get to and from places? DAYS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _9How much time do you spend walking or bicycling for travel on a typical day?HOURS________MINUTES________Recreational activitiesThe next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness and recreational activities (leisure).10Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate like running or soccer, for at least 10 minutes continuously? (USE SHOWCARD)YES 1 NO 2 %%1311In a typical week, on how many days do you do vigorous-intensity sports, fitness or recreational (leisure) activities? DAYS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _12How much time do you spend doing vigorous-intensity sports, fitness or recreational activities on a typical day?HOURS________MINUTES________13Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that causes a small increase in breathing or heart rate such as brisk walking, cycling, swimming, volleyball, or dancing, for at least 10 minutes continuously? (USE SHOWCARDS) YES 1 NO.2 skip 14 & 1514In a typical week, on how many days do you do moderate-intensity sports, fitness, or recreational (leisure) activities? DAYS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _15How much time do you spend doing moderate-intensity sports, fitness or recreational (leisure) activities on a typical day?HOURS________MINUTES________Sedentary behaviourThe following question is about sitting or reclining at work, at home, getting to and from places, or with friends, including time spent sitting at a desk, sitting with friends, travelling in a car, bus, train or taxi, reading, playing cards or watching television, but do not include time spent sleeping. (USE SHOWCARDS)16How much time do you usually spend sitting or reclining on a typical day?HOURS________MINUTES________ SECTION 3: Life Events A. General Events Please tick all appropriate events that have happened to you within the past 6 months During the last 6 months, has any household member (including you) been injured as a result of violence in the areas where you live or work? Yes=1No=0During the last 6 months, has any household member (including you) been a victim of a violent crime (e.g. murder, robbery, mugging, assault, rape)? Yes=1No=0 Yes=1No=0 During the last 6 months, did you witness a violent crime (e.g. murder, robbery, mugging, assault, rape)? Yes=1No=0During the last 6 months, have you or anyone in your close family been seriously ill? During the last 6 months, did any member of your close family pass away? Yes=1No=0 Yes=1No=0 Is there anyone in your close family (including you) with a serious disability (for example, epilepsy, mental retardation, deafness, blindness, mental illness)? Yes=1No=0Is there anyone in your close family (including you) that has a problem with drugs or alcohol? During the last 6 months, have you had any serious fight or alienation from members of your family or your close neighbours? Yes=1No=0 Yes=1No=0 During the last 6 months, have you or any member of your close family been arrested, had to go to court, or consulted a lawyer on a non-routine matter? B. Relationship with a partner YesNoAre you or were you in a relationship during the past 6 months? If No, skip to C (children) If Yes, answer the following Has the following happened to you in the past 6 months? YesNo1. You entered into a serious relationship2. You moved in with your partner, became engaged, or got married3. You had a break-up with your partner or got divorced4. You or your partner have been unfaithful5. Your partner went to jail/prison6. Your partner has been in poor health because of illness or an accident7. Your partner has hit or beaten you8. You experienced the death of a partner C: Children YesNo Have you ever had a child? YesNo Have you/your partner been pregnant in the past 6 months? If No to both questions, skip to D (Early life stress) If Yes to either question, answer the following: YesNo Is your child/pregnancy registered with 3G? Has the following happened to you? In the past 6 months:YesNo1. You found out that you/your partner was pregnant 2. You/your partner had a stillbirth3. You/your partner had an abortion or miscarriage4. You/your partner had a baby5. You/your partner had your first child6. You adopted, fostered, or took on support of a child7. You have had a custody battle with a former partner8. Your child passed awayEver:9. Was your child born with a disability or has your child had an illness or an accident at any time in their life that resulted in a disability? D: Early life stress These questions refer to when you were growing up (before 18 years of age). YesNo1. Did a parent or other adult in the household often or very often Swear at you, insult you, put you down, or humiliate you? OR Act in a way that made you afraid that you might be physically hurt?2. Did you often or very often feel that No one in your family loved you or thought you were important or special? OR Your family didnt look out for each other, feel close to each other, or support each other?3. Did you often or very often feel that You didnt have enough to eat, had to wear dirty clothes, and had no one to protect you? OR Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?4. Were your parents ever separated or divorced? (If the young adults parents were never together, please write NOT APPLICABLE)5. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? OR Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? OR Ever repeatedly hit at least a few minutes or threatened with a gun or knife?6. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?7. Was a household member depressed or mentally ill, or did a household member attempt suicide?8. Did a household member go to prison?9. Was there anyone in your household who was chronically ill when you were a child?10. Was one or more of your parents/caregivers mostly unemployed during your childhood because they could not get a job?11. Did either of your parents/caregivers pass away before you turned 18? E. Social Support Questionnaire: The following questions ask about people in your environment who provide you with help or support. For each question, list all the people you know (initials or first name or relationship only), excluding yourself, who you can count on for help or support in the manner described. If you have no support for a question, select the no-one option. 1. Who can you really count on to be dependable when you need help? 1) 4) 7) No-one 2) 5) 8) 3) 6) 9) 2. Who can you really count on to help you feel more relaxed when you are under pressure or tense? 1) 4) 7) No-one 2) 5) 8) 3) 6) 9) 3. Who accepts you totally, including both your worst and your best points? 1) 4) 7) No-one 2) 5) 8) 3) 6) 9) 4. Who can you really count on to care about you, regardless of what is happening to you? 1) 4) 7) No-one 2) 5) 8) 3) 6) 9) 5. Who can you really count on to help you feel better when you are feeling generally down-in-the-dumps? 1) 4) 7) No-one 2) 5) 8) 3) 6) 9) 6. Who can you count on to console you when you are very upset? 1) 4) 7) No-one 2) 5) 8) 3) 6) 9) SECTION 4: Body Image WEIGHT CHANGE ATTEMPTS  Have you tried to lose weight during the past year? If yes, what was the most important reason (mark only one)? ReasonTick oneCodeIt is healthy1I want to look better2My clothes were too tight3I am too fat compared to my friends4I am unhappy with myself5I have a dreams of being a model or movie/TV star6Any other reason, specify 7 If you did try to lose weight, describe all the methods you have tried. Include any information on diet, exercise, pills or anything else that you have tried. MethodTick all that applyCodeDieting1Exercising2Pills3Any other method, specify4 Did you try to build more muscles or grow bigger during the past year? If yes, what was the most important reason (mark only one)? ReasonTick oneCodeIt is healthy1I want to look better2I have too little muscles compared to my friends3I am unhappy with myself4I have a dream of being a model or movie/TV star5Any other reason, specify 6 If you did try to build more muscles, describe all the methods you have tried. Include any information on diet, exercise, pills or anything else that you have tried. MethodTick all that applyCodeDieting1Exercising2Pills3Any other method, specify4 Body image assessment [USE BODY SILHOUTTE CARDS PLEASE ENSURE THAT THEY ARE SHUFFLED BEFORE GIVEN TO THE YOUNG ADULT] Please look at the following female sillhouettes and choose the figure that you think (Females & Males) aLooks the bestbLooks the worstcIs clumsydHas more respect from otherseHas less respect from othersfIs the strongestgIs the weakesthIs the happiestiIs the most unhappy Choose the figure that (Females only) aLooks like youbYou would want to look likecYour family will want you to look likedYour friends will want you to look like  Between figure 1 or 9, which would you rather look like? (Females only) Between figure 1 or 9, which would you rather have as your girlfriend? (Males only) EATING ATTITUDES TEST AlwaysVery oftenOftenSometimesSeldomNever1. I am terrified (very scared) about being overweight2. I avoid eating (try not to eat) when I am hungry3. I find myself preoccupied with food (think about food a lot)4. I have gone on eating binges (a lot of food in a short time) where I feel that I may not be able to stop5. I cut my food into small pieces 6. I am aware of the calorie/ kilojoule (energy) content of foods that I eat 7. I particularly avoid foods with a high carbohydrate (starch) content such as bread, potatoes, rice and pap8. I feel that others would prefer (like it) if I ate more9. I vomit (bring up food / throw up) after I have eaten10. I feel extremely guilty (Ive done wrong) after eating11. I am preoccupied with a desire to be thinner (think about being thinner a lot)12. I think about burning up calories/ kilojoules (energy) when I exercise13. Other people think I am too thin14. I am preoccupied with the thought of having fat on my body (think about having fat on my body a lot)15. I take longer than other people to eat my meals (food)16. I avoid (try not to eat) foods with sugar in them17. I eat diet foods (special foods to lose weight)18. I feel that food controls my life19. I display self control around food (I can control my eating if there is a lot of food available)20. I feel that others put pressure on me to eat21. I give too much time and thought to food22. I feel uncomfortable (not good) after eating sweets23. I engage in dieting behaviour (try to lose weight)24. I like my stomach to be empty (I like the feeling)25. I enjoy trying new rich (creamy/ fatty) foods26. I have the impulse (need) to vomit after meals SECTION 5: General Health I am now going to ask you the General Health Questionnaire (GHQ 28) We would like to know if you have had any medical complaints and how your health has been in general, over the past few weeks. Please answer ALL the questions on the following pages simply by ticking the answer which you think most nearly applies to you. Remember that we want to know about present and recent complaints, not those that you had in the past. Have you recently, A1Been feeling perfectly well and in good health?Better than usualSame as usualWorse than usualMuch worse than usualA2Been feeling in need of a good tonic?Not at allNo more than usualRather more than usualMuch more than usualA3Been feeling run down and out of sorts?Not at allNo more than usualRather more than usualMuch more than usualA4Felt that you are ill?Not at allNo more than usualRather more than usualMuch more than usualA5Been getting any pains in your head?Not at allNo more than usualRather more than usualMuch more than usualA6Been getting a feeling of tightness or pressure in your head?Not at allNo more than usualRather more than usualMuch more than usualA7Been having hot or cold spells?Not at allNo more than usualRather more than usualMuch more than usual Have you recently, B1Lost much sleep over worry?Not at allNo more than usualRather more than usualMuch more than usualB2Had difficulty in staying asleep once you fall off to sleep?Not at allNo more than usualRather more than usualMuch more than usualB3Felt constantly under strain?Not at allNo more than usualRather more than usualMuch more than usualB4Been getting edgy and bad tempered?Not at allNo more than usualRather more than usualMuch more than usualB5Been getting scared or panicky for no good reason?Not at allNo more than usualRather more than usualMuch more than usualB6Found everything getting on top of you?Not at allNo more than usualRather more than usualMuch more than usualB7Been feeling nervous and strung-out all the time?Not at allNo more than usualRather more than usualMuch more than usual Have you recently, C1Been managing to keep yourself busy and occupied?More so than usualSame as usualRather less than usualMuch less than usualC2Been taking longer to do the things you do?Quicker than usualSame as usualLonger than usualMuch longer than usualC3Felt on the whole you were doing things well?Better than usualAbout the same as usualLess well than usualMuch less well than usualC4Been satisfied with the way youve carried out your tasks?More satisfied than usualAbout the same as usualLess satisfied than usualMuch less than usualC5Felt that you are playing a useful part in things?More so than usualSame as usualLess so than usualMuch less than usualC6Felt capable of making decisions about things?More so than usualSame as usualRather less than usualMuch less than usualC7Been able to enjoy your normal day-to-day activities?More so than usualSame as usualRather less than usualMuch less than usual Have you recently, D1Been thinking of yourself as a worthless person?Not at allNo more than usualRather more than usualMuch more than usualD2Felt that life is entirely hopeless?Not at allNo more than usualRather more than usualMuch more than usualD3Felt that life isnt worth living?Not at allNo more than usualRather more than usualMuch more than usualD4Thought of the possibility that you might make away with yourself?Definitely notI dont think soHas crossed my mindDefinitely haveD5Found at times you couldnt do anything because your nerves were too bad?Not at allNo more than usualRather more than usualMuch more than usualD6Found yourself wishing you were dead and away from it all?Not at allNo more than usualRather more than usualMuch more than usualD7Found that the idea of taking your own life kept coming into your mind?Definitely notI dont think soHas crossed my mindDefinitely have Section 6: Health Services Access Have you had any illness or condition in the last 12 months? YesGo to Q2NoConclude questionnaireDont Know Please state these illnesses or conditions and where you sought treatment for them IllnessPlace of treatment (Use codes below)1)2)3)4) Coding 1: Self treatment2: Private Doctor (General Practitioner)3: Government Clinic4: Government Hospital5: Private Clinic 6: Private Hospital7: Chemist/Pharmacist8: Faith Healer9: Sangoma/Traditional Healer10: Other (specify) SKIP Question 3 if the participant used a clinic, hospital or doctor for all illnesses/conditions. Why did you not use a clinic, hospital or doctor to treat your illness? 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