Module 5 CASI questionnaire: Less sensitive information [instrument]

Health, satisfaction, media consumption, political / social participation, social networks, . . .

Questions

Sort Question Name
0 How would you describe your state of health during the last 12 months, in general? she0100
1 Have you visited a doctor (or dentist) in the last 12 months? (This includes check-ups, visits to psychotherapists, health practitioners, chiropractors, etc.) doc0100
2 Please state the number of visits to doctors. (Note: total number in the last 12 months. If you are not sure, please estimate.) doc0101
3 To what extent would you say your illness limits you in your everyday life? imp0100
4 Has a doctor ever diagnosed you with one or more of the following illnesses? dia0100
5 Has a doctor ever diagnosed you with one or several of the following illnesses? dia1600
6 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0101
7 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0201
8 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0301
9 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0401
10 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0501
11 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0601
12 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0701
13 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0801
14 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia0901
15 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia1001
16 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia1101
17 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia1201
18 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia1301
19 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia1401
20 You said you have been diagnosed with [insert disease from the previous question ]. During what period did the illness occur? dia1501
21 Do you smoke? hbe0100
22 How old were you when you started smoking (even if you didn't smoke much)? hbe0101
23 Do you tend to smoke alone or with friends or acquaintances? hbe0102
24 Have you ever drunk alcohol, and if so, how old were you when you drank alcohol for the first time? If you don't remember exactly, please estimate. hbe0200
25 Do you tend to drink alone or with friends or acquaintances? hbe0201
26 How often would you say that you drink "a lot"? hbe0202
27 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0210
28 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0218
29 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0219
30 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0220
31 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0228
32 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0229
33 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0230
34 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0238
35 When you drink what you would describe as "a lot" in a day or in an evening, how much do you drink? Please state the number of glasses. hbe0239
36 The following questions are about the past 12 months. How much alcohol have you consumed in the last 12 months? hbe0240
37 How often in the last 12 months did you not do your work as well as usual because you had consumed alcohol? hbe0250
38 Do you regularly take medication that adversely affect your ability to think or your emotions or cause other serious side effects? hbe0300
39 In the following we would like to know what you do to care for your health. To what extent does this statement apply to you personally: I take active steps to stay healthy (e.g., go to regular checkups, follow a healthy diet, and avoid unhealthy behavior, etc.). hbe0400
40 NOT twin: Please give your height and weight. bdy0100
41 twin: Please give your height and weight. bdy0300
42 Below we would like to know how satisfied you are with your life in general. You can agree or disagree with the following statements. gls0100
43 Below is a list of groups that one might be active in. For each one, please state how often you take part: once a week, once a month, less than once a month, never. sop0100
44 Do you have a (volunteer) position in one of these associations or groups? sop0200
45 Which function? sop0201
46 Generally speaking, how interested are you in politics? pop0100
47 Which of the following activities did you take part in within the last 12 months? pop0200
48 Did you vote in the last election of the federal parliament? pop0300
49 If there were an election for federal parliament next Sunday, would you vote? If you are not eligible to vote, please indicate what you would do if you were eligible to vote. pop0301
50 Do you usually think of yourself as close to any particular party? Which party do you feel closest to? pop0302
51 Do you usually think of yourself as close to any particular party? Which party do you feel closest to? pop0303
52 Now we have some questions about your personal experiences. During the last 12 months, have you felt that you were disadvantaged or discriminated against due to any personal characteristics (e.g., your ethnic or cultural background, gender, religious beliefs)? dis0100
53 If so, what do you think was the reason for the discrimination? Multiple answers possible. dis0200
54 How heavily did this discrimination [show boxes ticked for discrimination] weigh on you? dis0201
55 How heavily did this discrimination [show boxes ticked for discrimination] weigh on you? dis0301
56 How heavily did this discrimination [show boxes ticked for discrimination] weigh on you? dis0401
57 How heavily did this discrimination [show boxes ticked for discrimination] weigh on you? dis0501
58 How heavily did this discrimination [show boxes ticked for discrimination] weigh on you? dis0601
59 How heavily did this discrimination [show boxes ticked for discrimination] weigh on you? dis0701
60 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0100
61 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0197
62 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0199
63 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0200
64 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0297
65 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0299
66 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0300
67 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0397
68 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0399
69 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0400
70 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0497
71 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0499
72 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0500
73 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0597
74 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0599
75 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0600
76 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0697
77 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0699
78 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0700
79 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0797
80 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0799
81 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0800
82 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0897
83 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0899
84 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0900
85 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0997
86 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med0999
87 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med1000
88 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med1097
89 The next questions are about your media usage. How much time do you spend per day on the following devices or activities? Please state as precisely as possible how much time you spend on the activity outside of school or working hours. med1099
90 Below are three statements that you can either agree or disagree with. What is your opinion on the following three statements ? net0100
91 Now a few general questions about your friends. What applies to you? net0200
92 Now follow a few questions about your friends and acquaintances: How many close friends do you have? This includes family members who you are close to. This does not include Facebook friends. net0203
93 And how many of them do not live with you? net0204
94 Now please think of three people who don't live in your household who are important to you personally. We are only referring to people who are not your relatives. How old is the first person? net0300
95 Is the first person male or female? net0301
96 Which is the first person's highest school-leaving certificate? net0302
97 What type of school does the first person attend? net0303
98 How old is the second person? net0400
99 Is the second person male or female? net0401
100 Which is the second person's highest school-leaving certificate? net0402
101 What type of school does the second person attend? net0403
102 How old is the third person? net0500
103 Is the third person male or female? net0501
104 Which is the third person's highest school-leaving certificate? net0502
105 What type of school does the third person attend? net0503
106 To what extent does the following statement apply to you? net0600
Instrument info

Name: twinlife-2014-f2f_modul5_casi

Label: Module 5 CASI questionnaire: Less sensitive information


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