Riskante gewoonten en zorg voor eigen welzijn

(1963)–I. Gadourek– rechtenstatus

Auteursrechtelijk beschermd

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Appendix

Interview schedule

Page 1 (Separate sheet)

Strictly confidential.

Survey of smoking-habits.

Place of residence..... No.: .....

Respondent no.:.....

Interviewed by: ....., on ..... 1958.

at .... o'clock.

Coded by: ....., on ..... 1958, at ..... o'clock.

Introduction:

Place where interview was held:

Description of the respondent:

clothing:

physical appearance:

reaction-pattern, qualities:

Interview-situation

other persons present:

Interaction-process during the interview:

Special views of the interviewee:

Other remarks:

Page 2 and following:

Underline the response category that fits best the given response. If none of the printed response-categories fits, put down, if possible, literally all that is said. See that every question is provided with a written answer.

1. I am speaking with a man/a woman.
(do not ask!)

2. Where were you born? Place ..... Year .....

3. In which community have you lived the longest time? .....

4. How often did you move in the past ten years? ..... times.

5. What is your school-education?

primary school		some classes/completed
ULO	} continuation schools {	some classes/completed
MULO	} continuation schools {	some classes/completed
Secondary school		some classes/completed
Domestic economy		some classes/completed
Technical school		some classes/completed
Higher education: which ..... Degree? .....
Other education .....
Part-time courses or special courses? .....

6. Are you: single, not engaged?

engaged?

married?

divorced?

widowed?

divorced re-married?

widowed re-married?

7. How many children do you have: 0 1 2 3 4 5 6 7 8 9 10 11 12?

8. How many of these from this marriage: .....

9. What is your profession? ..... Your job? .....

What is the profession of your husband/wife? .....

10. What was the profession of your father? .....

11. How many hours do you work per day? (Travel-time included) ..... hours per day.

12. Do you enjoy your work? yes/no/does not know/no opinion/no answer

13. Do you work under pressure? yes/no/d.n.k./n.o./n.a.

If yes, how does it come about? .....

14. Do you often think about your work, in the evenings?

How often does it occur? often/sometimes/seldom/never/d.n.k./no answer

15. Does it frequently happen to you that you cannot sleep because you are thinking of your work? yes/no/d.n.k./n.a.

16. Do you think that you or your husband may become unemployed in the next ten years? yes/no/d.n.k./n.a.

17. Are you satisfied with what you achieved in your life? yes/no/d.n.k./n.a.

18. If you do not mind to report, what are your incomes?

..... a week

..... a month

..... per year

19. Do you think that you can afford more, by now, than some five years ago? yes/no/d.n.k./n.a.

20. If yes, how do you spend the addition (what do you do?):

better eating

eating more sweets

better clothing

going out more frequently

saving more

others; what? .....

21. Do you think you have a chance to improve your conditions in the future? yes/no/d.n.k./n.a.

22. If not, do you regret it? yes/no/d.n.k./n.a.

23. Are you satisfied with your health and physical condition? satisfied/rather/dissatisfied

24. Have you ever been seriously ill? yes/no/d.n.k./n.a.

25. If yes, in what year? this year, last year/..... years ago

26. What was wrong? .....

27. When did you consult your doctor, the last time?

this week

..... weeks ago

..... months ago

..... years ago

28. Is there in your home: clinical thermometer/iodine/gauze bandage/aspirin/APC/some other medicine; if yes, which one ....; a book about health or medicine; if yes, which one .....? a book about baby and child-care; which .....?

30. Which of the following defects or forms of illness do you think is the worst? (Underline! use cards!)

a. ulcer

b. blindness

c. tuberculosis

d. deafness

e. epilepsy

f. mental illness

g. diabetes

h. lung-cancer

i. amputation of arm or leg

And which follows then? ..... Why? .....

Which do you think is the least objectionable? .....

31. Are you a member of a Red Cross organization? member/contribution/function/

of White-Yellow Cross?

of Green Cross?

of Orange-Green Cross?

Do you pay the contributions?

Do you attend the meetings?

Have you a function in this organization? If yes, which one?

32. A housewife told us: ‘I do not understand those people who drag themselves to the market; I order twenty tins of vegetable from my greengrocer's and am ready for the month; it is easy and healthy too!’ Do you agree with this statement? agree/disagree/d.n.k./n.a.

If you do not, why not? .....

I still have other questions to ask you. Some time ago one used to think that illness and discomfort were caused by bad housing conditions ...

33. Are you, generally speaking, satisfied with your dwelling or housing conditions or are you dissatisfied? satisfied/neither - nor/dissatisfied

If dissatisfied or rather dissatisfied, what is the matter? .....

34. What living space do you have? (yourself, your family or your parental family with whom you are staying).

..... kitchen

..... w.c.

..... cellar

..... attic

..... bath-room

..... living-rooms

..... bedrooms

other space; specify .....

35. Do you find this enough or would you like to have more space? enough/neither - nor/insufficient/n.a./d.n.k.

36. Are there children at home? How many? ..... children

37. How much do you pay for your rent?

nothing, living in own house

fl ..... per week

fl ..... per three months

fl ..... per year

38. Is your house moist and damp? ..... dark? .....

39. How are your bedrooms? Where do the parents sleep? and the children? How large is the bedroom? Are there bedsteads, how many? Is there a window? Are the bedrooms separated by paper, wooden-walls, normal walls? etc.

40. How many hours do you sleep per night, on the average? ..... hours.

41. What sanitary equipment is there in your house?

Are there wash-basins? 0 1 2 3 4 5 6 or more

Bathroom with a shower

Bathroom with a bath-tub

Bath-room without bath or shower; used for .....

Wash-basin with a water heater

Other equipment; which? .....

42. Do you find the sanitary equipment in your house satisfactory? satisfactory/neither - nor/unsatisfactory/d.n.k./n.a.

43. What are your desires in this field?

44. How do you manage in your circumstances: do you take a bath or a shower regularly? in summer/in winter

If yes, how?

at home a bath

at home a shower

at home in a tub

in a community bath-establishment

in another way; how? .....

Still other questions; we also wish to know a bit about what one eats and drinks.

45. How do you drink your coffee?

With milk

without milk

strong/on average/mild

46. How many cups of coffee do your drink every day usually?
0 1 2 3 4 5 6

47. Do you eat cookies or other sweets, every day?
about every second day? on week-ends? now and then? on holidays? rarely? never?

48. What do you choose, usually? .....

How much? .....

49. Are there periods when you are inclined to eat more sweets than usually? .....

If yes, which are these? .....

Some people do not eat sweets but prefer to light a cigarette.

50. What do you smoke?

cigarettes without filters

cigarettes with filters

shag-tobacco

cigars

a pipe

other form of tobacco; what .....?

nothing: see question no. 64

(When two answers are given, underline both categories!)

51. How much do you smoke per day?

..... cigarettes

..... g of tobacco

..... cigars

52. Do you see yourself as

a heavy smoker?

a chain-smoker?

quite a smoker?

as a temperate smoker?

as a light smoker?

an occasional smoker?

a non-smoker?

53. When do you start smoking every day? at ..... o'clock.

Do you smoke then:

before breakfast? .....

during breakfast? .....

after breakfast? .....

in the morning, during work? .....

towards noon? .....

during the noon-break? .....

early in the afternoon? .....

later in the afternoon? .....

before dinner or the evening-meal? .....

during or immediately after dinner? .....

in the evening? .....

before going to bed? .....

in bed? .....

54. What occasions make you smoke more than usually?

a. the need to keep awake and alert?

b. business contacts with people?

c. social contacts with people?

d. hunger?

e. strenuous work?

f. work-frustrations? work without results or with bad results?

g. other frustrations? when you looked forward to something which did not materialize?

h. strong emotion or nervous tensions?

i. borendom?

j. something else; what? .....

55. Are there some special days or opportunities when you smoke a lot?

holidays?

birthdays and other family feasts?

parties?

others; which? .....

56. Are there some days in the week when you smoke more than usual?

Saturday } weekend/Mondag/Tuesday/Wednesday/Thursday/Friday

Sunday }

57. How much did you smoke yesterday? On ..... day ..... cigarettes or g tobacco.
(Fill in the day of the week!)

58. Did you ever consider stopping smoking or smoking less? yes/no/d.n.k./n.a.

59. When? ..... Why? .....

60. Did you try it, then? yes/no/d.n.k./n.a.

If yes, how? .....

61. What were the greatest difficulties?

62. Do you by now, smoke more, less, or just as much as before? more/less/just as much/d.n.k./n.a.

63. Did you, at times, resume your old habits? yes/no/d.k.n./n.a.

64. Did you (always) smoke before? yes/no/n.a.
(If not, see question no. 72)

At what age did you start smoking? ..... years

65. Can you remember how you acquired the habit?

66. When you started, did your father smoke? your mother? your brothers or sisters? your colleagues? your friends?

67. At the time you lit your first cigarette were you allowed to do so by your father/your mother/your teacher/your boss
(Smokers, see no. 72!)

68. Why did you decide to stop smoking? .....

69. Did you stop suddenly or slowly? at once/gradually/d.n.k.

70. Did you gain weight?

71. Do you resume the habit of smoking, now and then? If you do, at what times? .....

72. (If married) what does your spouse (husband or wife) smoke? .....
(If single, see no. 75!)

73. About how much a day? .....

74. How do you find it? Nice/good/do not mind/not quite good/rather bad

75. Do you find smoking healthy or unhealthy? healthy/unhealthy/neither-nor/d.n.k./n.a.

76. Have you read about it? If yes, what? .....

Have you heard about it? If yes, from whom? .....

And what? .....

77. Do you believe that smoking causes lung-illness? .....

If you do, which illness? .....

78. Did you discuss it with your wife (husband) or family-members? yes/no/d.n.k./n.a.

79. If you did, what was her(his) opinion?

She(he) finds smoking: healthy/unhealthy/d.n.k./n.a.

80. Which of the following statements approaches your standpoint? (see cards!)

a. Smoking is O.K. and I will not give it up.

b. Smoking is not so good, I shall drop it and I shall do so easily.

c. Smoking is not too good, but I cannot stop it.

d. Smoking is neither good nor bad - I do not know whether I shall keep on smoking or not.

e. Smoking is O.K. but I wish to stop it which I easily can.

f. Smoking is not too good, but I do not wish to stop it.

81. We registered all kinds of opinions about the smokers and the smoking:

a. Some say it is childish not to smoke. Do you agree? disagree? no opinion; no answer.

b. Others say it would be silly not to smoke since practically everybody does so. (answers as above).

c. Yet others told us: Smokers are just small children who cannot resist their impulse.

d. We also were told: A smoker knows how to enjoy life and how to make the best of it.

e. Yet another: Square and prudent people do not smoke.

f. We also heard them remark: It does not matter at all whether you smoke or not.

82. How do you think of non-smokers?

a. As square persons with a strong will?

b. As people who actually do not know how to enjoy life?

c. As prudent persons who know what is good for one?

d. As persons who wish to pass for good?

e. As quite common, normal people?

f. As persons who never actually came into contact with the world?

83. If you are married or are going to marry later on would you mind if your son smoked? If not, at what age? ..... years. Would you mind if your daughter smokes? yes/no/d.n.k./n.a.

If not, at what age? ..... years.

You see we are somewhat curious. We would also like to know what is your attitude towards a drink.

84. When someone offers you a drink, what do you choose, as a rule? beer/wine/Dutch gin/vermouth/sherry/whisky/gin/port/liqueur/black-currant-gin/other alcoholic beverages; which? ..... Non alcoholic beverage: cola/limonade/tomato-juice/orange-juice/other; which? .....

85. Do you serve drinks, sometimes? yes/no/d.n.k./n.a. If yes, what kind? ..... How much? ..... Whom? ..... Where? at home/at a pub or café

How?

buy a round

serve to visitors

drink some one's health

in another way; which one? .....

86. Do you drink at regular times? yes/no/d.n.k./n.a.

If yes, what? ..... How much? ..... At what times? ..... o'clock ..... o'clock.

Do you drink alone, with family-members/friends/acquaintances/someone else; whom? .....

87. Are there days in the weeks when you take a drink, as a rule? Monday/Tuesday/Wednesday/Thursday/Friday/Saturday/Sonday

88. What do you usually drink at table (with your warm meals)? nothing/water/soft drinks/cola/beer/wine/something else; what?

89. What alcoholic beverages have you consumed in the past week and how much?

Monday .....

Tuesday .....

Wednesday .....

Thursday .....

Friday .....

Saturday .....

Sonday .....

90. On what occasions do you especially use alcoholic beverages? What kind? How much?

birthdays

visits

weddings

funerals

card-playing

playing billiards

when receiving your wage or salary

when a child is born

on market days

others; which ones? .....

91. Do you (or your husband) drink in connection with your (his) job or together with the people you (he) work(s)? .....

How does it come about? (Describe what gives occasion to it, how much one consumes, where, with what ritual) .....

92. What is, according to you, the highest number of glasses one can consume in an evening? ..... glasses/d.n.k.

How do you know it? .....

93. What is the highest number of glasses that you consume in a day or during a party? ..... glasses/d.n.k./n.a.

94. Do you sometimes drink a glass too much? yes/no/d.n.k./n.a.

95. How do you feel then? merry/sad/stimulated/strong/desolate/relaxed/sick/differently; how? .....

96. How much must you have drunk to feel this way? ..... glasses/d.n.k./n.a.

97. Did you drink more, less or just about the same (or nothing) than (as) now? more/less/about the same/d.n.k./n.a.

98. If you changed, how did it come about? .....

99. Do you keep alcoholic beverages in stock at home? What sorts? ..... How much? .....

100. How many glasses would you allow a man to drink in an evening?

0 1 2 3 4 5 6 7 8 9 glasses/d.n.k./n.a.

and a woman?

0 1 2 3 4 5 6 7 8 9 glasses/d.n.k./n.a.

101. When you consume alcoholic drinks why do you do it, in fact? (use cards!)

a. because others drink and I do not wish to cut a poor figure

b. it tastes good

c. to forget bad luck and misery

d. I feel better

e. to gain self-confidence

f. to get warm or to get rid of a cold

g. I find it healthy

h. I find it nice (gezellig) and sociable

Other reasons .....

102. What would you call the misuse of alcohol? .....

103. Would you find it objectionable if someone of your family:

a. was drunk, now and then? yes/no/d.n.k./n.a.

b. was tipsy, now and then? yes/no/d.n.k./n.a.

c. was drunk every week? yes/no/d.n.k./n.a.

d. would drink a glass before or after dinner every day? yes/no/d.n.k./n.a.

e. would be intoxicated by evening, every day? yes/no/d.n.k./n.a.

f. would not drink alcohol, at all, on principle? yes/no/d.n.k./n.a.

104. Can you understand why some persons become alcoholics, addicted to alcohol? yes/no/d.n.k./n.a.

105. Did you have a feeling, at some time of your life or another, that you needed alcohol? yes/no/d.n.k./n.a.

When was it about? ..... ago.

106. Why, do you think? .....

107. Did you stop drinking?

If yes, how did it happen? .....

108. Young men commit all kinds of foolish deeds. We put some of these here down; choose two of them that you think to be about the worst: (employ cards!)

a. to get drunk by oneself at home, alone;

b. to drive a car or a motor recklessly;

c. to seek one's pleasure with prostitutes;

d. to become aggressive, when heavily drunk;

e. to steal or embezzle money;

f. to charm the girls and leave them with a baby behind;

g. to blaspheme God;

h. to commit treason;

i. to be reckless about one's health;

j. the abortion of one's own child.

Which one of the two you chose do you find the worse? .....

Which one do you find the least objectionable? .....

And then? .....

Then we have got here a few personal questions about the general situation in the world in order to know what our people do worry about at this time.

109. Do you have fears? yes/no/d.k.n./n.a.

110. Can you say of what? .....

111. Do you get rid of these feelings sometime? yes/no/d.k.n./n.a.

On what occasion? .....

Do you actively try to get rid of them? .....

112. Is there something that makes you feel down and blue? yes/no/d.n.k./n.a.

113. If yes, what is it? .....

114. Do you get rid of these depressing feelings, now and then? yes/no/d.n.k./n.a.

If yes, under what circumstances? .....

115. Is there something you are brooding about? If yes, what is it? .....

116. Are you sometimes worried about:

a. your money-affairs? yes/no/does not know/n.a.

b. political affairs? yes/no/does not know/n.a.

c. your relation to God? yes/no/does not know/n.a.

d. your health? yes/no/does not know/n.a.

e. your children or family? yes/no/does not know/n.a.

f. your future; how you will be getting on? yes/no/does not know/n.a.

g. death? yes/no/does not know/n.a.

117. Do you find that the future will be better, worse or just about the same for the people? better/worse/the same/d.n.k./n.a.

118. Are you worried in this respect? .....

119. Do you consider yourself as a:

socialist

humanist

Roman Catholic

liberal

Protestant

communist

theosophist

Jehovah's witness

existentialist

Jew

advocate of an other movement; which?

(If more alternatives were mentioned) What do you think you are in the first place? .....

(If no category was mentioned) Is there yet another idea or movement that appeals to you, which you agree with? What idea or movement? .....

120. Do you think a lot about the ..... teachings?

If yes, what problem occupies you? .....

121. Did you read about it?

If yes, in what books and what magazines? .....

122. Do you talk sometimes with someone about the ..... teaching?

If yes, with whom? acquaintances/friends/family-members/persons of the same denomination

123. Do you try sometimes to convert other people to your conviction or movement?

124. How would you find it if your brothers or sisters or your children did not share your convictions or faith? would regret it a lot/would regret it a bit/would not mind much/would not object much/would not be sorry at all

125. Which of the following statements can you agree with:

a. I can hardly imagine my living without or outside ..... agree/disagree/no opinion/no answer

b. I called myself a ..... but actually I can also do without it.

c. Whatever I do I always try to act as a good .....

d. I consider myself as a ..... but for the rest do not participate in their activities.

e. I have grown up in ..... circles and consider myself of them without pondering much about it.

f. I know quite well what I know and what I will: I am a ..... and that says enough.

126. What is your opinion of other people? We once more put a few statements on separate cards. Would you kindly pick one that expresses your attitude in the best way?

a. Everybody must know how to care for himself and must not bother other people.

b. In cases of bad lack or need people should be helped a bit.

c. I have got nothing to do with others; they should leave me alone.

d. You must treat people, even when you do not know them, with love, as brothers or sisters.

e. You must actually not live for yourself alone but also for the others.

f. If it is necessary I help them but I find it also nice to be left alone.

g. I do not bother about others; it is already bad enough that they exist.

Which card would you choose as your second choice?

With which one do you disagree the most?

127. Do you feel esteemed and appreciated? yes/no/d.n.k./n.a.

128. Whom do you think of first?

friends or acquaintances

family-members

a fiancé or marriage partner

your superiors (referred to work)

your mates or colleagues

your neighbours

others; whom? .....

129. Have there been people in your life whom you esteemed and liked and who have shattered your confidence? yes/no/d.n.k./n.a.

130. If yes, were they:

friends

acquantances

people you worked with

fiancé

family-members

others; who? .....

131. In what way did they disappoint you?

132. When you noticed it did you feel badly for a long time? yes/no/d.n.k./n.a.

133. Did you then:

suffer from insomnia?

suffer from headaches or pains in your chest?

experience other bodily troubles?

seek relaxation in a pub or café?

seek support of friends or acquaintances?

smoke more than usual?

consume more alcohol than usual?

134. When you think of your childhood in you parental house, have you got nice or not so nice memories? nice/not so nice/rather bad/no opinion/no answer

135. Did you experience one or more of the following events during the childhood (before reaching 18 years of age):

divorce of parents?

death of the father?

death of the mother?

death of one of the siblings?

longer absence of father; reason .....?

longer absence of mother: reason .....?

drunkenness of someone at home?

other things that impressed you rather: .....?

136. Do you feel lonely, now and then? Do you have the feeling that you are quite alone in the world, in the long run, alone to do all the tasks? yes/no/d.n.k./n.a.

What do you do to get rid of this feeling? .....

137. Is there something you are striving for in your life, which you would like to achieve?

If yes, what? .....

138. Have you got the feeling that your life is devoid of any meaning and purpose? yes/no/d.n.k./n.a.

139. Do you often feel bored?

in your work

during the evenings, when free

on weekends

140. What is your hobby or main leisure activity? .....

141. How much time do you spend on it? ..... each day ..... each week

142. How often did you visit your family or acquaintances, the last week? Monday/Tuesday/Wednesday/Thursday/Friday/Saturday/Sunday

How many of the reported visits did you pay to your neighbours?

143. On what days of the last week did you receive a visit:
Monday/Tuesday/Wednesday/Thursday/Friday/Saturday/Sonday/none

Did you receive your neighbours, last week? On what days? .....

144. Is it about the same in winter? How often then do you visit other people per week? .....

145. How often do you go to see the pictures? ..... times a .....

to the theatre or concert? .....

to a pub or café? .....

to a meeting? .....

for a walk? .....

146. Are you a church-member? .....

Of which church? .....

What is your husband or wife? .....

What was the denomination of your father? .....

And of your mother? .....

147. Do you go to church regularly?

If yes, how often? ..... per week/..... per month/on holidays/rarely/never.

148. Do you pay the church-dues or other contributions to your church? yes/no/d.n.k./n.a.

149. Do you hold an office in your church or through the mediation of the church?

If yes, what office? .....

150. What other associations or organisations are you affiliated with?

	do you pay the dues?	do you attend the meetings?	an office?
trade unions or craft-union
employers' association
association of civil servants or professionals
election-committee or a party
radio listeners association
others .....

151. Do you read a newspaper regularly? yes/no/no answer

152. If yes, which one? .....

153. Are there other magazines or papers that you read as a rule? Titles .....

154. When did you read a book, the last time? yesterday/this week/last week/this month/a few months ago

155. Can you tell us the titles of the last (three) books you read?

.....

156. Do you listen to the wireless-set?

If yes, how often? .....

the news? ..... lectures? .....

That was it. You will probably ask the reason for all these questions. If this is the case we shall try to explain. Did you find the questions difficult?

Would you, eventually, later on, be ready to help us if we forgot to ask something?

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