[Homestead] A health questionnaire

Akka Homestead akkabhomestead at yahoo.com
Sun Sep 14 02:36:52 EDT 2008


I'm posting this because I am conducting this survey for my own informal 
research, and I would like you to answer the following 13 questions 
about your life.  The more people that I can get to take it, the better. 
 Please take the survey yourself and then get your spouse or other 
adults to take it.  I don't need names.  If you don't want to 
incriminate yourself on the marijuana question, you may leave it blank, 
but know that no one besides me will see this questionnaire-I'm not judging!<g>  Please do 
not post the results to the list, please send them to
akkabhomestead at yahoo.com
Just hit reply, edit as you see fit to make the answer obvious to me, and that will be good enough.  I'm hoping for 100 adults to take this...please!

Thanks.

Are you male or female?


Are you
18-40 years old?
40-50 years old?
50-60 years old?
60-70 years old?
Over 70 years old?


In general terms, describe your diet:
For example:  I eat whatever, love cheese and bread or I am a vegetarian 
or I eat for diabetes, or I don't eat red meat, etc.

Are you overweight?
How much would you like to lose?

Do you drink alcohol?
If so, what and how much per day?

Have you ever been a vegetarian if you aren't now?
For how long and why did you stop?
Please describe your vegetarian habits (e.g. vegan, lacto-veg, etc.)

Do you smoke cigarettes?
If so, how much per week?
If you ever smoked, how long have you been quit?

What is you blood type?
If you don't know, leave it blank.

Do you smoke marijuana?
If so, how much per week?

Do you have chronic medical issues that you take prescribed medication 
to treat? (i.e. diabetes, RA, high blood pressure, etc.)

What is your level of education?
High school graduate or less?
Some college?
College graduate?

How often do you eat away from home(answer in meals per week)?

Do you garden, raise animals or grow any of your own food?
If yes, please describe.

Do you drink treated water, well water,  bottled/treated, or 
bottled/distilled?





      


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