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2. What is your gender?Male Female 3. How old are you?14 or less 15-24 25-34 35-44 45-54 55-64 65 or more 4. What is your race/ethnicity?American Indian/Alaskan Native Asian/Pacific Islander Black Hispanic White Other (combination)
3. How old are you?14 or less 15-24 25-34 35-44 45-54 55-64 65 or more 4. What is your race/ethnicity?American Indian/Alaskan Native Asian/Pacific Islander Black Hispanic White Other (combination)
4. What is your race/ethnicity?American Indian/Alaskan Native Asian/Pacific Islander Black Hispanic White Other (combination)
5. Which of these diseases have your ancestors died of?Alzheimers Benign Neoplasms (Tumors) Cerebro-vascular Disease (Stroke) Chronic Lower Respiratory Disease Circulatory System Disease (Emphysema, chronic bronchitis) Diabetes HIV Heart Disease Hypertension Influenza & Pneumonia Liver Disease Malignant Neoplasms (Cancer) Nephritis and Nephrosis (Kidney disease) Respiratory Distress Septicemia (Systemic infection) 6. According to your doctor and/or medical charts what term best describes your weight?Underweight Normal Overweight Obese Morbidly obese 7. Do you drink alcohol?Yes, like a fish Yes, occasionally (a drink or two a day or less) No 8. Do you smoke?Yes, like chimney Yes, but on rare occasion No 9. What best describes your level of physical activity?Inactive, sedentary--I'm a couch potato. Moderate--I enjoy a walk or other light exercise. Vigorous--I consider myself an athlete. 10. Are you now or do you plan to be employed in the following jobs? Bullfighter Cat burglar Chauffeur Commercial fisher Construction worker Dentist Detective Doctor Farmer Food batchmaker (operates food mixer in processed food plant) Forester Guard High wire circus performer Judge Lathe & turning machine operatorLawyer Mafia informant Mathematician Miner Nurses Police officer Prison snitch Pornographic movie performer Salesperson Scientist Social worker Taxicab driver Tool and die maker Tornado chaser Urban planner White female painter, sculptor, or artist. 11. What are your religious views/activities?Attend a house of worship regularly Atheist/agnostic Cult member 12. How much time do you spend in the car?Less than 30,0000 miles per year More than 30,0000 miles per year 13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
6. According to your doctor and/or medical charts what term best describes your weight?Underweight Normal Overweight Obese Morbidly obese 7. Do you drink alcohol?Yes, like a fish Yes, occasionally (a drink or two a day or less) No 8. Do you smoke?Yes, like chimney Yes, but on rare occasion No 9. What best describes your level of physical activity?Inactive, sedentary--I'm a couch potato. Moderate--I enjoy a walk or other light exercise. Vigorous--I consider myself an athlete. 10. Are you now or do you plan to be employed in the following jobs? Bullfighter Cat burglar Chauffeur Commercial fisher Construction worker Dentist Detective Doctor Farmer Food batchmaker (operates food mixer in processed food plant) Forester Guard High wire circus performer Judge Lathe & turning machine operatorLawyer Mafia informant Mathematician Miner Nurses Police officer Prison snitch Pornographic movie performer Salesperson Scientist Social worker Taxicab driver Tool and die maker Tornado chaser Urban planner White female painter, sculptor, or artist. 11. What are your religious views/activities?Attend a house of worship regularly Atheist/agnostic Cult member 12. How much time do you spend in the car?Less than 30,0000 miles per year More than 30,0000 miles per year 13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
7. Do you drink alcohol?Yes, like a fish Yes, occasionally (a drink or two a day or less) No 8. Do you smoke?Yes, like chimney Yes, but on rare occasion No 9. What best describes your level of physical activity?Inactive, sedentary--I'm a couch potato. Moderate--I enjoy a walk or other light exercise. Vigorous--I consider myself an athlete. 10. Are you now or do you plan to be employed in the following jobs? Bullfighter Cat burglar Chauffeur Commercial fisher Construction worker Dentist Detective Doctor Farmer Food batchmaker (operates food mixer in processed food plant) Forester Guard High wire circus performer Judge Lathe & turning machine operatorLawyer Mafia informant Mathematician Miner Nurses Police officer Prison snitch Pornographic movie performer Salesperson Scientist Social worker Taxicab driver Tool and die maker Tornado chaser Urban planner White female painter, sculptor, or artist. 11. What are your religious views/activities?Attend a house of worship regularly Atheist/agnostic Cult member 12. How much time do you spend in the car?Less than 30,0000 miles per year More than 30,0000 miles per year 13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
8. Do you smoke?Yes, like chimney Yes, but on rare occasion No 9. What best describes your level of physical activity?Inactive, sedentary--I'm a couch potato. Moderate--I enjoy a walk or other light exercise. Vigorous--I consider myself an athlete. 10. Are you now or do you plan to be employed in the following jobs? Bullfighter Cat burglar Chauffeur Commercial fisher Construction worker Dentist Detective Doctor Farmer Food batchmaker (operates food mixer in processed food plant) Forester Guard High wire circus performer Judge Lathe & turning machine operatorLawyer Mafia informant Mathematician Miner Nurses Police officer Prison snitch Pornographic movie performer Salesperson Scientist Social worker Taxicab driver Tool and die maker Tornado chaser Urban planner White female painter, sculptor, or artist. 11. What are your religious views/activities?Attend a house of worship regularly Atheist/agnostic Cult member 12. How much time do you spend in the car?Less than 30,0000 miles per year More than 30,0000 miles per year 13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
9. What best describes your level of physical activity?Inactive, sedentary--I'm a couch potato. Moderate--I enjoy a walk or other light exercise. Vigorous--I consider myself an athlete. 10. Are you now or do you plan to be employed in the following jobs? Bullfighter Cat burglar Chauffeur Commercial fisher Construction worker Dentist Detective Doctor Farmer Food batchmaker (operates food mixer in processed food plant) Forester Guard High wire circus performer Judge Lathe & turning machine operatorLawyer Mafia informant Mathematician Miner Nurses Police officer Prison snitch Pornographic movie performer Salesperson Scientist Social worker Taxicab driver Tool and die maker Tornado chaser Urban planner White female painter, sculptor, or artist. 11. What are your religious views/activities?Attend a house of worship regularly Atheist/agnostic Cult member 12. How much time do you spend in the car?Less than 30,0000 miles per year More than 30,0000 miles per year 13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
10. Are you now or do you plan to be employed in the following jobs? Bullfighter Cat burglar Chauffeur Commercial fisher Construction worker Dentist Detective Doctor Farmer Food batchmaker (operates food mixer in processed food plant) Forester Guard High wire circus performer Judge Lathe & turning machine operatorLawyer Mafia informant Mathematician Miner Nurses Police officer Prison snitch Pornographic movie performer Salesperson Scientist Social worker Taxicab driver Tool and die maker Tornado chaser Urban planner White female painter, sculptor, or artist. 11. What are your religious views/activities?Attend a house of worship regularly Atheist/agnostic Cult member 12. How much time do you spend in the car?Less than 30,0000 miles per year More than 30,0000 miles per year 13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
11. What are your religious views/activities?Attend a house of worship regularly Atheist/agnostic Cult member 12. How much time do you spend in the car?Less than 30,0000 miles per year More than 30,0000 miles per year 13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
12. How much time do you spend in the car?Less than 30,0000 miles per year More than 30,0000 miles per year 13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
13. Are you diabetic?Yes No 14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
14. Which of these activities do you do? Bicycling Canoeing/kayaking/rafting Cheating at cards Coin/stamp collecting Dating wives of jealous husbands Dueling Fishing Freestyle mountain and cliff climbingGorging on food Having unprotected gay sex Horseback ridingHunting Illegal drag racing Jogging/running Russian roulette Skydiving Snow skiing/SnowboardingSwimming Using intravenous drugs Walking Water skiing Other 15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
15. What is your economic situation?Poor Middle class Rich 16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
16. In your next life, what would you like to be? A cowboy. A baker. An astronaut. An actor. A gardener. W.C. Fields A criminal lawyer. An auctioneer. A farmer. A teacher. George W. Bush A military leader. A vulture. An angel. Nothing. I don't believe in an afterlife or god.
