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                          PART C: YOUR LIFESTYLE
Now I’d like to learn about your lifestyle – the work, leisure and spiritual parts of your
life. Some questions may not apply to you but remember that many different people in
the Arctic will be taking part in this survey. I will start with a few questions on paid work.

C1.     Last week, did you work for pay or in self-employment?

             1 YES           SKIP TO Q.C16
             2 NO

(NOT WORKING FOR PAY OR IN SELF-EMPLOYMENT LAST WEEK)
C2. Last week, were you on temporary lay-off or absent from your job or business?

             1 YES
             2 NO            SKIP TO Q.C4

      C3.     Were you on temporary lay-off from a job to which you expected to return,
              on vacation, ill, on strike or locked out, or absent for other reasons?

                     1 ON TEMPORARY LAY-OFF FROM A JOB TO WHICH YOU EXPECTED TO
                      RETURN:

                     2 ON VACATION, ILL, ON STRIKE OR LOCKED OUT, OR ABSENT FOR
                      OTHER REASONS              SKIP TO Q.C16

C4.    Last week, did you have definite arrangements to start a new job within the next
       four weeks?

             1 YES
             2 NO

C5.    Did you look for paid work during the past four weeks? For example: did you
       contact an employment center, check with employers, place or answer
       newspaper ads, etc?

             1 YES           SKIP TO Q.C6
             2 NO


       C5a. Is the reason that you didn’t look for paid work that you thought that there
            were there no jobs to look for?

                     1 YES
                     2 NO

C6.    Could you have started a job last week had one been available?

             1 YES    SWEDEN            SKIP TO Q.C8; OTHER             SKIP TO Q.C15
             2 NO

DRAFT                                 PAGE C-1                                           3/4/12
                                                                           TIME:



C7.    Were there any particular reasons why you could not start a job last week:
       (INTERVIEWER: READ LIST)

       1     2       9
       YES   NO      NA
                        C7a. You had a temporary illness or disability?
                        C7b. You had no one to take care of young children at
                           home?
                        C7b. You had other personal or family responsibilities?
                        C7c. You were going to school?
                        C7d. You didn’t have the necessary clothes or transportation
                           for a job?
                        C7e. Other reasons? (PLEASE SPECIFY)



OTHER COUNTRIES                   SKIP TO Q.C15

SWEDEN
C8. Are you registered with the Swedish Employment Service?

            1 YES
            2 NO

C9.    Have you visited an official employment centre in the past four weeks?

            1 YES
            2 NO          SKIP TO Q.C10

      C9a. How many visits have you made in the past four weeks?

       00__(TIMES)

C10. Have you taken part in a “job seekers” seminar or support group or anything
     similar through an official employment centre in the past 12 months or are you
     doing so at present?

            1 HAVE TAKEN PART
            2 TAKING PART AT PRESENT
            3 HAVE NOT TAKEN PART




DRAFT                               PAGE C-2                                        3/4/12
                                                                           TIME:


C11. What, if any, other efforts have you made to find a job in the past four weeks:

      1      2      9
     YES NO         NA
                        C11a. Have you read job advertisements in newspapers
                           and other sources?
                        C11b. Prepared a personal resumé (i.e. Curriculum Vitae)?
                        C11c. Filled in one or more application forms?
                        C11e. Made direct contact with one or more employer(s)
                           (e.g. by telephoning, writing, or visiting)?
                        C11f. contacted relatives and friends to get tips about
                           possible work?
                        C11g. contacted former job acquaintances to get tips about
                           possible work?
                        C11h. contacted career adviser(s) or occupational/vocational
                           guidance counselor(s)?

                        C11i. used other methods (e.g. contacted a private
                           employment agency, placed an ad about a job, took steps to
                           set up own business, etc.)

C12. In the past month, have you thought about your job security in the future, often,
     once in a while, or have you not thought about your job security?

            1 OFTEN
            2 ONCE IN A WHILE
            3 NOT THOUGHT ABOUT IT            SKIP TO Q.C13

      C12a. When you think about your future job security, do you feel: a sense of
            optimism, a sense of despair, or do you have no feeling about it?

                   1 SENSE OF OPTIMISM
                   2 SENSE OF DESPAIR
                   3 NO FEELING ABOUT IT

C13. Do you believe that your present relationship to employment will, in the next five
     years, improve, remain unchanged or stay as it is, come under threat, lead to
     unemployment, or lead to further unemployment?

                   1 IMPROVE
                   2 REMAIN UNCHANGED OR STAY AS IT IS
                   3 COME UNDER THREAT
                   4 LEAD TO UNEMPLOYMENT OR FURTHER UNEMPLOYMENT
                   8 DON’T KNOW




DRAFT                               PAGE C-3                                       3/4/12
                                                                             TIME:


C14. Since leaving school what has been your longest period when you were
     unemployed and seeking work? This might include times when you were
     unemployed, seeking work, and at home with children. Please exclude periods of
     full disability or retirement. Please tell me your longest period of unemployment in
     weeks, months, or years.

      00_______(WEEKS)     00_______(MONTHS) 00_______(YEARS)




C15. When did you last work for pay or in self-employment, even for a few days?
     (INTERVIEWER: MARK ONE ONLY)
                                 ST
             1 FROM JANUARY 1        1999, TO DECEMBER 2000   GO TO Q.C30
             2 BEFORE JANUARY 1ST 1999                        GO TO Q.C40
             3 NEVER / NOT APPLICABLE                         GO TO Q.C40




DRAFT                                  PAGE C-4                                      3/4/12
                                                                           TIME:


(WORKED FOR PAY LAST WEEK)
C16. The next series of questions I am about to ask refer to your job or business last
     week. Last week, how many hours did you spend working for pay or in self-
     employment?

             00___ HOURS

C17. If you held more than one job last week, answer for the job that you worked the
     most hours. What kind of business, industry or service was this? Please be
     specific.

             00___ INDUSTRY



C18. What was your work or occupation?

             00___ OCCUPATION


C19. In this work, what were your most important duties or activities? Please name up
     to 3.

      Activity 1) 00_______________________________________________
      Activity 2) 00_______________________________________________
      Activity 3) 00_______________________________________________

C20. In this job or business, were you mainly: self-employed, with or without paid help
     (alone or in partnership); working for pay (including wages, salary, tips or
     commissions); or, working without pay in a family business?

            1 SELF-EMPLOYED
            2 WORKING FOR PAY
            3 WORKING WITHOUT PAY IN A FAMILY BUSINESS



C21. Was this job full-time (30 hours or more per week)?

            1 YES         SKIP TO Q.C23
            2 NO

      C22. What are the reasons that have kept you from working a full-time job?


      00___ 00___ 00___

DRAFT                              PAGE C-5                                        3/4/12
                                                                             TIME:




C23. Are you satisfied or unsatisfied with this job?

             1 SATISFIED           SKIP TO Q.C25
             2 UNSATISFIED

      C24. Do you think that it is likely that you will have a better job in a few years?

                     1 YES
                     2 NO


C25. Have you been treated unfairly in your job?
             1 YES
             2 NO            SKIP TO Q.C26

      C25a.       Do you think that you have been treated unfairly because you are
                  (Inuit/Iñupiat/Saami/Greenlandic)?

                     1 YES
                     2 NO


C26. When you were deciding to take this job, did see anyone’s advice?
             1 YES
             2 NO

      C26a. Whose advice did you seek? (PROBE: Is that person a relative?)

             1 RELATIVE MENTIONED
             2 RELATIVE NOT MENTIONED
             0 INAP. DIDN’T SEEK ADVICE


C27. Thinking about all the jobs you may have had over the past 12 months, is this job
     the one in which you worked the most hours?

             1YES            C27a. Altogether, how many jobs have you
                                    had in the past 12 months?

                                    00___(JOBS)           GO TO Q.C40
             2 NO


C28. Are you currently working at more than one paid job?

             1 YES
             2 NO            SKIP TO Q.C30


DRAFT                                 PAGE C-6                                       3/4/12
                                                                           TIME:


C29. Including the job we just talked about, how many jobs do you have?

        ______ JOBS


C30. Since January 1st, 1999 have you worked at more than one paid job (besides the
     job(s) you currently have)?

            1 YES
            2 NO          BEGIN WITH Q.C32 (SKIP Q.C31 AND INTRODUCTION)

C31. How many jobs have you worked at since January 1st, 1999?

        ______ JOBS


(INTRODUCTION TO ADDITIONAL PAID JOBS)
The next few questions are about the additional paid job that you have had since
January 1st, 1999 that is the one in which you worked the most hours.

C32. What was the kind of business, industry or service at this job? Please be
     specific.

             00___ INDUSTRY



C33. What was your work or occupation?

             00___ OCCUPATION

C34. In this work, what were your most important duties or activities? Please name up
     to 3.

      Activity 1) 00_______________________________________________
      Activity 2) 00_______________________________________________
      Activity 3) 00_______________________________________________

C35. In this job or business, were you mainly: self-employed, with or without paid help
     (alone or in partnership); working for pay (including wages, salary, tips or
     commissions); or, working without pay in a family business?

            1 SELF-EMPLOYED
            2 WORKING FOR PAY
            3 WORKING WITHOUT PAY IN A FAMILY BUSINESS


DRAFT                              PAGE C-7                                        3/4/12
                                                                               TIME:


C36. Are you satisfied or unsatisfied with this job?

             1 SATISFIED           SKIP TO Q C39
             2 UNSATISFIED

      C37. Do you think that it is likely that you will have a better job in a few years?

                     1 YES
                     2 NO

C38. Have you been treated unfairly in your job?
             1 YES
             2 NO            SKIP TO Q.C38

      C38a.       Do you think that you have been treated unfairly because you are
                  (Inuit/Iñupiat/Saami/Greenlandic)?

                     1 YES
                     2 NO


C39. What are the reasons why you have had more than one job since January 1st,
     1999?

      00__00__00__

C40. In the last 12 months, did you hunt, fish, or gather food?

             1 YES
             2 NO            SKIP TO Q.C42

      C41. I’d like to ask you about your hunting, fishing, trapping, and gathering
           activities in the past 12 months. Did you:
              (REGIONALLY SPECIFIC LIST OF ACTIVITIES REPRESENTING THE RANGE OF ACTIVITIES)

               1      2       9
              YES     NO      NA
                                 C41a. Hunt for marine mammals?
                                 C41b. Fish?
                                 C41c. Gather berries or other plants?
                                 C41d. Hunt (caribou/reindeer)?
                                 C41e. Hunt waterfowl?
                                 C41f. Gather eggs?
                                 C41f. Trap?




DRAFT                                 PAGE C-8                                         3/4/12
                                                                             TIME:


C42. Over the past 12 months, have you had time that you didn’t have to work, hunt,
     fish, or take care of family or personal responsibilities?)

            1 YES
            2 NO          SKIP TO Q.C44

C42a. What did you most often do with this time: rest, more work, harvesting for food,
      leisure activities, visiting, or something else?

             1 REST
             2 MORE WORK
             3 HARVESTING FOR FOOD
             4 LEISURE ACTIVITIES
             5 VISITING
             6 SOMETHING ELSE: _______________________

C43. Some people feel that they mostly get enjoyment out of the work they do – like
     their job, hunting, or making crafts. Other people feel that they mostly get
     enjoyment out of recreation and leisure activities. Which is closer to the way you
     feel: get enjoyment out of work activities, or get enjoyment out of recreation and
     leisure activities?

             1 ENJOYMENT OUT OF WORK ACTIVITIES
             2 ENJOYMENT OUT OF LEISURE AND RECREATION ACTIVITIES
             3 BOTH
             4 NEITHER

C44. Are there activities that you have done over the past 12 months that you consider
     as leisure activities? I’m thinking here of things like bingo, reading, and visiting.

            1 YES
            2 NO          SKIP TO Q.C46

      C45. Which of these activities did you do in the past 12 months:

             1       2       9
             YES     NO      NA
                               C45b. Play bingo?
                               C45c. Make handicrafts?
                               C45d. Listen to the radio or stereo?
                               C45e. Go to the movies or live performances?
                               C45f. Read?
                               C45g. Visit friends or family in town?

C46. In the past 12 months, did you do any traditional (Inuit/Iñupiat/Saami) dances,
     singing or games?

            1 YES
            2 NO          SKIP TO Q.C48



DRAFT                               PAGE C-9                                         3/4/12
                                                                             TIME:


      C47. Which of these activities did you do in the past 12 months:

             1       2      9
             YES     NO     NA
                               C47b. Take part in a/an (Inuit/Iñupiat/Saami) dance?
                               C47c. Sing a/an (Inuit/Iñupiat/Saami) traditional
                                        song?
                               C47d. Take part in a/an (Inuit/Iñupiat/Saami)
                                        traditional game?
                               C47e. ?

C48. Did you participate in any sports or outdoor recreation activities in the past 12
     months?

            1 YES
            2 NO          SKIP TO Q.C50

      C49. Which of these activities did you do in the past 12 months:

             1       2       9
             YES     NO      NA
                               C49a. Hike?
                               C49b. Play basketball, hockey, or soccer?
                               C49b. Sport hunting or fishing?
                               C49c. Ski or skate?
                               C49d. Go snowmobiling or dog sledding?
                               C49e. Wolleyball, tennis, badminton, or handball?
                               C49f. Running, jogging, or walking?
                               C49g. Martial arts, wrestling or boxing?
                               C49h. Meditation or ?

C50. Did you watch TV last week?

            1 YES
            2 NO          SKIP TO Q.C51

      C50a. How many hours did you watch TV last week?

                    (1) Less than 1 hour
                    (2) 1-5 hours
                    (3) 6-10 hours
                    (4) 11-20 hours
                    (5) 20 hours or more
                    (8) Don’t know




DRAFT                               PAGE C-10                                        3/4/12
                                                                                 TIME:


C51    In the past 12 months, did you:

       1      2       9
      YES     NO      NA
                          C51a. visit a friend or relative in another community?
                          C51b. Go on holiday to another (province/state/territory)?
                          C51b. Go on holiday to another country?
                          C51c. Travel on business to another
                             (province/state/territory)?
                          C51d. Travel on business to another country?

C52. Now, I’d like to turn to the spiritual and religious part of your life. Are traditional
     (Inuit/Iñupiat/Greenlandic/Saami) spiritual beliefs part of your life?

             1 YES
             2 NO           GO TO Q.C58

C53. Have you ever been in touch with spirits (Aneersak)?

             1 YES
             2 NO

C54. Have you ever experienced any visions of the future (Naasaartoq)?

             1 YES
             2 NO

C55. Do you have any special abilities in your family (Inuar)?

             1 YES
             2 NO

C56. Do you have assisting spirits (Toornat)?

             1 YES
             2 NO

C57. Do you know anyone who has abilities to:

       1      2       9
      YES     NO      NA
                          C57a. Heal?
                          C57b. Find missing persons?
                          C57b. Change the weather?

C58. Are Christian religious beliefs part of your life?

             1 YES
             2 NO           GO TO Q.C62



DRAFT                                 PAGE C-11                                          3/4/12
                                                                             TIME:


C59. Are you a member of a Christian church?

            1 YES
            2 NO            SKIP TO Q.C61

      C60. What type of church?

                            1 PROTESTANT
                            2 CATHOLIC
                            3 RUSSIAN ORTHODOX
                            4 JEHOVAH’S WITNESS
                            5 SEVENTH DAY ADVENTIST
                            6 OTHER: ______________

C61. How often do you go to church: every week, 1-3 times a month, a few times a
     year, or less often?

                    (1) EVERY WEEK
                    (2) 1-3 TIMES A MONTH
                    (3) FEW TIMES A YEAR
                    (4) LESS OFTEN

C62. Are religious or spiritual beliefs other than traditional
     (Inuit/Iñupiat/Greenlandic/Saami) or Christian beliefs part of your life?

            1 YES
            2 NO            GO TO Q.C66

      C63. How would you describe these beliefs?

             00__00__00__

      C64. Do you belong to a group that shares these beliefs?

                    1 YES
                    2 NO          GO TO Q.C66

      C65. How often do you get together with this group to practice these beliefs:
           every week, 1-3 times a month, a few times a year, or less often?

                    (1) EVERY WEEK
                    (2) 1-3 TIMES A MONTH
                    (3) FEW TIMES A YEAR
                    (4) LESS OFTEN




DRAFT                               PAGE C-12                                        3/4/12
                                                                          TIME:


C66. Do you think that people’s lives are determined mostly by nature, by a supreme
being, by their own actions, or by the actions of other people?

                    1 NATURE
                    2 SUPREME BEING(S)
                    3 THEIR OWN ACTIONS
                    4 ACTIONS OF OTHER PEOPLE
                    5 A MIX – NOT MOSTLY ANY ONE
                    8 DON’T KNOW

C67. Are there missionaries in your community?

                    1 YES
                    2 NO
                    8 DON’T KNOW

C68. What type of effect to you think that organized religions have had on your
     community: positive, negative, or no effect?

                    1 POSITIVE
                    2 NEGATIVE
                    3 BOTH POSITIVE AND NEGATIVE
                    4 NO EFFECT
                    8 DON’T KNOW

C69. Do you consider yourself to be (a/an) (Inuit/Iñupiat/Greenlander/Saami)?

            1 YES
            2 NO            SKIP TO Q.C74 (EXCEPT SWEDEN SKIP TO C70)

             C69a. Do you consider yourself to be all or part
                   (Inuit/Iñupiat/Greenlander/Saami)?

                                   1 ALL
                                   2 PART

      SWEDEN
      C70. Do you consider yourself to be part Swedish?

                    1 YES
                    2 NO

      C71. Do you consider yourself to be part Scandinavian?

                    1 YES
                    2 NO                                          SKIP TO Q. C74




DRAFT                               PAGE C-13                                       3/4/12
                                                                                TIME:


C72. What activities and customs do you think are important to maintaining your
     (Inuit/Iñupiat/Greenlander/Saami) identity?


               00__00__00__



C73. I’d like to read a list of activities and customs that may be important to
     maintaining your (Inuit/Iñupiat/Greenlander/Saami) identity. For each one, please
     tell me the letter on this card (CARD 1) that best fits your choice.

                                                                      3-C NOT
                                             1-A VERY      2 –B                   4-D NOT
                                                                       VERY
                                            IMPORTANT   IMPORTANT               IMPORTANT
                                                                    IMPORTANT
        C73a. The (CULTURE) handicrafts
        you produce?                                                            
        C73b. The (CULTURE) food I
                                                                                
        eat?
        C73c. The hunting and fishing I
        do?
                                                                                
        C73d. The harvesting of wild
        berries I do?
                                                                                
        C73e. My occupation or
        profession?
                                                                                
        C73f. The preserving of
        (CULTURE) foods I do?
                                                                                
        C73g. My use of CULTURE)
        language?
                                                                                
        C73h. The (CULTURE) events
        and social occasions I attend?
                                                                                

        C73i. My childhood upbringing?                                          

        C73j. The clothes I wear?                                               
        C73k. The personal contacts I
        have with other (CULTURE)?
                                                                                
        C73l. The (CULTURE) poetry
        and literature I read?
                                                                                
        C73m. The personal contacts I
        have with other (CULTURE)?
                                                                                
        C73n. My religious and spiritual
        practices?
                                                                                
        C73o. What I learned in school
        about CULTURE)?
                                                                                




DRAFT                                      PAGE C-14                                    3/4/12
                                                                             TIME:


C74. For each of the following activities that you do, please tell me how much contact
     they involve with (Inuit/Iñupiat/Greenlander/Saami) people: lots, some, or none:


                                                                               0 NOT
                                               1 LOTS   2 SOME     3 NONE
                                                                             APPLICABLE

        C74a. Home?                                                           

        C74b. Work?                                                           

        C74b. Community events?                                               

        C74b. Leisure & sport activities?                                     

        C74b. Work?                                                           

        C74b. Church?                                                         

C75. Are you satisfied or unsatisfied with the amount of contact you have with other
     (Inuit/Iñupiat/Greenlander/Saami) people?

                                1 SATISFIED
                                2 UNSATISFIED

C76. We’re doing great. I realize that this is a lot of questions. But your story isn’t
     complete yet. I’d like to ask you about your health. How would you describe your
     health in general: very good, good, fair, poor, or very poor?

                                1 VERY GOOD
                                2 GOOD
                                3 FAIR
                                4 POOR
                                5 VERY POOR

C77. Which, if any, of the following symptoms have you experienced in the last 12
     months?

      1       2         9
     YES      NO        NA
                            C77a. Dry or itching skin?
                            C77b. Pain in the legs at night?
                            C77b. Foot problems like bunions or corns?
                            C77b. Trouble with fingernails or toenails?
                            C77b. Joint pain?
                            C77b. Morning joint stiffness?
                            C77b. Shortness of breath?
                            C77b. Low back pain?
                            C77b. Bladder problems?

DRAFT                                       PAGE C-15                                3/4/12
                                                                         TIME:

        1    2       9
       YES   NO      NA
                       C77b. Tooth loss?
                       C77b. Vision problems?
                       C77b. Low back pain?
                       C77b. Seizure or blackout?
                       C77b. Frequent headaches?
                       C77b. Anxiety or nervousness?
                       C77b. Depression or unhappiness?

                       C77b. Other problems: ___________________?

C78. Do you wear glasses?

            1 YES
            2 NO

C79. How would you describe your eyesight (with glasses on): very good, good, fair,
     poor, or very poor?

                          1 VERY GOOD
                          2 GOOD
                          3 FAIR
                          4 POOR
                          5 VERY POOR

C80.    Do you wear a hearing aid?

            1 YES
            2 NO

C81. How would you describe your ability to hear a conversation (with your hearing
     aid): very good, good, fair, poor, or very poor?

                          1 VERY GOOD
                          2 GOOD
                          3 FAIR
                          4 POOR
                          5 VERY POOR

C82. Using the numbered response categories on this card (CARD 1), how easily can
     you run (100 meters/100 yards)? (You can just tell me the number of the
     response. READ CATEGORIES IF NECESSARY)

                          1 EASILY
                          2 WITH SOME DIFFICULTY
                          3 WITH GREAT DIFFICULTY
                          4 NOT AT ALL




DRAFT                                PAGE C-16                                   3/4/12
                                                                               TIME:


C83. And carry (10 kilograms/20 pounds)?
      (PROMPT WITH RESPONSE CATEGORIES IF NECESSARY)

                               1 EASILY
                               2 WITH SOME DIFFICULTY
                               3 WITH GREAT DIFFICULTY
                               4 NOT AT ALL

C84. Bite and chew on hard foods?

                               1 EASILY
                               2 WITH SOME DIFFICULTY
                               3 WITH GREAT DIFFICULTY
                               4 NOT AT ALL

C85. Does a physical condition or mental condition or health problem reduce the
     amount or the kind of activity you can do:

      1        2         9
     YES      NO       INAP
                            C85a. At home?
                            C85b. At work or school?
                            C85c. Traveling?
                            C85d. During leisure time?

C86. During the past 12 months, has someone intentionally struck you or physically
     injured you in some way?

             1 YES
             2 NO             SKIP TO Q.D87

      D86b.        Do you think that someone intentionally struck you or physically injured
                   you because you are (Inuit/Iñupiat/Saami/Greenlandic)?

                      1 YES
                      2 NO

C87. (IF RESPONDENT IS FEMALE): How many children have you given birth to?
      (EXCLUDING STILLBIRTHS)

      _________(CHILDREN)

C88. It is important to know when analyzing health whether or not a person is
     pregnant. Are you currently pregnant?

             1 YES
             2 NO

C89. How tall are you without shoes on?

      ___ FT ___ ___ INCHES                    OR   ___ ___ ___ CENTIMETRES


DRAFT                                 PAGE C-17                                        3/4/12
                                                                          TIME:


C90. How much do you weigh?

      ____(POUNDS) _____(KILOGRAMS)

C91. Is there a place where you can go for medical aid in (COMMUNITY)?

            1 YES          SKIP TO Q.C93
            2 NO

      C91a. How far away is the nearest place you can go to get medical aid?

      _____(MILES) ______(KILOMETERS)

C92. Is there a place where you can go for specialized medical help in
     (COMMUNITY)?

            1 YES          SKIP TO Q.C93
            2 NO

      C92a. How far away is the nearest place you can go to get specialized medical
      help?

      _____(MILES) ______(KILOMETERS)

C93. In the past 12 months, how many times – if any - have you seen a doctor for a:

             0  9
     TIMES NONE NA
      ___                 C93a. Severe cough?
      ___                 C93b. High temperature?
      ___                 C93c. Stomach upset?
      ___                 C93d. Pain in the ears?
      ___                 C93e. Sore throat?
      ___                 C93f. Skin irritation?
      ___                 C93g. Anxiety or depression?

C94. How many times have you seen a doctor for other reasons?

      ____TIMES

C95. How easy is it for you to communicate with your doctor: would you say it is easy
     or difficult?

            1 EASY
            2 DIFFICULT
            3 IT DEPENDS




DRAFT                              PAGE C-18                                      3/4/12
                                                                           TIME:


C96. Which of the following health professionals have you seen in the past 12 months:

     1       2       9
     YES     NO      NA
                        C96a. Eye doctor?
                        C96b. Medical specialist like a surgeon, orthopedist,
                           allergist?
                        C96d. Dentist or orthodontist?
                        C96d. Chiropractor?
                        C96d. Physiotherapist or occupational therapist?
                        C96d. Social worker, counselor, or psychologist?
                        C96d. Pharmacist?

C97. Do you have access to a/an (Inuit/Iñupiat/Greenlandic/Saami) traditional healer in
     (COMMUNITY)?

            1 YES
            2 NO

C98. During the past 12 months, have you seen a/an (Inuit/Iñupiat/Greenlandic/Saami)
     traditional healer?

            1 YES
            2 NO          SKIP TO Q.C101

     C99. In the past 12 months, how many times – if any - have you seen a
          traditional healther for a:

                      0    9
           TIMES     NO    INAP
            ___                 C99a. Severe cough?
            ___                 C99b. High temperature?
            ___                 C99c. Stomach upset?
            ___                 C99d. Pain in the ears?
            ___                 C99e. Sore throat?
            ___                 C99f. Skin irritation?
            ___                 C99g. Anxiety or depression?

      C100. How many times have you seen a traditional healer for other reasons?

             ____TIMES

      C101. How easy is it for you to communicate with your traditional healer: would
            you say it is easy or difficult?

                    1 EASY
                    2 DIFFICULT
                    3 IT DEPENDS




DRAFT                               PAGE C-19                                      3/4/12
                                                                             TIME:


The next set of questions you can answer yourself on this form. (HAND RESPONDENT
SELF-ADMINISTERED QUESTIONNAIRE) Please answer all the questions you feel
comfortable answering and skip those you don’t feel comfortable answering.

C102. The next few questions are about smoking. Do you smoke?

              1 YES
              2 NO          SKIP TO Q.C104

       C103a.          How many cigarettes do you smoke a day?

               _____(NUMBER)        _____(PACKS)

       C103b.          At what age did you begin smoking daily?

               ____(AGE)           DON’T SMOKE DAILY

C104. Do you ever drink wine, beer, or liquor?

              1 YES
              2 NO          SKIP TO Q.C105

       C104a.      How often do you drink: daily or almost daily; 3-6 times per week;
            1-3 times per week; 1-3 times per month; or less often?

                 (1) DAILY OR ALMOST DAILY
                 (2) 3-6 TIMES PER WEEK
                 (3) 1-3 TIMES PER WEEK
                 (4) 1-3 TIMES PER MONTH
                 (5) LESS OFTEN

       C104b. During the past 12 months, how often have you had five or more drinks
            on one occasion: daily or almost daily; 3-6 times per week; 1-3 times per
            week; 1-3 times per month; or less often?

                 (1) DAILY OR ALMOST DAILY
                 (2) 3-6 TIMES PER WEEK
                 (3) 1-3 TIMES PER WEEK
                 (4) 1-3 TIMES PER MONTH
                 (5) LESS OFTEN

C105. Have you fallen into depression and lost heart over the last month?

              1 YES
              2 NO

C106. Have you felt like being in such a difficult situation that nothing seemed to be
      able to cheer you up over the last month?

              1 YES
              2 NO

DRAFT                                PAGE C-20                                       3/4/12
                                                                                     TIME:



C107. Have you experienced a moment when it was difficult for you to concentrate
      attention on something definite over the last month?

              1 YES
              2 NO

C108. Have you found it difficult to sleep over the last month?

              1 YES
              2 NO

C109. For this next set of questions, please tell me if you’ve had this feeling all of the
      time, most of the time, a good bit of the time, some of the time, a little of the time,
      or none of the time. How often in the last month have you:
                                               2 MOST   3 GOOD BIT   4 SOME
                                   1 ALL THE                                  5 LITLE OF   6 NONE OF
                                               OF THE     OF THE     OF THE
                                      TIME                                    THE TIME      THE TIME
                                                TIME       TIME        TIME
        C109a. been a nervous
        person?                                                                          
        C109b. felt calm and
                                                                                         
        peaceful?
        C109b. felt
                                                                                         
        downhearted and blue?
        C109b. been a happy
                                                                                         
        person?
        C109b. felt so down
        that nothing could                                                               
        cheer you up?

C110. Have you ever thought seriously of committing suicide ?

              1 YES
              2 NO             CONTINUE WITH PART D

       C110a.         Was this during the last year ?

              1 YES
              2 NO

       C110b.         What were your reasons for considering suicide?



       C110c.         What kept you from doing it?




DRAFT                                     PAGE C-21                                          3/4/12
                                                             TIME:


    C110d.   Have you ever tried to commit suicide?

         1 YES
         2 NO

    C110e.   Was this during the last year ?

         1 YES
         2 NO

    C110f. What were your reasons for considering suicide?


CONTINUE WITH PART D: YOUR ENVIRONMENT




DRAFT                          PAGE C-22                             3/4/12

				
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