ABSTRACT
Demographic details Age 1 1. Marital status of the respondent
Married 1 Divorced/legally separated 2 Separated 3 Single (alone) 4 Widowed 5 Single (steady relationship) 6 Single (living partner) 7 Married (living apart) 8 Exclusion Order 9
2. Family composition (people living in the house) Partner/husband 1 Son(s) 2 Daughter(s) 3 Living alone 4 Mother 5 Father 6 Relative 7 Other 8
Please specify the number of people living in the house 9
3. Age groups No of children aged 0-5 years 1 No of children aged 6-17 years 2 No of adults aged 18-45 years 3 No of adults aged 45-60 years 4 No of adults aged over 60 years 5
4. Employment status Full-time 1 Part-time 2 Unemployed 3 Engaged in home duties 4 Student 5 Retired 6 Ill/disabled 7 Have you ever been employed? 8 Generations unemployed 9
Other 10 (Specify: _______________________________)
6. Employment status of partner/husband Full-time 1 Part-time 2 Unemployed 3 Engaged in home duties 4 Student 5 Retired 6 Ill/disabled 7 Has he ever been employed? 8 Generations unemployed 9 Other 10 (Specify: _______________________________)
7. Social class Professional 1 Managerial/technical 2 Skilled – non-manual 3 Skilled – manual 4 Partly skilled 5 Unskilled 6
8. What level of education have you attained? Primary school 11+ 1 Secondary school 2 GCSE/‘O’ Levels 3 GCSE/‘A’ Levels 4 Technical 5 BTEC 6 HND 7 Degree/university 8 None 9 Other 10 (Specify: _______________________________)
9. Car ownership YES NO Do you own a car 1 2 Do you have access to a car 1 2 Car provided by DHSS 1 2
10. What form of transport do you use most? Taxi 1 Bus 2
Car 3 Other 4 (Specify: _______________________________)
11. Type of housing Housing executive 1 Own your own house 2 Rented accommodation 3 Homeless 4 Sheltered accommodation 5 Residential accommodation 6 Other 7 (Specify: _______________________________)
12. Thinking of your housing is it: Damp 1 Draughty 2 Centrally heated 3 Got a garden 4 Overcrowded 5 Safe place to live 6
13. Are you receiving any benefits? Yes 1 No 2
14. If yes, are they: Housing benefit 1 Sickness benefit 2 Attendance allowance 3 Disability allowance 4 Family income supplement 5 Others 6 (Specify: _______________________________)
15. Are you exempt from prescription charges? Yes 1 No 2 Don’t know 3
16. Are you a member of an ethnic minority? Yes 1 No 2
Lifestyle 1. Which of the following statements is true for you?
