| | 1. Gender: Male, female | | 2. Age: | | 3. Nationality: | 4. Duration of residence in the locality:
-less than 5, 5–9 years, 10–19 years, 20 and more year | | 5. Education: incomplete secondary, secondary, specialized secondary, incomplete higher, higher | | 6. Marital status: married, divorced, widower, single | | 7. Occupation: worker, government worker, farmer, pensioner, student, housewife, individual work activity, unemployed | | 8. Disability (Group): 1, 2, 3 | 9. Frequency of visits to healthcare facilities during the year
Not once. [5], 1–4 times [4], 5–9 times [3], monthly [2], weekly [1] | 10. How often do respiratory diseases signs (runny nose, sneezing, cough, etc.) occur during the year
Not once. [5], 1–4 times [4], 5–9 times [3], monthly [2], weekly [1] | 11. How often do signs of the stomach, intestinal diseases, diarrhea, nausea, vomiting, etc. occur during the year
Not once. [5], 1–4 times [4], 5–9 times [3], monthly [2], weekly [1] | 12. How often do signs of heart and vascular disease (heart pain, swelling, increased blood pressure, etc.) occur during the year
Not once. [5], 1–4 times [4], 5–9 times [3], monthly [2], weekly [1] | 13. How often do skin changes (itching, redness, enlarged lymph nodes, etc.) occur during the year
Not once. [5], 1–4 times [4], 5–9 times [3], monthly [2], weekly [1] | 14. How often do signs of kidney disease (frequent and difficult urination, etc.) occur during the year
Not once. [5], 1–4 times [4], 5–9 times [3], monthly [2], weekly [1] | 15. How often do signs of nervous diseases (irritability, insomnia, spinal pain, etc.) occur during the year
Not once. [5], 1–4 times [4], 5–9 times [3], monthly [2], weekly [1] | | 16. How often do you experience pain: do not [5], relatively rarely [4], relatively often [3], often [2], very often [1] | 17. Are you worried about physical pain or discomfort?
No [5], a little [4], moderately [3], relatively strongly [2], Very strongly [1] | 18. Do you have enough energy for everyday life?
Yes [5], a little lacking [4], moderately lacking [3], severely lacking [2], very much lacking [1] | 19. How easily do you get tired?
No [5], relatively rarely [4], moderately [3], strongly [2], very strongly [1] | 20. How well do you sleep?
Very good [5], good [4], satisfactory [3], Bad [2], Very bad [1]. | 21 How do you assess your health now?
Very good [5], good [4], satisfactory [3], Bad [2], Very Bad [1]. | 22. Emotional state during the last 4 weeks caused difficulties at work, in communicating with family, relatives, neighbors or work colleagues:
No [5]; a little [4]; moderately [3]; strongly [2]; Very strongly [1]. | 23. Your mood during the last 4 weeks. Did you feel cheerful and calm:
Very often [5]; often [4]; sometimes [3]; rarely [2]; never [1]. | 24. Your mood during the last 4 weeks. Were you nervous and feeling depressed?
Never [5] rarely [4] sometimes [3]; often [2]; very often [1] | 25. Do family and household conflicts often occur?
Very rarely [5]; rarely [4], sometimes [3]; often [2]; very often [1]. | 26. How satisfied are you with your ability to learn new things, focus attention and make decisions?
Very strongly [5]; strongly [4], moderately [3]; little [2]; not satisfied [1]. | 27. How satisfied are you with your appearance and yourself?
Very strongly [5]; strongly [4], moderately [3]; little [2]; not satisfied [1]. | 28. How well are you able to move around?
Very good [5], good [4], satisfactory [3], bad [2], very bad [1]. | 29. To what extent are you able to cope with everyday tasks?
Very good [5], good [4], satisfactory [3], bad [2], very bad [1]. | 30. Are you dependent on medications?
No [5]; a little [4]; moderately [3]; strongly [2]; very strongly [1]. | 31. How badly do you need any medical treatment for everyday life?
No [5], a little [4], moderately [3], relatively strongly [2], Very strongly [1] | 32. Can you work?
Fully [5]; slightly less [4], moderately less [3], little [2], not at all [1] | 33. Personal relationships with relatives, friends, neighbors and colleagues
Very good [5], good [4], satisfactory [3], bad [2], very bad [1]. | 34. Do you feel happy in communicating with your family members?
Fully [5]; slightly less [4], moderately less [3], little [2], not at all [1] | 35. Do you get any support from others when you need it?
Fully [5]; slightly less [4], moderately less [3], little [2], not at all [1] | 36. How satisfied are you with the support you receive from others?
Fully [5]; slightly less [4], moderately less [3], little [2], not at all [1] | 37. How safe do you feel in your daily life?
Fully [5]; slightly less [4], moderately less [3], little [2], not at all [1] | 38. How comfortable is your accommodation (place of residence)?
Fully [5]; slightly less [4], moderately less [3], little comfortable [2], uncomfortable [1]. | 39. Are you satisfied with your financial situation?
Fully [5]; slightly less [4], moderately less [3], little satisfied [2], no [1]. | 40. How easily can you get qualified medical care?
Easy [5]; a little harder [4], moderately harder [3], with great difficulty [2], cannot [1]. | 41. How satisfied are you with the availability of medical care for you?
Fully [5]; slightly less [4], moderately less [3], little satisfied [2], no [1]. | 42. Are you having trouble in purchasing medicines?
No [5], a little [4], moderately [3], relatively strongly [2], Very strongly [1] | 43. How do you assess the quality of social assistance available to you?
Very good [5], good [4], satisfactory [3], Bad [2], Very bad [1]. | 44. How accessible is the information you need in your daily life?
Fully [5]; slightly less [4], moderately less [3], little available [2], not available [1]. | 45. What are the opportunities for recreation and entertainment?
Very good [5], good [4], satisfactory [3], Bad [2], Very bad [1]. | 46. How important is the adequate operation of transport in everyday life for you?
Fully [5]; slightly less [4], moderately less [3], Little important [2], not important [1]. | 47. Do you smoke? (How much)
No [5]; 1–3 cigarettes per day [4]; up to 0.5 packs per day [3]; up to a pack per day [2]; more than one pack per day [1]. | 48. Alcohol consumption
No [5], on holidays [4], once a month [3], once a week [2]; every day [1]. | | 49. Drug use (Есірткіні пайдалану) yes [1], No [5] | 50. Do you suffer from dustiness of the atmospheric air?
No [5], slightly [4], moderately [3], strongly [2], very strongly [1] | 51. Are you satisfied with the climate?
Fully [5]; slightly less [4], moderately [3], little [2], no [1] | 52. Are you satisfied with the quality of drinking water? (Ауыз судың сапасы қанағаттандыра ма?)
Fully [5]; slightly less [4], moderately [3], little [2], no [1] | 53. Are you satisfied with the landscaping of the territory?
Fully [5]; slightly less [4], moderately [3], little [2], no [1] | 54. Are you satisfied with the environment?
Fully [5]; slightly less [4], moderately [3], little [2], no [1] | 55. Are you concerned about the presence of a cosmodrome in your region, areas of falling of separating parts of launch vehicles?
No [5], slightly [4], moderately [3], strongly [2], very strongly [1] | 56. Do the launches of launch vehicles from the baikonur cosmodrome affect you?
No [5], slightly [4], moderately [3], strongly [2], very strongly [1] | | 57. The impact effects on the state of health is (underline) environmental pollution; poor drinking water; polluted air; poor living conditions; lack of work; lack of money, poor-quality medical care; conflicts in the family, conflicts at work | | 58. What needs to be improved in the first place: medical care; job creation; water supply, living conditions, etc.___________________________________ |
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