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<br /> <br /> <br />6. Have you ever been told by a doctor, nurse, or other health professional that you have any of <br />the health conditions? (DK= Don’t know/ Not sure; R= Refuse to answer) <br />a. Asthma € Yes € No € DK € R <br />b. Depression or anxiety € Yes € No € DK € R <br />c. High Blood Pressure € Yes € No € DK € R <br />d. High Cholesterol € Yes € No € DK € R <br />e. Diabetes (not during <br />pregnancy) <br />€ Yes € No € DK € R <br />f. Osteoporosis € Yes € No € DK € R <br />g. Overweight/Obesity € Yes € No € DK € R <br />h. Heart Disease € Yes € No € DK € R <br />i. Cancer € Yes € No € DK € R <br /> <br />7. Do you identify as Male or Female, or another way? <br />€ Male <br />€ Another Way <br />€ Female <br />€ Refused to Answer <br /> <br />8. When it comes to Cancer screenings, have you ever had a…..(DK= Don’t know/ Not sure; R= <br />Refuse to answer, NA = Not Applicable/Does not apply) <br />Mammogram (Female)? – An <br />x-ray taken only of the breast <br />by a machine that presses <br />against the breast. <br />€ Yes € No € DK € R € NA <br />PSA or DRE test (Male)? – The <br />prostate-specific antigen (PSA) <br />test and digital rectal exam <br />(DRE) are tests used to check <br />men for prostate cancer. <br />€ Yes € No € DK € R € NA <br />Blood Stool Test <br />(Male/Female)? – A test that <br />may use a special kit at home <br />to determine whether the stool <br />contains blood. <br />€ Yes € No € DK € R € NA <br /> <br />9. In the past 30 days, have there been any days when feeling sad or worried kept you from <br />going about your normal business? <br />€ Yes <br />€ Don’t Know/Not Sure <br />€ No <br />€ Refused to Answer <br /> <br />