1. Do you have high blood pressure?
2. Have you ever been diagnosed with diabetes?
3. Do you have high cholesterol?
4. Have you ever had a stroke?
5. Do you have serious difficulty walking or climbing stairs?
6. How do you rate your general health? (1 = Excellent, 5 = Poor)
7. What is your age?
8. How many days during the past 30 days was your physical health not good?
9. Have you smoked at least 100 cigarettes in your entire life?
10. What is your income category?
