Chapter 4 Health Symptoms

4.1 Background

The Health Symptoms Form asked the following 39 questions for symptoms assessment.

  1. Headache
  2. Feeling your heart pound or race
  3. Back pain
  4. Pain in arms, legs, or joints
  5. Fainting spells
  6. Stomach or abdominal pains
  7. Dizzy spells
  8. Tiredness or fatigue
  9. Chest pain
  10. Menstrual or menopausal problems
  11. Nausea, gas or indigestion
  12. Constipation, loose bowels or diarrhea
  13. Sexual problems
  14. Trouble sleeping
  15. Trouble falling asleep
  16. Awakening during sleep
  17. Shortness of breath
  18. Skin problems
  19. Trouble urinating
  20. Numbness in hands or feet
  21. Problems swallowing
  22. Sinus problems
  23. In the past 1-2 year have you had your blood pressure taken?
  24. In the past 1-2 years have you had your blood cholesterol (fat) checked?
  25. In the past 1-2 years have you had your blood glucose (sugar) checked?
  26. In the past year have you had an examination for blood in your stool performed?
  27. If you are over 50 years old, have you had a colonoscopy performed (bowel scope exam)?
  28. If you are a male, do you perform monthly testicular self-exams?
  29. If you are a male over the age of 50 years old, have you had a blood test performed to check your prostate?
  30. If you are a sexually active female and have a cervix, have you had a pelvic/PAP Smear examination every 3 years?
  31. If you are a female, do you perform monthly breast self-exams?
  32. If you are a female over 40 years old, have you had a breast x-ray (mammogram) performed every 2 years?
  33. Have you had a Rubella vaccine?
  34. Have you had a Hepatitis B vaccine?
  35. Have you had a Tetanus and Diphtheria vaccine (every 10 years)?
  36. If you never had chickenpox, have you had a Varicella vaccine?
  37. If you are over 50 years old, have you had a flu vaccine?
  38. If you are over 65 years old, have you had a pneumonia vaccine?
  39. From the following statements, please choose the most appropriate statement relating to your level of physical activity.