(NKR)Q'Naire India Marathi Rural Ambegaon 0701

Life Preference Study-2012 Rural Area

Questionnaire Srl. No. Centre: Delhi (DEL) Mumbai (MUM) Bangalore (BLR) Respondent Name 1 2 3 Kolkata (KOL) 4

Address:

Landmark: Telephone: Mobile: Email: Date Interview: Start time: End time: Name Interviewer Assign code Name SupervisorAC 1 1 1 R1 R2 R3 R4 TEL BC 2 2 2 SPOT BC 3 3 3 1 2 3 4 PER BC 4 4 4 VC 5 5 5 GENDER Age group SC 6 6 6 Male Female 20-29 30-39 40-49 50-69 DATE 1 1 1 1 2 1 2 3 4 1 1 1

STD Code:

Number:

of

________ ________/________ ________/ 2012 (dd/mm/2012)

________ : ________am/pm ________ : ________am/pm of

Mandatory - to be filled Mandatory - to be filled Assign code

of

TL EIC GH QUOTAS SEC(old type)

SCREENER S1. You are: Male

1 2

Female

S2.

vkidh mez-------------------------------------------------Your age is: Less than 20 20-29 30-39 40-49 50-59 60-69 70-79 More than 79 X 1 2 3 4 5 X Terminate Continue

Terminate

S3.

Can you please tell the occupation of the main earning member as per grid below?

- Occupation (specify): ___________________________

?

Occupation Owner Farmer Leased Farmer Agricultural Worker Owner of livestock Owner of fisheries Owner of poultry Unskilled Labour (other than agriculture) ( ) Artisan/Skilled Labour Shop/Trade Postman Teacher Doctor Service (Rural-in any village) ( - ) Service (Urban) ( ) Not Working Student Retired 1. Can you please specify the type of house that you stay in?

ME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

?

Pucca House Semi Pucca House Kutcha House

1 2 3

Definitions as below: Pucca House: A pucca house is one, which has walls and roof made of the following material. Wall material: Burnt bricks, stones (packed with lime or cement), cement concrete, timber, ekra etc Roof Material: Tiles, GCI (Galvanised Corrugated Iron) sheets, asbestos cement sheet, RBC, (Reinforced Brick Concrete), RCC ( Reinforced Cement Concrete) and timber etc. , (

), , ,

.

, ( ) , , ( ) .

, ( ), Semi -Pucca house:

A house that has fixed walls made up of pucca material but roof is made up of the material other than those used for pucca house. -

Kutcha House: The walls and/or roof of which are made of material other than those mentioned above, such as unburnt bricks, bamboos, mud, grass, reeds, thatch, loosely packed stones, etc. are treated as kutcha house. / -

, , , ,

, , , .?

2.

Can you please tell the highest education of the main earning member as per grid below? - Education (specify ): __________________________

Education of Chief wage earner -

Pucca

Type of House Semi-Pucca Kutcha

Illiterate

1 1 R4

2 R4 R4

3 R4 R4

(Self Learning)/No 2 R3 School ( )

Upto Class 4 4 Class 5-Class 9 5 9 SSC/HSC / College

3 R3 4 R3 5 R2 6 R1

R3 R3 R3 R2 R2

R4 R4 R3 R3 R3

Graduate/Postgradu 7 R1 ate generall /

Graduate/Post 8 R1 Graduate professional /

R2

R3

R1 R2 R3 R4

1 2 3 4

S4.

Which ones do you have in your household? (MA)

01 02 03 04 05 06 07 08 09 10 11

Electricity Connection

Ceiling Fan

LPG Stove

Two Wheeler

Color TV

Refrigerator

Washing Machine

Personal Computer/ Laptop

Car/Jeep/Van

/ / Air Conditioner

Agricultural Land

No of durables

S4-2.Chief Earner: Education . No of Durables 1 None 1 2 3 4 5 6 7 8 9+ E3 E2 E1 D2 D1 C2 C1 C1 B1 B1 E2 E1 E1 D2 C2 C1 B2 B1 A3 A3 Illiterate Some College (incl a Diploma) but not Grad Graduate/Post Graduate:General Graduate/Post Graduate: Professional Literate but no formal schooling/SchoolUpto 4 years School-5 to 9 years SSC/HSC

5 9 3 E2 E1 D2 D1 C2 C1 B2 B1 A3 A3

/

/

/

/42

4 E2 E1 D2 D1 C1 B2 B1 A3 A3 A2 E2 D2 D1 C2 C1 B1 A3 A3 A2 A2 5 E1 D2 D1 C2 B2 B1 A3 A2 A2 A1 6

7 D2 D2 D1 C2 B2 B1 A3 A2 A2 A1

New type of Social-Economic level[SA]

Code 01 02 03 04 05 06 07 08 09 10 11 A1 A2 A3 B1 B2 C1 C2 D1 D2 E1 E2

Rural area survey 2012 MAIN Section1 AQ1 How true for you are each of the following statements? Answer for each on a scale from 1 to 5, where 1 means it is particularly true for you and 5 means it doesn't hold true at all for you. SELECT ONLY ONE THAT IS APPLICABLE. ? 1 5 ,

1

5 It is It is particularly somewhat true for me true for me

. It is rather not true for me

. Cant say which

It doesnt hold true at all for me

1

My daily life is fulfilling

1

2

3

4

5

2

I plan to spend a lot of money or plan to purchase expensive items in the future.

1

2

3

4

5

3 4

I dont feel uncomfortable borrowing money.

1 1

2 2

3 3

4 4

5 5

I am so occupied with my daily life that I cannot save much money

5

Even if I make plans, I end up procrastinating

1

2

3

4

5

6

If there is something that I want, I need to buy it

1

2

3

4

5

7

I always plan things before I actually do them

1

2

3

4

5

8

If I have work that can wait to be done tomorrow, I wait until tomorrow to do it

1

2

3

4

5

9 10 11 12

I have anxieties about my health.

1 1 1.

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

I am deeply religious.

.

Ive been feeling stressed lately.

Ive been feeling depressed lately.

1.

It is It is particularly somewhat true for me true for me

Cant say which

It is rather not true for me


13 14 15

I havent been sleeping well lately.

1.

2 2 2

3 3 3

4 4 4

5 5 5

Ive been feeling lonely lately.

1.

I have anxieties about my life after I am 65 years old* (For those who are already aged 65 or above, life in future) 65

1

/

( 65

)

16

I want to leave as much of my inheritance as possible to my spouse. /

1

2

3

4

5

17

Behaving similarly to people around me makes me feel comfortable

1

2

3

4

5

18

When I am faced with a problem, I usually act before I think

1

2

3

4

5

.

19 20 21

I never cut into a line of people

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

I always keep my promise

I am never late for appointments/deadlines

/

22 23 24 25

Work is something to live for

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

Work is for making money

I enjoy competing with other

If someone does me a favor, I am prepared to return it

26

If I suffer a serious wrong, I will take revenge as soon as possible, no matter what the cost .

1

2

3

4

5

,

27

If somebody puts me in a difficult position, I will do the same to him/her

1

2

3

4

5

,

It is It is particularly somewhat true for me true for me

Cant say which

It is rather not true for me


28

I go out of my way to help somebody who has been kind to me before

1

2

3

4

5

29

If somebody offends me, I will offend him/her back

1

2

3

4

5

30

I am ready to undergo personal costs to help somebody who helped me before

1

2

3

4

5

31

Other people frequently tell me that what I have said is impolite, even though I think it is polite , .

1

2

3

4

5

32 33

I enjoy social chit-chat

1 1

2 2

3 3

4 4

5 5

When I talk, it is not always easy for other to get a word in edgeways

34

I find it easy to read between the lines when someone is talking to me

1

2

3

4

5

35

I prefer to do things with others rather than on my own

1

2

3

4

5

36 37

I find it hard to make new friends

1 1

2 2

3 3

4 4

5 5

I find it easy to work out what someone is thinking or feeling just by looking at their face

AQ2

To what extent do you agree with each of the following statements? Answer on a scale from 1 to 5,

where 1 means you agree completely and 5 means you disagree completely. Of course, you may choose any number in between. SELECT ONLY ONE THAT IS APPLICABLE. ? 1 5

1 5 Completely disagree

. Completely agree

. . Cant say Somewhat Somewhat which agree disagree

1

Since the future is uncertain, it is a waste to think about it.

1

2

3

4

5

2

In general, most people are trustworthy.

1

2

3

4

5

3

I feel happy when I do a good deed that I think benefits others (such as picking up trash in a park) ( )

1

2

3

4

5

4

Although an economy regulated by market forces widens the income gap between the rich and the poor, it makes people wealthier in general; so in total, they are better off.

1

2

3

4

5

,

,

5

It is the governments responsibility to take care of those who cannot take care of themselves financially.

1

2

3

4

5

6

At work, I should follow the opinion of the group

1

2

3

4

5

7

At home, I should follow my familys opinion

1

2

3

4

5

8

Working as a group results in greater achievement than working Individually

1

2

3

4

5

9

I am more satisfied when I achieve a goal by cooperating with others than only by myself

1

2

3

4

5

10

The most important factor for success in life is hard work rather than luck and connections

1

2

3

4

5

11

God is watching and sees all bad deeds

1

2

3

4

5

Completely agree 12 Life after death exists

Somewhat agree

Cant say which

Somewhat disagree

Completely disagree

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

13

Spirits and Ghosts exist

14

What is written in science text books is reliable

15

The earth is not round, but it is flat ,

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

16

Heaven exists

17

It is possible to move an object by using psychokinesis

18

God or Gods exist

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

19

I believe in fortunetelling

20

A persons blood type indicates their character

21

Human beings evolved from other living things

1

2

3

4

5

22

You should place a greater value on thinking with your head than with your heart

1

2

3

4

5

23

What is broadcast in TV programs is reliable

1

2

3

4

5

AQ3.

Suppose that you are to receive money from someone. You can either choose to receive the money today, or 7 days from today, but the amounts will be different. Compare the amounts and dates below in Option A and Option B, and indicate which option you prefer for each of 9 choices. SELECT ONLY ONE FROM A and B FOR EACH OF ALL 9 ROWS. . 7 , Option A Receive today (Rs.)

.

9 . .Which ONE do you prefer?

9 or Option B Receive 7 days from today(Rs.) 7 1 2 3 4 5 6 7 8 9 300.50 Rs 300.30 Rs 300.80 Rs 300.00 Rs 300.50 Rs 300.90 Rs 300.10 Rs 300.20 Rs 300.80 Rs 301.40 Rs 329.70 Rs 303.70 Rs 300.00 Rs 595.10 Rs 306.80 Rs 311.90 Rs 299.60 Rs 301.10 Rs

?

Option A

Option B

A A A A A A A A A

B B B B B B B B B

AQ4.

Now, suppose that you are to receive money from someone and you can choose either to receive the money 90 days from today, or 97 days from today, but the amounts will be different. Compare the amounts and dates below in Option A and Option B and indicate which option you prefer for each of the 9 choices. SELECT ONLY ONE FROM A and B FOR EACH OF ALL 9 ROWS. . 90

97

,

.

9 . 9 Option A Receive 90 days from today(Rs.) 90 1 2 3 4 5 6 7 8 9 300.00 Rs 300.60 Rs 300.00 Rs 300.70 Rs 300.60 Rs 300.20 Rs 300.70 Rs 300.10 Rs 300.70 Rs 311.80 Rs 300.00 Rs 300.90 Rs 330.10 Rs 303.50 Rs 300.50 Rs 595.50 Rs 300.10 Rs 306.60 Rs A A A A A A A A A B B B B B B B B B or Option B Receive 97 days from today(Rs.) 97 Option A Option B

.Which ONE do you prefer? ?

AQ5.

Now, suppose that you are to receive money from someone and you can choose either to receive the money today, or 28 days from today, but the amounts will be different. Compare the amounts and dates below in Option A and Option B and indicate which option you prefer for each of the 9 choices. SELECT ONLY ONE FROM A and B FOR EACH OF ALL 9 ROWS. . 28

,

. .Which ONE do you prefer? ? Option A Option B

9 .

9 Option A Receive today(Rs.)

or

Option B Receive 28 days from today(Rs.) 28

1 2 3 4 5 6 7 8 9

300.40 Rs 300.00 Rs 300.50 Rs 300.10 Rs 300.60 Rs 300.70 Rs 300.20 Rs 300.90 Rs 300.70 Rs

324.00 Rs 300.00 Rs 301.70 Rs 1476.90 Rs 312.20 Rs 347.90 Rs 297.80 Rs 418.70 Rs 304.20 Rs

A A A A A A A A A

B B B B B B B B B

AQ6.

In which of the following two ways would you prefer to receive your monthly salary? Assume that your job assignment is the same for each scenario. If you are a dependent (e.g. student, housewife, etc.) and not working, please answer based on the assumption that your monthly income equals your current actual living expenses. SELECT ONLY ONE FROM A and B FOR EACH OF ALL 7 ROWS. ?

. - ( . , . ) . .Which ONE do you prefer?

7 Option A or

Option B

?

Option A 1 A 50% chance of the salary doubling, but also a 50% chance of the salary decreasing by 60% 50

Option B B

Guaranteed to the salary increase by 0.5%

A

,

0.5

60

50

. Guaranteed to the salary increase by 0.5%

2

A 50% chance of the salary doubling, but also a 50% chance of the salary decreasing by 50% 50

A

B

,

0.5

50

50


3


A

B

,

0.5

45

50


4


A

B

,

0.5

30

50


5


A

B

,

0.5

10

50


6

A 50% chance of the salary doubling, but also a 50% chance of the salary decreasing by 5% 50 , 5 50 . A 50% chance of the salary doubling, but also a 50% chance of the salary decreasing by 1% 50

A

B

0.5

7

Guaranteed to the salary increase by 0.5%

A

B

,

1

0.5

50

.

AQ7.



7 Option A or

Option B

?

Option A 1 A 50% chance of the salary decreasing by 30%, but also a 50% chance of the salary decreasing by 19% 30

Option B B

Guaranteed to the salary decrease by 20%

A

20

50

,

19

50 2

.

A 50% chance of the salary decreasing by 30, but also a 50% chance of the salary decreasing by 17% 30


A

B

20

50

,

17

50 3

.

A 50% chance of the salary decreasing by 30%, but also a 50% chance of the salary decreasing by 15% 30


A

B

20

50

,

15

50 4

.



A

B

20

50

,

13

50 5

.


Guranteed to the salary decrease by 20%

A

B

20

50

,

12

50 6

.



A

B

20

50

,

11

50 7

.



A

B

20

50

,

10

50

.

AQ8.



7 Option A or

Option B

?

Option A 1 A 50% chance of the salary increasing by 30%, but also a 50% chance of the salary increasing by 10.5% 30

Option B B

Guaranteed to the salary increase by 20%

A

50

,

20

10.5 50 .

2

A 50% chance of the salary increasing by 30%, but also a 50% chance of the salary increasing by 11% 30

Guaranteed to the salary increase by 20%

A

B

50

,

20

11

50

. Guaranteed to the salary increase by 20%

3


A

B

50

,

20

13

50


4


A

B

50

,

20

14

50


5


A

B

50

,

20

15

50


6


A

B

50

,

20

16

50


7


A

B

50

,

20

18

50

.

AQ9

Overall, how happy would you say you are currently? Using a scale from 0 - 10 where 10 is very happy and 0 is very unhappy, how would you rate you current level of happiness? SELECT ONLY ONE THAT IS APPLICABLE.

? 0 10

10

0

,

. 7 6 5 4 3 2 1

(Rate)

10 Very Happy

9

8

0 Very Unhappy

AQ10

Compared to one year ago, do you think that you are happier now than you were then? SELECT ONLY ONE THAT IS APPLICABLE.

, .

?

Happier than one year ago

1 2 3 43,4

Almost the same as one year ago Less happy than one year ago

Don't know

AQ11 How does your standard of living compare with people around you? SELECT ONLY ONE THAT IS APPLICABLE.

?

.

Theirs is much lower than mine

1 2 3 4 5

Theirs is somewhat lower than mine

Theirs is about the same as mine

Theirs is somewhat higher than mine

Theirs is much higher than mine

AQ11-1

In AQ11, with whom did you compare your standard of living? SELECT ONE THAT IS MOST APPLICABLE. ?

. 1 2 3 4 5 6

Neighbor Your own classmates when you were in school Relatives Families of your childrens classmates Worker in your company who is in your age group, has similar academic background, or who started working in the same year , ,

Worker in your company who is assigned a similar job as yours, regardless of his or her age, academic background, and year in which he or she joined the company. , , . ,

Worker in another company in the same industry who belongs to the same age group, has similar academic background, or who started working in the same year - ,

7

Worker in another company in the same industry who is assigned a similar job as yours, regardless of his or her age, academic background, and year in which he or she joined the company - , . ,

8

Average person in India Average person in the world Friend or acquaintance excluding above choices Others (Specify: ) I dont know AQ12 Suppose that there is a speed lottery with a 50% chance of winning 10,000 Rs. If you win, you get the prize right away. If you lose, you get nothing. How much would you spend to buy a ticket for this lottery? Choose Option A if you would buy it at that price, and choose Option B if you would not buy the ticket at that price. SELECT ONLY ONE FROM A and B FOR EACH OF ALL 8 ROWS. .10,000

9 10 11 12 13

50

.

. .

.

?

8 . Price of the speed lottery ticket (Rs.)

Which ONE do you prefer? ? Option A Option B (buy the speed lottery ticket) (DO NOT buy the speed lottery ticket)

(1 2 3 4 5 6 7 8 AQ13. 1 200 400 800 1500 2500 3500 5000 A A A A A A A A

(

)B B B B B B B B

)

Which figure does not belong with the other three figures? SELECT ONE THAT IS MOST APPLICABLE.

?

1

2

3

4

AQ14. How satisfied are you with each of the followings? SELECT ONLY ONE THAT IS APPLICABLE FOR EACH ROW. ?

Satisfied

Unsatisfied

1 2 3 4

Your life overall

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

The place you live in

Your non-work activities

The current financial situation of your household

5 6 7

Relationships with your friends

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5 6 dont work

Work

8

Relationships with your spouse / Relationships with your family member(s), except for your spouse /

6 dont have spouse / 6 dont have any family except for spouse /

1

2

3

4

5

AQ15.

Imagine that you have just found that something you carelessly said hurt a friends feelings. How would you feel? SELECT ONLY ONE THAT IS APPLICABLE. ?

. 1 2 3 4 5 6

I would feel guilty but would not feel very ashamed

I would feel guilty and would feel somewhat ashamed

I would feel both guilty and ashamed

I would feel ashamed and feel somewhat guilty

I would feel ashamed but would not feel very guilty

I would feel neither guilty nor ashamed

AQ16.

Thinking about when you were a child and were given an assignment during school vacation, how early did you usually finish up the assignment? SELECT ONLY ONE THAT IS APPLICABLE. .

( ) .

.

Got it done right away. Tended to get it done early, before the due date Worked on it daily up until the due date Tended to get it done toward the end. Got it done at the last minute

1 2 3 4 5

AQ17.

Thinking about when you were a child and were given an assignment during school vacation, how early to finish up did you plan for the assignment? SELECT ONLY ONE THAT IS APPLICABLE. ( ) ?

( )

. .

I planned to get it done right away. I planned to get it done rather early, before the due date

1 2 3 4 5 6

I planned to work it daily up until the due date.

I planned to get it done rather toward the end. I planned to do get it done at the last minute. I didnt make any plan. AQ18.

Thinking about when you were a child and were given an assignment during school vacation, when did you think was the ideal time to finish up the assignment? SELECT ONLY ONE THAT IS APPLICABLE.

( ) . . 1 2 3 4

( ) ? To get it done right away. To get it done early, before the due date To work on it daily up until the due date To get it done toward the end.

To get it done at the last minute

5

AQ19.

How high does the chance of rain have to be before you will bring an umbrella with you when you go out? (Write In Number) ? (

)

% AQ20. Please circle ONE applicable number next to each statement to indicate the extent to which you agree or disagree with that statement. SELECT ONLY ONE THAT IS APPLICABLE FOR EACH ROW.

.

.

I see myself as; Disagree strongly

Agree a little

Disagree moderately

Agree moderately

Disagree a little

Neither agree nor disagree

Agree Strongly

A

Extraverted, enthusiastic.

B C

Critical, quarrelsome. , Dependable, selfdisciplined. .

D

Anxious, upset. ,

easily

E

Open to new experiences, complex.

F G H

I

Reserved, quiet. , Sympathetic, warm. , Disorganized, careless. , Calm, emotionally stable. ,

J

Conventional, uncreative. ,

AQ21.

How often do you do the followings? SELECT ONLY ONE THAT IS APPLICABLE FOR EACH ROW. ?

. Never

Very Often

Often

Some times

Infrequ ently

1

You lend personal possessions (e.g., CDs, books, car, bicycle) to your friends (. , , , )

1

2

3

4

5

2

You borrow your friends personal possessions (e.g., CDs, books, car, bicycle) and do not return them

1

2

3

4

5

6 I dont borrow my friends personal possessions

3

(. , , , )

You lend money to your friends?

1

2

3

4

5

4

?

You borrow money from your friends and do not return it

1

2

3

4

5

6 I dont borrow money from my friends .

AQ22 How do you feel about leaving an inheritance to your children? (If you do not have any children, please respond on the assumption that you actually do have children) SELECT ONLY ONE THAT IS APPLICABLE. ( ) )

?(

. 1 . 2

I plan to leave an inheritance to my child(ren) no matter what. ( )

I plan to leave an inheritance to my child(ren) only if they provide care (including nursing care) during old age.

( )

( 3 4 5

)

I plan to leave an inheritance to my child(ren) only if they provide financial assistance during old age ( ) I plan to leave an inheritance to my child(ren) only if they carry on the family business.

( )

I do not plan to make special efforts to leave an inheritance to my child(ren) but will leave whatever is left over. ( ) .

I do not plan to leave an inheritance to my child(ren) under any circumstances because doing so may reduce their will to work. . ( )

6

I do not plan to leave an inheritance to my child(ren) under any circumstances because I want to use my wealth myself.

7

( ) 8

I want to leave an inheritance to my child(ren) but I wont because I dont have the financial capacity to do so.

.

( )

[IF THE RESPONDENT ANSWERED 1 TO 5 FOR AQ22, PLEASE CONTINUE TO AQ22-1. OTHERWISE, SKIP TO AQ23.] AQ22 1-5 AQ22-1. AQ23

AQ22-1 How do you plan to divide your inheritance among your children? SELECT ONLY ONE THAT IS APPLICABLE. ( ) ?

. I plan to divide my inheritance equally among my children. ( )

1 . 2

Go to AQ23 AQ23 Go to AQ22-2 AQ22-2

I do not plan to divide my inheritance equally among my children

( )

. 3 Go to AQ23 AQ22-2

I have only one child so there is no need to divide my inheritance among my children. ( )

.

[IF THE RESPONDENT ANSWERED 2 FOR AQ22-1, CONTINUE TO AQ22-2. OTHERWISE, SKIP TO AQ23.] SELECT ALL THAT ARE APPLICABLE. AQ22-1 2

AQ22-2

AQ23

AQ22-2

Then how do you plan to divide your inheritance among your children? ? 1 2 3 4 5 6 7

I plan to leave more or all to the child (children) who lives with me.

I plan to leave more or all to the child (children) who lives near me.

I plan to leave more or all to the child (children) who helps me with housework.

I plan to leave more or all to the child (children) who provides nursing care.

I plan to leave more or all to the child (children) who provides financial assistance.

I plan to leave more or all to the child (children) who carries on the family business.

I plan to leave more or all to my eldest son or daughter even if he/she does not live with me, does not live near me, does not help me with housework, does not provide nursing care, does not provide financial assistance, and does not carry on the family business. , , .

, , 8 9 10

I plan to leave more or all to the child (children) who has less earning capacity.

I plan to leave more or all to the child (children) who has greater needs.

I plan to leave more or all to the child (children) whom I like more. .

AQ23.

Have you received any inheritances (including real estate and financial assets) with a total value of 500,000Rs or more from your parents or your spouses parents in the past? SELECT ONLY ONE THAT IS APPLICABLE.

/ .500,000 ?

(

)

. NO

YES

Received an inheritance with a total value of 500,000Rs or more in the past from my parents. .500,000 Received an inheritance with a total value of 500,000Rs or more in the past from my spouse's parents. / .500,000

1

2

1

2

AQ24.

Do you expect to receive any inheritances (including real estate and financial assets) with a total value of 500,000Rs or more from your parents or your spouses parents in the future? SELECT ONLY ONE THAT IS APPLICABLE. / .500,000

( ) ? YES

NO

Expect to receive an inheritance with a total value of 500,000Rs or more in the future from my parents. .500,000

1

2

Expect to receive an inheritance with a total value of 500,000Rs or more in the future from my spouses parents. / .500,000

1

2

AQ25.

Have you received any monetary transfers (including real estate and financial assets) or financial support (for example, for educational expenses in college/graduate school, housing purchase, marriage expenses, etc.) with a total value of 500,000Rs or more from your parents or your spouses parents in the past? SELECT ONLY ONE THAT IS APPLICABLE.

/ .500,000 ? YES

( ) ( . , , )

/

NO

Received a monetary transfer or financial support with a total value of 500,000Rs or more in the past from my parents. .500,000

1

2

Received a monetary transfer or financial support with a total value of 500,000Rs or more in the past from my spouse's parents. / .500,000

1

2

AQ26.

Do you expect to receive any monetary transfers (including real estate and financial assets) or financial support (for example, for educational expenses in college/graduate school, housing purchase, marriage expenses, etc.) with a total value of 500,000Rs or more from your parents or

your spouses parents in the future? SELECT ONLY ONE THAT IS APPLICABLE. / .500,000

( ) ( . , , ) YES

/

? NO

Expect to receive a monetary transfer or financial support with a total value of 500,000Rs or more in the past from my parents. .500,000

1

2

Expect to receive a monetary transfer or financial support with a total value of 500,000Rs or more in the past from my spouse's parents. / .500,000

1

2

Section2

BQ1 Where do you currently live? Delhi suburb Mumbai suburb

?

Bangalore suburb Kolkata suburb Other region (Specify: ) (___)

1 2 3 4 5

BQ1-1

Which of the following castes do you belong to? SELECT ONLY ONE THAT IS APPLICABLE. ?

.

Backward caste

1 2 3 4 5

Scheduled caste

Scheduled tribes Neo-Buddhist - Other

BQ2

What is your gender? ? Male Female

1 2

BQ3

Please answer your marital status. SELECT ONE THAT IS MOST APPLICABLE. .

. 1 2 3 4 5 6 Skip to BQ4 BQ4 Skip to BQ4 BQ4

I have a spouse (husband or wife, including a common law marriage). / ( , ) I am currently unattached, having divorced or separated , I am an unattached widow or widower.

I have never married.

I am currently separated in the process of divorce

I am not married but living with significant other* .

INTERVIEWER NOTE: If you are not married but living with significant other(BQ3=6), please do not answer further questions involving a spouse.

BQ3-1. When did you marry your spouse? (Write In number) / ? ( )

Month

Year

or when I was

years old

ASK ALL BQ4 Do you already have plans to marry or would like to marry in the future? SELECT ONLY ONE THAT IS APPLICABLE.

?

. 1 2 3

I already have plans to marry.

I do not have any plans to marry but would like to.

I do not have any plans to marry and do not want to.

I already have married.

BQ5

What is your height and weight? (ROUND TO NEAREST INTEGER)

? ( Weight:

) kg

Height:

cm

IF THE RESPONDENT DOES NOT HAVE A SPOUSE, ASK THE FOLLOWING QUESTIONS ONLY ABOUT THE RESPONDENT (YOURSELF) /

BQ6

When were you born? yourself 19

? Your spouse

19 /

BQ7.

Please indicate your/ your spouses highest level of education (or equivalent) completed. If he/she is still in school, select the one he/she is in now. SELECT ONLY ONE THAT IS APPLICABLE. / .

.

. You YourSpouse

Illiterate Literate but no formal schooling (or dropped out of 4-year school) /4 School : Up to 4 year 4 School : Up to 5~9 year 5 9 HSC/SSC / Some college but not graduate Graduate/ Post-Graduate-General (B.A., M.Sc., B.Com. etc) / ( , . ) Graduate/ Post-Graduate-Professional (B.E., M.Tech, MBA, MBBS, etc) / ( , , , .) Dont know / Cant Say /

1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8

9

9

BQ7-1 Please indicate the highest level of education (or equivalent) completed by your parents and your spouses parents. SELECT ONLY ONE THAT IS APPLICABLE. , /

Your Father

Your Mother

Your Spouses Father

Your Spouses Mother

/

/

Illiterate Literate but no formal schooling (or dropped out of 4-year school) /4 School : Up to 4 year 4 School : Up to 5~9 year 5 9 HSC/SSC / Some college but not graduate Graduate/ Post-Graduate-General (B.A., M.Sc., B.Com. etc) / ( ,

1 2

1 2

1 2

1 2

3 4 5 6 7

3 4 5 6 7

3 4 5 6 7

3 4 5 6 7

. )Graduate/ Post-Graduate-Professional (B.E., M.Tech, MBA, MBBS, etc) / ( , , 8 8 8 8

,

.) Dont know / Cant Say / BQ7-2.

9

9

9

9

How many brothers and sisters do you/ does your spouse have who are now living? (Write In Number For EACH)

, / ? Your brothers/sisters Number

Your spouses brothers/sisters Number / /

/ Older brothers

Older sisters

Younger brothers

Younger sisters

ASK ALL BQ8. Have you ever refrained from academic advancement due to financial trouble? ?

Yes

1 2 Skip to BQ9 BQ9

No

BQ8-1. At what point did you forgo academic advancement? SELECT ONLY ONE THAT IS APPLICABLE.

. 1 2 3 4 5 6 7

Elementary school (School up to 4 year) (4 ) Junior high school (School up to 5-9 year) (5-9 ) High school

Technical college

Junior college

Four-year college

Graduate school

BQ9

To what age do you and your spouse plan to work? If you are already retired, write in your age at the time of retirement. If you havent worked outside the home, please check 1.havent worked. If your spouse hasnt worked outside the home, please check 1. hasnt worked.

/

?

. 1 .

. .

/ 1 .

You

Years ol

1.Havent worked

Years old /

1. Hasnt worked 2.

Your Spouse

BQ10

What are your occupation and your spouse's occupation including part-time work? SELECT ONLY ONE THAT IS MOST APPLICABLE FOR EACH. , . Yourself

/

? Your Spouse

/

Office and administrative support

1 2 3 4 5

1 2 3 4 5

Sales and related occupations

Management, business, and financial operations

,

Professional and related occupations

Service occupations (healthcare support/protective service, or food preparation and serving-related, security guards, etc.) ( /

,

, , .)

Construction, extraction, and maintenance ,

6 7 8 9 10 11 12

6 7 8 9 10 11 12

, ,

Farming, fishing, and forestry

Housewives/Househusbands / Student

Retired (excluding housewives/househusbands)

Unemployed (excluding housewives/househusbands) (

/

)

Other (Specify:__________________________________)

IF THE RESPONDENT ANSWERED 1 TO 7 FOR YOURSELF OR YOUR SPOUSE FOR BQ10, CONTINUE THE FOLLOWING QUESTIONS FROM BQ10-1 TO BQ10-7. OTHERWISE, SKIP TO BQ11.

/

BQ10 1 7 BQ10-1 BQ10-

7 BQ10-1

BQ11 ?

What is the type of employment of you and of your spouse? SELECT ONLY ONE THAT IS APPLICABLE FOR EACH. Yourself

Your Spouse /

Employee of private company or organization

1 2 3 4 5 6

1 2 3 4 5 6

Government employee

Management position

Self-employed

Family employee (in self-employed business)

( )

Employee of state-run/governmental factory

BQ10-2

For how many years have you been working for your present employer? And for how many years has your spouse been working for his or her present employer? SELECT ONLY ONE THAT IS APPLICABLE FOR EACH. ? ? /

. Yourself

Your Spouse /

Less than a year

1 2 3

1 2 3

A year to less than 5 years

5

5 years to less than 10 years 5 10

10 years to less than 20 years 10 20 30 40 20 30 40

4 5 6 7

4 5 6 7

20 years to less than 30 years

30 years to less than 40 years More than 40 years

BQ10-3

Approximately how many employees are working for the company that employs you, and how many are working for the company that employs your spouse? Indicate the approximate numbers including the head office, all branch offices, branch stores, sales offices and factories. If the employer is a government organization, select "9. Government employee." SELECT ONLY ONE THAT IS APPLICABLE FOR EACH.

,

/

? ,

,

. 9 .

. Yourself

Your Spouse /

1 to 5 people 1 5 6 to 29 people 6 29 30 99

1 2 3 4 5 6 7 8 9

1 2 3 4 5 6 7 8 9

30 to 99 people

100 to 299 people 100 299 300 to 499 people 300 499 500 to 999 people 500 999 1,000 to 4,999 people 1000 4999

5,000 or more people 5,000 Government employee

BQ10-4

Which one of the following best describes the industry in which you work, and which one best describes the industry in which your spouse works? SELECT ONLY ONE THAT IS APPLICABLE FOR EACH. , /

? Yourself

. Your Spouse /

Agriculture and related industries

1 2 3 4 5 6 7 8 9 10 11

1 2 3 4 5 6 7 8 9 10 11

Mining

Construction

Manufacturing

Wholesale trade/Retail trade /

Finance and insurance

Real estate

Transportation/ Telecommunications /

Utilities

Professional and business services

Others

BQ10-5

To what extent is your salary or wage based on your work performance, and to what extent is your spouses salary or wage based on his or her work performance? SELECT ONLY ONE THAT IS APPLICABLE FOR EACH. ,

/

? . Yourself

Your Spouse /

The wage is based almost entirely on performance

1 2 3 4

1 2 3 4

The wage is based mostly on performance

The wage is based slightly on performance

The wage is not at all based on performance

BQ10-6

About how hard do you work each day, and how hard does your spouse work each day? Please answer based on the amount of work done per hour. SELECT ONLY ONE THAT IS APPLICABLE FOR EACH. , / ? -

.

. Yourself

Your Spouse /

Could not work any harder than currently

1 2 3 4 5

1 2 3 4 5

Work hard continuously

Work continuously but not hard

Work but have some downtime

Work but have a lot of downtime

BQ10-7 What is the possibility that you or your spouse will be unemployed (or in the case of running your own business, the possibility that your business will fail) within the next 2 years? SELECT ONLY ONE THAT IS APPLICABLE. / (

)?

. Yourself

Your Spouse

/ Strong possibility

1 2 3 4

1 2 3 4

Some possibility

Little possibility

Don't know

[ASK ALL] BQ11. What is the occupation of the longest job in your career and what is the occupation of the longest job in your spouses career? SELECT ONLY ONE THAT IS APPLICABLE. Please do not regard "Housewife/Househusband," "Student," "Retired" "Unemployed as occupations for the purposes of this question. / .

.?

, , ,

Yourself

Your Spouse /

Office and administrative support

1 2 3 4 5

1 2 3 4 5

Sales and related occupations

Management, business, and financial operations

,

Professional and related occupations

Service occupations (healthcare support/protective service, or food preparation and serving-related, security guards, etc.) ( / , ,

, , .) 6 7 8 9 6 7 8 9

Construction, extraction, and maintenance , , Farming, fishing, and forestry

Have/Has never worked

Other(Specify):____________________________________

BQ12.

How many children do you have? If you do not have any sons/daughters, please indicate 0 in the following boxes.(Write In Number) ? / 0

.

Son

child/ren

Daughter

child/ren

BQ13.

Before your first child was born, how many children did you want to have? If you do not have any children right now, please indicate how many children you would like to have. (Write In Number)

?

? child/ren

BQ14. Thinking back to when your first child was not yet born, if it had been possible to choose a son or daughter, how many would you have wanted to have of each? If you have a preference, please select 1 and write how many you would have wanted to have of each. If you do not have a preference, please select 2. If you dont have any children now, would you prefer to have a son or daughter? If you have a

preference, please select 1 and write how many you would like to have of each. If you do not have a preference, please select 2. .

, .

? 1 2 Son

1

Have a preference

child/ren

Daughter

childr/en

2

Have No preference

BQ15

Approximately how much was your monthly salary before taxes and with bonus in 2011 (including business income if you are self-employed), and approximately how much was your spouses monthly salary before taxes and with bonus in 2011? 2011 ( ) , /

2011

? Rs. .

You

Income per month

Your spouse

Income per month

Rs. .

/

BQ16

How much time do you and your spouse spend doing housework everyday? Please answer an average amount of time per day for weekdays and weekends. . You

/

?

Your spouse / Minutes

Weekdays Weekends

Hours

Minutes

Weekdays Weekends

Hours

Hours

Minutes

Hours

Minutes

BQ17

How long does it take for you and for your spouse for round-trip commute? If you or your spouse do not work, please indicate 0 in the following boxes.

/ .

?

/ You

Hours

Minutes

Your spouse / Hours Minutes

BQ18

Which of the following best describes your current household? SELECT ONLY ONE THAT IS APPLICABLE. ?

.

Single

1 2 3

You and your parent(s)

You and your spouse

/

You, your spouse and your children / You and your children (no spouse) You, your spouse, and your (or your spouse's) parent(s)

4 5 6

/

You, your spouse, your children and your (or your spouse's) parent(s)

7 8 9

/ ,

You, your spouse, your children and your (or your spouse's) parent(s)/sibling(s) / , /

You and your friend(s) Others (please specify: ( )

)

10

BQ19

How many people are currently living in your household and sharing the same budget including yourself?

Number of people:

BQ20

How much did you spend on durable consumer goods such as housing, cars, and expensive electronic products for your entire family in 2011? Please answer the amount paid in 2011 that means initial payment (if any in 2011) plus monthly installments, not the whole price of housing, cars, etc. 2011 , ?

2011

(2011 ) Rs. per year .

, , .

.

Approximate expense in 2011 for entire family 2011

BQ20-1. Did your household purchase a house (or condo) in 2011?

2011

( )

?

Yes

1 2

No

BQ21 How much were the average food expenses of your entire family per month in 2011? 2011

? Rs. per month . Rs. per month .

Approximate food expenses (excluding expenses of eating out) ( ) Approximate expenses of eating out

BQ22

How much were average expenditures on items other than food and durable consumer goods of your entire family per month in 2011?

Please include clothing, rent, utility charges (gas, electric, water, phone, etc.), medical care, education, leisure and recreation, etc. 2011 ? ,

, .

(

,

, , , ) ,

, .

Approximate other expenses in 2011 for entire family 2011

Rs. per month .

BQ23 By what percentage do you expect consumer prices will change in 2012, compared with the previous year? SELECT ONLY ONE THAT IS APPLICABLE. 2012 ? 3.5

. 1.5 2.5 0.5

Increasee by at least 1.5% but less than 2.5% 2.5 1.5

Decrease by at least 0.5% but less than 1.5% 1.5

Decrease by at least 2.5% but less than 3.5% 3.5

Decrease by at least 4.5% 4.5 Decrease by at least 3.5% but less than 4.5% 4.5

Increase by at least 3.5% but less than 4.5% 4.5

Increase by at least 0.5% but less than 1.5% 1.5 0.5

3.5

Change by less than 0.5% in either direction

2.5

Increase by at least 2.5%but less than 3.5% 3.5

Decrease by at least 1.5% but less than 1% 1

0.5

4.5

10

BQ24

Increase by at least 4.5%

9

8

7

6

5

4

3

2

1

0

Was your mother working when you were 3 years old, 7 years old, and/or 15 years old? Was your spouses mother working when your spouse was 3 years old, 7 years old, and/or 15 years old? Please select from the following and write in the number for the proper selection. .

3

,7

/ ,7 ?

15

? /

3

/

15

/

3 years old

/

7 years old / /

15 years old / / 15

/

7

3 Your mother

Your spouses mother /

1. Full time worker (a company or government institution) (

)

2. Full time worker (self employment) (

) )

3. Part time worker (a company or government institution) (

4. Part time worker (self employment) (

)

5. My mother was not working then.

6. Mother had passed away already or lived separately from respondent.

BQ25

Now, we would like to ask you about dependents in your family. SELECT ONLY ONE THAT IS APPLICABLE. .

. I am supporting someone in my family

1 2 3

I am being supported by someone in my family

I am neither supporting nor being supported by anyone in my family (including singleperson households) (

)

BQ26

Which is the type of your residence? SELECT ONLY ONE THAT IS APPLICABLE. ?

. 1 2 3 4 5 6 7 8

Your own house (a single-family house) ( ) Your own apartment/flat Private rented house (a single house or an apartment) ( ) Supplied house (a company house or an official residence) ( ) Government-owned housing

Lodgings (Hotels, Motels, etc.) ( , , .) Dormitory, Group Quarters, etc. / Others

BQ27

Approximately how much was the annual earned income before taxes and with bonuses included of your entire household for 2011? (If you are a student, please indicate the income of your parents' entire household.) 2011 ?

(

) Rs.

BQ28

Approximately how much household income is your goal? (If you are a student, please indicate the income of your parents entire household.) ? (

) Rs.

BQ29 Approximately how much household income is common for people around you?

? Rs.

BQ30

In 2011, what was the approximate percentage change in your familys total annual income compared with 2010? Please select the most appropriate response from the following list. (If you are a student, please answer for the income of your parents entire household.) 2011 , 2010 ?

. ( Increased by at least 1%but less than 3% Changed by less than 1%in either direction Decreased by at least 1%but less than 3% Decreased by at least 3%but less than 5% Decreased by at least 5%but less than 7% Decreased by at least 7%but less than 9%

)

Increased by at least 9%

Increased by at least 7%but less than 9%



Decreased by at least 9%

9 10

9

7 9

1

5 7 8

5 7

1 3

3 5 7

3 5

9

1 3

9 7

1 1

6

5

4

3

2

1

0

8

Decrease by at least 9%

Decrease by at least 20%

0

0

0

BQ31 In 2012 what will be the approximate percentage change in your familys total annual income

What do you estimate will be the change in total annual income of your household in 2016

your entire household, for you and for your spouse. (If you are a student, please answer on the

, /

compared with 2011? Please select the most appropriate response from the following list. Please

answer for your entire household, for you and for your spouse. (If you are a student, please answer

compared to 2011? Select the most appropriate response from the following list. Please answer for

, /

?

?

9 Decrease by at least 7% but less than 9%

20

0

0 , 2011

Decrease by at least 15% but less than 20%

1

1

1

, 2011


9 7

15

20

1

1income of your parents' entire household.)


2

2

2


5 7

10

2

2 3 4 5 6 7 8 9 10

15 Decrease by at least 6% but less than 10%

3

3


3 5

6

10

3

3 4 5 6 7 8 9 10


)

)

1 3

2

4

6

4

4 5 6 7 8 9 10Entire househould

(

(

5

5

.

1 1 Increase by at least 1% but less than 3%

1

.

Increase by at least 2% but less than 6%

for the income of your parents entire household.)

1 3

2 6

6

6

Increase by at least 3% but less than 5% 3 5


6

10

7

7

Increase by at least 5% but less than 7% 5 7


10

15

8

89

Increase at least 15% but less than 20%

Increase by at least 7% but less than 9% Increase by at least 9%

15

20

9

9

Increase by at least 20%

10

10

20

Entire househould

10Your spouse /

92016 You BQ32

8

7

6

5

Change by less than 1% in either direction

Changed by less than 2% in either direction

2

2 1

4

3

2

1

0

Your spouse 2012

/

You

BQ33.

After you are retired, what proportion of the living expenses of you and your spouse do you think you will be able to cover using Social Security income? SELECT ONLY ONE THAT IS APPLICABLE.

( . 1 2 3 4 5 6 7 8 9 10 11

)

/ 0~9% 10~19% 20~29% 30~39% 40~49% 50~59% 60~69% 70~79% 80~89% 90% or more I dont have social security income.

BQ34

Approximately how much is the present appraised value of all housing and property owned by your entire household? (If you are a student, please answer about the housing and property owned by your parents' entire household.) ? (

) Rs.

X. Do not possess housing or properties.

BQ35

Approximately how much is the balance of financial assets (savings, stocks, bonds, insurance, etc. ) of your entire household? (If you are a student, please indicate the balance of financial assets of your parents' entire household.)

( ,

, , , )

( )

Rs.

BQ36

Please indicate which of the following financial assets you own. SELECT ALL THAT ARE APPLICABLE. .

. unions and other 1

Bank savings (including cooperative banks, credit associations) , Postal savings

2 3 4 5

Life insurance

Stocks

Investment trusts

Foreign currency deposits

6 7 8 9 10 11 12 13 Go to BQ37 BQ37

Futures / Options / India government bonds

Government bonds of foreign countries

Private individual pensions (from life insurance companies, etc.) ( , .) Company pensions

Cash None BQ36-1 Here, financial assets are categorized into the following two groups.

Group A: Bank savings, Postal savings, cash, Indian government bonds

,

, ,

Group B: Investment trusts, Stocks, Futures/Options, Corporate bonds, Foreign currency deposits, Government bonds of foreign countries , / , , ,

Of the financial assets of your entire household that are in either Group A or Group B, about what percentage is in the Group B?

.

%

ASK ALL Does your household have a saving plan for the next one year? If so, how detailed is the plan?

BQ37.

SELECT ONLY ONE THAT IS APPLICABLE. ? ? . 1 2 3 4 5

Have plans for each month

Have plans for each 3 month period.

3 6

Have plans for each 6 month period. Have plans for the whole year.

Dont have any saving plans for the next year.

BQ38.

Do you currently have any debts? Debts here include housing loans, car loans and any other installment payments on which you have to pay interest charges. SELECT ALL THAT ARE APPLICABLE. ?

,

.

. 0 1 2 3 4 5 6 7 8 9

No debts

Housing loan(s)

Car loan(s).

Installment payment(s) for consumption.

Education loan(s).

Borrowing for living and/or medical expenses.

/

Borrowing for business fund(s).

Borrowing for entertainment expenses.

Borrowing to pay off debts.

Other.

BQ39

Do you use credit cards? If you do, how do you use them? SELECT ALL THAT ARE APPLICABLE.

? 1 2 3 4 5 6

.

For payments in full

For payments in installments with no interest

For payments in installments with interest charges

For revolving payments

I have a credit card or cards but do not use it or them

I do not have a credit card

BQ40

Have you ever been rejected for a loan application (excluding housing loans)? SELECT ALL THAT ARE APPLICABLE. (

) ? 1 2

.

Yes

No, but I did not get approved for the full amount for which I applied, only for a reduced amount. , ,

Did not apply because I did not think I would be approved.

3 4 5

No, I have always been able to borrow the amount I applied for. , I have never attempted to borrow money.

BQ41

On a scale of 0-10 with 10 being Highest and 0 being Lowest, please indicate what you think your standard of living is. SELECT ONLY ONE THAT IS APPLICABLE. 0 10 10 0 ,

. 7 6 5 4 3 2 1 0

(Rate)

10

9

8

Highest

Lowest

BQ42

How would you describe your current health status: Is it excellent, very good, good, fair, or poor? SELECT ONLY ONE THAT IS APPLICABLE. , .

,

,

, ,

Excellent

1 2 3 4 5

Very good

Good

Fair

Poor

BQ43

Do you smoke? SELECT ONLY ONE THAT IS APPLICALBE. ?

. 1 2 3 4 5 6 7 8 9 10 -> Skip to BQ44 BQ44

Never smoked

Hardly smoke

Occasionally Smoke

I smoke about 1 to 5 cigarettes a day. 1 5 I smoke about 6 to 10 cigarettes a day. 6 10 I smoke about 11 to 20 cigarettes a day. 11 20 I smoke about 21 to 30 cigarettes a day. 21 30 I smoke about 31 to 40 cigarettes a day. 31 40 I smoke 41 cigarettes or more a day. 41 I used to smoke, but I quit ,

IF THE RESPONDENT ANSWERED 2 TO 10 FOR BQ43, CONTINUE TO THE FOLLOWING QUESTIONS FROM BQ43-1 TO BQ43-2. OTHERWISE, SKIP TO BQ44. BQ43 2 10 BQ43-1 43-2 BQ44

BQ43-1 How old were you when you started smoking?

?

Around ____________years old

....................

BQ43-2

How long does it take to get to a smoking area in your work place? If you are not working, please answer about smoking at the place you spend most of the day. If you used to smoke but quit, please answer about the time when you were smoking. SELECT ONLY ONE THAT IS APPLICABLE.

? .

.

. 1 2 3 4 5 6

0 minutes (I can smoke right at my seat) 0 ( ) 1-2 minutes 1-2 3-5 minutes 3-5 6-10 minutes 6-10 11 minutes or more 11 Smoking is not allowed at all at my workplace

BQ43-3. Do you want to quit smoking? Would you like to quit smoking? SELECT ONLY ONE THAT IS APPLICABLE. ?

? 1 2 3 4 5

. Yes, I want to quit smoking ? I want to reduce the amount of cigarettes I smoke

No, I dont want to quit smoking

I dont know

I dont smoke.

IF THE RESPONDENT ANSWERED 10 FOR BQ43, CONTINUE THE FOLLOWING QUESTIONS FROM BQ43-4 TO BQ43-5. OTHERWISE, SKIP TO BQ44. BQ43 10 BQ43-4 43-5 BQ44

BQ43-4 When is the last time you smoked? (approximately)

? ( ) YY

MM

around (_______) / (_______) /

BQ43-5 How long did it take for you to finally quit smoking once you decided to quit?

?

about ____________days

....................

ASK ALL BQ44 Do you exercise? Please select one that is the most applicable to you.

? . 1 2 3 4 5

Almost everyday

A few times a week

About once a week

About once a month

Dont exercise at all

BQ45

Do you drink alcoholic beverages? SELECT ONLY ONE THAT IS MOST APPLICABLE. ?

.

Don't drink at all

1 2 3 4 5

Hardly drink (a few times a month or less) ( ) Drink sometimes (a few times a week) ( ) Drink a little almost daily

Drink a lot almost daily

BQ46

Do you gamble in lotteries or at casinos, or bet on sporting events or horse races? SELECT ONLY ONE THAT IS MOST APPLICABLE. ,

?

.

Don't gamble at all

1 2 3 4 5 6

Hardly gamble

Several times a year or so

Once a month or so

Once a week or so

Almost everyday

BQ47

Please indicate if you are affiliated with any of the following religions. SELECT ONLY ONE THAT IS APPLICABLE.

.

Do not belong to any denomination

1 2 3 4 5 6 7 8 9 10

Buddhism

Christian Protestant

Christian - Roman Catholic Other Christian

Hinduism

Islam / Muslim / Jainism

Sikhism

Others (Specify.)

Thank you very much for your cooperation.

8

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