1. Do you wear gloves when using cleaning agents?
a. Often
b. Sometimes
c. Occasionally
d. Never
2. How effectively do you manage your stress?
a. I feel stressed out occasionally
b. Not too badly—I feel I am coping
c. I feel overwhelmed a lot of the time
d. I feel my stress affects my health (I experience stress-related symptoms such as backaches, insomnia, indigestion or headaches)
3. How do you feel you manage your relationships with others?
a. Great—my friendships and family ties are strong
b. Somewhat lacking, because I am so busy
c. I feel isolated a lot of the time
d. Good—even though I may not speak to or see people regularly
4. Do you get the flu shot?
a. Yes, I had it once
b. Yes, I have had between two and four flu shots
c. Yes, I have had more than five flu shots
d. No, I have never had the flu shot
5. How often do you eat fried or deep-fried foods?
a. Never
b. Occasionally
c. Often
d. All the time
6. How many things in your life make you happy and grateful?
a. I don’t have much to be happy about
b. Life is okay, nothing special
c. There are a few things that really make me happy
d. The list is so long I don’t know where to start.