Research with East London Adolescents Community Health Survey (RELACHS Study)

Your answers are CONFIDENTIAL – nobody other than the research team will know what your answers are.
They will NOT be seen by your parents or teachers.

Your views are important to us.

Enjoy!

RELACHS study, Queen Mary, 3rd floor, BMS Building, London E1 4NS Tel: 020 7882 7727

Some questions about you

REMEMBER YOUR ANSWERS WILL BE KEPT CONFIDENTIAL

1.  Are you a boy or a girl? Boy 1

Girl 2

2.  What is your date of birth?

______/______/______

date month year

3.  What languages are spoken in your home?

*tick ALL languages that apply*

1 English 2 Hindi 3 Gujerati 4 Punjabi

5 Bengali 6 Sylheti 7 Tamil 8 Mandarin

9 Urdu 10 Patois/Creole 11 Hakka 12 African Language

13 Yiddish 14 Hebrew 15 Cantonese

16 Other(s) (please write) ______

4.  What is the main language spoken in your home?

*tick ONE language*

1 English 2 Hindi 3 Gujerati 4 Punjabi

5 Bengali 6 Sylheti 7 Tamil 8 Mandarin

9 Urdu 10 Patois/Creole 11 Hakka 12 African Language

13 Yiddish 14 Hebrew 15 Cantonese

16 Other(s) (please write) ______

5.  What religious group or church do you belong to?

*tick ONE box*

1 None 2 Jewish

3 Christian 4 Muslim/Islam

5 Church of England 6 Hindu

7 Methodist 8 Sikh

9 Baptist 10 Agnostic/Atheist

11 Catholic 12 Don’t know

13 Other (please write)______

6. How often, outside of school, do you go to a church or synagogue or

temple or mosque?

*tick ONE box*

1 Never

2 Less than once a year

3 About once or twice a year

4 About 3 or 4 times a year

5 About once a month

6 Once a week

7 Once a day, or more

7. Which category best describes you? - This is your race

or ethnic group

*tick ONE box*

White White: UK 1
White: Irish 2
White: Greek 3
White: Turkish 4
White: Orthodox Jewish 5
White: Kurdish 6
White: other (please write) ______7
Mixed Mixed: White and Black Caribbean 8
Mixed: White and Black African 9
Mixed: White and Asian 10
Mixed: other (please write) ______11
-
Asian Asian: Indian 12
Asian: Pakistani 13
Asian: Bangladeshi 14
Asian: other (please write) ______15
Black Black: Caribbean 16
Black: African 17
Black: Somali 18
Black: British 19
Black: other (please write)______20
Chinese 21
Vietnamese 22
Other (please write) ______23
Your home and family

These questions are about your home.

If you live in different homes, answer for the home where you live most of the time.

8. Who do you live with?

If you live in different homes, answer for the home where you live most of the time.

*tick ALL boxes that apply* IF YOU DO LIVE WITH YOUR

Mum 1 MUM AND DAD

Dad 2 IN THE SAME HOME GO TO Q.10

Step-dad 3

Step-mum 4

Mum’s boyfriend / partner 5 IF YOU DO NOT LIVE WITH YOUR

Dad’s girlfriend / partner 6 MUM AND DAD IN THE

Grandmother 7 IN THE SAME HOME GO TO Q. 9

Grandfather 8

In care 9

Other 10

9. If you do not live with both your Mum and your Dad in the same home, why is this?

*tick ONE box*

I do not live with my Mum or Dad because…

1 they are separated or divorced

2 my Mum is not alive

3 my Dad is not alive

4 another reason


10. How MANY other people do you live with at home, apart from yourself?

If you live in different homes, answer for the home where you live most of the time.

*write the NUMBER on the line below*

I live with ______other adults and children not including myself

(e.g. If you live with Mum, Step-dad and two sisters write ‘4’)

11. Are the adults you live with working in a job, or not working in a job, at the

moment?

If you live in different homes, answer for the home where you live most of the time.

*tick ONE box for each person you live with*

1 Mum or Step-mum does not have a job

2 Mum or Step-mum has a job/ is a student

3 Dad or Step-dad does not have a job

4 Dad or Step-dad has a job/ is a student

5 Don’t live with any of these people

12. How MANY rooms other than the kitchen, bathroom and hall does your home have?

*write the NUMBER on the line below*

My home has ______rooms not including the kitchen, bathroom and hall

13. Does anyone you live with have a car or van?

1 No 2 Yes, one 3 Yes, two or more

14. What is your postcode?

(We are collecting this information to see what your local area is like)

1 My postcode is______

Full Postcode (e.g. E14 8BS):

2 I don’t know my postcode

15. How long have you lived in this country ?

1 All of my life

2 Over 10 years

3 6 – 10 years

4 1 – 5 years

5 Less than 1 year

16.  Which country were you born in?

I was born in: ______

Your health

17. In general would you say your health is…

*tick ONE box*

1 very good 2 good 3 fair 4 bad 5 very bad

17. Do you have any long-standing illness or disability? By this we mean a health problem that has troubled you over a period of time, or is likely to affect you over a period

of time.

1 No I don’t have a long standing illness Go to Question 19

2 Yes I do have a long standing illness Go to Question 18.1

18.1 Do you have any of these health problems?

*tick ALL that you have*

Asthma 1

Eczema 2

Epilepsy 3

Diabetes 4

Hearing problems 5 If you ticked ANY of these,

Eyesight problems 6 go to question 18.2

Hay fever 7

Chronic Fatigue Syndrome / ME 8

Other health problem/s (please write)

______9

18.2 Does the problem you have limit your activities in any way?

*tick ONE box for each problem you have*

Not at all A little Quite a lot A great deal
Asthma limits me / 1 / 2 / 3 / 4
Eczema limits me / 1 / 2 / 3 / 4
Epilepsy limits me / 1 / 2 / 3 / 4
Diabetes limits me / 1 / 2 / 3 / 4
Hearing problems limit me / 1 / 2 / 3 / 4
Eyesight problems limit me / 1 / 2 / 3 / 4
Hay fever limits me / 1 / 2 / 3 / 4
Chronic Fatigue Syndrome / ME limits me / 1 / 2 / 3 / 4
Other health problem/s limit me / 1 / 2 / 3 / 4

19. In the last month, how often have you had the following?

*tick one box on EVERY LINE*

Rarely About About More than About

or once last weekly once a daily

never month Week

Headache / 1 2 3 4 5
Stomach ache / 1 2 3 4 5
Back pain / 1 2 3 4 5
Other aches and pains / 1 2 3 4 5
Extreme tiredness / 1 2 3 4 5
Your moods and feelings

20. For each item, please mark the box for Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not absolutely certain or the item seems daft! Please give your answers on the basis of how things have been for you over the last six months.

Not Somewhat Certainly

True True True

I try to be nice to other people, I care about their feelings / 1 2 3
I am restless, I cannot stay still for long / 1 2 3
I get a lot of headaches, stomach-aches or sickness / 1 2 3
I usually share with others
(food, games, pens etc.) / 1 2 3
I get very angry and often lose my temper / 1 2 3
I am usually on my own, I generally play alone or keep to myself / 1 2 3
I usually do as I am told / 1 2 3
I worry a lot / 1 2 3

PLEASE CHECK: Have you ticked one box on EVERY LINE???

Not Somewhat Certainly

True True True

I am helpful if someone is hurt, upset or feeling ill / 1 2 3
I am constantly fidgeting or squirming / 1 2 3
I have at least one good friend / 1 2 3
I fight a lot. I can make other people do what I want / 1 2 3
I am often unhappy, downhearted or tearful / 1 2 3
Other people my age generally like me / 1 2 3
I am easily distracted, I find it difficult to concentrate / 1 2 3
I am nervous in new situations. I easily
lose confidence / 1 2 3
I am kind to younger children / 1 2 3

PLEASE CHECK: Have you ticked one box on EVERY LINE???

Not Somewhat Certainly

True True True

I am often accused of lying or cheating / 1 2 3
Other children or young people pick on me or bully me / 1 2 3
I often volunteer to help others (parents, teachers, children) / 1 2 3
I think before I do things / 1 2 3
I take things that are not mine from home, school or elsewhere / 1 2 3
I get on better with adults than with people my own age / 1 2 3
I have many fears, I am easily scared / 1 2 3
I finish the work I’m doing. My attention is good. / 1 2 3

PLEASE CHECK: Have you ticked one box on EVERY LINE???


Some questions about school

21. Have you ever been bullied at school? (This could be at any school)

No 1 Go to question 22


Yes 2 Go to question 21.1

21.1 How often have you been bullied in school this term? (This could be at any school)

I haven’t been bullied in school this term 1

Once or twice 2

Sometimes 3

About once a week 4

Several times a week 5

22. How often this term has someone done any of these things to you?

*tick one box on EVERY LINE*

Not Once Sometimes About More than

this or once once a

term twice a week week

Made fun of you because 1 2 3 4 5

of your religion or race

Made fun of you because 1 2 3 4 5

of your looks or the way

you talk

Hit, slapped or pushed 1 2 3 4 5

you

Spread rumours or mean 1 2 3 4 5

lies about you

Physical activities

These questions are to see how much exercise you do. Please read them carefully.

23.  OUTSIDE SCHOOL HOURS: How often do you usually exercise in your free

time so much that you get out of breath or sweat?

*tick ONE box*

Every day 1

4-6 times a week 2

2-3 times a week 3

Once a week 4

Less than once a month 5

Never 6

24. OUTSIDE SCHOOL HOURS: How many hours a week do you usually exercise in your free time so much that you get out of breath or sweat?

*tick ONE box*

None 1

About half an hour 2

About 1 hour 3

About 2-3 hours 4

About 4-6 hours 5

7 hours or more 6

25. OUTSIDE SCHOOL HOURS: On average, how many hours a day do you usually watch TV / videos, play video games or play on the computer?

*tick ONE box*

Not at all 1

Less than half an hour a day 2

Half an hour to 1 hour 3

2-3 hours 4

4 hours 5

More than 4 hours 6

Smoking

REMEMBER - NOBODY YOU KNOW WILL SEE YOUR ANSWERS

26. Now read the following sentences carefully and tick the box next to the one which best describes you

I have never smoked……………………. 1 Go to question 27

I have only ever tried smoking once…… 2

I used to smoke sometimes but I never

smoke a cigarette now…………………. 3

I sometimes smoke cigarettes now, but I

don’t smoke as many as one a week….. 4 Go to question 28

I usually smoke between one and six

cigarettes a week………………………... 5

I smoke more than six cigarettes a week 6

27. Just to check, read the statements below carefully and tick the box next to the

one which best describes you.

I have never tried smoking a cigarette, not 1 Go to question 30

even a puff or two.

I did once have a puff or two of a cigarette, but 2

I never smoke now. Go to question 28

I do sometimes smoke cigarettes. 3

28.  How old were you when you first tried smoking a cigarette, even if it was only

a puff or two?

Write how old you were then: ______

29. Did you smoke any cigarettes last week?

Yes 1 Go to question 29.1 No 2 Go to question 30