Respiratory Health Survey-P3-PostTraining-MM

As part of our research, we would like to know more about your respiratory health and to learn how recently you have experienced symptoms.

Thank you for your involvement, time and efforts!

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* 1. ID and Zip/Postal Codes

Your ID Code

ZIP/Postal Code

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* 2. Please enter today's date:

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* 3. Please indicate the last time you recall having symptoms of each of these conditions.

	Within the last 30 days.	Three to twelve months ago.	One to five years ago.	More than 5 years ago.	I do not recall/ Not applicable	I prefer not to respond to this question.
Sinusitis or Rhino-sinusitis	Sinusitis or Rhino-sinusitis Within the last 30 days.	Sinusitis or Rhino-sinusitis Three to twelve months ago.	Sinusitis or Rhino-sinusitis One to five years ago.	Sinusitis or Rhino-sinusitis More than 5 years ago.	Sinusitis or Rhino-sinusitis I do not recall/ Not applicable	Sinusitis or Rhino-sinusitis I prefer not to respond to this question.
Chronic Obstructive Pulmonary Disease or other lung dysfunction (other than asthma)	Chronic Obstructive Pulmonary Disease or other lung dysfunction (other than asthma) Within the last 30 days.	Chronic Obstructive Pulmonary Disease or other lung dysfunction (other than asthma) Three to twelve months ago.	Chronic Obstructive Pulmonary Disease or other lung dysfunction (other than asthma) One to five years ago.	Chronic Obstructive Pulmonary Disease or other lung dysfunction (other than asthma) More than 5 years ago.	Chronic Obstructive Pulmonary Disease or other lung dysfunction (other than asthma) I do not recall/ Not applicable	Chronic Obstructive Pulmonary Disease or other lung dysfunction (other than asthma) I prefer not to respond to this question.
Tonsillitis or other throat infections	Tonsillitis or other throat infections Within the last 30 days.	Tonsillitis or other throat infections Three to twelve months ago.	Tonsillitis or other throat infections One to five years ago.	Tonsillitis or other throat infections More than 5 years ago.	Tonsillitis or other throat infections I do not recall/ Not applicable	Tonsillitis or other throat infections I prefer not to respond to this question.
Pneumonia or influenza	Pneumonia or influenza Within the last 30 days.	Pneumonia or influenza Three to twelve months ago.	Pneumonia or influenza One to five years ago.	Pneumonia or influenza More than 5 years ago.	Pneumonia or influenza I do not recall/ Not applicable	Pneumonia or influenza I prefer not to respond to this question.
Bronchitis	Bronchitis Within the last 30 days.	Bronchitis Three to twelve months ago.	Bronchitis One to five years ago.	Bronchitis More than 5 years ago.	Bronchitis I do not recall/ Not applicable	Bronchitis I prefer not to respond to this question.
Asthma	Asthma Within the last 30 days.	Asthma Three to twelve months ago.	Asthma One to five years ago.	Asthma More than 5 years ago.	Asthma I do not recall/ Not applicable	Asthma I prefer not to respond to this question.
Allergies or reactivity to airborne irritants	Allergies or reactivity to airborne irritants Within the last 30 days.	Allergies or reactivity to airborne irritants Three to twelve months ago.	Allergies or reactivity to airborne irritants One to five years ago.	Allergies or reactivity to airborne irritants More than 5 years ago.	Allergies or reactivity to airborne irritants I do not recall/ Not applicable	Allergies or reactivity to airborne irritants I prefer not to respond to this question.
Cough	Cough Within the last 30 days.	Cough Three to twelve months ago.	Cough One to five years ago.	Cough More than 5 years ago.	Cough I do not recall/ Not applicable	Cough I prefer not to respond to this question.
Laryngitis or hoarseness	Laryngitis or hoarseness Within the last 30 days.	Laryngitis or hoarseness Three to twelve months ago.	Laryngitis or hoarseness One to five years ago.	Laryngitis or hoarseness More than 5 years ago.	Laryngitis or hoarseness I do not recall/ Not applicable	Laryngitis or hoarseness I prefer not to respond to this question.
Mouth or gum infections	Mouth or gum infections Within the last 30 days.	Mouth or gum infections Three to twelve months ago.	Mouth or gum infections One to five years ago.	Mouth or gum infections More than 5 years ago.	Mouth or gum infections I do not recall/ Not applicable	Mouth or gum infections I prefer not to respond to this question.
Ear infections	Ear infections Within the last 30 days.	Ear infections Three to twelve months ago.	Ear infections One to five years ago.	Ear infections More than 5 years ago.	Ear infections I do not recall/ Not applicable	Ear infections I prefer not to respond to this question.

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* 4. In your own experience, please tell us about any triggers that are associated with nasal or sinus congestion or infection. Please include both environmental triggers and other health associated factors that may be related to onset or duration of these problems.

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* 5. Regarding the wellness activities that are part of your life, please indicate any category in which you have participated over the last year. Select as many as apply. Select the frequency category that best applies to your activities.

	None	Less than 10 minutes a week	Less than an hour a week	2 to 6 hours per week	7 to 15 hours per week	16 or more hours per week
Meditative movement (Tai Chi, Qigong, Yoga, or similar)	Meditative movement (Tai Chi, Qigong, Yoga, or similar) None	Meditative movement (Tai Chi, Qigong, Yoga, or similar) Less than 10 minutes a week	Meditative movement (Tai Chi, Qigong, Yoga, or similar) Less than an hour a week	Meditative movement (Tai Chi, Qigong, Yoga, or similar) 2 to 6 hours per week	Meditative movement (Tai Chi, Qigong, Yoga, or similar) 7 to 15 hours per week	Meditative movement (Tai Chi, Qigong, Yoga, or similar) 16 or more hours per week
Seated meditation	Seated meditation None	Seated meditation Less than 10 minutes a week	Seated meditation Less than an hour a week	Seated meditation 2 to 6 hours per week	Seated meditation 7 to 15 hours per week	Seated meditation 16 or more hours per week
Strength training (Weight training, resistance machines, or similar)	Strength training (Weight training, resistance machines, or similar) None	Strength training (Weight training, resistance machines, or similar) Less than 10 minutes a week	Strength training (Weight training, resistance machines, or similar) Less than an hour a week	Strength training (Weight training, resistance machines, or similar) 2 to 6 hours per week	Strength training (Weight training, resistance machines, or similar) 7 to 15 hours per week	Strength training (Weight training, resistance machines, or similar) 16 or more hours per week
Endurance (Aerobic ) training (Walking, running, jogging, cycling, etc)	Endurance (Aerobic ) training (Walking, running, jogging, cycling, etc) None	Endurance (Aerobic ) training (Walking, running, jogging, cycling, etc) Less than 10 minutes a week	Endurance (Aerobic ) training (Walking, running, jogging, cycling, etc) Less than an hour a week	Endurance (Aerobic ) training (Walking, running, jogging, cycling, etc) 2 to 6 hours per week	Endurance (Aerobic ) training (Walking, running, jogging, cycling, etc) 7 to 15 hours per week	Endurance (Aerobic ) training (Walking, running, jogging, cycling, etc) 16 or more hours per week
Sports	Sports None	Sports Less than 10 minutes a week	Sports Less than an hour a week	Sports 2 to 6 hours per week	Sports 7 to 15 hours per week	Sports 16 or more hours per week
Occupational activity that you feel supports your wellness.	Occupational activity that you feel supports your wellness. None	Occupational activity that you feel supports your wellness. Less than 10 minutes a week	Occupational activity that you feel supports your wellness. Less than an hour a week	Occupational activity that you feel supports your wellness. 2 to 6 hours per week	Occupational activity that you feel supports your wellness. 7 to 15 hours per week	Occupational activity that you feel supports your wellness. 16 or more hours per week
Calisthenic type activities (Zumba, Pilates, etc)	Calisthenic type activities (Zumba, Pilates, etc) None	Calisthenic type activities (Zumba, Pilates, etc) Less than 10 minutes a week	Calisthenic type activities (Zumba, Pilates, etc) Less than an hour a week	Calisthenic type activities (Zumba, Pilates, etc) 2 to 6 hours per week	Calisthenic type activities (Zumba, Pilates, etc) 7 to 15 hours per week	Calisthenic type activities (Zumba, Pilates, etc) 16 or more hours per week
Other	Other None	Other Less than 10 minutes a week	Other Less than an hour a week	Other 2 to 6 hours per week	Other 7 to 15 hours per week	Other 16 or more hours per week

Other (please specify)

Thank you for your time and commitment to this project!