Health Risk Assesment Question Title * 1. Age Question Title * 2. Sex Male Female Question Title * 3. Rank Question Title * 4. Branch of Service USMC USMCR USN USNR USA USAR USAF USAFR USCG USCGR Question Title * 5. Race/Ethnicity Caucasian African American Asian/Pacific Islander American Indian Native Alaskan Other Prefer not to answer Question Title * 6. Height Question Title * 7. weight (for women, enter non pregnant weight) Question Title * 8. Would you say that your health in general is Excellent Good Fair Poor Question Title * 9. Do you currently smoke cigarettes, cigars, pipes or hookah? Every day Most days Some days Never smoked I quit Question Title * 10. Do you currently use smokeless tobacco (e.g., dip, snuff)? Every day Most days Some days Never used smokeless tobacco I quit Question Title * 11. How many alcoholic beverages do you have during a typical day when you drink alcohol? (One drink = 12 ounces of regular beer, 5 ounces of wine, 1.5 ounces of 80-proof distilled spirits) 5 or more 3-4 1-2 Not applicable, I do not drink alcohol or I seldom drink alcohol Question Title * 12. How often do you typically drink 5 or more alcoholic drinks on one occasion?("One Occasion" refers to an event or period when drinking exceeds one drink per hour) Daily Weekly Monthly Once or twice per year Never Question Title * 13. How often do you drive when perhaps you have had too much to drink? Often (i.e., more than once during the past 6 months) Sometimes (i.e., once during the past 6 months) Rarely (i.e., not in the past past 6 months, but at least once during the past year) Never Question Title * 14. Do you use a seat belt when you drive or ride as a passenger? Always Most of the time Sometimes Rarely Never Question Title * 15. How often do you wear a helmet when you ride a motorcycle, all-terrain vehicle, or bicycle? Always Most of the time Sometimes Rarely Never Does not apply to me / I do not ride these vehicles Question Title * 16. How often do you use the safety equipment recommended for your job? (e.g., hearing and vision protection, respirators, barriers, and other safety devices) Always Most of the time Sometimes Rarely Never Does not apply to me / None recommended Question Title * 17. In general, how satisfied are you with your life? (e.g., work situation, social activity, accomplishing what you set out to do) Very satisfied Mostly satisfied Somewhat satisfied Not satisfied Question Title * 18. How often do you feel that your work situation is putting you under too much stress? Always Most of the time Sometimes Rarely Never Question Title * 19. If you are feeling lonely, depressed, angry, stressed, or in need of help, do you have someone to talk to? Always Most of the time Sometimes Rarely Never Not applicable. I do not experience these feelings and have no need to talk about them. Question Title * 20. In the past 12 months, how often did you or your partner(s) use a condom when you had sex?(read all choices below carefully before responding) Does not apply to me because I am in a long-term relationship where we only have sex with each other Currently I am not sexually active Always Most of the Time Sometimes Rarely or Never Question Title * 21. On average, how many weeks per month do you engage in a total of at least 150 minutes of moderate-intensity aerobic activity (moderate-intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation. i.e., brisk walking, swimming leisurely, or leisurely biking ) OR at least 75 minutes of vigorous-intensity aerobic activity (vigorous-intensity means you will not be able to say more than a few words without pausing for a breath , i.e., jogging/running, swimming laps, or jumping rope)? 4 weeks per month 3 weeks per month 2 weeks per month 1 week per month I do not participate in aerobic training Question Title * 22. On average, how many days per week do you engage in muscle-strengthening actvities that work all muscle groups (legs, hips, back, abdomen, chest, shoulders and arms). 4 or more days a week 3 days a week 2 days a week 1 day a week I do not participate in strength training Question Title * 23. How often do you usually eat high-fat foods? (e.g., fried foods; high-fat dairy products such as butter, cheese, or whole milk; regular salad dressing or mayonnaise; or packaged foods high in fats) At most or every meal At least once a day 3-5 times per week 1-2 times per week Rarely or never Question Title * 24. About how many cups of fruit do you eat each day? (One cup of fruit = one small piece of fruit, one cup of cut-up fruit, one cup of 100% fruit juice, or 1/2 cup of dried fruit) Four or more Three Two One Less than one Question Title * 25. How often do you use over the counter (OTC) drugs, dietary supplements, or herbal products to help you manage your weight, enhance athletic performance, or treat depression? Daily Weekly Monthly Seldom Never Question Title * 26. How frequently do you floss your teeth? Daily Most days Sometimes Rarely Never Question Title * 27. About how many cups of vegetables do you eat each day? (One cup of vegetables = one cup of raw or cooked vegetables, 1 cup of 100% vegetable juice, or 2 cups of raw leafy greens) Four or more Three Two One Less than one Question Title * 28. How often do you get enough restful sleep to function well in your job and personal life? Always Most of the time Sometimes Rarely Never Question Title * 29. For both men and women, pregnancy is a life-changing event for mother and father. Regarding your actions related to possible pregnancy I am not having sexual intercourse at this time in my life Either my partner or I cannot become pregnant My partner and I are pregnant, we are trying to have a baby now, or we would welcome a pregnancy if it occurred now My partner or I are correctly and consistently using birth control ALL the time My partner or I are correctly using birth control MOST of the time My partner or I are correctly using birth control SOME of the time My partner and I are not using birth control Done