Hhq-Gp-1 Healthy Heart Questionnaire - Urban Indian Heart Health Program Page 7
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15Healthy Heart Questionnaire (HHQ-GP-1)
7
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No
25. In the future, do you intend to reduce the amount of fat you eat so it is lower than it is now?
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Yes, and I intend to in the next 30 days
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Yes, and I intend to in the next 6 months
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No, and I do not intend to in the next 6 months
26. Do you smoke cigarettes now? (For these questions, we are not interested in the tobacco
you may smoke for ceremonial use.)
Yes
No you may go to question #32
27. Thinking over the past 30 days, including today, how many days during this time did you
smoke?
_________ days
28. About how many cigarettes a day do you now smoke?
__________cigarettes a day
29. About how many years have you been smoking?
_________ years
30. In the past year, how many times have you quit smoking for at least 24 hours?
_________ times
31. Are you seriously thinking of quitting smoking?
Yes, within the next 30 days
Yes, within the next 6 months
No, not thinking of quitting
Next, we’d like to ask you about the signs and symptoms of a heart attack.
32. Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?
Yes
No
Don’t Know/Not Sure
33. Do you think feeling weak, lightheaded, or faint are symptoms of a heart attack?
Yes
No
Don’t Know/Not Sure
34. Do you think swelling of the feet and legs is a symptom of a heart attack?
Yes
No
Don’t Know/Not Sure
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