General health condition
Health compared to one year ago
Bodily pain during the past month
Physical health interfered normal activities past month
Height
Weight
Ever regularly smoked cigarettes or used tobacco
Smoke or use tobacco now
Type of tobacco smoked
Frequency of Smoking (Amt/day)
Past 2 Weeks: How Many Times 5+ Drinks
Number of Drinks Typically Consumed at Party
Number of Drinks Others Have a Parties
Ever Injure Self Because of Drinking
Ever Injure Anyone Else Because of Your Drinking
Rode in a car driven by someone who had been drinking
Drove after having three or more drinks
Wear a seat belt
In past 12 months, Ride a motorcycle
Wear a helmet when you rode motorcycle
In past 12 months, ride a bicycle
Wear a helmet when you rode bicycle
Past 30 days, days carried a weapon
Past 30 days, days carried a gun
Ever tried marijuana?
Past month, times used marijuana
Ever tried cocaine or crack
Past month, times used cocaine or crack
Ever tried hallucinogens
Past month, times used hallucinogens
Ever tried amphetamines-cat 3 added 98
Past month, times used amphetamines/other drugs
Ever Tried Ritalin
Times/Past Month, Ritalin
Ever tried heroin, opium, or other narcotics
Past month, times used narcotics
Ever injected any non-prescription drugs
Past month, times injected non-prescription drugs
Use herbal remedies
Inform care provider about herbal remedies use
Intercollegiate athletics
Days per week exercise
Average exercise length
Handling the stress
Past year, sought counseling for stress
Sex
Marital status
Ever engaged in sexual intercourse
Age first engage in sexual intercourse
Number of sexual partners last year
Had sex under influence of drugs, alcohol
How often had sex under influence of drugs, alcohol
Alcohol, drug make poor choice on contraception, safe sex
Last sexual intercourse, contraceptive used
Contraceptive method used no None and combined cats in 98
Ever had sexually transmitted disease
Sexually transmitted diseases(1)
Sexually transmitted diseases(2)
Sexually transmitted diseases(3)
Sexually transmitted diseases(4)
Ever been/gotten someone pregnant
Pregnancies intended or accidental
Pregnancies while student at the UO
Past year, forced to have sex
Alcohol/Drugs Involved with Sexual Abuse
Sexual orientation
Had a Pap smear test in past 3 years
Past month, days sick enough to miss class/work
Considered/dropped out due to health problems
Considered/dropped out due to medical expenses
Ever seriously thought about suicide
Past 12 months, ever seriously consider suicide
Past 12 months, made suicide attempts
Times used SHC past year
Health improve because of your visit
Use services again if needed
Why not used SHC past year
SHC can improve services
Cost of SHC compared to other health services
Currently covered by health insurance
Who pays your health insurance
Often found unable to afford needed health care
All UO students be required to have health insurance
Prefer increase in prepaid/increased charges
Pay 2-3 dollars more for health center expantion and renovation
Ever seen health center web page
Ever seen Well Now on Emerald
Primary health center mission should be
Convenient time to visit health center
Class status
Age
Living arrangement
Member of a fraternity or sorority
Race
International student
Pell grant
Credit hours enrolled this term
Most stressful experience past year
Why not had PAP smear test
Most serious health-related issue
Personal major health concern
How health center can improve services
Major