PARTICIPANT ID NUMBER

WHO STEPS Instrument

for Epi Info training
Questions
1 Date of completion of the instrument Sex (Record Male / Female as observed) 2 3 4 5 6 How old are you? Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes? If Yes, Do you currently smoke tobacco products daily? On average, how many of the following do you smoke each day? (RECORD FOR EACH TYPE) Dont remember 777 Pipes full of tobacco Cigars, cheroots, cigarillos Other Other (please specify): 7 Have you consumed alcohol (such as beer, wine, spirits, fermented cider or [add other local examples] within the past 12 months? In the past 12 months, how frequently have you had at least one drink? Yes No Daily 5-6 days per week 1-4 days per week 1-3 days per week Less than once a month 9 When was your blood pressure last measured by a health professional? Height Weight If too large for scale, code 666.6 SBP Reading 1 SBP Reading 2 SBP Reading 3 Within past 12 months 1-5 years ago Not within past 5 years in Centimetres (cm) in Kilograms (kg)

Response

dd Male Female Years Yes No Yes No Manufactured cigarettes Hand-rolled cigarettes 1 2 mm year

Code

I5
C1 C3 T1 T2 T5a T5b T5c T5d T5e T5other A1

1 2 1 2 If No, go to T6 If No, go to T6

If other, go to T5 other
1 2 1 2 3 4 5 1 2 3 If No, go to D1

A2

H1 M3 M4 M11a M12a M13a

10 11 12 13 14

. .
Systolic ( mmHg) Systolic ( mmHg) Systolic ( mmHg)

STEPS introduction to Epi Info training: Instrument