CDEs
Forms
In the past 7 days My friends and I helped each other out.
In the past 7 days I felt everything in my life went wrong.
In the past 7 days I felt unhappy.
In the past 7 days I was less interested in doing things I usually enjoy
In the past 7 days It was hard for me to care about anything.
In general, how would you rate your physical health?
Thinking about my life, I can reach my goals in life.
In the past 7 days It was hard for me to play sports or exercise because of my asthma.
In the past 7 days It was hard for my child to have fun when he/she had pain.
In the past 7 days, when my child was in pain he/she asked for someone to help him/her.
After not smoking for a while, I need to smoke in order to avoid feeling any discomfort.
In the past 7 days I could walk up stairs without holding on to anything.
Smoking helps me concentrate.
I love the feel of inhaling the smoke into my mouth.
In the past 7 days I am disappointed in my ability to socialize with my family
In the past 7 days, How many days did you exercise or play so hard that your body got tired?
CURRENT level of confidence I can take my medication when I am working or away from home.
In the past 30 days How often have you stopped sexual activity because of discomfort or pain in your vagina?
In the past 7 days My child could do sports and exercise that other kids his/her age could do.
I had trouble finishing things because I was too tired
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