| If yes, please answer the following questions about your obstetrical history Otherwise, go to IV. | ||
30 | Gestity (number of pregnancies) | /_____/_____/ | atcd1 |
31 | Number of miscarriages | /_____/_____/ | atcd2 |
32 | Parity (number of births) | /_____/_____/ | atcd3 |
33 | Number of living children | /_____/_____/ | atcd4 |
34 | Have you exclusively breastfed your child (ren)? | 0 = No 1 = Yes | atcd5 |
Social survey | |||
35 | Do you drink alcohol daily or often? | 0 = No 1 = Yes | es1 |
36 | If so, how many can you estimate in terms of the number of standard glasses per dose? | /____/ standard glasses | es2 |
37 | Do you use tobacco (smoked, chewed, snuffed)? | 0 = No 1 = Yes | es3 |
38 | Do you often stay with someone who smokes cigarettes or tobacco (pipe)? | 0 = No 1 = Yes | es4 |
39 | Do you use chicha or other narcotics? | 0 = No 1 = Yes | es5 |
Eating habits/behaviours | |||
40 | Do you eat fruit and/or vegetables? | 0 = No 1 = Yes | ha1 |
41 | If so, how many servings per dose? | /_____/ | ha2 |
42 | Specify frequency per week | 0 = <3 times/week 1 = ≥3 times/week | ha3 |
43 | How often do you eat fast food? | 0 = No 1 = Yes | ha4 |
44 | Do you enjoy consuming too much sugar or sweetened drinks? | 0 = No 1 = Yes | ha5 |
45 | Do you enjoy eating foods that are too fatty? | 0 = No 1 = Yes | ha6 |
46 | Do you like your food too salty or do you often add salt to the food in your bowl/plate? | 0 = No 1 = Yes | ha7 |
Physical activities | |||
47 | Do you do any sport or strenuous physical activity for at least 15 minutes at least three times a week? | 0 = No 1 = Yes | prat1 |
48 | Do you walk or do any other moderate physical activity for at least 30 minutes at least three times a week? | 0 = No 1 = Yes | prat2 |
Information on cancer awareness/early detection of breast cancer | |||
49 | Have you ever heard of breast cancer? | 0 = No 1 = Yes | c1 |
50 | If yes, specify the information channel(s) | 1 = Radio 2 = Television 3 = Written diaries 4 = Word of mouth/discussion group 5 = Other… | c2 |