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Dear Participant,
The purpose of this study is to investigate the health and behavioral health practices of psychologists and psychology trainees. After you have completed your responses to the survey, you will be able to enter into a raffle to win a $100 Visa gift card.
Instructions:
1. Please read all information presented and answer accordingly.
2. Click “Submit” once you are satisfied with all of your responses.
3. Click on the link and enter your email address to be eligible to win a gift card. NOTE: Email addresses are collected in a secondary form to ensure participants’ identifying information is separate and responses on the survey are kept confidential.
Your completion of these instructions will be considered your consent to participate in this study. Participation in this study is strictly voluntary. Refusal to participate will involve no penalty or loss of benefits to which you are otherwise entitled. You may discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled. All information that you provide will be kept entirely confidential. There are no foreseeable risks involved in participating in this study. Benefits of participating in the study may include gaining awareness into personal health behaviors and a chance at winning a gift card.
Please feel free to contact me at [email protected] with any questions or comments regarding the study.
Regards,
J. Denard Yearwood, M.S.
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| * Are you currently a professional psychologist? |
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| * Are you currently a psychology trainee (i.e., graduate student, pre-doctoral intern, or post-doctoral resident)? |
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| * Please indicate the setting of your primary employment/practicum/internship position. |
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How many hours per week do you spend in the following activities in your primary employment/practicum/internship position?
NOTE: Write “0” if you do not engage in a particular activity. YOUR ANSWERS SHOULD ADD UP TO THE TOTAL NUMBER OF HOURS PER WEEK IN YOUR PRIMARY POSITION
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| * Are you Hispanic or Latino? |
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| * Which one or more of the following would you say is your race? |
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| * What is your age? (specify in years) | | |
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| * About how much do you weigh without shoes? [specify in pounds] | | |
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| * About how tall are you without shoes? [specify in inches] | | |
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| * Would you say that in general your health is — ? |
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| * Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? |
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| * Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? |
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| * During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation? |
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| * Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Indian Health Services? |
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| * Do you have one person you think of as your personal doctor or health care provider? |
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| * Was there a time in the past 12 months when you needed to see a doctor but could not because of cost? |
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* About how long has it been since you last visited a doctor for a routine checkup?
A routine checkup is a general physical exam, not an exam for a specific injury, illness, or condition. |
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| * Have you smoked at least 100 cigarettes in your entire life? NOTE: 5 packs = 100 cigarettes |
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| * Do you now smoke cigarettes every day, some days, or not at all? |
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| * During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? |
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* Do you currently use chewing tobacco, snuff, or snus every day, some days, or not at all?
NOTE: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum. |
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* These next questions are about the fruits and vegetables you ate or drank during the past 30 days. Please think about all forms of fruits and vegetables including cooked or raw, fresh, frozen or canned. Please think about all meals, snacks, and food consumed at home and away from home.
During the past month, how many times per week did you drink 100% PURE fruit juices? Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to. Only include 100% juice. |
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| * During the past month, not counting juice, how many times per week did you eat fruit? Count fresh, frozen, or canned fruit. |
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| * During the past month, how many times per week did you eat cooked or canned beans, such as refried, baked, black, garbanzo beans, beans in soup, soybeans, edamame, tofu or lentils. Do NOT include long green beans. |
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| * During the past month, how many times per week did you eat dark green vegetables for example broccoli or dark leafy greens including romaine, chard, collard greens or spinach? |
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| * During the past month, how many times per week did you eat orange-colored vegetables such as sweet potatoes, pumpkin, winter squash, or carrots? |
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| * Not counting what you just told me about, during the past month, about how many times per week did you eat OTHER vegetables? Examples of other vegetables include tomatoes, tomato juice or V-8 juice, corn, eggplant, peas, lettuce, cabbage, and white potatoes that are not fried such as baked or mashed potatoes. |
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* The next few questions are about exercise, recreation, or physical activities other than your regular job duties.
During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? |
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| * How many times per week did you take part in this activity during the past month? |
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| * And when you took part in this activity, for how many minutes did you usually keep at it? |
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| * During the past month, how many times per week did you do physical activities or exercises to STRENGTHEN your muscles? Do NOT count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands. |
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| * How often do you use seat belts when you drive or ride in a car? Would you say — |
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| * During the past 30 days, how many days per week did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor? |
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* One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. During the past 30 days, on the days when you drank, about how many drinks did you drink on the average?
NOTE: A 40 ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drinks. |
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| * Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [X = 5 for men, X = 4 for women] or more drinks on an occasion? |
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| * During the past 30 days, what is the largest number of drinks you had on any occasion? |
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| * During the past 30 days, for about how many days have you felt you did not get enough rest or sleep? |
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* On average, how many hours of sleep do you get in a 24-hour period? Think about the time you actually spend sleeping or napping, not just the amount of sleep you think you should get.
NOTE: Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more up to the next whole hour and dropping 29 or fewer minutes. |
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| * Please indicate your current primary theoretical orientation. |
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| * Please indicate all reported training in intervention(s) for health issues. |
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| * Approximately what percentage (%) of your patients do you counsel on some type of health behavior (e.g., diet, exercise, smoking, weight, alcohol consumption, medical adherence, seatbelt use, sleep, etc.)? | | |
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| With a typical patient, how often do you actually perform counseling for these activities?
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| In general, how confident are you in your abilities to counsel your patients on health behaviors?
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| How important is counseling patients about health behaviors?
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| Are you currently attempting to change the following personal health practices?
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| To what extent does your own health behavior impact your counseling of patients about these same behaviors?
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