CURHAN Base Protocol Socioeconomic Questionnaire

Adapted from China Health and Retirement Longitudinal Study (CHARLS) questionnaire


 

(1) Basic Information

 

Basic Information:

  1. What is your name? _______________________
  1. What is your gender?
  1. Male
  2. Female
  1. What is your birthdate? ______ (Year) _____ (Month) _____ (Day)

 

  1. What is your age? ________ (1 – 120 years old)
  1. What is your current permanent address?

__________________________ (Province)

___________________________(City/District or County)

___________________________ (Neighborhood or Village)

 

Anthropometry:

 

88*88=Refused,   99*99=Not done or Unk.

 

  1. |__|__|__*|__|__|__ Height (cm, to next lower cm)

 

 

  1. |__|__|__| Weight (kg)    (400=400 or more 888=refused, 999=Unk.)

 

 

  1. |__| In the past year, have you lost more than 5kg?

0=No, 1= Yes, unintentionally, NOT due to dieting or exercise

2= Yes, intentionally, due to dieting or exercise

 

 

  1. |__|__|__*|__|__|__ Neck Circumference (inches, to next lower cm)

 

 

  1. |__|__|__*|__|__|__ Waist Girth at umbilicus (inches, to next lower cm).

 

 

  1. |__|__|__*|__|__|__ Hip Girth (inches, to next lower cm)

 

 

  1. |__|__|__*|__|__|__ Thigh Girth (inches, to next lower cm)

 

 

(2) Demographics

Birth Place

 

  1. What is your birthplace?

 

  1. Same as current permanent address
  2. Other:

_______ (Province)

_______ (City/District or County)

_______ (Neighborhood or Village)

  1. Abroad:

_______ (Country)

  1. Is your birthplace a rural village or an urban community?

 

  1. Rural Village
  2. Urban Community

 

Current HuKou – Family Register

  1. What is your current HuKou location?

 

  1. Current permanent address
  2. Birthplace
  3. Other:

_______ (Province)

_______ (City/District or County)

_______ (Neighborhood or Village)

 

Education

 

  1. What is the highest level of education you have attained? (Do not including adult education)

 

  • No formal education (Illiterate)
  • Did not finish primary school but capable of reading and writing
  • Sishu/home school
  • Primary school graduation
  • Middle school graduation
  • High school graduation
  • Vocational school graduation
  • Two- or Three-Year College graduation / Associate’s degree
  • Four-Year College graduation / Bachelor’s degree
  • Master’s degree
  • Doctoral degree

 

Marital Status

 

  1. What is your marital status?

 

  • Married with spouse present
  • Married but not living with spouse temporarily for reasons such as work
  • Separated
  • Divorced
  • Widowed
  • Never married
  • Cohabiting

Family

 

  1. How many persons do you live together with in a household?

(Do not include yourself)

 

________ (0 – 25 persons)

 

  1. What is the relationship of other household members to you? (Circle all that apply)
  • Mother
  • Father
  • Mother-in-law
  • Father-in-law
  • Sibling
  • Brother-in-law, sister-in-law
  • Child/Children
  • Daughter-in-law, son-in-law
  • Grandchild/Grandchildren
  • Other, please specify:_________________
  1. How many children (biological or adopted) do you have who are currently living?

 

________ (0 – 25 persons)

  1. How many children (biological or adopted) do you have who have passed away?

 

________ (0 – 25 persons)

 

(3) Work and Time Use

  1. In the past year, did you engage in agricultural work (including farming, forestry, fishing, animal husbandry, and bringing goods to market) …

 

in your own family household?

 

  1. Yes
  2. No

 

for other households as a paid job?

 

  1. Yes
  2. No

 

  1. In the past year …

 

did you engage in self-employed work or operate your own business?

  1. Yes
  2. No

 

did you work without pay in your family’s business?

  1. Yes
  2. No

 

 

were you employed by others in a paid job (in non-agricultural work)?

  1. Yes
  2. No

 

 

  1. During the past year …

 

how many months did you work? __________ (0 – 12 months)

 

how many days did you typically work per week? ________ (0 – 7 days)

 

 

how many hours did you typically work per day (excluding meal and rest breaks, but including any paid or unpaid overtime)? _________ (0 – 24 hours)

 

  1. In the past year, have you spent time providing childcare without pay?

 

  1. Yes
  2. No

 

<If no, skip to question 7>

 

 

  1. Who did you provide childcare for? (Circle all that apply)

 

  • Grandchildren
  • Great-grandchildren
  • Children of relatives
  • Children of friends or neighbors
  • Other, please specify: ________________________

 

  1. How often did you provide childcare? (Circle all that apply)

 

  1. Daily
  2. Several times a week
  3. About once a week
  4. Several times a month
  5. Once a month
  6. Less than once a month

 

  1. In the past year, have you spent time providing care without pay for an adult who needs help due to aging, illness, or disability?

 

  1. Yes
  2. No

<If no, skip to next section – Household Incomes and Assets>

 

  1. Who did you provide care for?

 

  • Parent or Parent-in-law
  • Spouse or Partner
  • Adult child
  • Sibling
  • Aunt or Uncle
  • Grandparent or Grandparent-in-law
  • Other relative
  • Friend or Neighbor
  • Other, please specify: ______________________

 

  1. How often did you provide care?
  • Daily
  • Several times a week
  • About once a week
  • Several times a month
  • Once a month
  • Less than once a month

 

(4) Household Income and Assets

Income

  1. Approximately how much income did your household receive last year (including all members of your household, and all forms of cash income – wages, pensions, subsidies, and self-employment or business net income)?

 

_____________ (in Yuan)

 

Or

Drop-down list for income brackets (in Yuan):

  • 5000
  • 10,000
  • 50,000
  • 100,000
  • 200,000
  • 500,000
  • 1,000,000

Current Residence

  1. What year did your household start to live at your current residence?

 

________ (1900 – 2016 Year)

 

  1. When was your current residence constructed?

 

________ (1900 – 2016 Year)

 

Or

Drop-down list for time point:

  • 0 to less than 5 years ago
  • 5 to less than 10 years ago
  • 10 to less than 20 years ago
  • 20 to less than 30 years ago
  • 30 to less than 40 years ago
  • 40 or more years ago

 

  1. What is the constructed floor area size of your residence?

 

________ (square meters)

 

  1. How many bedrooms, bathrooms, living rooms, and kitchens are there in your residence?

 

_________ (number of bedrooms)

 

_________ (number of bathrooms)

 

_________ (number of living rooms)

 

_________ (number of kitchens)

 

  1. What is the present market value of your residence? Or, what is the present market value of a similar residence in its neighborhood?

 

Total price: ____________  (in Yuan)

Or

Unit price  __________ (Yuan/Square-Meter)

Or

Drop-down list for price brackets (in Yuan):

  • 20,000
  • 50,000
  • 100,000
  • 200,000
  • 500,000
  • 1,000,000
  • 2,000,000
  1. Do members of your household own your residence?

 

  1. Members of household wholly own the house
  2. Members of household partly own the house
  3. Members of household do not own any part of the house

<If b or c, skip to question 9>

  1. Do members of your household currently carry a bank mortgage loan to finance the purchase, construction, or renovation of your house?

 

  1. Yes
  2. No

 

If yes, what is the outstanding amount of the bank mortgage loan?

__________ (in Yuan)

 

Financial Assets and Debt

  1. Approximately what is the value of financial assets of your household (including all members of your household, and all types of financial assets – cash, savings, stocks, funds)?

_____________ (in Yuan)

Or

Drop-down list for asset value (in Yuan):

  • 5000
  • 10,000
  • 50,000
  • 100,000
  • 200,000
  • 500,000
  • 1,000,000
  • 2,000,000

10. Approximately what is the value of outstanding (unpaid) debt of your household, other than home mortgage loans? (Include all members of your household, and all loans from banks and financial institutions, except home mortgage loans.)

_____________ (in Yuan)

Or

Drop-down list for outstanding loan (in Yuan):

  • 5000
  • 10,000
  • 50,000
  • 100,000
  • 200,000
  • 500,000
  • 1,000,000
  • 2,000,000

 

CURHAN Socioeconomic Questionnaire Protocol, March 9, 2016

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About 陈馨雨

2014级本科生
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