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Q21 Thinking about your physical health, which includes physical illness and injury, for <br />how many days during the past 30 days was your physical health not good? <br />Enter number of days. <br />77. DON'T KNOW/ NO RESPONSE <br />99. REFUSED <br />Q22 Would you say, in general, that your mental health is poor, fair, good, very good, or <br />excellent? <br />i . <br />Poor <br />2. <br />Fair <br />3. <br />Good <br />4. <br />Very good <br />5. <br />Excellent <br />7. DON'T KNOW/ NO RESPONSE <br />9. REFUSED <br />Q23 Thinking about your mental health, which includes stress, depression, and problems <br />with emotions, for how many days during the past 30 days was your <br />mental health not good? <br />Enter number of days <br />77. DON'T KNOW/ NO RESPONSE <br />99. REFUSED <br />Q24a Would you say, in general, that the quality of your relationships with family <br />members is poor, fair, good, very good, or excellent? <br />1. Poor <br />2. Fair <br />3. Good <br />4. Very good <br />5. Excellent <br />6. DO NOT HAVE RELATIONSHIPS WITH FAMILY MEMBERS <br />7. DON'T KNOW/ NO RESPONSE <br />9. REFUSED <br />19F -332 <br />