Packet 4
Please think about the two weeks since you filled out the first survey. We’d like to know
how typical these two weeks have been for you. Compared to what the first two weeks of
April are usually like, these last two weeks have been (please circle one)
Much
Worse
Somewhat
Worse
Pretty
Typical
Somewhat
Better
Much
Better
1
2
3
4
5
What is your employment status? (check all that apply)
___ I do not currently work regularly for income
___ I am a student
___ I am retired and receiving a pension
___ I am currently looking for more work
___ I have a regular job on which I normally work…………………… ___ hours per week
___ I have one or more part-time jobs, on which I normally work….. ___ hours per week
(total for all jobs)
___ I am self-employed and normally work for income……………… ___ hours per week
___ I regularly do volunteering work for………………………………. ___ hours per week
Traveling Vacations
Now we’d like to know something about any vacations you’ve had in the last year in which
you spent five days or more away from home. Business trips do not count. If you had a
combined business-vacation trip, the vacation portion should be five days or more.
During the last twelve months how many vacation trips did you take in which you spent five
days or more away from home? (circle one)
No trips of
5 days or more
1
trip
2
trips
3 or more
trips
For each vacation trip indicate the number of days it lasted, next to the month in
which it began: (If two or more vacations started in the same month, separate
the days by commas.)
May 2004…………. __________days
June………………. __________days
July……………….. __________days
August……………. __________days
September……….. __________days
October…………… __________days
November………… __________days
December………… __________days
January 2005…….. __________days
February………….. __________days
March……………... __________days
April……………….. __________days
In the next three pages, we will ask you questions about these vacations you
had. If you had 1 or 2 or 3, please tell us about each one. If you had more than
3, please tell us about the 3 longest (in number of days away from home).
Longest traveling vacation
The first day of this vacation was in which month? (circle one)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Where did you go? ______________________________________________________
What were the main activities? (Check all that apply):
___ Relaxing
___ Spent time with relatives or friends
___ Participated in Sports (golf, tennis, skiing, etc)
___ Entertainment events (Theatre, Concerts, Professional Sports, Night Clubs, Theme Parks, etc.)
___ Sightseeing, museums, arts, etc.
___ Shopping
___ Eating out, fine dining
Please remember the worst day of this vacation.
Which day was it? (circle one)
First day
Somewhere in the middle
What made it the worst day? _
Last day
__________
Next, please remember the best day of the vacation.
Which day was it? (circle one)
First day
What made it the best day? _
Somewhere in the middle
Last day
______________
Now think of the day that was the most typical day for this vacation. Try to relive
how you felt during that day of this vacation. What percentage of the time were
you:
in a bad mood
____%
a little low or irritable
____%
in a mildly pleasant mood
____%
in a very good mood
____%
Sum
100%
Now please rate each feeling on the scale below. A 0 means that you did not experience
that feeling at all during the most typical day of this vacation trip. A 6 means that the
feeling was an important part of your experience that day. Please circle the number
between 0 and 6 that best describes your experience.
Not at all
Very much
Bored…………………………. 0
1
2
3
4
5
6
Tense/stressed……………… 0
1
2
3
4
5
6
Happy………………………… 0
1
2
3
4
5
6
Depressed / blue……………. 0
1
2
3
4
5
6
Interested / focused………… 0
1
2
3
4
5
6
Affectionate / friendly……….. 0
1
2
3
4
5
6
Angry / hostile……………….. 0
1
2
3
4
5
6
Calm / relaxed………………. 0
1
2
3
4
5
6
Tired………………………….. 0
1
2
3
4
5
6
Second longest traveling vacation
The first day of this vacation was in which month? (If you had only one vacation, skip to next page)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Where did you go? ______________________________________________________
What were the main activities? (Check all that apply):
___ Relaxing
___ Spent time with relatives or friends
___ Participated in Sports (golf, tennis, skiing, etc)
___ Entertainment events (Theatre, Concerts, Professional Sports, Night Clubs, Theme Parks, etc.)
___ Sightseeing, museums, arts, etc.
___ Shopping
___ Eating out, fine dining
Please remember the worst day of this vacation.
Which day was it? (circle one)
First day
Somewhere in the middle
What made it the worst day? _
Last day
__________
Next, please remember the worst day of the vacation.
Which day was it? (circle one)
First day
What made it the worst day? _
Somewhere in the middle
Last day
______________
Now think of the day that was the most typical day for this vacation. Try to relive
how you felt during that day of this vacation. What percentage of the time were
you:
in a bad mood
____%
a little low or irritable
____%
in a mildly pleasant mood
____%
in a very good mood
____%
Sum
100%
Now please rate each feeling on the scale below. A 0 means that you did not experience
that feeling at all during the most typical day of this vacation trip. A 6 means that the
feeling was an important part of your experience that day. Please circle the number
between 0 and 6 that best describes your experience.
Not at all
Very much
Bored…………………………. 0
1
2
3
4
5
6
Tense/stressed……………… 0
1
2
3
4
5
6
Happy………………………… 0
1
2
3
4
5
6
Depressed / blue……………. 0
1
2
3
4
5
6
Interested / focused………… 0
1
2
3
4
5
6
Affectionate / friendly……….. 0
1
2
3
4
5
6
Angry / hostile……………….. 0
1
2
3
4
5
6
Calm / relaxed………………. 0
1
2
3
4
5
6
Tired………………………….. 0
1
2
3
4
5
6
Third longest traveling vacation
The first day of this vacation was in which month? (If you had only two vacations, skip to next page)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Where did you go? ______________________________________________________
What were the main activities? (Check all that apply):
___ Relaxing
___ Spent time with relatives or friends
___ Participated in Sports (golf, tennis, skiing, etc)
___ Entertainment events (Theatre, Concerts, Professional Sports, Night Clubs, Theme Parks, etc.)
___ Sightseeing, museums, arts, etc.
___ Shopping
___ Eating out, fine dining
Please remember the worst day of this vacation.
Which day was it? (circle one)
First day
Somewhere in the middle
What made it the worst day? _
Last day
__________
Next, please remember the worst day of the vacation.
Which day was it? (circle one)
First day
What made it the worst day? _
Somewhere in the middle
Last day
______________
Now think of the day that was the most typical day for this vacation. Try to relive
how you felt during that day of this vacation. What percentage of the time were
you:
in a bad mood
____%
a little low or irritable
____%
in a mildly pleasant mood
____%
in a very good mood
____%
Sum
100%
Now please rate each feeling on the scale below. A 0 means that you did not experience
that feeling at all during the most typical day of this vacation trip. A 6 means that the
feeling was an important part of your experience that day. Please circle the number
between 0 and 6 that best describes your experience.
Not at all
Very much
Bored…………………………. 0
1
2
3
4
5
6
Tense/stressed……………… 0
1
2
3
4
5
6
Happy………………………… 0
1
2
3
4
5
6
Depressed / blue……………. 0
1
2
3
4
5
6
Interested / focused………… 0
1
2
3
4
5
6
Affectionate / friendly……….. 0
1
2
3
4
5
6
Angry / hostile……………….. 0
1
2
3
4
5
6
Calm / relaxed………………. 0
1
2
3
4
5
6
Tired………………………….. 0
1
2
3
4
5
6
Breaks From Your Normal Routine
During the last three months, were there occasions on which you spent two or more days
doing something very different than your normal routine? Such occasions could
involve out of town travel or staying in town. Examples include attending a funeral, a
wedding, an entertainment event or festival; being home or taking care of a sick child or
relative; dealing with unexpected crises or emergencies.
___ No
___ Once
___ times
(If you answered “No”, skip to the next page)
What were you doing?
_____________________________________________________________________
_____________________________________________________________________
Now think of the most recent occasion on which you departed from your routine for two or
more days. Was it something you did for pleasure, or something you had to do?
____ For pleasure
____ I had to do it
How long did this last? ____ days
Now think of a typical day during this most recent occasion. Try to relive how you
felt during that day. What percentage of the time were you:
in a bad mood
____%
a little low or irritable
____%
in a mildly pleasant mood
____%
in a very good mood
____%
Sum
100%
Now please rate each feeling. A 0 means that you did not experience that feeling at all
during a typical day of this break from your routine. A 6 means that the feeling was an
important part of your experience that day. Please circle the number between 0 and 6 that
best describes your experience.
Not at all
Very much
Bored…………………………. 0
1
2
3
4
5
6
Tense/stressed……………… 0
1
2
3
4
5
6
Happy………………………… 0
1
2
3
4
5
6
Depressed / blue……………. 0
1
2
3
4
5
6
Interested / focused………… 0
1
2
3
4
5
6
Affectionate / friendly……….. 0
1
2
3
4
5
6
Angry / hostile……………….. 0
1
2
3
4
5
6
Calm / relaxed………………. 0
1
2
3
4
5
6
Tired………………………….. 0
1
2
3
4
5
6
Week Day (Working)
In a typical week, how many days do your work for income? ________
If you work for income less than 2 days in a typical week – skip to the next page
Which of the following things do you do on a typical working weekday (Mon-Fri)?
Check all that apply:
___ Shopping/housework/cooking
___ Spend time with husband/SO
___ Exercise, walk
___ Spend time with my children
___ Watch television
___ Spend time with friends
___ Read
___ Spend time with parents
___ Browse Internet/personal projects
___ Pray, meditate
___ Care for sick relative
___ Volunteer work
Try to relive how you feel during a typical working weekday. What percentage of
the time are you:
in a bad mood
____%
a little low or irritable
____%
in a mildly pleasant mood
____%
in a very good mood
____%
Sum
100%
Now please rate each feeling on the scale below. A 0 means that you did not experience
that feeling at all during a typical working weekday. A 6 means that the feeling was an
important part of your experience that day. Please circle the number between 0 and 6 that
best describes your experience.
Not at all
Very much
Bored…………………………. 0
1
2
3
4
5
6
Tense/stressed……………… 0
1
2
3
4
5
6
Happy………………………… 0
1
2
3
4
5
6
Depressed / blue……………. 0
1
2
3
4
5
6
Interested / focused………… 0
1
2
3
4
5
6
Affectionate / friendly……….. 0
1
2
3
4
5
6
Angry / hostile……………….. 0
1
2
3
4
5
6
Calm / relaxed………………. 0
1
2
3
4
5
6
Tired………………………….. 0
1
2
3
4
5
6
Weekday (Not working)
If you worked for income every weekday of the last two weeks, skip to the next page
Think of a typical weekday (Mon-Fri) on which you do not work for income.
Which of the following things do you do on such a day?
___ Shopping/housework/cooking
___ Spend time with husband/SO
___ Exercise, walk
___ Spend time with my children
___ Watch television
___ Spend time with friends
___ Read
___ Spend time with parents
___ Browse Internet/personal projects
___ Pray, meditate
___ Care for sick relative
___ Volunteer work
Try to relive how you feel during a typical non-working weekday. What
percentage of the time are you:
in a bad mood
____%
a little low or irritable
____%
in a mildly pleasant mood
____%
in a very good mood
____%
Sum
100%
Now please rate each feeling on the scale below. A 0 means that you did not experience
that feeling at all during a typical non-working weekday. A 6 means that the feeling was an
important part of your experience that day. Please circle the number between 0 and 6 that
best describes your experience.
Not at all
Very much
Bored…………………………. 0
1
2
3
4
5
6
Tense/stressed……………… 0
1
2
3
4
5
6
Happy………………………… 0
1
2
3
4
5
6
Depressed / blue……………. 0
1
2
3
4
5
6
Interested / focused………… 0
1
2
3
4
5
6
Affectionate / friendly……….. 0
1
2
3
4
5
6
Angry / hostile……………….. 0
1
2
3
4
5
6
Calm / relaxed………………. 0
1
2
3
4
5
6
Tired………………………….. 0
1
2
3
4
5
6
Saturday
Do you usually work on Saturdays?
___No
___Yes
Which of the following things do you do on a typical Saturday?
___ Shopping/housework/cooking
___ Spend time with husband/SO
___ Exercise, walk
___ Spend time with my children
___ Watch television
___ Spend time with friends
___ Read
___ Spend time with parents
___ Browse Internet/personal projects
___ Pray, meditate
___ Care for sick relative
___ Volunteer work
Try to relive how you feel during a typical Saturday. What percentage of the time
are you:
in a bad mood
____%
a little low or irritable
____%
in a mildly pleasant mood
____%
in a very good mood
____%
Sum
100%
Now please rate each feeling on the scale below. A 0 means that you did not experience
that feeling at all during a typical Saturday. A 6 means that the feeling was an important
part of your experience that day. Please circle the number between 0 and 6 that best
describes your experience.
Not at all
Very much
Bored…………………………. 0
1
2
3
4
5
6
Tense/stressed……………… 0
1
2
3
4
5
6
Happy………………………… 0
1
2
3
4
5
6
Depressed / blue……………. 0
1
2
3
4
5
6
Interested / focused………… 0
1
2
3
4
5
6
Affectionate / friendly……….. 0
1
2
3
4
5
6
Angry / hostile……………….. 0
1
2
3
4
5
6
Calm / relaxed………………. 0
1
2
3
4
5
6
Tired………………………….. 0
1
2
3
4
5
6
Sunday
Do you usually work on Sundays?
___No
___Yes
Which of the following things do you do on a typical Sunday?
___ Shopping/housework/cooking
___ Spend time with husband/SO
___ Exercise, walk
___ Spend time with my children
___ Watch television
___ Spend time with friends
___ Read
___ Spend time with parents
___ Browse Internet/personal projects
___ Pray, meditate
___ Care for sick relative
___ Volunteer work
Try to relive how you feel during a typical Sunday. What percentage of the time
are you:
in a bad mood
____%
a little low or irritable
____%
in a mildly pleasant mood
____%
in a very good mood
____%
Sum
100%
Now please rate each feeling on the scale below. A 0 means that you did not experience
that feeling at all during a typical Sunday. A 6 means that the feeling was an important part
of your experience that day. Please circle the number between 0 and 6 that best describes
your experience.
Not at all
Very much
Bored…………………………. 0
1
2
3
4
5
6
Tense/stressed……………… 0
1
2
3
4
5
6
Happy………………………… 0
1
2
3
4
5
6
Depressed / blue……………. 0
1
2
3
4
5
6
Interested / focused………… 0
1
2
3
4
5
6
Affectionate / friendly……….. 0
1
2
3
4
5
6
Angry / hostile……………….. 0
1
2
3
4
5
6
Calm / relaxed………………. 0
1
2
3
4
5
6
Tired………………………….. 0
1
2
3
4
5
6
Likable and Dislikable Activities
We would like to learn how likable or dislikable various activities are. Below we list a
number of different things that you may often be likely to do in your life. For each one,
please circle the response that indicates how much you like or dislike it:
(if one does not apply to you, you may skip it)
Dislike a
great deal
Like a
great deal
commuting to work……………… -5
-4
-3
-2
-1
0
1
2
3
4
5
working in your main job……….. -5
-4
-3
-2
-1
0
1
2
3
4
5
having lunch on a workday…….. -5
-4
-3
-2
-1
0
1
2
3
4
5
socializing at work………………. -5
-4
-3
-2
-1
0
1
2
3
4
5
commuting to home from work… -5
-4
-3
-2
-1
0
1
2
3
4
5
socializing with friends…………. -5
-4
-3
-2
-1
0
1
2
3
4
5
talking on the phone at home…. -5
-4
-3
-2
-1
0
1
2
3
4
5
taking care of your children……. -5
-4
-3
-2
-1
0
1
2
3
4
5
doing housework………………… -5
-4
-3
-2
-1
0
1
2
3
4
5
cooking/preparing food……….… -5
-4
-3
-2
-1
0
1
2
3
4
5
having dinner on a workday……. -5
-4
-3
-2
-1
0
1
2
3
4
5
relaxing at home…………………. -5
-4
-3
-2
-1
0
1
2
3
4
5
watching TV……………………… -5
-4
-3
-2
-1
0
1
2
3
4
5
You have now completed the survey. Please return this packet to the
envelope labeled Packet 4. Make certain that all three packets (Packet 1,
Packet 3, and Packet 4) are in the large envelope and that you have
completed all the questions. When you are finished, take the materials
to the lobby.