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NON-COMMUNICABLE DISEASES RISK-FACTOR STEPS SURVEY, GEORGIA, 2016 EXECUTIVE SUMMARY Tbilisi 2018 AUTHORS: AMIRAN GAMKRELIDZE NANA MEBONIA LELA STURUA NINO DEMETRASHVILI NATIA KAKUTIA INTERNATIONAL CONSULTANTS: DR. ENRIQUE LOYOLA - Coordinator, Surveillance of Noncommunicable Diseases, Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe STEFAN SAVIN - technical officer, Surveillance of Noncommunicable Diseases, Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe 2 CONTENTS STEPS 2016 Fact Sheet ……………………………………………………………………………………………………………..……….. 5 Tobacco ……………………………………………………………………………………………………………….………………………..….. 7 Alcohol ……………………………………………………………………………………………………..……………………………..……….. 9 Diet ………………………………………………………………………………………………………………..………………………….…….
10 Physical Activity ………………………………………………………………………………………………..……………………….….… 13 Anthropometry ……………………………………………………………………………………………..……………………………….. 14 Arterial Hypertension ……………………………………………………………………………………………………………………….

16 Diabetes ……………………………………………………………………………………………………………………………………….….
19 Cholesterol ……………………………………………………………………………………………………………………………………... 22 Combined risk-factors …………………………………………………………………………………………………………………… 23 Healthy lifestyle advice from doctors/medical professionals …………………………………………………………... 24 Visiting a doctor ……………………………………………………………………………………………………………………………….

26 Cervical Cancer Screening ……………………………………………………………………………………….……………………….
27 Oral health ……………………………………………………………………………………………………………….……….…………….. 27 Mental health / Suicide …………………………………………………………………………………………….………………..…... 27 Injury ……………………………………………………………………………………………………………………….……………………... 27 Violence ……………………………………………………………………………………………………………………….………………….
28 Sexual health ………………………………………………………………………………………………………………………………….. 28 STEPS 2010-2016 …………..…………………………………………………….……………………………………………………….... 29 Conclusions ………………………………………………………………………….……………………………………………………….... 33 Recommendations ……………………………………………………………………………………………………………….………….
34 Annex 1: STEPS 2016 Coordination Council …………………………………………………………………………….……... 35 Annex 2: STEPS 2016 Survey personnel ……………………………………………………………………………………….….. 36 Annex 3: WHO STEPS Instrument……….……………………………………………………………….…………………………… 38 3 Introduction WHO’s STEPwise approach to noncommunicable diseases (NCDs) risk factors surveillance is the most common instrument for the surveillance of Non-Communicable Diseases risk-factors.
Conducting first STEPS Survey in Georgia in 2010 was made possible through the financial support of European Union and the technical and financial support of World Health Organization.

STEPS survey gave us possibility to collect basic information on prevalence of NCDs and its biological and behavioral risk- factors in the country.
The second STEPS survey was conducted in Georgia in 2016 through the technical and financial support of World Health Organization and the National Center of Disease Control and Public Health of Georgia.

Survey was carried out from June to September 2016.

Both surveys have nationwide representation and were implemented by the National Center of Disease Control and Public Health.
In order to plan and successfully implement STEPS survey in the country, STEPS coordinating committee has been formed which was chaired by the Deputy Minister of Health, Labor and Social Affairs, Dr. Nino Berdzuli.

STEPS Instrument covers three different levels of "steps" of risk factors assessment.

These steps are: I. II.

III.


Socio-demographic and behavioural information Physical measurements such as height, weight, waist and hip circumference, blood pressure, pulse Biochemical measurements to assess blood glucose, cholesterol and high density lipoproteins (HDL); urinary salt and cotinine The target population of STEPS survey was adults aged 18-69.

The population-based survey using a multi- stage, clustered sample design was conducted simultaneously both in the East and the West parts of Georgia.
A total of 5,554 adults participated in the survey.

The overall response rate was 75.7%.

It is worth noting, that Georgia is the only country in the European Region carried out the second STEPS survey.

This gives us possibility to get evidence based information about trends of NCDs and its biological and behavioral risk factors in the county.
This is an important resource to plan important public health decisions and interventions, which from its end, will support to improve the health of the Georgia’s population.

Conducting the third STEPS survey is recommended for 2021.

4 Georgia STEPS Survey 2016 Fact Sheet The STEPS survey of noncommunicable disease (NCD) risk factors in Georgia was carried out from June 2016 to September 2016.

Georgia carried out Step 1, Step 2 and Step 3.


Socio demographic and behavioural information was collected in Step 1.

Physical measurements such as height, weight and blood pressure were collected in Step 2.

Biochemical measurements were collected in Step 3.

The survey was a population-based survey of adults aged 18-69.

A Multi-stage cluster sampling design was used to produce representative data for that age range in Georgia.

A total of 5554 adults participated in the survey.


The overall response rate was 75.7%.

A repeat survey is planned for 2021 if funds permit.

Results for adults aged 18-69 years (incl.
95% CI) (adjust if necessary) Both Sexes Males Females Step 1 Tobacco Use Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily For those who smoke tobacco daily 31.0% (28.9 – 33.0) 28.0% (26.0 – 30.0) 57.0% (53.6 – 60.3) 51.5% (48.1 – 55.0) 7.0% (5.8 – 8.2) 6.2% (5.1 – 7.4) Average age started smoking (years) among current daily smokers Average age started smoking (years) among current smokers Percentage of daily smokers smoking manufactured cigarettes 18.3 - 18.4 - 17.8 - 17.9 - 98.6% (97.7 - 99.5) 98.4% (97.5 - 99.4) Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) 21.3 - 22.2 - Step 1 Alcohol Consumption Percentage who are lifetime abstainers Percentage who are past 12 month abstainers Percentage who currently drink (drank alcohol in the past 30 days) Percentage who engage in heavy episodic drinking (6 or more drinks on any occasion in the past 30 days) Step 1 Diet Mean number of days fruit consumed in a typical week Mean number of servings of fruit consumed on average per day Mean number of days vegetables consumed in a typical week Mean number of servings of vegetables consumed on average per day Percentage who ate less than 5 servings of fruit and/or vegetables on average per day Percentage who always or often add salt or salty sauce to their food before eating or as they are eating Percentage who always or often eat processed foods high in salt Step 1 Physical Activity 10.4% (8.9 - 12.0) 20.1% (18.5 - 21.7) 39.1% (36.6 - 41.5) 18.3% (16.1 - 20.6) 5.3 (5.2 - 5.4) 2.0 (1.9 - 2.1) 6.0 (5.9 - 6.1) 2.4 (2.3 - 2.5) 63.0% (60.1 - 66.0) 26.7% (24.7 - 28.8) 14.3% (12.4 - 16.2) 3.9% (2.6 - 5.3) 11.4% (9.5 - 13.3) 58.9% (55.2 - 62.5) 35.3% (31.2 - 39.4) 5.1 (4.9 - 5.3) 2.0 (1.8 - 2.1) 5.9 (5.8 - 6.0) 2.4 (2.3 - 2.6) 63.8% (59.6 - 67.9) 33.4% (29.4 - 37.3) 18.9% (15.3 - 22.5) 22.4 - 22.6 - 100.0% - 14.4 - 16.4% (14.1 - 18.8) 28.1% (25.8 - 30.4) 20.8% (18.6 - 22.9) 2.6% (1.7 - 3.5) 5.4 (5.3 - 5.6) 2.1 (1.9 - 2.2) 6.1 (5.9 - 6.2) 2.4 (2.3 - 2.5)
 62.4% (59.5 - 65.3) 20.6% (18.6 - 22.7) 10.1% (8.7 - 11.5) Percentage with insufficient physical activity (defined as < 150 minutes of moderate-intensity activity per week, or equivalent)* 17.4% (15.6 - 19.2) 16.2% (13.6 - 18.9) 18.4% (16.3 - 20.4) Median time spent in physical activity on average per day (minutes) (presented with inter-quartile range) 137.1 (40.0 - 300.0) 158.6 (55.7 - 342.9) 173.8 (30.0 - 270.0) Percentage not engaging in vigorous activity 82.4% (80.3 - 84.6) 72.2% (68.5 - 75.9) 91.8% (90.1 - 93.4) 5 Results for adults aged 18-69 years (incl.
95% CI) (adjust if necessary) Both Sexes Males Females Step 1 Cervical Cancer Screening Percentage of women aged 30-49 years who have ever had a screening test for cervical cancer Step 2 Physical Measurements Mean body mass index - BMI (kg/m2) Percentage who are overweight (BMI ≥ 25 kg/m2) Percentage who are obese (BMI ≥ 30 kg/m2) Average waist circumference (cm) 28.1 (27.8 - 28.4) 64.6% (62.3 - 67.0) 33.2% (31.3 - 35.2) 27.9 (27.5 -28.3) 65.5% (61.4 - 69.7) 30.2% (26.9 - 33.6) 95.7 (94.3 - 97.2) Mean systolic blood pressure - SBP (mmHg), including those currently on medication for raised BP 129.4 (128.4 - 130.4) 132.6 (131.3 - 134.0) Mean diastolic blood pressure - DBP (mmHg), including those currently on medication for raised BP Percentage with raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg) who are not currently on medication for raised BP Step 3 Biochemical Measurement Mean fasting blood glucose, including those currently on medication for raised blood glucose [mmol/L] Percentage with impaired fasting glycaemia as defined below  Capillary whole blood value ≥5.6 mmol/L and <6.0 mmol/L Percentage with raised fasting blood glucose as defined below or currently on medication for raised blood glucose  Capillary whole blood Capillary whole blood value value ≥ 6.1 mmol/L 82.2 (81.6 - 82.8) 37.7% (35.5 - 40.0) 55.4% (52.1 - 58.8) 4.4 (4.3 - 4.5) 2.0% (1.4 - 2.5) 4.5% (3.7 - 5.3) Mean total blood cholesterol, including those currently on medication for raised cholesterol [mmol/L] 4.3 (4.3 - 4.4) 83.0 (82.1 - 84.0) 38.6% (35.1 - 42.2) 64.2% (59.3 - 69.0) 4.4 (4.3 - 4.5) 2.0% (1.0 - 3.0) 4.7% (3.5 - 6.0) 4.1 (4.0 - 4.3) 23.9% (20.6 - 27.3) 28.3 (28.0 - 28.6) 63.8% (61.4 - 66.3) 36.0% (33.7 - 38.2) 89.6 (88.7 - 90.5) 126.5 (125.4 - 127.6) 81.4 (80.7 - 82.1) 36.9% (34.7 - 39.1) 47.2% (43.4 - 50.9) 4.4 (4.3 - 4.5) 1.9% (1.4 - 2.4) 4.3% (3.4 - 5.2) 4.5 (4.4 - 4.6) Percentage with raised total cholesterol (≥ 5.0 mmol/L or
 currently on medication for raised cholesterol) Mean intake of salt per day (in grams) Cardiovascular disease (CVD) risk 27.7% (25.5 - 29.9) 8.5 (8.3 - 8.6) 21.9% (18.6 - 25.2) 33.0% (30.4 - 35.6) 9.7 (9.4 - 9.9) 7.4 - Percentage aged 40-69 years with a 10-year CVD risk ≥ 30%, or with existing CVD1 28.8% (25.9 - 31.7) 30.8% (25.9-35.7) 27.1% (24.3 – 29.9) Summary of combined risk factors    current daily smokers less than 5 servings of fruits & vegetables per day insufficient physical activity   overweight (BMI ≥ 25 kg/m2) raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with none of the above risk factors Percentage with three or more of the above risk factors, aged 18 to 44 years Percentage with three or more of the above risk factors, aged 45 to 69 years Percentage with three or more of the above risk factors, aged 18 to 69 years 7.6% (6.0 - 9.2) 25.2% (22.1 - 28.3) 48.6% (45.7 - 51.5) 36.1% (33.8 - 38.4) 5.7% (3.4 - 8.0) 37.9% (32.5 - 43.3) 55.1% (50.4 - 59.8) 45.4% (41.7 - 49.2) 9.3% (7.7 - 11.0) 12.5% (10.2 - 14.8) 43.4% (40.2 - 46.5) 27.6% (25.5 - 29.8) 1 A 10-year CVD risk of ≥30% is defined according to age, sex, blood pressure, smoking status (current smokers OR those who quit smoking less than 1 year before the assessment), total cholesterol, and diabetes (previously diagnosed OR a fasting plasma glucose concentration >7.0 mmol/l).
6 Tobacco Almost one third of Georgia’s population (31%) are smokers; 57% of male - current smokers, among them 90.5 % - daily smokers; 7% of female noted that, they are current smokers; in fact, according to urine cotinine test, smoking prevalence in female is 12.2%.

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Picture #1.

Current smokers (%) by age and sex % 80.0 60.0 40.0 20.0 0.0 59.5 62.0 58.0 33.8 7.0 35.0 8.8 30.9 7.1 38.4 3.9 18.6 18–29 years 30–44 years 45–59 years 60–69 years Men Women Both sexes Mean age of starting smoking in male - 17.7 years and in female - 22.4 years.

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Picture #2.

Mean age of starting smoking by age and sex % 30.0 25.0 20.0 15.0 10.0 5.0 0.0 17.4 18.3 17.5 21.4 17.6 17.0 25.1 18.4 19.1 28.3 19.2 20.3 18–29 years 30–44 years Men Women 45–59 years Both sexes 60–69 years The absolute majority of smokers (98.6%) smoke manufactured cigarettes.

Mean number of manufactured cigarettes smoked per day by daily smokers is 21.3 cigarettes (male - 22.2 cigarettes, female - 14.4 cigarettes).

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Picture #3.

Mean number of manufactured cigarettes smoked per day by daily smokers by age and sex % 30.0 25.0 20.0 15.0 10.0 5.0 0.0 19.9 19.0 11.4 24.0 23.0 15.8 23.0 22.1 14.5 19.9 19.4 16.3 18–29 years 30–44 years 45–59 years 60–69 years Men Women Both sexes 7 25.3 % of current smokers (male 25.5%, female 24.2%) tried to quit smoking during the past 1 year.
Those who have tried to quit smoking used the following: consultation on a primary healthcare level - 11.0%; electronic cigarettes - 9.4%; nicotine replacement therapy - 0.3%; pharmacotherapy (Tabex, Bypropion) - 0.4%; none of them referred to Quit-line service.

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Picture #4.

Current smokers, who tried to quit smoking during the past one year (%) by age and sex % 40.0 30.0 20.0 10.0 0.0 Men Women Both sexes 28.6 28.2 24.9 25.0 22.9 24.7 26.4 21.2 20.5 34.1 32.5 20.5 18–29 years 30–44 years 45–59 years 60–69 years 39.3% of male and 30.4% of female current smokers received doctor’s/health worker’s advice to quit smoking.

43% of respondents are exposed to secondhand smoke at home and 15.8 % at their workplaces.

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Picture #5.

Secondhand smoke exposure at home during the past 30 days (%) by age and sex % 60.0 50.0 40.0 30.0 20.0 10.0 0.0 58.0 51.5 44.7 47.7 44.6 46.1 44.9 39.3 34.3 30.4 30.4 30.4 18–29 years 30–44 years 45–59 years 60–69 years Men Women Both sexes Picture #6.
Secondhand smoke exposure at workplaces during the past 30 days (%) by age and sex % 30.0 20.0 10.0 0.0 28.2 26.4 19.1 10.6 17.7 9.4 23.5 15.5 9.1 18–29 years 30–44 years Men Women 45–59 years Both sexes 9.2 5.6 7.1 60–69 years 8 Alcohol 89.6% of respondents (male 96.1%, female 83.6%) consumed any type of alcohol at least once in a lifetime.

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Picture #7.

Alcohol consumption (%) by sex Alcohol consumption status by gender both sexes 39 30.4 20.1 10.4 female 20.7 34.7 28.1 16.4 male 58.9 25.8 11.4 3.9 0 20 40 60 80 100 current (past 30 days) drinker drank (consumed) in past 12 month, not current past 12 months abstainer lifetime abstainer Current (during the past 30 days) alcohol consumption prevalence is 39% (male 58.9%, female 20.7%).

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Picture #8.

Past 30 days alcohol consumption (%) by age and sex % 80.0 60.0 40.0 20.0 0.0 61.3 45.9 29.8 18–29 y 68.5 45.0 22.1 30–44 y male female 54.8 34.9 17.3 45–59 y both sexes 41.4 24.8 12.4 60–69 y Number of drinking occasions on average is 2 times higher in male than in female respondents (5.7 vs. 2.5 occasions, accordingly).

Average number of standard drinks is almost 3 times higher in man than in women (5.7 vs. 2.0, accordingly).
Heavy drinking occasion (6 or more standard drinks on a single occasion) prevalence is 18.3%; it’s almost 14-times higher in man than in women (35.3% vs. 2.6%).

Quit alcohol drinking because of medical problem or per doctor’s/health worker’s advice among the abstainers during the past 12 months accounts to 21.6% (male 42.4%, female 13.8%).

38.8% of current drinkers (male 43.6%, female 26%) consumed unregistered alcohol during the past 7 days.

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Picture #9.

Consumption of 6 or more standard alcohol drinks at least once during the past 30 days (%) by age and sex % 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Men Women Both sexes 33.2 19.1 4.5 45.3 23.8 2.9 33.8 16.9 1.9 20.2 0.8 9.0 18–29 years 30–44 years 45–59 years 60–69 years 9 Diet On average, respondents consumed fruits 5.3 days a week and vegetables 6 days a week.

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Picture #10.

Fruits consumption, mean number of days in a typical week by age and sex 7 6 5 4 3 2 1 0 5.0 5.4 5.2 5.0 5.5 5.2 5.1 5.5 5.3 5.5 5.4 5.5 18–29 y 30–44 y 45–59 y 60–69 y male female both sexes Picture #11.

Vegetables consumption, mean number of days in a typical week by age and sex 7 6 5 4 3 2 1 0 5.6 6.1 5.9 5.8 6.1 6.0 6.1 6.0 6.0 6.2 6.1 6.1 18–29 y 30–44 y male female 45–59y both sexes 60–69 y On average 2 servings of fruits and 2.4 servings of vegetables are consumed per day.
Less than 5 servings of fruits and vegetables per day are consumed by 63.8% of male and 62.4 % of female respondents.

Fruits and vegetables are not consumed at all by 6% of male and 4% of female respondents.

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Picture #12.

Consumption of 5 or more serving of fruit and vegetables (%) by age and sex % 50.0 40.0 30.0 20.0 10.0 0.0 35.7 35.8 36.4 36.9 35.4 37.0 38.8 38.9 18–29 years 30–44 years Men Women 45–59 years Both sexes 60–69 years On average, meat and meat products were consumed on 2.2 days a week; fish and sea-products are consumed on 1 day a week; milk and diary products are consumed on 5.5 days a week; bread products – 6.7 days a week; sweets or sugar products – 1.5 days a week.
51.2% respondents eat three times a day; about 32% - four times a day; 14% of respondents eat more than 4-times a day ; 0.1% of the population does not eat everyday.

10 Picture #13.

Mean number of days by age and sex when meat and meat products were consumed 3 2 1 0 2.7 2.3 2.0 2.5 2.3 2.1 2.2 2.1 1.9 2.1 1.9 1.7 18–29 y 30–44 y 45–59 y 60–69 y male female both sexes Picture #14.
Mean number of days by age and sex when fish and fish products were consumed 2 1 0 1.2 1.0 0.7 1.1 1.0 1.0 1.2 0.9 1.0 1.1 0.9 1.0 18–29 y 30–44 y 45–59 y 60–69 y male female both sexes Picture #15.

Mean number of days by age and sex when milk and dairy products were consumed 8 6 4 2 0 5.3 5.4 5.4 5.2 5.5 5.4 5.3 5.6 5.5 5.8 5.7 5.7 18–29 y 30–44 y 45–59 y 60–69 y male female both sexes 11 Picture #16.
Mean number of days by age and sex when bread and bread products were consumed 8 6 4 2 0 6.7 6.6 5.7 6.8 6.7 6.0 6.8 6.7 6.0 6.8 6.8 5.9 18–29 y 30–44 y 45–59 y 60–69 y male female both sexes Picture #17.

Mean number of days by age and sex when sweets were consumed 6 4 2 0 5.4 5.5 5.4 4.9 5.3 5.1 4.8 5.1 5.0 5.0 4.5 4.7 18–29 y 30–44 y 45–59 y 60–69 y male female both sexes Mean daily consumption of salt is 8.5 gr.

(male 9.7 gr; female 7.4 gr).


12 Physical Activity Level of physical activity in 17.4% of respondents (male 16.2%, female 18.4%) does not meet WHO recommendations on physical activity.

Younger men (18-29 years) are more physically active.

Picture #18.

Proportion of respondents not meeting WHO recommendations on physical activity (%), by age and sex Mean length of general physical activity per day is 194.9 minutes (male 218.1 minutes, female 173.8 minutes).
Recreational physical activity is 3.5% out of total physical activity (male 5.3%, female 1.5%).

Picture #19.

Average length of a physical activity (minutes) by age and type of physical activity by age and sex 82.4% of respondents (male 72.2%, female 91.8%) are not involved in a vigorous physical activity.

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Proportion of respondents, not participating in a vigorous physical activity by age and sex 13 Anthropometry Mean height in male is 173.8 cm and average male weight is 84.4 kg.
Mean height in female is 161.2 cm and average female weight is 73.6 kg.

Body Mass Index (Mean BMI) is 28.1; 27.9 in male and 28.3 in female.

Body Mass Index increases with age.

Picture #21.

Body Mass Index by age and sex 64.6% of respondents are overweight or obese (BMI ≥25), 32.8% of respondents have normal weigh and 2.5% are underweight.
The prevalence of overweight is higher in male (35.3% and 27.9% accordingly), while the prevalence of obesity is higher in female (36.0% and 30.2% accordingly) Picture #22.

Body Mass Index categories by sex Picture #23.

Overweight by age and sex 14 Picture #24.

Obesity by age and sex Waist-to-hip ratio is 1.0 among men and 0.9 in women.

Both indexes are higher than the indexes according to WHO definition of obesity (male > 0.9 and female > 0.86).
15 Arterial Hypertension 24.5% of respondents have never had blood pressure measured by a doctor or other health worker.

Among those who have ever been told that they have raised blood pressure or hypertension, 53.5% (47.5% male, 58.1% female) were taking some drugs (medication) for raised blood pressure prescribed by a doctor or other health worker.

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Blood pressure measurement and diagnosis by sex 37.7% (male 38.6%, female 36.9%) of respondents have high blood pressure (≥140/100 mmHg).
Prevalence of stage II hypertension (≥160/100 mmHg) is 24.0% (male 22.8%, female 25.2%).

Among those who had high blood pressure during the research and currently are not receiving medication for raised blood pressure, 25.1% (male 28.7%, female 21.6%) have elevated blood pressure.
Among those who currently are on medication for raised blood pressure, 16.4% (male-12.9% and female-19.7%) have normal blood pressure – controlled hypertension; 28.2% are on medication but still have raised blood pressure; 55.4% (male 64.2%, female 47.2%) were not receiving medication for raised blood pressure and also have high blood pressure.

53.5% of people with diagnosed arterial hypertension are currently on medication for raised blood pressure.

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Picture #26.

Antihypertensive treatment and blood pressure by sex 4.7% are currently taking Aspirin and 1.5% Statins for CVD prevention and treatment.

Among those who past 2 weeks were taking medication for raised blood pressure, 30% were taking medication only when the blood pressure raises and 3.2% - irregularly, when recalled.

16 Picture #27.
16 Picture #27.

Regimen of taking medication for raised blood pressure by age and sex 8.3% of medication recommended by the medical doctor (according respondents) to control blood pressure does not belong to the antihypertensive medicines.

5% of respondents have anamnesis of atrial fibrillation or arrhythmia and 11.3% - varicose veins disease; 5.5% are currently taking anticoagulants.
Mean systolic blood pressure was 129.4 mmHg (male 132.6, female 126.5) and mean diastolic blood pressure - 82.2 mmHg (male 83.0, female 81.4); mean heart rate was 79.2 (male 79.3, female 79.1).

Picture #28.

SBP ≥140 and/or DBP ≥ 90 mmHg or currently on medication for raised blood pressure (%) by age and sex 17 Picture #29.

SBP ≥160 and/or DBP ≥ 100 mmHg or currently on medication for raised blood pressure (%) by age and sex Picture #30.
SBP ≥140 and/or DBP ≥ 90 mmHg, excluding those on medication for raised blood pressure (%) by age and sex Picture #31.

SBP ≥160 and/or DBP ≥ 100 mmHg, excluding those on medication for raised blood pressure (%) by age and sex 18 Diabetes 62.4% of respondents have never measured blood glucose.

5.1% of respondents (5.7% female and 4.6% male) mentioned that they have high blood glucose or are diagnosed with diabetes.
Almost 60% of respondents with high blood glucose or those diagnosed with diabetes are on medication regardless of the gender.

Among those who take drugs, 21.9% of male and 14.3% of female respondents are insulin dependant.

Picture #32.

Measurement of blood glucose level and diagnoses (%) by sex Picture #33.

Raised blood glucose level or diagnosed with diabetes during the past 12 months (%) by age and sex Picture #34.
Insulin users among persons with high blood glucose or with diabetes (%) by age and sex 19 Mean fasting glucose was 4.4 mmol/l.

Pre-diabetes condition was 2%.

3.3% of respondents were on anti- diabetic medication; rate increases with aging.

Picture #35.

Impaired fasting glycemia (%) by age and sex Picture #36.

Raised blood glucose (>6.1 mmol/l) or currently on medication for diabetes (%) by age and sex Picture #37.

Fasting Blood sugar (%) by age and sex 20 Picture #38.
Respondents with high blood sugar or on anti-diabetic treatment (%) by age and sex Picture #39.

Blood sugar concentration (%) by age and sex 21 Cholesterol 84.2% of respondents have never measured blood cholesterol.

Only one third of people with high cholesterol are taking oral medication for raised blood cholesterol.

Picture #40.

Total cholesterol measurement and diagnosis during the lifetime (%) by age and sex Picture #41.
Respondents who have never measured blood cholesterol (%) by age and sex Picture #42.

Respondents with high blood cholesterol diagnosed within past 12 months (%) by age and sex Mean total cholesterol was 4.3 mmol/l.

27.7% of respondents have total cholesterol level ≥5.0 mmol/l or are currently on medication for raised cholesterol and 8.7% have total cholesterol level ≥6.2 mmol/l or are currently on medication for raised cholesterol.

Mean high density lipoprotein (HDL) was 1 mmol/l.


76.1% of male population has HDL<1.03 mmol/l and 76.3% of female has HDL<1.29 mmol/l.

22 10-year cardiovascular (CVD) risk 28.8% of respondents between 40-69 years of age have 10-year cardiovascular disease (CVD) risk of ≥30% or existing CVD.

28% of them are receiving drug therapy and consultations to prevent heart attacks and strokes.

Picture #43.
Picture #43.

People receiving drug therapy and consultation among those with a 10-year CVD risk of ≥30%, including those with existing CVD (%) by age and sex Picture #44.

Respondents with a 10-year CVD risk of ≥30% or with existing CVD (%) by age and sex Combined risk-factors 92.4% of respondents (male 94.3%, female 90.7%) have one or more risk-factors and 36.1% (male 45.4%, female 27.6%) have 3 and more risk-factors.
23 Healthy lifestyle advice from doctors/medical professionals Only one fifth of respondents have been advised by a doctor or other health worker regarding the healthy lifestyle components (tobacco, alcohol, nutrition, physical activity, maintenance of healthy weight, restriction of salt and fat).
16.6% have been advised to not to start smoking or to quit; 19.1% to decrease salt consumption; 20.8% to eat more than 5 servings of fruits and vegetables daily; 22.4% to optimize physical activity and 21.1% to maintain healthy weight or to loose weight.

Picture #45.

Advised not to start or to to quit smoking (%) by age and sex 40 30 20 10 0 39.5 30.5 21.6 28.6 17.0 5.8 5.9 15.3 4.0 16.2 10.8 5.3 18–29 30–44 45–59 60–69 Men Women Both sexes Picture #46.
Advised to eat ≥5 servings of fruit and vegetables daily (%) by age and sex 40 30 20 10 0 10.8 14.8 19.7 19.3 27.0 24.3 30.7 26.6 18–29 30–44 Women Men 45–59 Both sexes 60–69 Picture #47.

Advised to optimize physical activity (%) by age and sex 29.0 26.3 23.8 27.1 25.6 24.5 23.8 21.9 20.1 19.4 16.3 13.3 30 20 10 0 18–29 30–44 Men Women 45–59 Both sexes 60–69 24 Picture #48.
Advised to maintain healthy weight or to loose weight (%) by age and sex 28.6 27.1 25.7 27.6 27.0 27.3 20.8 18.7 16.6 30 20 10 0 15.2 13.0 10.9 18–29 30–44 45–59 60–69 Men Women Both sexes Picture #49.

Advised to reduse salt consumption (%) by age and sex 30.8 25.4 20.6 32.6 27.1 23.1 15.7 13.7 14.7 40 30 20 10 0 13.5 11.6 9.7 18–29 30–44 Men Women 45–59 Both sexes 60–69 Picture #50.
Advised to reduce fat in the diet (%) by age and sex 30.5 27.7 25.2 31.9 28.5 26.0 40 30 20 10 0 13.6 12.5 11.4 17.5 16.2 16.9 18–29 30–44 Men Women 45–59 Both sexes 60–69 25 Visit to doctors 46.3% of respondents have visited doctor or medical personnel during last 12 months.

In 75% of cases the main reason of last visit to doctor was specific health problem and in just 18.2% - preventive health checkup.

Picture #51.
Picture #51.

Reasons of last visit to doctor or medical personnel (%) by sex Both sexes Female Male 75 71.7 18.2 6.3 21.4 6.7 78.9 14.4 5.8 0% 20% 40% 60% 80% 100% specific health problem two above preventive health checkup administrative Picture #52.
Recommendations from health professionals (%) 25% 20% 15% 10% 5% 0% 19.1% 16.6% 20.8% 20.8% 22.4% 21.1% o c c a b o t t l a s l s e b a t e g e v / 26 Cervical Cancer Screening 19.9% of women have ever had screening test for cervical cancer; in 30-49 years old women this rate is 23.9%.

Picture #53.
Picture #53.

Cervical cancer screening (%) by age 22.8 26.8 15.5 30 25 20 15 10 5 0 10.4 18-29 30-44 45-59 60-69 Oral health 60.9% of respondents reported having more than 20 natural teeth; 4.3% of respondents do not have any teeth.

86.2% of respondents reported they clean their teeth once a day and 35.3% - clean their teeth twice a day.

34% of respondents have experienced pain or discomfort caused by their teeth or mouth during the past 12 months.

Picture #54.
Picture #54.

Pain or discomfort in mouth during the past 12 months (%) by age and sex 37.3 34.6 31.9 36.3 35.9 36.1 31.6 29.1 30.2 35.3 33.3 31.3 50 40 30 20 10 0 18–29 y 30–44 y 45–59 y 60–69 y male female both sexes Mental health / Suicide During the past 12 months 1.5% of respondents have seriously considered attempting suicide during the past 12 months, among which 16% made a plan about how to attempt suicide during the past 12 months.

0.9% have ever attempted suicide.


27 Injury 2.7% of respondents were involved in a road traffic accidents during the past 12 months.

Picture #55.

Road-traffic accidnts durign the past 12 mnths (%) by age and sex 10 8 6 4 2 0 5.6 3.9 2.2 5.2 3.9 2.6 2.9 1.7 0.5 0.4 0.7 0.6 18–29 y 30–44 y 45–59 y 60–69 y male female both sexes Violence 0.6% of respondents were involved in a violent incident during the past 12 months at least once.
In 66.9% of cases violent incidence was done without a weapon and in 33.1% with weapon (other than a firearm).

Picture #56.

Relationship with a person who caused the injury (%) by age and sex 60 40 20 0 62.6 0 18.1 0 18.5 5.4 sexual partner parents 29.1 24 11.2 friend or acquaintance 53 39.9 7.7 unknown male female total Sexual health 91.1% of respondents (male 96.7%, female 86.2%) have had a sexual intercourse during a lifetime.
Average Age Index of first sexual intercourse was 19.8 year (male 18.1, female 21.5).

First sexual intercourse before age of 15 was detected in 3.4% (male 6.3%, female 0.9%) of respondents.

25% has the past sexual intercourse during the past 1 week/past 1 month period.

76.9% did not report any use of contraception during the past sexual intercourse.
During the past sexual intercourse usage of contraceptives was: condom in 32.6% (male 39.5%, female 22.6%), oral contraception in 2.5% and other methods in 3.6% of cases.

28 STEPS 2010-2016 Tobacco Consumption  Percentage of current smokers increased both in male (from 55% to 59.2%) and in female (from 4.8% to 7.3 %) respondents.

According to Urine Cotinine test smoking prevalence in women is - 12.2%  Average age started smoking decreased from 18.6 (2010) to 18.2 (2016).
 The mean number of cigarette sticks consumed by daily smokers increased from 19.5 (2010) to 21.4 (2016) Picture #57.
Current smokers (%), 18-64 y., by age and sex; STEPS 2010-2016 70 60 50 40 30 20 10 0 55.5 30.3 4.8 59.2 32.4 12.2 7.3 2010 Male Female 2016 Both sexes Alcohol Consumption  Alcohol consumption during the lifetime - increased from 78.5% (2010) to 89.7% (2016)  Alcohol consumption during the past 1 year – reduced from 85.5% (2010) to 81% (2016)  Alcohol consumption during the past 30 days - increased by - 1.3%  Excessive alcohol use has been relatively low in 2016 compared to 2010 - (13.4% less men and 7.4 % less women consumed excessive alcohol) Picture #58.
Alcohol consumption (%), 18-64 age.

; STEPS 2010-2016 100 80 60 40 20 0 89.7 78.5 85.5 81.0 58.5 59.8 Lifetime use Past 1 year use Past 1 month use STEPS 2010 STEPS 2016 29 Diet  Number of days fruits/vegetables consumed as well as amount of servings consumed per day has been increased  ≥5 fruit and/or vegetables servings - has been increased from 30.4% (2010) to 36.8% (2016) Picture #59.
Consumption of 5 and more servings of fruit and vegetables (%), 18-64 y; STEPS 2010-2016 40 35 30 25 20 15 10 5 0 35.8 29.3 37.8 31.4 36.8 30.4 Male Female Both sexes STEPS 2010 STEPS 2016 Physical Activity  Mean minutes of physical activity has been reduced by 5 minutes per day  Work-related physical activity has been reduced by 14.9 minutes  Transport-related physical activity has been increased by 10.4 minutes  Recreation physical activity has been increased by 1.1. minutes.
 Percentage of people who participate in vigorous physical activity has been reduced by 3%.

 Consumption of 5 and more servings of fruit and vegetables (%), 18-64 y; STEPS 2010-2016 Picture #60.
Total physical activity (minutes), 18-64 y; STEPS 2010-2016 250 200 150 100 50 0 225 220 180 178 203 198 Male Female Both sexes STEPS 2010 STEPS 2016 30 Anthropometry  Mean Body Mass Index has been increased from 26.7 (2010) to 27.9 (2016)  Significantly increased overweight (from 56.4 % to 62.9) and obesity (from 25.1% to 31.7%) indexes.

Picture #61.
Picture #61.

Overweight and obesity, 18-64 y; STEPS 2010-2016 80 70 60 50 40 30 20 10 0 64.5 58.6 61.5 54.2 62.9 56.4 28.5 21.8 33.7 29.6 Male Female Both sexes Male Female Overweight % Obesity % STEPS 2010 STEPS 2016 Biochemical Indicators  Mean fasting blood glucose reduced by 1.3.mmol/l  Mean fasting Cholesterol reduced by 0.2 mmol/l  Percentage of those with total cholesterol 5.0. mmol/l or more or those who are on anti-lipid treatment has been increased almost 1.5 times.
The raise is more visible in women.

Picture #62.

Fasting glucose and choleterol (mmol/l), 18-64 y; STEPS 2010-2016 7 6 5 4 3 2 1 0 4.4 4.3 4.4 4.1 4.4 4.3 5.8 5.4 5.6 4.4 4.5 4.5 Male Female Both sexes Male Female Both sexes Glucose Cholesterol STEPS 2010 STEPS 2016 31 Arterial Hypertension  Systolic and diastolic blood pressure levels have been slightly changed - systolic (from 129.3 mmHg to 128 mmHg.)

and diastolic blood pressure (from 81.3 to 81.9 mmHg).
 Percentage of those with raised blood pressure or currently on medication has been increased by 1.2%.

Prevalence of high blood pressure in men has been reduced by 1.1%, while increased by 3.4 % in women.

 Percentage of those with raised blood pressure but not on anti-hypertension medication has been increased by 0.5%.

 Prevalence of high blood pressure in men has been reduced by 2.6 % while increased by 4.1% in women.

Picture #63.
Raised blood pressure (%), 18-64 y; STEPS 2010-2016 40 30 20 10 0 36.0 33.2 34.6 27.3 23.9 20.5 37.1 Male 29.8 33.4 30.0 16.4 23.4 Female Both sexes Male Female Both sexes SBP ≥140 and/or DBP ≥ 90 mmHg or currently on medication for raised blood pressure SBP ≥140 and/or DBP ≥ 90 mmHg, excluding those on medication for raised blood pressure STEPS 2010 STEPS 2016 Cardiovascular disease (CVD) risk  Percentage of those with at least one risk-factor for CVDs reduced by 1.6%  Percentage of those with 3-5 of above risk-factors tendency is reduced both in men and women as well as both in 18-44 and 45-64 age groups.
 Percentage of those with 3-5 of above risk-factors in 18-64 age group has been reduced from 35.2% (2010) to 34.6%.

Picture #64.
Picture #64.

3-5 CVD risk-factors in 18-44 and 45-64age groups (%); STEPS 2010-2016 57.6 56.9 49.7 42.8 47.5 39.7 70 60 50 40 30 20 10 0 39.4 37.9 27.0 25.2 13.5 12.5 2010 2016 18-44 2010 2016 45-64 32 Conclusions  According to the research results, 31.0% of the adult population in Georgia are smokers; 28% are current daily smokers; At this point, the highest smoking prevalence among both sexes was seen in the most productive period, among 30-44 age groups;  39.0% of the population consumes alcohol.
18.3% consumes alcohol excessively;  63.0% of the population in Georgia consumes less than 5 standard servings of fruits and/or vegetables per day; More than one fourth of the population (26.7%) always or often adds salt or salty sauce the dish before or after trying it;  Physical activity level among 17.4% of the population does not comply with WHO recommendations; 64.6% is overweight; 33.2% is obese.
 37.7% has hypertension or currently is receiving treatment for hypertension; Among those who currently are not receiving treatment for hypertension, 25.1% has high blood pressure;  4.5% of the population in Georgia has high blood glucose levels (≥6.1 mmol/l) or is receiving medications; 8.7% of the population has hypercholesterolemia;  Only 20% of the woman population has had cervical cancer screening.

Proportion of such women is highest among 30-59 age groups.
But, even in this age group less that one third of the women had been screened;  Majority of the population (92.4%) is under the influence of 1 or more risk factors of non- communicable diseases.

36.1% is under the influence of 3-5 risk factors.

Men are influenced twice as much as women.


Almost half of the population of 45 years of age and older (48.6%) has high risk of non-communicable diseases;  Research results clearly highlight immediate need to implement effective system for non- communicable diseases prevention and control.
33 Recommendations  Research results clearly highlight immediate need to implement effective system for non- communicable diseases prevention and control;         It is crucial to use research results as an evidence to raise awareness, encourage healthy lifestyle and decrease non-communicable disease risk factors; It is essential to develop, plan and implement interventions tailored to decrease risk factors for non-communicable diseases taking into account the best buys for premature death caused by NCDs, which represent the best interventions; It is appropriate to disseminate results among all interested organisations and parties, including mass media sources, to raise awareness among population regarding NCD risks and health promotion; It is appropriate to share results with insurance companies and other governmental or non- governmental, national and international organisations working on health issues in order to accomplish in depth analyses which will be focused on win-win decisions, offered possibilities by insurance companies to manage NCDs and increase coverage; It is important to develop simplified informational, educational and communication materials for diverse groups of the population, which will ensure accessibility of health literacy; It is crucial to improve competencies among primary healthcare workers on NCD prevention and control and health promotion.
It is vital to increase accessibility of preventive check-ups and essential medications for NCDs; This especially concerns hypertension.

It is advised to develop and strengthen mechanisms for monitoring health status and surveillance; It is important to review NCD strategy and action plan, various laws and normative acts.

34 Annex 1.

STEPS 2016 Coordination Council 1.

Nino Berdzuli 2.

Amiran Gamkrelidze 3.

Irma Khonelidze 4.

Lela Sturua 5.

Maia Kereselidze 6.

Nana Mebonia 7.

Lela Shengelia 8.


Nuka Maglakelidze 9.

Dali Trapaidze 10.

Tamar Chachava 11.

Zaal Merabishvili 12.

Rusudan Kvanchakhadze 13.

Lela Kvachantiradze 14.

Marina Shakhnazarova 15.

Nino Grdzelidze 16.

Bejan Tsinamdzgvrishvili 17.

Koka Liluashvili 18.

Nato Shengelia 19.

Levan Jijeishvili 20.

Vakhtang Barbakadze 21.

Ramaz Kurashvili 22.

Elene shelestova 23.

Nino Makhashvili 24.

Jana Javakhishvili 25.

Elene Giorgadze 26.

Irma Chokhonelidze 27.

Mamuka Margvelashvili 28.


Kakha Gvinianidze 29.

Giorgi Bakhturidze 30.

Paata Shavishvili 31.

Nato Kopaleishvili 35 Annex 2.
STEPS 2016 Survey personnel Project Director Lela Sturua MD PhD MPH Field Coordinator Nana Mebonia MD PhD Lela Shengelia MD MPH Dali Trapaidze MD Interviewers: Tamar Chachava Zaal Merabishvili Rusudan Kvanchakhadze Iulia Zedgenidze Nino Buadze Natia Kakutia Teona Todua Tea Bokuchava Sofo Chiraqadze Nino Chekurishvili Maia Beruchashvili Irina Rukhadze Fiqria Shavreshiani Eka Jorjoliani Eka Nodia Mikheil Gelovani Levan Bakuradze Tamar Kvatadze Lela Sabadze Mariam Kakauridze Tamar Kutaladze Nino Chiqovani Aleksandre Tavadze Tedo Dumbadze Shota Mzhavia Lela Shashikasvili Lela Bokoveli Elene Eristavi Liana Shekiladze Giorgi Kikabidze 36 Nino Kikabidze Nana Baratashvili Gocha Giorgidze Davit Ugrekhelidze Dali Kobuladze Alina Phakhuridze Maka Tsilosani Marina Khimshiashvili Lab specialist: Nato Tsomaia Otar Tsagareishvili Nino Sarashvili Lia Skhirtladze Nino Tsetskhladze Marina Topuridze Tamar Mamatsashvili Khatuna Aladashvili Eka Gabitashvili Dali Gongadze Eka Oragvelidze Qetevan Rukhadze Nana Tsaguria Tatiana Kutubidze Khatuna Zoidze Shorena Gedenidze Maia Chubinidze Iza Rokva Nana Kishmareia 37 WHO STEPS Instrument for Noncommunicable Disease Risk Factor Surveillance <Georgia 2016> Survey Information Response Code └─┴─┴─┴─┴─┴─┘ └─┴─┴─┘ └─┴─┘ └─┴─┘ └─┴─┴─┴─┘ dd mm year Location and Date Cluster/Centre/Village ID Cluster/Centre/Village name Interviewer ID Date of completion of the instrument Consent, Interview Language and Name Consent has been read and obtained Response Yes 1 No 2 If NO, END Time of interview (24 hour clock) Family Surname First Name Personal ID Number Additional Information that may be helpful Contact phone number where possible └─┴─┘: └─┴─┘ hrs mins 38 I1 I2 I3 I4 Code I5 I7 I8 I9 I9a I10 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Step 1 Demographic Information Demographic Information Question Sex (Record Male / Female as observed) What is your date of birth?
Don't Know 77 77 7777 How old are you?

In total, how many years have you spent at school and in full- time study (excluding pre-school)?

Demographic Information Response Male Female 1 2 └─┴─┘ └─┴─┘ └─┴─┴─┴─┘ If known, Go to C4 dd mm year Years Years └─┴─┘ └─┴─┘ No formal schooling Not completed primary Primary school (1-6 years) Main secondary (7-10 years) What is the highest level of education you have completed?
Secondary school completed (11-12 years) Professional education University completed Post graduate degree What is your ethnical background?

What is your marital status?

Which of the following best describes your main work status over the past 12 months?

(USE SHOWCARD) How many people older than 18 years, including yourself, live in your household?
Refused 88 Georgian Armenian Azeri 1 2 3 Ossetian 4 Russian 5 Other Refused 77 88 Never married Currently married Separated Divorced Widowed Cohabitating Refused 88 Government employee Non-government employee Self-employed Non-paid Student Homemaker Retired Unemployed (able to work) Unemployed (unable to work) Refused 88 Number of people └─┴─┘ 39 Code C1 C2 C3 C4 C5 C6 C7 C8 C9 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Demographic Information, Continued Question Taking the past year, can you tell me what the average earnings of the household have been?
(RECORD ONLY ONE, NOT ALL 3) If you don’t know the amount, can you give an estimate of the annual household income if I read some options to you (per month)?

(READ OPTIONS) What is your religion?
Response Per week └─┴─┴─┴─┴─┴─┴─┘ Go to X1 OR per month └─┴─┴─┴─┴─┴─┴─┘ Go to X1 OR per year └─┴─┴─┴─┴─┴─┴─┘ Go to X1 Refused 88 ≤ 250 GeL 251 – 500 GeL 501 – 1000 GeL 1001 – 1500 GeL 1 2 3 4 >1500 GeL 5 Don’t know Refused 77 88 Orthodox Cristian Catholic Gregorian Muslim Jewish Not religious Refused 88 Code C10a C10b C10c C10d C11 X1 40 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Step 1 Behavioural Measurements Tobacco Use Now I am going to ask you some questions about tobacco use.
Question Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes?

(USE SHOWCARD) Do you currently smoke tobacco products daily?

How old were you when you first started smoking?

Do you remember how long ago it was?


(RECORD ONLY 1, NOT ALL 3) Don’t know 77 Response Yes 1 No 2 If No, go to T8 Yes No 1 2 Age (years) Don’t know 77 └─┴─┘ If Known, go to T5a/T5aw In Years └─┴─┘ If Known, go to T5a/T5aw OR in Months └─┴─┘ If Known, go to T5a/T5aw OR in Weeks └─┴─┘ DAILY↓ WEEKLY↓ Code T1 T2 T3 T4a T4b T4c On average, how many of the following products do you smoke each day/week?
(IF LESS THAN DAILY, RECORD WEEKLY) (RECORD FOR EACH TYPE, USE SHOWCARD) Don’t Know 7777 During the past 12 months, have you tried to stop smoking?

During the last 12 months which methods to quit smoking did you use?
Manufactured cigarettes Hand-rolled cigarettes Pipes full of tobacco Cigars, cheroots, cigarillos Number of Shisha sessions └─┴─┴─┴─┘└─┴─┴─┴─┘ └─┴─┴─┴─┘└─┴─┴─┴─┘ └─┴─┴─┴─┘└─┴─┴─┴─┘ └─┴─┴─┴─┘└─┴─┴─┴─┘ └─┴─┴─┴─┘└─┴─┴─┴─┘ T5a/T5aw T5b/T5bw T5c/T5cw T5d/T5dw T5e/T5ew Other └─┴─┴─┴─┘└─┴─┴─┴─┘ If Other, go to T5other, else go to T6 T5f/T5fw Other (please specify): └─┴─┴─┴─┴─┴─┘ Yes No 1 2 go to T7 Consultation at the Primary Healthcare level Nicotine Replacement Therapy Drugs (Buproprion, Tabex) Telephone consultation Electronic Cigarette Other, Specify--------------------------------------- None 77 88 T5other/ T5otherw T6 X2 During any visit to a doctor or other health worker in the past 12 months, were you advised to quit smoking tobacco?
In the past, did you ever smoke any tobacco products?

(USE SHOWCARD) In the past, did you ever smoke daily?
Yes 1 If T2=Yes, go to T12; if T2=No, go to T9 No No visit during the past 12 months 2 If T2=Yes, go to T12; if T2=No, go to T9 T7 3 If T2=Yes, go to T12; if T2=No, go to T9 Yes 1 No 2 If No, go to T12 Yes 1 If T1=Yes, go to T12, else go to T10 No 2 If T1=Yes, go to T12, else go to T10 T8 T9 41 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Tobacco Use Question How old were you when you stopped smoking?

How long ago did you stop smoking?


(RECORD ONLY 1, NOT ALL 3) Don’t Know 77 Do you currently use any smokeless tobacco products such as [snuff, chewing tobacco, betel]?

(USE SHOWCARD) Do you currently use smokeless tobacco products daily?

On average, how many times a day/week do you use ….
(IF LESS THAN DAILY, RECORD WEEKLY) (RECORD FOR EACH TYPE, USE SHOWCARD) Don’t Know 7777 Response Age (years) Don’t Know 77 └─┴─┘ If Known, go to T12 Years ago └─┴─┘ If Known, go to T12 OR Months ago └─┴─┘ If Known, go to T12 OR Weeks ago └─┴─┘ Yes 1 No 2 If No, go to T15 Yes 1 No 2 DAILY↓ WEEKLY↓ Snuff, by mouth └─┴─┴─┴─┘└─┴─┴─┴─┘ Snuff, by nose └─┴─┴─┴─┘└─┴─┴─┴─┘ Chewing tobacco └─┴─┴─┴─┘└─┴─┴─┴─┘ Betel, quid └─┴─┴─┴─┘└─┴─┴─┴─┘ Code T10 T11a T11b T11c T12 T13 T14a/ T14aw T14b/ T14bw T14c/ T14cw T14d/ T14dw Other └─┴─┴─┴─┘└─┴─┴─┴─┘ If Other, go to T14other, if T13=No, go to T16, else go to T17 T14ew T14e/ Other (please specify): └─┴─┴─┴─┴─┴─┘ If T13=No, go to T16, else go to T17 T14other/ T14otherw In the past, did you ever use smokeless tobacco products such as [snuff, chewing tobacco, or betel]?
In the past, did you ever use smokeless tobacco products such as [snuff, chewing tobacco, or betel] daily?

During the past 30 days, did someone smoke in your home?

During the past 30 days, did someone smoke in closed areas in your workplace (in the building, in a work area or a specific office)?
Yes No Yes No 1 2 If No, go to T17 1 2 Yes 1 No 2 Yes 1 No Don't work in a closed area 2 3 T15 T16 T17 T18 42 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Tobacco Policy You have been asked questions on tobacco consumption before.

The next questions ask about tobacco control policies.

They include questions on your exposure to the media and advertisement, on cigarette promotions, health warnings and cigarette purchase.
Question During the past 30 days, have you noticed information about the dangers of smoking cigarettes or that encourages quitting through the following media?

(RECORD FOR EACH) Response Code Newspapers or magazines Television Radio During the past 30 days, have you noticed any advertisements or signs promoting cigarettes in stores where cigarettes are sold?

During the past 30 days, have you noticed any of the following types of cigarette promotions?
(RECORD FOR EACH) Free samples of cigarettes Cigarettes at sale prices Coupons for cigarettes Free gifts or special discount offers on other products when buying cigarettes Clothing or other items with a cigarette brand name or logo Cigarette promotions in the mail The next questions TP4 – TP7 are administered to current smokers only.
1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 1 Yes No 2 Don't know 77 During the past 30 days, did you notice any health warnings on cigarette packages?

During the past 30 days, have warning labels on cigarette packages led you to think about quitting?
Did not see any cigarette packages Yes 1 No 2 If no, go to TP6 3 If "did not see any cigarette packages", go to TP6 Don't know 77 If Don't know, go to TP6 1 Yes No 2 Don't know 77 The last time you bought manufactured cigarettes for yourself, how many cigarettes did you buy in total?

Don't know or Don't smoke or purchase manuf.

cigarettes 7777 Number of cigarettes └─┴─┴─┴─┘ If "Don't know or don't smoke or purchase manuf.

cig.

", end section In total, how much money did you pay for this purchase?
(DIGITS TO BE ADAPTED TO COUNTRY NEEDS) Amount Don't know Refused └─┴─┴─┴─┘ 7777 8888 43 TP1a TP1b TP1c TP2 TP3a TP3b TP3c TP3d TP3e TP3f TP4 TP5 TP6 TP7 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Alcohol Consumption The next questions ask about the consumption of alcohol.

Question Have you ever consumed any alcohol such as beer, wine, spirits or Chacha, Nalivka?

(USE SHOWCARD OR SHOW EXAMPLES) Have you consumed any alcohol within the past 12 months?
Have you stopped drinking due to health reasons, such as a negative impact on your health or on the advice of your doctor or other health worker?

During the past 12 months, how frequently have you had at least one standard alcoholic drink?
(READ RESPONSES, USE SHOWCARD) Response Yes 1 No 2 If No, go to A16 Yes 1 If Yes, go to A4 No 2 Yes 1 If Yes, go to A16 No 2 If No, go to A16 Daily 5-6 days per week 3-4 days per week 1-2 days per week 1-3 days per month Less than once a month Yes Have you consumed any alcohol within the past 30 days?

No 2 If No, go to A13 During the past 30 days, on how many occasions did you have at least one standard alcoholic drink?
During the past 30 days, when you drank alcohol, how many standard drinks on average did you have during one drinking occasion?

(USE SHOWCARD) During the past 30 days, what was the largest number of standard drinks you had on a single occasion, counting all types of alcoholic drinks together?

During the past 30 days, how many times did you have six or more standard drinks in a single drinking occasion?

During each of the past 7 days, how many standard drinks did you have each day?
(USE SHOWCARD) Don't Know 77 Number Don't know 77 └─┴─┘ Number Don't know 77 Largest number Don't Know 77 Number of times Don't Know 77 └─┴─┘ └─┴─┘ └─┴─┘ Monday └─┴─┘ Tuesday └─┴─┘ Wednesday └─┴─┘ Thursday └─┴─┘ Friday └─┴─┘ Saturday └─┴─┘ Sunday └─┴─┘ 44 Code A1 A2 A3 A4 A5 A6 A7 A8 A9 A10a A10b A10c A10d A10e A10f A10g Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Alcohol Consumption, continued I have just asked you about your consumption of alcohol during the past 7 days.
The questions were about alcohol in general, while the next questions refer to your consumption of homebrewed alcohol, alcohol brought over the border/from another country, any alcohol not intended for drinking or other untaxed alcohol.

Please only think about these types of alcohol when answering the next questions.
Question Response Code During the past 7 days, did you consume any homebrewed alcohol, any alcohol brought over the border/from another country, any alcohol not intended for drinking or other untaxed alcohol?

(USE SHOWCARD) On average, how many standard drinks of the following did you consume during the past 7 days?
[INSERT COUNTRY-SPECIFIC EXAMPLES] (USE SHOWCARD) Don't Know 77 Alcohol Consumption During the past 12 months, how often have you found that you were not able to stop drinking once you had started?

During the past 12 months, how often have you needed a first drink in the morning to get yourself going after a heavy drinking session?

Yes 1 No 2 If No, go to A13 Homebrewed spirits, e.g.
Chacha, Nalivka └─┴─┘ Homebrewed beer or wine └─┴─┘ Alcohol brought over the border/from another country └─┴─┘ Alcohol not intended for drinking, e.g.
alcohol-based medicines, perfumes, after shaves └─┴─┘ Other untaxed alcohol in the country └─┴─┘ Daily or almost daily Weekly Monthly Less than monthly Never Daily or almost daily Weekly Monthly Less than monthly Never A11 A12a A12b A12c A12d A12e A13 A15 45 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Diet The next questions ask about the fruits and vegetables that you usually eat.

I have a nutrition card here that shows you some examples of local fruits and vegetables.
Each picture represents the size of a serving.

As you answer these questions please think of a typical week in the last year.

Question Response Code In a typical week, on how many days do you eat fruit?

(USE SHOWCARD) Number of days Don't Know 77 └─┴─┘ If Zero days, go to D3 How many servings of fruit do you eat on one of those days?

(USE SHOWCARD) Number of servings Don't Know 77 └─┴─┘ In a typical week, on how many days do you eat vegetables?
(USE SHOWCARD) Number of days Don't Know 77 └─┴─┘ If Zero days, go to X3 How many servings of vegetables do you eat on one of those days?

(USE SHOWCARD) Number of servings Don’t know 77 └─┴─┘ In a typical week, on how many days do you eat meat or meat products?

In a typical week, on how many days do you eat fish or sea products?

In a typical week, on how many days do you drink milk or milk products?

In a typical week, on how many days do you eat bread or bread products?
In a typical week, on how many days do you eat sugar or sweet products?

How many times a day you usually eat?
Dietary salt Number of days Don't Know 77 └─┴─┘ If Zero days, go to X4 Number of days Don't Know 77 └─┴─┘ If Zero days, go to X5 Number of days Don't Know 77 └─┴─┘ If Zero days, go to X6 Number of days Don't Know 77 Number of days Don't Know 77 └─┴─┘ If Zero days, go to X7 └─┴─┘ If Zero days, go to X8 I don’t eat everyday Once a day Twice a day 3 times a day 4 times a day More than 4 times a day Don't Know 77 D1 D2 D3 D4 X3 X4 X5 X6 X7 X8 With the next questions, we would like to learn more about salt in your diet.
Dietary salt includes ordinary table salt, unrefined salt such as sea salt, iodized salt, salty stock cubes and powders, and salty sauces such as soya sauce or fish sauce (see showcard).

The following questions are on adding salt to the food right before you eat it, on how food is prepared in your home, on eating processed foods that are high in salt such as marinade vegetables, smoked meat, smoked cheese, adjika, tkemali etc., and questions on controlling your salt intake.
Please answer the questions even if you consider yourself to eat a diet low in salt.

How often do you add salt or a salty sauce such as soya sauce to your food right before you eat it or as you are eating it?

(SELECT ONLY ONE) (USE SHOWCARD) How often is salt, salty seasoning or a salty sauce added in cooking or preparing foods in your household?
Always 1 Often 2 Sometimes 3 Rarely Never 4 5 Don't know 77 Always 1 Often 2 Sometimes 3 Rarely Never 4 5 Don't know 77 D5 D6 46 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ How often do you eat processed food high in salt?
By processed food high in salt, I mean foods that have been altered from their natural state, such as packaged salty snacks, canned salty food including pickles and preserves, salty food prepared at a fast food restaurant, cheese, bacon and processed meat [add marinade vegetables, smoked meat, smoked cheese, etc.

(USE SHOWCARD) How much salt or salty sauce do you think you consume?

Diet Question How important to you is lowering the salt in your diet?
Do you think that too much salt or salty sauce in your diet could cause a health problem?

Do you do any of the following on a regular basis to control your salt intake?
(RECORD FOR EACH) Limit consumption of processed foods Look at the salt or sodium content on food labels Buy low salt/sodium alternatives Use spices other than salt when cooking Avoid eating foods prepared outside of a home Do other things specifically to control your salt intake Always 1 Often 2 Sometimes 3 Rarely Never 4 5 Don't know 77 Far too much 1 Too much 2 Just the right amount 3 Too little Far too little 4 5 Don't know 77 Response Very important 1 Somewhat important Not at all important 2 3 Don't know 77 Yes No Don't know 1 2 77 Yes No Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 1 2 Yes 1 If Yes, go to D11other No 2 D7 D8 Code D9 D10 D11a D11b D11c D11d D11e D11f Other (please specify) └─┴─┴─┴─┴─┴─┴─┘ D11other The next questions ask about the oil or fat that is most often used for meal preparation in your household, and about meals that you eat outside a home.
What type of oil or fat is most often used for meal preparation in your household?

(USE SHOWCARD) (SELECT ONLY ONE) On average, how many meals per week do you eat that were not prepared at a home?

By meal, I mean breakfast, lunch and dinner.


47 Vegetable oil 1 Lard 2 Butter 3 Margarine 4 Other 5 If Other, go to D12 other None in particular 6 None used 7 Don’t know 77 D12 Other └─┴─┴─┴─┴─┴─┴─┘ D12other Number Don’t know 77 └─┴─┘ D13 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Physical Activity Next I am going to ask you about the time you spend doing different types of physical activity in a typical week.
Please answer these questions even if you do not consider yourself to be a physically active person.

Think first about the time you spend doing work.

Think of work as the things that you have to do such as paid or unpaid work, study/training, household chores, harvesting food/crops, fishing or hunting for food, seeking employment.

[Insert other examples if needed].


In answering the following questions 'vigorous-intensity activities' are activities that require hard physical effort and cause large increases in breathing or heart rate, 'moderate-intensity activities' are activities that require moderate physical effort and cause small increases in breathing or heart rate.
Question Work Response Code Does your work involve vigorous-intensity activity that causes large increases in breathing or heart rate like [carrying or lifting heavy loads, digging or construction work] for at least 10 minutes continuously?

(USE SHOWCARD) In a typical week, on how many days do you do vigorous- intensity activities as part of your work?

How much time do you spend doing vigorous-intensity activities at work on a typical day?
Does your work involve moderate-intensity activity that causes small increases in breathing or heart rate such as brisk walking [or carrying light loads] for at least 10 minutes continuously?

(USE SHOWCARD) Yes 1 No 2 If No, go to P 4 Number of days └─┘ Hours : minutes └─┴─┘: └─┴─┘ hrs mins Yes 1 No 2 If No, go to P 7 In a typical week, on how many days do you do moderate- intensity activities as part of your work?
Number of days └─┘ How much time do you spend doing moderate-intensity activities at work on a typical day?

Hours : minutes └─┴─┘: └─┴─┘ hrs mins P1 P2 P3 (a-b) P4 P5 P6 (a-b) Travel to and from places The next questions exclude the physical activities at work that you have already mentioned.

Now I would like to ask you about the usual way you travel to and from places.

For example to work, for shopping, to market, to place of worship.
[Insert other examples if needed] Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places?

In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places?

How much time do you spend walking or bicycling for travel on a typical day?
Yes 1 No 2 If No, go to P 10 Number of days └─┘ Hours : minutes └─┴─┘: └─┴─┘ hrs mins P7 P8 P9 (a-b) 48 Physical Activity, Continued Question Response Code Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Recreational activities The next questions exclude the work and transport activities that you have already mentioned.
Now I would like to ask you about sports, fitness and recreational activities (leisure) Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate like [running or football] for at least 10 minutes continuously?

USE SHOWCARD) In a typical week, on how many days do you do vigorous- intensity sports, fitness or recreational (leisure) activities?
How much time do you spend doing vigorous-intensity sports, fitness or recreational activities on a typical day?

Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that cause a small increase in breathing or heart rate such as brisk walking, [cycling, swimming, and volleyball] for at least 10 minutes continuously?

(USE SHOWCARD) In a typical week, on how many days do you do moderate- intensity sports, fitness or recreational (leisure) activities?
Yes 1 No 2 If No, go to P 13 Number of days └─┘ Hours : minutes └─┴─┘: └─┴─┘ hrs mins Yes 1 No 2 If No, go to P16 Number of days └─┘ How much time do you spend doing moderate-intensity sports, fitness or recreational (leisure) activities on a typical day?
Hours : minutes └─┴─┘: └─┴─┘ hrs mins P10 P11 P12 (a-b) P13 P14 P15 (a-b) Physical Activity Sedentary behaviour The following question is about sitting or reclining at work, at home, getting to and from places, or with friends including time spent sitting at a desk, sitting with friends, traveling in car, bus, train, reading, playing cards or watching television, but do not include time spent sleeping.

(USE SHOWCARD) How much time do you usually spend sitting or reclining on a typical day?
Hours : minutes └─┴─┘: └─┴─┘ hrs mins P16 (a-b) 49 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ History of Raised Blood Pressure Question Have you ever had your blood pressure measured by a doctor or other health worker?

Have you ever been told by a doctor or other health worker that you have raised blood pressure or hypertension?

Have you been told in the past 12 months?


In the past two weeks, have you taken any drugs (medication) for raised blood pressure prescribed by a doctor or other health worker?

What is the regime of taking drugs?

Which drug do you take?

(note all drugs respondent mentions) Have you ever seen a traditional healer for raised blood pressure or hypertension?

Are you currently taking any herbal or traditional remedy for your raised blood pressure?
History of Diabetes Have you ever had your blood sugar measured by a doctor or other health worker?

Have you ever been told by a doctor or other health worker that you have raised blood sugar or diabetes?

Have you been told in the past 12 months?

In the past two weeks, have you taken any drugs (medication) for diabetes prescribed by a doctor or other health worker?

Are you currently taking insulin for diabetes prescribed by a doctor or other health worker?
Have you ever seen a traditional healer for diabetes or raised blood sugar?

Are you currently taking any herbal or traditional remedy for your diabetes?
Code H1 H2a H2b H3 X9 X10 H4 H5 H6 H7a H7b H8 H9 H10 H11 Response Yes 1 No 2 If No, go to H6 Yes 1 No 2 If No, go to H6 Yes 1 No 2 Yes No 1 2 Everyday despite the blood pressure numbers When the pressure is high Irregularly, when remember 1 2 3 Yes No Yes No 1 2 1 2 Yes 1 No 2 If No, go to H12 Yes 1 No 2 If No, go to H12 Yes 1 No 2 Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 50 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ History of Raised Total Cholesterol Question Have you ever had your cholesterol (fat levels in your blood) measured by a doctor or other health worker?
Have you ever been told by a doctor or other health worker that you have raised cholesterol?

Have you been told in the past 12 months?

In the past two weeks, have you taken any oral treatment (medication) for raised total cholesterol prescribed by a doctor or other health worker?

Have you ever seen a traditional healer for raised cholesterol?

Are you currently taking any herbal or traditional remedy for your raised cholesterol?
History of Cardiovascular Diseases Have you ever had a heart attack or chest pain from heart disease (angina) or a stroke (cerebrovascular accident or incident)?

Are you currently taking aspirin regularly to prevent or treat heart disease?

Are you currently taking statins (Lovastatin/Simvastatin/Atorvastatin/Rosuvastatin or any other statin) regularly to prevent or treat heart disease?

Have you ever been told by a doctor or other health worker that you have Atrial Fibrillation/?
Have you ever been told by a doctor or other health worker that you have chronic vein vessel disease or varicose veins of lower extremities or deep vein thrombosis (DVT)?

Are you currently taking anticoagulants (Aspirin/Heparin) prescribed by a doctor or other health worker?
Response Yes 1 No 2 If No, go to H17 Yes 1 No 2 If No, go to H17 Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 Yes No Yes No Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 1 2 1 2 Lifestyle Advice During the past three years, has a doctor or other health worker advised you to do any of the following?
(RECORD FOR EACH) Quit using tobacco or don’t start Reduce salt in your diet Eat at least five servings of fruit and/or vegetables each day Reduce fat in your diet Start or do more physical activity Maintain a healthy body weight or lose weight Yes No Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 1 2 Yes 1 If C1=1 go to X14 No 2 If C1=1 go to X14 51 Code H12 H13a H13b H14 H15 H16 H17 H18 H19 X11 X12 X13 H20a H20b H20c H20d H20e H20f Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ (for women only): Cervical Cancer Screening The next question asks about cervical cancer prevention.
Screening tests for cervical cancer prevention can be done in different ways, including Visual Inspection with Acetic Acid/vinegar (VIA), pap smear and Human Papillomavirus (HPV) test.

VIA is an inspection of the surface of the uterine cervix after acetic acid (or vinegar) has been applied to it.

For both pap smear and HPV test, a doctor or nurse uses a swab to wipe from inside your vagina, take a sample and send it to a laboratory.
It is even possible that you were given the swab yourself and asked to swab the inside of your vagina.

The laboratory checks for abnormal cell changes if a pap smear is done, and for the HP virus if an HPV test is done.

Code CX1 Code X14 X15 Code O1 O6 O9 Question Have you ever had a screening test for cervical cancer, using any of these methods described above?

Admission to the medical personnel Question Have you visited medical doctor or other medical personnel during the last 12 months?
From the following what was the main reason of the last visit?

Response Yes No 1 2 Don’t know 77 Response Yes 1 go to X15 No 2 go to M1 Don’t know 77 go to M1 Concrete health problem Prophylactic check-up 1 2 Administrative (non-medical) reasons Both 3 4 77 Don’t know Oral Health The next questions ask about your oral health status and related behaviours.

Question Response No natural teeth 1 If no natural teeth, go to O6 How many natural teeth do you have?
During the past 12 months, did your teeth or mouth cause any pain or discomfort?

How often do you clean your teeth?

1 to 9 teeth 2 10 to 19 teeth 3 4 77 1 2 20 teeth or more Don't know Yes No Never 1 If Never, go to MH1 Once a month 2-3 times a month Once a week 2-6 times a week Once a day Twice or more a day 52 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Mental health / Suicide The next questions ask about thoughts, plans, and attempts of suicide.
Please answer the questions even if no one usually talks about these issues.

Question Response Code During the past 12 months, have you seriously considered attempting suicide?

During the past 12 months, have you made a plan about how you would attempt suicide?

Have you ever attempted suicide?

Yes No Refused Yes No Refused 1 2 If No, go to MH4 88 1 2 88 Yes No 1 2 Refused 88 Injury The next questions ask about different experiences and behaviours that are related to road traffic injuries.
Question In the past 12 months, have you been involved in a road traffic crash as a driver, passenger, pedestrian, or cyclist?

Response Yes (as driver) Yes (as passenger) Yes (as pedestrian) Yes (as a cyclist) 1 2 3 4 No 5 Don’t know 77 Refused 88 The next questions ask about the most serious accidental injury you have had in the past 12 months.

In the past 12 months, were you injured accidentally, other than the road traffic crashes which required medical attention?
Please indicate which of the following the cause of this injury was.

Yes No Don't know Refused Fall Burn Poisoning Cut Near-drowning Animal bite Other (specify) 1 2 77 88 Don't know Refused 77 88 MH1 MH3 MH4 Code V3 V5 V6 Other (please specify) └─┴─┴─┴─┴─┴─┴─┘ V6other 53 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Violence The following questions are about different experiences and behaviours that are related to violence.
Question In the past 12 months, how many times were you in a violent incident in which you were injured and required medical attention?

Response Never 1 go to SH1 Rarely (1- 2 times) Sometimes (3 – 5 times) Often (6 or more times) 2 3 4 Don’t know 77 go to SH1 Refused 88 go to SH1 The next questions ask about the most serious violent incidence you have had in the past 12 months.

Please indicate which of the following caused your most serious injury in the last 12 months.
Please indicate the relationship between yourself and the person(s) who caused your injury.
Being shot with a firearm A weapon (other than a firearm) was used by the person who injured me Being injured without any weapon 1 2 (slapped, pushed…) 3 77 Don’t know Refused 88 Intimate partner Parent 1 2 Child, sibling, or other relative 3 Friend or acquaintance Unrelated caregiver Stranger Official or legal authorities Other (specify) Refused 88 Code V11 V12 V13 Other (please specify) └─┴─┴─┴─┴─┴─┴─┘ V13other 54 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Sexual Health (expanded questions are shaded) The next questions ask about different experiences and behaviours that are related to sexual and reproductive health.
Question Have you ever had sexual intercourse?

How old were you when you first had sexual intercourse?

(USE SHOWCARDS) When did you last have sexual intercourse?

The last time you had sexual intercourse, did you use any kind of protection against pregnancy and/or infection?
Response 1 Yes No 2 If No, finish the interview Refused 88 Age in years └─┴─┘ 77 Don't remember 88 Refused 1 In the last week Between a week and a month ago 2 Between a month and a year ago 3 Code SH1 SH2 More than a year ago 4 If More than a year ago, finish the interview SH5 Don't remember 77 If Don't remember, finish the interview Refused 88 Yes 1 No 2 If No, finish the interview Don't know 77 If Don't know, finish the interview Refused 88 SH9 The last time you had sexual intercourse, were any of the following methods of protection against pregnancy and/or infection used?
(RECORD FOR EACH) A condom The pill 1 Yes No 2 Don't remember 77 Yes 1 No 2 Don't remember 77 1 If Yes, please specify Yes No 2 Don't remember 77 A different method Other (please specify) └─┴─┴─┴─┴─┴─┴─┘ No 2 Don't remember 77 1 If Yes, please specify Yes No 2 Don't remember 77 Other (please specify) └─┴─┴─┴─┴─┴─┴─┘ Other SH10a SH10b SH10c SH10cOther SH11d SH11dOther 55 Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Step 2 Physical Measurements Response Code Blood Pressure Question Interviewer ID Device ID for blood pressure Cuff size used Reading 1 Reading 2 Reading 3 During the past two weeks, have you been treated for raised blood pressure with drugs (medication) prescribed by a doctor or other health worker?
Height and Weight For women: Are you pregnant?
Interviewer ID Device IDs for height and weight Height Weight If too large for scale 666.6 Waist Device ID for waist Waist circumference EXPANDED: Hip Circumference and Heart Rate Hip circumference Heart Rate Reading 1 Reading 2 Reading 3 └─┴─┴─┘ └─┴─┘ 1 2 3 Small Medium Large Systolic ( mmHg) └─┴─┴─┘ Diastolic (mmHg) └─┴─┴─┘ Systolic ( mmHg) └─┴─┴─┘ Diastolic (mmHg) └─┴─┴─┘ Systolic ( mmHg) └─┴─┴─┘ Diastolic (mmHg) └─┴─┴─┘ Yes No 1 2 Yes 1 If Yes, go to M 16 No 2 └─┴─┴─┘ Height └─┴─┘ Weight └─┴─┘ in Centimetres (cm) └─┴─┴─┘.
└─┘ in Kilograms (kg) └─┴─┴─┘.└─┘ └─┴─┘ in Centimeters (cm) └─┴─┴─┘.└─┘ in Centimeters (cm) └─┴─┴─┘.└─┘ Beats per minute └─┴─┴─┘ Beats per minute └─┴─┴─┘ Beats per minute └─┴─┴─┘ 56 M1 M2 M3 M4a M4b M5a M5b M6a M6b M7 M8 M9 M10a M10b M11 M12 M13 M14 M15 M16a M16b M16c Participant Identification Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Step 3 Biochemical Measurements Blood Glucose Question During the past 12 hours have you had anything to eat or drink, other than water?
Technician ID Device ID Time of day blood specimen taken (24 hour clock) Fasting blood glucose Today, have you taken insulin or other drugs (medication) that have been prescribed by a doctor or other health worker for raised blood glucose?

Blood Lipids Device ID Total cholesterol During the past two weeks, have you been treated for raised cholesterol with drugs (medication) prescribed by a doctor or other health worker?

Urinary sodium and creatinine Had you been fasting prior to the urine collection?
Technician ID Device ID Time of day urine sample taken (24 hour clock) Urinary sodium Urinary creatinine Triglycerides and HDL Cholesterol Question HDL Cholesterol [CHOOSE ACCORDINGLY: MMOL/L OR MG/DL] Response Yes No 1 2 └─┴─┴─┘ └─┴─┘ Hours : minutes └─┴─┘: └─┴─┘ hrs mins mmol/l └─┴─┘.

└─┴─┘ Yes No 1 2 └─┴─┘ mmol/l └─┴─┘.

└─┴─┘ Yes 1 No 2 Yes No 1 2 └─┴─┴─┘ └─┴─┘ Hours : minutes └─┴─┘: └─┴─┘ hrs mins mmol/l └─┴─┴─┘.└─┘ mmol/l └─┴─┘.

└─┴─┘ Response mmol/l └─┘.


└─┴─┘ mg/dl └─┴─┴─┘.└─┘ Code B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14 B15 Code B17 57