The Common Health Traditions on Cultural Heritage

Note: The greater the number of positive responses, the greater the person’s identification with a traditional heritage. The one exception to positive answers is the question about family name change. This question may be answered negatively.
1. Where was your mother born?__Ethiopia
2. Where was your father born? Ethiopia
3. Where were your grandparents born?
(1) Your mother’s mother? Ethiopia
(2) Your mother’s father? Ethiopia

(3) Your father’s mother? Ethiopia
(4) Your father’s father? Ethiopia
4. How many brothers 9 and sisters 6 do you have?
5. What setting did you grow up in? Urban _____ Rural _X__
Suburban _____
6. What country did your parents grow up in?
Father _ Ethiopia
Mother Ethiopia
7. How old were you when you came to the United States? 28_
8. How old were your parents when they came to the United
States? Mother _____ Father _____They are in Ethiopia!
9. When you were growing up, who lived with you? My Father, mother, brothers and sisters.
10. Have you maintained contact with
a. Aunts, uncles, cousins? (1) Yes _X____ (2) No _____
b. Brothers and sisters? (1) Yes _X____ (2) No _____
c. Parents? (1) Yes __X___ (2) No _____
d. Your own children? (1) Yes __X___ (2) No _____
11. Did most of your aunts, uncles, cousins live near your home?
(1) Yes __X___ (2) No _____
12. Approximately how often did you visit your family members who lived outside your home?
(1) Daily __X___ (2) Weekly _____ (3) Monthly _____ (4) Once a year or less _____ (5) Never _____
13. Was your original family name changed?
(1) Yes _____ (2) No __X___
14. What is your religious preference?
(1) Catholic _____ (2) Jewish _____ (3) Protestant __X___
(4) Denomination (5) Other _____ (6) None _____
15. Is your spouse the same religion as you?
(1) Yes __X___ (2) No _____
16. Is your spouse the same ethnic background as you?
(1) Yes __X___ (2) No _____
17. What kind of school did you go to?
(1) Public __X___ (2) Private _____ (3) Parochial