Use the following letters to fill out your degree of concern for yourself or others in terms of physical, mental and social health for the following items:
A. Not Concerned B. Mildly Concerned C. Moderately Concerned D. Very Concerned E. Extremely Concerned
_____ 1. Acne
_____ 2. Airplane Accidents
_____ 3. Air Pollution
_____ 4. Accidents Due To Electric Current
_____ 5. Alcohol Dependence
_____ 6. Nuclear Warfare
_____ 7. Auto Accidents
_____ 8. Biological and Chemical Warfare
_____ 9. Birth Control
_____ 10. Being Burned
_____ 11. "Colds"
_____ 12. Cancer
_____ 13. Childbirth
_____ 14. Death
_____ 15. Drowning
_____ 16. Drug Abuse
_____ 17. Headaches
_____ 18. Sexually Transmitted Disease Other Than AIDS
_____ 19. Eye Disorders And Blindness
_____ 20. Emphysema or Respiratory Disease
_____ 21. Firearm Accidents
_____ 22. Heart Disease
_____ 23. Halitosis (Bad Breath) Or Body Odor
_____ 24. Homosexuality
_____ 25. Kidney Diseases
_____ 26. Liver Diseases
_____ 27. Masturbation
_____ 28. Mental Illness
_____ 29. Moodiness
_____ 30. Mononucleosis ("Mono")
_____ 31. Nausea
_____ 32. Nervousness
_____ 33. Combat
_____ 34. What I'll Be Like In 10 or 15 Years
_____ 35. Overweight
_____ 36. Poor Teeth Decay
_____ 37. Population Explosion
_____ 38. Pregnancy
_____ 39. Sex Behavior
_____ 40. Poisoning By Snakes
_____ 41. Radiation
_____ 42. Riots
_____ 43. Smoking And Disease
_____ 44. Starvation And Malnutrition
_____ 45. Sterility
_____ 46. Suicide
_____ 47. Tuberculosis ("TB")
_____ 48. Use Of Contraceptives
_____ 49. Water Pollution Pollution
_____ 50. AIDS