| What year were you born? |
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| What is your gender? |
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| Are you married? |
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| How far do you drive to work? |
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| Is there a history of longevity in your family? |
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| How much do you smoke? |
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| Is there a history of heart disease or stroke in your family? |
|
| Is there a history of lung disease in your family? |
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| How much do you exercise? |
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| Do you have sex at least once a week? |
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| Are you in the military? |
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