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