<h:html xmlns="http://www.w3.org/2002/xforms" xmlns:ev="http://www.w3.org/2001/xml-events" xmlns:h="http://www.w3.org/1999/xhtml" xmlns:jr="http://openrosa.org/javarosa" xmlns:orx="http://openrosa.org/xforms/" xmlns:xsd="http://www.w3.org/2001/XMLSchema">
  <h:head>
    <h:title>nhrc</h:title>
    <model>
      <instance>
        <nhrc id="nhrc"><formhub><uuid/></formhub>
          <heavy_estimate/>
          <nondrinkers_estimate/>
          <drink_note/>
          <audit1/>
          <audit2/>
          <audit3/>
          <audit4/>
          <audit5/>
          <audit6/>
          <audit7/>
          <audit8/>
          <audit9/>
          <audit10/>
          <heavy_drinker/>
          <problem>
            <problem1/>
            <problem2/>
            <problem3/>
            <problem4/>
            <problem5/>
            <problem6/>
            <problem7/>
            <problem8/>
          </problem>
          <store>
            <storedrinks/>
            <storeprice/>
            <bardrinks/>
            <barprice/>
          </store>
          <isolated/>
          <age/>
          <gender/>
          <binge_women/>
          <anxiety>
            <anxiety_note/>
            <anxiety1/>
            <anxiety2/>
            <depression1/>
            <depression2/>
          </anxiety>
          <ptsd>
            <ptsd_note/>
            <ptsd1/>
            <ptsd2/>
            <ptsd3/>
            <ptsd4/>
          </ptsd>
          <deployed/>
          <tbi1/>
          <tbi2/>
        </nhrc>
      </instance>
      <bind nodeset="/nhrc/formhub/uuid" type="string" calculate="'a957100691794d0988f060a495e4e9f4'" />
      <bind constraint=".&lt;=100" nodeset="/nhrc/heavy_estimate" required="true()" type="int"/>
      <bind constraint=".&lt;=100" nodeset="/nhrc/nondrinkers_estimate" required="true()" type="int"/>
      <bind nodeset="/nhrc/drink_note" readonly="true()" type="string"/>
      <bind nodeset="/nhrc/audit1" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit2" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit3" relevant="/nhrc/audit1!='zero' or /nhrc/audit2!='never'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit4" relevant="/nhrc/audit1!='zero' or /nhrc/audit2!='never'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit5" relevant="/nhrc/audit1!='zero' or /nhrc/audit2!='never'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit6" relevant="/nhrc/audit1!='zero' or /nhrc/audit2!='never'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit7" relevant="/nhrc/audit1!='zero' or /nhrc/audit2!='never'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit8" relevant="/nhrc/audit1!='zero' or /nhrc/audit2!='never'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit9" relevant="/nhrc/audit1!='zero' or /nhrc/audit2!='never'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/audit10" relevant="/nhrc/audit1!='zero' or /nhrc/audit2!='never'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/heavy_drinker" required="true()" type="select1"/>
      <bind nodeset="/nhrc/problem/problem1" required="true()" type="select1"/>
      <bind nodeset="/nhrc/problem/problem2" required="true()" type="select1"/>
      <bind nodeset="/nhrc/problem/problem3" required="true()" type="select1"/>
      <bind nodeset="/nhrc/problem/problem4" required="true()" type="select1"/>
      <bind nodeset="/nhrc/problem/problem5" required="true()" type="select1"/>
      <bind nodeset="/nhrc/problem/problem6" required="true()" type="select1"/>
      <bind nodeset="/nhrc/problem/problem7" required="true()" type="select1"/>
      <bind nodeset="/nhrc/problem/problem8" required="true()" type="select1"/>
      <bind nodeset="/nhrc/store/storedrinks" required="true()" type="int"/>
      <bind nodeset="/nhrc/store/storeprice" required="true()" type="decimal"/>
      <bind nodeset="/nhrc/store/bardrinks" required="true()" type="int"/>
      <bind nodeset="/nhrc/store/barprice" required="true()" type="decimal"/>
      <bind nodeset="/nhrc/isolated" required="true()" type="select1"/>
      <bind constraint=".&gt;=17" nodeset="/nhrc/age" required="true()" type="int"/>
      <bind nodeset="/nhrc/gender" required="true()" type="select1"/>
      <bind nodeset="/nhrc/binge_women" relevant="/nhrc/gender='female'" required="true()" type="select1"/>
      <bind nodeset="/nhrc/anxiety/anxiety_note" readonly="true()" type="string"/>
      <bind nodeset="/nhrc/anxiety/anxiety1" required="true()" type="select1"/>
      <bind nodeset="/nhrc/anxiety/anxiety2" required="true()" type="select1"/>
      <bind nodeset="/nhrc/anxiety/depression1" required="true()" type="select1"/>
      <bind nodeset="/nhrc/anxiety/depression2" required="true()" type="select1"/>
      <bind nodeset="/nhrc/ptsd/ptsd_note" readonly="true()" type="string"/>
      <bind nodeset="/nhrc/ptsd/ptsd1" required="true()" type="select1"/>
      <bind nodeset="/nhrc/ptsd/ptsd2" required="true()" type="select1"/>
      <bind nodeset="/nhrc/ptsd/ptsd3" required="true()" type="select1"/>
      <bind nodeset="/nhrc/ptsd/ptsd4" required="true()" type="select1"/>
      <bind nodeset="/nhrc/deployed" required="true()" type="select1"/>
      <bind nodeset="/nhrc/tbi1" relevant="/nhrc/deployed = 'yes'" required="true()" type="select"/>
      <bind nodeset="/nhrc/tbi2" relevant="/nhrc/deployed = 'yes'" required="true()" type="select"/>
    </model>
  </h:head>
  <h:body>
    <input ref="/nhrc/heavy_estimate">
      <label>What percentage of Marines your gender and age do you think drank heavily during the past 30 days? (Drinking &quot;heavily&quot; means 5 or more drinks per drinking occasion at least 1 time a week)</label>
    </input>
    <input ref="/nhrc/nondrinkers_estimate">
      <label>What percentage of Marines your gender and age do you think were non-drinkers during the past 30 days?</label>
    </input>
    <input ref="/nhrc/drink_note">
      <label>For the following questions, one drink is equivalent to: One 12-ounce bottle of beer or wine cooler, OR One 4-ounce glass of wine, OR 1 shot glass of 80-proof distilled liquor straight or in a mixed drink</label>
    </input>
    <select1 ref="/nhrc/audit1">
      <label>During the last year, on the average.. How many drinks containing alcohol do you have on a typical day when you are drinking?</label>
      <item>
        <label>1 or 2</label>
        <value>one_or_two</value>
      </item>
      <item>
        <label>3 or 4</label>
        <value>three_or_four</value>
      </item>
      <item>
        <label>5 or 6</label>
        <value>five_or_six</value>
      </item>
      <item>
        <label>7 to 9</label>
        <value>seven_to_nine</value>
      </item>
      <item>
        <label>10 or more</label>
        <value>ten_or_more</value>
      </item>
      <item>
        <label>0 - I don't drink</label>
        <value>zero</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit2">
      <label>How often do you have a drink containing alcohol?</label>
      <item>
        <label>Never</label>
        <value>never</value>
      </item>
      <item>
        <label>Monthly or Less</label>
        <value>monthly_or_less</value>
      </item>
      <item>
        <label>2-4 times a month</label>
        <value>two_four_month</value>
      </item>
      <item>
        <label>2-3 times a week</label>
        <value>two_three_week</value>
      </item>
      <item>
        <label>4 or more times a week</label>
        <value>four_more_week</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit3">
      <label>How often do you have 6 or more drinks on one occasion?</label>
      <item>
        <label>Never</label>
        <value>never</value>
      </item>
      <item>
        <label>Less than monthly</label>
        <value>less_than_monthly</value>
      </item>
      <item>
        <label>Monthly</label>
        <value>monthly</value>
      </item>
      <item>
        <label>Weekly</label>
        <value>weekly</value>
      </item>
      <item>
        <label>Daily or almost daily</label>
        <value>daily</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit4">
      <label>How often during the last year have you found that you were not able to stop drinking once you had started?</label>
      <item>
        <label>Never</label>
        <value>never</value>
      </item>
      <item>
        <label>Less than monthly</label>
        <value>less_than_monthly</value>
      </item>
      <item>
        <label>Monthly</label>
        <value>monthly</value>
      </item>
      <item>
        <label>Weekly</label>
        <value>weekly</value>
      </item>
      <item>
        <label>Daily or almost daily</label>
        <value>daily</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit5">
      <label>How often during the last year have you found you failed to do what was normally expected from you because of drinking?</label>
      <item>
        <label>Never</label>
        <value>never</value>
      </item>
      <item>
        <label>Less than monthly</label>
        <value>less_than_monthly</value>
      </item>
      <item>
        <label>Monthly</label>
        <value>monthly</value>
      </item>
      <item>
        <label>Weekly</label>
        <value>weekly</value>
      </item>
      <item>
        <label>Daily or almost daily</label>
        <value>daily</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit6">
      <label>How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?</label>
      <item>
        <label>Never</label>
        <value>never</value>
      </item>
      <item>
        <label>Less than monthly</label>
        <value>less_than_monthly</value>
      </item>
      <item>
        <label>Monthly</label>
        <value>monthly</value>
      </item>
      <item>
        <label>Weekly</label>
        <value>weekly</value>
      </item>
      <item>
        <label>Daily or almost daily</label>
        <value>daily</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit7">
      <label>How often during the last year have you had a feeling of guilt or remorse after drinking?</label>
      <item>
        <label>Never</label>
        <value>never</value>
      </item>
      <item>
        <label>Less than monthly</label>
        <value>less_than_monthly</value>
      </item>
      <item>
        <label>Monthly</label>
        <value>monthly</value>
      </item>
      <item>
        <label>Weekly</label>
        <value>weekly</value>
      </item>
      <item>
        <label>Daily or almost daily</label>
        <value>daily</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit8">
      <label>How often during the last year have you been unable to remember what happened the night before because you had been drinking?</label>
      <item>
        <label>Never</label>
        <value>never</value>
      </item>
      <item>
        <label>Less than monthly</label>
        <value>less_than_monthly</value>
      </item>
      <item>
        <label>Monthly</label>
        <value>monthly</value>
      </item>
      <item>
        <label>Weekly</label>
        <value>weekly</value>
      </item>
      <item>
        <label>Daily or almost daily</label>
        <value>daily</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit9">
      <label>Have you or someone else been injured as a result of your drinking?</label>
      <item>
        <label>No</label>
        <value>no</value>
      </item>
      <item>
        <label>Yes, but not in the last year</label>
        <value>yes_this_year</value>
      </item>
      <item>
        <label>Yes during the last year</label>
        <value>yes_not_this_year</value>
      </item>
    </select1>
    <select1 ref="/nhrc/audit10">
      <label>Has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?</label>
      <item>
        <label>No</label>
        <value>no</value>
      </item>
      <item>
        <label>Yes, but not in the last year</label>
        <value>yes_this_year</value>
      </item>
      <item>
        <label>Yes during the last year</label>
        <value>yes_not_this_year</value>
      </item>
    </select1>
    <select1 ref="/nhrc/heavy_drinker">
      <label>During the past 30 days, on how many days did you have 5 or more drinks at the same time or within a couple of hours of each other?</label>
      <item>
        <label>About every day</label>
        <value>every_day</value>
      </item>
      <item>
        <label>5-6 days a week</label>
        <value>five_six_week</value>
      </item>
      <item>
        <label>3-4 days a week</label>
        <value>three_four_week</value>
      </item>
      <item>
        <label>1-2 days a week</label>
        <value>one_two_week</value>
      </item>
      <item>
        <label>2-3 days in the past 30 days</label>
        <value>two_three_month</value>
      </item>
      <item>
        <label>Once in the past 30 days</label>
        <value>once_month</value>
      </item>
      <item>
        <label>I drank during the past 30 days, but I did not have 4 or more drinks on the same occasion</label>
        <value>month_less_than_four</value>
      </item>
      <item>
        <label>I didn't drink in the past 30 days</label>
        <value>no_drink</value>
      </item>
    </select1>
    <group appearance="field-list" ref="/nhrc/problem">
      <label></label>
      <select1 ref="/nhrc/problem/problem1">
        <label>I didn't get promoted because of my drinking.</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/problem/problem2">
        <label>I got a lower score on my performance rating because of my drinking.</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/problem/problem3">
        <label>I received formal written counseling or UCMJ punishment (including: Court Martial, Article 15, Page 11) because of my drinking</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/problem/problem4">
        <label>I drove within 2 hours of drinking any alcohol.</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/problem/problem5">
        <label>I was arrested for driving under the influence of alcohol.</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/problem/problem6">
        <label>I was arrested and/or spent time in jail or the brig for a drinking incident not related to driving.</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/problem/problem7">
        <label>I got into a fight where I hit someone when I was drinking</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/problem/problem8">
        <label>My spouse or live-in partner threatened to leave me or left me because of my drinking, or I was asked to leave or did leave because of my drinking.</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
    </group>
    <group appearance="field-list" ref="/nhrc/store">
      <label></label>
      <input ref="/nhrc/store/storedrinks">
        <label>On average, how many drinks do you have per week from a store?</label>
      </input>
      <input ref="/nhrc/store/storeprice">
        <label>What is the average price per drink from a store?</label>
      </input>
      <input ref="/nhrc/store/bardrinks">
        <label>On average, how many drinks do you have per week from a bar or club?</label>
      </input>
      <input ref="/nhrc/store/barprice">
        <label>What is the average price per drink from a bar or club?</label>
      </input>
    </group>
    <select1 ref="/nhrc/isolated">
      <label>In your opinion, is the base you are stationed at…?</label>
      <item>
        <label>Isolated from a wide variety of activities.</label>
        <value>isol</value>
      </item>
      <item>
        <label>Not isolated from a wide variety of activities.</label>
        <value>not_isolated</value>
      </item>
    </select1>
    <input ref="/nhrc/age">
      <label>What is you age?</label>
    </input>
    <select1 ref="/nhrc/gender">
      <label>What is your gender?</label>
      <item>
        <label>Male</label>
        <value>male</value>
      </item>
      <item>
        <label>Female</label>
        <value>female</value>
      </item>
    </select1>
    <select1 ref="/nhrc/binge_women">
      <label>During the past 30 days, on how many days did you have 4 or more drinks of beer, wine, or liquor on the same occasion?</label>
      <item>
        <label>About every day</label>
        <value>every_day</value>
      </item>
      <item>
        <label>5-6 days a week</label>
        <value>five_six_week</value>
      </item>
      <item>
        <label>3-4 days a week</label>
        <value>three_four_week</value>
      </item>
      <item>
        <label>1-2 days a week</label>
        <value>one_two_week</value>
      </item>
      <item>
        <label>2-3 days in the past 30 days</label>
        <value>two_three_month</value>
      </item>
      <item>
        <label>Once in the past 30 days</label>
        <value>once_month</value>
      </item>
      <item>
        <label>I drank during the past 30 days, but I did not have 4 or more drinks on the same occasion</label>
        <value>month_less_than_four</value>
      </item>
      <item>
        <label>I didn't drink in the past 30 days</label>
        <value>no_drink</value>
      </item>
    </select1>
    <group appearance="field-list" ref="/nhrc/anxiety">
      <label></label>
      <input ref="/nhrc/anxiety/anxiety_note">
        <label>Over the last 2 weeks, how often have you been bothered by the following problems?</label>
      </input>
      <select1 ref="/nhrc/anxiety/anxiety1">
        <label>Feeling nervous, anxious, or on edge</label>
        <item>
          <label>Not at all</label>
          <value>none</value>
        </item>
        <item>
          <label>Several days</label>
          <value>several_days</value>
        </item>
        <item>
          <label>More than half the days</label>
          <value>more_than_half</value>
        </item>
        <item>
          <label>Nearly every day</label>
          <value>every_day</value>
        </item>
      </select1>
      <select1 ref="/nhrc/anxiety/anxiety2">
        <label>Not being able to stop or control worrying</label>
        <item>
          <label>Not at all</label>
          <value>none</value>
        </item>
        <item>
          <label>Several days</label>
          <value>several_days</value>
        </item>
        <item>
          <label>More than half the days</label>
          <value>more_than_half</value>
        </item>
        <item>
          <label>Nearly every day</label>
          <value>every_day</value>
        </item>
      </select1>
      <select1 ref="/nhrc/anxiety/depression1">
        <label>Feeling down, depressed, or hopeless</label>
        <item>
          <label>Not at all</label>
          <value>none</value>
        </item>
        <item>
          <label>Several days</label>
          <value>several_days</value>
        </item>
        <item>
          <label>More than half the days</label>
          <value>more_than_half</value>
        </item>
        <item>
          <label>Nearly every day</label>
          <value>every_day</value>
        </item>
      </select1>
      <select1 ref="/nhrc/anxiety/depression2">
        <label>Little interest or pleasure in doing things</label>
        <item>
          <label>Not at all</label>
          <value>none</value>
        </item>
        <item>
          <label>Several days</label>
          <value>several_days</value>
        </item>
        <item>
          <label>More than half the days</label>
          <value>more_than_half</value>
        </item>
        <item>
          <label>Nearly every day</label>
          <value>every_day</value>
        </item>
      </select1>
    </group>
    <group appearance="field-list" ref="/nhrc/ptsd">
      <label></label>
      <input ref="/nhrc/ptsd/ptsd_note">
        <label>Have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you…</label>
      </input>
      <select1 ref="/nhrc/ptsd/ptsd1">
        <label>Have had nightmares about it or thought about it when you did not want to?</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/ptsd/ptsd2">
        <label>Tried hard not to think about it or went out of your way to avoid situations that remind you of it?</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/ptsd/ptsd3">
        <label>Were constantly on guard, watchful, or easily startled?</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
      <select1 ref="/nhrc/ptsd/ptsd4">
        <label>Felt numb or detached from others, activities, or your surroundings?</label>
        <item>
          <label>Yes</label>
          <value>yes</value>
        </item>
        <item>
          <label>No</label>
          <value>no</value>
        </item>
      </select1>
    </group>
    <select1 ref="/nhrc/deployed">
      <label>Have you ever been on a deployment where you felt you were in imminent danger?</label>
      <item>
        <label>Yes</label>
        <value>yes</value>
      </item>
      <item>
        <label>No</label>
        <value>no</value>
      </item>
    </select1>
    <select ref="/nhrc/tbi1">
      <label>Did you have any injury(ies) during your deployment from any of the following? (check all that apply):</label>
      <hint>Select all that apply.</hint>
      <item>
        <label>Fragment</label>
        <value>fragment</value>
      </item>
      <item>
        <label>Bullet</label>
        <value>bullet</value>
      </item>
      <item>
        <label>Vehicular</label>
        <value>vehicular</value>
      </item>
      <item>
        <label>Fall</label>
        <value>fall</value>
      </item>
      <item>
        <label>Blast (improvised explosive device, RPG, land mine, grenade, etc.)</label>
        <value>blast</value>
      </item>
      <item>
        <label>Other</label>
        <value>other</value>
      </item>
    </select>
    <select ref="/nhrc/tbi2">
      <label>Did any injury received while you were deployed result in any of the following? (check all that apply):</label>
      <hint>Select all that apply.</hint>
      <item>
        <label>Being dazed, confused or &quot;seeing stars&quot;</label>
        <value>dazed</value>
      </item>
      <item>
        <label>Not remembering the injury</label>
        <value>no_memory</value>
      </item>
      <item>
        <label>Losing consciousness (knocked out) for less than a minute</label>
        <value>lost_short</value>
      </item>
      <item>
        <label>Losing consciousness for 1-20 minutes</label>
        <value>lost_medium</value>
      </item>
      <item>
        <label>Losing consciousness for longer than 20 minutes</label>
        <value>lost_long</value>
      </item>
      <item>
        <label>Having symptoms of concussion afterward (such as headache, dizziness, irritability, etc.)</label>
        <value>concussion</value>
      </item>
      <item>
        <label>Head injury</label>
        <value>head</value>
      </item>
      <item>
        <label>None of the above</label>
        <value>none</value>
      </item>
    </select>
  </h:body>
</h:html>
