NON-HODGKIN'S LYMPHOMA (NHL)

######## 

[DETAILED medical history]{.underline}

In the next series of questions, I\'m going to ask about a wide variety
of diseases, operations, and other medical conditions. Please consider
the time period from your birth up until one year ago. If some event
that I ask you about occurred [for the first time]{.underline} within
the past year, please do not include it.

There may be some questions that you can\'t answer precisely. When that
happens, please try to give me an approximate answer, even if you think
you might be off by a little.

CM-1. Before one year ago, did you ever have a blood transfusion?

YES 1

NO 2 (CM-6)

CM-2. Please tell me all of the conditions or surgical procedures for
which you had a transfusion.

> ASK CM-3 THROUGH CM-5 FOR EACH CONDITION
>
> FOR WHICH A BLOOD TRANSFUSION WAS RECEIVED.
>
> ONLY ASK CM-5 IF CM-3 \> 1 TRANSFUSION OR DK.

CM-3. Before one year ago, how many transfusions did you have for
(CONDITION/PROCEDURE)? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| BLOOD TRANSFUSIONS

1 - 4 1

5 - 9 2

10 - 19 3

20 OR MORE 4

CM-4. (How old were you when you first had a transfusion for
(CONDITION/PROCEDURE)/How old were you when you had it)? IF DK, PROBE
FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-5. How old were you when you last had a transfusion for
(CONDITION/PROCEDURE)? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-6. Before one year ago, did you ever have kidney dialysis?

YES 1

NO 2 (INTRO TO CM-9)

CM-7. When did you first have dialysis?

\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

MO YR

CM-8. When did you last have dialysis?

\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

MO YR

Now I would like to ask about different types of surgery. **Please be
sure to include all biopsies and plastic, cosmetic, or reconstructive
surgery, including laser surgery**.

CM-9. Before one year ago, did you ever have an organ transplant?

YES 1

NO 2 (INTRO TO CM-13)

CM-10. What organs were transplanted?

ASK CM-11 AND CM-12 FOR EACH ORGAN TRANSPLANT.

CM-11. What disease or diseases caused you to need (this/the ORGAN)
transplant?

CM-12. When did you have this transplant?

\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

MO YR

+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| SURGERY                                | CM-13. (Before one year     |
|                                        | ago), did you ever have     |
|                                        | (SURGERY)?                  |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Skin surgery                           |                             |
+----------------------------------------+-----------------------------+
| a\. Skin surgery anywhere on your      | > YES 1                     |
| body, including biopsies and surgeries | >                           |
| to remove moles or cysts               | > NO 2                      |
|                                        |                             |
|                                        | IF "YES" TO SKIN (CM-13a),  |
|                                        | ADD: "For the rest of these |
|                                        | questions, please don't     |
|                                        | repeat any skin surgery     |
|                                        | that you just told me       |
|                                        | about."                     |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Surgery on your eyes                   |                             |
+----------------------------------------+-----------------------------+
| b\. Surgery involving your eyes or     | > YES 1                     |
| eyelids                                | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Nose or sinus surgery                  |                             |
+----------------------------------------+-----------------------------+
| c\. Surgery on your nose or sinuses.   | > YES 1                     |
| (IF RESPONSE IS ADENOIDS, ASK: Were    | >                           |
| your adenoids operated on at the same  | > NO 2                      |
| time as your tonsils? IF RESPONSE IS   |                             |
| NO, INCLUDE ADENOIDS HERE. IF RESPONSE |                             |
| IS YES, SAY: I will ask about your     |                             |
| adenoids and tonsils a little bit      |                             |
| later.)                                |                             |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Brain surgery                          |                             |
+----------------------------------------+-----------------------------+
| d\. Brain surgery                      | > YES 1                     |
|                                        | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Surgery on your ears                   |                             |
+----------------------------------------+-----------------------------+
| e\. Surgery on your inner or outer     | > YES 1                     |
| ears                                   | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Face or jaw surgery                    |                             |
+----------------------------------------+-----------------------------+
| f\. Surgery on your face or jaw        | > YES 1                     |
|                                        | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Throat or neck surgery                 |                             |
+----------------------------------------+-----------------------------+
| g\. Surgery on your throat or neck.    | > YES 1                     |
| Please include your tonsils, vocal     | >                           |
| cords, or thyroid or parathyroid       | > NO 2                      |
| glands.                                |                             |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Breast surgery                         |                             |
+----------------------------------------+-----------------------------+
| h\. Surgery or biopsies on your        | > YES 1                     |
| breasts                                | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+

+----------------------------------------+-----------------------------+
| Heart or lung surgery                  |                             |
+----------------------------------------+-----------------------------+
| i\. Surgery on your lungs or heart,    | > YES 1                     |
| including angiograms.                  | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Other chest surgery                    |                             |
+----------------------------------------+-----------------------------+
| j\. Other surgery on your chest        | > YES 1                     |
|                                        | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Spleen surgery                         |                             |
+----------------------------------------+-----------------------------+
| k\. Surgery on your spleen             | > YES 1                     |
|                                        | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Kidney or bladder surgery              |                             |
+----------------------------------------+-----------------------------+
| l\. Surgery on your kidneys or bladder | > YES 1                     |
|                                        | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| A Cesarean delivery                    |                             |
+----------------------------------------+-----------------------------+
| m\. (WOMEN ONLY) A Cesarean delivery   | > YES 1                     |
|                                        | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| A vasectomy                            |                             |
+----------------------------------------+-----------------------------+
| n\. (MEN ONLY) A vasectomy             | > YES 1                     |
|                                        | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Surgical sterilization                 |                             |
+----------------------------------------+-----------------------------+
| o\. (WOMEN ONLY) Surgical              | > YES 1                     |
| sterilization or your tubes tied       | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Other surgery on your female organs    |                             |
+----------------------------------------+-----------------------------+
| p\. (WOMEN ONLY) Any other surgery on  | > YES 1                     |
| your female organs. Please include     | >                           |
| biopsies and a total or partial        | > NO 2                      |
| hysterectomy.                          |                             |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Surgery on your prostate, testes, or   |                             |
| penis                                  |                             |
+----------------------------------------+-----------------------------+
| q\. (MEN ONLY) Other surgery on your   | > YES 1                     |
| prostate, testes, or penis, including  | >                           |
| biopsies                               | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Surgery on your liver, gallbladder, or |                             |
| pancreas                               |                             |
+----------------------------------------+-----------------------------+
| r\. Surgery on your liver,             | > YES 1                     |
| gallbladder, or pancreas               | >                           |
|                                        | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Surgery on your appendix, stomach, or  |                             |
| bowel                                  |                             |
+----------------------------------------+-----------------------------+
| s\. Surgery on your appendix, stomach, | > YES 1                     |
| or bowel, including your small         | >                           |
| intestines                             | > NO 2                      |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Bone surgery                           |                             |
+----------------------------------------+-----------------------------+
| t\. Surgery on any of your bones,      | > YES 1                     |
| tendons, or joints. (Please [do        | >                           |
| not]{.underline} include any surgery   | > NO 2                      |
| on your bones that you may have        |                             |
| already told me about.)                |                             |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+
| Any other surgery                      |                             |
+----------------------------------------+-----------------------------+
| u\. Any other surgery that you have    | > YES 1                     |
| not already mentioned, including       | >                           |
| angiograms. Do not include dental      | > NO 2                      |
| surgery.                               |                             |
|                                        |                             |
| (SPECIFY):                             |                             |
+----------------------------------------+-----------------------------+
|                                        |                             |
+----------------------------------------+-----------------------------+

> BOX CM-1
>
> FOR EACH \"YES\", IN CM-13, ASK TYPE, FREQUENCY, AGE-1, AND ANESTHESIA
> SUBROUTINES (EVENT = \"this type of surgery\").\
> DO [NOT]{.underline} ASK \"TYPE\" FOR CM-13k, CM-13m, CM-13n, or
> CM-13o. THERE IS NO CYCLING THROUGH. THESE QUESTIONS SHOULD BE ASKED
> RIGHT AFTER EACH CM-13 (a-u).

Now I\'m going to ask about dental work. I will ask you separately about
dental surgery, fillings, and cleanings.

CM-14. Before one year ago, did you ever have any teeth pulled?

YES 1

NO 2 (CM-14A)

> BOX CM-2
>
> IF YES TO CM-14, ASK FREQUENCY, AGE-1, AND ANESTHESIA SUBROUTINES
> (EVENT = \"a tooth pulled\").

CM-14A. (Before one year ago), did you ever have a root canal?

YES 1

NO 2 (CM-14B)

> BOX CM-2A
>
> IF YES TO CM-14A, ASK FREQUENCY, AGE-1, AND ANESTHESIA SUBROUTINES
> (EVENT = \"a root canal\").

CM-14B. (Before one year ago), did you ever have gum surgery?

YES 1

NO 2 (CM-14C)

> BOX CM-2B
>
> IF YES TO CM-14B, ASK FREQUENCY, AGE-1, AND ANESTHESIA SUBROUTINES
> (EVENT = \"gum surgery\").

CM-14C. (Before one year ago,) did you ever have any other type of
dental surgery?

YES 1

NO 2 (BOX CM-2D)

> BOX CM-2C
>
> IF YES TO CM-14C, ASK TYPE, FREQUENCY, AGE-1, AND ANESTHESIA
> SUBROUTINES (EVENT = \"other dental surgery\").
>
> BOX CM-2D
>
> ONLY ASK CM-15 THROUGH CM-16 IF CM-14=1 [OR]{.underline} CM-14A=1
> [OR]{.underline} CM-14B=1 [OR]{.underline} CM-14C=1. OTHERWISE, GO TO
> CM-17.

CM-15. After (this dental surgery/any of these dental surgeries), did
you take antibiotics to prevent or treat an infection?

YES 1

NO 2 (CM-17)

> ONLY ASK CM-16 IF \> 1 DENTAL SURGERY.

CM-16. After how many of the dental surgeries did you take antibiotics?
IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| SURGERIES

1-2 01

3-4 02

5-9 03

10-14 04

15 OR MORE 05

ALL 06

CM-17. Before one year ago, about how many times did you have a cavity
filled or have a crown or a cap put on a tooth? IF DK, PROBE FOR
CATEGORY.

NONE 0 (CM-26)

\|\_\_\_\|\_\_\_\| TIMES

LESS THAN 5 1

5-9 2

10-19 3

20 OR MORE 4

CM-18. Did you (ever) have novocaine for (this/these) procedure(s)?
(Please do [not]{.underline} include novocaine you received when you had
dental surgery.)

YES 1

NO 2 (CM-26)

> IF CM-17 = 01, GO TO CM-20.

CM-19. How many times? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| TIMES

LESS THAN 5 1

5-9 2

10-19 3

20 OR MORE 4

ALL 5

CM-20. How old were you when you (first) had novocaine for dental
fillings, crowns, or caps? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> IF CM-17 = 01, GO TO CM-26.

CM-21. How old were you when you last had novocaine for these
procedures? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> CM-22 THROUGH CM-25 HAVE BEEN OMITTED.

CM-26. During your adult life, but not including the past year, about
how often were your teeth cleaned in a dentist\'s office? Would you say:

Never, 1 (BOX CM-3)

Less than once a year, 2

Once a year, 3

Twice a year, 4

Three times a year, or 5

More than three times a year. 6

CM-27. Did you ever have novocaine for these cleanings?

YES 1

NO 2 (BOX CM-3)

CM-28. About how many times? Would you say:

All of the time, 1

Most of the time, 2

Sometimes, or 3

Rarely? 4

CM-29. How old were you when you (first) had novocaine for a dental
cleaning? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-30. How old were you when you last had novocaine before a cleaning?
IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> BOX CM-3
>
> ONLY ASK CM-31 IF CM-14=1 [OR]{.underline} CM-14A=1 [OR]{.underline}
> CM-14B=1 [OR]{.underline} CM-14C=1, [OR]{.underline} (CM-17 ≠ 0, DK,
> OR REFUSED) [OR]{.underline} (CM-26 ≠ 0, DK, OR REFUSED). OTHERWISE,
> GO TO INTRO TO CM-35.

CM-31. Do you have mitral valve prolapse or any other medical condition
for which you are routinely required to take antibiotics
[before]{.underline} dental surgery or other dental procedures?

YES 1

NO 2 (INTRO TO CM-35)

CM-32. How old were you when you first took antibiotics before any
(dental surgery) (or) (other) (dental procedures)?

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> CM-33 THROUGH CM-34 HAVE BEEN OMITTED.

The next series of questions ask about tattoos and ear and body
piercing. Again, if these were done only in the past year, please answer
no.

CM-35. Before one year ago, did you ever receive a permanent tattoo?

YES 1

NO 2 (CM-39)

CM-36. How many? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| NUMBER

LESS THAN 5 1

5 OR MORE 2

CM-37. How old were you when you (first) had this done? IF DK, PROBE FOR
CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> IF CM-36 = 01, GO TO CM-39.

CM-38. How old were you the last time you got a permanent tattoo? IF DK,
PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-39. Before one year ago, did you ever have your ears pierced?

YES 1

NO 2 (CM-43)

CM-40. In total, how many holes have you had pierced in your ears? If
you\'ve ever had an ear re‑pierced, please count each separate time it
was pierced. IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| HOLES

LESS THAN 5 1

5 OR MORE 2

CM-41. How old were you (when/the first time) you had your ears pierced?
IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> IF CM-40 = 01, GO TO CM-43.

CM-42. How old were you the last time you had your ears pierced? IF DK,
PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-43. Before one year ago, did you ever have holes pierced in any other
part of your body for the purpose of wearing jewelry?

YES 1

NO 2 (CM-47)

CM-44. How many holes? If you\'ve ever had a hole re-pierced, please
count each piercing as a separate one. IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| HOLES

LESS THAN 5 1

5 OR MORE 2

CM-45. How old were you when this was (first[)]{.underline} done? IF DK,
PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> IF CM-44 = 01, GO TO CM-47.

CM-46. How old were you when this was last done? IF DK, PROBE FOR
CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-47. Now I\'m going to read a list of illnesses. Before one year ago,
were you ever diagnosed with:

> IF R, SAYS DK: \"IF YOU HAD THIS ILLNESS, YOUR DOCTOR PROBABLY WOULD
> HAVE TOLD YOU ITS NAME. SO, IF YOU DON\'T KNOW, JUST ASSUME THAT YOU
> DIDN\'T HAVE IT.\"

YES NO

a\. Hodgkin\'s disease? 1 2

b\. Leukemia? 1 2

c\. Multiple myeloma? 1 2

d\. Any other type of cancer not already asked about? 1 2

> ONLY ASK CM-47d (1) IF CM-47d = 1.

\(1\) In what part of the body did this cancer start?

> IF \"SKIN CANCER\" SPECIFIED IN CM-47d(1), ASK CM-47d(2). OTHERWISE,
> GO TO BOX CM-3A.

\(2\) Was it malignant melanoma?

YES 1

NO 2

BOX CM-3A.

FOR EACH \"YES\" IN CM-47a-d, ASK CM-48.

CM-48. How old were you when you were first diagnosed with (CONDITION)?
IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-49 THROUGH CM-52 HAVE BEEN OMITTED.

The next set of questions is about viral infections. Please do not count
an infection or condition if you were told you had it for the first time
in the past year.

> IF R, SAYS DK: \"IF YOU HAD THIS ILLNESS, YOUR DOCTOR PROBABLY WOULD
> HAVE TOLD YOU ITS NAME. SO, IF YOU DON\'T KNOW, JUST ASSUME THAT YOU
> DIDN\'T HAVE IT.\"

+----------------------+-----------------------+-----------------------+
| VIRAL INFECTION      | CM-53. (Before one    | CM-54. ASK            |
|                      | year ago, were you    | SUBROUTINES           |
|                      | ever told by a doctor | (EVENT = \"this       |
|                      | or other health       | condition\").         |
|                      | professional that you |                       |
|                      | had) (VIRAL           |                       |
|                      | INFECTION)?           |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| Chicken pox          |                       |                       |
+----------------------+-----------------------+-----------------------+
| a\. Chicken pox      | > YES 1               | > ASK FREQUENCY AND   |
|                      | >                     | > AGE-1 SUBROUTINES.  |
|                      | > NO 2                |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| Shingles             |                       |                       |
+----------------------+-----------------------+-----------------------+
| b\. Shingles         | > YES 1               | > ASK FREQUENCY AND   |
|                      | >                     | > AGE-1 SUBROUTINES.  |
|                      | > NO 2                |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| Herpes simplex or    |                       |                       |
| cold sores           |                       |                       |
+----------------------+-----------------------+-----------------------+
| c\. Herpes simplex   | > YES 1               | > ASK CM-55 AND AGE-1 |
| or cold sores around | >                     | > SUBROUTINE.         |
| the mouth or lips    | > NO 2                |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| Genital herpes       |                       |                       |
+----------------------+-----------------------+-----------------------+
| d\. Genital herpes   | > YES 1               | > ASK CM-56 AND AGE-1 |
|                      | >                     | > SUBROUTINE.         |
|                      | > NO 2                |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| Hepatitis or other   |                       |                       |
| infectious liver     |                       |                       |
| disease              |                       |                       |
+----------------------+-----------------------+-----------------------+
| e\. Hepatitis or     | > YES 1               | > ASK CM-57 AND AGE-1 |
| other infectious     | >                     | > AND MEDS            |
| liver disease        | > NO 2                | > SUBROUTINES.        |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| Cirrhosis of the     |                       |                       |
| liver or liver       |                       |                       |
| damage               |                       |                       |
+----------------------+-----------------------+-----------------------+
| f\. Cirrhosis of the | > YES 1               | > ASK AGE-1           |
| liver, liver damage, | >                     | > SUBROUTINE.         |
| jaundice, yellow     | > NO 2                |                       |
| eyes, or brown urine |                       |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| Infectious           |                       |                       |
| mononucleosis        |                       |                       |
+----------------------+-----------------------+-----------------------+
| g\. Infectious       | > YES 1               | > ASK DURATION AND    |
| mononucleosis        | >                     | > AGE-1 SUBROUTINES.  |
|                      | > NO 2                |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| Chronic fatigue      |                       |                       |
| syndrome             |                       |                       |
+----------------------+-----------------------+-----------------------+
| h\. Chronic fatigue  | > YES 1               | > ASK DURATION AND    |
| syndrome             | >                     | > AGE-1 SUBROUTINES.  |
|                      | > NO 2                |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+
| The Epstein-Barr     |                       |                       |
| virus                |                       |                       |
+----------------------+-----------------------+-----------------------+
| i\. The Epstein-Barr | > YES 1               | > ASK DURATION AND    |
| virus                | >                     | > AGE-1 SUBROUTINES.  |
|                      | > NO 2                |                       |
+----------------------+-----------------------+-----------------------+
|                      |                       |                       |
+----------------------+-----------------------+-----------------------+

GO TO CM-58

HERPES SIMPLEX QUESTION (CM-55)

CM-55. How many episodes of this did you have? Please count every
outbreak, even those that were not diagnosed by a doctor. IF DK, PROBE
FOR CATEGORY.

\|\_\_\_\|\_\_\_\| NUMBER

1 - 2 1

3 - 4 2

5 - 9 3

10 - 14 4

15 OR MORE 5

GENITAL HERPES QUESTION (CM-56)

CM-56. How many episodes of genital herpes have you had? Please count
every outbreak, even those that were not diagnosed by a doctor. IF DK,
PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| NUMBER

1 - 2 1

3 - 4 2

5 - 9 3

10 - 14 4

15 OR MORE 5

hepatitis QUESTION (CM-57)

CM-57. Which type or types of hepatitis or other infectious liver
disease were you told that you had? Was it:

YES NO

a\. Hepatitis A? 1 2

b\. Hepatitis B? 1 2

c\. Hepatitis C? 1 2

d\. Non-A, non-B hepatitis? 1 2

e\. Any other type of hepatitis? (SPECIFY) 1 2

CM-58. Before one year ago, did a doctor ever tell you that you were
infected with, or that you tested positive for:

[YES]{.underline} [NO]{.underline}

a\. HTLV1? 1 2

b\. HTLV2? 1 2

CM-59 AND CM-60 HAVE BEEN OMITTED.

The next series of questions asks about some other diseases. Again,
please consider the time period before one year ago. Do not count a
condition if you were told you had it for the first time within the past
year.

IF R, SAYS DK: \"IF YOU HAD THIS ILLNESS, YOUR DOCTOR PROBABLY WOULD
HAVE TOLD YOU ITS NAME. SO, IF YOU DON\'T KNOW, JUST ASSUME THAT YOU
DIDN\'T HAVE IT.

+-----------------------+----------------------+-----------------------+
| CONDITION             | CM-61. (Before one   | CM-62. ASK            |
|                       | year ago, were you   | SUBROUTINES AND OTHER |
|                       | ever told by a       | QUESTIONS (EVENT =    |
|                       | doctor or other      | \"this condition\").  |
|                       | health professional  |                       |
|                       | that you had)        |                       |
|                       | (CONDITION)?         |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| Diabetes              |                      |                       |
+-----------------------+----------------------+-----------------------+
| a\. Diabetes          | > YES 1              | > ASK TYPE, AGE-2,    |
| mellitus, also called | >                    | > AND MEDS            |
| sugar diabetes        | > NO 2               | > SUBROUTINES.        |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| b\. Crohn\'s disease  | > YES 1              | > ASK AGE-2 AND MEDS  |
|                       | >                    | > SUBROUTINES.        |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| c\. Ulcerative        | > YES 1              | > ASK AGE-2 AND MEDS  |
| colitis               | >                    | > SUBROUTINES.        |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+

+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| d\. Peptic ulcers     | > YES 1              | > ASK AGE-2 AND MEDS  |
|                       | >                    | > SUBROUTINES.        |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| e\. Gallstones        | > YES 1              | > ASK CM-62B AND      |
|                       | >                    | > AGE-2 SUBROUTINE.   |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| Arthritis             |                      |                       |
+-----------------------+----------------------+-----------------------+
| f\. Any type of       | > YES 1              | > ASK AGE-2           |
| arthritis             | >                    | > SUBROUTINE AND      |
|                       | > NO 2               | > CM-63 THROUGH       |
|                       |                      | > CM-65.              |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| g\. Hypertension or   | > YES 1              | > ASK CM-66 THROUGH   |
| high blood pressure   | >                    | > CM-68.              |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| h\. Rheumatic heart   | > YES 1              | > ASK AGE-2 AND MEDS  |
| disease               | >                    | > SUBROUTINES.        |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| i\. WOMEN ONLY:       | > YES 1              | > ASK CM-70 AND AGE-2 |
| Endometriosis         | >                    | > SUBROUTINE.         |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| j\. Asthma            | > YES 1              | > ASK AGE-2           |
|                       | >                    | > SUBROUTINE AND      |
|                       | > NO 2               | > CM-71 AND CM-72.    |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| k\. Eczema            | > YES 1              | > ASK AGE-2           |
|                       | >                    | > SUBROUTINE.         |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| l\. Contact           | > YES 1              | > ASK AGE-2           |
| dermatitis            | >                    | > SUBROUTINE.         |
|                       | > NO 2               |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+
| m\. Lupus             | > YES 1              | > ASK CM-73, AND      |
|                       | >                    | > AGE-2 AND MEDS      |
|                       | > NO 2               | > SUBROUTINES.        |
+-----------------------+----------------------+-----------------------+
|                       |                      |                       |
+-----------------------+----------------------+-----------------------+

CM-62A. Now look at the show card listing some rare conditions. Please
tell me whether you were ever told by a doctor or other health
professional, before one year ago, that you had any of them. (Which
disease or diseases did you have?) (ENTER ALL THAT APPLY.)

+--------+-------------------------------------------------------------+
| > SHOW | > NONE 00                                                   |
| > CARD | >                                                           |
| > CM-1 | > CELIAC DISEASE 01                                         |
|        | >                                                           |
|        | > SJOGREN\'S DISEASE OR SICCA SYNDROME 02                   |
|        | >                                                           |
|        | > MALARIA 03                                                |
|        | >                                                           |
|        | > SARCOIDOSIS 04                                            |
|        | >                                                           |
|        | > MYASTHENIA GRAVIS 05                                      |
|        | >                                                           |
|        | > MULTIPLE SCLEROSIS 06                                     |
|        | >                                                           |
|        | > POLYMYALGIA RHEUMATICA 07                                 |
|        | >                                                           |
|        | > POLYMYOSITIS 08                                           |
|        | >                                                           |
|        | > DERMATOMYOSITIS 09                                        |
|        | >                                                           |
|        | > UVEITIS 10                                                |
+--------+-------------------------------------------------------------+

> FOR EACH CONDITION ENTERED IN CM-62A, SAY: \"You said that you had
> (CONDITION),\" AND ASK AGE-2 AND MEDS SUBROUTINES (EVENT = \"this
> condition\"). IF CM-62A = 03 (MALARIA), ASK CM-69 AND AGE-2
> SUBROUTINE.

GO TO INTRODUCTION TO CM-74

gallstones QUESTION (CM-62B)

CM-62B. Did your gallstones cause symptoms?

YES 1

NO 2

ARTHRITIS QUESTIONS (CM-63 THROUGH CM-65)

CM-63. Which type or types of arthritis were you told that you had? Was
it:

YES NO

a\. Rheumatoid arthritis? 1 2

b\. Osteoarthritis, also called degenerative arthritis? 1 2

c\. Some other form of arthritis? (SPECIFY) 1 2

CM-64. Have any of the following joints become enlarged and chronically
swollen because of your arthritis:

YES NO

a\. Your knees? 1 2

b\. Your hips? 1 2

c\. Your fingers? 1 2

d\. Your shoulders? 1 2

e\. Your elbows? 1 2

f\. Any other joint? (SPECIFY) 1 2

CM-65. Prior to one year ago, did you ever receive gold injections for
your arthritis?

YES 1

NO 2

HIGH BLOOD PRESSURE QUESTIONS (CM-66 THROUGH CM-68)

CM-66. Please look at this card and tell me whether you ever took any of
these medications for high blood pressure for a period of at least 6
months.

+--------+--------+----------------------------------------------------+
| SHOW   |        | TOOK MEDS 1                                        |
| CARD   |        |                                                    |
| CM-2   |        | DID NOT TAKE MEDS 2 (CM-68)                        |
+--------+--------+----------------------------------------------------+

CM-67. How old were you when you first took these medications? IF DK,
PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 20 01

IN YOUR 20\'S 02

IN YOUR 30\'S 03

IN YOUR 40\'S 04

IN YOUR 50\'S 05

IN YOUR 60\'S 06

IN YOUR 70\'S 07

CM-68. Prior to one year ago, did you ever take a diuretic or water pill
for your high blood pressure for a period of six months or longer?

YES 1

NO 2

MALARIA QUESTION (CM-69)

CM-69. How many attacks of malaria did you have? Please consider attacks
to be different if they occurred at least 1 month apart.

1 1

2 OR MORE 2

ENDOMETRIOSIS QUESTION (CM-70)

CM-70. For how many menstrual cycles did you take medication for
endometriosis? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| CYCLES

1 - 2 1

3 - 4 2

5 - 9 3

10 - 14 4

15 OR MORE 5

ASTHMA QUESTIONS (CM-71 AND CM-72)

CM-71. Not including the past year, did you ever take daily medication
for your asthma for a period of at least 6 months?

YES 1

NO 2

CM-72. Again, not including the past year, how many times were you
hospitalized or treated in an emergency room for your asthma? IF DK,
PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\|\_\_\_\| TIMES

1 - 4 1

5 - 14 2

15 - 24 3

25 - 49 4

50 OR MORE 5

lupus question (CM-73)

CM-73. Was it systemic lupus erythematosis, referred to as \"SLE\", or
another type of lupus?

SLE 1

ANOTHER TYPE (SPECIFY) 6

The next set of questions asks about various types of infections that
may be treated with antibiotics. Again, I am interested in the time
period before one year ago, so please do not count an infection if you
got it for the first time in the past year. Also, please do not count
infections that were not treated.

IF R, SAYS DK: \"IF YOU HAD THIS ILLNESS, YOUR DOCTOR PROBABLY WOULD
HAVE TOLD YOU ITS NAME. SO, IF YOU DON\'T KNOW, JUST ASSUME THAT YOU
DIDN\'T HAVE IT.

+-----------------------+-----------------------+-----------------------+
| INFECTION             | CM-74. \[Before one   | CM-75. IF CM-74 = 1   |
|                       | year ago, did you     | OR 3, ASK CM-75 AND   |
|                       | ever take             | SUBROUTINES           |
|                       | (ant                  |                       |
|                       | ibiotics/medications) | \[EVENT =             |
|                       | for\] (INFECTION)?    | \"(INFECTION) that    |
|                       |                       | was treated with      |
|                       | > USE =               | (antibiot             |
|                       | > \"antibiotics\" FOR | ics/medications)\"\]. |
|                       | > ALL CM-74 QUESTIONS |                       |
|                       | > EXCEPT \"p\". USE   | > USE =               |
|                       | > \"medications\" for | > \"antibiotics\" FOR |
|                       | > \"p\".              | > ALL CM-75 QUESTIONS |
|                       |                       | > EXCEPT \"p\". USE   |
|                       |                       | > \"medications\" FOR |
|                       |                       | > \"p\".              |
|                       |                       | >                     |
|                       |                       | > IF CM-74 = 3,       |
|                       |                       | > ALWAYS USE          |
|                       |                       | > \"medications\".    |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| A sore throat, cough, |                       |                       |
| cold, or flu          |                       |                       |
+-----------------------+-----------------------+-----------------------+
| a\. A sore throat,    | > YES 1               | > ASK FREQUENCY AND   |
| cough, cold, or flu   | >                     | > AGE-3 SUBROUTINES.  |
|                       | > NO 2                |                       |
|                       | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| A sinus infection     |                       |                       |
+-----------------------+-----------------------+-----------------------+
| b\. A sinus infection | > YES 1               | > ASK FREQUENCY AND   |
|                       | >                     | > AGE-3 SUBROUTINES.  |
|                       | > NO 2                |                       |
|                       | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Bronchitis            |                       |                       |
+-----------------------+-----------------------+-----------------------+
| c\. Bronchitis        | > YES 1               | > ASK FREQUENCY AND   |
|                       | >                     | > AGE-3 SUBROUTINES.  |
|                       | > NO 2                |                       |
|                       | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Pneumonia             |                       |                       |
+-----------------------+-----------------------+-----------------------+
| d\. Pneumonia         | > YES 1               | > ASK FREQUENCY AND   |
|                       | >                     | > AGE-3 SUBROUTINES.  |
|                       | > NO 2                |                       |
|                       | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| An eye infection      |                       |                       |
+-----------------------+-----------------------+-----------------------+
| e\. An eye infection  | > YES 1               | > ASK FREQUENCY AND   |
| or conjunctivitis,    | >                     | > AGE-3 SUBROUTINES.  |
| which is sometimes    | > NO 2                |                       |
| called \"pink eye\"   | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| A middle ear          |                       |                       |
| infection             |                       |                       |
+-----------------------+-----------------------+-----------------------+
| f\. A middle ear      | > YES 1               | > ASK FREQUENCY AND   |
| infection, which is   | >                     | > AGE-3 SUBROUTINES.  |
| also called otitis    | > NO 2                |                       |
| media                 | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| A gall bladder        |                       |                       |
| infection             |                       |                       |
+-----------------------+-----------------------+-----------------------+
| g\. An infection of   | > YES 1               | > ASK FREQUENCY AND   |
| the gall bladder,     | >                     | > AGE-3 SUBROUTINES.  |
| also called           | > NO 2                |                       |
| cholecystitis         | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| A kidney or bladder   |                       |                       |
| infection             |                       |                       |
+-----------------------+-----------------------+-----------------------+
| h\. A kidney or       | > YES 1               | > ASK FREQUENCY,      |
| bladder infection,    | >                     | > CM-76, AND AGE-3    |
| sometimes called a    | > NO 2                | > SUBROUTINES.        |
| urinary tract         | >                     |                       |
| infection             | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| A brain infection,    |                       |                       |
| meningitis, or        |                       |                       |
| encephalitis          |                       |                       |
+-----------------------+-----------------------+-----------------------+
| i\. A brain           | > YES 1               | > ASK TYPE,           |
| infection,            | >                     | > FREQUENCY, AND      |
| meningitis, or        | > NO 2                | > AGE-3 SUBROUTINES.  |
| encephalitis          | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Diverticulitis or     |                       |                       |
| another condition of  |                       |                       |
| the colon             |                       |                       |
+-----------------------+-----------------------+-----------------------+
| j\. Diverticulitis,   | > YES 1               | > ASK FREQUENCY AND   |
| or another condition  | >                     | > AGE-3 SUBROUTINES.  |
| of the colon or large | > NO 2                |                       |
| bowel (IF CROHN\'S    | >                     |                       |
| DISEASE OR ULCERATIVE | > TOOK MEDS, DK IF    |                       |
| COLITIS FOR WHICH R.  | >                     |                       |
| TOOK ANTIBIOTICS IS   | >    ANTIBIOTIC 3     |                       |
| MENTIONED, CODE AS    |                       |                       |
| \"YES\".)             |                       |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| A prostate infection  |                       |                       |
+-----------------------+-----------------------+-----------------------+
| k\. MEN: An infection | > YES 1               | > ASK TYPE,           |
| of the prostate       | >                     | > FREQUENCY, AND      |
|                       | > NO 2                | > AGE-3 SUBROUTINES.  |
|                       | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| A genital infection   |                       |                       |
| such as gonorrhea,    |                       |                       |
| syphilis, chlamydia,  |                       |                       |
| or genital warts      |                       |                       |
+-----------------------+-----------------------+-----------------------+
| l\. A genital         | > YES 1               | > ASK TYPE,           |
| infection such as     | >                     | > FREQUENCY, AND      |
| gonorrhea, syphilis,  | > NO 2                | > AGE-3 SUBROUTINES.  |
| chlamydia, or genital | >                     |                       |
| warts (IF WOMAN ADD:) | > TOOK MEDS, DK IF    |                       |
| \"but not including   | >                     |                       |
| yeast infections\"    | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Brucellosis           |                       |                       |
+-----------------------+-----------------------+-----------------------+
| m\. Brucellosis,      | > YES 1               | > ASK FREQUENCY AND   |
| following consumption | >                     | > AGE-3 SUBROUTINES.  |
| of unpasteurized milk | > NO 2                |                       |
|                       | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Acne                  |                       |                       |
+-----------------------+-----------------------+-----------------------+
| n\. Acne              | > YES 1               | > ASK FREQUENCY       |
|                       | >                     | > SUBROUTINE, AND     |
|                       | > NO 2                | > CM-77 AND CM-78.    |
|                       | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Other skin infections |                       |                       |
+-----------------------+-----------------------+-----------------------+
| o\. Other boils, skin | > YES 1               | > ASK FREQUENCY AND   |
| abscesses, or         | >                     | > AGE-3 SUBROUTINES.  |
| seriously infected    | > NO 2                |                       |
| pimples               | >                     |                       |
|                       | > TOOK MEDS, DK IF    |                       |
|                       | >                     |                       |
|                       | >    ANTIBIOTIC 3     |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Tuberculosis          |                       |                       |
+-----------------------+-----------------------+-----------------------+
| p\. Tuberculosis      | > YES 1               | > ASK AGE-3           |
|                       | >                     | > SUBROUTINE AND      |
|                       | > NO 2                | > CM-79.              |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+

GO TO CM-80

KIDNEY OR BLADDER INFECTION QUESTION (CM-76)

CM-76. Did (this infection/these infections) involve the:

Kidney only, 1

Bladder only, or 2

Both kidney and bladder? 3

ACNE QUESTIONS (CM-77 AND CM-78)

CM-77. How old were you when you first took (antibiotics/medications)
for your acne? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'s 03

IN YOUR 30\'s 04

IN YOUR 40\'s 05

IN YOUR 50\'s 06

IN YOUR 60\'s 07

IN YOUR 70\'s 08

CM-78. In total, for how many months or years did you take
(antibiotics/medications) for acne? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| MONTHS 1\
YEARS 2

LESS THAN 3 MONTHS 1

3-5 MONTHS 2

6-11 MONTHS 3

1-5 YEARS 4

MORE THAN 5 YEARS 5

TUBERCULOSIS QUESTION (CM-79)

CM-79. In total, for how many months or years were you treated with
medications for tuberculosis? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| MONTHS 1\
YEARS 2

LESS THAN 3 MONTHS 1

3-5 MONTHS 2

6-11 MONTHS 3

1-5 YEARS 4

MORE THAN 5 YEARS 5

CM-80. Before one year ago, were you ever told by a doctor or other
health professional that you had a positive tuberculosis skin test,
which was [not]{.underline} treated with medications?

YES 1

NO 2 (BOX CM-4)

CM-81. Did you ever receive a tuberculosis vaccination such as BCG?

YES 1

NO 2 (CM-83)

CM-82. ASK AGE-1 SUBROUTINE (EVENT = \"a tuberculosis vaccination\")?

GO TO BOX CM-4.

CM-83. ASK AGE-1 SUBROUTINE (EVENT = \"a positive tuberculosis skin
test\").

BOX CM-4

ONLY ASK CM-84 THROUGH CM-87 IF R. IS A WOMAN.

CM-84. Before one year ago, were you ever told by a doctor or other
health professional that you had a vaginal yeast infection?

YES 1

NO 2 (CM-88)

CM-85. How many episodes of this did you have? Please count each
infection, even those that were not diagnosed by a doctor. IF DK, PROBE
FOR CATEGORY.

\|\_\_\_\|\_\_\_\| TIMES

1-2 1

3-4 2

5-9 3

10-14 4

15 OR MORE 5

CM-86. ASK AGE-1 SUBROUTINE (EVENT = \"a vaginal yeast infection\").

CM-87. ASK MEDS SUBROUTINE (CONDITION = \"this condition\").

CM-88. Before one year ago, were you ever told by a doctor or other
health professional that you had thrush?

YES 1

NO 2 (CM-91A)

CM-89. How many episodes of this did you have? Please count each
infection, even those that were not diagnosed by a doctor. IF DK, PROBE
FOR CATEGORY.

\|\_\_\_\|\_\_\_\| TIMES

1-2 1

3-4 2

5-9 3

10-14 4

15 OR MORE 4

CM-90. ASK AGE-1 SUBROUTINE (EVENT = \"thrush\").

CM-91. ASK MEDS SUBROUTINE (CONDITION = \"this condition\").

CM-91A. Before one year ago, did you ever take antibiotics for a period
of [five or more days]{.underline} for a condition or procedure you have
not already mentioned?

YES 1

NO 2 (CM-92)

CM-91B. ASK TYPE SUBROUTINE (FOR \"condition or procedure\")
[AND]{.underline}, FOR EACH TYPE GIVEN, ASK CM-91C THROUGH CM-91E.

CM-91C. \[You said that you took antibiotics for (TYPE).\] If you added
up all the days that you took antibiotics for (TYPE), about how many
days would that be? IF DK, PROBE FOR CATEGORY.

DAYS 1

\|\_\_\|\_\_\|\_\_\| MONTHS 2

YEARS 3

LESS THAN 20 DAYS 1

20-99 DAYS 2

100 DAYS OR MORE 3

CM-91D. How old were you when you first took antibiotics for (TYPE)? IF
DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> IF CM-91C = 01 DAY,\
> GO TO CM-92.

CM-91E. How old were you when you last took antibiotics for (TYPE)? IF
DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-92. Before one year ago, did you ever take corticosteroids, such as
cortisone or prednisone?

YES 1

NO 2 (CM-97)

CM-93. If you added up all the days that you took corticosteroids, about
how many days would that be? IF DK, PROBE FOR CATEGORY.

DAYS 1

\|\_\_\|\_\_\|\_\_\| MONTHS 2

YEARS 3

LESS THAN 20 DAYS 1

20-99 DAYS 2

100 DAYS OR MORE 3

CM-94. How old were you when you first took corticosteroids? IF DK,
PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> IF CM-93 = 01 DAY,\
> GO TO CM-96.

CM-95. How old were you when you last took corticosteroids? IF DK, PROBE
FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-96. For what illnesses or conditions did you take corticosteroids?

CM-97. Before one year ago, did you ever take methotrexate?

YES 1

NO 2 (CM-102)

CM-98. If you added up all the days that you took methotrexate, about
how many days would that be? IF DK, PROBE FOR CATEGORY.

DAYS 1

\|\_\_\|\_\_\|\_\_\| MONTHS 2

YEARS 3

LESS THAN 20 DAYS 1

20-99 DAYS 2

100 DAYS OR MORE 3

CM-99. How old were you when you first took methotrexate? IF DK, PROBE
FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> IF CM-98 = 01 DAY,\
> GO TO CM-101.

CM-100. How old were you when you last took methotrexate? IF DK, PROBE
FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-101. For what illnesses or conditions did you take methotrexate?

CM-102. Up until one year ago, did you ever receive a vaccination to
prevent you from getting the flu, referred to as a flu shot?

YES 1

NO 2 (CM-106)

CM-103. About how many flu shots have you gotten? IF DK, PROBE FOR
CATEGORY.

\|\_\_\_\|\_\_\_\|

1 - 2 1

3 - 4 2

5 - 9 3

10 OR MORE 4

CM-104. How old were you when you first got a flu shot? IF DK, PROBE FOR
CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

> IF CM-103 = 01,\
> GO TO CM-106.

CM-105. How old were you when you last got a flu shot? IF DK, PROBE FOR
CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-106. Up until one year ago, did you ever receive any vaccinations for
travel to Asia?

YES 1

NO 2 (CM-109)

CM-107. For how many of these trips to Asia did you receive a
vaccination? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| TRIPS

1 1

2 TO 4 2

5 OR MORE 3

CM-108. At what age did you (first) get a vaccination to travel there?
IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-109. Up until one year ago, did you ever receive vaccinations for
travel to Africa?

YES 1

NO 2 (CM-112)

CM-110. For how many of these trips to Africa did you receive a
vaccination? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| TRIPS

1 1

2 TO 4 2

5 OR MORE 3

CM-111. At what age did you (first) get a vaccination to travel there?
IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

CM-112. Up until one year ago, did you ever receive vaccinations for
travel to Central or South America?

YES 1

NO 2 (END SECTION)

CM-113. For how many of these trips to Central or South America did you
receive a vaccination? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| TRIPS

1 1

2 TO 4 2

5 OR MORE 3

CM-114. At what age did you (first) get a vaccination to travel there?
IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

END OF MODULE

SHOW CARD CM-1

Diseases

-   Celiac disease

-   Sjogren\'s disease or sicca syndrome

-   Malaria

-   Sarcoidosis

-   Myasthenia gravis

-   Multiple sclerosis

-   Polymyalgia rheumatica

-   Polymyositis

-   Dermatomyositis

-   Uveitis

SHOW CARD CM-2

Medications for High Blood Pressure

-   Procardia

-   Nifedipine

-   Adalat

-   Cardizem

-   Diltiazem

-   Dilacor

-   Norvaso

-   Calan

-   Verapamil

-   Nicardipine

-   Cardene (either the regular form or the slow-release form, which is
    followed by XL, SR, or CD)

FREQUENCY SUBROUTINE

FR-1. How many times did you have (EVENT)? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| TIMES

1 - 2 1

3 - 4 2

5 - 9 3

10 -- 14 4

15 OR MORE 5

TYPE SUBROUTINE

TYPE-1. Please describe the type of (SURGERY/INFECTION/CONDITION) that
you had.

ANESTHESIA SUBROUTINE

> ASK AN-1 IF ONLY ONE SURGERY (FR1=01).

AN-1. Were you put to sleep for this surgery?

YES 1 (END SERIES)

NO 2

> ASK AN-2 IF \> 1 SURGERY OR DK.

AN-2. For how many of these surgeries were you put to sleep? IF DK,
PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| SURGERIES

NONE 00

1 -- 2 01

3 -- 4 02

5 -- 9 03

10 -- 14 04

15 OR MORE 05

ALL 06 (END SUBROUTINE)

BOX AN-1

IF \[FR-1 \> \"01\" [AND]{.underline} NUMBER IN FR-1 = NUMBER IN AN-2
(NOT INCLUDING CATEGORIES\], END SUBROUTINE.

AN-3. Were you given an injection to numb you without putting you to
sleep for (this surgery/any of these surgeries)? Please include
novocaine or lidocaine.

YES 1

NO 2 (END SUBROUTINE)

BOX AN-2

IF FR-1 = \"01,\" END SUBROUTINE.

AN-4. For how many of these surgeries were you given an injection to
numb you without putting you to sleep? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| SURGERIES

NONE 00

1-2 01

3-4 02

5-9 03

10-14 04

15 OR MORE 05

ALL 06

DURATION SUBROUTINE

DUR-1. How long did it last? (IF R. SAYS HE OR SHE HAD IT MORE THAN
ONCE, CONSIDER THE LONGEST EPISODE.) IF DK, PROBE FOR CATEGORY.

WEEKS 1

\|\_\_\_\|\_\_\_\| MONTHS 2

YEARS 3

LESS THAN 1 MONTH 01

1-3 MONTHS 02

4-6 MONTHS 03

7-12 MONTHS 04

1-5 YEARS 05

MORE THAN 5 YEARS 06

MEDS SUBROUTINE

MEDS-1. Have you taken any medication for (CONDITION)?

YES 1

NO 2 (END SUBROUTINE)

MEDS-2. What medication did you take? Anything else?

AGE-1 SUBROUTINE

IF NUMBER OF EVENTS FROM FREQUENCY SUBROUTINE = \"01,\" OMIT \"first.\"

AGE1-1. How old were you when you ([first]{.underline}) had (EVENT)? IF
DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 YEARS OLD 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

AGE-2 SUBROUTINE

AGE2-1. At what age were you when you were first diagnosed? IF DK, PROBE
FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 YEARS OLD 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08

AGE-3 SUBROUTINE

AGE3-1. How old were you (the first time)? IF DK, PROBE FOR CATEGORY.

\|\_\_\_\|\_\_\_\| YEARS OLD

LESS THAN 10 YEARS OLD 01

10-19 02

IN YOUR 20\'S 03

IN YOUR 30\'S 04

IN YOUR 40\'S 05

IN YOUR 50\'S 06

IN YOUR 60\'S 07

IN YOUR 70\'S 08