[EDITORIAL NOTE]{.underline}: These medications are specifically for
digestive problems.

STUDY OF DIGESTIVE HEALTH

SECTION E. [MEDICATION HISTORY]{.underline}

The next section of questions asks about a variety of prescription and
over-the-counter medications (you/your\_\_\_\_\_\_\_\_\_\_\_) may have
taken. We are interested only if (you/s/he) took these drugs [before a
year ago]{.underline}. Please try to think only about this time when
answering these questions.

E1. Here is a list of some [prescription]{.underline} medications taken
for ulcers, heartburn, and other stomach problems. Please look over the
list. [Before a year ago]{.underline}, did (you/your
\_\_\_\_\_\_\_\_\_\_\_\_) ever take any of them at least [once a
week]{.underline} for [one month]{.underline} or longer?

## SHOW CARD E1

YES 1

NO 2 (E7)

DK 8 (E7)

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

E2. Which of these medications (have you/has your \_\_\_\_\_\_\_\_/had
your \_\_\_\_\_\_\_\_\_\_\_) taken at least once a week for one month or
longer?

**[SHOW CARD E1]{.underline}**

[BRAND NAMES]{.underline} [GENERIC NAMES]{.underline}

Axid (AK-sid) 01 nizatidine (ni-ZA-ti-deen) 09

Carafate (CARE-a-fate) 02 sucralfate (SOO-cral-fate) 10

Cytotec (SI-tow-tec) 03 misoprostol (mi-zo-PRO-stall) 11

Losec (LO-sec) 04 omeprazole (oh-ME-pra-zall) 12

Prilosec (PRI-lo-sec) 05 famotidine (fam-AH-ti-deen) 13

Pepcid (PEP-sid) 06 cimetidine (si-MED-deen) 14

Tagamet (TAG-a-met) 07 ranitidine (ran-IH-ti-deen) 15

Zantac (ZAN-tac) 08

**WRITE THE NUMBER AND NAME OF EACH MEDICATION RESPONDENT REPORTED IN
E2, THEN ASK E3-E6 FOR EACH OF THESE MEDICATIONS.**

+----------+----------+-----------+-----------+-----------+-----------+
| E2.      | E2.      | E3.       | E4.       | E5.       | E6.       |
|          |          |           |           |           |           |
| ME       | ME       | When did  | When did  | Before a  | How often |
| DICATION | DICATION | (you/yo   | (you/yo   | year ago, | did       |
|          | NAME     | ur\_\_\_) | ur\_\_\_) | for how   | (         |
| CODE     |          | start     | stop      | many      | you/s/he) |
|          |          | taking    | taking    | months or | [us       |
| NUMBER   |          | (MED      | (MED      | years, in | ually]{.u |
|          |          | ICATION)? | ICATION)? | total,    | nderline} |
|          |          |           |           | did       | take      |
|          |          |           |           | (         | (MED      |
|          |          |           |           | you/s/he) | ICATION)? |
|          |          |           |           | take      |           |
|          |          |           |           | (MED      |           |
|          |          |           |           | ICATION)? |           |
+----------+----------+-----------+-----------+-----------+-----------+
| a.       |          | \|\_\     | \|\_\     | \|\_\     | \|\_\     |
|   \|\_\_ |          | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| |
| \|\_\_\| |          | \|\_\     | \|\_\     | MONTHS..1 | DAY       |
|          |          | _\|\_\_\| | _\|\_\_\| |           | \......1  |
|          |          |           |           | \# OF     |           |
|          |          | AGE OR    | AGE OR    | YEARS..2  | TIMES     |
|          |          | YEAR      | YEAR      |           | WEEK      |
|          |          |           |           | DK        | \...2     |
|          |          | DK        | CURRE     | ......    |           |
|          |          | ......    | NTLY...95 | ......... | PER       |
|          |          | .......98 |           | 98        | MONTH.3   |
|          |          |           | DK        |           |           |
|          |          |           | ......    |           | DK        |
|          |          |           | ......... |           | ......    |
|          |          |           | 98        |           | ......... |
|          |          |           |           |           | 98        |
+----------+----------+-----------+-----------+-----------+-----------+
| b.       |          | \|\_\     | \|\_\     | \|\_\     | \|\_\     |
|   \|\_\_ |          | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| |
| \|\_\_\| |          | \|\_\     | \|\_\     | MONTHS..1 | DAY       |
|          |          | _\|\_\_\| | _\|\_\_\| |           | \......1  |
|          |          |           |           | \# OF     |           |
|          |          | AGE OR    | AGE OR    | YEARS..2  | TIMES     |
|          |          | YEAR      | YEAR      |           | WEEK      |
|          |          |           |           | DK        | \...2     |
|          |          | DK        | CURRE     | ......    |           |
|          |          | ......    | NTLY...95 | ......... | PER       |
|          |          | .......98 |           | 98        | MONTH.3   |
|          |          |           | DK        |           |           |
|          |          |           | ......    |           | DK        |
|          |          |           | ......... |           | ......    |
|          |          |           | 98        |           | ......... |
|          |          |           |           |           | 98        |
+----------+----------+-----------+-----------+-----------+-----------+
| c\.      |          | \|\_\     | \|\_\     | \|\_\     | \|\_\     |
| \|\_\_   |          | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| |
| \|\_\_\| |          | \|\_\     | \|\_\     | MONTHS..1 | DAY       |
|          |          | _\|\_\_\| | _\|\_\_\| |           | \......1  |
|          |          |           |           | \# OF     |           |
|          |          | AGE OR    | AGE OR    | YEARS..2  | TIMES     |
|          |          | YEAR      | YEAR      |           | WEEK      |
|          |          |           |           | DK        | \...2     |
|          |          | DK        | CURRE     | ......    |           |
|          |          | ......    | NTLY...95 | ......... | PER       |
|          |          | .......98 |           | 98        | MONTH.3   |
|          |          |           | DK        |           |           |
|          |          |           | ......    |           | DK        |
|          |          |           | ......... |           | ......    |
|          |          |           | 98        |           | ......... |
|          |          |           |           |           | 98        |
+----------+----------+-----------+-----------+-----------+-----------+
| d\.      |          | \|\_\     | \|\_\     | \|\_\     | \|\_\     |
| \|\_\_   |          | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| |
| \|\_\_\| |          | \|\_\     | \|\_\     | MONTHS..1 | DAY       |
|          |          | _\|\_\_\| | _\|\_\_\| |           | \......1  |
|          |          |           |           | \# OF     |           |
|          |          | AGE OR    | AGE OR    | EARS..2   | TIMES     |
|          |          | YEAR      | YEAR      |           | WEEK      |
|          |          |           |           | DK        | \...2     |
|          |          | DK        | CURRE     | ......    |           |
|          |          | ......    | NTLY...95 | ......... | PER       |
|          |          | .......98 |           | 98        | MONTH.3   |
|          |          |           | DK        |           |           |
|          |          |           | ......    |           | DK        |
|          |          |           | ......... |           | ......    |
|          |          |           | 98        |           | ......... |
|          |          |           |           |           | 98        |
+----------+----------+-----------+-----------+-----------+-----------+
| e\.      |          | \|\_\     | \|\_\     | \|\_\     | \|\_\     |
| \|\_\_   |          | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| |
| \|\_\_\| |          | \|\_\     | \|\_\     | MONTHS..1 | DAY       |
|          |          | _\|\_\_\| | _\|\_\_\| |           | \......1  |
|          |          |           |           | \# OF     |           |
|          |          | AGE OR    | AGE OR    | YEARS..2  | TIMES     |
|          |          | YEAR      | YEAR      |           | WEEK      |
|          |          |           |           | DK        | \...2     |
|          |          | DK        | CURRE     | ......    |           |
|          |          | ......    | NTLY...95 | ......... | PER       |
|          |          | .......98 |           | 98        | MONTH.3   |
|          |          |           | DK        |           |           |
|          |          |           | ......    |           | DK        |
|          |          |           | ......... |           | ......    |
|          |          |           | 98        |           | ......... |
|          |          |           |           |           | 98        |
+----------+----------+-----------+-----------+-----------+-----------+
| f\.      |          | \|\_\     | \|\_\     | \|\_\     | \|\_\     |
| \|\_\_   |          | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| |
| \|\_\_\| |          | \|\_\     | \|\_\     | MONTHS..1 | DAY       |
|          |          | _\|\_\_\| | _\|\_\_\| |           | \......1  |
|          |          |           |           | \# OF     |           |
|          |          | AGE OR    | AGE OR    | YEARS..2  | TIMES     |
|          |          | YEAR      | YEAR      |           | WEEK      |
|          |          |           |           | DK        | \...2     |
|          |          | DK        | CURRE     | ......    |           |
|          |          | ......    | NTLY...95 | ......... | PER       |
|          |          | .......98 |           | 98        | MONTH.3   |
|          |          |           | DK        |           |           |
|          |          |           | ......    |           | DK        |
|          |          |           | ......... |           | ......    |
|          |          |           | 98        |           | ......... |
|          |          |           |           |           | 98        |
+----------+----------+-----------+-----------+-----------+-----------+
| g\.      |          | \|\_\     | \|\_\     | \|\_\     | \|\_\     |
| \|\_\_   |          | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| |
| \|\_\_\| |          | \|\_\     | \|\_\     | MONTHS..1 | DAY       |
|          |          | _\|\_\_\| | _\|\_\_\| |           | \......1  |
|          |          |           |           | \# OF     |           |
|          |          | AGE OR    | AGE OR    | YEARS..2  | TIMES     |
|          |          | YEAR      | YEAR      |           | WEEK      |
|          |          |           |           | DK        | \...2     |
|          |          | DK        | CURRE     | ......    |           |
|          |          | ......    | NTLY...95 | ......... | PER       |
|          |          | .......98 |           | 98        | MONTH.3   |
|          |          |           | DK        |           |           |
|          |          |           | ......    |           | DK        |
|          |          |           | ......... |           | ......    |
|          |          |           | 98        |           | ......... |
|          |          |           |           |           | 98        |
+----------+----------+-----------+-----------+-----------+-----------+
| h\.      |          | \|\_\     | \|\_\     | \|\_\     | \|\_\     |
| \|\_\_   |          | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| | _\|\_\_\| |
| \|\_\_\| |          | \|\_\     | \|\_\     | MONTHS..1 | DAY       |
|          |          | _\|\_\_\| | _\|\_\_\| |           | \......1  |
|          |          |           |           | \# OF     |           |
|          |          | AGE OR    | AGE OR    | YEARS..2  | TIMES     |
|          |          | YEAR      | YEAR      |           | WEEK      |
|          |          |           |           | DK        | \...2     |
|          |          | DK        | CURRE     | ......    |           |
|          |          | ......    | NTLY...95 | ......... | PER       |
|          |          | .......98 |           | 98        | MONTH.3   |
|          |          |           | DK        |           |           |
|          |          |           | ......    |           | DK        |
|          |          |           | ......... |           | ......    |
|          |          |           | 98        |           | ......... |
|          |          |           |           |           | 98        |
+----------+----------+-----------+-----------+-----------+-----------+

E7. Here is a group of some additional [prescription]{.underline}
medications taken for ulcers, heartburn, and other reasons. Thinking of
these drugs as a group, before a year ago, did (you/your
\_\_\_\_\_\_\_\_\_) take any of them at least once a week for [six
months]{.underline} or longer?

**[SHOW CARD E2]{.underline}**

YES 1

NO 2 (E13)

DK 8 (E13)

E8. Which of these medications did (you/your \_\_\_\_\_\_\_\_) take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E2]{.underline}**

[BRAND NAMES]{.underline}

Bentyl (BEN-till) 01

Donnatal (DON-a-tall) 02

Librax (LI-brax) 03

Pro-Banthine (pro-BAN-theen) 04

Robinul (RO-bin-ull) 05

[GENERIC NAMES]{.underline}

dicyclomine (di-SI-clo-meen) 06

propantheline (pro-PAN-thi-leen) 07

glycopyrrolate (gli-co-PEER-o-late) 08

E9. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E10. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E11. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E12. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E13. Here is a group of some [over-the counter]{.underline} medications
taken for ulcers, heartburn, and other reasons. Thinking of these drugs
as a group, before a year ago, did (you/your \_\_\_\_\_\_\_\_\_) take
any of them at least once a week, for six months or longer?

**[SHOW CARD E3]{.underline}**

YES 1

NO 2 (E18)

DK 8 (E18)

**[SHOW CARD E3]{.underline}**

[BRAND NAMES]{.underline}

Any type or strength of:

Digel 01 Mylanta 06

Gaviscon 02 Riopan 07

Gelusil 03 Rolaids 08

Maalox 04 Tums 09

Milk of Magnesia 05 Any [other]{.underline} over-the-counter

antacid 99

E14. When did (you/s/he) start taking any of these medications?

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

> AGE OR YEAR

DK 98

E15. When did (you/s/he) stop taking any of these medications?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E16. Before a year ago, for how many months or years, in total, did
(you/s/he) take any of these medications?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E17. How often did (you/your \_\_\_\_\_\_\_) usually take any of these
medications?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E18. Before a year ago, did (you/your \_\_\_\_\_\_\_) ever take
Pepto-Bismol at least once a week for six months or longer?

YES 1

NO 2 (E23)

DK 8 (E23)

E19. When did (you/s/he) start taking Pepto-Bismol?

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

AGE OR YEAR

DK 98

E20. When did (you/s/he) stop taking Pepto-Bismol?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E21. Before a year ago, for how many months or years, in total, did
(you/s/he) take Pepto-Bismol?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E22. How often did (you/your \_\_\_\_\_\_\_\_) [usually]{.underline}
take Pepto-Bismol?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E23. Here is a group of some [prescription]{.underline} medications
taken for high blood pressure or heart problems. Thinking of these drugs
as a group, before a year ago, did (you/your \_\_\_\_\_\_\_\_\_) take
any of them at least once a week, for [six months]{.underline} or
longer?

**[SHOW CARD E4]{.underline}**

YES 1

NO 2 (E29)

DK 8 (E29)

E24. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E4]{.underline}**

[BRAND NAMES]{.underline}

Adalat (A-da-lat) 01

Procardia (pro-CAR-dee-a) 02

Calan (KAY-lan) 03

Isoptin (i-SOP-tin) 04

Verelan (VER-e-lan) 05

Cardene (CAR-deen) 06

Cardizem (CAR-di-zem) 07

Dynacirc (DYE-na-sirk) 08

Nimotop (NIM-o-top) 09

Norvasc (NOR-vask) 10

Plendil (PLEN-dill) 11

Vascor (VASK-or) 12

[GENERIC NAMES]{.underline}

nifedipine (ni-FE-di-peen) 13

verapamil (ver-A-pam-ill) 14

nicardipine (ni-CAR-di-peen) 15

diltiazem (dil-TE-a-zem) 16

isradipine (is-RA-di-peen) 17

nimodipine (nim-O-di-peen) 18

amlodipine (am-LO-di-peen) 19

Felodipine (fell-O-di-peen) 20

bepridil (BE-pri-dill) 21

E25. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E26. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E27. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E28. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E29. Here is a second group of [prescription]{.underline} medications
taken for heart problems. Thinking of these drugs as a group, before a
year ago, did (you/your \_\_\_\_\_\_\_\_\_) take any of them at least
once a week, for six months or longer?

**[SHOW CARD E5]{.underline}**

YES 1

NO 2 (E35)

DK 8 (E35)

E30. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E5]{.underline}**

[BRAND NAMES]{.underline}

Isordil (I-sor-dill) 01

Sorbitrate (SOR-bi-trate) 02

Nitro-Bid (NI-tro-bid) 03

Nitrospan (NI-tro-span) 04

Nitrostat (NI-tro-stat) 05

Nitrodisc (NI-tro-disk) 06

Nitro-Dur (NI-tro-dur) 07

Transderm-Nitro (TRANS-derm-NI-tro) 08

[GENERIC NAMES]{.underline}

isosorbide dinitrate (i-so-SOR-bide di-NYE-

trate) 09

nitroglycerin tablets/capsules (ni-tro-GLIH-

ser-in) 10

nitroglycerin patch (ni-tro-GLIH-ser-in) 11

E31. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E32. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E33. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E34. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E35. Before a year ago, did (you/your \_\_\_\_\_\_\_) ever take Norpace
at least once a week for six months or longer?

YES 1

NO 2 (E40)

DK 8 (E40)

E36. When did (you/s/he) start taking Norpace?

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

AGE OR YEAR

DK 98

E37. When did (you/s/he) stop taking Norpace?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E38. Before a year ago, for how many months or years, in total, did
(you/s/he) take Norpace?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E39. How often did (you/your \_\_\_\_\_\_\_) usually take Norpace?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E40. Here is another group of [prescription]{.underline} medications
taken for high blood pressure or heart problems. Thinking of these drugs
as a group, before a year ago, did (you/your \_\_\_\_\_\_\_\_\_) take
any of them at least once a week, for six months or longer?

**[SHOW CARD E6]{.underline}**

YES 1

NO 2 (E46)

DK 8 (E46)

E41. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E6]{.underline}**

[BRAND NAMES]{.underline}

Kaon (KAY-on) 01

K-Dur (KAY-dur) 02

K-Tab (KAY-tab) 03

Micro-K (MI-cro-kay) 04

Slow-K (SLOW-kay) 05

[GENERIC NAMES]{.underline}

potassium chloride (po-TASS-e-um-KLOR-

ide) 06

E42. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E43. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E44. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E45. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E46. Here is a group of some [prescription]{.underline} medications
taken for pain or inflammation. Thinking of these drugs as a group,
before a year ago, did (you/your \_\_\_\_\_\_\_\_\_) take any of them at
least once a week, for six months or longer?

**[SHOW CARD E7]{.underline}**

YES 1

NO 2 (E52)

DK 8 (E52)

E47. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E7]{.underline}**

[BRAND NAMES]{.underline}

Anaprox (AN-a-prox) 01

Naprosyn (NAP-row-sin) 02

Ansaid (AN-sed) 03

Butazolidin (bew-ta-ZOL-ih-din) 04

Clinoril (CLIN-o-rill) 05

Daypro (DAY-pro) 06

Dolobid (dol-O-bid) 07

Feldene (FELL-deen) 08

Indocin (IN-do-sin) 09

Lodine (LOW-deen) 10

Meclomen (MECK-low-men) 11

Nalfon (NAL-fon) 12

Orudis (or-OO-diss) 13

Relafen (re-LAF-fin) 14

Tolectin (to-LECK-tin) 15

Voltaren (vol-TARE-en) 16

[GENERIC NAMES]{.underline}

naproxen (na-PROCKS-in) 17

flurbiprofen (flur-bi-PRO-fen) 18

phenylbutazone (fee-nill-BYEW-ta-zone) 19

sulindac (SOO-lin-dack) 20

oxaprozin (ocks-a-PRO-zin) 21

diflunisal (di-FLOON-i-zall) 22

piroxicam (pi-ROCKS-i-cam) 23

indomethacin (in-do-METH-a-sin) 24

etodolac (e-TOW-doe-lack) 25

meclofenamate (meck-lo-FEN-a-mate) 26

fenoprofen (fee-no-PRO-fen) 27

ketoprofen (kee-to-PRO-fen) 28

nabumetone (nah-BYEW-ma-tone) 29

tolmetin (TOLL-met-in) 30

diclofenac (di-CLO-fen-ack) 31

E48. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E49. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E50. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E51. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E52. Here is a group of some [over-the-counter]{.underline} medications
that contain aspirin and are taken for pain or inflammation. Thinking of
these drugs as a group, before a year ago, did (you/your
\_\_\_\_\_\_\_\_\_) take any of them at least once a week, for six
months or longer?

**[SHOW CARD E8]{.underline}**

YES 1

NO 2 (E57)

DK 8 (E57)

**[SHOW CARD E8]{.underline}**

[BRAND NAMES]{.underline}

Any type or strength of aspirin-containing medications, such as:

Anacin 01 Bufferin 04

Aspirin 02 Excedrin 05

Ascriptin 03 Any [other]{.underline} kind of aspirin-containing

product not listed here 99

**Please do not include drugs containing only acetaminophen, such as
Tylenol, Excedrin PM, Aspirin-Free Anacin, etc.**

E53. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E54. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E55. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E56. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E57. Here is a group of [over-the-counter]{.underline} medications that
contain ibuprofen and are taken for pain or inflammation. Thinking of
these drugs as a group, before a year ago, did (you/your
\_\_\_\_\_\_\_\_\_) take any of them at least once a week, for six
months or longer?

**[SHOW CARD E9]{.underline}**

YES 1

NO 2 (E62)

DK 8 (E62)

**[SHOW CARD E9]{.underline}**

[BRAND NAMES]{.underline}

Advil 01 Nuprin 04

Medipren 02 Rufen 05

Motrin 03 Generic ibuprofen 06

E58. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E59. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E60. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E61. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E62. Here is a group of some [prescription]{.underline} medications
taken for depression, anxiety or insomnia. Thinking of these drugs as a
group, before a year ago, did (you/your \_\_\_\_\_\_\_\_\_) take any of
them at least once a week, for six months or longer?

**[SHOW CARD E10]{.underline}**

YES 1

NO 2 (E68)

DK 8 (E68)

E63. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E10]{.underline}**

[BRAND NAMES]{.underline}

Asendin (a-SEN-din) 01

Aventyl (a-VEN-till) 02

Pamelor (PAM-a-lor) 03

Elavil (ELL-a-vill) 04

Endep (EN-dep) 05

Ludiomil (LOO-dee-o-mill) 06

Sinequan (SIN-e-quan) 07

Surmontil (sur-MON-till) 08

Tofranil (TOF-ran-ill) 09

Vivactil (vi-VACK-till) 10

[GENERIC NAMES]{.underline}

amoxipine (am-OCKS-i-peen) 11

nortriptyline (nor-TRIP-ti-leen) 12

amitriptyline (am-ih-TRIP-ti-leen) 13

maproteline (ma-PRO-te-leen) 14

doxepin (DOCKS-i-pin) 15

trimipramine (trim-IP-ra-meen) 16

imipramine (im-IP-ra-meen) 17

protriptyline (pro-TRIP-ti-leen) 18

E64. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E65. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E66. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E67. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E68. Here is a group of some [prescription]{.underline} medications
taken for asthma. Thinking of these drugs as a group, before a year ago,
did (you/your \_\_\_\_\_\_\_\_\_) take any of them at least once a week,
for six months or longer?

**[SHOW CARD E11]{.underline}**

YES 1

NO 2 (E74)

DK 8 (E74)

E69. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E11]{.underline}**

[BRAND NAMES]{.underline}

Alupent (AL-yew-pent) 01

Metaprel (MET-a-prel) 02

Brethaire (BRETH-aire) 03

Brethine (BRETH-een) 04

Bricanyl (BRI-can-ill) 05

Bronkometer (BRON-koe-mee-ter) 06

Bronkosol (BRON-koe-sol) 07

Isuprel (EYE-soo-prel) 08

Maxair (MAX-air) 09

Proventil (pro-VEN-til) 10

Ventolin (VENT-o-lin) 11

Tornalate (TOR-na-late) 12

[GENERIC NAMES]{.underline}

metaproterenol (met-a-PRO-ter-en-ol) 13

terbutaline (ter-BYEW-ta-leen) 14

isoetharine (i-so-ETH-a-reen) 15

isoproterenol (i-so-PRO-ter-en-ol) 16

pirbuterol (per-BYEW-ter-ol) 17

albuterol (al-BYEW-ter-ol) 18

bitolterol (bi-TOL-ter-ol) 19

E70. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E71. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E72. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E73. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E74. Here is another group of some [prescription]{.underline}
medications taken for asthma. Thinking of these drugs as a group, before
a year ago, did (you/your \_\_\_\_\_\_\_\_\_) take any of them at least
once a week, for six months or longer?

**[SHOW CARD E12]{.underline}**

YES 1

NO 2 (E80)

DK 8 (E80)

E75. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E12]{.underline}**

[BRAND NAMES]{.underline}

Aerolate (AIR-o-late) 01

Asbron (AS-bron) 02

Constant-T (CON-stant-T) 03

Marax (MAR-acks) 04

Quadrinal (QUA-drin-all) 05

Quibron (QUI-bron) 06

Theodur (THEE-o-dur) 07

Aminophyllin (a-meen-O-fill-in) 08

Atrovent (A-tro-vent) 09

Choledyl (CO-le-dill) 10

Dilor (DI-lore) 11

Lufyllin (loo-FILL-in) 12

Respbid (RES-bid) 13

Slo-Bid (SLOW-bid) 14

T-PHYL (TEE-fill) 15

Tedral (TE-drall) 16

Theo-24 (THEE-o-24) 17

Theobid (THEE-o-bid) 18

Theolair (THEE-o-lare) 19

Theo-Organdin (THEE-o-or-GAN-din) 20

Uniphyl (EW-ni-fill) 21

[GENERIC NAMES]{.underline}

theophylline (thee-O-fi-lin) 22

aminophylline (a-min-O-fi-lin) 23

ipratropium bromide (i-pra-TROP-e-um-

BRO-mide) 24

oxtriphylline (ocks-TRI-fi-leen) 25

dyphylline (DI-fi-leen) 26

anhydrous theophylline (an-HI-drus-thee-

O-fi-lin) 27

E76. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E77. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E78. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E79. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E80. Here is a group of some [over-the-counter]{.underline} medications
taken for asthma. Thinking of these medications as a group, before a
year ago, did (you/your \_\_\_\_\_\_\_\_\_) take any of them at least
once a week, for six months or longer?

**[SHOW CARD E13]{.underline}**

YES 1

NO 2 (E86)

DK 8 (E86)

E81. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

> **[SHOW CARD E13]{.underline}**

[BRAND NAMES]{.underline}

Asthmahaler Mist (AS-ma-hale-er-MIST) 01

Asthmanefrin (as-ma-NEF-rin) 02

Bronkaid Mist (BRONK-ade-MIST) 03

Bronkaid Tablets (BRONK-ade-TAB-lets) 04

Bronkolixir (bronk-o-LIX-er) 05

Bronkotabs (BRONK-o-tabs) 06

Primatene Mist (PRY-ma-teen-MIST) 07

Primatene Tablets (PRY-ma-teen-TAB-lets) 08

E82. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E83. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E84. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E85. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98

E86. Here is a group of some [prescription and
over-the-counter]{.underline} medications taken for allergies. Thinking
of these drugs as a group, before a year ago, did (you/your
\_\_\_\_\_\_\_\_\_) take any of them at least once a week, for six
months or longer?

**[SHOW CARD E14]{.underline}**

YES 1

NO 2 DK 8

E87. Which of these medications did (you/your \_\_\_\_\_\_\_\_\_\_\_)
take?

**DO NOT READ LIST UNLESS NECESSARY. FOR EACH MEDICATION REPORTED,
CIRCLE THE CORRESPONDING CODE BELOW.**

**[SHOW CARD E14]{.underline}**

[BRAND NAMES]{.underline}

Actidil (ACK-ti-dill) 01

Atarax (AT-ar-acks) 02

Vistaril (VIH-sta-rill) 03

Benadryl (BEN-a-drill) 04

Chlor-Trimeton (clor-TRI-me-ton) 05

Teldrin (TELL-drin) 06

Dimetane (DI-me-tane) 07

Phenergan (FEN-er-gan) 08

Ploaramine (PLOR-a-meen) 09

Tavist (TA-vist) 10

Temaril (TEM-a-rill) 11

[GENERIC NAMES]{.underline}

triprolidine (tri-PRO-li-deen) 12

hydroxyzine (hi-DROCKS-i-zeen) 13

diphenhydramine (di-fen-HI-dra-meen) 14

chlorpheniramine (clor-fen-EER-a-meen) 15

brompheniramine (brom-fen-EER-a-meen) 16

promethazine (pro-METH-a-zeen) 17

dexchlorpheniramine (decks-clor-fen-EER-a-meen) 18

clemastine (CLEM-a-steen) 19

trimeprazine (tri-MEP-ra-zeen) 20

E88. When did (you/s/he) start taking (this medication/any of these
medications)?

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

AGE OR YEAR

DK 98

E89. When did (you/s/he) stop taking (this medication/any of these
medications)?

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

AGE OR YEAR

CURRENTLY 95

DK 98

E90. Before a year ago, for how many months or years, in total, did
(you/s/he) take (this medication/any of these medications)?

> \|\_\_\|\_\_\| MONTHS 1

\# OF YEARS 2

DK 98

E91. How often did (you/your \_\_\_\_\_\_\_) [usually]{.underline} take
(this medication/any of these medications)?

> \|\_\_\|\_\_\| PER DAY 1

TIMES WEEK 2

MONTH 3

DK 98