Plan and Operation

of the NHANES 1

Epidemiologic

FO11OWUP Study

198M4

This report describesthe Epidemiologic

Followup Study to the first National Health

and Nutrition Examination Survey cohort,

25-74 years of age.

Programs and Collection Procedures

Series 1, No. 22

DHHS Publication No. (PHS) 87-1324

U.S. Department of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattsville, Md.

June 1987
All material appearing in this report is in the public domain and may be 

reproduced or copied without permission; citation as to source, however, is 

appreciated. 

Nattonal Center for Health Statistics, B. B. Cohen, H. E. Barbano, C. S. Cox, 

et al.: Plan and operation of the NHANES I Epidemiologic Followup Study, 

1982-84. vital and Health Statistics. Series 1, No. 22. DHHS Pub. No. (PHS) 

87-1324. Public Health Service. Washington. U.S. Government Printing office, 

June 1967. 

Plan and operation of the NHANES I Epidemiologic Followup Study: 1982-64. 

(Series 1, Programs and collection procedures ; no. 22) (DHHS publication ; 

no. (PHS) 87-1324) 

Prepared by Bruce 8. Cohen et al. 

Bibliography: p. 

Supt. of Dots. no.: HE 20.8209:1/22 

1. National Health and Nutrition Examination Survey (U.S.). Epidemiologic 

Followup Study. 2. Health surveys-United States. I. Cohen, Bruce B. 

II. National Center for Health Statistics (U.S.) III. Series: Vital and health 

statistics. Series 1. Programs and collection procedures ; no. 22) IV. Series: 

DHHS publication ; no. (PHS) 87-1324. [DNLM: 1. Epidemiologic Methods. 

2. Health Surveys-United States. 3. Nutrition Surveys--United States. 

W2 A N148va no. 221 

RA409U44 no. 22 362.1’0723 87600051 

IRA407.31 [362.1’0723] 

ISBN O-6406-0366-5 

For sale by the Superintendent of Documents, U.S. Qovernment Printing Office, Washington, D.C. 2010.2 
National Center for Health Statistics

Manning Feinleib, M.D., Dr.P. H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph. D., Associate Director for Analysis

and Epidemiology

Gail F. Fisher, Ph. D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

Stephen E. Nieberding, Associate Director for Management

George A. Schnack, Associate Director for Data Processing

and Services

Monroe G. Sirken, Pli.D., Associate Director for Research

and Methodology

Sandra S. Smith, lnforrnation Oj$cer

Office of Analysis and Epidemiology Program

Jacob J. Feldman, Ph. D., Associate Director

Dwision of Analysis

Joel C. Kleinman, Ph.D., Director

Jennifer Madans, Ph. D., Deputy Director

Jennifer Madans, Ph. D.,

Acting Chief, Health Economics Analysis Branch

Diane M. Makuc, Dr.P.H.,

Chief, Analytical Coordination Branch

Dwision of Epidemiology and Health Promotion

Ronald W. Wilson, Director

Patricia M. Golden, Special Assistant

Ronald W. Wilson,

Acting ChieJ Environmental Studies Branch

Thomas F. Drury, Ph. D.,

Chie$ Health Status Measurement Branch
Acknowledgments

The planning and operation of the Epidemiologic Followup

Study to the first National Health and Nutrition Examination

Survey (NHEFS) could not have been accomplished without

the valuable assistance from many individuals and groups.

Space constraints make it impossible to recognize all who

participated in the planning, development, and conduct of

the varied aspects of the survey; nonetheless, the authors

are grateful for the support received, and apologize to those

omitted.

Special thanks are extended to Dr. Joan Comoni-Huntley

of the National Institute on Aging, who played an important

role in this survey. Without her persistence in the necessity

for this study and her dedication in seeking financial support,

this study would not have been conducted. The Epidemiologic

Followup Study was jointly initiated by the National Institute

on Aging and the National Center for Health Statistics, and

has been developed and funded by the National Institute on

Aging; National Center for Health Statistics; National Cancer

Institute; National Heart, Lung and Blood Institute; National

Institute of Child Health and Human Development; National

Institute of Mental Health; National Institute on Alcohol Abuse

and Alcoholism; National Institute of Allergy and Infectious

Diseases; National Institute of Arthritis, Diabetes, Digestive,

and Kidney Diseases; and the National Institute of Neurological

and Communicative Disorders and Stroke.

The contribution of Westat, the contractor who conducted

this study, is also gratefully acknowledged. Directed by Mr.

Thomas McKenna and Diane Cadell, Westat’s dedicated research team carried out their assignments skillfully.

Finally, Dr. Doris Calloway (University of California,

Berkeley) served as nutrition consultant and Dr. Nemat Borhani

(University of California, Davis) was responsible for directing

the blood pressure measurement.

.

Ill
Contents

Background . . . . . . . . . . . . . . . . . . . . .

NHANESI sample design . . . . . . . . . . . .

NHANES I questionnaire and examination content (‘

Nonresponse in NHANESI . . . . . . . . . . .

Objectives and design . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

971–75) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Feasibility study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Study design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tracing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Losttofollowup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interviewdatacollection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interviewprocedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Questionnairecontent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interviewnonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physicalmeasurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Healthfacilitiesanddeathcertificate datacollection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Healthfacilitiesrecordcollection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deathcertificatecollection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ongoingactivities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Appendixes

I. ContentofNHANES Iforsubjects 25–74yearsofage, 1971-75 . . . . . . . . . , . . . . . . . . . . . . . . . .

II. Data items available liom NHANES Isubjects 25-74 years ofage . . . . . . . . . . . . . . . . . . . . . . . . .

III. Serological, urological, and blood chemical tests conducted on selected NHANES I sample subjects,

1971–75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. NHANESIEpidemiologicFollowup Study Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V. Sample locationsbyregionofdatacollection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VI. Studymaterials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VII.CorrectionsandrevisionstotheNHANES Ibaselinedata . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Listof text figures

1. Summ~of ticingad intemiewing success in Baltimore, Md., Femibili~S~dy, 1980 . . . . . . . . . . . . . .

2. Smm~ofda@ collection used inthe WWIEpidemiologic Follomp Stidy, 1982–84 . . . . . . . . . . . .

List of text tables

A.

B.

c.

Number and percent of nonresponse to the first National Health and Nutrition Examination Survey household

interview and examination of subjects 25–74 years of age, by sample location . . . . . . . . . . . . . . . . . . .

Percent of nonresponse to the first National Health and Nutrition Examination Survey examination, by sex, race, and

selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of respondents and percent distribution by status in the Epidemiologic Followup Study, according to sex and

ageatthe first HeakhandNutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

1

2

2

5

5

6

7

7

11

11

12

14

14

17

17

19

19

20

22

23

47

49

50

51

142

6

8

3

3

9

v
D. Number of respondents and percent distribution by status in the Epidemiologic Followup Study, according to race,

sex, and age at the first Health and Nutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . 9

E. Odds ratios, confidence intervals, and statistical significance for health characteristics on loss to followup based on

multiple logistic regression with age, sex, and race included . . . . . . . . . . . . . . . . . . . . . . . . . . , . 10

F. Number and percent of traced NHANES I Epidemiologic Followup Study cohort without completed interview,

by race, sex, age at baseline examination, and subject status . . . . . . . . . . . . . . . . . . . . . . . . . . ,, , 15

G. Number and percent of interviewed NHANES I Epidemiologic Followup Study cohort without successful completion

of physical measurements, by race, sex, and age at baseline examination . . . . . . . . . . . . . . . . . . . . , . 16

H. Receipt of medical facility episode reports for the NHANES I Epidemiologic Followup Study cohort, by race, sex,

andageat baseline examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...18

J. Number of’ deaths among NHANES I Epidemiologic FoUowup Study cohort members and percent of decedents

without an available death certificate, by race, sex, and age at baseline examination . . . . . . . . . . . . . . ,, . 19

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less

than 500

●

Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements

vi
Plan and Operation of the

NHANES 1Epidemiologic

FOliOWUp Study 198=4

by Bruce B. Cohen, Ph. D., Helen E. Barbano, M.S.P.H.,

Christine S. Cox, M.A., Jacob J. Feldman, Ph. D., Fanchon F.

Finucane, M. H.S., Joel C. Kleinman, Ph. D., Jennifer H.

Madans, Ph. D., Office of Analysis and Epidemiology Program

Background

In the first National Health and Nutrition Examination

Survey (NHANES I) data were collected from a national

probability sample of the civilian noninstitutionalized population. Participants of the survey were between the ages of

1 and 74 years. The survey, which included a strmdardlzed

medical examination and questionnaires that covered various

topics, took place from 1971 through 1974 and was augmented

by an additional national sample in 1974-75. The NHANES

I sample included 20,729 persons 25 to 74 years of age,

of whom 14,407 (70 percent) were medically examined. 1-3

Although NHANES I provides a wealth of information

on the prevalence of health conditions and risk factors, the

cross-sectional nature of the original survey limits its usefulness

in studying the effects of clinical, environmental, and behavioral factors and in tracing the natural history of disease.

Therefore, the NHANES I Epidemiologic Followup Study

(IWEFS) was designed to investigate the association between

factors measured at the baseline with the development of

specific health conditions.4

The followup study originated as a joint project between

the National Center for Health Statistics (NCHS) and the

National Institute on Aging (NIA). The 1982–84 initial followup of the cohort was funded primarily by NIA, with additional financial support from the following components of

the National Institutes of Health (NIH) and Public Health

Service agencies: National Cancer Institute; National Institute

of Mental Health; National Institute on Alcohol Abuse and

Alcoholism; National Heart, Lung, and Blood Institute; National Institute of Neurological and Communicative Disoders

and Stroke; National Institute of Arthritis, Diabetes, Digestive,

and Kidney Diseases; National Institute of Allergy and Infectious Diseases; and the National Institute of Child Health

and Human Development. All of these agencies were involved

in both developing topics important to their specialty areas

and designing procedures to collect data that would address

these issues.

The size and scope of the population in NHEFS provides

a unique opportunity to examine causal relationships in a

large, heterogeneous, nationally distributed population. The

followup study population included the 14,407 participants

who were 25 to 74 years of age when first examined in

NHANES I (1971-75). Data collection for the followup was

conducted from 1982 to 1984, and included ~rsonal interviews

with those traced (or with proxies for those who were incapacitated or deceased); pulse rate, weight and blood pressure

measurements for surviving participants; hospital and nursing

home records; and death certificates for decedents.

Whereas NHANES I contains information gathered from

physical exams, laboratory tests, and interviews, NHEFS is

primarily an interview survey that relies on self-reporting of

conditions. Attempts were made, however, to supplement the

interview information by obtaining hospital records and death

certificates.

Furthermore, a continued followup (consisting of telephone reinterviews and hospital record checks, as well as

annual death clearance using the National Death Index) of

the NHEFS population is planned to supplement the information already collected. The plan and operations for ongoing

data collection efforts will be described in future NCHS

reports.

NHANES I sample design

To use the followup study data most effectively, it is

necessary to understand the design, content, and procedures

of the original NHANES I survey. NHANES I was a multistage, stratified, probability sample of clusters of persons.

The successive sampling elements included a primary sampling

unit (PSU), an enumeration district, a segment (or cluster

of households), a household, an eligible person, and finally,

,a sample person. A randomly selected subset of the. sample

persons was examined in more detail and provided with additional questionnaire items. The design was further complicated

by the oversampling of certain population subgroups, including

pxsons living in poverty areas, women of childbearing age

(2.544 years of age), and elderly persons (65 years of age

and over). OverSampling of poverty areas was most pronounced for PSU’S 1through 35.

The first-stage sample consisted of 65 PSU’S selected

from approximately 1,900 PSU’S into which the coterminous

United States had been divided. Each PSU represented a county

or a small group of contiguous counties. The 65 PSU’S consisted of 15 self-representing large metropolitan areas with

populations greater than 2,000,000 persons, plus 2 PSU’s

from each of 25 other strata into which the 1,900 PSU’S

were grouped. The grouping was based on geographic region

and population density.

In 1973 NCHS decided to extend the survey time period

1
and double the number of participants receiving the detailed

examination during the 15-month time period, July 1974

through September 1975. This 15-month sample, known as

the “Augmentation Survey, “ involved the selection of a national probability sample of 35 PSU’S (sampling locations

66 through 100) so that the total sample locations 1 through

100 would constitute a national probability sample. The Augmentation Survey was similar to the first part of NHANES

I except for some changes in the sample design and content.

This second-stage sample of NHANES I included 3,059 persons 25–74 years of age and did not involve oversampling

of any special subgroups.

NHANES I questionnaire and examination

content (1971-75)

NHANES I included interview, medical examination, and

laboratory components. (Appendix I contains a summary of

the content for adults 25–74 years of age.) The study focused

on a number of index conditions that could be identified

by examination and could also be associated with complaints

and symptoms reported by the respondents selected for study.

The symptoms included shortness of breath, chronic cough

and phlegm production, joint pain, chest pain, skin problems,

dental difficulties, and hearing and visual problems. The

examination included aspects of pulmonary disease; cardiovascular disease; chronic disabling arthritis; dermatological disease; dental, oral, and ocular conditions; thyroid abnormality;

auditory impairments; and visual impairments. (Appendix II

provides a detailed list of data items collected for NHANES

I adult subjects.)

The medical examination began with a general physical

exam that had a nutritional emphasis and was conducted by

a physician. After monitoring blood pressure and pulse, the

physician examined the head and neck, looking particularly

for lesions associated with nutritional deficiencies, especially

the lack of vitamins A, B complex, C, and minerals. The

chest, abdomen, and neurological and musculoskeletal systems

were then evaluated for other vitamin and mineral deficiencies.

Venipuncture was performed on all examinees. Persons in

the detailed subsample received a comprehensive cardiovascular and musculoskeletal examination and the appropriate supplemental Medical History Questionnaire. Persons in sample

locations 1 through 35 were given a thorough ophthalmologic

examination. Next, dermatologica.1 and dental examinations

were administered.

Laboratory and health technicians conducted the remainder

of the examination, which included the following tests:

hematology and urinalysis, measurements of height and

weight, and body and skinfold measurements. In the detailed

subsample, examinees received an electrocardiogram; audiometric, spirometric, single breath diffusion capacity, and

goniometric tests; and x rays of the chest, hand, wrist, hips,

and knees.

Several methods were used to collect nutrition information. The first was an assessment of food intake that consisted

of a 24-hour recall and food frequency questions. Second,

a clinical appraisal by a trained physician was incorporated

into the examination to survey any nutritional deficiencies

or malnutrition. Third, the nutritional biochemistry section

of the exam consisted of determinations of blood serumllevels

for vitamins A and C, magnesium, serum iron, iron binding

capacity, serum folate, total protein and albumin, and cholesterol (see appendix III for detail). Fourth, a Food Programs

Questionnaire was used to obtain information about family

participation in food stamp and commodity programs. Next,

the relationship of body build and composition to nut~itional

status was evaluated. Relevant measurements included lheight,

weight, triceps, and subscapular skinfolds (measures of obesity); elbow and bitrochanteric breadth (measures of bone structure); and sitting height (measure of trunk length). The final

component of NHANES I was the dental examination, in

which gums were examined for signs of malnutrition and

related diseases. Participants were also asked questions about

chewing foods to determine the relationship between {dietary

intake and dental conditions.

The content of the Augmentation Survey was revised

in several respects.5 The dietary questionnaires and the dental,

dermatologic, and ophthalmologic examinations were eliminated. Three new procedures, however, were added—a hearing

test for speech comprehension, a visual acuity test, and a

water sample collaborative study (in conjunction witlh NIH

and the Environmental Protection Agency). In addition, several

new sets of questions were provided. Questions fra,m the

1971 National Health Interview Survey (NHIS) on vision and

hearing were used to evaluate the relationship between survey

response and clinical findings. Questions from the 1974 NHIS

on hypertension were added to compare with blood pressure

measurements. Also, a 20-question depression scale developed

at the National Institute of Mental Health was administered

to participants.6 Serological tests for syphilis were added to

the survey to monitor the prevalence of venereal disease.

As a result of these varied design features of NHANES

I, not all of the followup study subjects received the same

questions or examinations at baseline. All 14,407 respondents

received the general medical examination, but only 6,913

respondents (3, 172 men and 3,741 women) received the detailed medical examination. Those respondents who were given

the detailed examination also may have received the arthritis,

cardiovascular, or respiratory supplementary questionnaire,

depending on their responses to screening questions.

Moreover, only 11,348 persons in the NHEFS cohort (those

in sampling locations 1 through 65) received the nutritional

questionnaires described previously.

Nonresponse in NHANES I

Nonresponse rates for the household interview amd the

examination in the mobile exam center are given in table A. The home interview nonresponse rate for those contacted

initially was less than 2 percent and varied little by demographic characteristics. The examination nonresponse riite was

considerably more, approximately 30 percent. Nonresponse

rates for the examination are presented by sociodernographic

characteristics in table B. Substantial differences in nonresponse rates were observed by age, race, and sex. CWerall,

2
Table A- Number and percent of nonrasponse to the first National Health and Nutrition Examination Survey hcusehold interview and examination of subjects

25-74 years of age, by sample location

hrterview Examination

Number of nonresponse nonresponse

Sample location’ all sample persons Number Percent Number Percent

Locations 1-65, nutrition sample . . . . . . . . . . 16,441 z?l 1.3 5,093 31.0

Locations 1-65, detail sample . . . . . . . . . . . . . 5,593 71 1.3 1,739 31.1

Locations 66-100, detail sample . . . . . . . . . . . 4,286 66 1.6 1,229 28.7

Locations 1-100, detail sample . . . . . . . . . . . . 9,661 139 1.4 2,96a 30.0

Locations l-100, all persons. . . . . . . . . . . . . . 26,322 360 1.4 8,0+31 30.6

‘Sample Iccations havs Men referred to as “’stands” in previous NCHS publications.

Table B. Percent of nonrasponse to the first National Health and Nutrftkrrr Examination Survey examhration, by sex, race, and selected characteristics

White Black

All Both Both

Characteristic persons’ sexes Male Female sexes Male Female

Total . . . . . . . . . . . . . . . . . . 30.5 30.6 30.0 31.1 29.8 29.6 29.6

40.3

34.2

20.9

35.0

29.8

14.9

35.6

30.7

14.6

34.7

29.3

15.2

SMSA, central . . . . . . . . . . .

SMSA, noncentral . . . . . . . .

Not SMSA . . . . . . . . . . . . . .

37.5

33.3

21.1

38.6

33.5

22.3

36.0

32.4

23.2

39.8

26.3

28.0

24.1

37.4

34.3

21.9

30.3

40.0

36.2

20.9

25.3

35.9

33.2

22.5

33.1

38.4

29.0

26.6

24.1

38.5

28.1

26.0

23.3

36.5

27.9

28.1

22.1

East . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . .

Income

Lessthan$7,000 . . . . . . . . .

$7,000-$14,999 . . . . . . . . . .

$15,0Mlor more . . . . . . . . . .

28.4

26.2

25.8

29.7

26.0

25.4

26.9

29.6

28.0

26.0

30.1

32.0

27.4

29.5

24.3

29.2

27.3

25.6

28.6

27.6

25.6

Age

25-34 years . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . .

65years Andover . . . . . . . . .

29.4

28.4

33.6

28.2

29.5

32.1

35.3

31.2

29.5

24.9

28.2

26.1

35.2

27.2

33.6

26.7

27.4

2S6

32.5

35.3

26.1

27.0

28.9

33.2

36.4

29.7

27.6

27.5

31.0

32.0

24.3

26.7

30.0

35.1

39.8

Education

Lessthan12years . . . . . . .

12years . . . . . . . . . . . . . . . .

More than 12years . . . . . . .

27.6

32.9

28.9

33.0

26.3

24.6

32.4

26.7

24.7

33.5

Z9.1

24.5

27.6

33.2

29.1

27.6

34.0

29.5

31.9

26.8

25.0

‘Includes races other than white or black.

East (39 percent), with the Midwest and South having intermediate rates (28 percent), and the West having the lowest

rates (23 percent). Among black respondents, the highest nonresponse rates also occumed in the East (37 percent) but the

lowest rates occurred in the South (22 percent), not the West

(30 percent). The Midwest also showed high nonresponse

rates for black persons (34 percent).

The nonresponse rates were also examined according to

the education of respondents. Among white persons, the examination nonresponse rates decreased with education (33 percent

for those with less than 12 years of education compared with

25 percent for those with more than 12 years). By contrast,

black persons with less than 12 years education had the lowest

examination nonresponse rates (28 percent) and those with

exactly 12years had the highest rates (33 percent).

examination nonresponse rates increased according to age,

with 27 percent recorded for persons aged 25–34 years and

35 percent recorded for persons aged 65 and over. This trend

was most evident for white female respondents. A notable

exception occurs in the black male category, where persons

aged 65 and over had the lowest examination nonresponse

rates (25 percent).

The pattern of examination nonresponse rates according

to place of residence is consistent across all race-sex groups

with the highest rates recorded in the central cities of SMSA’S

having populations of more than 1,000,000 persons (38 percent). As urbanization decreases, the rates also decrease, with

the lowest occurring in areas not in SMSA’S (21 percent).

However, the pattern of nonrespcrnse for the examination

differs across the groups according to region and race. Among

white persons, the highest nonresponse rates occurred in the

3
To examine how health variables may have affected nonre- heart disease (OR =0.97), respiratory illness (OR =0.87), diasponses to the examination, a log linear model was fit to betes (OR= 1.09), high blood pressure (OR= 0.89), or lack

the cross-classification of age, sex, race, and selected self-re- ef exercise (OR= 1.09). However, persons who had arthritis

ported health status measures. After steps were taken to adjust or trouble with their vision were less likely to be norlparticifor age, race, and sex, no statistically significant differences pants in the examination than those not so impaired (OR’s

in response rates were found when odds ratios (OR’s) were of 0.69 and 0.61, respectively, P< O.001).

computed for those individuals with or without a history of

4
Objectives and design

The primary purpose of NHEFS is to investigate the relationships of clinical, nutritional, and behavioral factors assessed in NHANES I to subsequent morbidity and mortality.

More precisely, there are three major objectives of NHEFS:

●

●

●

MorbidiQ and mortali~ associated with suspected risk

factors. The study of the relationships between risk factors

measured in NHANES I and subsequent morbidity and

mortality is the major objective of NHEFS. Information

is available from the baseline on blood pressure, smoking,

cholesterol levels, alcohol consumption, nutritional deficiencies, estrogen use, impaired pulmonary function,

weight, and psychological characteristics. Morbidity and

mortality data are available from the interview, from hospital and nursing home records, and from death

certificates.

Changes in participants’ characteristics. The followup

questionnaire was also designed to evaluate changes in

risk factors that occurred during the period between

NHANES I and NHEFS. For example, changes in blood

pressure attributed to respondents’ advancing age can be

studied in association with moderating variables.

Natural histoq of chronic disease and finctional impairments. Because a large proportion of the subjects over

60 years of age in the NHANES I interview reported

having a chronic disabling condition and/or loss of visual

acuity or hearing, the progression or remission over time

of these condhions can be studied by comparing responses

at followup with the original questions used in NHANES

I. It is important to attempt to understand, for example,

why certain individuals with radiological evidence of osteoarthritis (as determined in the baseline NHANES I

exam) develop functional impairment and others with the

same severity of disease do not. Extensive arthritis data

were collected in both NHANES I and NHEFS. Furthermore, a performance scale on activities of daily living

was developed specifically for NHEFS to measure functional status.

To address these objectives most effectively, NHANES

I adult respondents were traced and interviewed during 1982–

84. Hospital and nursing home records were also collected

for any episode that occurred since the respondent’s NHANES

I examination, and death certificates were collected for those

who had died. This sample will continue to be followed annually with the use of the National Death Index to obtain death

certificates for respondents who have died after their followup

interview. Moreover, as mentioned earlier, a continued telephone followup of the elderly (those who were at least 55

years of age at the NHANES I examination) is currently

in operation, and plans are being made for additional telephone

followups of the entire cohort. These efforts will be described

in future NCHS reports.

Feasibility study

In January 1979, representatives from all participating

institutes of NIH, NCHS, and consultants in nutrition, environmental health, behavioral sciences, and health services began

planning for the followup study. The initial step was to design

a feasibility study to address several fundamental survey design

issues. For example, could NHANES I participants be located

after the lengthy time interval that had already elapsed? Would

subjects consent to be reinterviewed? Would they sign authorizations to allow for hospital record data collection efforts?

Would hospitals participate? Could deaths in the cohort be

identified? Could death certificates be obtained?

To answer these questions, a feasibility study was conducted in Baltimore, Md., beginning in January 1980. This

5-week study included 191 subjects who had been 25–74

years of age at the time of the 197I NHANES I pretest.

NCHS conducted the preliminary tracing for the feasibility

study. The use of crisscross directories, U.S. Post Office

change-of-address services, files of licensed drivers from the

Maryland Department of Motor Vehicles, and the death certificate files from the Maryland Office of Health Statistics provided addresses for 134 (70 percent) of the cohort. An additional 33( 17percent) were located by field tracing.

Figure 1 illustrates the results of the tracing efforts. Only

15 (8 percent) of the 191 persons in the study were lost

to followup. Black male participants and persons in the

youngest age group (25–34 years old at the 1971 pretest)

tended to be the most difficult to trace.

Among the group of 176 traced subjects, 33 individuals

had died. Almost one-half of these decedents were from the

age cohort of 65–74 years at the time of NHANES I. Twentythree persons agreed to act as proxies for the decedents and

to participate in an interview. Twenty-one (79 percent) of

these proxy respondents signed authorization forms to permit

the retrieval and use of medical and death records. Death

certificates were obtained for 24 (80 percent of 30 in-State

deaths) of the decedents.

Of the 143 traced survivors, 74 (52 percent) were living

at the same address as during the 1971 pretest, 56 (39 percent)

had moved locally (within a 50-mile radius of the survey

5
I I

176 traced 15 lost to

92 percent followup

8 percent

1

I

9

I I

13 relocated 130 interview 33 deceased

7 percent attempts

74 percent

19 percent

t

I

I

126interviewed

28 next-of-kin

4 refused 5 next-of-kin

97 percent

located

3 percent not located

85 percent 15 percent

I

I

I

23 interviewed

I I

4 refused

85 percent 15 percent I

Combined response rate

for interviews:

126 + 23 — = 95 percent

130 + 27

Fiiure 1. Summery of tracing and interviewing success in Baltimore, Md., Feaaibilii Study, 1980

location), and 13 (9 percent) had moved outside of the Baltimore area. About 97 percent of the 130 subjects who lived

in the survey area completed a 10- to 15-minute survey questionnaire. Ninety-one percent of the subjects who completed

a questionnaire also signed medical records authorization

forms.

Overall, vital status was determined for 92 percent of

the 191 subjects in the cohort. Interviews were conducted

with 78 percent of the original cohort with 95 percent of

the attempted interviews completed. Thus, the results of the

feasibility study indicated that sufficient numbers of subjects

and proxy respondents for decedents could be located and

interviewed, and that health facility and death records could

be obtained for the NHANES I examinees.

Study design

Data collection for NHEFS began in 1981 and concluded

in August 1984. A detailed account of the training schedule

is provided in appendix IV, and the time and location of

the actual data collection are given in appendix V.

The design of NHEFS consisted of five steps:

. Tracing the subjects or their proxies to a current address.

. Performing in-depth interviews with the subjects or with

their proxies.

. Taking pulse, blood pressure, and weight measurements

of subjects.

6
. Obtaining hospital and nursing home records, includlng

pathology reports and electrocardiograms.

. Acquiring death certificates.

Copies of all pertinent study materials (tracing materials,

questionnaires, authorization forms, and health facility data

collection forms) can be found in appendix VI.

Although each component of NHEFS represents a separate

survey activity with its own set of procedures for data collection, processing, and reporting, the information gathered for

any one part of the survey was used to field other components.

Data from the different components were thus intended to

be used together when appropriate. In addition, the information

respondents provided directly enabled certain items that were

obtained by observation or through proxy response in the

NHANES I to be updated or modified (for example, race

and age. Appendix VII contains a complete listing of those

changes. )

A summary of the NHEFS design and the results of

the data collection procedures for the cohort are presented

in figure 2. The flow chart shows the relationship between

each of the data collection activities and provides information

on the number of subjects included in each component. The

information summarized in figure 2 will be explained in detail

in the following sections.

Tracing

The first phase of the project was to trace and locate

each subject. The NHANES I examinees had not been contacted in any way before the inception of NHEFS. Because

the validity of longitudinal studies depends on the completeness

of followup, a large variety of sources were used to trace

subjects, including crisscross and city dlrectones, telephone

contacts, direct mail, U.S. Post Office address information

requests, State Department of Motor Vehicle listings, State

Vital Statistics files, and field visits to neighbors at last known

address.

Attempts were made to trace all subjects in the cohort

and to determine their vital status. Date and place of death

were obtained for subjects who had died. This information

was used to obtain a copy of the death certificate from the

appropriate State Vital Statistics office. The tracing process

was also used to obtain the current address of surviving subjects

as well as to identify a knowledgeable proxy respondent for

deceased subjects. (Throughout this report, the term “subject”

refers to the individual examined as part of NHANES I and

the term “respondent” refers to the person who provides the

information at followup. )

Respondents who were identified and located through

the tracing procedure were then contacted and asked to participate in a personal interview. In a few cases, respondents

who had been traced successfully could not be relocated for

the interview. Only vital status as of tracing was available

for those subjects.

A subject was considered successfully traced if the person

or a proxy (in the case of those deceased or incapacitated)

comectly responded to a set of verification questions that

established the subject’s identity. F]rst, the name of the subject

had to be verified. Then the respondent was asked to correctly

supply atleast two of the following three items:

Date of birth-The date of birth was considered verified

if the year of birth obtained in the NHEFS tracing was

the same year reported at NHANES I, or if the month

and day were the same, and the birth year was within

2 years of the year reported in NHANES 1.

Address at date of NHANES I exam—The address of

the subject was considered verified if the respondent correctly reported the street name, city, and State of the

address at the time of the NHANES I exam. It was

not necessary that the house number match.

Household membership at the time of the NHANES I

exan-The household composition was considered verified if the subject or proxy recalled the name and relationship of at least one household member correctly. The

household composition was asked only if the birthdate

or address had not been supplied correctly.

Lost to followup

All persons who could not be traced were considered

lost to followup. The fact of death had to be confirmed by

a death certificate or a proxy interview. In some cases, information about the death of a subject was obtained from neighbors

or other tracing contacts. Although this information was noted

in the record, these persons were considered lost to followup

unless the information was verified by a proxy interview or

a death certificate.

As of August 1984, 93 percent of the study population

was located successfully. However, the success of the tracing

efforts varied by age, race, and sex (tables C and D). To

summarize how demographic factors were related to tracing

success, a multiple logistic model was fitted to the crossclassification of age, race, and sex, with the proportion of subjects

who were lost to followup representing the dependent variable.

Because there were few participants of “other” races (172),

this analysis was limited to black respondents and white respondents. Terms were deleted from the saturated model to develop

the simplest model that would fit the data. The smallest P

value (probability) for a deleted term was 0.10. The final

model included a main effect forage (P<O .001) and an interaction between sex and race (P<O.001 ). The number of persons

lost to followup was highest for those under 35 years of

age at the time of NHANES I, and then generally decreased

with each 10-year increase in age for all sex-race groups

(odds ratios were 4.43, 1.97, 1.25, 0.91, relative to those

65 years of age and over).

Within each age group, the effect of sex on lost-to-folIowup rates depended on the race of the individual. Among

white respondents slightly more women were reported lost

to followup, but among black respondents, men had the higher

rates in this category. Odds ratios relative to white men were

1.27 for white women, 3.17 for black men, and 2.27 for

black women. Thus, the lowest lost-to-followup rates were

found among white men 55 years of age and over, and the

highest rates were reported for black men under 35 years

of age.

7
NHEFS: 1982-64

14,4o7 respondence

100.0 percent

I

13,383 traced 1,024 lost to followup

92.9 percent 7.1 percent

I

ml’===

I■ I

10,523 interviewed

92.6 percent

. . . . . . . . . . . . . . . . . . . .

10,145 pulse

measured

96.4 percent

9,956 blood

pressure measured

94.6 percent

10,006 weight

measured

95.1 percent

m

Fiiure 2. Summary of data collection used in the NHANES I Epidemiologic Followup Study, 1982-64
Table C. Number of respondents and percent distribution by statua in the Ep4demIofogic FOIIOWUPStudy, according to sex and age at the first Health and

Nutrition Examination Survey

Status at followup Status at followup

Lost to Lost to

Sex and aga’ All respondents Suwiving Deceased followup Total Surviving Deceased followup

Number Percent distribution

All respondents. . . . . . . . . . . 14,407 11,3431 2,022 1,024 10Q.O 78.9 14.0 7.1

Male

Under 35years . . . . . . . . . . . 1,127 989 16 142 100.0 86.0 1.4 12.6

35-44 years . . . . . . . . . . . . . . 928 816 44 68 i 00.0 87.9 4.7 7.3

45-54 years . . . . . . . . . . . . . . 1,060 667 124 49 lrl).o 83.7 11.7 4.6

55-84 years . . . . . . . . . . . . . . 660 652 183 25 100.0 75.8 21.3 2.9

65-74 years . . . . . . . . . . . . . . 1,836 934 835 67 IOQ.O 50.9 45.5 3.6

Female

Under 35years . . . . . . . . . . . 2@2 1,965 26 371 100.0 83.3 1.1 15.6

35-44 years . . . . . . . . . . . . . . 2,013 1,822 54 137 100.0 90.5 2.7 6.8

45-54 years . . . . . . . . . . . . . . 1,220 1,104 61 55 100.0 90.5 5.0 4.5

55-64 years . . . . . . . . . . . . . . 964 830 100 34 100.0 86.1 10.4 3.5

65-74 years . . . . . . . . . . . . . . 2,017 1,362 579 76 100.0 67.5 28.7 3.8

‘The sampling frame for the fhst Health and Nutrition Examination Survey included parsons sgad 1-74 years at the time of the intewiew. Several subjects reached their 75th birthday between the Interview and the examination. In addition, date of birth was incorrectly coded for several subbota. ~is was Corr=ted in the fOllowuP, and, as a result, one subiect is over 75

years of age but has been retained in the anaIysls.

Tabfe D. Number of respondents and percent distribution by status in the Epfdemidogic Followup Study, according to race, sex, and age at the first Health and

Nutrition Examination Survey

Status at followup Status at followup

All re- Sur- De Lost to sur- De Lost to

Race, sex, and age’ spondents Wfrg ceased followup Tots/ vfving ceased followup

WHITE

Bothsexes . . . . . . . .

Male

Under35 years . . . . .

35-44 years . . . . . . . .

45-54 years . . . . . . . .

55-64 years . . . . . . . .

65-74 years . . . . . . . .

Female

Under35 years . . . . .

35-44 years . . . . . . . .

45-54 years . . . . . . . .

55-64 years . . . . . . . .

65-74 years . . . . . . . .

BIACK

Bothsexes . . . . . . . .

Male

Under 35 years . . . . .

35-44 years . . . . . . . .

45-54 years ..{.,...

55-64 years . . . . . . . .

65-74 years . . . . . . . .

Female

Under 35 years . . . . .

35-44 years . . . . . . . .

45-54 years . . . . . . . .

55-64 years, . . . . . . .

65-74 years . . . . . . . .

Seafootnoteatend of table.

Number Percent distribution

12,036 9,706 1,599 731 100.0 60.7 13.3 6.0

13

37

88

149

675

96

49

35

19

36

100.0

100.0

100.0

100.0

IOQ.O

6&7

89.3

86.3

77.3

52.6

1.3

4.6

9.8

20.1

45.0

10.0

6.1

3.9

2.6

2.4

964

802

895

741

1,501

855

716

772

573

790

85.2

91.9

92.5

86.9

69.1

0.6

2.1

3.6

10.4

27.8

14.1

6.1

3.9

2.7

3.2

1,980

1,609

1,047

819

1,678

1,888

1,478

866

712

1,159

15

33

38

85

488

279

96

41

22

53

100.0

100.0

100.0

10Q.O

10Q.O

2,199 1,532 403 264 100.0 69.7 18.3 12.0

25.7

16.8

8.4

5.7

9.6

2.1

6.5

22.7

30.5

46.3

144

107

154

105

313

104

82

106

67

138

3

7

35

32

145

37

18

13

6

30

100.0

100.0

10Q.O

100.0

100.0

72.2

76.6

68.8

63.8

44.1

11

21

23

15

111

79

35

12

11

23

10Q.O

100.0

100.0

100.0

100.0

75.6

64.7

79.0

81.7

59.8

3.0

5.8

13.8

10.6

33.3

21.4

9.6

7.2

7.7

6.9

369

365

167

142

2S3

279

309

132

116

199

9
Table D. Number of respondents and percent dlstrlbutlon by status in the Epidemiologic Followup Study, eccording to rsce, sex, and age at the first Health

and Nutrition Examination Survey-Con.

Status st followup Status at followup

All re- Sur- De- Lost to SurRace, sex, and agel

Dr+ Lost to

spondents Wing caased followup Total viving ceased followup

OTHER Number Percent distribution

Both aexes . . . . . . . . 172 120 20 32 100.0 69.8 11.6 18.6

Male

Under 35 years . . . . 19 10 9 100.0 52.6

35-44 years . . . . . . . .

47.4

19 18 1 100.0 94.7

45-54 yeara . . . . . . . . 11 9 1 1

5.3

100.0 81.6 9.1

55-64 years . . . . . . . . 14 12 2

9.1

100.0 65.7 14.3

65-74 years .,....,. 22 6 15 1 100.0 27.3 66.2 4.5

Femaie

Lfnder35 years . . . . . 33 20 13 100.0 60.6

35-44 years ..,...., 39 35

39.4

4 100.0 89.7 10.3

45-54 years,....,.. 6 4 2 100.0 66.7 33.3

55-64 years.....,.. 3 2 1 100.0 66.7

65-74 years . . . . . . . . 6 4 2

33.3

100.0 66.7 33.3

‘The sampling frame for the firat Health and Nutrition Examination Survey included persons aged 1-74 years at the time of the interview. Several subjects reached their 75th birthday

between the interview and the examination. In addition, date of birth was incorrectly coded for several subjects. This was corrected in the followup, and, as a result, one subject is over

75 years of age but has been retainsd in the analysie,

Table E. Odds rstioa, confidence intervals, and statistical significance for heaith characteristics on loss to followup baaed on multiple logistic regression with

age, sex, and race included

95-percent

confidence interval

Odds

Sta tjs fj~. /

Lower Upper

Characteristic

si!ynificance

ratio bound bound (P-value)

High blood presaure . . . . . . . . . . . . . . . . . . . 0.81 0.66 0.97 0.024

Highcholesterol . . . . . . . . . . . . . . . . . . . . . . 1.03 0.86 1.23

Overweight . . . . . . . . . . . . . . . . . . . . . . . .

0.754

0.94 0.80 1.10

Heart attack, . . . . . . . . . . . . . . . . . . . . . . . .

0.450

1.18 0.79 1.77

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.408

1.21 0.84 1.74

Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.310

1.66 1.52 2.28 0.001

Analysis using a multiple logistic regression was conducted to determine whether those persons lost to followup

were at relatively high risk of death. Six health characteristics

(in addition to age, race, and sex) that have been established

as risk factors for mortality were considered: high blood pressure (systolic blood pressure of 140 millimeters of mercury

or more), high cholesterol (260 milligrams per 100 milliliters

or more), overweight (body mass index above the 85th percentile), history of heart attack, history of diabetes, and smoking

status (smoker, nonsmoker, or unknown).

The results of this multiple logistic regression are presented in table E. Two risk factors were inversely associated

with loss to followup: NHANES I examinees with high blood

pressure were 19percent less likely (P = 0.024) and overweight

examinees were 6 percent less likely to be lost to followup

(P= 0.450). High cholesterol had virtually no effect on tracing,

and persons with a history of heart attack or diabetes were

approximately 20 percent more likely to be lost to fiollowup

(none of these differences were statistically significant). Smoking had the strongest effect on loss to followu~~mokers

were 86 percent more likely than nonsmokers to be untraced

(Pco.ool).

These results suggest that those subjects who were lost

to followup were somewhat more likely to have died than

those who were successfully traced, The strong association

between smoking and lost-to-followup rates indicates that the

effects of smoking on mortality, especially at younger ages,

should be interpreted with caution. It should be noted, however, that among those aged 55 years and over the proportion

lost to followup is quite small relative to the proportion deceased. Thus, in these age groups, there should be relatively

little bias in mortality findings as a result of loss to followup.

10
Interview data collection

Interview procedures

An attempt was made to interview all subjects identified

during tracing. Subjects and proxies were sent a letter in

advance describing the followup study about 2 weeks before

interviews were to begin in an area. Interviewers then called

the subject or proxy to schedule an appointment for the interview. If the person could not be reached by telephone, the

interviewer made an in-person attempt to interview or to

scheduIe a future appointment.

Interviews were conducted wherever the subject resided,

including in nursing homes, prisons, mental health facilities,

or occasionally at some other convenient location (for example,

a parent’s home), After physical measurements were completed, the subjects were given written reports of the measurements. At the close of the interview, the respondent was

asked to sign a form authorizing NCHS to obtain information

from medical records. Subjects were remunerated $10 for

their participation in this approximately 2-hour interview.

Thorough quality control procedures were instituted, with

the interviewer and the field office conducting field edits.

Respondents were recontacted if there were discrepancies or

missing sections in key items. Fifteen percent of the questionnaires were randomly selected for validation. This was done

primarily by telephone and, if necessary, by mail. Additional

questionnaires were selected for verification if the data were

believed to be false. Ten percent of the telephone interviews

were also validated.

Followup interviews first occurred in a pilot phase, referred to as phase 1. Twelve interviewers and three office

support staff members were hired to conduct phase 1 using

the NHANES I Philadelphia area sample (sample locations

1, 51, 86, and 97). A 3-day program of physical measurements

training and a 5-day interviewer training program were held.

(The schedule and locations of the training are given in appendix IV. ) In-field tracing was conducted in conjunction with

interviewing when necessary. Field tracing was performed

to locate subjects or proxies not found through office tracing

methods.

After phase 1, the questionnaires and field procedures

were evaluated, and it was decided that, in most instances,

proxy interviews for deceased subjects could be conducted

most efficiently by telephone. The exceptions to this rule

would occur when the proxy had no telephone or when the

proxy was also a subject in the study. In the latter case,

a personal interview was conducted with the subject. and

then a proxy interview was conducted for the decedent.

Main data collection began in October 1982, 3 months

after the pilot study interviews were completed. The field

work for NHEFS was conducted regionally. Because the original NHANES I sample was clustered by sample location,

most of the followup respondents were similarly clustered.

Although some subjects had moved during the survey period

and some proxy respondents did not necessarily live in the

original clusters, the number of subjects located within the

original set of clusters was sufilcient to organize the field

work around the original sample locations. Procedures were

developed to secure interviews with those not living in the

original areas. The 100 PSU’S in the NHANES I national

sample, excluding the phase 1 locations, were grouped into

four approximately equal workload regions representing the

North (Northeast), South, Midwest, and West. To ensure

close contact with interviewers in the area, each region had

a central field supervisor and three field offices with a supervisor and assistant in each office. The sample locations included for each region are listed in appendix V, along with

the locations for the pilot study and the respective interviewing

periods.

NHEFS interviews occurred first in the North in October

1982. Work began in the South in February 1983, followed

by the Midwest in May and the West in August. The final

interviews were completed in the West in December 1983.

Procedures were instituted to ensure that the necessary

information was collected from respondents in a consistent

manner. In each of the four regions, 50 to 60 interviewers,

who were indigenous to the sample locations, were trained

to meet the precise standards of the study. Interviewer candidates had to successfully complete the 3-day physical measurements training session and be certified to take blood pressure

measurements before they were accepted for the intensive

8-day interview training session. Interviewers were trained

and certified to take blood pressure measurements according

to the guidelines of the American Heart Association and the

National Heart, Lung, and Blood Institute. The field supervisors in each region remained in close contact with the interviewers by telephone. and personal visits were made to observe

each interviewer in the field. Interviewers were retested on

the physical measurements procedures early in the interviewing

phase.

Nonetheless, some NHEFS respondents were located in

remote regions of the country, and the costs of securing these

dispersed interviews were very high. Furthermore, although

tracing occurred continually throughout the survey period and

11
field work was conducted regionally, some subjects woidd

be located only after field work was completed in that region.

A small cadre of traveling interviewers continued to handle

these kinds of cases; however, it was impossible to field

all cases that were traced, particularly those at the end of

the field period. Thus, these subjects were interviewed by

telephone to gain as much information as possible without

incurring extreme costs. Certain sections of the questionnaire

were omitted to ensure that the telephone questionnaire was

of an acceptable length. Telephone interviews were completed

for 131 subjects. This process was called the U.S. Sweep

and was conducted early in 1984.

When one of these subjects could not be contacted by

telephone, a mail form was sent. This form was designed

to obtain the information necessary to verify the subject’s

identity, to obtain information for future tracing, and to collect

the names of hospitals in which the subject had stayed and

the dates of each stay. Mail forms were also sent to proxies

for deceased subjects in cases when the proxy could not be

reached by telephone and the costs associated with the personal

interview would be too high. Forty-seven mail forms were

received. The receipt of a mail form did not constitute an

interview; however, the information was important for other

survey components, for example, in verifying vital status and

collecting hospital records and death certificates.

The initial followup interview consisted of two sections:

a detailed questionnaire that was provided to all subjects and

proxy respondents, and a physical measurement section in

whidh selected physical measurements were taken on subjects

only. Additional survey procedures that provided information

and materials required by other survey components were performed atthe time of the interview.

The personal interview was designed to gather information

on selected aspects of the subject’s health history since the

time of the NHANES I exam. This information included a

history of the occurrence or recurrence of selected medical

conditions; an assessment of behavioral, social, nutritional,

and medical risk factors believed to be associated with these

conditions; and an assessment of various aspects of functional

status. Whenever possible, the questionnaire was designed

to retain item comparability between NHANES I and NHEFS

as a measure of change over time. However, questionnaire

items were modified, added, or deleted when necessary to

take advantage of current improvements in questionnaire

methodology. The revised questionnaire also included a complete history of hospital and nursing home use.

Two versions of the interview questionnaire were developed—the subject questionnaire and the proxy questionnaire. The subject questionnaire was used when the subject

was alive at the time of interview. Although the questionnaires

were administered by trained interviewers, certain sections

of the subject questionnaire were included in a special booklet

to be self-administered.

If a subject was incapacitated or otherwise unable to

take part in the interview, selected portions of the subject

questionnaire were given to a proxy respondent. This version

of the subject questionnaire is referred to as the “boxed”

questionnaire (appendix VI). Questions on the subject questionnaire that were also included in the boxed questionnaire

12

were designated by the shaded boxes in which the question

numbers were enclosed. In general, only objective questions

were included in the boxed questionnaire. Questions that related to feelings, opinions, or perceptions were omitted,

The proxy questionnaire (appendix VI) was provided only

when the subject was deceased. In most cases, proxy questionnaires were administered by telephone, whereas subject questionnaires were administered in person.

The distinction between a proxy respondent and the proxy

questionnaire is important. To reiterate, a proxy re,ymndent

was asked to answer the proxy questionnawe when the subject

was deceased or to assist with a subject questionnaire when

the subject was unable to participate in the interview for

other reasons. A proxy questionnaire, however, was given

to a proxy respondent only when the subject was deceased.

Proxy respondents completed 1,697 proxy questionnaires for

decedents. In addition, proxy respondents completed 256 of

the 10,523 subject questionnaires.

Questionnaire content

Both the subject and the proxy questionnaires were divided

into sections based on general topics, Where appropriate,

entire sections and specific questions in other sections were

omitted from the proxy questionnaire. General topics as well

as specific question batteries were developed collaboratively

by the participating agencies.

Part A of the subject and proxy questionnaires includes

questions on the subject’s household composition. The first

part of the Mental Status Questionnaire (MSQ) was administered to subjects 60 years of age and over.7 The MSQ was

used to identify dementia and also to determine if the subject

was capable of responding to the questionnaire. If the subject

received a score of less than 3, the interviewer immediately

administered the second part of the battery, located in section

H. If the subject scored less than 8 on both parts of the

MSQ, the subject was asked to -respond to parts I, J, and

P, but the interviewer was instructed to enlist the aid of

a proxy respondent, usually a relative or close friend, to

assist the subject with the rest of the questionnaire. Potential

proxy respondents answered a series of verification questions

to determine whether they were knowledgeable enough about

the subject to complete the questionnaire. However, if the

interviewer felt that the subject could provide valid responses

or if a proxy respondent could not be located, the subject

was asked to complete the questionnaire. Among those surveyed, 173 subjects scored less than 8 on the MSQ. In 81

of these cases, another person assisted the subject with the

interview.

Part B of the NHEFS questionnaire contains information

on the composition and vital status of the subject’s family

of origin and on the family’s history of cancer. Questions

on the vital status of the parents were omitted from the subject

telephone interview.

Part C contains questions on the female medical history,

including menstrual and pregnancy history, exposure tc)estrogens, and status of reproductive organs. Some questions on

status of reproductive organs found in section C of the subject
questionnaire are also found in section G of the proxy

questionnaire.

Part D of the questionnaire contains a self-reported history

of selected conditions. The conditions, which were selected

on the basis of prevalence and severity, include hypertension,

angina, myocardial infarction, claudication, stroke, gallbladder

disease, cancer, and respiratory problems. The coronary heart

disease questions were developed by Dr. Geoffrey Rose of

the University of London.* A diagram was included in the

self-administration booklet to enable the subject to identify

the location of the anginal pain. The respiratory scale was

adapted from the questionnaire developed by the American

Thoracic Society and the Division of Lung Disease of the

National Heart, Lung, and Blood Institute.9 Each set of questions on a particular condition also included a question to

ascertain whether or not the subject had been hospitalized

for that condition since 1970. If there was a hospitalization,

information on the name and address of the facility, the year

of the stay, and the reason for the stay was recorded on

a special chart in the questionnaire booklet. In addition, part

D included a battery of questions on exposure to sunlight

and the occurrence of bedsores attributed to bed confinement.

Symptom questions were omitted from the boxed questionnaire

and the proxy questionnaire.

Part E of the subject questionnaire relates to arthritis.

The battery of questions is adapted from the Arthritis Supplement used in NHANES I. The symptom questions meet the

American Rheumatism Association diagnostic criteria for

rheumatoid and osteoarthritis. 10The battery includes a scale

found in the self-administration booklet and is designed to

measure the amount of joint pain the subject experienced.

The battery was not included in the proxy questionnaire, but

a global question on arthritis was added to part G in the

questionnaire. The questions in part E of the subject questionnaire relating to the experience of pain or other symptoms

were omitted from the boxed questionnaire.

Part F of the questionnaire concerns functional impairment. The battery consists of modified, selected items from

the Fries Functional Disability Scale for arthritis,] *the RosowBreslau Scale,12 and the Katz Activities of Daily Living

Scale.*3 The questions are designed to measure the difficulty

the subject has doing a set of everyday activities without

the help of another person or mechanical aid. Information

was also collected on whether or not help had been received

and how this help affected the subject’s ability to perform

the activity. Thus, this information could be used to measure

the impact of disease on functioning ability as well as the

actual functioning level as affected by the receipt of help

or use of aids. The items could thus be grouped in different

ways to investigate different aspects of functional status. Part

F was omitted from the proxy questionnaire and a shorter

version was used for the subject telephone questionnaire.

Part G is a checklist designed to provide information

on diseases and conditions not identified in other parts of

the questionnaire. Conditions that were identified in the original NHANES I as having a high probability of being reported

or conditions proposed for analysis were included in the list.

Information was collected to determine if the subject was

diagnosed by a doctor as having the condition, the year of

initial diagnosis, and whether or not the subject had been

hospitalized since 1970 for that condition. Information was

also gathered on any hospitalizations or stays in other health

facilities that were not obtained previously. Questions on the

subject’s use of selected prescription medicines, aspirin, antacids, vitamins, minerals, and other nutritional supplements

are also included in part G. The subject’s social security

number was also obtained in part G of the subject

questionnaire.

Part H of the NHEFS questionnaire contains the second

portion of the Mental Status Questionnaire, described in the

previous explanation of Part A. Part I includes the CES–D

Depression Scale6 and selected items from the General Well

Being Scale 14that correspond to the following variables: negative affect, positive affect, and health concern. Both scales

are designed to be self-administered and, therefore, are included in the self-administration booklet. Social support questions are also included in this section.

Part J consists of questions regarding the bowel and bladder. This section is included in the self-administration booklet

to reduce the possible sensitivity of this topic. The next section,

part K, contains questions on changes in the subject’s weight

over a period of time.

Part L is designed to obtain a smoking history that identifies periods of smoking commencement and cessation, the

average number of cigarettes smoked, the current amount

smoked, and the use of cigars, pipes, snuff, and chewing

tobacco. Because such smoking information was obtained only

for subjects in the detailed NHANES I examination, these

followup questions could be used to construct smoking status

at baseline for the subjects who were not in the detailed

sample.

Part M concerns consumption of alcoholic beverages.

The questions are designed to obtain the subject’s lifetime

pattern of usual drinking. In addition, information was collected on binge drinking during the past year as well as the

period of heaviest lifetime drinking:

Part N of the questionnaire contains an extensive battery

of questions designed to identify aspects of the subject’s usual

diet. The section includes an expanded food frequency inventory covering the major food groups—meat, fish, poultry,

grains, fruits, vegetables, dairy products, sweets, and snacks.

The main criteria for inclusion of individual food items in

this expanded food frequency was whether or not the food

was high in fat, fiber. vitamin A, or vitamin C. The food

frequency inventory also includes items on condiments, coffee,

tea, soda, and alcohol. Questions on food preparation, use

of prepared foods, special diets, frequency of meal eating

and snacking, use of salt and eating problems are also included

in this section. Part N was not a part of the proxy questionnaire

or the subject telephone questionnaire.

In part O, information was gathered on sleeping problems

and changes in sleep patterns. The questions were adapted

from those used in the Stanford Sleep Study. 15These questions

were not included in either the boxed or proxy questionnaires.

Part P includes two scales designed to measure the traits

13
of extroversion and openness to experience.16 Measures of

Type A personality are also included in this section. Part

P was excluded from the boxed and proxy questionnaires.

Part Q contains a limited number of questions on physical

activity. Physical activity items were taken from the second

National Health and Nutrition Examination Survey, performed

from 1976 through 1980. In addition, questions on jogging

were added. Again, these items were excluded from both

the boxed and proxy questionnaires.

Part R was used to identify the extent of tooth loss,

the use of dental plates, and the use of fluoridated toothpaste.

These items were repeated from the original NHANES I.

The proxy questionnaire did not contain this section.

Part S includes questions to measure the subject’s auditory

abilities, and part T contains questions to measure visual

abilities. The scales in both sections are repeated from

NHANES I. Only selected questions from parts S and T

were included in the boxed questionnaire.

Part U was provided to obtain background information

on race; marital status; primary place of residence during

the subject’s lifetime; usual occupation; current activity; exposure to dust, fumes, or vapors when working or engaged

in hobbies; sources of income; and maiden name for female

subjects.

A final section, part V of the proxy questionnaire, pertains

only to deceased subjects and includes questions on the circumstances surrounding the subject’s death. Items include

information on whether the subject was confined to home

or an institution prior to death, cause of death, who was

present at the time of death, the experience of pain at death,

and place of death.

Interview nonresponse

Interviews with the participant or a proxy were completed

for 85 percent of the original cohort or 91 percent (12,220

persons) of those successfully traced. Of the 1,697 proxy

interviews, 1,206 were completed by telephone. In 131 cases,

interviews with surviving NHANES I participants were conducted by telephone rather than in person. Telephone interviews were used if the respondent lived in a remote area

or if the respondent was traced too late in the field period

to conduct a personal interview.

Nonresponse rates for the interview by age, race, sex,

and vital status are given in table F. Among traced, surviving

participants, 7 percent were not interviewed, and proxy interviews could not be obtained for 16 percent of the deceased.

The lower interview success rate for decedents compared with

surviving NHANES I participants was apparent for all age-sexrace groups. This difference is attributed in part to the fact

that many of the deceased were located from vital statistics

files, and no proxy could be identified.

To summarize how demographic factors related to interview status, multiple logistic models were fitted to the crossclassification of age, race, and sex, with the proportion of

subjects who did not complete the interview representing the

dependent variable. Separate models were fitted for surviving

and deceased persons. When nonsignificant terms were deleted

from the saturated model (the smallest P value for a deleted

term was O.18), the final model for deceased persons included

only a main effect for race (P< O.001). Nonresponse rates

for the proxies of black decedents were substantially higher

than those for whites (odds ratio of 2.40). The final model

for surviving NHANES I participants included a main effect

for age (P= 0.003) and a marginally significant interaction

between sex and race (P= 0.11 ).

All other terms deleted from the model had P values

greater than 0.26. Noninterview rates were lowest for those

subjects 55-64 years of age, but similar for all other age

groups (odds ratios of 1.68 for those aged 25–34 years, 1.46

for those aged 3544 years, 1.47 for those aged 45–54 years,

and 1.63 for those aged 65–74 years). Black men had the

poorest interview completion rates, whereas the rates for the

other race-sex groups were similar to each other. The odds

ratios relative to white women were 1.08, 1.52, and 1.02

for white men, black men, and black women, respectively.

Physical measurements

In part X of the questionnaire, at the end of the subject

interview, the subject’s pulse rate, three consecutive blood

pressure readings, and a weight measurement were attempted.

Measurements were obtained according to a specific protocol.

Arm cuffs were available in child, adult, and large sizes

and the interviewer selected the correct size. Blood pressure

measurement procedures were adapted from Kirkenda:ll17and

the Hypertension Detection and Follow-up Program. 1*

Physical measurements were not attempted for 131 subjects interviewed by telephone or for 161 subjects who were

incapacitated and could not take part in the interview. (An

additional 85 incapacitated subjects did not act as respondents

to the interview but did participate in the physical measurement

section.) Another 11 subjects ended the interview before the

physical measurement section. Thus, physical measurements

were not attempted for 303 of the 10,523 subjects who completed an interview. The percent of subjects not measured

successful]y for pulse, blood pressure, and weight are shown

by race and age atthe baseline in table G.

In addition to those 303 subjects without physical m,easurements, 75 subjects did not have their pulse measured. The

measurement was not attempted on 65 of these subjects because

of refusals (8 cases), medical contraindications (32 cases),

or other reasons (25 cases). A valid measure was not obtained

for the remaining 10subjects.

Three blood pressure measurements were attempted for

each subject interviewed. Failure to obtain a reading was

considered an attempt and could not be repeated. Either the

second or third of the three blood pressure measurements

attempted had to be successful for the procedure to be considered complete. During the followup, blood pressure could

not be measured for 264 subjects (in addition to the previously

mentioned 303 subjects without measurements). The blood

pressure procedure was not attempted on 184 of these subjects

(15 refusals, 117 medical contraindications, and 52 far other

reasons) and the procedure was attempted, but not completed

successfully, for the remaining 80 subjects.

Therefore, 5.4 percent of the NHEFS subjects with a

completed interview had no blood pressure measurements.

14
Table F. Number and percent of traced NHANES I Epidemiologic Followup Study cohort without completed interview, by race, sex, and age at baseline

examination, and subject status

Subjects without comp/eted interview’

suNivirrg Deceased

Race, sex, and age2 Number Percent Number Percent

ALL RACES3

Bothsexes . . . . . . . . . . . . . . 838 7.4 325 16.1

Male

Under 35years . . . . . . . . . . . 93 9.3 2 12.5

35-44 years . . . . . . . . . . . . . . 88 8.1 9 20.5

45-54 years . . . . . . . . . . . . . . 67 7.6 18 14.5

55-64 years . . . . . . . . . . . . . . 28 4.3 34 18.6

65-74 years . . . . . . . . . . . . . . 82 8.8 122 14.6

Female

Under 35years . . . . . . . . . . . 151 7.6 9 34.6

35-44 years . . . . . . . . . . . . . . 124 6.8 9 16.7

45-54 yeara . . . . . . . . . . . . . . 80 7.2 14 23.0

55-64 years . . . . . . . . . . . . . . 48 5.8 12 12.0

65-74 years . . . . . . . . . . . . . . 102 7.5 98 16.6

WHITE

Bothsexes . . . . . . . . . . . . . . 697 7.2 212 13.3

Male

Under 35years . . . . . . . . . . . 76 8.9 2 15.4

35-44 years . . . . . . . . . . . . . . 53 7.4 8 21.6

45-54 years . . . . . . . . . . . . . . 58 7.5 10 11.4

55-64 years . . . . . . . . . . . . . . 21 3.7 23 15.4

65-74 years . . . . . . . . . . . . . . 67 8.5 86 12.7

Female

Under 35years . . . . . . . . . . 123 7.3 2 13.3

35-44 years . . . . . . . . . . . . . . 99 6.7 4 12,1

45-54 years . . . . . . . . . . . . . . 70 7.2 8 21.1

55-64 years . . . . . . . . . . . . . . 43 6.0 6 7.1

65-74 years . . . . . . . . . . . . . . 87 7.5 63 13.5

BLACK

Bothsexes . . . . . . . . . . . . . . 125 8.2 108 26.8

Male

Under 35years . . . . . . . . . . . 14 13.5

35-44 years . . . . . . . . . . . . . . 10 12.2 1 14.3

45-54 years . . . . . . . . . . . . . . 7 6.6 8 22.9

55-64 years . . . . . . . . . . . . . . 5 7.5 11 34.4

65-74 years . . . . . . . . . . . . . . 15 10.9 33 22.8

Female

Under 35yeara . . . . . . . . . . . 24 8.6 7 63.6

35-44 years . . . . . . . . . . . . . . 22 7.1 5 23.8

45-54 years . . . . . . . . . . . . . . 9 6.8 6 26.1

55-64 years . . . . . . . . . . . . . . 5 4.3 6 40.0

65-74 years . . . . . . . . . . . . . . 14 7.0 31 27.9

‘Percents are based on subjects who were successfully traced.

2Sasappendix Vil for a discussion of revised race, corrected sex, and recalculated age.

%cludes races other than white or black.

Although no significant interactions occurred that involved

age, race, or sex, the failure rate was associated with all

of these variables. The odds ratios for no blood pressure

measurement relative to those under 55 years of age were

1.66 for those aged 55-64 years and 3.32 for those 65 years

of age and over. Women were 20 percent more likely than

men to have no blood pressure measurement available, and

black persons were 46 percent more likely than white persons

to be without this measurement.

A total of 214 subjects did not have their weight measured,

in addition to the 303 subjects noted previously. Weight was

not measured in 203 cases as a result of 34 refusals, 134

medical contraindications, and 35 cases in which other reasons

were noted. Measures were determined invalid in 11 other

instances. Although the failure rate for weight was slightly

higher than for pulse (4.9 percent compared with 3.6 percent),

the patterns were similar. There was a significant age-sex

interaction (P= 0.025) as well as a significant race effect

15
Table G. Number and petcent of Interviewed NHANES I Epidemiologic Followup Study cohort without successful completion of physical measurements, by reca,

sex, and age at baselina examination

hrcom@efe physical measurements

Pulse Blood pressure3 Weight 4

Race, sex, and age’ Number Percent 2 Number Percent2 Number Percent 2

AU RACES5

Bothsexes . . . . . . . . . . . . . .

Male

Under 35years . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . .

Female

Under 35years . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . .

WHITE

Bothsexes . . . . . . . . . . . . . .

Male

Under 35years . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . .

Female

Under 35years . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . .

BLACK

Bothsexes . . . . . . . . . . . . . .

Male

Under 35years . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . .

Female

Under 35years . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . .

376

24

17

15

31

55

53

30

i8

22

113

312

20

15

13

28

44

46

24

16

17

69

65

4

2

1

3

11

7

6

2

5

24

3.6

2.7

2.3

1.6

5.0

6.5

2.9

1.8

1.6

2.6

9.0

3.5

2.6

2.3

1.6

5.1

6.1

2.9

1.7

1.8

2.5

8.3

4.6

4.4

2.6

1.0

4.8

6.9

2.7

2.1

1.6

4.5

13.0

567

2S

22

27

38

79

77

61

37

43

154

461

24

19

24

34

60

66

44

31

36

121

105

5

3

2

4

19

9

17

6

7

33

5.4

3.3

2.9

3.3

6.1

9.3

4.2

3.6

3.6

5.5

12.2

5.1

3.1

2.9

3.4

6.2

8.3

4.4

3.2

3.5

5.4

11.3

7.5

5.6

4.2

2.0

6.5

15.4

3.5

5.9

4.9

6.3

17.8

517

31

22

24

36

75

57

38

35

35

164

418

24

17

19

34

56

50

31

29

27

131

96

7

4

4

2

19

7

6

6

8

33

4.9

3.5

2.9

2.9

5.8

8.8

3.1

2.2

3.4

4.5

13.0

4.6

3.1

2.6

2.7

6.2

7.7

3.2

2.2

3.2

4.0

12.2

6.8

7.8

5.6

4.0

3.2

15.4

2.7

2.1

4.9

7.2

17.8

‘See appendix Vll for a discussion of revlaedrace,cmrected sex, and rsoalculated age.

2Percenta are based on the total number of traced, living aubjscts with a completed subject interview. This includsa 131 caaes who were interviewed by telephone and on whom rlo

measurement ware attempted.

3Completed blood preaaure measurement is defined as the succ~sful completion of either the second or the third attempt to get a reading.

‘Completed weight measurement Is defined as a successful measurement taken on either of two attempts.

‘Mudea races other than white or black.

(P<O.001). As compared with women under 65 years of

age, the odds ratios were 1.21 for men under 65 years of

age, 4.70 for women 65 years of age and over, and 3.04

for men 65 years of age and over. Black subjects were 48

percent more likely than white subjects to have no weight

measurement.

16
Health facilities and death

certificate data collection

For the NHEFS, attempts were made to obtain a complete

history of overnight stays in health care facilities (hospitals

and nursing homes) and to collect death certificates for all

subjects who were deceased. This information can be used

to provide two crucial endpoints for epidemiologic study:

a clinical measure of morbidity based on hospital discharge

diagnosis and cause-specific mortality coded from the death

certificate.

Health facilities record collection

Parts D, E. and G of the subject, boxed, and proxy

questionnaires all contain items to determine whether or not

the subject had an overnight stay in a health care facility

after 1970. If a stay was reported, information on the name

and address of the facility, the date of the stay, and the

reason for the stay was recorded on a special chart on the

back cover of the self-administration booklet.

The hospital and nursing home survey portion of NHEFS

was conducted from April 1983 through August 1984. As

field interviewing in a region neared completion, all area

hospitals and nursing homes in which stays were reported

by study subjects were sent a medical records survey packet.

Consequently. eight hospittil and nursing home survey

mailings were neceswuy: two in both the Northeast and the

South, one in both the Midwest and the West, and two for

the U.S. Sweep. The first U.S. Sweep mailing included previously unidentified hospital stays that were reported by hospitals

on the returned abstract form. The second mailout included

hospital or nursing home stays that subjects reported during

the U.S. Sweep data collection.

As mentioned previously, information on hospital stays

was elicited for the period from 1970 to the time of followup.

Interviewers recorded the full name of the hospital, the hospital

address. and the approximate dtites of hospitalization. (Because

respondents may not have remembered exact dates, the request

to the hospital did not include the dates of hospitalization,

but asked for all admissions from January 1 of the year of

the NHANES I examination, ) At the conclusion of the interview. respondents were asked to sign a Medical Authorization

Form that would be used to request hospitals to release hospital

record inforrnation to the study. These forms were retained

on tile and a photocopy was made for each hospital that

the respondent had identified during the interview.

A list of all subjects who uhed a particular hospital was

aggregated in each region, The hospitals and nursing homes

in which study subjects reported stays were then contacted

and asked to provide information from their records on all

subjects for all stays occurring from January 1 of the year

of the NHANES I exam until the date of the followup interview.

At the same time, a letter was mailed to the hospital administrator advising that information was being requested from the

hospital’s medical records department. A similar letter was

sent to each nursing home identified during the interview.

Abstract forms were mailed to the nursing home administrators

requesting information on the dates and reasons for admission

for each nursing home stay.

Some hospitals did not have the staff to answer these

requests. In those cases an abstracter, usually someone at

the hospital, was hired to collect the data. In on]y two cases

did the NCHS contractor have to provide an abstracter to

collect the data.

Limited data were requested on the hospital and nursing

home abstract forms. The major data items requested were

the dates of admission and discharge apd the diagnoses. Additionally, a photocopy of the “face sheet” and “discharge summary” was requested for each hospital episode occurring in

the relevant time period. For myocardial infarction diagnoses

410 codes in the International Classification of Diseases,

9th Revision, Clinical Modljication (ICD-9-CM),’9 a photocopy of the third day electrocardiogram was requested. For

an admission where a malignancy was diagnosed, a photocopy

of the pathology report was requested. All medical records

were recoded by trained medical coders using ICD-9-CM.

Seventeen thousand, six hundred ninety-five hospital records and 433 nursing home records were received for 6,477

subjects. Table H shows the results of the facility record

collection. Among males, both the proportion of respondents

with at least one facility report and the average number of

facility reports received per person increased with age. Among

females, the pattern of association is J-shaped because the

age group under 35 years has a high hospitalization rate,

primarily attributed to childbearing. These patterns correspond

with those expected, based on national hospital discharge

rates. 20

Although these patterns are encouraging there are several

indications that the hospital file is not complete. First, 190

of the 2,557 hospitals and 59 of the 409 nursing homes contacted for records refused to participate. Second, because several hospitals had closed and no information about the disposition of their records was obtained, these facilities could not

be contacted. Third, some facilities did not return records

either because the records were inaccessible or because the

search for records was unsuccessful. Finally, authorization

17
Tabla H. Receipt of medical facility episode reports for the NHANES I Epidemiologic Followup Study cohort, by race, sex, and age at baseline examination

Average number of

Subjects with at Number reports received--

least one report of For For subjects

received reports traced with at least

Race, sex, and age’ Number Percent received subjects 4cmereport

ALL RACES*

Bothsexes . . . . . . ... . . . . . . 6,477 48.4 18,128 1.35 2,8

Male

Under 35years . . . . . . . . . . . 264 26.8 516 .53 2.0

35-44 yeara . . . . . . . . . . . . . . 330 36.4 800 .93 2.4

45-54 years . . . . . . . . . . . . . . 486 46.1 1,247 1.23 2.6

55-64 years . . . . . . . . . . . . . . 456 54.6 1,417 1.70 3.1

65-74 years . . . . . . . . . . . . . . 1,059 59.9 3,460 1.96 3.3

Female

Under35years . . . . . . . . . . 984 48.9 2,299

35-44 yeara . . . . . . . . . . . . . . 644 45.0 1,935

45-54 years . . . . . . . . . . . . . . 499 42.6 1,337

55-64 years . . . . . . . . . . . . . . 444 47.7 1,231

65-74 years . . . . . . . . . . . . . . 1,111 57.2 3,8s4

WHITE

Bothsexea . . . . . . . . . . . . . .

Male

Under 35years . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . .

Female

Under 35years . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . .

5,572

226

293

413

402

853

693

434

393

973

49.3

26.0

36.9

46.0

55.7

60.9

50.1

45.9

43.1

49.3

59.9

15,666

446

720

1,054

1,266

2,971

1,966

1,575

1,146

1,095

3,425

1.14

1.03

1.15

1.32

2.00

1.39

.51

.96

1.23

1.76

2.03

1.17

1.04

1.14

1.37

2.11

2.3

2.3

2.7

2.8

3.5

2.8

2.0

2.5

2.6

3.2

3.3

2.3

2.3

2.6

2.8

3.5

BLACK

Bothsexes . . . . . . . . . . . . . . 859 44.4 2,332 1.21 2.7

Male

Under35yeara . . . . . . . . . . 36 35.5 72 .67 1.9

35-44 years . . . . . . . . . . . . . . 33 37.1 75 .84 2.3

45-54 years . . . . . . . . . . . . . . 71 50.4 191 1.35 2.7

55-64 years . . . . . . . . . . . . . . 48 48.5 138 1.39 2,9

65-74 yeara . . . . . . . . . . . . . . 158 55.8 473 1.67 3.0

Female

Under 35years . . . . . . . . . . . 122 42.1 292 1.01 2.4

35-44 years . . . . . . . . . . . . . . 136 41.2 306 .93 2.3

45-54 years . . . . . . . . . . . . . . 65 41.9 191 1.23 2.9

55-64 years . . . . . . . . . . . . . . 51 38.9 136 1.04 2.7

65-74 years . . . . . . . . . . . . . . 137 44.2 458 1.48 3.3

‘SeeappendixWI for a discussion of revised race, corrected sex, and recalculated age.

‘Includes races other than white or black.

forms were not obtained for 3 percent of surviving participants

and 13percent of decedents.

It is difficult to measure precisely the extent to which

the NHEFSfacility record file incomplete. Todo so requires

that reported stays and facility records be matched based on

admission date and reason for stay. The accuracy of such

a search depends on the respondent’s ability to recall these

events for the average followup period of 10 years. As this

kind of recall can be prone to error, this kind of match was

not attempted.

It is possible, however, to identify one group of missing

records. No hospital records were obtained for 1,825 surviving

and deceased subjects who reported at least one hospitalization.

In 48 percent of these cases, the hospital refused to supply

the information, or was not contacted for other reasons. In

another 9 percent of these cases, respondents refused to sign

18
the authorization forms. In the remaining cases, the hospitals

were unable to locate the records. This latter failure may

be a result of respondent’s reporting errors. The name of

the facility, for example, could have been misreported; or

the date of a hospitalization might have been reported as

occurring after the NHANES I examination when in fact it

occurred prior to it. Therefore, the stay would have been

excluded from consideration. A more extensive analysis is

currently under way to evaluate the completeness of the record

collection.

Additional information will be available in future years.

Periodically, the survivors of this cohort will be reinterviewed

and additional data on functional status and morbidity will

be ascertained. Searches using the National Death Index will

add death certificate information to the data set.

Table J. Number of deaths among NHANES 1 Epidemiologic Followup Study

cohort members and percent of decedents without an available death

certificate, by race, sex, and age at baaeline examination

Number of Percent wifhout

Race, sex, and age’ deaths a death certificate

Death certificate collection

Deaths identified by the National Death Index (NDI) or

other tracing methods were verified by obtaining the death

certificate from the State of death. These death certificates

were coded by NCHS using the Ninth Revision of the International Classfzcation of Diseases multiple cause-of-death

codes.

Through inquiries, tracers were able to identify 2,022

deaths in the cohort. An NHANES I participant was considered

deceased only if a death certificate was received or a proxy

interview was completed to verify the death. Death certificates

were obtained for almost 96 percent (1,935) of all decedents

by the end of the initial followup. Currently, efforts are being

continued to locate the missing death records.

Both a death certificate and a proxy interview were available for 1,610 (80 percent) of the 2,022 decedents. A proxy

interview only was available for 87 decedents (4 percent)

and a death certificate only was available for the remaining

325 decedents (16 percent).

The percent by age, sex, and race for whom death certificates were not available are presented in table J. Death certificates were obtained for a high percent of decedents in most

age and race groups (from 85.7 percent to 100 percent among

cells with more than 10 deaths). The difference in age among

the percent of decedents for whom no death certificate was

obtained was slight. However, black decedents were 77 percent

more likely than white decedents and females were 66 percent

more likely than males to have no death certificate available.

Ongoing activities

In addition to the analyses and data cleanup currently

in progress for this study, public use data tapes are being

produced. Four data tapes containing vital status, interview,

health care facility, and mortality data from NHEFS will

be available from the National Technical Information Service

(NTIS) in 1988. These data tapes must be combined with

the tape from the NHANES I survey (also available from

NTIS) in order to investigate the effects of baseline measures

on subsequent health status. The study identification number

can be used to link the Epidemiologic Followup Study files

to all NHANES I files.

ALL RACES*

Bothsexes . . . . . . . . . . . . . . . . . .

Male

Lfnder35years . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . .

Female

Under 35years . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . .

WHITE

Bothsexes . . . . . . . . . . . . . . . . . .

Male

Under 35years . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . .

Female

Under 35years . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . .

BLACK

Bothsexes . . . . . . . . . . . . . . . . . .

Male

Under 35years . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . .

Female

Under 35years . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . .

2,022 4.3

16 6.3

44 2.3

124 1.6

183 2.2

835 3.6

26

54 5.6

61 8.2

10Q 6.0

579 5.7

1,599 3.8

13

37 2.7

68 1.1

149 2.0

675 3.3

15

33

38 5.3

85 4.7

466 5.6

403 6.7

3 33.3

7

35 2.9

32 3.1

145 6.9

11

21 14.3

23 13.0

15 13.3

111 5.4

‘See appendix WI for a diacuaaion of revised race, corrected sex, and recalculated aga.

‘Includes races other than white or black.

19
References

INational Center for Health Statistics: Plan and OpeHtiOtr of the

Health and Nutrition Examination Survey, United States, 1971–73.

Vital and Health Statistics. Series 1, No. 10a. DHEW Pub. No.

(HSM) 73-1310. Health Services and Mental Health Administration.

Washington. U.S. Government Printing Office, Feb. 1973.

zNation~ Center for Health Statistics: Plan and operation of the

Health and Nutrition Examination Survey, United States, 1971–73.

Vital and Health Statistics. Series 1, No. 10b. DHEW Pub. No.

(HSM) 73–13 10. Health Services and Mental Health Administration.

Washington. U.S. Government Printing Office, Feb. 1973.

sNational Center for Health Statistics: Plan and operation of the

HANES I Augmentation Survey of adults 25–74 years, United States,

197475. Vital and Health Statistics. Series 1, No. 14. DHEW

Pub. No. (PHS) 78–13 14. Public Health Service. Washington. U.S.

Government Printing Office, June 1978.

4J comoni.Huntley, H. E. Barbano, J. A. Brody, et al.: National

Health and Nutrition Examination I—Epidemiologic Followup Survey. Public Health Report 98(3):245–25 1, 1983.

5National Center for Health Statistics: Plan and operation of the

HANES I Augmetitation Survey of adults 25-74 years, United States,

1974-75. Vital and Health Statistics. Series 1, No. 14. DHEW

Pub. No. (PHS) 78-1314. Public Health Service. Washington. U.S.

Government Printing Office, June 1978.

GL s. Rad]offl The CE$D scale, a self-report depression scale

fo; research in the general population, Appl. Psychol. A4eas, 1:385-

401, 1977.

7R. L. Kahn A. 1. Goldfmb, M. PoIlack, et aI.: Brief objective

measures for the determination of mental status in the aged. Am.

J. Psychiat~ 117:326-328, 1960.

8G. A. Rose: Chest pain questionnaire. Milbank Mem, Fund Q.

43(2):32-39, 1965.

gNational Hem, Lung and Blood Institute, B. F. Ferris: Epidemiology

Standardization Project. Contract No. I-HR–5–3028 (Report No.

HR–53028–F). Division of Lung Diseases, JuIy 1978. pp. 7-54.

10ACA G1ossa~ Committee: Dictiona~ of Rheumatic Diseases. VOIS.

1 and 2. New York. Contact Associates Intl., Ltd., 1982.

I lJ F. Ffies, p. spitz,R. G. Krains, et al.: Measurement of patient

ou;come in arthritis. Arthritis Rheum. 23:137–145, 1980.

121 Resow and N. Breslau: A Guttman health scale for the aged.

J. Gerontol. 21(4):556-559, 1966.

13S Katz and C. A. Akpom: Index of ADL. Med. Care 14

(5 Supp.):1 16-118, May 1976.

lQNation~ Center for Health Statistics: A Corrmsrrent v:~lidational

study of the NCHS general well-being schedule. Vital and Health

Statistics. Series 2, No. 73. DHEW Pub. No. (HRA) 78-1347.

Health Resources Administration. Washington. U. S, Government

Printing Office, Sept. 1977.

15[ Karacan, J, 1. Them@, and R. L. Wi[]iams: Sleep disturbance,

a community survey, in C. Guilleninault and E. Lugaresi, eds.,

Sleep/Wake Disorders: National History, Epidemiology and Long

Term Evolution. New York. Raven Press, 1983.

I6P T Costa, Jr., and R. R. McCrae: Still stable after all these

.,

years, personality as a key to some issues in aging, in P. B. Bakes

and O. G. Brim, eds., Life Span Development and Behavior,

Vol. 3. New York. Academic Press, 1980. pp. 68-74.

17w M Kirkendall A. C. Burton, F. H. Epstein, et al.: Recommen-

. .

dations for human blood pressure determination by sphygmomanometer. Circulation 36:980-988, 1967.

IgHYPefiension Detection and Follow-up program Ccloperative

Group, variability of blood pressure and the results of screening

in the Hypertension Detection and Follow-Up Program. J Chronic

Dis. 31:651-667, 1978.

‘gPublic Health Service and Health Care Financing Administration:

International Class@cation of Diseases, 9th Revision, Clinical Modification. DHHS Pub. No. (PHS) 80-1260. Public Health Service.

Washington. U.S. Government Printing Office, Sept. 1980.

2oNationa[ Center for Health Statistics, R. Pokras and J. I-. Kozak:

Adjustment of hospital rates, United States, 1965–80. ‘Vital and

Health Statistics. Series 13, No. 81. DHHS Pub. No. (PHS) 85–1742.

Public Health Service. Washington. U.S. Government Printing Office, Dec. 1984.

20
Appendixes

Contents

1. Content of NHANES I for subjects 25–74 years of age, 1971–75 . . . . . . . . 22

II. Data items available from NHANES I subjects 25–74 years of age . . . . . . . . . 23

III. Serological, urological, and blood chemical tests conducted on selected NHANES I sample subjects, 197 1–75 . . . . 47

IV. NHANESI Epidemiologic Followup Study Schedule..,....,.. . . . . . . . . . . . . . . . . . . . . . . 49

V, Sample locations byregion of data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

VI. Study materials, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...51

VII. Corrections and revisions to the NHANES I baseline data . . . . . . . . . . . 142

21
Appendix 1

Content of NHANES I for

subjects 25-74 years of age,

1971-75

Recipients Questionnaires

Allhouseholds inthesample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Household Questionnaire

All households containing one or more sample persons . . . . . Food Programs Questionnaire’

Allsample persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General Medical History’

Dietary Intake, 24-Hour Recall’

Dietary Intake, Food Frequency’

Additional for all sample persons in the detailed component . . . . . General Medical History Supplement

Supplement A, Arthritis; Supplement B, Respiratory; Supplement C,

Cardiovascular. (Supplements A, B, and C depend on certain

positive responses in other history questionnaires.)

Health Care Needs Questionnaire

General Well-Being Questionnaire

Depression Scale*

Water Usage Supplementz

1975 NHIS Questionnaire items on hearing, visual acuity, reading,

and hypertension

Allsample persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Additional for all sample persons in the detailed component . . . . . . . . . . .

Examination procedures and measurements

General medical examination

Dental examination

Dermatological examination’

Ophthalmic examination

Anthropometric measurements

Laboratory determinations:

Hemoglobin Serum iron

Hematocrit iron binding capacity

Red cell count Serum folates

White cell count Cholesterol

Sedimentation rate Glucose qualitative (urine)

MCV Albumin qualitative

MCH (urine)

MCHC Occult blood qualitative

Vitamin A (urine)

Vitamin C Creatinine (urine)

Magnesium Thiamine (urine)

Total protein Riboflavin (urine)

Albumin lodine (urine)

Extended medical examination

X rays of chest and major joints (hand-wrist, knee, hip)

Audiometry (air and bone)

Electrocardiography

Goniometry

Spirometry

Pulmonary diffusion

Tuberculin tes~

Speech testz

Vision test2

Laboratory determinations

Bilirubin Phosphorus

SGOT W.B.C. differential count

Alkaline phosphatase Serological tests for

Uric acid amebiasis, measles,

Calcium tetanus, diphtheria,

Thyroid U-3, T-4) rubella, polio

Serology for syphilis2 Blood urea nitrogen2

‘Locations 1-65 only.

2Locations 66-100 only.

3Locations 1-35 only,

22
Appendix II

Data items available from

NHANES I subjects 25-74 years

of age

Detailed information is available on all of the data items

collected in the baseline NHANES I examination. The complete list of information is organized according to four areas:

(l) by source type, which refers to the method used to obtain

the particular data item—P = physical exam, H = history,

L= laboratory, T= test, R = record, and O = otheq (2) by survey year, referring to the years during the 1971–75 period

in which that information was collected; (3) by “contents

of this data field,” which refers to a brief description of

the specific data item; and (4) by data category, which refers

to the general category of information. Provided below is

a list of the data categories used, followed by the complete

listing of all four types of NHANES I data items. Both listings

are in alphabetical order according to data category.

Abdomen

Allergy

Back

Behavior

Body measurement

Bone

Breast

Cardiovascular

Chest

Demography

Dental

Dental care

Dermatology

Drugs

Datacategories

Ears

Endocrine

Extremities

Eyes

Gastroenterology

Gynecology

Head

Health (general)

Hearing

Hematology

Infection

Joints

Medical care

Metabolic

Mouth

Musculoskeletal

Nasal

Neck

Neoplasm

Neurology

Nutrition

Oropharynx

Pregnancy

Psychology

Respiratory

Speech

Urinary

Vision

23
Source Type Survey Year Contents of this Data Field Data Catego,y

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

74-75

71-75

74-75

74-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-73

71-75

71-75

71-75

74-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

74-75

71-73

74-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

Abdomen, other findings

Abdominal evaluation

Hernia,umbilical

Mass,abdominal

Allergy,food

Allergy,other

Asthma

Asthma

Hayfever

Hayfever

Hives

Back findings

Back,injury

Back,limitation of motion

Back,other findings

Back,pain on motion

Kyphosis

Kyphosis

Kyphosis

Kyphosis

Lordosis

Sacroiliac tenderness

Sciatic notch tenderness

Scoliosis

Scoliosis

Scoliosis

Scoliosis

Straight leg raising test

Activity,physical

Exercise

Smoking history

Tobacco usage,other forms tobacco

Tobacco usage, snuff,chewing, other

Albumin, serum

Alkaline phosphatase,serum

Bilirubin,total, serum

Blood specimen,time day collected

BUN (blood urea nitrogen)

Calcium, serum

Cholesterol,serum

Creatinine,serum

Food,hours since last meal

Food,type of last meal

Magnesium,serum

Phosphate, serum

Physical activity,last 24 hours

Potassium, serum

Protein,serum

Sodium, serum

SGOT

Uric acid, serum

Arm girth,upper

Bitrochanteric breadth

Chest circumference, inspir,expiration

Elbow breadth

Height

Height

Skinfold,subscapular

Skinfo!d,triceps

Weight

Weight

Bone density, phalanx,x ray

Bone density, radius,x ray

Cortical thickness, phalanx

Fracture, hip

Fracture, spine

Fracture,wrist

ABDOMEN

ABDOMEN

ABDOMEN

ABDOMEN

ALLERGY

ALLERGY

ALLERGY

ALLERGY

ALLERGY

ALLERGY

ALLERGY

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BACK

BEHAVIOR

BEHAVIOR

BEHAVIOR

BEHAVIOR

BEHAVIOR

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BIOCHEMISTRY

BODY MEASUREMENT

BODY MEASUREMENT

BODY MEASUREMENT

BODY MEASUREMENT

BODY MEASUREMENT

BODY MEASUREMENT

BODY MEASUREMENT

BODY MEASUREMENT

BODY MEASUREMENT

BODY MEASUREMENT

BONE

BONE

BONE

BONE

BONE

BONE

24
Source Type Survey Year Contents of this Data Field Data Category

71-73

74-75

74-75

71-75

71-75

71-73

71-73

71-73

71-73

71-75

74-75

71-75

71-75

74-75

71-75

71-75

71-75

71-73

74-75

71-75

71-75

74-75

71-75

74-75

71-75

74-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

Fractures

Fractures, other

Fractures, rib

Fractures, rib

Fractures, rib

Gynecomastia

Gynecomastia,etiology

Supernumerary areolae,glandular tissue

Supernumerary areolae,no glandular tissue

Alveolar fluid,lung

Alveolar fluid,lung

Alveolar fiuid,lung

Arterial pulses, peripheral

Azygous vein enlargement

Azygous vein enlargement

Azygous vein enlargement

Blood pressure (systolic& diastolic)

Blood pressure,hih

Blood pressure,in?ormation on problem

Blood pressure,low

Blood pressure, recumbent

Blood pressure, results of last reading

Blood pressure,sitting

Blood pressure, subjective symptoms

Blood pressure,time

Blood pressure,time since last reading

Blood pressure,times taken last year

Cardiovascular conditions, status

Cardiovascular evaluation

Cardiovascular findings,other

Cardiovascular, disability

Cardiovascular, hospitalization

Cardiovascular,job status,work loss

Cardiovascular, medical care

Cardiovascular, other findings

Chest pain

Chest pain, angina

Chest pain,severe

Cyanosis

Ecg diagnosis, interpetation code

Ecg,axis,P-wave

Ecg,axis,QRS

Ecg,axis,T-wave

Ecg,calibration

Ecg,complex measured

Ecg,lead quality codes

Ecg,mean rate

Ecg,noise level

Ecg,P-wave amplitude

Ecg,P-wave duration

Ecg,P-R wave duration

Ecg,Q-wave amplitude

Ecg,Q-wave duration

Ecg,Q-S amplitude

Ecg,Q-S duration

Ecg,QT interval

Ecg,R-wave amplitude

Ecg,R-wave duration

Ecg,R-P amplitude

Ecg,R-P duration

Ecg,S-wave amplitude

Ecg,S-wave duration

Eca.STl

EC5;ST2

Ecg,ST3

Ecg,ST4 (ST2-STl)/(ST3-ST2)

Ecg,T-wave amplitude

BONE

BONE

BONE

BONE

BONE

BREAST

BREAST

BREAST

BREAST

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARD1OVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

‘CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARD1OVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARD1OVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

25
Source Type Survey Year Contents of thisData field Data Category TT~HTTTTTTHHEPP;TGHHHHH;TTTTTTHHTTTTTTPPhTTTHHPPPEHP;HHHHH

71-75

71-75

71-75

71-75

74-75

71-75

71-75

74-75

71-75

74-75

71-75

71-75

71-75

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

71-75

74-75

71-75

71-75

74-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-73

71-75

71-73

71-75

74-75

71-75

71-73

71-75

71-75

71-73

71-73

71-75

71-75

Ecg,T-wave duration

Ecg,T-P amplitude

Ecg,T-P duration

Edema

Electrocardiogram,last

Heart attack

Heart enlargement,left

Heart enlargement,left

Heart enlargement,left

Heart enlargement, right

Heart enlargement, right

Heart enlargement, right

Heart failure

Heart failure

Heart murmur

Heart murmur

Heart murmur,location,grade,syst.,dia.

Heart murmur, origin, systolic,diastolic

Heart murmur,type,systolic,diastolic

Heart rate,ecg

Heart size measurements

Heart sounds,first,second

Hypertension,at present time

Hypertension, bed days

Hypertension, cured, under control

Hypertension, doctors diagnosis

Hypertension, medicine

Hypertension,salt use

Hypertension, symptom severity

Hypertension,weight reduction

Interstitial fluid,lung

Interstitial fluid,lung

Interstitial fluid,lungs

Kerley Iines,lung

Kerley Iines,lung

Kerley Iines,lung

Leg pain while walking

Leg pain while walking

Pulmonary artery enlargement

Pulmonary artery enlargement

Pulmonary artery enlargement

Pulmonary vessels, cephalization

Pulmonary vessels, cephalization

Pulmonary vessels, cephalization

Pulse rate

Pulse, irregular

PMl,head

Rheumatic fever

Rosettes,lung

Rosettes,lung

Rosettes,lung

Shortness of breath

Stroke

Thrills, heart

Varicosities,extremities

Vein distension,neck

Chest evaluation

Chest pain

Chestx ray,last

Chest, other findings

Chest, other findings

Age,at examination

Age,at interview

Age,head of household

Alimony, child support,etc.

Ancestry or national origin

Birth,date and place of

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR,

CARDIOVASCULA13

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAFI

CARDIOVASCULARI

CARDIOVASCUL4RI

CARDIOVASCULAFI

CARDIOVASCLUJW

CARDIOVASCULAR

CARDIOVASCUIJIRl

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCUIAFI

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCULAFI

CARDIOVASCUIAF1

CARDIOVASCULAR{

CARDIOVASCULAFI

CARDIOVASCULAFl

CARDIOVASCULAR]

CARDIOVASCUIAFI

CARDIOVASCUIAF]

CARDIOVASCUIJW

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCULAR

CARDIOVASCUIAFl

CARDIOVASCUiAFl

CARDIOVASCULAR

CARDIOVASCLLW

CARDIOVASCULAFI

CARDIOVASCULAR?

CARDIOVASCULAR

CARDIOVASCUIJW

CARDIOVASCULAR?

CARDIOVASCULAR?

:A..:}OVASCULAF?

CHEST

CHEST

CHEST

CHEST

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

26
Source Type Survey Year Contents of this Data Field Data Category

71-75

71-75

71-75

71-73

71-75

71-73

71-75

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-75

71-75

71-75

71-73

71-73

71-75

71-75

71-75

71-73

71-75

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-72

71-73

71-72

71-73

74-75

71-75

71-75

71-73

71-75

71-73

71-75

71-75

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-75

Business or indust~ code

Catalo number

Dateo7 examination

Dividends, interest or rent

Education

Education,head of household

Family unit code

Farm, residence

Government employee pensions, other

Head of household, relationship

House, kitchen facilities, use of

House, number of rooms

House, piped water

House, piped water, hot and cold

House, range or cook stove

House, refrigerator

House,sink with piped water

Income,family

Income, other

Income,total amount

Land usage

Language, other than English

Marital status

Net income from farm

Net income from non-farm business

Occupation code

Persons in household,total number

Persons in household,total sample

Poverty index

Primary sampling units

Race, examined person

Race,head of household

Region

Residence,SMSA, central city

Rural, number of acres

Sale of crops

Sample sequence number

Sample weights, all,locations 1-35

Sample weights, all,locations 1-65

Sample weights, detail,locations 1-35

Sample weights, detail,locations 1-65

Sample weights, detail,locations 66-100

Sample weights, detail,locations 1-100

Sex,examined person

Sex,head of household

Size of place

Social security or railroad retirement

Strata

Type of living quarters

Unemployment or workmen’s compensation

Veteran’s payments

Wages

Welfare or public assistance payments

Workin status, recent

Bridge,

?!xed,teeth replaced

Calculus index

Chewing or biting trouble

Debris index

Dental plate

Denture status

Denture utilization, eating

Denture, partial,removable,teeth replace

Flouride content, enamel biopsy

Gum status

Gums, bleeding

Inflammation, margional diffuse

Oral hygiene

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DEMOGRAPHY

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL 

27
Source Type Survey Year Contents of this Data Field Data Categoty

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-75

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

74-75

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

Oral hygiene index

Orthodontic appliances

Papillae, swollen red

Periodontal disease

Recession

Teeth cleaned

Teeth posterior,four or more pairs oppos

Teeth, extraction,need for

Teeth,need for filling

Teeth, permanent

Teeth, permanent, decayed

Teeth, permanent, erupted

Teeth, permanent,filled

Teeth, permanent, missing, reason

Teeth, permanent, nonfunctional, carious

Teeth, permanent, normai

Teeth, permanent,DMF

Teeth, primary

Teeth, primary, carious,nonfunctional

Teeth, primary, decayed

Teeth, primary, decayed, nonfunct.,filled

Teeth, primary,filled

Teeth, primary, normal

Teeth, primary, unerupted

Tooth status

Treatment need

Treatment need, bridges,dentures

Treatment need, gingivitis

Treatment need, malocclusion

Treatment need, periodontal disease

Treatment need, removal debris, calculus

Treatment need,teeth permanent,fillings

Treatment need,teeth primary, extractions

Treatment need,teeth primary,fillings

Treatment need,teeth permanent, extract

Treatment need, teeth primary, extractions

Treatment need,teeth primary,fillings

Dental appointment

Dental checkup,need for,self perceived

Dental problem,no dental visit,reason

Dental visit,last,frequency

Dental visit,reminder

Dentist consultation,time last

Dentist visit,last,appointment

Dentist visit,last,reason for

Dentist visit,last,satisfaction

Dentist visit,last,transportation

Dentist visit,last,waiting time

Dentist, personal

Dentist, personal

Acanthosis nigracans

Acne

Acne cysts

Acne rosacea

Acne vulgaris

Acne vulgaris,activity

Acne vulgaris,severity

Acne, cystic scarring

Acne,location

Acne, pit scarring

Acne, secondary

Actinic damage

Actinic domedones

Actinic keratosis

Addisons disease

Albinism

Alopecia,anti-metabolizes

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DENTAL CARE

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

28
Source Type Survey Year Contents of this Data Field Data Category

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71 “73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71”73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

Alopecia,areata

Alopecia,diffuse

Alopecia,familial

Alopecia,infection

Alopecia,localized

Alopecia,male pattern

Alopecia, postclimacteric

Alopecia,trauma

Anhydrotic

Araneus,location

Araneus,number

Atopic dermatitis, distribution

Atopic dermatitis, eczema

Atopic dermatitis, severity

Atopy,family history

Basal cell epith,superficial,location

Basal cell epithelioma,location

Biopsy, skin, diagnosis

Blue nevus,location

Blue nevus,number

Blue nevus,size of largest

Bowens disease,location

Cafe au Iait,location

Cafe au Iait,number

Cafe au Iait,size of largest

Cancer,skin,metastatic, location

Cancer, skin,other,location

Cavernous,location

Cavernous, number

Cavernous,size of largest

Clavus

Clubbing, acquired

Ciubbing,acquired,disfigufing

Clubbing,familial

Ciubbing,familial, disfiguring

Coldness

Complexion, erythematous,sallow

Complexion,florid, pallid

Contact dermatitis,chemical

Contact dermatitis,cosmetics

Contact dermatitis,fabrics

Contact dermatitis,leather

Contact dermatitis, medication

Contact dermatitis, metal

Contact dermatitis, obscure cause

Contact dermatitis, plant

Contact dermatitis, rubber

Cutis marmorata

Cyanosis

Dermatofibromata

Dermatological treatment

Dermatophytoses

Diagnosis, dermatological, current

Diagnosis,dermatological,in remission

Dishydrotic,feet

Dishydrotic,hands

Ears, deformed

Ears, deformed, chondodermatitis

Ecchymoses

Eccrine activity,feet

Eccrine activity,forehead

Eccrine activity, hands

Eczema

Edema

Edema, chronic

Ephilides

Epidermal nevi

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

29
Source Type Survey Year Contents of this Data Field Data Category PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPbPPPP

i!EHPLPPPPPPPPPPEPPP

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

Epithelial tags

Eye color

Eyebrows, sparse,absent

Eyelashes,sparse,absent

Fibromata,other

Fine telangiectasia

Fingernails, absent,non traumatic

Fingernails, alopecia areata

Fingernails, bands, pigmented,long

Fingernails, bands,white,cross

Fingernails, brittle

Fingernails,clubbed

Fingernails,fungus

Fingernails, green, browm or black

Fingernails,lichen planus

Fingernails, nevus

Fingernails, other abnormalities

Fingernails, pitted surface

Fingernails, psoriasis

Fingernails, raised contour

Fingernails, ridged surface

Fingernails,soft

Fingernails,spooned contour

Fingernails,thickened

Fingernails,trauma

Fingernails,white

Fingernails,yellow

Flag sign(hair)

Flameus,location

Flameus,number

Flameus,size of largest

Follicular hyperkeratosis, arms

Follicular hyperkeratosis,location

Folliculitis

Folliculitis,location

Fox Fordyce disease,location

Fungal infections,location, Koh,Woods

Fungus culture reports

Furuncles,location

Ganglioma

Genitalia,candida,parisites

Genitalia,chancre,other VD

Genitalia,psoriasis, seborrheic dermat

Genitalia,ulcers

Hair color,age at first graying

Hair color,natural

Hair color,previous(if grey or white)

Hair Ioss,unsual

Hair,axillary,sparse, absent

Hair,body,quantity,location

Hair,dyed,tinted or bleached

Hair,facial,alopecia areata

Hair,facial,endocrine

Hair,facial,female, excessive

Hair,facial,genetically determined

Hair,facial,males,sparse,absent

Hair,facial,other causes

Hair,facial,post infection

Hair,facial,post trauma

Hair,pubic,inappropriate escutcheon

Hair,pubic, sparse,absent

Hair,texture

Herpes simplex

Hives

Hyperpigmentation, hands and face

Ichthyosis,keratosis

Icterus

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DEflMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

30
Source Type Survey Year Contents of this Data Field Data Category

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

Impetigo,location

Inclusion cysts,location

Inclusion cysts, number

Inclusion cysts,size of largest

Inter-gluteal fissure

Keloids

Lichen striatus

Lipoma

Lymphoma,leukemia,location

Mammary gland development

Mites

Moles or birthmarks

Mongolian spot,location

Mongolian spot, number

Mongolian spot,size of largest

Mosaic skin

Mycosis Fungoides,location

Neoplasm, sweat glands and ducts, benign

Neoplastic change,skin

Neurofibromata

Nevi,junctional,location

Nevi,junctional, number

Nev~,junctional, size of largest

Nev!,Hutchinsons,location

Nevi,Hutchinsons, size of largest

Nevus of iris

Nevus of Ota,location

Nevus of Ota,number

Nevus of Ota,size of largest

Nose,deformed

Occupational exposure

Occupational exposure,chemicals,fumes

Occupational exposure,immersion

Occupational exposure, insecticides

Occupational exposure,oils

Occupational exposure,other

Papulosa negra

Pediculosis capitis

Pediculosis corporis

Pediculosis pubis

Pellagroid pigmentation

Perifolliculosis

Petechial

Pigment aberrations

Pigment aberrations,body

Pigment aberrations, extremities

Pigment aberrations,face

Pigment aberrations,mel. gen. disfig.

Pigment aberrations,mel. Ioca!,hypo

Pigment aberrations,mel. Iocal,disfig.

Pigment aberrations,mel. Iocal,hyper

Pigment aberrations, melanin gen. hyper

Pigment aberration:, melanin gen. hypo

Pigmentation,chromc illness (hyper)

Pigmentation,other diagnosis

Pigmentation,post inftamatory

Pilonidal cysts

Poikiloderma vasculare atrophioans

Precancerous,skin

Psoriasis

Psoriasis

Psoriasis, activity

Psoriasis,family history

Psoriasis,joint involved

Psoriasis,joint problem precede

Psoriasis, iocation

Psoriasis, severity

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

31
Source Type Survey Year Contents of this Data Field Data Category PFPPEH!PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPjPEP

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71 “73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71”73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

Purpura,other than senile

Purpura,senile

Raynauds phenomenon, duration

Raynauds phenomenon,location

Raynauds phenomenon, source

Rectal fistula,fissure

Residence, state,cou ntry,years

Residence, state,foreign country

Scalp, other abnormalities

Scalp, psoriasis

Scalp, scaling, erythema

Scalp, seborrheic dermatitis

Scalp,trauma

Scars, atrophic

Scars, hypertrophic

Sebaceous adenoma

Sebaceous gland diseases

Seborrheic dermatitis

Seborrheic dermatitis,location

Seborrheic keratosis

Seborrheic keratosis,location

Sebum production

Senile depigmentation

Senile elastosis

Senile hemangioma,location

Senile hemangioma,number

Senile lenticrens

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

Skin

condition evaluation, codes

condition, activity limitation

condition, activity past year

condition,care quality

condition, disfigurement

condition, handicap, occupational

condition, handicap, severity

condition, improvement obstacles

condition, itching

condition,limitation of motion

condition, overall discomfort

condition,pain or burning

condition, possible improvement

condition, recurrent

condition, social handicap

condition, source of care

condition, years duration

evaluation

texture, atrophic,thickened

texture, coarse,fine

texture, dry

texture,findinas

Skin texture; moistSkin texture,oily,scaling

Skin texture,other

Skin texture,wrinkled

Skin,dry and scaling

Skin,other findings

Squamous cell carcinoma,location

Striae,congenital malformation

Striae,draining fistula

Striae,pigented

Striae,purple

Striae,white

Sunlight exposure

Swimmers Itch

Tatoo,attifact

Tatoo,traumatic

Telangiectasia,family history

Telangiectasia, idiopathic familial

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

32
Source Type SurveyYear Contents of thk Data Field Data Category

71-73

71-73

71-73

71-73

71-73

71-73

71-73

?-t-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-75

71-75

71-73

71-75

71-75

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

Telangiectasia, other diagnosis

Telangiectasia, otherj location

Telangiectasia, post Irradiation

Telangiectasia, sclerodactly

Telangiectasia,Weber Osler Rondou

Tinea cruris

Tinea pedis

Thea unguim

Tinea versicolor

Toenails, discolored

Toenails,fungus

Toenails, nevus

Toenails, other abnormalities

Toenails, pigmented bands

Toenails, psoriasis

Toenails,thickened

Toenails,trauma

Tophi

Tumours

Urticaria,angioneurotic edema

Urticaria,asthma,family history

Urticaria,asthma, personal history

Urticaria,cholinergic

Urticaria,cold

Urticaria,food

Urticaria,giant

Wticaria,inhalent

Urticaria,medication

Urticaria,ordinary

Urticaria,other cause

Vascular changes, other than nevi

Vasculosus,location

Vasculosus,number

Vasculosus,size of largest

Venous stars

Verruca vulgaris

Viral infections, herpes,varicella

Vkiligo

Vitfit$so

Warts,feet

Warts, genital

Warts,hand

Warts, other

Xanthomata

Xerosis

Aspirin,recent ingestion

Diuretics, recent ingestion

Medication

Medication,high blood pressure,bowels

Medication,lack of pep,convulsions

Medication,other, recent ingestion

Medication,skin,fluid,wt. Ioss,infect.

Medication,thyroid trouble

Auditory canal,findings

Auditory canal,occlusion

Ear discharge

Ear discharge, medical care

Ear drum findings

Ear drum,calcium plaques

Ear drum,dull

Ear drum,fluid

Ear drum, other findings

Ear drum, perforation

Ear drum, red,other discoloration

Ear drum, retracted, bulging

Ear drum,scars

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

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DERMATOLOGY

DERMATOLOGY

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DERMATOLOGY

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DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DERMATOLOGY

DRUGS

DRUGS

DRUGS

DRUGS

DRUGS

DRUGS

DRUGS

DRUGS

EARS

EARS

EARS

EARS

EARS

EARS

EARS

EARS

EARS

EARS

EARS

EARS

EARS

33
Source TVDe Survev Year Contents of this Data Field Data Category HFP

Fi HHHPPPPPPLLbPPPPPPPPPPPPFEHPPPPEHPEHHEHPPPPPPPPPPPPPPP

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-73

71-73

71-73

74-75

74-75

74-75

71-72

71-73

71-73

71-73

71-72

71-73

71-73

71-73

74-75

71-73

71-73

71-73

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

Ear operation

Ear,external,findings

Ear,external,operative scar

Ear,external,other findings

Pierced ears

Tinnitus

Diabetes

Diabetes, insulin,oral medication

Thyroid disease

Thyroid nodule

Thyroid tenderness

Thyroid trouble, goiter,treatment

Thyroid, enlargement (goiter)

Thyroid, isthmus

Thyroid, other findings

Thyroid, other findings

T3

T4

T4,Murphy Pattee test

Bowed leas

Deformitv~extremities ,acauired,severitv

Deformifi;extremities;acquired;disfig-

Deformity, extremities ,familial,severity

Deformity, extremities,familial, disfig

Knock knees

Amblyopia

Amblyopia,condition decreases vision

Amblyopia,eye affected

Amblyopia,treatment

Angioid streaks, retina

Anterior chamber, cells

Anterior chamber,flare

Anterior chamber,no abnormality

Anterior chamber, other findings

Arcus senilis

Arcus senilis,age of onset

Arcus senilis,family history

Arterioles, narrow, retina

Arterioles,tortuous, retina

AV compression, retina

Bitot’s spot,conjunctiva

Blepharitis,angular

Blepharitis,angular, age of onset

Blepharitis,angular,family history

Blepharitis,lids

Blepharitis,not angular

Blepharitis,not angular,age onset

Blepharitis,not angular,family history

Cataracts

Chalazion

Chalazion,age onset

Chalazion,family history

Chalazion,lids

Concretions,lids

Conjunctiva,no abnormality

Conjunctiva,other findings

Conjunctivitis

Cornea, arcus senilis

Cornea,band keratopathy

Cornea,degeneration

Cornea, dystrophy

Cornea, edema epithelial

Cornea, edema stromal

Cornea, endothelial KP’s

Cornea, guttata

Cornea, keratitis

Cornea, keratomalacia

EARS

EARS

EARS

EARS

EARS

EARS

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

ENDOCRINE

EXTREMITIES

EXTREMITIES

EXTREMITIES

EXTREMITIES

EXTREMITIES

EXTREMITIES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

34
Source Type Survey Year Contents of this Data Field Data Category

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-75

74-75

74-75

74-75

71-72

74-75

71-72

71-72

71-73

71-73

71-73

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

74-75

74-75

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

74-75

71-72

71-72

71-73

71-73

71-73

71-72

71-72

71-72

71-72

Cornea,no abnormality

Cornea, opaci

Cornea, other ‘?’indings

Cornea, pterygium

Cornea, supeticial stromal

Cornea,vessels

Cornea, Krukenberg spindle

Diagnosis,eye,treatment needs

Dilation,eyes

Ectasia,sclera

Ectropion,lids

Entropion,lids

Enucleation

Episcleritis,sclera

Exophthalmos,globe

Eyelids,no abnormality

Eyelids, other findings

Eyes, conjunctival injection

Eyes,fundus not visualized

Eyes, globe absent

Eyes, ocular fundi

Follicles, conjunctiva

Glaucoma

Globe,no abnormality

Globe, other findings

Hordeolum

Hordeolum,age onset

Hordeolum,family history

Hordeolum,lids

lnclusions,conjunctiva

lris,atrophy

Iris,coloboma

Ms,neovascularization

lris,no abnormality

Iris,other findings

Iris,synechiae

Iritis

Iritis

Lens opacities

Lens opacity

Lens,aphakia

Lens,cataract

Lens,no abnormality

Lens, other findings

Lens, pigment on surface

Macula,degeneration

Macula,diabetic involvement

Macula,edema

Macula,hypertensive involvement

Macula,other findings

Macula,pigment epith detachment

Micropthalmos,globe

Nystagmus,motility

Ocular history,other

Ocular history,other,injury, infection

Ocular history,significant

Ophthalmic abnormalities

Papilledema

Phoria

Pingueculum,conjunctiva

Pterygium

Pterygium,age onset

Pterygium,family history

Ptosis,lids

Pupils, absent light reflex

Pupils, anisocoria

Pupils,no abnormality

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

35
Source Type Survey Year Contents of this Data Field Data Category

71-72

71-72

71-72

71-72

74-75

74-75

71-72

71-72

71-72

71-72

74-75

71-72

74-75

74-75

71-72

71-72

71-72

71-72

74-75

71-72

74-75

71-72

71-72

74-75

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-72

71-73

71-73

71-73

71-72

71-72

71-72

71-72

71-72

71-73

71-73

71-73

71-72

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

Pupils,other findings

Refraction (acuity less than 20/40)

Refraction, present glasses

Retina,chorioretinitis

Retina, detached

Retina,disc abnormal

Retina,disc,other findings

Retina,drusen

Retina, drusen

Retina, epithelial changes

Retina, exudate

Retina, glaucomatous cup

Retina, hemorrhage

Retina, increased light reflex

Retina, neovascularization

Retina,no abnormality

Retina, not visualized

Retina, optic atrophy

Retina, other conditions

Retina, other findings

Retina, other findings

Retina, papilledema

Retina, papillitis

Retina,venous engorgement

Retinal arteries, general narrowing

Retinal arteries,occlusion

Retinal arteries, sclerosis

Retinal capillaries, microaneurysms

Retinal capiliaries,neovascularization

Retinal detachment

Retinal exudates

Retinal hemorrhages

Retinal pigment changes

Retinal veins, dilation

Retinal veins, occlusion

Retinal veins, sausaging

Retinal veins, sheathing

Retinal veins,tortuosity

Retinal vessels,other findings

Retrolental fibroplasia

Sclera,no abnormality

Sclera,other findings

Scleritis

Surgery, strabismus,cataract

Tonometry

Tropia

Tumour,eyes

Tumour,eyes,age onset

Tumour,eyes,family history

Vitreous, detachment

Vitreous, hemorrhage

Vitreous,no abnormality

Vitreous, opaci

Vitreous, other ?’indings

Xanthelasma

Xanthelasma,age of onset

Xanthelasma,family history

Xerosis,conjunctiva

Abdominal pain

Blood Ioss,stomach or bowels

Bowel movement, black

Bowel movement, blood streaked

Bowel movement,frequency

Bowel movement,grey

Bowel movement, white

Bowel movements, color

Bowel trouble, diarrhea, constipation

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

EYES

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROL-OGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

:36
Source Type Survey Year Contents of this Data Field Data Category HHHHzHHHHHHHHHHHHPPPPEH:TTTTTTTTTTTTTTTTTT:HHHHHHHHHHLhL:LL

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-72

71-73

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-75

74-75

74-75

74-75

71-75

71-75

71-75

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

Colitis

Enteritis

Gallstones

Hepatitis

Hepatomegaly

Hiatus hernia

Jaundice

Operation,gallstone

Operation, hiatus hernia

Operation, ulcer

Parasites or worms in stool

Swallowing, difficulty

Tumour,gastrointestional operation

Ulcer, peptic, stomach, duodenal

Vomiting

Birth control medication

Menstrual periods

Operation,tumour, uterus or ovaries

Head,eyes,ears, nose,throat,findings

Heent,other findings

Sinus, maxillary,transillumination

Diagnostic findings(lCD codes)

Diagnostic impressions (ICD codes)

Evaluation, general

Health problems,want to talk to doctor

Health status

Systems, body, other

Audiometry, air conduct,l 000hz,rt. ear

Audiometry, air conduct,l 000hz,left ear

Audiometry, air conduct,l OOOhz,left ear

Audiometry, air conduct,2000hz,left ear

Audiometry, air conduct,4000hz,rt. ear

Audiometry,air conduct,4000hz,left ear

Audiometry, air conduct,500hz,left ear

Audiometry,air conduct~500hz,rt. ear

Audiometry,air conduct[on,l 000hz,rt ear

Audiometry,air conduction,2000hz,rt ear

Audiometry,bone conduct,l 000hz,left ear

Audiometry,bone conduct,l OOOhz,left ear

Audiometry,bone conduct,l 000hz,rt. ear

Audiometry,bone conduct,l 000hz,rt. ear

Audiometry,bone conduct,2000hz,left ear

Audiometry,bone conduct,2000hz,rt. ear

Audiometry,bone conduct,4000hz,left ear

Audiometry,bone conduot,4000hz,rt. ear

Audiometty,bone conduot,500hz,left ear

Audiometry,bone conduot,500hz,rt. ear

Audiometry, conditions affecting test

Hearing aid usage, history

Hearing aid,current usage

Hearing aid,satisfaotion

Hearing scale

Hearing status

Hearing test

Hearing trouble

Hearing trouble, cause

Hearing, improvement with hearing aid

Hearing, poor, rehabilitation

Anemia

Anisocytosis

Basophils,wbc differential

Clotting defect

Eosinophils,wbc differential

Hematocrit

Hematological findings, miscellaneous

Hematology morphological interpretations

Hematology, quality of slide

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GASTROENTEROLOGY

GYNECOLOGY

GYNECOLOGY

GYNECOLOGY

HEAD

HEAD

HEAD

HEALTH GENERAL

HEALTH GENERAL

HEALTH GENERAL

HEALTH GENERAL

HEALTH GENERAL

HEALTH GENERAL

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEARING

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

37
Source Tvpe Survey Year Contents of this Data Field Data Category

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

74-75

71-75

71-72

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

74-75

71-75

71-75

71-75

71-72

Hematology, slide reading results

Hematology,technician (reader) number

Hemoglobin

Hemoglobin phenotype

Hemoglobin, percent A2

Hemoglobin, percentF

Hypochromia

Iron binding capacity,total

Iron,serum

Leukoblasts,wbc differential

Lymphocytes,wbc differential

Macrocytosis

Metamyelocytes,wbc differential

Microcytosis

Monocytes,wbc differential

Myelocytes,wbc differential

Neutrophils,band,wbc differential

Neutrophils,segmented,wbc differential

Nucleated redcells

Platelet estimate

Poikilocytosis

Promyelocytes,wbc differential

Red blood cell count

Sedimentation rate

Splenomegaly

Transferringsaturation

White blood cell count

Amebiasis serology

Cold,flu,virus,last month

Diphtheria serology

Measles serology

Polio,serology

Rubella,serology

Syphilis serology

Tetanus serology

Tuberculin test (PPD-S and PPD-B)

Tuberculosis“

Tuberculosis,test for

Ankle,tender,swelling, deform,lim,pom

Arthritis

Arthritis diagnosis, broad categories

Back or neck pain

Back sprain

Chondrocalcinosis, hip,x ray

Chondrocalcinosis, hip,x ray

Chondrocalcinosis, hip,x ray

Chondrocalcinosis, knee,x ray

Chondrocalcinosis, knee,x ray

Chondrocalcinosis, knee,x ray

Disability,joints

Elbow,tender,swelling, deforrn,lim,pom

Feet,tender,swelling, deform, hm,pom

Fingers,tender, swell,deform,lim, pom,hebr

Genu recurvatum

Genu valgum

Genu varum

Gout

Groin tenderness

Head deformity, hip joint,x ray

Head deformity, hip joint,x ray

Head deformity: hip joint,x ray

Hip or knee pam

Hip pain, buttock, groin,thigh

Hip,abnormal data,film reader number

Hip,dislocated

Hip,fracture

Hip,knee range of motion, goniometry

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

HEMATOLOGY

INFECTION

INFECTION

INFECTION

INFECTION

INFECTION

INFECTION

INFECTION

INFECTION

INFECTION

INFECTION

INFECTION

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

38
Source Type Survey Year Contents of this Data Field Data Category

71-75

71-75

71-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

Hips,findings

Hips, general abnormal,x ray

Hips, other findings

Hips,pain on motion

Hospitalization,back or neck pain

Joint injury,symptoms

Joint pain

Joint stiffness

Joint swelling and pain

Joints,findings

Kneepain

Knee instability

Knee,fracture

Knee,loose calcified bodies

Knee,loose calcified bodies, knee,x ray

Knee,loose calcified bodies, knee,x ray

Knee, other injury

Knee, sprain

Knees,film reader number1

Knees,findings

Knees,fixed flexion

Knees,fluid

Knees, general abnormal

Knees, other bony irregularities

Knees,other findings

Knees,pain on motion

Knees,quality of film

Knees,soft tissue proliferation

Knees,subpatellar crepitus

Knees,swelling

Knees,tenderness

Leg length differences,x ray

Medical care,joints

Medical treatment,joints,type of doctor

Morning stiffness, assorted joints

Osteoarthrosis components, knee,x ray

Osteoarthrosis components, knee,x ray

Osteoarthrosis components, knee,x ray

Osteoarthrosis, hip,components,x ray

Osteoarthrosis, hip,components,x ray

Osteoarthrosis, hip,components,x ray

Osteoarthrosis, hips,x ray

Osteoarthrosis, knees,x ray

Osteoarthrosis, sacro-illiac,x ray

Pain, ankle

Pain,back or neck

Pain,elbow

Pain,fingers

Pain,foot

Pain, hip

Pain,knee

Pain, knee,last,longest

Pain,other joints

Pain,shoulder

Pain,wrist

Pelvis,quality of film

Ruptured disc

Sacro-illiac,general,abnormalx ray

Sacroiliitis,components, hip,x ray

Shoulder, tender,swelling, deform,lim,pom

Surge~ hip,knee,back

Swelling and tenderness,assorted joints

Treatment modalities,joints

Trochanter tenderness

Whiplash injuty

Wrist,tender,swelling, deform,lim,pom

Checkup exam,last

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

JOINTS

MEDICAL CARE

39
Source Type Survey Year Contents of this Data Field Data Category

74-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-73

71“73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

Checku ,medical,source medical care

Dentist

Pees,insurance

Doctor consulation,last

Doctor fees,insurance

Doctor visit,last,appointment

Doctor visit,last,delay

Doctor visit,last,satisfaction

Doctor visit,last,transportation

Doctor visit,last,waiting time

Doctor visit,reason for last visit

Doctor-patient communication

Drug expenses, insurance

Health problem, reason for no dr. visit

Hospitalization,last stay

Hospitalization,last, delay

Hospitalization,last, reason for

Hospitalzation,condition,!ength stay

Hospitalziation,last expenses, insurance

lmmunizations,last

Insurance,medical coverage,amount

lnsurance,medical,type of coverage

Operation,abdominal

Operations, abdominal, other

Physician visit,appointment required

Physician,personal

Respiratory conditions, medical care

Self medication

Surgical scars,abdomen

Temperature

Buccal mucosa,fissuring

Buccal mucosa,pigmented lesion

Cheilosis

Gingiva,fissuring

Gingiva,pigmented lesion

Leukoplakia,buccal mucosa

Leukoplakia,gingiva

Leukoplakia,lips

Leukoplakia,tongue

Lichen planus,buccal mucosa

Lichen planus,gingiva

Lichen planus,lips

Lichen planus,tongue

Lips,angular lesions or scars

Lips,fissuring

Lips,pigmented lesion

Palate,arched, cleft

Palate,smokers, glandular hypertrophy

Tongue, atrophy

Tongue, beefy red,magenta

Tongue,fissures

Tongue,forked

Tongue, geograph,hairy, pyramid,scrotal

Tongue, papillae,atrophic

Tongue, pigmented lesion

Tongue, serrations,swelling

Tumour,buccal mucosa

Tumour,gingiva

Tumour,lips

Tumour,tongue

Muscle wasting (gluteal)

Muscle wasting,thigh

Musculoskeletal evaluation

Musculoskeletal, other findings

Deviated nasal septum

Nares,chronic inflammation

Nares,findings

Nares,obstruction

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL CARE

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

MEDICAL

METABO1

CARE

CARE

CARE

CARE

CARE

CARE

CARE

CARE

CARE

CARE

CARE

CARE

CARE

CARE

CARE

SC

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MOUTH

MUSCULOSKELETAL

MUSCULOSKELETAL

MUSCULOSKELETAL

MUSCULOSKELETAL

NASAL

NASAL

NASAL

NASAL

40
Source Type Survey Year Contents of this Data Field Data Category PPPPPHHPP:HPPPEHHH

!!HHHzHHHHHH;HHHHHH;HHHkHHHHHHHH:P;HHHb

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-75

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

74-75

71-73

Nares,other findings

Nasal turbinates,swollen

Adenopathy,cervical

Neck,findings

Neck, other findings

Tracheal deviation

Tumour,benign

Tumour,malignant

Ankle jerk, absent

Apathy

Chvostek sign, positive

Handedness

Head injury

Hyperirritability, marked

Knee jerk, absent

Neurological evaluation

Neurologica!,other findings

Numbness,tmgling or loss of sensation

Paralysis or weakness

Polio or paralysis

Speech, difficulty,slurred

Vision Ioss,temporary

Alcohol consumption

Appetite, reduction

Bean and peas, dty,consumption frequency

Beverages,sweetened,frequency

Bitot’s spots

Bread consumption,frequency

Breast feeding, now

Butter, margarine,consumption frequency

Calcium, per cent standard

Calcium,24 hour recall, consumption

Calcium,24 hour recall, consumption

Calories, per cent standard

Calories,24 hour recall, consumption

Calories,24 hour recall, consumption

Candy consumption frequency

Carbohydrate,24 hour recall,consumption

Carbohydrates,fiber,24 hour recall

Carbohydrates,total,24 hour recall

Cereals, consumption frequency

Cheese and cheese dish consumption,freq

Cheilosis

Cholesterol,24 hour recall

Coffee or tea,consumption frequency

Completion code

Completion code, 24 hour recall

Creatinine,urinary

Day of recall,24 hour recall

Desserts,sweets, consumption,frequency

Diet habits,24 hour recall

Diet,recent,change in

Diet,special

Dietary recall, day of

Drinks, cold, diet, consumption frequency

Eating, condition interfering with

Egg consumption,frequency

Epiphysial enlargement,wrists

Eyes, angular blepharitis

Eyes, circumcorneal injection

Eyes,xerosis

Fat,24 hour recall, consumption

Fat,24 hour recall, consumption

Fats, avoidance

Fish or shellfish, consumption frequency

Folate,serum

Follicular hyperkeratosis, upper back

NASAL

NASAL

NECK

NECK

NECK

NECK

NEOPIASM

NEOPLASM

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NEUROLOGY

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

41
Source Type Survey Year Contents of this Data Field Data Category

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-73

Food avoidance, disagreement

Food code,24 hour recall

Food group,24 hour recall

Food ingestion time period

Food items description, model grams

Food programs

Food source,24 hour recall

Foods, avoidance,other

Fruits,vegtables, consumption frequency

Grams food,24 hour recall

Greens, avoidance

Hair, abnormal texture,curl loss

Hair, dry staring

Hair, dyspigmented

Hair,easily pluckable

Height

Interviewer code

Interviewer code,24 hour recall

lodine/Creatinine (urine)

Iodine, urine

Iodized salt

Iron, per cent standard

lron,24 hour recall, consumption

lron,24 hour recall, consumption

Keratomalacia

Line number,24 hour recall

Linoleic acid,24 hour recall

Lips,angular lesions

Lips,angular scars

Mastication,trouble with

Meat and poultry,consumption frequency

Milk,avoidance

Milk,skim, consumption frequency

Milk,whole,consumption frequency

Minerals, recent ingestion

Naso-labial seborrhea

Niacin,24 hour recall,consumption

Niacin,24 hour recall,consumption

Nutrient composition, descriptive foods

Nutrition status,examiner impression

Obesity

Oleic acid,24 hour recall

Pellagrous dermatitis

Phosphorus,24 hour recall, consumption

Phosphorus,24 hour recall, consumption

Pica

Pot belly

Potassium,24 hour recall, consumption

Potassium,24 hour recall, consumption

Protein, per cent standard

Protein,24 hour recall, consumption

Protein,24 hour recall, consumption

Respondent,food frequency

Respondent,24 hour recall

Respondent,24 hour recall

Restaurants,frequency patronised

Riboflavin/Creatinine (urine)

Riboflavin, urine

Riboflavin,24 hour recall, consumption

Riboflavin,24 hour recall, consumption

Ribs,beading of

Salt use-

Saturated fatty acids,24 hour recall

Seafood, avoidance

Skull, bossing of

Snack food,consumption frequency

Sodium,24 hour recall, consumption

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

42
Source Type Survey Year Contents of this Data Field Data Category

I/k

l-l

l-l

F’ PPPPG

l-i

l-l

l-l

i-i

l-l

1! H

l-l

IiPPEE

l-l H

l-l

l-l ;

l-l

l-l

l-f HHHE

1+:

l-l

f-l :

-rPPPPPE~TEH

l-l !

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-75

71-75

71-75

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-73

71-73

71-73

71-73

71-73

71-73

71-75

71-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

74-75

71-75

71-75

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

Sodium,24 hour recall,consumption

Thiamine/Creatinine (urine)

Thiamine, urine

Thiamine,24 hour recall, consumption

Thiamine,24 hour recall, consumption

Time of day,24 hour recall

Tongue,fissures

Tongue, magenta

Tongue, papillary atrophy

Tongue, papillary hypertrophy

Tongue, scarlet beefy

Tongue,serrations,swelling

Vitamin and mineral consumption, pills

Vitamin A(per cent standard)

Vitamin A,24 hour recall, consumption

Vitamin A,24 hour recall, consumption

Vitamin C(per cent standard)

Vitamin C,24 hour recall, consumption

Vitamin C,24 hour recall, consumption

Vitamins, recent ingestion

Weight

Weight, maximum

Weight, minimum since age 18

Xerophthalmia

Parotids,enlarged visibly

Tongue, geographic

Pregnancy history

Uterine enlargement

Anxiety

Anxiety

Depre&ion

Demession scale, NIMH CES-D

Emotional behavioral control

Energy, pep,feeling of

GWB filled out by

Health, bothered by illness,pain

Health, concern about ill health

Help,felt need for

Imputations for GWB

Life satisfaction, personal

Life,daily, interest in

Mental health counseling

Mental health patient care

Mental strain

Nervous breakdown

Nervous breakdown

Tiredness

Well being scale and sub scale scores

Blebs,bullae

Blebs,bullae

Blebs,bullae

Breath sounds,decreased

Breath sounds,lower Iobe,left

Breath sounds,lower Iobe,right

Breath sounds, middle Iobe,right

Breath sounds, upper Iobe,left

Breath sounds, upper Iobe,right

Bronchitis, emphysma,chronic

Calcified nodes

Calcified nodes

Calcified nodes

Chest auscultation

Chest condition, status

Cough or phlegm, increased

Cough, chronic

Cough,chronic

Cough, early morning

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

NUTRITION

OROPHARYNX

OROPHARYNX

PREGNANCY

PREGNANCY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

PSYCHOLOGY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

43
Source Type Survey Year Contents of this Data Fie/d Data Category :

Pi TTzTTTTTT1:TTTTTT1T1TTTTTTHHTTTHT

!’PPPPPPPLHTTTTTT1TTTT

71-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

74-75

71-75

71-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

74-75

74-75

71-75

71-75

74-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

74-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

Cough, persistent

Cough,seasonal

Disability,chest

Disability,chest or lung

Emphysema

Emphysema

Emphysema

Hospitalization, chest condition

Infiltrates,diffuse, homogeneous

Infiltrates,diffuse, homogeneous

Infiltrates,diffuse, homogeneous

Infiltrates,diffuse, nonhomogeneous

Infiltrates,diffuse, nonhomogeneous

Infiltrates, diffuse, nonhomogeneous

Infiltrates,localized, segmental

Infiltrates,localized, segmental

Infiltrates,localized, seg mental

Infiltrates,other

Infiltrates,other

Infiltrates,other

Lung surface area

Nipple shadows, x-ray

Nipple shadows, x-ray

Nipple shadows, x-ray

Nodes, enlarged,lung

Nodes, enlarged,lung

Nodes, enlarged,lung

Nodules, extrapulmonary, other

Nodules, extrapulmonary, other

Nodules, extrapulmonary, other

Nodules, intrapulmonary

Nodules, intrapulmonary

Nodules, intrapulmonary

Pectus

Pectus

Pectus

Phlegm

Phlegm

Pleural disease

Pleural disease

Pleural disease

Pleurisy

Pulmonary diffusion (Dlco)

Rales,lower Iobe,left

Rales,lower Iobe,right

Rales,middle lobe

Rales,upper Iobe,left

Rales,upper Iobe,right

Rhonchi,lower lobe right

Rhonchi,lower Iobe,left

Rhonchi,middle lobe

Rhonch~,upper lobe,left

Rhonch!,upper Iobe,right

Shortness of breath

Shortness of breath,wheezing,faintness

Spirometry,best trial

Spirometry,calibration factor

Spirometry,diagnosis code

Spirometry,flow at.2 liters volume

Spirometry,flow at .25 seconds

Spirometry,flow at .5 seconds

Spirometiy,flow at .75 seconds

Spirometry,flow at peak flow +4 seconds

Spirometry,flow at peak flow +3 seconds

Spirometry,flow at peak flow +2 seconds

Spirometry,flow at peak flow+1 seconds

Spirometry,flow at peak flow +.5 second

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

44
Source Type Survey Year Contents of this Data Field Data Category TTT:TTT;TTTTTTTTTTTTTTTTTTT1:T:TTTTTTTTTTTTTTTTFPFHH7tHkL

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

71-73

71-75

71-75

71-75

71-75

71-75

71-75

71-75

71-73

74-75

71-75

71-75

71-75

74-75

71-73

71-75

Spirometty,flow at peak flow +.1 second

Spirometry,flow at1 liters volume

Spirometry,flow at1 second

Spiromet~,flow at 1.2 liters volume

Spirometry,flow at2 liters volume

Spirometry,flow at2 seconds

Spirometty,flow at 25%FVC

Spirometry,flow at3 liters volume

Spirometry,flow at3 seconds

Spirometry,flow at4 liters volume

Spirometry,flow at4 seconds

Spirometry,flow at5 liters volume

Spirometry,flow at 50% FVC

Spirometry,flow at6 liters volume

Spirometry,flow at 75% FVC

Spirometry,forced vital capacity

Spirometry,maximum mid expiatory flow

Spirometry,mid expiatory flow rate

Spirometry,peak flow

Spirometry,peak flow volume

Spirometry,reliability of test

Spirometry,reproducibility

Spirometry,time at1 liters volume

Spirometry,time at 1.2 liters volume

Spirometry,time at2 liters volume

Spirometry,time at 25%FVC

Spirometry,time at3 liters volume

Spirometry,time at4 liters volume

Spirometry,time at5 liters volume

Spirometfy,time at 50% FVC

Spirometry,time at6 liters volume

Spirometry,time at 7570 FVC

Spiromet~,time of peak flow

Spirometry,time of FVC

Spirometty,time,.2 liters volume

Spirometry,trial number

Spiromet~,volume at .25 seconds

Spiromety,volume at.5 seconds

Spirometry,volume at .75 seconds

Spirometry,volume at peak flow +4 sec.

Spirometry,volume at peak flow +3 sec.

Spirometty,voh.rme at peak flow +2 sec.

Spirometry,vo!ume at peak flow +1 sec.

Spirometry,volume at peak flow +.5 sec.

Spirometty,volurne at peak flow +,1 sec.

Spiromet~,volume at

1 second

Spirometry,volume at2 seconds

Spirometry,volume at3 seconds

Spirometry,volume at4 seconds

Spiromet~,BTPS factor

Thoracic diameter

Tracheal diameter

Wheezes,lower Iobe,left

Wheezes,lower Iobe,right

Wheezes, middle lobe

Wheezes, upper Iobe,left

Wheezes, upper Iobe,right

Wheezing

Wheezing

Wheezing, chest (diffuse& focal)

Audiometty,sentence repitition,speech

Acidity(pH),urine dipstick

Albumin, urine, dic)stick

Albuminuria-“

Bilirubin,urine, dipstick

Dysuria

Glucose, urine, dipstick

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

RESPIRATORY

SPEECH

URINARY

URINARY

URINARY

URINARY

URINARY

URINARY

45

I
Source Type Survey Year Contents of this Data field Data Category

71-75

71-75

71-73

74-75

71-75

71-75

71-75

71-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

74-75

71-73

71-72

74-75

74-75

74-75

74-75

Hematest,urine,dipstick

Hematuria

Hematuria

Ketones, urine, dipstick

Kidney disease or stones

Kidney, bladder, infection

Proteinuria

Sugar,in urine

Urobilinogen,urine dipstick

Blind,either or both eyes

Distance vision, binocular, corrected

Distance vision, binocular, uncorrected

Distance vision, monocular, corrected

Light recognition

Near vision, illiterate, Keeney,binocular

Near vision, illiterate,Sloan, binocular

Near vision, Keeney reading cards, binoc

Near vision, Sloan reading cards, binoc

Vision difficulties,with eyeglasses

Vision, distance

Vision,distance, correction usage

Vision,near

Vision, near, correction usage

Vision, using glasses or contact lenses

Visual acuity

Visual acuity

Visual acuity angle,near

Visual difficulty,duration

Visual acuity angle,near

Visual difficulty,duration

URINARY

URINARY

URINARY

URINARY

URINARY

URINARY

URINARY

URINARY

URINARY

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

VISION

46

I
Appendix Ill

Serological, urological, and

blood chemical tests conducted

on selected NHANES I sample

subjects, 1971-75

Locations Locations Detai/ed

Test 1-65 66-100 samDle

Serum bioohemist~

Serum protein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Serum albumin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Serum cholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Serum magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Serum sodium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serum potassium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serum folate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.%dimentation rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Total bilirubin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SHOT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alkaline phosphatase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

~alcium Uric acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phosphate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BUN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Creatinine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

T-4test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

T3test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

T-4 Murphy-Pattee (if T-4>7.5). .,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White blood cell count

Leukoblasts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Promyelc@es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Myelocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metamyelooytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bandneutrophils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Segmented neutrophils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eosinophils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Basophils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lymphocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Monocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Red blwd cell indexes

Hemoglobin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hemoglobin phenotype’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent AZ hemoglobin (when A2 hemoglobin present) . . . . . . . . . . . . . . . . .

Percent F hemoglobin (when F hemoglobin present) . . . . . . . . . . . . . . . . . . .

Hematocrit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Numbarof nucleated redcells per100whitecells . . . . . . . . . . . . . . . . . . . . . . .

Serum iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total iron binding capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent transferrin saturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Red blood cell morphology

Anisocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poikilocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Macrocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Microoytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypcchromia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

Platelets

Platelets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnote at end of table.

x

47
Appendix Ill

Serological, urological, and

blood chemical tests conducted

on selected NHANES I sample

subjects, 1971-7=on.

Sample

Locations Locations Detailed

Test 1-65 66-100 sample

Serology

Urinalysis

PA X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hematest (blood) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urobilinogen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ketones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Red blood cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White blood cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urinary iodine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urinary riboflavin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urinary thiamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urinary creatinine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urinary iodine orcreatinine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urinary riboflavin orcreatinine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urinary thiamine orcreatinine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

‘Hemoglobin phenotyping was performed as a special study during NHANES I on 12,282sample subjects, aample Iccationa 37-100. These subjects do not represent a scientific

subsample of the NHANES I sample.

46
Appendix IV

NHANES I Epidemiologic

Followup Study Schedule

Planning for NHEFS began in February 1979. As a result,

a feasibilityy study was conducted from January 1980 through

February 1980. OMB granted clearance for the study on February 12, 1982. The actual training schedule for the initial

followup study is presented below.

Training schedule for the followup

Type of training and region Time of training Location of training

Phase 1

Blood pressure training 4127182-4129182 Philadelphia, Pa.

Interviewer training 5/3/82-5/6/82 Philadelphia, Pa.

Field period 5f7182-7131 [82

North region

Blood pressure training 10/5/82-1 OiT/82 Rockville, Md.

Blood pressure training 10/5/82-1 0/7/82 Danvers, Mass.

Blood pressure training 10/1 2f82-1 0/1 4182 Lyndhurst, N.J.

Blood pressure training 10/1 2/82-1 0/1 4/82 Pittsburgh, Pa.

Interviewer training 10/1 7182- 10/24/82 Rockville, Md.

Field period 10/25/82-’2/28/83

South region

Blood pressure training 1/24/83-1/26/83 Savannah, Ga.

Blood pressure training 1/24/83-1 /26/83 Tampa, Fla.

Blood pressure training 1131183-213183 Knoxville, Term.

Blood pressure training 1/31/83-2/3/83 New Orleans, La.

Interviewer training 2f8/83-2f15183 Gaithersburg, Md.

Field period 2/16/83-6/30/83

Midwest region

Blood pressure training 4/26/83-4/26/63

Blood pressure training 4/26/83-4/28/83

Blood pressure training 5/2f63-515183

Interviewer training 5f8163-5117[83

Field period 5/18/83-9/30/83

West region

Blood pressure training 7125163-7128183

Blood pressure training 7/27/63-7/29/83

Blood pressure training 817183-813183

Interviewer training 8/8/83-8/1 5183

Field period 8/1 6183-12f31183

Chicago, Ill.

Columbus, Ohio

Detroit, Mich.

Schaumburg, Ill.

Dallas, Tex.

San Francisco, Calif.

Los Angeles, Calif.

Los Angeles, Calif.

49
Appendix V

Sample locations by region of

data collection

Sample location Sample location

number name

Phase 1 field region

01 . . . . . . . . Philadelphia, Pa.

51 . . . . . . . . Philadelphia, Pa.

86 . . . . . . . . . New Castle, Del.

97 . . . . . . . . . Philadelphia, Pa.

North field region

02 . . . . . . . . . Pittsburgh, Pa.

03 . . . . . . . . . Albany, N.Y.

04 . . . . . . . . . Mercer, Pa.

05 . . . . . . . . . Boston, Mass.

07 . . . . . . . . . Livingston, N.J.

08 . . . . . . . . . Springfield, Masa.

11 . . . . . . . . Garden City, N.Y.

26 . . . . . . . . . Bronx, N.Y.

29 . . . . . . . . . Manchester, Corm.

32 . . . . . . . . . Georgetown, Del.

34 . . . . . . . . . Washington, D.C.

36 . . . . . . . . . Elmira, N.Y.

39 . . . . . . . . . Oak Hill, W.Va.

54 . . . . . . . . . Providence, R.1.

57 . . . . . . . . . Scranton, Pa.

60 . . . . . . . . . Brooklyn, N.Y.

61 . . . . . . . . . Bedford, Pa.

63 . . . . . . . . . Orangeburg, N.Y.

64 . . . . . . . . . Roanoke, Va.

66 . . . . . . . . . Glens Falls, N.Y.

68 . . . . . . . . . Middletown, Corm.

70 . . . . . . . . . Boston, Mass.

72 . . . . . . . . . Union, N.J.

88 . . . . . . . . . Pittsburgh, Pa.

90 . . . . . . . . . Altoona, Pa.

92 . . . . . . . . . Rochester, N.Y.

98 . . . . . . . . . Garden City, N.Y.

99 . . . . . . . . . Spencer, W.Va.

100 . . . . . . . . . Bronx, N.Y.

West field region

15 . . . . . . . . . Los Angeles, Calif.

18 . . . . . . . . . Tucson, Ariz.

19 . . . . . . . . . San Antonio, Tex.

21 . . . . . . . . . Fresno, Calif.

24 . . . . . . . . . San Francisco, Cal if.

27 . . . . . . . . . Port Angeles, Wash.

28 . . . . . . . . . St. Joseph, Mo.

30 . . . . . . . . . Moses Lake, Wash.

41 . . . . Dallas, Tex.

44 . . . . . . . . . Globe, Ariz.

47 . . . . . . . . . San Diego, Calif.

49 . . . . . . . . . St. Louis, Mo.

50 . . . . . . . . . Los Angeles, Cal if.

53 .,....... Monterey, Calif.

73 . . . . . . . . . Kansas City, Mo.

75 . . . . . . . . . Greenville, Tex.

Sample location

number

Sample Iociation

name

77 . . . . . . . . .

79 . . . . . . . . .

81 . . . . . . . . .

83 . . . . . . . . .

85 . . . . . . . . .

87 . . . . . . . . .

91 . . . .

14 . . . . . . . . .

16 . . . . . . . . .

17 . . . . . . . . .

20 . . . . . . . . .

22 . . . . . . . . .

25 . . . . . . . . .

40 . . . . . . . . .

42 . . . . . . . . .

43 . . . . . . . . .

45 . . . . . . . . .

46 . . . . . . . . .

48 . . . . . . . . .

74 . . . . . . . . .

76 . . . . . . . . .

78 .,.......

80 . . . . . . . . .

82 . . . . . . . . .

84 . . . . . . . . .

06 .,.......

09 . . . . . . . . .

lo . . . . . . . . .

12 . . . . . . . . .

13 . . . . . . . . .

23 . . . . . . . . .

31 . . . . . . . . .

33 . . . . . . . . .

35 . . . . . . . . .

37 . . . . . . . . .

38 . . . . . . . . .

52 . . . . . . . . .

55 . . . . . . . . .

56 . . . . . . . . .

58 . . . . . . . . .

59 . . . . . . . . .

62 . . . . . . . . .

65 . . . . . . . . .

67 . . . . . . . . .

69 . . . . . . . . .

71 . . . . . . . . .

89 . . . . . . . . .

93 . . . . . . . . .

94 . . . . . . . . .

95 . . . . . . . . .

96 . . . . . . . . .

Los Angeles, Calif.

Sacramento, Cal if.

San Francisco, Cal if.

Olympia, Wash.

Denver, Colo.

Oklaho,ma City, okla

Leavenworth, Kans.

South field region

Albermarle, N.C.

Savannah, Ga.

West Palm Beach, Fla.

Eufaula, Ala.

Marksville, La.

Columbia, Miss.

Natchitoches, La[.

Knoxville, Term.

New Orleans, La.

Tampa, Fla.

Morristown, Term.

Statesboro, Ga.

Morristown, Term.

Greenvil Ie, S.C.

Birmingham, Ala.

Daytona Beach, Fla.

New Orleans, La.

Saluda, S.C.

Midwest field region

Detroit, Mich.

Cleveland, Ohio

Bay City, Mich.

LaPorte, Ind.

Angola, Ind.

Columbia, S.C.

Chicago, Ill.

Boone, Iowa

Wauwatosa, Wis.

Chillicothe, Ohio

Omaha, Nebr.

Cresco, Iowa

Chicago, Ill.

Fargo, N. Dak.

Columbus, Ohio

Fergus Falls, Minn.

Minneapolis/St. Paul, Minn.

Three Rivers, Mich.

Dayton, Ohio

Ladysmith, Wis.

Indianapolis, Ind.

Fullerton, Nebr.

Jackson, Mich.

Wilmington, Ohio

Chicago, Ill.

Detroit, Mich.

NOTE Sample locations have been referred to aa “standa” in previous NCHS publications.

50
Appendix VI

Study materials

Contents

Tracing

Verification Questions (subject).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..52

Verification Questions (proxy) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..53

Interview-Subject

Brochure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Advancelettertosubject. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Subject Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Self-administration Subject Interview Booklet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Hand Cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . ...101

Physical MeasurementsRecord (PMR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..109

ReportofPhysical Measurement Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Authorization to Obtain Information from Medical Records . . . . . , . . . . . . . . . . . . . . . . . . . . . . . 112

Interview-Proxy

Advance letter to proxy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...113

Proxy Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...114

Hospital and Heahh Care Facility Chati . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Hospital and Nursing Home Data Collection

Letter to hospital administrator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...135

Letter to Director of Medical Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136

Hospital Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...137

Letter tonursing home administrator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...139

Nursing Home/Personal Care Home Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

51
Tracing

OMB No,, c92sQ16,

ID*: m-~-n

Aw,o”d E.0, ma 12.3! .83

SUBJECT NAM : Date

U.S. Oepartme.t of Health and Human SeWlces

Nattoml Centw for Health Sutlstlcs

National Irntk.te.. Asl.g

NHANES 1 Epldero[olo@ FOI!OWUP Survey

VERIFICATION QUESTIONS ( TO BE ASKED OF SUBjEC’tS)

1.

1.

3,

4.

5.

6.

In (EX4M YEAR) you took part in a medical examin.tlon survey conducted by the National

Cmtes for Health Statmtics, a part of the U.S. Public Hea2th Ser.,... 1’ d like to ask

a few quest . . . . to verify that you are the person who pmticipsted i“ that 8.rvey. 1

#ant to mention that the i“fc.rmation you give will ta kept strictly confidential and

will be used for stat .stical purposes only. The int=rvimi M cmpletely volwat my and

is authorlzad by the Public Health Service Act.

mat M your full mm in.ludi~ Y... middle initial? [PRD8E FOR M.41OEN NAME IF FEMALE.)

(IF ~ CHANGED NA14E, EXPLAIN. )

W.4S4E:

tid YOUr date .f birth ,. (REpEAT BIRTHDATE). 18 that correct?

VES . . . . . . ..1(Q.4)

NO . . . . . . ..2(Q.3)

lsIN, T KNOW . . . . 8 (Q.4)

What is your date of broth? EIRTEDATE: —/—/—

hUNTH DAY YEAR

Were YOU living at (LABEL ADDREss) in (h$JNTH ANO YEAR OF EXAM)?

YES. ., . . . ..1(8OXA)

ND . . . . . . . . 2 (Q.5)

OONOT KNDW . . . . 8 (BOX A)

At what address were you living in (mNIH AND YEAR DF EXAM)?

PDDRESS :

STR[ET APT . #

CITY 5TA1E

I

BOX A

I

INTERVIEWER REVIEW 0.2 AND 0.4 AND CIRCLE ONE:

Q.2 ANO Q.& VERIFY. . . . . . . . 1 (SET UP INrfRvlEh9

0.2 AND Q.& 00 NOT vERIFY . . . . 2 ( Thank you very m.ch, [ don !t bel.eve you are

the person we a.= looking for. ) (TERMINATE)

OTHER . . . . . . . . . . . ...3 (Q.6)

I

Can you g,ve me the names of the people you were living with m (MONTH AND YEAR OF EXAM)?

[Ad how was =related to you?] (PROBE FOR FULL NAWE AND Relationship. )

NAWI RELATIONSHIP

1.

2.

3.

4.

OR

LIVED ALONE . . . . . . . . . . . . ..0

Thank you very much but 1 am not sure .hether you are the person we are looklng for. 1

.111 check the lnfor.atm” you have gl,en me against our records and .111 call y.. back

,r wc m the correct person. (TERMINATE)

52

—
OMB No.: 09254161

~ppro,.1 EXPIKS 12.3143

PROXY %lw: Date

US. Department of Hczlth and Human Serwicc$

National Center for Health SZWS1(CS

National Institute on Ating

NHANES ! Epidemiologic Followup Survey

VERIFICATION QUESTIONS (TO BE ASKED OF PROXIES)

1. 1.Pdld lxke to ask a few cp?stlans to verify that I have the corr~t pcrson. I w~”t

to nent um that the NIformat ion you give me will be kept confident ml and WI] 1 te used

for Statlstlcsl purposes Only. The Interview XS completely voluntary a“d IS ~uthoplzed

by the Publlc Health Service Act.

‘iihst (is/was) (SUBJECT ‘S) full “are Includlq middle “me? (IF ~ CHANCED NAME, EXPLAIN)

NAME :

2. And (hx3/her) dete of birth (is/was) (REPIAT 61 RTHDAT6). 1S that correct?

3. (IF lkCAPAC1 TAT ED)

(IF MCfASED) Mmt

YEs . . . . . . ..1(o.4)

NO . . . . . . ..2(Q.3)

CWJNrl KNOW . . . . 8 (Q.3)

What 2s (hn/hr) (dste of birth/agm)7

BIRIHJATE: // OR AGE:

M2NTH OAY V3AR

was (his/bar) (dmte of birth/qe ●t death)? [Whnt year did (he/she) die?]

BIRltX3ATEt // OR 4GE AT OCAIH:

l#2NTH MY YEAR

WAR Cf OEAIH:

4, was (SUBJECT) living .t (LABEL Am,wss)in (WDNTH AND YEAR OF EXAM)7

YES . . . . . . ..1 (BOXA)

NO. . . . . . . . 2 (Q.5)

EX7N1T KNOW . . . . E (FKIKA)

5. At what address was (he/she) llvlng L“ (WUNTH ANO YEAR OF EXAM)?

mp~ss:

STREET AP!. #

CITY STATE ZIP CO02

00X A

INTERVIEWER REVIEW !3.2 ANO Q.4 ANO CIRCLE ONE:

0.2 AND Q.4 VZRIFY. . . . . . . . 1 (SET UP INTERvIEW; COMPLEIE SUF IF APPROPRIATE)

Q.2 AVD Q.4 00 NOT VERIFY . . . . 2 (Thank you very much, 1 don, t belxeve we are

talking about the sum person. ) (TEii141NAlE)

OTHER . . . . . . . . . . . . .. 3(9.6)

6.

~ YOU remember the . ..es of the people (he/she) was living with In (IQNTH ANO YEAR OF EXAM)?

[4ndhow was~ related to (hlmlher)?] (PROBE FOR FULL NAfsE ANO RELATIONSHIP. )

NANE RELATIONSHIP

1.

2.

3.

4.

OR

LIVEO ALONE . . . . . . . . . . . . ..0

Thank you very much but 1 am not sure whether (he/she) X3 the person we are loc.kmg fur.

1 w1ll check the L“formatmn you have yven me agmns.t our records and WI1l call you back

If (he/she) AS the ~orrect Per%on. (TERMINATE)

I

mr[cz:-Inrm..tlon Cmt. und m u,,, ram

*M .auld W1.,t M.”t, f,c,t, m of any

irdiv,d..l 0, “tbli.knt h., bee. ce,,ect.d

.,th . g.. rmt” th. t it “,11 & held ,. strxt

.mf.drwc. “’11 k ““d MIY for P. VOS.,

st.t.d for thi. stud”, and “,11 “o, be d,,cl.,ed

0, r.l . . ..d t. othr. .Itha.t ,ti COns,nt or LM

I“d,v,ti..l ., ..tk-Li,lwa”t ,“ scc.,a,nce .,th

%ct,on >OO[d) of thaPub],. HealthS..v,ce Act

53
Interview-ubject

#

During the next several years, a very important followup study will be

conducted with approximately 14,000 persons who took part in the first

National Health and Nutrition Examination Survey (NHANES I) in the

early 1970’s.

WHAT IS THE NHANES I EPIDEMIOLOGIC FOLLOWUP SURVEY?

The NHANES I Epidemiologic Followup Survey is a nationwide survey

being conducted by the National Center for Health Statistics, a part of the U.S.

Public Health Ser$;ce, with the assistance of Westat, a national survey organization. The survey is being funded by the National Institute on Aging and

other Institutes of the t:ati~. ,al Institutes of Health.

We are interviewing persons who took part in the NHANES I survey to

ask about their health status and hospital care since the earlier survey. If the

original participant cannot be interviewed because of illness or death, we will

be talking to relatives or dose friends who know about the participant’s health

status since the earlier survey.

The interview will be conducted in person by specially trained interviewers who will ask questions about illnesses, dietary habits, and activities

that might be related to health, such as work, smoking, and exercise.

The interviewer who calls on you will be a Westat employee representing

the National Center for Health Statistics. When our interviewer arrives, be

sure he or she presents a Westat identification card.

There will be no physical examination associated with the followup

interview. However, blood pressure and weight wil [ be measured.

WHY SHOULD I PARTICIPATE?

The persons who took part in the first survey made up a group that

represented all types of people in all areas of the United States. This is the

first nationwide survey that will provide information on changes in health

over time for people from all different backgrounds and regions. Each participant represents thousands of others with similar characteristics. Although

participation in this survey is voluntary, it is important that you participate

so that the results will represent a true scientific sample of the U.S.

population.

54
HOW DO I KNOW MY ANSWERS WILL BE KEPT CONFIDENTIAL?

All the information you give will be protected by the confidentiality

requirements of the U.S. Public Health Service Act (42 USC 242m) and the

Privacy Act of 1974 (5 USC 552a). Your answers will be used only by research staff working on the survey. Each of them must sign a statement

pledging to keep confidential all information provided by respondents. No

information that would permit the identification of any individual will be

released or published. Survey results will be published only as statistical

summaries. Your responses to the survey are entirely voluntary. There are no

penalties for refusing to answer any questions.

WHAT WILL BE DONE WITH THE INFORMATION?

The data from the NHANES I Epidemiologic Followup Survey,

combined with the data from the earlier survey,will show how the health

of the U.S. population changes over a period of time. 1n addition, the

data will help to identify some of the factors that contribute to good health

as well as illness. Health planners and medical experts will translate these

findings into ways to improve the prevention and treatment of disease and

delivery of health care.

HOW CAN I HELP?

By voluntarily participating in the survey, you are helping us gather

information in the best possible way. Your cooperation is the key to the

successof this followup survey.

Any queries or correspondence should

be directed to the following address:

NHANES I Epidemiologic Foliowup Survey

1650 Research Boulevard

Rockville, Maryland 20850

(301 ) 251-1500

55
smlct,,o

/ *

4

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Servica

{

5 L

‘%.ti,ra National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

DearParticipant:

As youmay recallwe havebeenin touchwithyouthispastyearconcerning

a nationalsurveythattheNationalCenterforHealthStatisticsis conducting.

Youparticipatedin thefirstNationalHealthandNutritionExamination

Surveyin 1971-1975.Theresultsof thatsurveyhaveprovidedmuchneeded

informationaboutthehealthneedsandcharacteristics of theAmerican

people.We wouldliketo expressourappreciationtoyouforyourpart

in making that survey a success, and, as we have indicated to you, we

would like to have your help again.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another interviewof all the adults

whotookpartin thatstudy.We havecontractedwithWestat,a mtional

researchfirm,to conductthesurveyforus. Withinthenexttwoweeks

a Westatinterviewerwillcontactyou to seta timeto visityouforthe

interview.Whentheinterviewerarrives,be sureto askhimor herto

showyouaWestatidentificationcard.

.Theinterviewwillincludequestionsaboutyourhealthstatusandany

hospitalcareyoumay havehad. In addition,yourbloodpressuretill

be takenandyouwillbe weighed.Therewillbe no otherphysicalexamination. Youwillalsoreceive$10.00foryourparticipationin thestudy.

Thissurveyis authorizedby Title42,UnitedStatesCode24Zk. Your

participationin thissurveyis completelyvoluntary.Thereareno penalties

forrefusingto answeranyquestion.

As in theprevioussurvey,anyinformationyougivetillbe keptconfidential.

NO infomationthatcouldbe usedto identifyouor anyindividualtill

be releasedor published.Resultsof thisstudywillbe publishedonly

as statisticalsummaries.

Yourparticipationis vitalto thesuccessof thissurvey,andyourcooperation

willbe appreciatedgreatly.

Sincerely yours,

RobertA. Israel

ActingDirector

56
ID NUMBER m-m-n Oh*El No 0925.0161

Auwwd E?P,w% 123183

PPRT A.

\\- -Jv

$’

:

-g

U.S. DEPARTMENT OF HEALTH ANO HUMAN SERVICES

8 PUBLIC HEALTH SERVICE

z

>

NATIONAL CENTER FOR HEALTH STATISTICS

“z> NATIONAL INSTITUTE ON AGING

4’

4%,,

NATIONAL INSTITUTES OF HEALTH

NHANES I

EPIDEMIOLOGIC

FOLLOWUP SURVEY

SUBJECT QUESTIONNAIRE

ASSURANCE OF CONFIDENTIALITY

All information which would provide identification of the individual will be bald in strict ~onfiden<

will be used only for purposes of and by persons engaged in the wrwy, and will not be djsclomd

releawd to others for my purposes i“ accordance with Section 308(d) of the Public Health Servi

Act (42 USC 242 m).

m

-4 PHS.

AM

TINE BEGAN: _

~ ‘M

I

BOX A

I

I

INTERvIEwER: REVIEU LASEL MiD CIRCLE !3NE: ISegin AO

jISUNDER 60 . . . . . . ..l(Q.A-6)

~ IS600R OLDER . . . . . . 2 (VA-1)

BOXEOQL!ESTIONNkIRE . . . . . 3 (Q.&6)

First ISd like to verify a feii facts.

f4sQ 1

lat is your complete address?

.1. Nmber and street A-1

. ---- ----- . ..-. ---

(RECORO fGJWER AflD

STREET NANE

FRO+I LABEL)

RE5p0N5E VS. ACTUAL sCORE

ANSHERS

(R)

(NO.)

—

~ ‘R)

----- . . . . . . . . .

(A)

(W.)

~ ‘A)

k2. Cfty and State A-2

—-mm---(’) “

~ ‘R) ----- .. . ..----- .. . . . .. ...----- .. . . .----

(REcORO cITy ANo

sTATE FRffl LABEL) ~ ‘A)

~ ‘A)

k-3. How old are you non? A-3

~ ‘R) —

----- ----- . . . . . ----- ---- i---- ----- -----

(AGE AT LAST BIRTHDAY,

RESPONSE SSUULO BE flITHIN

ONE YE!R OF ACTUAL AGE. ] L)(A)

FREM LABE

Hhen ware you born?

A-4. fbnth? (DO NOT SCORE A-4

“OAY”) — (R)

m ‘A) —

A-5. Year? A-5

— ‘R) m&’OJb- ‘A) —

BOX B

I

lNTERVIEHER: REVIEli BOX 1 AfAl CIRCLE ONE, —

BOX1lSLESS THAH 3.... 1 (HSQ 11 P. 43) I

BOX1 IS 3 OR WRE . . . . . 2 (Q.A.6) I

Box 1

INTERVIEWER:

A-6 INTERVIEWER OBSERVE TYPE OF LIVING QUARTERS ANO CIRCLE ONE

PRIVATE RESIOENCE OR APARTMENT BUILOING . . 1 (Q.A-7)

SHELTERED NOISING . . . . . . . . ...lIIIIIIRI1..zQ,A-7)

NURSING HOHE

PERSONALCARE~O~E”IIIRIIlt :::::::::::::..

[

. . 3 Q. A-16)

4 1O.A-16)
ol

m

This (next) secles of questions is about your household.

ENTER NAME OF ~ ON LINE a OF QUESTION A-12 BELOW.

,%@; How many people live in your A-7 ONE . . . . . . . . . . . . ..OI

household Including yourself? # PEOPLE: I—.

I I (Q.A-9) 2’-23

;* About how long have you lived alone? A-8 LESS THAN ONE

YEAR . . . . . . . . . . 00 (Q-A-25)

# YEARS: I——I I (11.A-25)

DK . . . . . . . . . . . . . . 98 (Q. A-25) 2“-25

~ What is the name of the head of your household? (IFS IS NOT HEAD

OF HOUSEHOLD ENTER HH ON LINE 12b AND CIRCLE. )

26

‘~w What (is/are) the name(s) of the other Person(s) who llve(s) In YOUI “..

household? (RECORD NAW5 IN Q.A-lZ).

#&&k Have 1 missed wone who usually lives A-1 1 YES.............. 1 $::;~lN

here but is now away frcdn home?

NO . . . . . . . . . . . . . . . 2

&

.

.. ””. ......

3i#&t .* *.

,.,..? ,&y&@

AFTER LISTING HOUSEHOLD How old was (ASK SEX IF How is (-)

ASK Q.A-l J THROUGH A-15 (PERSON) on QUESTIONABLE. ) related to

FOR EACH PERSON, AS (T=7i=r) Is (-) Z?

APPROPRIATE. NAME (FIRST, last birthday? male or female?

MIOOLE INITIAL, LAST).

1 I

NAME YEARS OF AGE M F RELATIONSHIP

b. YRS: l_l_l 1 2

c. YRS: l_l_l 1 2

d. YRS: l_l_l 1 2

e. YRS: l_l_l 1 2

f. YRS: l_[_l 1 2

9. YRS: l_l_l 1 2

h. YRS: I I I 1 2 ——

i. YR5: l_l_t 1 2

j. YRS : l_l_l 1 2

k. YRS: I_I_! 1 2

1. YRS: l_l_l 1 2

27-31

32-36

37-, ,

42–46

,7-51

52-56

57-61

62-66

67-7,

72-76

77-81

82-86

This (next ) series of questions is about the last household In which YOU lived.

ENTER NAhE OF ~ ON LINE a OF QUESTION A-21 BELOW.

k-lb. How many people lived in your A-16 ONE . . . . . . . . . . . . ..OI

household including yourself?

# PEOPLE: I I I (0. A-18) ,,_,,

A-f7. About how long dld you live alone?

IA-’7

LESS THAN ONE

YEAR . . . . . . . . . . 00 (Q. A-25)

# YEARS: I I I (Q. A-25)

DK . . . . . . . . . . . . . . 98 (Q. A-25) ~u-~,

A-l@. What was the nane of the head of your household? (1F > IS NOT HEAO

OF HOUSEHOLD ENTER HH ON LINE 21b ANO CIRCLE. )

26

&???. What (was/were) the name(s) of the other person(s) who lived in your

household? (RECORO NAm5 IN Q.A-21 ).

&@. Have I missed anyone who usually A-20 YES . . . . . . . . . . . . . . I (RECORU IN

lived there? Q. A-21)

NO . . . . . . . . . . . . . . . 2

-. . ..

MIDDLE INITIAL, LAST) . I househ~ld? I I

I I I

NAME YEARS OF AGE M F RELATIONSHIP

b. YRS: I I I 1 2 ——

c. YRS: l_l_l 1 2

d. YRS: l_l_l 1 2

e. YRS: l_l_l 1 2

f. YRS: l_l_l 1 2

9. YRS: l_l_l 1 2

h. YRS : l_!_l 1 2

i. YRS: l_l_l 1 2

I I

j. YRS: l_l_l 1 2

k. YRS: l_l_l 1 2

1. YRS: l_l_i 1 2

,7-31

32–,6

37_b1

,2–.6

+! 7-5,

52-56

57-bl

6,-66

67-71

72-76

77-81

82-86

INTERVIEWER: GO TO Q.A-25

3

4
PART B: FAMILY HISTORY

In this part of the questionnaire, I would like to ask you about your

relatives. This includes your natural parents, your sisters and brothers a“d

your children. Do ~ include adopted or step relatives, but ~ include half

—

!-2:

—

,-2(

—

!-2;

a

b

c

d

e

—

* hhat is the highest grade or yeac of

school that (HEAD OF H0U5EHOLO) ~ver

canpleted? Include trade or vocational

NONE. . . . . . . . . . . . . . . 10

GRADE I . . . . . . . . . ...21

CRADE 2 . . . . . . . . . . . . 22

GRAoE J . . . . . . . . . . . . 2J

GRADE . . . . . . . . . . . . 24

GRADE. . . . . . . . . . . . 25

GRAOE 6 . . . . . . . . . . . . 26

GRADE . . . . . . . . . . . . 27

GRADE . . . . . . . . . . . . 28

GRADE . . . . . . . . . . . . 31

GRADE 10 . . . . . . . . ...32

GRADE I d. . . . . . . . . . . 33

GRADE 12 . . . . . . . . . . . 34

VOCATIONAL

1 YEAR. . . . . . . . . . . . . 01

2YEARS . . . . . . . . . ...02

3 YEARS OR MORE. . . . 03

COLLEGE

1 YEAR. . . . . . . . . . . . . 41

2YEARS . . . . . . . . . ...42

3 YEARS. . . . . . . . . . . . 43

4 YEARS . . . . . . . . . . . . 44

GRADUATE SCHOOL. . . . 45

DO. . . . . . . . . . . . . . . . . 9B

school .

relatives. Begin Bll —

B-1

—

B-2

—

3-3

—

3-4

—

3-5

—

3-6

—

3-7

—

1-8

—

I-9

—

l-l{

—

I-I

—

B-1;

NONE. . . . . . . . . 00 (Q. B-J)

#: Ill——

DK. . . . . . . . . . . 98 (Q. B-3)

—S OLDEST . . . . . 00

# OLDER: . . . . . I I I ——

OK . . . . . . . . . . . 98

%$% HOWmaw brothers and sisters living

or deceased do YO” have?

11-12

13-14

,5-,6

17

16-21

22

23-26

27

28-31

32

33-36

97

....

W HOWmaw of these brothers and sisters

were born before you?

M %. ~=w children liviw Or deceased

have you had? Remetier “ot to include

akpted or step children.

NONE. . . . . . . . . 00

# CHILDREN: I—— I I

YEs . . . . . . . . . . 1 (( J.B-l)

NO. . . . . . . . . . . 2

OK. . . . . . . . . . . 8 (Q. B-7)

YR: 1119111 ————

CM. . . . . . . . . . . 9998

‘* Is YOur mother still living?

m: I“whatyear didshe die?

=,

as your motherls death due to an

injury or an accident?

YES. . . . . . . . . . 1

NO. . . . . . . . . . . 2

Cu . . . . . . . . . . . B

102-103

&?& (I. the last household i“ which yo”

lived) how many chil’dren (did/do)

you have who live(d) away from home?

NONE. . . . . . . .. OO(PARTB)

# OF CHILDREN: I—— I I ,..,-

f&# Inwhat Ye=rwas yo”rmtherbor”?

,0, -,0s YR:II ———— III

04(. . . . . . . . . . . 9998

‘w. (At that time) How many of your

children live(d) . . . # OF CHILDREN:

Ill——

Ill——

Ill——

Ill——

Ill

a.

b.

c.

d.

e.

less than 7/2 hour away?

about 1/2 hour away?

about an hour away?

about two hours away?

more than two hours away?

YES . . . . . . . . . . 1 (Q. B-11)

NO. . . . . . . . . . . 2

ox . . . . . . . . . . . B (Q. B-111

106-107

,08-,09

,10-111

,12-113

114-115

w I“whatyeac didhe die? YR: 1119111 ————

Dx . . . . . . . . . . . 9998

YES. . . . . . . . . . 1

NO. . . . . . . . . . . 2

EM. . . . . . . . . . . 8

YR:II III

TX . . . . . . . . . . . 9998

_ Was your Fathet’,s death d“e to .“

injury or an accident?

llG-l~-

- h what year was your father b..”?

m Think* out the relatives that y.”

have included in the previous questions,

your parents, brothers, sisters, and

children. Did a doctor ever say that

any of these relatives had cancer?

YES . . . . . . . . . . 1

No . . . . . . . . . . . 2 (BOX C)

DK. . . . . . . . . . . B (BOX C)

mw

5

6
8 f“,3-$>; Could you tell me which relatives have had cancer?

‘ “-’ [CIRCLE Relationship TO~IN coLuMN A.1

PART o: HEALTH/OISEASES ANO OPERATIONS

The questions I’m goinq to ask you now concern your health as well as diseases and .—

COLUMN B

operations you might h;ve had.

Begin D1

COLUMN A

:ould you tell me the site or type of

;he cancer which your (RELATIVE) had?

CIRCLE

RELATIONSHIP TO SUBJECT I

2

3

6

5

—

6

7

8

9

1

EXCELLENT . . . . . . . . . 1

VERY GOOD . . . . . . . . . 2

GOOD . . . . . . . . . . . . . . 3

FAIR . . . . . . . . . . . . . . 4

POOR . . . . . . . . . . . . . . 5

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (Q.o-6)

oK . . . . . . . . . . . . . . . . 8 (0.0-6)

YR:II ————191 I I (Q.O-5)

OK . . . . . . . . . . . . . 9998 13-

D-l . Would you say that your health in

general is excellent, very good,

a. Filcher....................... 1 iITE: good, fair, or poor?

FATHER ....................... 2

SISTER . ...................... 3

BROTHER . .............. ....... 4

IR

rYPE : 11

12

SON .......................... 5

DAUGHTER . .................... 6

3e

t!-z. Have you ever been told by a doctor

that you had hypertension or high

blood pressure?

LLu 3?-’+1

~ 42-*Q

SITE :

IR

rYPE:

b. MOTHER . ............... ....... 1

FATHER ... .................... 2

SISTER ....................... 3

BROTHER . ..................... 4

SON .......................... 5

OAUGHTER . .................... 6

B-3. In what year were you first told that

you had this condition?

16

Q-4 . Can you remember if it was less than

a year ago, between 1 and 5 years ago,

between 5 and 10 years ago, or 10 or

more years ago?

LESS THAN ONE YEAR. . . . . . . 1

1 BUT LESS THAN 5 YEARS. . 2

5 BUT LESS THAN 10 YEARS. 3

100 R~RE . . . . . . . . . . . . . . . 4

OK . . . . . . . . . . . . . . . . . . . . . . . B

YES . . . . . . . . . . . . . . . 1 (CHART)

NO . . . . . . . . . . . . . . . . 2

YES . . . . . . . . . . . . . . . I (Q.o-B)

NO . . . . . . . . . . . . . . . . 2

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (Q. O-27)

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (Q, O-19)

NEVER WALKS UPHILL

OR HURRIES . . . . . . 3

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2

YES NO—

STOP OR SLOW DOWN. 1 2

LL-L-J$6-4B

LLL-J 49-51

c. MOTHER SITE: . . . . . . . . . . . . . . . . . . . . . . . I

FATHER . . . . . . . . . . . . . . . . . . . . . . . 2

sISTER . . . . . . . . . . . . . . . . . . . . . . . 3

BROTHER . . . . . . . . . . . . . . . . . . . . . . 4

SON . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DAUGHTER . . . . . . . . . . . . . . . . . . . . . 6

s

17

18

19

20

21

22

23

24

25

OR

TYPE :

D-5. Since 1970, have you been hospitalized

overnight for problems related to your

hypertension or high blood pressure?

0-6. Have you ever had any pain or disccinfort in your chest?

L—1—l— 53-55

L-JJ.-J 56-58

d. MOTHER . . . . . . . . . . . . . . . . . . . . . . . 1 SITE:

FATHER . . . . . . . . . . . . . . . . . . . . . . . 2

SISTER . . . . . . . . . . . . . . . . . . . . . . . 3

BROTHER . . . . . . . . . . . . . . . . . . . . . . 4

SON . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DAUGHTER . . . . . . . . . . . . . . . . . . . . . 6

0-7. Have you ever had any pressure

or heaviness in your chest? OR

TYPE :

D-8 . Oo you get this (pain or discomfort/

pressure or heaviness) when you walk

uphill or hurry? I——L.lJ bo-fiz

L..l_lJ 53-65

SITE:

OR

TYPE:

~ 67-69

L_lJJ 70-72

e. MOTHER. . . . . . . . . . . . . . . . . . . . . . . I

FATHER . . . . . . . . . . . . . . . . . . . . . . . 2

SISTER . . . . . . . . . . . . . . . . . . . . . . . 3

BROTHER . . . . . . . . . . . . . . . . . . . . . . 4

sON . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DAUGHTER . . . . . . . . . . . . . . . . . . . . . 6

D-9 . Oo you get this (pain or discomfort/

pressure or heaviness) when you walk

at an ordinary pace on level ground?

o-1o. What do you do if you get this pain

while you are walking, stop or slow

down, take a nitroglycerin, or

continue at the same pace? (CIRCLE

YES OR NO FOR EACH. )

TAKE A

NITROGLYCERIN. .. 1 2

CONTINUE AT THE

SAME PACE ....... I(Q.D-19) 2

,Wx c

INTERVIEWER: CIRCLE ONE:

~ IS FEMALE .......I (PART c - SELF ADMINISTRATION BOOKLET)

~ISFIALE .........Z (F’AFliu)

7 8
D-1 1. If you do stop or slow down, is D-1 1 RELIEVED., . . . . . . . . 1

the pain relieved or not? NOT RELIEvED ...... 2 (Q.D-19) ,6

D-12. How soon is the pain relieved? 0-12 TEN MINUTES OR LESS.. 1

1.!3RETHAN 10 MINUTES. 2 (Q.D-19)

27

0-13. Have you eve> had this (pain or 0-13 YEs ............... 1

discomfort/pressure or heaviness)

mare than three times?

NO . . . . . . . . . . . . . . . . 2

28

D-14. About how old were you when you first

had it? (REPD AGE CATEGORIES IF—

NECESSARY. )

11 LESS THAN 15 YEARS OLO. 01

15 LESS THAN 20 YEARS.. 02

20 LESS THAN 30 YEARS.. 03

30 LESS THAN 40 YEARS.. 04

40 LESS THAN 50 YEARs. . 05

50 LESS THAN 60 YEARS.. 06

60 LESS THAN 70 YEARS.. 07

70 LESS THAN 80 YEARS.. 08

80 YEARS OR OLDER . . . . . . 09 .9-30

D-1 5. Have you been bothered by this (pain D-1 5 YEs . . . . . . . . . . . . . . . 1 (Q. D-17)

or discanfort./pre ssure or heaviness)

in the past 12 months?

NO . . . . . . . . . . . . . . . . 2

31

0-16, In what year did you last experience 0-16 YR : 11191 I I

the (pain or discomfo~ressure or

——————

heaviness)? DK ............. 9998 32-35

0-17. Please look at this diagram. Do you

get this (pain or discomfort/pressure

or heaviness) (SHOW DIAGRAM IN SELFN3MINISTRATION BOOKLET, PAGE 6) Fr

a. in region A -- ?

b. in region B -- ?

c. in region C -- ?

d. in region O -- ?

a

b

c

d

1 2B 36

128 37

128 36

1 28 39

D-1B. Do you feel it anywhere else? D-18 YEs ............... 1 (MARK ON

OIAGRAM) q 0

NO . ............... 2

Ubl

*“ Have y.” ever had . severe pain

u +2

0-19 YES . . . . . . . . . . . . . . . 1

across the front of your chest

lasting half an hour or more? NO, . . . . . . . . . . . . . . . 2 (Q. O-27)

DO., .............. 8 (Q.O-27) U$

a] Oid y.” see. doctor because of

this pain?

I I

What did the doctor say it was? 0-21 SPECIFY:

DO . . . . . . . . . . . . . . . . 8

U,*5

0

9

=

How many of these attacks have you

O-23. In what year was your ( first) cfctack~ O-23

# ATTACKS: 1 I ] ——

DK . . . . . . . . . . . . . . . . 9B 46-”7

YR : 11191 ———— I I

OK . . . . . . . . . . . . . . . . 9998 4’-51

1/2 TO ONE HOUR... 00

# HRS: Ill

52-59

I ODxo

h

INTERVIEWER: CHECK THE NI!MBER IIF ATTACKS REPORTED

D-25. In what year was your last attack? O-25 YR : — 11191 II

I I ‘K”””””””””””””””” 9998 54-57

b26a. How long was the epieode of pain? D-26a 1/2 TO ONE HOUR . . . 00

I l#HRs:l I I —— 58-59

&26b. Since 1970, have you been D-26b YES . . . . . . . . . . . . . . . 1 (CHART)

hospitalized overnight for (this/

these) attack(a)? NO. . . . . . . . . . . . . . . . 2

D-27. Oo you get pain in either leg O-27 YES. . . . . . . . . . . . . . . I

when walking? NO. . . . . . . . . . . . . . . . 2 (Q. D-39a)

UNABLE TO WALK . . ...3 (Q. D-39a)

O-28. Does this pain ever begin when 0-28 YEs . . . . . . . . . . . . . . . 1 (Q. D-39a)

you are standing still or sitting? NO . . . . . . . . . . . . . . . . 2

D-29 . In what part of your leg do you O-29 PAIN INCLUDES

feel it? (IF CALVES NOT MENTIONED, CALF/CALVES. ,,. . 1

ASK, “Anywhere else?” IF STILL

NOT MENTIONED, CIRCLE 2.) PAIN DOES NOT

INCLUOE CALF . . . . 2 (Q. D-39a)

D-30. Oo you get this pain when you walk D-30 YES. . . . . . . . . . . . . . . 1

uphill or hurry? NO. . . . . . . . . . . . . . . . 2 (Q, O-39a)

NEVER WALKS UPHILL OR HURRIES. 3

0-31. Oo you get this pain when you walk 0-31 YES. . . . . . . . . . . . . . . 1

at an ordinary pace on level ground? NO . . . . . . . . . . . . . . . . 2

0-32. floes this pain ever disappear while D-32 YES.., . . . . . . . . . . . . 1 (Q. O-39a)

you are still walking? NO. . . . . . . . . . . . . . . . 2

0-33. mat do you do if you get this pain o-33 STOP OR SLACKEN

khile walking, stop or slacken your PACE. . . . . . . . . . . . 1

pace or continue at the sane pace? CONTINUE AT SAME

PACE. . . . . . . . . . . . 2 (Q. O-39a)

10

60

61

62

69

64

65

66

67
mNJ

D-34 . If you do stop, is the pain D-34 RELIEVED . . . . . . . . . . 1

relieved or not? NDT RELIEVED . . . . . . 2 (Q. D-39a) 68

0-43. Did a doctor ever tell you that you D-43 YES . . . . . . . . . . . . . . . 1

had gall bladder disease? NO . . . . . . . . . . . . . . . . 2 (BDX E) 85

I I

T&44. In what year were YOU ~ told that D-44 ~R: ,119111

you had this condition? ————

86-89

TM@. Did you have surgery or a surgical D-45 YES . . . . . . . . . . . . . . . 1

procedure for this condition? ND . . . . . . . . . . . . . . . . 2 (Q. D-47) 90

D-35 . How soon after stopping is the pain D-35 TEN NINUTES OR

relieved? LESS . . . . . . . . . . . . 1

MDRE THAN 10

MINUTES . . . . . . . . . 2

6’+

0-36. How old were you when you first had D-36 LESS TUAN 15 YEARS OLD. 01

it? (REAO CATEGORIES IF NECESSARY. )

15 LESS THAN 20 YEARS. . D2

D-W. In what year did you first have ID-46 YR: 11 I 9 l_l_l ,1-,.

surgery for this condition?

I

II 20 LESS THAN 30 YEARS.. D3

30 LESS THAN 40 YEARS. . D4

f3e4J~ Since 197D, have you been D-47 YES . . . . . . . . . . . . . . . I (CHART)

hospitalized overnight for this

condition? ND . . . . . . . . . . . . . . . . 2

II 40 LESS THAN 50 YEARS. . 05

5D LESS THAN 60 YEARS. . 06

95

96

97

II 60 LESS THAN 70 YEARS. . D7

70 LESS THAN BO YEARS. . 08

&3X E

INTERVIEWER: CIRCLE DNE:

—S IS FEMALE . . . . . . . . . . . . . . . .. I (Q. D-4B)

—5 IS MALE. . . . . . . . . . . . . . . . ...2 (Q. D-55)

I I 80 yEARS DR ‘JLOER . . . . . ..D9 70-7,

D-37 . Have you been bothered by this o-37 YES . . . . . . . . . . . . . . . 1 (Q. O-39a)

condition in the past 12 months? ND . . . . . . . . . . . . . . . . 2

72

0-38. In what year did you last experience D-38 YR : 11191 I I

this problem?

————

DO . . . . . . . . . . . . . . . 9998 ., -,’

.%48.; Did a doctor ever tell you that you D-48 YES . . . . . . . . . . . . . . . 1

had a lump or cyst in your breast? NO . . . . . . . . . . . . . . . . 2 (Q. O-54)

REAO COLUMN a TO S. IF THE ANSWER TD COLUWN a IS “YES, ” ASK COLOMN b

FOR THE CONOITIO~. IF “NO, ” ASK COLONN a FOR THE NEXT CONDITION. I HF., Did you ever have a biopsy or o-49 YES . . . . . . . . . . . . . . . 1

aspiration for this condition? NO . . . . . . . . . . . . . . . . 2 (Q. D-52)

CDLUNN a

Have YOU ever had (CONDITION):

D-%%. A sudden loss of vision?

YES . . . . . . . . . . . 1

NO . . . . . . . . . . . . 2 (Q. O-40a)

D-@a. A sudden loss of speech,

difficulty in speaking, or

slurred speech?

YES . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . 2 (Q. o-41a)

~~?a, A sudden paralysis or weakness of

an arm and/or leg on the same

side of the body?

YES . . . . . . . . . . . . 1

ho . . . . . . . . . . . . ..2. (Q. O-42a)

&42ik. A sudden numbness on one side

of the body?

..-.

I L> . . . . . . . . . . . . 1

ND . . . . . . . . . . . . . 2 (Q. O-43)

11

COLOMN b

Oid this condition last longer

than 24 hours? @%’fI.; What is the total number of breast D-SO NO BIOPSIES . . . . . . 00 (Q.o-54)

biopsies that you have had? Do not

include aspiration where fluid was

# BIOPSIES: I—— I I

ET-39b .

YES . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . 2

OK . . . . . . . . . . . . . B 77-78

.?%,; In what year did you (first) have a 0-51 YR : 11191 I I

biopsy for a cyst or lump?

————

OK . . . . . . . . . . . . . . . . 999B 100-103

Sf-40b .

YES . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . 2

OK . . . . . . . . . . . . . B

~$~.? Oid the doctor ever tell you that a D-52 YES . . . . . . . . . . . . . . . 1

lump or cyst in your breast was

cancerous or malignant? NO . . . . . . . . . . . . . . . . 2

104

b~~~~ Have you had one or both of your D-53 YES, ONE BREAST . . . 1

breasts removed? YES, BOTH BREASTS. 2

79-80

w-m%

YES..’::...: . . . . 1

NO . . . . . . . . . . . . . 2

LX . . . . . . . . . . . . . B

I I NEITHER . . . . . . . . . . . 3 105

&*.: Since 1970 have you been hospitalized 0.54 YES . . . . . . . . . . . . . . . I (CHART)

overnight for any type of breast

condition, female problem or a

NO . . . . . . . . . . . . . . . . 2

pregnancy?

81-82

106

@42b*

YES . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . 2

OK . . . . . . . . . . . . . El

12
These next questions are about skin problems you may have had.

T

.——.

0-55. Have you ever had a skin tumor, gro~th D-55 YES. . . . . . . . . . . . . . . 1

on your skin, skin ulcer or other skin

lesions for which you received medical NO ............ .... 2 (Q.0_6z)

treatment by a doctor? Do not include

bedsores. )

,2.

.— / t

D-56. Since 1970, for how many skin

.—

D-56 NONE . . . . . . . . . . . . . . 00 (0.0-62)

conditions have you received

treatment by a doctor? # OF CONDITIONS: I II

——___l_ I ““””””o”””””””””” “

1 “8-109

Now 11 d like to ask you about (this/thesa) (NUMBER) =~nditi~”(~).

Was the (#SKIN CONOITION) T!IMOR OR TUMOR OR TUMOR OR

a tumor or growth, a GROWTH. . . . . 01 GROWTH. . . . . 01 GROWTH. . . . . 01

skin ulcer or something

else? SKIN ULCER. . 02 SKIN ULCER. . 02 SKIN ULCER. . 02

MALE . . . . . . . . 03 MALE. . . . . . . . 03 t4JLE . . . . ...0 03

CYST . . . . . . . . 04 CYST . . . . . . . . 04 CYST . . . . . . . . 04

WART . . . . . . . . 05 WART O.., $$. O 05 WART. O...... 05

OTHER (SPECIFY) OTHER (SPECIFY) OTHER (SPECIFY)

Did the doctor tell you YES . . . . . . . . . . 1 YES . . . . . . . . . . 1 YES . . . . . . . . . . 1

that this condition was No

cancerous or malignant? ........... 2 NO ... ........ z No...,....<.. 2

I

13 I29 45 61

L59.

HOW mw times has W. # TIMES: l_l_l

condition recurred which

required treatment by a CDNTINUEIUS, , 96

doctor, including

surgical removal? D’ . . . . . . . . . . 98

D-60.

On what parts of the

body was this conditicm

located? (CIRCLE YES

OR NO FOR EACH. )

10-15

——YN

a. HEAD OR

FACE . . . . . 1 2

b. ARMs..,,. 1 2

c. HANDS . . . . 1 2

d. LEGS . . . . . 1 2

e. FEET . . . . . 1 2

f. OTHER (SPEC, )

I

12

# TIMES: l_l_l

CONTINUOUS. . 96

D’ . . . . . . . . . . 98

30-31

—

YN——

a. HEAD OR

FACE . . . . . 1 2

b. ARMS . . . . . 1 2

c. HANDS . . . . 1 2

d, LEGS . . . . . 1 z

e. FEET . . . . . 1 2

f. OTHER (SPEC. )

12

I

1# TIMES: l_l_l

~C0NTINU01J5. . 96

D’ . . . . . . . . . . 98 62-63

46-47

YN -—

a. HEAD OR

FACE..,.. 1 2

b. ARMS . . . . . 1 2

c. HANDS . . . . 1 2

d. LEGS.,,.. 1 2

e. FEET . . . ...1 2

f. OTHER (SPEC. )

12

ul_u L_L-l L-i-1 LU-LJ

16-25 32-41 6k-73

D-61 .

Since 1970, have you YES . . . . 1 (CHART) YES . . . . 3 (CHART) yES . . . . 1 (CHART)

ever stayed in a

hospital overnight for ;; “~~;T;ER No . . . . . 2 No . . . . . 2

treatment of this (IF ANOTHER (IF ANDTHER

condition? CONDITION GO CONDITION GO CONDITION GO

TO D-57) TO D-57) TO D-57)

D-62. Did a doctor ever tell you that you ID-621 YES . . . . . . . . . . . . . . . I

had any cancer ( other than the cancer

we talked about)? (ODN’T INCLUOE No . . . . . . . . . . . . . . . . 2 (Q, D..66)

SKIN CANCER UNLESS hELANOMA . )

ASK D-63 ANO RECUSU EACH

SEPARATE DIAGNOSIS OF

CANCER, THEN A5K C!-64 AN(

D-65 FOR EACH OIAGNOSIS.

b6J.

Where was the cancer or

mhat type of cancer was

itv (Have you had any

c,t her c.n,:ei”cJiagrmsd? )

*.

In what year were you

first told that you

-51 TE/TYPE)7

&6s.

Since 1970, have you

been hospitalized

overnight for this

condition?

Ist 01 AGN051S 2nci DIAGNOSIS 3rd OIAGNDSIS

SITE: SITE: SITE:

nR OR nR

TYPE : TYPE : TYPE :

VR:[I1911[ ——_— YR:II 19111 YR:II 19111

DO. . . . . . . . . . 9998 OK . . . . . . . . . . 9998 D’ . . . . . . . . . . 9998

79 -*Z 87-9u 95-98

YES . . . . 1 (CHART) YES..,. 1 (CHART) yEs . . . . I (CHART)

NO. . . . . 2 NO . . . . . 2 ND..,.. 2

83 91 99

These next questions are about respiratory problems.

D-66. Do you usually have a cough? Exclude D-66 YES . . . . . . . . . . . . . . . 1

clearing your throat. (Include a

cough when getting up, a cough when NO . . . . . . . . . . . . . . . . 2 (Q. D-68)

going out of doors, a cough with the

first smoke, or coughing at all during

the rest of the day or night. )

1 1

0-67. Do you usually cough like this on D-67 YEs . . . . . . . . . . . . . . . 1

most days for three consecutive

rrmntha or more during the year? NO . . . . . . . . . . . . . . . . 2

D-68. Oo you usually bring up phlegm from 0-60 YES . . . . . . . . . . . . . . . 1

your chest? Exclude phlegm fran your

nose. (Include bringing up phlegm

No . . . . . . . . . . . . . . . . 2 (Q. D-70)

at all when getting up in the merning,

when first going mt of doors, with

the first smoke or bringing up phlegm

at all the rest of the day. )

II

D-69. Oo you bring up phlegm like this O-69 YES . . . . . . . . . . . . . . . 1

cm most days for three consecutive

- or more during the year?

NO..., ............ 2

75

100

101

102

103

I 26 I 42 I 58 74

8

13 14
—

-7

—

-8

—

-8

—

-8

—

-8

—

0) I I

D-79 . In the summer, once you have already

been in the sun several times, what

reaction will your skin have the next

time you go out in the SU” for two m.

more hours on a bright day? Would you

say you would get no reaction, some

redness only, a burn, or a painful

burn?

ND REACTION/TAN . . . 1

SONE REONESS. . . . . . 2

BURN. . . . . . . . . . . . . . 3

PAINFUL BURN. . . . . . 4

DK. . . . . . . . . . . . . . . . 8

s

(IF s IS ut4Ai3i_E TO WALK, CODE 3.) II

D-70 . Are you troubled by shortness of D-70 YES . . . . . . . . . . . . . . . 1

breath when hurrying on level No . . . . . . . . . . . . . . . . 2 (Q. D-75)

ground or walking up a slight hill?

UNABLE TO WALK. . . . 3 (Q. O-74) 1U4

105

106

107

108

115

116

117

0-71. Oo You have to walk slower than ID-71 I YES . . . . . . . . . . . . . . . 1

people of your age on level ground

because of breathlessness? 1! NO. . . . . . . . . . . . . . . . 2

D-80 . After repeated sun exposures, for

example, a two-week vacation outdoors, would your skin become

slightly darker, somewhat darker,

very dark, or would there be no

change?

SLIGHTLY DARKER. . . 1

SOMEWHATOARKER. . . 2

VERY OARK. . . . . . . . . 3

NO CHANGE. . . . . . . . . 4

OK. . . . . . . . . . . . . . . . 8

YES. . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . 2 (pART E)

D-72 . Oo you ever have to stop for breath 0-72

when walking at your own pace on

level ground?

YES . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

&8~. In the past ten years, have you ever

been confined to bed for most of the

day for at least a two-week period?

D-73. Do you ever have to stop for breath D-7

after walking about 100 yards or

after a few minutes, on level ground?

YES . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

&lX. Have YOU ever had “a bedsore, an open

sore caused by being confined to bed

for a long time or unable to move

about as usual?

D-74 . Are you too breathless to leave the o-74 YES. . . . . . . . . . . . . . . 1

house or breathless on dressing or NO. . . . . . . . . . . . . . . . 2

undressing?

YES . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2 (PART E)

118

119

0-75. Ones your chest ever sound wheezy D-7:

or whistling. . . D+,, When this bedsore occurred, were you

at home, in a hospital, in a nursing

home or somewhere else?

HOME (OWN) . . . . . . . . 1

HOSPITAL . . . . . . . . . . 2

NURSING HOME. . . . . . 3

OTHER (SPECIFY) . . . 4

109

110

a. on most days or nights? la 1 (Q. o-76) 2

b. when you have a cold? Ibl 1 2

c. occasionally when you don’ t

have a cold? IIc 1 2

111

The next few questions are about ways in which the environment may affect

your skin.

TIME ENOEO:

AM

R-7’6~1 During your adult life, as part of PM

your usual job, were you outdoors

in the sun frequently, occasionally,

rarely or never?

-76 FREQUENTLY. . . . . . . 1

OCCASIONALLY. . . . . 2

RARELY . . . . . . . . . . . 3

NEVER . . . . . . . . . . . . 4

DO. . . . . . . . . . . . . . . 8 112

$il-~~.~ Ouring your adult life, in your D-77 FREQUENTLY. . . . . . . 1

leisure time, including hobbies

and sports, were you outdoors in

OCCASIONALLY. . . . . 2

the sun frequently, occasionally, RARELY . . . . . . . . . . . 3

rarely or never? NEVER . . . . . . . . . . . . 4

DK . . . . . . . . . . . . ...8 113

0-78. When You were a child or teenaaer. ID-78 I YES . . . . . . . . . . . . . . . 1

were ~ou ever sunburned so badiy

that your skin blistered? NO. . . . . . . . . . . . . . . . 2

DO. . . . . . . . . . . . . . . . 8

11*

15

16

3,,.3,, c, . ,, . ,
TIME BEGAN: AM

PM

PARI E: MJSCULOSKELETAL PROBLEMS

E-1 1. How old were you when you first

experienced this recurring neck

pain? (REPJ3 CATEGORIES IF

NECESSARY . )

Th~se next qupstions are abaut snmp other health problems you miqht experience

from time to time.

E-2 . Have YOCJ had pain in >n,Ir tia?k on

most (days for at least me month?

E-4a . Have you had pain in or around the

knee, Including back of knee, on most

days for at least one mnnthT

E-&b . Which knee?

E-5 . Have you had pain or aching In any

joint other than the hip, back or knee

on most days for at least SLX weeks?

E-6 . Have you had any swollen joints

hirich were painful when touched

on most days far at least o“e moral-h?

E-7 . Have you had stiffness in your joints

hen first getticq out of bed on most

mmvrings for at least one month?

c-$. Have you ever been told by a doctor

that you fractured a hip?

E4. Have you ever been told by a doctor

that you had a dislocated hip?

E-10. What was the longest episode of neck

psin you ever had? [IF S INDICATES

LESS THAN 1 HDNTH, REASK–Q. E-l . ]

-3 YES . . . . . . . . . . . . . . . 1 (lj.E-Xl)

No. . . . . . . . . . . . . . . . 2

,

-4a YES . . . . . . . . . . . . . . . 1

*:

-5 YES . . . . . . . . . . . . . . . 1 (Q. E-72)

NO . . . . . . . . . . . . . . . . 2

-6 YES . . . . . . . . . . . . . . . 1 (11. E-74)

NO . . . . . . . . . . . . . . . . 2

:-7 YES . . . . . . . . . . . . . . . 1 (Q. E-83)

NO . . . . . . . . . . . . . . . . 2

:-8 YES . . . . . . . . . . . . . . . 1 (Q. E-91)

NO . . . . . . . . . . . . . . . . 2

:-9 YES., . . . . . . . . . . . . . 1 (Q, E-96)

NO . . . . . . . . . . . . . . . . 2 (PART F)

11

Ii

13

,4

13

16

17

18

19

20

:-1o 1 MONTH. . . . . . . . . . . 1

f43RE THAN 1 BuT

LESS THAN 6

1’41NTHS . . . . . . . . . 2

6-12 MINTS . . . . . . . 3

MORE THAN 1 YEAR.. 4

E-12. Are you still having this neck pain?

E-13, When was the last time you had this

pain? (REAO CATEGORIES IF NECESSARY. )

E-14. Does this neck pain occur more

frequently than it used to?

E-15. (Is/was) the pain” present when you

(are/were) resting at night?

E-16. (Ooes/did ) it awaken you from

sleep at night?

E-17. (Ooes/did) the pain seem to

spread?

E-IB. (Ooes/did) the pain spread to:

a. the top and back of the head?

b. either shoulder?

c. the arms or fmcls?

E-19. (Is/was) your neck pain made worse,..

a. by coughing, sneezing or deep

breathing?

b. with bending or twisting motion?

c. after prolonged sittirq?

d. after prolonged standing?

e. with other motion?

E-2o . Have you ever had neck pain due

to an injury?

E-21 . Was the neck pain caused by playing

a s~rt, doing your job at work, or

some other activity?

—

-1

—

-1

—

-1

—

-1

;

—

-18

—

-1

T

a

b

c

—

-1’

a

b

c

d

e

—

-21

—

-2

—

LESS THAN 15

YEARS OLD . . . . . . . . . . . . . 01

15 LESS THAN 20 YEARS. 02

20 LESS THAN 30 YEARS. 03

30 LESS THAN 40 YEARS. 04

40 LESS THAN 50 YEARS. 05

50 LESS THAN 60 YEARS. 06

60 LESS THM+ 7!3 YEARS. 07

70 LESS THAN 80 YEARS. 08

BO AND OLDER . . . . . . . . . . 09 2,-23

YES . . . . . . . . . . . . . . . 1 (Q. E-14)

ELI . . . . . . . . . . . . . . . . z

14

LESS THAN 1 YEAR AGO.. 1 (Q. E-15)

1 BUT LESS THAN 3 . . . . . 2 (Q. E-15)

3 BUT LESS THAN 5 . . . . . 3 (Q. E-15)

5 OR NtIRE YEARS AGO... 4 (Q. E-15)

DO . . . . . . . . . . . . . . . . . . . . 5 (Q. E-15)

YES . . . . . . . . . . . . . . . 1

NO.., . . . . . . . . . . . . . 2

YES., . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (Q. E-17)

YES. . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (Q. E-19)

YES NO OK —— .

1 2 8

1 2 8

1 2 B

YES ~ ~ —

1 2 8

1 2 8

1 2 8

1 2 8

1 2 8

YES . . . . . . . . . . . . . ,. 1

NO . . . . . . . . . . . . . . . . 2 (Q. E-23)

PLAYING A SPORT . . . . . . . . . 1

00ING YOUR JOB AT WORK.. 2

ANOTHER ACTIVITY . . . . . . . . 3

OK . . . . . . . . . . . . . . . . . . . . . . 8

25

26

2?

20

29

30

31

32

33

34

35

3b

37

38

39

0)

(n 17 18
!3

E-22. Have you ever been told by a doctor E-22 YES . . . . . . . . . . . . . . . 1

that you had a ‘Whiplash!! injury of

the neck? NO . . . . . . . . . . . . . . . . 2

I I

40

E-23. Have you ever been told by a doctor E-23 YES . . . . . . . . . . . . . . . 1

that you had a slipped or ruptured

disc in your neck? ND . . . . . . . . . . . . . . . . 2 (Q. E-25) “1

I I

E-24 . Were you in traction to treat this

slipped or ruptured disc?

-24 YES . . . . . . . . . . . . . . . 1’

NO . . . . . . . . . . . . . . . . 2

42

1 1

E-25 . Have you ~ stayed in a hospital

overnight for neck pain?

-25 YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (Q. E-28) ‘3

I I

E-26 . Was this hospitalization since 1970? E-26 yes . . . . . . . . . . . . . . . 1 (CHART)

NO . . . . . . . . . . . . . . . . 2 4,

E-27a. Oid you have any surgery for

neck pain?

E-27b. How many times?

E-2EI . Have you had pain in your back on

most days for at least one~th?

E-29 . What was the longest episode of

back pain you have ever had?

(IF S INOICATES LESS THAN ONE

MONTH, REASK Q .E-2Ll)

E-30. How old were you when you first

experienced this recurring back

pain? (READ CATEGORIES IF

NECESSARY .)

E-31 . Are you still having this pain?

E-27a YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (9. E-2LI) ‘5

I

-27b # OF TIMES: I I I Q6-4, ——

0

=’) 40 -29 1 MONTH . . . . . . . . . . . 1

MORE THAN 1

BUT LESS THAN

6MDNTHS . . . . . . . . 2

6-12 MONTHS . . . . . . . 3

1.13RE THAN 1

YEAR . . . . . . . . . . . . 4

49

I

-30 LESS THAN 15

YEARS OLD . . . . . . . . . . . . . 01

15 LESS THAN 20 YEARS. 02

20 LESS THAN 30 YEARS. 03

30 LESS THAN 40 YEARS. 04

40 LESS THAN 50 YEARS. 05

50 LESS THAN 60 YEARS. 06

60 LESS THAN 70 YEARS. 07

70 LESS THAN 80 YEARS. 08

80 ANO OLDER . . . . . . . . . . 09 50-5,

I

.31 YES . . . . . . . . . . . . 1 (Q. E-33)

INO . . . . . . . . . . . . . 2 ,,

E-32. When was the last time you had this E-32 LESS THAN 1 YEAR AGO.. 1 (Q. E-YI)

pain? (REAO CATEGORIES IF

NECESSARY . )

1 BUT LESS THAN 3 . . . . . z (Q. E-x)

II 3 BUT LESS THAN 5 . . . . . 3 (Q. E-34)

5 OR k13RE YEARS AGO... 4 (Q. E-.34)

E-33. Ones this pain occur more frequently E-33 YES . . . . . . . . . . . . 1

than it used to?

NO . . . . . . . . . . . . . 2

E-34. (is/was) the pain located in your . . . E-34 YES NO —_

a. upper back? a UPPER BACK 1 2

b. mid-back? b NIO-BACK 12

c. lower back? c LOWER BACK 1 2

BOX F

INTERVIEWER: CHECK E-34a-c AND CIRCLE ONE:

Q. E-34a-c, 2 or more = YES(l). . . . I (Q. E-3 E,)

OTHERWISE. . . . . . . . . . . , . . z (Q. E-36)

E-35. When you (have/had) this pain, where E-35

(is/was) it most intense, in your

(Upper back-or lower b,ck)?

YES NO

a UPPER BACK. . . . 1 I

b MIO-BACK. . . . . . 1 2

c LOWER BACK. . . . 1 z

E-36. (Was/is) the pain present when you

(are/were) resting at night?

E-36 YES . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . z (Q. E-JB)

E-37 . (Ooes/did) it awaken you from sleep E-37 YEs . . . . . . . . . . . . 1

at night?

NO . . . . . . . . . . . . . 2

E-3B. (Ooes/did) the pain seem to E-3B YES . . . . . . . . . . . . 1

spread?

NO . . . . . . . . . . . . . z (Q. E-40)

E-39. (Ooes/did) the pain spread to: E-39 YES NO OK —_

a. the back of the right leg? a I 2 8

b. the back of the left leg? b 1 2 B

C. the top of the head? c 1 2 8

d. the sides of the body? d 1 2 B

..

54

55

56

57

58

59

60

61

62

63

64

65

66

67

19 20
—

E-40. (ls/was) Your back pain made worse . . . IE-40

a. by coughing, sneezing or I

a

deep breathing?

b. with bending or twisting Ib

mot ion?

c. after prolonged sitting? Ic

d. after prolonged standing? I

d

e. with other motion? e

I

E-41 . Have you ever had back pain due to E-41

an injury?

E-42 . Was the back pain caused by playing E-42

a sport, doing your job at work or

some other activity?

E-43. Have you ever been told by a doctor E-43

that you had a slipped or ruptured

disc in your back?

E-44 . Were you in traction to treat this E-44

slipped or ruptured disc?

E-45 . Have you ever stayed in a hospital E-45

overnight= back pain?

E-46 . Was this hospitalization since 1970? E-46

E-o7 . Oid you have any surgery? E-47

E-48 . How many times? IE-4’

E-49 . Have you had pain in or around either E-49

hip joint, including the buttock,

groin, and side of the upper thigh

on most days for at least one month?

E-SO. What is the longest episode of hip E-50

pain you have ever had? [IF S

INOICATES LESS THAN ONE MONTH~

REASK Q. E-49]

21

—

YES NO OK — — —

1 2 8

1 2 8

1 2 8

1 2 8

1 2 8

YES . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . 2 (Q. E-43)

PLAYING A SPORT. . . . . . . . . 1

00ING YOUR JOB

AT WORK. . . . . . . . . . . . . . . 2

ANOTHER ACTIVITY . . . . . . . . 3

DY. . . . . . . . . . . . . . . . . . . . . . . 8

YES . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . 2 (Q. E-45)

YES . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . 2

YES . . . . . . . . . . . . 1

No . . . . . . . . . . . . . 2 (Q. E-49)

yes . . . . . . . . . . . . I (CHART)

NO. . . . . . . . . . . . . 2

YES . . . . . . . . . . . . 1

No . . . . . . . . . . . . . 2 (Q. E-49)

,,,

6,

70

11

7/

77

, ,.

75

7 ?<

77

IS

79

# OF TIMES: I I I 80-81

YES . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . 2 (Q. E-60) 82

1 MONTH, . . . . . . . . . . . . . . . . . 1

MORE THAN 1 BUT LESS

THAN 6 MONTHS. . . . . . . . . . 2

6-12 MONTHS. . . . . . . . . . . . . . 3

MJRE THAN I YEAR. . . . . . . . . 4 89

E-51 . How old were yau when you first

experienced this recurring pain

in the hip? (REPtJ CATEGORIES IF

NECESS!RY . )

E-52. Are you e.till having this hip pain?

E-53. Whsn was the last tlmti you had the hip

pain?

S.-54 . In which of these areas of the body

(is/was) the hip pain usually most

intense:

a. right buttock?

b. left buttock?

c. right groin?

d. left groin?

e, side of right upper thigh?

f’. side of left upper thigh?

9. somewhere else?

E-55. From the hip (does/did) the pain

tend to spread?

E-56 . (Ooes/did) the pain tend to epread

to:

a. the inside of your leg?

b. the front of your leg?

c. the outside of your leg?

d. the back of yOUr kg?

e. somewhere else?

E-57. (Clo/did) you have pain in or around

the hlo when either coughing or

sr,eezing?

E-58. When this pain ( is/was) present,

(does/did) it hurt when resting as

well as when moving?

-5

—

-5

—

-5

—

-5

a

b

c

d

e

f

9

—

-5

—

-5

a

b

c

d

e

—

-5

—

-5

—

.ESS THAN 15 YEARS...,.... 01

15 BUT LESS THAN 20 YEARS. 02

!0 BUT LESS THAN 30 YEARS. 03

}0 BIJT LESS THAN 40 YEARS. 04

10 BUT LESS THAN 50 YEARS, 05

;0 BUT LESS THAN 60 YEARS. 06

;0 BUT LESS THAN 70 YEARS. 07

~0 BuT LESS THAN 60 YEARS. W

10 AND OLOER . . . . . . . . . . . . . . 09

(ES . . . . . . . . . . . . . . . 1 (Q. E-54)

.. . . . . . . . . . . . . . ...2

.ESS THAN 1 YEAR AGO . . . . . . 1

[ BUT LESS THAN 3 . . . . . . . . . 2

}BUT LESS THAN 5 . . . . . . . . . 3

i OR MORE YEARS AGO . . . . . . . 4

OK. . . . . . . . . . . . . . . . . . . . . . . . 8

YES ~y

1 2fl

1 28

1 28

1 28

1 28

1 28

2B

;

(SPECIFY)

8k-a5

36

87

9s

89

90

31

92

,3

’34

L.-lJ95-9b

YES . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . 2 (Q. E-57) 97

YES ~g

1 2 8

YO

1 2 8 Y?

1 2 8 100

1 2 8 lUI

1 2 8 10?

+

(SPECIFY)

l_.lL_1103 -lo,’

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 l~s

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2

106

0)

-4
E-67a YES ............... 1

NO ................ 2 (Q.E-68a)

E-67b LEFT .............. 1

RIGHT ............. 2

BOTH .............. 3

E-6Ba YES ............... 1

NO ................ 2 (Q.E-69)

E-59. Since 1970, have you stayed in a

hospital overnight for problems

related to your hip pain?

-59 :s............... I (cHART)

) 2

177

. . . . . . . . . . . . . . . .

E-67a. Have you ever had “locking” of the

knee? 119

120

1,1

122

123

,.4

,.5

—

E-67b. Nhich knee?

E-60a. Have you had pain in or around the

knee, including the back of the knee,

on most days for at least one month?

.60a :5 . . . . . . . . . . . . . . . 1

1. . . . . . . . . . . . . . . .

2 (Q.E_71) ,CK

.60b

—

.61

AFT......’........ 1

IGHT ............. 2

ITH.............. 3 ,0,

E-60b. Which knee? E-68a. Has either knee ever “given way” uncle

you?

+---

E-68b LEFT .............. 1

RIGHT ............. 2

BOTH .............. 3

E-69 YES ............... 1

NO ................2(Q. E-7I)

E-68b. Which knee?

E-61 . What was the longest episode of knee

psi” YOU have ever had? [IF >

INOICATES LESS THAN ONE MONTH,

REASK Q.E-60a1

MONTH ................... 1

IRE THAN 4 WEEKS BUT

LESS THAN 6 WEEKS. . . . . . . 2

IRE THAN 6 WEEKS BUT

LESS THAN 6 MONTHS. . . . . . 3

-Iz MONTHS . . . . . . . . . . . . . . . 4

IRE THAN I YEAR . . . . . . . . . . S LIU

E-69. Have you ever had a severe twisting o

either knee resulting in a sprain or

swelling lasting more than two weeks?

E-70 RIGHT ............. 1

LEFT .............. 2

BOTH .............. 3

E-70 . Which knee?

E-62 . How old were you when you first

experienced recurring pain in the

knee? (REAo CATEGORIES If NECESSARY.)

-62

—

-63

—

-64

—

-65

ESS THAN 15

EARS OLO ................. 01

5 BUT LESS THAN 20 YEARS. 02

D BUT LESS THAN 30 YEARS. 03

0 BUT LESS THAN 40 YEARS. 04

0 BUT LESS THAN 50 YEARS. 05

0 BUT LESS THAN 60 YEARS. 06

0 BUT LESS THAN 70 YEARS. 07

0 BUT LESS THAN 60 YEARS. OB

OANOOLOER . . . . . . . . . . . . . . 09

111-112

E-71 . Have you had pain or aching in any

joint other than the hip, back, neck

or knee on most days for at least six

weeks?

E-71 YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . Z (Q. E-73)_

4-----=’’’”’2 F !!YES!!> . ..Was it the right

or the left?

E-72 YES NO RIGHT LEFT BOTH — ———

a 12 a 1 23 11-12

b 12 b 1 2 3 13-14

c 12 c 1 2 3 Is-lb

d 12 d 1 2 3 17-18

e 12 e 1 23 1,-20

f 12 f 1 2 3 21-22

E-72 . Which joints were painful. . .

a. Finger(s)?

b. Wrists?

C . Elbows?

ES . . . . . . . . . . . . . . . 1 (Q. E-65)

o .............. .. 2

ESS THAN 1 YEAR AGO . . . . 1

BUT LESS THAN . . . . . . . 2

BUT LESS THAN 5....... 3

OR MORE YEARS AGO . . . . . 4

K . . . . . . . . . . . . . . . . . . . . . . B

E-63 . Are you still heving thie knee pain?

113

114

115

116

117

118

d. Shoulders?

e. Ankles?

“E-64. When was the last time you had this

knee pain? (READ CATEGORIES IF

NECESSARY . )

f. Toes?

E-73 . Have you ever had any swollen

joints which were painful when

touched on most days for

at least one month?

E-73 YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (Q. E-76) 23

E-65 . When this pain (is/was) present,

(does/did) it hurt when resting as

well as when moving?

ES . . . . . . . . . . . . . . . 1

0 ................ 2

E-74 . How old were you when you first

experienced swelling of yo~ints?

(READ CATEGORIES IF NECESSARy. )

15 BUT LESS THAN 20 YEARS. 02

20 BUT-LESS THAN 30 YEARS. 03 E-66 . When this knee pain (is/was) present:

a. (Is/was) there also swelling of

the knee joint?

b. (Is/was) the joint warm to the

touch?

c. (Ooes/did ) the joint appear red?

-66

a

b

c

YES NO

TT

1 2

1 2

30 BUT LESS THAN 40 YEARS. 04

60 BUT LESS THAN 50 YEARS. 05

50 BUT LESS THAN 60 YEARS. 06

60 BUT LESS THAN 70 YEARS. 07

~ 24-25

24 23
—

-81

a

b

c

d

e

f

9

—

-82

.

.8:

—

JJ1

—

-8:

—

-8(

a

b

c

d

e

f

9

h

i

—

7

7

7

a

b

c

d

e

f

9

h

.7

.7

8

b

c

d

e

f

Q

i-

.8

X . . . . . . . . . . . . . . . 1 (Q. E-77)

1. . . . . . . . . . . . . . . . 2

IF jlYES’i . . .How many

4—> replacements?

fES —— NO [ I

12a l_l_l

lZb l_l_l .

12C l_l_l

12d l_l_l

1 2e l_l_l

12F l_l_l

l_l_l

;l_; ‘

E-75. Are you still having this swelling of

your joints? E-81 . Which joints were replaced. . .

a. Finger(s) on right hand?

b. Finger(s) on left hand?

c. Left hip?

d. Right hip?

e. Left knee?

f. Right knee?

q. Any other joints?

62-64

65-b7

68-70

71-73

74-76

77-79

80

E-76. When was the last time you had this

swelling? (READ CATEGORIES IF

NECESSARY.)

:SS THAN 1 YEAR AGO. . . . . 1

BuT LESS THAN . . . . . . . . 2

BUT LESS THAN . . . . . . . . 3

OR MORE YEAR5 AGO.. . . . . 4

{ . . . . . . . . . . . . . . . . . . . . . . . 8

‘ “YES”>. .. Was it the rqht

or the left?

E-77. 14h!ch yllr!ts ( are/were) u’.!Jally

lIWUILCSJ .I>rr,,, v.. c ,01, (h.,,,/t,. d) ttll,

,.nvlllrq wktll t.mdt.rrwh.. ,cm twchlrq..

a. Firqer(s)?

b. Wrists?

c. Elbows?

d. Shoulders?

e. Hips?

f. Knees?

g. Ankles?

h. Toes?

12

12

12

12

12

12

12

12

123

123

123

123

123

123

123

123

a

b

c

d

1?

F

Cl

h

—

E-82 . Have you had stiffness in your

joints when first getting out of

3 . . . . . . . . . . . . . . . 1

1. . . . . . . . . . . . . . . . 2 (Q. E-EIEI) 87

88-89

9“

91

92-93

108

bed on most mornings for at least

one month?

E-83 . How old were you when you First

experienced this morning s~ess

of your joints? (READ CATEGORIES

IF NECESSARY. )

:SS THAN 15 YEARS OLD. . . . 01

5 BUT LESS THAN 20 YEARS. 02

1 BUT LESS THAN 30 YEARS, 03

1 BUT LESS THAN 40 YEARS. 04

1 BUT LESS THAN 50 YEARS. 05

1 BUT LESS THAN 611 YEARS, 06

3 BUT LESS THAN 70 YEARS. 07

0 BUT LESS THAN 80 YEARS. OB

OANOOLOER . . . . . . . . . . . . . . 09

E-78. D1d you ever have a surqical

procedure on any of your jotnf.s?

As. . . . . . . . . . . . . . . 1

0. . . . . . . . . . . . . . . . 2 (o. E-f12)

F !’YES’r> . .. Was It the rlqht

or the left?

E-79. Which joints were operated upon.. .

a. Finger(s)?

b. Wrist?

C. Elbow?

d. Shoulder?

e. HIP?

f. Kneev

g, Ankle?

h. TOWS? 1

ES—— NO

12a

1 2b

12C

12d

12e

12f

129

12h

——IGHI LEFT —EiOTH

123

123

123

1 23

123

123

1 23

123

E-84. Are you still having this morning

stiffness?

:s. . . . . . . . . . .. . . . 1 (Q. E-L36)

o. . . . . . . . . . . . . . . . 2

E-85. When was the last time you had this

morning stiffness? (REAO CATEGORIES

IF NECESSARY. )

ESS THAN 1 YEAR AGO. . . . . . . . 1

BUT LESS THAN 4 YEARS AGO. 2

BUT LESS THAN 10 YEARS

AGO, . . . . . . . . . . . . . . . . . . . . . . 3

00 RMJRE YEARS AGO. . . . . . . . 4

K. . . . . . . . . . . . . . . . . . . . . . . . . . 8

F “YES”>.. .Was it the right

E-86. Which joints (are/were) usually in- or the left?

volved whenever you (have/had) this

morning stiffness. .,

a. Finger(s)?

b. Wrists?

C. Elbows?

d. Shoulders?

e. Hips?

f. Knees?

g. Ankles?

h. Toes?

i. Back?

E-BO. Oid you have the joints replaced? ES. . . . . . . . . . . . . . . 1

ES—— NO

12

12

12

12

12

12

12

12

12

——— IGHT LEFT BOTH

1 23

1 23

123

1 23

1 23

1 23

1 23

1 23

0. . . . . . . . . . . . . . . . 2 (Q. E-82) ‘1

?!

b

c

d

e

f

9

h

—

al

w
E-87. After getting up and moving a&und

(did/does) this morning stiffness

usually last. . .

a. all day?

b. longer than 1/2 hour?

c. longer than 15 minutes?

E-88. Have you ever stayed overnight in a

hospital because of joint problems?

E-89 . Since 1970, have you stayed overnight

in a hospital because of joint

problems?

E-90. Have you ever been told by a doctor

that you had a fractured hip?

E-91, Which hip was broken?

E-92. How old were you when it happened?

E-93. Did you have surgery?

E-94, Since 1970, have you stayed in a

hospital overnight for a fractured

hip?

E-95. Have you ever been told by a doctor

that you had a dislocated hip?

E-96. Which hip was dislocated?

E-97. How old were you when it happened?

E-98. Did you have surgery?

.87 YES —NO

a I (Q. E-813) 2

d I (Q. E-88) 2

cl”

.88 YES . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2 (Q. E-90)

.89 YES . . . . . . . . . . . . . . . I (CHART)

NO. . . . . . . . . . . . . . . . 2

.90 YES . . . . . . . . . . . . . . . 1

No..., . . . . . . . . . . . . 2 (Q. E-95)

.91 RIGHT . . . . . . . . . . . . . 1

LEFT . . . . . . . . . . . . . . 2

BOTH. . . . . . . . . . . . . . 3

E.%. Since 1970, have you stayed in the E-99 YES . . . . . . . . . . . . . . . I (CHART)

hospital overnight for problems

related to your dislocation? NO. . . . . . . . . . . . . . . . 2 125

10 E-1OO. Now, I‘ d like you to look at this line in this booklet.

1:

In the ast week, how much pain have you had from your joint

co.dikifiTO SELF-AOt41NISTRATION BOOKLET, PAGE 6.)

~ 126-127

1?

113

11.

115

.92 AGE : Ill——

DO. . . . . . . . . . . . . . . . 98

116-117

F

.93 YES . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

.94yEs . . . . . . . . . . . . . . . 1 (CHART)

NO. . . . . . . . . . . . . . . . 2

95Y ES. . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . 2 (Q. E-100)

.96 RIGHT . . . . . . . . . . . . . 1

LEFT . . . . . . . . . . . . . . 2

BOTH. . . . . . . . . . . . . . 3

118

119

120

121

.971AGE: , , ,

DO. . . . . . . . . . . . . . . . 98

122-123

EEIL!-- 124

27

28

393-368 0 83 3
Bwm FO

1“\llR5[\G H(1ML l\ ST RUCT 1UN5: CII?CLC ONE:

Rr\PONl)F\T CAN Ah W611 1141S 5FCTI ON. 1

I

il. Are vou usually co. f ,ned to bed For nmst of th? day7 YE5 . ...1

NO. 2 [F->. ) 12

F2 . H“. long have you he,. co” f,ned to bedq # Of M0V1H5: l__l __ I (ASK . QULSTIONS ONLY) 13-24

OR

6 OF YEARS: I __l___l (ASK “ QUE511ON5 ONLY) U 15

.—— —. —.— —.

L...:.....

—.

l\ TERvl Fwi R 1V?TRUCTIOW: ASK f-~a lNROUGH F-28.. IF ANY RE’5PONSE . J OR 4, ASK F->b THROUGH 1 -28b.

If b = Yt 5 (U5t5 HLLI’ t lfliLR FROM ANOIHFR PERWV OR AN AID) ASK f->, THROUGH F-24, WHLRL INDICATED.

—--———. ——T—... — ..— .__ —____________ 1

k.. 1 am qol”q t. reao a !,st of artIVltles

w,th wh, ch S0!7!, F@@, have d! ff lCLIILY. (JSMW

the cateqorles O“ Lh, s card, Pleas, t?ll me lf:

I

a.

YOU have “o d, ff, culty, some dlfflculty,

much d, fflc.lty or are .“able to do

I

these act,vltzes at .11 when y.. are by

yourself and without the .-e of aids.

F-3. Dress yourself, lncl.dlnq ty,ng shoes, .orkmg zLppers

and do, nq buttons?

F-4. Shannoo YOU I’ he I r, --l-+---l---l- +---l--{---kV -----

— -’-——–—

-------------lizxi=--’-v~-v-”- F.%$. Walk a quarter m,Le (two or three bl.rks)~

‘Z-~~:~-f-3T:$-7z TXZ’_w 1k f mm one mm t 0 ‘mother O;-tX;=i&–lSi;i~—–

F-1$. Walk up and down at least two SL.PS7

$-15. Get ,. and out OF the bathtubq

——————

F-$6. Mash and dry your whole bodye

=Get —.—..———.——— on and off the Lollet” ——— +-t%. Comb yo.r halrv

—.- —— —-—......

. . ..t...t-..t.–t.=-~r-~---–

—--—. —

=:::====I=E-EE= F-19. Reach ad qet down a 5 lb. .bJect (baq of suqar) from ,

f-ti, Oend down md p,ck up clothmq fram the floorq

~;e~”p~h butto-ar drmrsv

F-Z& Open Jars which have been pcevlcusly ope.ed~

~e~p;~p~c~~~w, th~

F-2$. Get ,. and out of a car,

4. e, I

You sa,d that you (have d, ff,c”lt y/are unable !45K ONLY r UAE HELP) (

to) (~) by yourself. . Cc you have hel P W,Lt, help h,,. d, ff,,-ult ,, ,1 f,,,

frm. . . you to Jo, I

31

w L

—“--iiaBB$— lNTERVIEWFR: RFVIFM F-3. thro.qh F-28a AND

CIRCLF (WC:

1

ALL RF5PON5E5, F-}. THROIJ3H F-28a = 1 DR 2. . . 1 (PAR1 G)

FOR ANY RF5PON5F Iv F-3. THROUGH F-28a = 3 OR O 2 (Q. F-}b)

30
.4 PART G:

N

NEDICAL CONDI TIDNS

Did a doctor ever tell

you that you had any of

the following conditions?

G“8S .

P31yps or tumor of

the colon

YES.. . . . . . . . . . . . . . 1

ND . . . . . . . . . . . . . . . . 2

In what year were you Since 197D, have you

first told that you had stayed overnight In a hos-

(CONOITION)? pital for (CONOITION)?

INTERVIEWER INSTRUCTIONS: REAO G-1a THROUGH G-23a FIRST. IF RESPONSE . YES (1)

ASK b ANO C.

n what year were you

irst told that you had

CONDITION)?

G-8b. IG-8C .

Did a doctor ever tell

you that you had any of

the following conditions?

&la.

Asthma

YES . . . . . . . . . . . . . . . 1

jince 1970, have you

stayed overnight in a hos-

]ital for (CONDITION)?

YR:II 19111 YES. . . . . . . . . . . I (CHART I

NO. . . . . . . . . . . . 2

DK . . . . . . . . . . . . . . . 9998

G-lb.

YR:II ————1911 I

DK . . . . . . . . . . . . . . .

G-2b .

YR: 1119111 ————

DK . . . . . . . . . . . . . . .

G-lc. Begin G1

=,:—f, :

59-6.

fed . . . . . . . . . . . I (cHART)

!O . . . . . . . . . . . . 2 G-9a .

Cirrhosis of the liver

Yes . . . . . . . . . . . . . . . 1

Y. . . . . . . . . . . . . . . . . . 2

G-9b .

I

NO G-9.2.. . . . . . . . . . . . . . . . 2

9998

9998

11-16

G-2C .

YR:I 119111 YES . . . . . . . . . . . I (cH,4RT)

NO . . . . . . . . . . . . 2

OK . . . . . . . . . . . . . . . 9998

G-2a.

Chronic bronchitis,

emphysema

YES . . . . . . . . . . . I (cHART)

No . . . . . . . . . . . . 2

17-22

VES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2

G-10a.

Parkinson’s disease

YES . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . 2

G-IL8J.

I

G-1Oc ,

YR: 1119111 Yes . . . . . . . . . . . I (CHART)

_—— —

NO . . . . . . . . . . . . 2

G3a. OK . . . . . . . . . . . . . . . 9998

Migraine

YES . . . . . . . . . . . . . . . 1

G-3b.

YR:II19111————

DK . . . . . . . . . . . . . . . 9998

G-#.

YR:II 19111

DO . . . . . . . . . . . . . . . 9998

G-5b.

YR:I ———— 119111

DO . . . . . . . . . . . . . . . 9998

G-6b ,

YR: 11191 I I

DK . . . . . . . . . . . . . . . 9998

G?b.

VR: 11191 ———— I 1

DK . . . . . . . . . . . . . . . 9998

G-3C,

YES . . . . . . . . . . . I (CHART)

. . . . . . . . . . . . . .2

23-20

G-ha.

Hult iple Sclerosis

YEs . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

G-llb. I G-llc.

ND . . . . . . . . . . . . . . . . 2

YR:I 119111 YE . . . . . . . . . . . I (CHART) ————

ND . . . . . . . . . . . . 2

G-4e. DO ............... 9998

Psoriasis

G4c..

71 -,6

‘/7-82

83-8,

YES . . . . . . . . . . . . . . . 1 yes., . . . . . . . . . I (CHART)

ND . . . . . . . . . . . . 2

23-,!,

G-1 2a.

Nervous breakdown

YEs . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2

G-1 2b . G-’I2C.

YR:II 19111 YES ........... I (CHART)

ND ............ 2

DK ............... 9998

NO ................ 2

G-5a. G-k ,

Ulcers: Peptic, stomach

or duodenal

YES . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

G-13a.

Diverticulitis

YES. . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

G13b.

I

&13c.

YES . . . . . . . . . . . 1 (CHART)

NO . . . . . . . . . . . . 2

95-40

YR:II 19111 YES . . . . . . . . . . . I (cHART)

NO . . . . . . . . . . . . 2

DK ............... 9998

G-6a.

Kidney disorder or

kidney stones

G-6c.

I

G-1 ha. e-14b. G-kit.

Colitis, enteritis

YES. . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2

VEST, . . . . . . . . . I (cHART)

NO . . . . . . . . . . . . 2

41-46

YR:II19111 YES ........... I (ctiART) ————

NO ............ 2

OK ............... 9998

G-7*.

Urinary tract or kidney

infection more than 3

times

YES . . . . . . . . . . . . . . . 1

G-?c,

G15e. Q..?%. G-%?.

Heart condition or

heart trouble

YES . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2

YR: 1119111 ‘VEST.......... I (cHART)

NO ............ 2

OK ............... 9998

yes . . . . . . . . . . . 1 (CHART)

NO . . . . . . . . . . . . 2

47-52

NO ................ 2

95-100

33

32
Did e doctor ever tell

you that you had any of

the following conditions?

n what year were you Since 1970, have you

‘irst told that you had stayed overni ht in a hosCONOITION)? pital for + CONDITION)?

Oid a doctor ever tell In what year were you Since 1970, have you

you that you had any of First told th~t you had stayed overni ht m a hos.

the following conditions? (CONOITION)? pital for + LoNDITION)?

G-23a. G-23b, G-23c .

Prostate trouble

YES . . . . . . . . . . . . . . . 1 YR:1119[I I ——. _

YES . . . . . . . . . . . I (CHART.)

NO, . . . . . . . . . . . . . . . 2 No . . . . . . . . . . . . ‘2

OK . . . . . . . . . . . . . . . 9998 >,-2*

[FOR Q.G-la-Q .G-23a, IF YES, ASK b and c.]

C-16a.

flngina

YES. . . . . . . . . . . . . . . 1

No. . . . . . . . . . . . . . . . 2

G-179.

Heart attack

YES. . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . z

c-16b. I

G-16c.

YR: 11191 I I YES . . . . . . . . . . . I (CHART)

.—— —

No. . . . . . . . . . . . 2

Do . . . . . . . . . . . . . . . 9998

101-106

G-17b’ I

G-1 7C .

-17-L These next questions will be about medications that You have taken or

are now taking.

G-18*.

Catdrdcth

YES . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . 2

a.

Antacids such as Rolaids,

Turns, Digel, Maalox

b.

Aspirin, not

including

aspirin

substitutes

YES. . . . 1

No. . . . . 2( Q. G-2Q!

37

# YEARS: I II

OK . . . . . . . . . . . . 98 ~,-,,

YES.,.. 1

NO.,,., 2 !,,!

# TINES/

DAY : I I I !,,.,,

OR

# TIMES/

WEEK: [

Ilu .3

READ Q.G-24 TO Q.G-28 FOR

ANTACIOS, THEN REAO Q.G-24

TO Q.G-27 FOR ASPIRIN

NO,

Glauctxna

YES .

. .

.

.

.

G19m.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

2

1 %’13-’18 G-24.

Have you ever taken

(MEDICATION) regularly, that

is at least once every week?

YES . . . . . . . . . . 1

NO . . . . . . . . . . . 2( Q. G-24b)

29

YR: 11191 I I YES . . . . . . . . . . . 1 (CHART I

NO . . . . . . . . . . . . 2

Do. . . . . . . . . . . . . . . 9998 11~-lzb G-25.

1

G-2m. c-me .

Far how many years hnve you

regularly taken (MEDICATION)?

# YEARS: I I I

OK..., . . . . . . 98

30-11

c-ma.

Detached retina

YES . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . 2

--

G26 .

on YOUstill take (MEDICATION]

regularly?

YES . . . . . . . . . . 1

NO . . . . . . . . . . . 2

3.

G-21a.

Small stroke sometimes

known as TIA (transient

Ischemlc attack)

YES . . . . . . . . . . . . . . . 1

. . . . . . . . . . . . . . . . ., 2

G-27 .

YR:II 19111 —— —— YES . . . . . . . . . . . 1 (CHART)

Nil . . . . . . . . . . . . 2

OK . . . . . . . . . . . . . . . 9998 11-16

(when YOU tOOk (llEOICAT1ON)

regularly)

On the average, how many

times a day or week

(do/did) you take it?

# TINES/OAY: I I [

. .

OR

# TIH!lS/WEEK: I I I ——

G-Z2C. c-22b . G22c . 31-Jh u

Stroke ( sDmetines

called a CVA)

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . z

G-28 ,

What is the brand name of the

antacid you (used/use ) most

frequently?

YR: 11191 II

.—— _

YES . . . . . . . . . . . 1 (CHART)

No. . . . . . . . . . . . 2

OK . . . . . . . . . . . . . . . 999% ,7-?,

MAALOX . . . . . . . 1

OIGEL . . . . . . . . 2

NYLANTA, ..,., 3

ROLAIDS...,.. 4

TAMS., . . . . . . . 5

OTHER

(SPECIFY).. 6

mx H

36

35
-P

G-29. Has a doctor ever prescribed G-29

digitalis, also called digoxin or

lanoxin for you?

G-3o. How old were you when this medication “G-30

was first prescribed?

YES . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . 2 (Q. G-33)

DK. . . . . . . . . . . . . . . 8 (Q. G-33) *4

AGE : Ill

45-.6

G-39. What is the name of this medication?

(CIRCLE ALL THAT APPLY)

G-M . Is this medication prescribed for you G.-31

now?

G-32 ,

I

How often do you take this medication? G-32

—--iG-33. Has a doctor ever prescribed G-33

~dication for you’ for hypertension

or high blood pressure?

thiscon”n G-34. Are you now taking medication for

YES . . . . . . . . . . . . . . 1

ND. . . . . . . . . . . . . . . 2 (Q. G-33) ,7

#TINES/•AY: I I I 48-49

——

OR

#TIMES/WK: [—— [ [

OK. . . . . . . . . . . . . . 98 u 5U

—

YES . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . 2 (Q. G-36)

OK. . . . . . . . . . . . . . . 8 (Q. G-36) 51

YES . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . 2 (Q. G-36) ~z

G-3$. What is the name of this medication?

(CIRCLE ALL THAT APPLY)

-35

a ALOACTAZIOE. . . . . . 1

b , ALDONET . . . . . . . . . . 1

c ‘ DIURIL . . . . . . . . . . . 1

d DYAZIOE . . . . . . . . . . 1

e HYOROCHLOROTHIAZIOE . . . . . . . 1

f HYOROOIURIL. . . . . . 1

g HYGROTFJN. . . . . . . . . 1

h INOERAL . . . . . . . . . . 1

i LASIX . . . . . . . . . . . . 1

j LOPRESSOR. . . . . . . . 1

k OTHER (specify). . 1

5?

50

59

6U

61

62

63

I-JJ 64-65

C.-U 66-67

LLl 68-69

G-36. Oid a doctor ever tell you that you G-36 YES . . . . . . . . . . . . . . 1

had diabetes or sugar diabetes? NO. . . . . . . . . . . . . . . 2 (Q. G-41)

oK . . . . . . . . . . . . . . . 8 (Q. G-41) ,,

G-37. In what year were you first told that

you had it?

-37 YR : 11191 ———— I I

OK. . . . . . . . . . . . 9998

71-!4

E-W. he you Qow taking medicationfor lG-38

this con=ion?

G-39

a OIABINESE . . . . . . . . 1 75

b INSULIN . . . . . . . . . . 1 77

c oTHER (Specify), . I

,?

II

I l– -79–SC

G-40. Since 1970, have you been hospitalized G-40 YES . . . . . . . . . . . . . . 1 (CHART)

overnight for diabetes? No. . . . . . . . . . . . . . . 2

51

G-41 . Oid a doctor ever tell vou that vou lG-41\ YES . . . . . . . . . . . . . . 1

had thyroid disease or goiter? ‘

I I W............... 2( Q. G-46)

I I

OK. . . . . . . . . . . . . . . 8 (Q. G-46)

.>

G-42. In what year were you first told that G-42’ YR:II —— 19111 ——

you had it?

OK. . . . . . . . . . . . 9998

%3–9C

G-43. Are you M taking medication for G-43 YES. . . . . . . . . . . . . . 1

this condition? No. . . . . . . . . . . . . . . 2 (Q. G-45) ,,

I I

G-44. What is the name of this medication? G-44

(CIRCLE ALL THAT APPLY)

a SYNTHROID . . . . . . . . 1

86

b THYROID . . . . . . . . . . 1 ,9

c THYRO1O STRONG. . . 1 90

d OTHER (SPECIFY).. I

~1

I l———

-92-93

I I

G-45. Since 1970, have you been hospitalized G-45 YES . . . . . . . . . . . . . . 1 (CHART)

overnight for this condition?

No . . . . . . . . . . . . . . . 2

94

G-46. Did a doctor ever tell you that you G-46 YES. . . . . . . . . . . . . . 1

had epilepsy?

NO. . . . . . . . . . . . . . . 2 (Q. G-51)

OK. . . . . . . . . . . . . . . 8 (Q. G-51) ,,

C-47, In what year were you first told that G-47 I YR: 1119! I I

you had it?

I

OK. . . . . . . . . . . . . 999B

9C–99

C48. Are you now taking medication for G-48 YES. . . . . . . . . . . . . . 1

this con-ion?

No. . . . . . . . . . . . . . . 2 (Q. G-50)

100

I I

G-49. What is the nane of this medication? G-49

(CIRCLE ALL THAT APPLY)

a OILANTIN . . . . . . . . . 1 1$1

YES . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . 2 (Q. G-40) ~,

37

b PHENOBARBITAL . . . . 1 102

c OTHER (SPECIFY ).. I

103

u 104

36
ci-50. Since 1970, have you been hospitalized G-SO YEs. . . . . . . . . . . . . . 1 (CHART)

overnight for this condltlon?

NO, . . . . . . . . . . . . . . 2

105

G-51 . DO you currently take any tranquilizers G-51 YES. . . . . . . . . . . . . . 1

that have been ordered by a doctor

such as Valium, Tranxene, Hellaril Ml. . . . . . . . . . . . . . . 2

or Comuazlne?

106

I I

‘-52’ b’’ad”c:d’’’’’’’:”” 107

DO you currently take any antidepressants that have been ordrred

SI%quan, Lunhltral, “r Tnfptir,j IT

We have been talking about specific medications you may have taken. Now

I ‘d like you to think about vitanins you may be taking.

INTERVIEWER INSTRUCTIONS: REAO G-53a - G-59a FIRST. FOR EACH ,iYESil RESPONSE.

Are you now

taking ..7

G-53*

Multivitamin pills

including therapeutic and qeriatric multivitamins

md Gcritol?

YEs . . . . . . . ...1

NO. . . . . . . . ...2

10R

ti-xa

Vitanin C tablets?

YES. . . . . . . . .. I

NO. . . . . . . . ...2

G-s%

Vitamin A capsules?

YES. . . . . . . . .. I

NO. . . . . . . . ...2

C-MO

Vitamin E capsules

YEs . . . . . . . . .. I

NO. . . . . . . . ...2

C-S7S

Cod liver oil or

other Fish liver

oils?

YES.., . . . . . .. I

NO. . . . . . . . ...2

ASK b-d .

+hat is the exact

lame of the multi-

~itamin you are

taking?

c-55b

{OW many (~)

)f (VITAMIN) dO yOU

:ake?

6-%

! OF TABLETS: l_[_[

\OAY . . . . . . . . ..l

\WEEK . . . . . . . ..Z

\t43NTH, . . . . ...3

c-m

F OF CAPSULES:

l_l_l

\OAY . . . . . . . . ..l

\kEEK . . . . . . ...2

\M3NTH...3 . ...3

&nb

# OF CAPSULES:

l_l_l

AOAY., . . . . . ...1

A WEEK. . . . . . ...2

At’!3NTH,..,.,..3

-

# OF SPOONFULS

OR TABLETS:

l_l_l

AOAY...l . . . ...1

AWEEK, . . . . . ...2

AM3NTH. . . . . ...3

{OWmany pills

m spoonfuls do

PJU take?

G53c

(How

# often?]

DWM

_l_l 1 2 3

_l_l 1 2 3

ihat is the

~osage of each

[tablet/

>apsule)?

6*

)OSAGE :

Illlmg.

e

3DSAGE :

11111

I.U.

,*

DOSAGE :

————I I I 11.U

‘or how many E

]f the last 10

@.!9 have Y=

taken (VITAMIN) on -

~ regular basl,s?

.C-53d

iEAR5: l_l_l ,; 3-,,5

(EARS : l_l_l ,,,-,,,

G%

(EARS : l_l_l

123-132

al-w Begin G3

fEARS: l_l_l

a-s;

YEARS: l_l_l

,*

YEARS: l_l_l

11-21

22-31

32-37

.

38

40
Are you now

taking . . . . .

G-58a

Any other vitamins

or minerals?

YES. . . . . . . . .. I

NO. . . . . . . . ...2

38

G-598

Any other nutritional supplements

such as lecithin,

protein powders,

nutritional yeast

or selenium?

YES . . . . . . . . .. I

NLI. . . . . . . . ...2

67

What is the exact

name of the other

(vitamin or mineral/nutritional

supplements) you

are taking?

G-58b

NAME: u

NAME: u

NAME: u

NAME: u

G-5%

NAME: uNAME: u

NAME: ~

G-Ml.’ For how many = of the last

10 years have you taken any

multivitamins on a regul=basis?

How many pills

or spoonfuls do

you take?

G-58c

(How

# often?)

DWM

l_l_l 1 2 3

l_l_l 1 2 3

l_l_l 1 2 3

l_l_l 1 2 3

For how many

years of the last

=%~~N~”

basis?

G-58d

YEARS: l_l_l

YEARS: l_l_l

YEARS: l_l_l

YEARS: l_l_l

G-59d

YEARS: l_l_l

YEARS: l_l_l

YEARS: l_l_l

39-45

46-52

53-59

60-,6

68-71

72-75

76-7,

80-81

G-61 . I have asked you about various

illnesses and whether or not you have

been hospitalized for them. Now, I

would like you to think back over the

time between 1970 and the present, thai

is the last ( NUMBE~) years. You would

have been abo~AGE) in 1970. Have

you stayed in a htiital overnight for

any other reason ( including

pregnancies) since you were (&)?

-.

-6 YES . . . . . . . . . . . . . . I (cHART)

NO. . . . . . . . . . . . . . . 2 (Q. G-62)

Box 1

HOSPITAL ANO HEALTH CARE FACILITY QUESTIONS

(SEE CHART ON BACK COVER OF SELF-ADMINISTRATION BOOKLET).

INTERvIEWER: ASK A-E FOR EACH OVERNIGHT STAY. RECORO ON CHART.

A. What year were YOU in the ( INSTITUTION)? (RECORO YEAR)

B. Why were YOU in the (INSTITUTION)? (RECORO CONOITION/ILLNESS)

c. What is the name of the (INSTITUTION)? (PROBE FOR FULL NAME ANO

RECORO ~ OF INSTITUTION)

D. What is the address of that ( INSTITUTION)? (RECORD STREET,

CITY AN(I STATE)

E. Have you stayed in ( INSTITUTION) for any other reason? (IF YES,

RECORD ON CHART. )

(IF NO, GO TO Q.G-62 IF NOT YET ASKED; OTHERWISE GO TO Q. G-64)

G-62. Since 1970 when you were (~), have

you ever stayed overnight in any other

health care facility such as a rest

home, a nursing home, a mental health

Facility or a ~ealth” care rehabilitation center of any kind? II

-62 YES, . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . 2 (Q. fi-64)

; G-64. As part OF this survey, I ‘d like to have your social security number.

Provision of this number is voluntary and not providing the number

will not have any effect o“ your receipt of benefits from the Federal

Government. This number will be useful in conducting future followup

studies. It will be used to match against future mortality records.

This information is collected under the authority of Section 306 of

the Public Health Service Act. What is your social security number?

SOCIAL SECURITY #: ]——. I I l-l I l-l ————I I I I

02

83

84-92

42

41
PART H: t4SQ II

NSQ 1 I

I

BOX J

INTERVIEWER: CHECK S ‘ S AGE ON THE LABEL AND

CIRCLE–ONE:

s IS UNDER 60 YEARS OLD. . , 1 (5ELF- —

AD141NISTRATION

i

BOOKLET, PART I

ANO PART 3)

~15600RoLDER . . . . , . 2 (Q.H-1)

BOXED QUESTIONNAIRE. . , . . > (PART K)

These next questions ask about particular bits of Information

that many people seen! to forget from time to time. They are ~outi”e que~tio”~

that we ask everyone and may or may not apply to you directly.

MSQ 11

E

H-1. Who is the President of

the United States?

H-2 . hho was the President

before him?

H-3 . What is today is date?

I

a. 14mt.h?

I

b. Day? (within one day)

I

c. Year?

-12

-2

—

-3a

b

c

(R)

(R)

_(R) (A)

m

(R)_ (A)

OAY

_(R) (A)

=7R--

SCORE

Begin HO

5

Score

l_l ,,

l_l ,,

l_l ,,

l_l 1.

l_l ,,

l_[

PART K: WEIGHT

These questions are about your weight and height. Begin KO

K-1 . When you were about 12-13 years old,

canpared to other (girls/boys) of the

sane age, were you considered to be

skinny, smmewhat slender, average,

chtiby, or very heavy?

K-2 . hhen you were about 12-13 years old,

compared to other (girls/boys) of the

‘~” ~e, ~re you cansi+rd t~ he

very tall, somewhat taller than

average, about average, somewhat

shorter than average, or very short?

K-3 . How does your weight now compare to

your weight 6 nmnths ago? 1s it at

least 10 pounds more, at least 10

pounds less or about the same?

K-4 . About how much do you weigh now?

K-5 . VAiat was your usual weight at the

age of 25?

SCORE FROM PAGE 1 I—1

TOTAL SCORE l_l ,,

(IF~ Is 41 OR OLDER, ASK:)

K-6 . hhat was your usual weight at the

age of 40?

I

SELF-ADMINISTRATION BOOKLET INSTRUCTIONS

(1) IF~ IS YOUNGER THAN 60 ~ MSQSCOREIS E OR MRE:

HAND S THE SELF-ADMINISTRATION BOOKLET AND TELL HIM/HER TO START

WITH FART I AND TO COMpLETE THE BOOKLET.

WIIEN ~ HAS COMPLETED BOOKLET, CONTINUE WITH INTERVIEW.

(2) IF ~ ffiQ SCORE IS LESS THAN 8:

.,

(IF ~ IS 66 OR OLDER, ASK:)

K-7. What was yuur usual weight at the

age of 65?

E

-1 SKINNY . . . . . . . . . . . . 1

SOMEWHAT SLENOER. . 2

AVERAGE . . . . . . . . . . . 3

CRUB13Y. . . . . . . . . . . . 4

VERY HEAVY . . . . . . . . 5

DK . . . . . . . . . . . . . . . . 8

11

-2

—

I

L

VERY TALL, . . . . . . . . 1

SOMEWHAT T!LLER. . . 2

AVERAGE . . . . . . . . . . . 3

SOMEWHAT SHORTER. . 4

VERY SHORT.., . . . . . 5

OK . . . . . . . . . . . . . . . . 8

12

-3 AT LEAST 10 PDUNDS MORE. 1

AT LEAST 10 POUNOS LESS. 2

ABOUT THE SAME . . . . . . . . . . 3

DK . . . . . . . . . . . . . . . . . . . . . . 8

13

-4 # LBS: I Ill

OK. . . . . . . . . . . . . . 998

I.-1b

-5 /) LBS: Ill]

OK . . . . . . . . . . . . . . 99B

17-19

-6 # LBs : 1111

DK . . . . . . . . . . . . . , 998 20-2,!

-7 # LBS : 1111

DO . . . . . . . . . . . . . . 99B 23-25

HAND S THE SELF-ADMINISTRATION BOOKLET AND ASK S TO COM+LETE PART I,

3 AND–THEN $WMINISTER PART P. THEN BRING A CLO~E FRIENO OR RELATIVE

TO ASSIST WITH THE INTERVIEW STARTING WITH PART A.

43 44
-J

m PART L: SHOKING HISTORY

This section of the questionnaire deals with your smoking history.

Begin LO

=~ Did you ~ smoke at least 100 L-1 YES. . . . . . . . . . . . . . . 1

cigarettes or more in your lifetime? NO. . . . . . . . . . . . . . . . 2 (Q. L-11) ,,

Oo you smoke cigarettes now? L-2a YES. . . . . . . . . . . . . . . 1 (Q. L-3)

I INO. . . . . . . . . . .. .. . . 2 ,2

I

-; Did you stop smoking cigarettes L-2b YES. . . . . . . . . . . . . . . 1

in the past year? NO. . . . . . . . . . . . . . . . 2

READ L-3 TO L-6 Smoking period Smoking period

FOR EACH SWOKING #1 #2

PERIDO

AGE: I I I AGE: I II

you when you (first/

next) began to smoke DK. . . . . . . . . . . . 98 OK. . . . . . . . . . . . 98

cigarettes 010 NOT SMOKE 010 NOT SNOKE

regularly? REGULARLY. . . . . 00 REGULARLY. . . . . 00

~ (BOX K) ,O_,~ (BOX K)

14-15

Smoking period

#3

AGE: I I I

OK. . . . . . . . . . . . 90

010 NOT SMOKE

REGULARLY. . . . . 00

~(BEIX K)

26-27

YES . . . . . 1

NO. . . . . . 2 (BOX K)

28

when you (first/

next) stopped for at OK. . . . . . . . . . . . 98 DO. . . . . . . . . . . . 9B DO. . . . . . . . . . . . 98

least a year?

17-18 23-24 29-30

W1

Did you ever start YES. . . . . 1 (Q.L-3) YES . . . . . 1 (Q. L-3) YES . . . . . I (Q.L-3)

smoking cigarettes

again? No. . . . . . 2 (Q. L-9) No . . . . . . 2 (Q. L-9) No . . . . . . 2 (Q. L-9)

I 19 25 31

~

: CHECK IF S SMOKES NOW (L-2a) ANO CIRCLE ONE:

~::

~T~ About ho” many cigarettes a day do

~=~~ For how long have y.. been smoking

.:

: L-9. ; During all the years when You were L-9 LESS THAN ONE A OAY. . . . . DOO

smoking, about how many cigarettes

a day did you usually smoke? # CIGARETTES: I———I I I

M . . . . . . . . . . . . . . . . . . . . . . 990

~L-%.; (Are/Were) the cigarettes which you

. .. .

L-10 FILTER . . . . . . . . . . 1

have smoked for the longest period of

time filtered or non filtered? NONFILTER. . . . . . . 2

I t

$-:$~~ Oid You ~ smoke cigars or a pipe? L-1 1 YES. . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . 2 (Q. L-13)

38-40

....”-.” .

: &-H&~ Oo you —now smoke cigars or a pipe? L-1 2 YES. . . . . . . . . . . . . 1

. .

NO. . . . . . . . . . . . . . 2

i.-$+~ Oid You ~ use . . . L-1 3 —YES ~

a. snuff? a 12

b. chewing tobacco? b 12

44

45

[Z=&j Have YOU ever been married to L-14 YES. . . . . . . . . . . . . 1

someone who smoked cigarettes?

NO. . . . . . . . . . . . . . 2

46

,,

# MDNTHS: I II

u 37

45 46
PART M: ALCOHOLIC BEVERAGES

Now

I would like to talk with You about drinkina alcohollc bevermms.

M-7. On the days that you havea drink,

about how many drinks do you

usual ly have?

.7 // OF ORINKS: I I I 20-.1

Alcoholic beverages incl!xle liquor, such” as mhiskey, rum, ‘q]n or vodka, and

beer and wine.

—

HCqin ,irl

~—

H-8. In how many of the past 12 mnnths

did you have at least one drink of

any alcoholic beverage, that IS,

beer, wine, or liquor?

.8# NONTHS: I I I 22-23 ——

N-1. Have you had at least 12 drlnk~

of any kind of alchohollc beverage

In any nne year?

-1 YE . . . . . . . . . . . . . . . . . . 1 Q.N-3)

am................... ,? 11

M-9. Ourirq the pask 12 months, an about

Imw mdnj. days did yuu h~ve

Y or more

drinks of= alcoholic bev=rage,

that 1s, b=, wine or liquor?

.9 NONE. . . . . . . . . . . . 000

#OAYS: I———I I i

OK . . . . . . . . . . . . . . 998

24-26

M-z. What 1s your main reason for not

clrink~nq?—

-2 F;U F,EEWWJT

NFI:E5SARY . . . . . . . . . . 1 (FJ’IRI f~)

Nv,T CARE TcI/[l IE,!. 11’E I T . . . . . . . . . . . . . . . . . 2 (PAtf

T NJ

fJF1-llrAl. /HEP1 1!+

IWATIN’-, . . . . . . . . . . . . . $

( rmrtl t:)

Ril 11-,Irlll</llrll{Jl

ltE4E,uN!i. .,......,..4 (PART N)

BRilUGHT UP MIT 1(3

DRAW . . . . . . . . . . . . . . $ (PARI M)

LiTHER (SPECIFY )......6 (PAF(l N)

M-10. Ouring the past 12 months, on about

~w many days dld you have at least~

—.

drinksd any alcoholic beverage.

(Iriclu,de th~.[sc ILJYS ~lready merltlo![!ed.)

-10 NONE . . . . . . . . . . . . 000 # DAYS: I Ill

ELK. . . . . . . . . . . . . . ‘?98 27 -., ,1

.11 MIRE. . . . . . . . . . . . . . 1

LESS . . . . . . . . . . . . . . 2

SAME . . . . . . . . . . . . . . 3

H-n. Oo you now drink more, less or

&out the same as you dida year ago?

30

31

32-33

34-35

36-37

OK,..., . . . . . . . . . . . . . . 8 (PART N) 1’

U-12. Oo you now consider yourselfa light,

moderate or heavy drinker?

-12 ABSTAINER . . . . . . . . . 1

LIGHT..,...,.,...,2

PJJOERATE . . . . . . . . . . 3

HEAvY . . . . . . . . . . . . . 4

=-’)1

H-3, Have you had at Irast one drink of

beer, wme or liquor during the

past year?

(GO TO SELF-ADMINISTRATION BOOKLET,

PAGE 7; RECORLT RESPONSES ON CHART.)

n4 . Mat is your main reason for

not drinking durinq the past

year?

4 Ml NE ED/NflT

NECESSARY . . . . . . . . . . 1 M-13. Now I would like you to think about

your drinkinq at several different

periods in your life. I cm interested in your drinking patterns

n

HANO at these periods. Look at this card. s Tell me the letter of the category

C~RO which best describes vour usual

-13A . . . . . . . . . . . . . . . . 01 8 . . . . . . . . . . . . . . . . 0’2 c . . . . . . . . . . . . . . . . 03 0 . . . . . . . . . . . . . . . . 04 E . . . . . . . . . ...! . . . 05 F . . . . . . . . . . . . . . . . 06 G. . . . . . . . . . . . . . . . 07

OK . . . . . . . . . . . . . . . 98

-14A . . . . . . . . . . . . . . . . 01 B . . . . . . . . . . . . . . . . 02 c . . . . . . . . . . . . . . . . 03 0 . . . . . . . . . . . . . . . . 04 E . . . . . . . . . . . . . . . . 05 F . . . . . . . . . . . . . . . . 06 G. . . . . . . . . . . . . . . . 07

OK . . . . . . . . . . . . . . . 98

DOW’1 CMfE TLU

DISLIKE I T . . . . . . . . . 2

MT) ICAL/HEALTH

REASONS . . . . . . . . . . . . 3

RELIGIOUS/MORAL

REASONS . . . . . . . . . . . . 4

BROUGHT UP NOT TO

BRINK...,., . . . . . . . . 5

OTHER (SPECIFY). . . . . . 6

~ drinkicq patter” when-ycw ware about

25 years old.

(IF~ IS 36 OR OLOER, ASK:)

M-14. How about when YOU were 35? P“”””””””””””””””””” 8

FM. About how old were you when you quit

drinking?

L5 IAGE: l_l

— I (Q.t4-13)

I&6. On the average, how often do you

drink alcoholic beverages, that is

beer, wine or liquor?

I-6# DAYSA WEEK I I I

,7_,”

——

OR

#DAYS AFYJNTHl ! I U 1’

H3RE THAN3 BUT

LESS THAN 12

TIMESA YEAR, .,.., 95

NO F43RE THAN3

TIMESA YEAR . . . . . . 96

M-1>. (IF~ 46 OR OLDER, ASK:) And when

you were 45?

L

k15A . . . . . . . . . . . . . . . . 01 B . . . . . . . . . . . . . . . . 02 c . . . . . . . . . . . . . . . . 03 0 . . . . . . . . . . . . . . . . 04 E . . . . . . . . . . . . . . . . 05 F . . . . . . . . . . . . . . . . 06 G . . . . . . . . . . . . . . . . 07

OK..., . . . . . . . . . . . 98

I

47

48
TIME BEGAN: AM

DM

%16., (IF ~ 56 OR OLDER, ASK:) And when

you were 55?

-16 A. . . . . . . . . . . . . . . . 01

B . . . . . . . . . . . . . . . . 02

c ................ 03

PART N:

r ,.!

NUTRITION

In this part of the interview 1 ‘m going to ask you some questions

about how often you eat certain foods and how your food is usually prepared.

In answering these questions, think about your eating pattern over the past

year.

—

—

You can answer by telling me the number of times per day, per weef,

per month or per year that you eat each food. If you haven’ t eaten that food

in the past year the answer would be “never.rr

38-39 NURSING HOME INSTRUCTIONS; CIRCLE ONE:

RESPONDENT CAN ANSWER THIS SECTION. . . . . . 1

D. . . . . . . . . . . . . . . . 04

E. . . . . . . . . . . . . . . . 05

F . . . . . . . . . . . . . . . . 06

G. . . . . . . . . . . . . . . . 07

H-17. (IF ~ 66 OR OLOER, ASK:) And when

YOU were 65? RESPONDENT CANNOT ANSWER THIS SECTION

Asw of NORSING HOME STAFF . . . . . . . . . . 2 (PART o)

c . . . . . . . . . . . . . . . . 03

0 . . . . . . . . . . . . . . . . 04

I

COOING GUIOE

E. . . . . . . . . . . . . . . . 05 I

F . . . . . . . . . . . . . . . . 06 I

THESE SYMBOLS ARE USEO IN THIS SECTION

D= AOAY Y ❑ A YEAR I

*

G . . . . . . . . . . . . . . . . 07

OK. . . . . . . . . . . . . . . 98 40-41

-18 A . . . . . . . . . . . . . . . . 01

B. . . . . . . . . . . . . . . . 02

c . . . . . . . . . . . . . . . . 03

D. . . . . . . . . . . . . . . . 04

I

W = A WEEK N = NEVER

M = A k13NTH DK . 00N’ T KNOW FREQUENCY I

I I

M-13. (IF ~ 76 OR OLOER, ASK:) And when

you were 75? N-1 . How often do you have the

following dairy products?

Include use as a beverage

or on cereal but not in

coffee or tea.

Begin N1

/1 OF

TIMES

a. l_l_l

E. . . . . . . . . . . . . . . . 05

F ................ 06

G ................ 07

r

.

1—

1—

1—

1—

1

T—

1—B

WMYNDK

23458

23458

23458

23458

23458

23458

23458

a. low fat milk, skim milk,

buttermilk or dry milk? 11-13

4,-43 b. whole milk or evaporated

milk?

?

b. t_l_l

c. l_l_l

d. l_l_l

14-16

17-19

20-22

(SHOW S IHE HIGHEST POINT ON THE

CHART ~D ASK QUESTION M-19)

H-19. Did you ever drink more than the

anount you drank when you were (AGE)

for 3 months or longer?

—

c. any kind of yogurt?

d cottage cheese?

-19 ‘YES ............... 1

No ................ 2 (PART N)

OK ................ 8 (PART N)

e. hard or soft cheese

including cheese dishes

such as macaroni and

. . cheese? e. l_l_l

f. l_l_l

23-25

f. ice crean? 2b-28

(IF HIGHEST POINT IS A, CIRCLE 97)

Which of the categories on the chart

g. crean, half and half,

or sour crean? M-20. r20 A ...... .......... 01

B ................ 02

g. l_l_l 29-31

best &scribes your drinking during

that period?

N-z . About how many servings per week

do you have of meat, fish or poultry?

Include all iwals and snacks. =-1”3 c. . . . . . . . . . . . . . . . 03

D . . . . . . . . . . . . . . . . 04

E. . . . . . . . . . . . . . . . 05

f ................ 06

G ................ 07

oK ............... 98

HIGHEST PT. IS A. 97

N-3. How often do you eat poultry including

chicken, turkey, duck, and game birds,

either plain or in salads, casseroles,

45-46 or stews?

-3 # OF TIMES: I I I 34-35

——

ADAY . . . . . . . . . . . . . . .. I

AWEEK..: . . . . . . . . . ...2

A tjONTH. . . . . . . . . . . ...3

AYEAR . . . . . . . . . . . . ...4

NEVER. . . . . . . . . . . . . . . . 5 (Q. N-5)

OK. . . . . . . . . . . . . . . . ...8 36

H-2*. About how old were you when you

started drinking that amount?

L21 AGE: Ill ——

OK ............... 98 1,7-48

*22., For about how long was this ,9-50

typical of your drinking?

1-22 # YEARS: Ill ——

OR

# NDNTHS: I——I I u ~1

OK. . . . . . . . . . . . . . . 98

I-4 WITH SKIN ............l

WITHOUT SKIN .........2

~ 37

w-f%. Oo you usually eat poultry with or

without the skin?

1

TIME ENOEO:

AN

49 PM

50
N-10. How often do YOU eat. . . . . IF ONLY

02

N-5. How often do you eat beef of al 1 N-5 # OF TIMES: I I I ,, .,.,

kinds includlng hamburger, ~t~,<k,

——

roast beef or beef strw? ADAY . . . . . . . . . . . . .. I

A wEtx . . . . . . . . . . ...2

A1.!iTNTH . . . . . . . . . . ..J

A YLAR . . . . . . . . . . ...4

NEVER . . . . . . . . . . . ...5 (fJ. N-7)

OK . . . . . . . . . . . . . . . . . !!

N-6. hhen you eat grounci b?et d,n ywJ

!Hldly h} I’~~lU18r, ]6?sUI C!r F,t T;l

lean? ‘%=== I IEXWTALEAN . . . . . . . . .

II CillE~:’T EAT . . . . . ...4

Ix . . . . . . . . . . . . . . . ..?i

N-7 . How often do you eat. .,,.

# OF

TIMEs

a. beef or chicken liver? a. l_l_l

b. liverwurst or liver sausage? b. [ I I ——

c. sandwich or packaqed luncheon

meats, hot dogs and meat

spreads? c. l_l_l

d. roast pork, pork chops,

fresh ham or spare ribs? d. l_l_l

e. bacon or pork sausage? e. 111 —— a

OWMYNDK

123458

123458

123458

123458

1 23450

I

aX L

INTERVIEWER: CHECK N-5 AND N-7d AND cIffCLE ONE: I

~ NEVER EATS OEEF ~ PORK (N-5 and N-7d = 5) . . l(Q.N-9)

OTHERWISE . . . . . . . . . . . . . . . . . . . . .2( Q.N.8)

N-fl. Da you usually eat the fat on beef N-8 YES.., . . . . . . . . . . ...1

cm pork? NO.., . . . . . . . . . . . ...2

I Id”””””””””””””””””’

N-9. How often do you eat . . . . .

# OF

lIHES

a. shellfish, including shrimp,

cl.ms, oysters, crab or

lobster? a. l_l_l

b. fresh or frozen fish,

including fish sticks? b. l_[_l

c. canned fish such as tuna

fish, sardines and herrtng? C. 111 —— ❑

DWMYNDK

12345R

12> 458

123458

# OF

TIMES

n. chicken, fish or

meat that has been

fried or deep fA

fried? a. l_l_l

b. chicken, fi!sh cm’

meat that has been

charcoal qr111ed7 b. l_l_l

c. chicken, fish m

meat that has been

broiled? c. l_l_[ a

CERTAIN

DWMYNDK TIMES

m

1 234580

123458 ()

12 34580

N-1 1. How often do you cat

peanuts or peanut butter?

l-l B%Bxl

ti-lz. How often do you eat other

nuts of all types?

l-l l%B%B

N-1 3. Do you eat cold cereal all year round, N-1 3 ALL YEAR ROUND. . ...1

maurly in cFiSGin seasons, or not at

all?

NAINLY IN CERTAIN

SEASONS . . . . . . . . . ...2

b7-7U

71-74

75-?6

79-81

82-84

I

NOT AT ALL . . . . . . ...3 (Q. N-16) 85

(In those seasone)

N-14. How often do you eat cold

cereal?

1-= ,-8

N-1 5. What is the nane of cold cereal that N-1 5 COOE #:1 I I

89-90

you eat most often? Looking at this

n

HAND card may help you. Please just tell OTHER (SPECIFY)

5 me the number,

C~RD

N-16, 011 you eat hot cereal or grits all N-1 6 ALL YEAR ROUND. . ...1

year round, %inly in certain seasons,

or not at all?

MAINLY IN CERTAIN

SEASONS . . . . . . . . . ...2

I

NOT AT ALL . . . . . . ...3 (Q. N-19) 91

I I

(In those seasons)

&l?, How often do you eat hot # OF

cereal?

,y, RmEFl ,2,*

51 52
# &.18. What kind of hot cereal do you N-If

usually eat? This list may make

n

HAND it easier to remember.

s

CiiRD

D

$/-19. How often do you eat . . . . .

# OF

TIMES

a. any kind of rice? a. [_l_l

b. pasta such as spaghetti,

noodles, macaroni? b. l_l_l

CREAM OF WHEAT/

FARINA . . . . . . . . . ..ol

OATMEAL. . . . . . . . . ...02

OARK FARINA/

RALSTON. . . . . . . . ..O3

GRITS . . . . . . . . . . . . ..O4

OTHER (SPECIFY) . . . .05

OK. . . . . . . . . . . . . . ...98

N-20. How often do you eat . . . . .

a. whole grain bread or rolls

such as whole wheat, bran,

rye, or pumpernickel?

b. white bread, rolls, or other

yeast breads including

bagels and English muffins?

c. quick breads such as muffins,

or biscuits, or flour

tortillas?

d. corn bread or hush puppies?

e. corn tortillas?

# OF

TIMEs

a. l_l_i

b. l_l_l

c. l_l_l

d. l_l_l

e. l_l_l

f. toaster tarts, breakfast bars

or instant breakfast? f. l_l_l

?5-95

7

)

—1

—1

—1

—1

1

—1 Iiil

w N Y N DK

23458

2 3458

2 3458

23458

23458

23458

1>3-lfi5

109-1, ,

,12-114

115-117

118-120

W-21. Now I ‘d like to ask you about fruits N-21 # PER OAY: I ] [ 121-122

and vegetables of all kinds. This

.—

includes fresh, canned, dried, frozen,

OR

cooked, raw or juices. About how many # PER WEEK: I I I ~ ,,,

servings of fruits and vegetables do

——

you have per day or per week?

OOESNrT EAT FRUIT

OR VEGETABLES . . . . . 96 (Q. N-z7)

N-22. Now 1am going to ask you how oftem you eat the following fruits. First,

tell me if you eat each fruit primarily during certain parts of the year.

Second, tell me how often you eat that fruit when you eat it. It may be

easier if yo” follow along on this card.

a

CA;O E

r

a.

b.

c.

d.

e.

f.

9.

h.

i.

k,

14

m.

n,

0.

P.

q.

# OF

TIMES

fresh apples? a. l_l_l

fresh pears? b. l_l_l

bananas? c. l_l_l

fresh oranges or tangerines? d. I——I I

orange juice? e. l_l_l

powdered orange juice substitutes such as Tang? f. l_l_l

fresh grapefruit? 9. l_l_l

grapefruit juice? h. l_l_l

Vitamin C enriched fruit

drinks? i l_l_l

fresh or canned peaches

or nectarines? j. l_l_l

cantaloupe? k. l_l_l

watermelon? 1. l_l_l

fresh plums? m. l_l_l

fresh or frozen strawberries? n. I——I I

fresh, canned or dried

apricots including nectar? 0. l_l_l

cooked or dried prunes including prune juice? P. l_l_l

all canned fruit such as

canned pears, pineapple,

fruit cocktail or apple

sauce? q. l_l_l

N-23. How often do you eat raw vegetables,

green or mixed salads or cole slaw?

OK. . . . . . . . . . . . . . . . 98

N-24. How often do you use salad dressing

of any kind?

53

N-25. Oo you usually use oil and vinegar

alone as a dressing, low calorie

dressing, or some other dressing?

54

Begin N2

IF ONLY

CERTAIN

TIMES

(4)

()

()

()

()

()

()

()

()

()

()

()

()

()

()

()

()

()

11-,4

43-46

71-7U

75-78

-23 # OF TIMES: I I I 79-80 ——

AOAY . . . . . . . . . . . ...1

AWEEK . . . . . . . . . . ...2

ANONTH . . . . . . . . . ...3

AYEAR . . . . . . . . . . ...4

NEVER. . . . . . . . . . . ...5 (Q. N-26)

OK. . . . . . . . . . . . . . ...8

81

-24 il OF TIMES: Ill 82-83

AOAY . . . . . . . . . . . . .. I

AWEEK . . . . . . . . . . ...2

AMONTH . . . . . . . . . ...3

AYEAR . . . . . . . . . . ...4

NEVER. . . . . . . . . . . ...5 (Q. N-26)

DK. . . . . . . . . . . . . . ...8 8Q

I-25 OIL ANO VINEGAR . . . .1

Lo! !YU3RIE . . . . . ...2

SOME OTHER KINO. . ..3 85
~. Now I’ m going to ask you how often you eat the following vegetables.

First, tell me if you eat each vegetable primarily during certain parts

of the year. Second, tell me how often You eat that vegeteble when you

eat it. It may be easier if you follow along on this card.

M. How often do you eat chocolate in # OF

the form of candy, cakes, ice

cream, cookies or fudge?

15, ~

?0-00

❑

HMO

C& F

a.

b.

c.

cl.

e.

f.

9.

h.

i,

j.

k.

1.

m.

n.

0.

P.

q.

r.

green peas?

qreen beans, green lima

beans or string beans?

other beans or peas such as

kidney or pinto beans, arwl

blazLe, rd ur chick peas?

okra?

broccoli?

cauliflower?

brussel sprouts?

corn?

sum+rer squash swh as

zwchini, or yellow crookneck?

winter squash such as acorn,

butternut, hubbard or

pumpkin?

raw or cooked carrots?

cucumber?

sweet red peppers?

sweet green peppers?

iceberg or head lettuce in

a salad?

leaf lettwe in a salad?

cabbage includic.g cole slaw?

raw or cooked areens. for

example spinacfi, coliards

or turnip greens?

s. sweet potatoes or yellow

yms?

t. instant or dehydrated

pot atoes?

u. baked, boiled or mashed

*it@ potatoes?

v. fried or hash brown

ptatoes?

w. fresh tmnatoes?

x. cooked tanatoes, tomato

soup, juice, sauce, or

canned tanatoea?

y. veget*le soup?

# OF

TIMES

a. l_l_l

b. i_l_l

c. l_l_l

d. l_[_[

e. l_l_l

f. l_l_i

g. l_l_l

h. l_t_i

i. l_l_l

j. l_l_l

k. l_l_l

1. i_l_l

m. l_l_l

n l_l_l

0. l_l_l

P. l_l_l

q. l_l_l

r. l_l_l

s. l_l_l

t l_l_l

u. l_l_l

v l_I_I

w. l_l_l

x. l_l_l

y. 111 ——

IF ONLY

CERTAIN

TINES

(i)

( ) 86-89

()

()

(1

()

()

()

()

( ) ,18-lZ,

Begin N3

( ) 11-14

()

()

()

()

()

()

()

()

()

()

()

()

()

()

( ) 7,-,,

How often do you eat all kinds of # OF

sweets and desserts such as cakes, TIMES DI wIMIYINIDK

donuts, codriea, pies, and candy? l_l_l 11213141518 ‘5-7’

,W. How often do you eat salty snacks # OF

such as ptato chips, pretzels, TIMES DI wIMIYINIOK

crackers, salted nuts, etc. ?

l_l_l 1121314151B ‘1-83

I&X On the average, how many eggs do you N-IO LESS THAN ONE A h’EEK...00

usuallY eat per week includiw dishes #OF EGGS pERWEEK:l I I

such as cmelettes and egg salad?

DOESN’T USE. . . . . . . ...96 8U-R5

~e How often do you eat TV type dinners $ OF

or other commercially prepared

frozen dinners?

,51 [~1 ,6-,,

.

~~ On the average, about how often d. # OF

you eat ccmcrcial fast food; for TIMES IDIWIM I YINIOK

example, hamburgers, fried chicken, , [ 1 ,

or pizza.? —— 12131415 El

89-91

=, How oft.” do you eat any mnbinatia. #OF

dishes with meat ~ cheese such as TIMES OIUIMIYINIOK

sp~hetti end mat balls, macaroni

and cheese. oizza. oork and beans. l_l_l 11213141518

and enchil~d~s? ‘ “

HOW often do you use. . . # OF

~

TIMES OH MYNOK

a. ketchup or tcmato chili

sauce? a. l_l_l 12345F3 9$-’37

b. chili pawder or hot red

chili peppers? b.l_l_l12345fJ 90-100

c. soy Saucw? C.]_l_l 127458 101-103

d. pickles or olives? d.l_l_l 123458 104-106

~, How often do you use cheese # OF

sauce, *ite 8auce or other

thick gravies? ,y, [~1 ,o,_,o,

,&#k, At how many meals pm day or par N-36 # OF FEALS

week do you add butter or

-arine to foods? PER OAY: Ill llU-111

OR

II PER WSEK: 11[ u 112

II DOESN’T USE. . . . . . . . . . 96 (Q. N-38)

; When you use it, do you usually use N-37 BUTTER. . . . . . . . . . . .. I

butter, margarine in a stick,

mcrgarine in a th, or something else? MARGARINE IN A

STICK . . . . . . . . . ...2

WARGARINE IN A TUB.3

OTHER (SPECIFY) . ...4

II OK., . . . . . . . . . . . . ...8 113

03

u 55 56
.- ——

K N-38, Not including potatoes, how often

do you eat vegetables. . . . . # OF

—F

TIMES

a. that are cooked or

boiled in a little

water?

k

a. l_l_l 1

b. steamed or blanched? b. l_l_[ 1

c. cooked or boiled in a

lot of water?

k

c. l_l_l 1

d. stir-fried or sauteed

in butter or oil? d. l_l_l 1

e. baked in a stew,

casserole, or in a soup? e. l_l_l 1

f. fried? f. l_l_l 1

— — H

~My NOK

23458

—23458

23458

23458

23458

23458

11.-116

117-1, .

120-12,

123-125

126-128

129-131

N-39. How often do you eat . . . . . # OF

‘m

TIMES D W MYNOK

Begin N4

a. canned vegetables? a. l_l_l 1 2 3 4 5 8 11-13

b. fresh or frozen

vegetables? b. l_l_l 1 2 3 4 5 8 14-16

—

?/-40. Look at the following list of fats N-40 OLIVE OIL ............. ....01

and oils. What type of oil or fat do

you usually use when frying foods at LIQUIO OIL OTHER THAN

❑

HAND home? OLIVE OIL . . . . . . . . . . . . ...02

s SOLID SHORTENING ., . . . . ...03

C~RO

G

MARGARINE IN A STICK . . . . . ,04

MARGARINE IN A TUB. . . . . . . .05

IBUTTER . . . . . . . . . . . . . . . . . . ..O6

LARD. . . . . . . . . . . . . . . . . . . ...07

BACON GREASE OR PORK

FAT . . . . . . . . . . . . . . . . . . . ..OB

OTHER (SPECIFY). . . . . . . . ...09

100N’T KNOW. . . . . . . . . . . . . . ..9B

NEVER FRY FOOD AT HOME... .96 ,,-1,

1 1

N-hi. On the average, how many ( a - e )

do you drink per day, week,

month or year? # OF

ORINKS

a. 91asses or cans of cOla type

soda, regular or diet a. l_l_l

b. cans or bottles of beer b. l_l_l

c. glasses of wine c. l_l_l

d. shots or drinks of hard

liquor, either straight or

in a mixed drink d. l_l_l

e. glasses or cans of diet

soda, including cola,

or any other artificially

sweetened drink e. l_l_l

IF ONLY

CERTAIN

TIMES

( ) 1,-22

( ) 23-26

( ) 27-30

( ) 31 3!+

( ) 35-38

:::::::::::~~

:~~~~ How often do you eat artificially # OF

““””””’”””’’””” sweetened foods or candies or add

artificial sweeteners to beverages

or foods? 1~1 m 39-”1

!@$$ Oo you drink coffee? N-43 YES. . . . . . . . . . . . . . .. I

NO. . . . . . . . . . . . . . ...2 (Q. N-44e)

h., I I

.

?=’% .................... Onthe average how many ( a - f ) 1} OF

do you drink per day, week, CUPS

month or year?

a.

b.

c.

d.

e.

f.

cups of instant

decaffeinated coffee . . l_l_l

cups of other instant

Cof fee b . l_i_l

cups of ground

decaffeinated coffee c. l_l_l

cups of other ground

coffee d. l_l_l

cups of herb tea e. l_l_l

cups of regular tea,

including iced tea f. l_l_l

43-.5

.6-4s

,9-51

52-54

55-57

58-60

S?QxM

INTERVIEWER: REVIEW N-43, N-44e, AND N-4&f ANO CIRCLE

ONE:

SUBJECT 00ES NOT DRINK COFFEE OR TEA [ N-43 = NO (2)

—ANO N-44e ANO N-44f = NEVER (5)] . . . . . . . . . . . . . . . . . . 1 (Q. N-46)

OTHERWISE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...2 (Q. N-45)

N-45. Which of these milk products do you

II

N-45 WHOLE MILK . . . . . . ..O1

n

usually put in your coffee or tea --

HANO whole milk, skim milk, low fat milk, SKIM MILK . . . . . . . ..o2

s half and half, creem or non dairy LOW fAT MILK.. . ...03

C~RO creamer?

H

HALF AND HALF. ....04

CREAM .............05

NONOAIRY CREAMER. .06

oTHER (5PECIFY).. .07

00ESN ‘ T AOO MILK

PROOUCT . . . . . . ...96

OK . . . . . . . . . . . . . ...98 61-62

H-46. Are you on any type of a special diet? N-46 YES...- . . . . . . . . . . . .. I

NO. . . . . . . . . . . . . . ...2 (Q. N-50) 53

%47. Was this diet prescribed for you by N-47 YEs . . . . . . . . . . . . . ...1

a doctor, nurse or dietic~

NO. . . . . . . . . . . . . . . ..Z 64

57 58
FM@. Are you on this diet because of...

a.

b.

c.

d.

e.

f.

hiqh blood pressure?

diabetes?

to 10SC weiqht~

food allergies?

heart disease?

srnm:ttung filse?

N-49 . What kind at diet is it. . .

a. low or no salt?

b. low sugar?

c. low calorie?

d. low fat?

e. smnethinq else?

N-SO. Are there sane foods that you are

unable to eat because you have

trouble chewirq or biticq?

N-51 . Oo any of the following problems

prevent you from eatirq the food

that you need. . .

a. problems getting to the store?

b. problems purchasing groceries?

c. problems storinq food?

N-52 . Do you usually eat your main meal

alone or with other people?

%5S. How often do you eat breakfast -

alnmst everyday, sometimes, rarely

or never?

N-54. Including evening snacks, how many

between wal snacks do you have per

day?

N-55. How many meals do you usually eat a

day? —

-48

a

b

c

d

c

f

I-45

a

b

c

d

e

1-5[

&5

a

b

c

4-5

—

~-5

V-5

V-5

—

YNDK -.—

12FJ 65

G 6

12 H

12 n

,, >

128 r,a

128 b?

1 2 Ii , r,

,....................

IX%3 DOYOUusc salt at the table or N-56 YES . . . . . . . . . . . . . . . 1

m couklnq? ND . . . . . . . . . . . . . . . . 2 (PART 0) ,0

1 I

::=.= .::

Hf+ziii k It1od1zed7

........ ...

N-57 YES.., . . . . . . . . . . . . 1

I IND. . . . . . . . . . . . . . . . 2

I

DO . . . . . . . . . . . . . . . . 8

91

I 1

: .................

:~~i How t“requently do you use salt at # OF

.-...... . . .

the tableT

l-l BzB333

.,-. .

-7,-7>

.. .

YN y

--

1 zn ,,

128 7.

128 75

128 ,fi

128 7,

+

(sPECIFY)

w 78-7’3

fES . . . . . . . . . . . . . . ..l

JO. . . . . . . . . . . . . . ...2

12 8

12s

128

\LONE . . . . . . . . . . . . ..l

OTHER PEOPLE . . . . . ..2

4Lt43ST EvERYDAY. . ..1

SOMETIMES . . . . . . . ...2

RARELY OR NEVER . . . . 3

# OF SNACKS: I—— I I

# OF WALS: I——I I

TIME ENDED: AM

PM

59 60
TIME BEGAN:

AM

PM

PART O: SLEEP

Now I ‘d like some information about how you sleep. Begin 00

0-1. Please look at Column I on this card.

How often do you have trouble falling

asleep? Would you say it is never,

n

HAND rarely, sometimes, often, or almost

s always?

C~RD

I

D-2 . How often do you have trouble with

waking up during the night? (Would

you say it was never, rarely, scmnetimes, often, or alrrmst always?)

0-3. How often do you have trouble with

waking up too early and not being able

to Fall asleep again? (Would you say

it is never, rarely, sometimes, often,

or alnwst always?)

o-4. How often do you get so sleepy during

the day or evening that you have to

take a nap? (Is it never, rarely,

sometimes, often, or almost always?)

Now look at Column II.

0-5, Conpared to one year ago, do you have

sleep problems much more now, somewhat

nmre now, somewhat less now, much less

now or is your sleeping pattern about

the sane?

O-6. How often do you usually take a

sedative or sleeping pill that has

been prescribed by a doctor to help

you sleep?

o-7. How many hours ;f. sleep do you

usually get a night (or when you

usually sleep)?

-1 NEVER. . . . . . . . . . . . . . . . . 1

RARELY. . . . . . . . . . . . . . . . 2

SOMETIMES . . . . . . . . . . . . . 3

OFTEN. . . . . . . . . . . . . . . . . 4

ALMOST ALWAYS. . . . . . . . . 5

DK. . . . . . . . . . . . . . . . . . . . B

11

L__

-2 NEVER. . . . . . . . . . . . . . . .

RARELY. . . . . . . . . . . . . . .

SOMETIMES . . . . . . . . . . . .

OFTEN. . . . . . . . . . . . . . . .

ALMOST ALWAYS. . . . . . . .

DO. . . . . . . . . . . . . . . . ...’

1

2

3

4

5

8 12

-3 NEVER. . . . . . . . . . . . . . . . . 1

RARELY. . . . . . . . . . . . . . . . 2

SOMETIMES . . . . . . . . . . . . . 3

OFTEN. . . . . . . . . . . . . . . . . 4

ALMOST ALWAYS. . . . . . . . . 5

DO. . . . . . . . . . . . . . . . . . . . B 13

-4 NEVER. . . . . . . . . . . . . . . . . 1

RARELY. . . . . . . . . . . . . . . . 2

SOMETIMES . . . . . . . . . . . . . 3

OFTEN. . . . . . . . . . . . . . . . . 4

ALMOST ALWAYS. . . . . . . . . 5

DO. . . . . . . . . . . . . . . . . . . . 8 lb

-5 MUCH M3RENOW. . . . . . . . . 1

SOMEWHAT t.’i2RE NOW. . . . . 2

SOMEWHAT LESS NOW. . . . . 3

MJCHLESSN OF. . . . . . . . . 4

ABOUT THE SAME. . . . . . . . 5

DO. . . . . . . . . . . . . . . . . . . . 8 1s

-6 NEVER. . . . . . . . . . . . . . . . 00

# TIMES: I_I_] 16-17

(CIRCLE ONE)

WEEKLY. . . . . . . . . . . . . . . . 1

ki3NTHLY. . . . . . . . . . . . . . . 2

YEARLY. . . . . . . . . . . . . . . . 3

DO. . . . . . . . . . . . . . . . . . . . 8

18

‘-7

# HOURS: l_l_l

19-20

Part P: TRAITS

Begin PO

P-1 . %netimes people have things they P-1 A LOT OF THE TIME. 1

want to do but they just feel too

weak, too tired or they dent t have SOME OF THE TIME.. 2

enouah enerov to do them. How ONCE IN AWHILE . . . . 3

ofte; do YO;, feel this way -- a lot

of the time, some of the time, once

NEVER. . . . . . . . . . . . . 4

in awhile, or do you never feel this

way?

Now 11m going to read you some traits some people have. Using the

categories on this card, please tell me how well these traits describe

M y.”. The first trait is . . . . .

l-l cm)

J

rFT=FT=

P-2 . Having a strong need to excel

or be best in most things. P-2 1 2 3 4

P-3 . Usually feeling pressed for time. P-3 1 2 3 4

P-4. Being hard driving and competitive, P-4 1 2 3 4

P-5. Eating too quickly. P-5 1 2 3 4

P-6. Getting upset when you have to

wait in line? P-6 1 2 3 4

OK

8

8

B

8

8

Now I’m going to read some statements. Don’t worry about the exact meaning of

these statements, just give me your first impressions. Using the categories on

this card, I ‘d like you to tell me if you strongly disagree, disagree, feel

neutral, agree, or strongly agree with each statement.

P-7 . I like to have a lot of P-7 STRONGLY OISAGREE. 1

people around me.

•1

HPND DISAGREE . . . . . . . . . . 2

FEEL NEUTRAL. . . . . . 3

C;RD

K

AGREE. . . . . . . . . . . . . 4

STRONGLY AGREE. . . . 5

11

12

13

14

15

16

17

62
P-8. I am a cheerful, high-spirited person.

P-9. I don’t qet much pleasure from

chatting uith p?nple.

P-lo. I am a wry :ict ivept!rsun.

P-1 1. I prefer jobs that let me work

without being bothered by other

people.

P-12. I have strong smotional attachments

to my frisnds.

P-13. I an daninant, forceful, and

assertive.

?-14. I have somstimes done thinqs just

for “kicks” or “thrills.’]

P-15. I don’t like to waste my time daydres$ning.

9 STRONGLY DISAGREE. 1

DIsAGREE . . . . . . . . . . 2

FEEL NEUTRAL. . . . . . 3

AGREE . . . . . . . . . . . . . 4

SIRONGLY AGREE . . . . 5

9 STRONGLY DISAGREE. 1

DILMxEC.......,.. Z

FEEL NEL!TRAL. . . . . . 3

AGREE . . . . . . . . . . . . . 4

STRONGLY AGREE . . . . 5

10 5TRIIWI.Y c11Y4HtEt:. 1

D15KFKE. . . . . . . . . . z

FEEL NEUTRAL. . . . . . 3

AGREE . . . . . . . . . . . . . 4

STRONGLY AGREE. . . . 5

11 STRONGLY DISAGREE, 1

DISAGREE . . . . . . . . . . 2

FEEL NEUTRAL. . . . . . 3

AGREE . . . . . . . . . . . . . 4

STRONGLY AGREE. . . . 5

12 SIRONGLy DISAGREE, 1

DISAGREE . . . . . . . . . . 2

FEEL NEuTRAL . . . . . . 3

AGREE . . . . . . . . . . . . . 4

STRONGLY AGREE. . . . 5

13 STRONGLY DISAGREE. 1

DISAGREE . . . . . . . . . . 2

FEEL NEUTRAL. . . . . . 3

AGREE . . . . . . . . . . . . . 4

STRONGLY AGREE. . . . 5

14 STRONGLY DISAGREE. 1

DISAGREE . . . . . . . . . . 2

FEEL NEUTRAL. . . . . . 3

AGREE . . . . . . . . . . . . . 4

STRONGLY AGREE. . . . 5

1 5 STRONGLY DISAGREE. 1

DISAGREE . . . . . . . . . . 2

FEEL NEUTRAL . . . . . . 3

AGREE . . . . . . . . . . . . . 4

STRONGLY AGREE. . . . 5

P-16. Poetry has little or no affect

on me.

P-17. I often try new and foreign foods.

P-in. I’m pretty set in my ways.

P-19. 1 enjoy solving problems or

puzzles.

P-20. I have a very active imagination.

2,

?3

,Ii

25

.16 STRONGLY OISAGREE. .1

OISAGREE . . . . . . . . ...2

FEEL NEUTRAL . . . . ...3

AGREE . . . . . . . . . . . ...4

STRONGLY AGREE. . ...5

I

.17 STRONGLY DISACREE. .1

DISACREE . . . . . . . . ...2

FEEL NEUTRAL. . . . ...3

AGREE . . . . . . . . . . . ...4

STRONGLY AGREE . . ...5

C

-18 STRONGLY OISAGREE. .1

DISAGREE . . . . . . . . ...2

FEEL NEUTRAL. . . . ...3

AGREE . . . . . . . . . . . ...4

STRONGLY AGREE. . ...5

-19 STRONGLY DISAGREE. .1

01 SAGREE . . . . . . . . ...2

t

FEEL NEUTRAL. . . . ...3

AGREE . . . . . . . . . . . ...4

STRONGLY AGREE. . ...5

-20 STRONGLY DISAGREE. .1

DISAGREE . . . . . . . . ...2

FEEL NEUTRAL. . . . ...3

AGREE ., . . . . . . . . . ...4

STRONGLY AGREE. . ...5

I

26

27

28

29

30

m

-J

.53 64
co

m I

I

PHYSICAL MEASUREMENT INTRODUCTION

I mentioned earlier that I would be measuring your pulse, blood pressure,

and weight as a part of the interview. I would like to start the procedure

now. As part of this procedure; you need to remain relaxedand seated for

about fifteen ( 15) minutes. Ouring this time, we will finish the questionnaire. If there are things you need to do before we start, such as going to

the bathroom, I would like you to do that now. I would also suggest that

should the phone or doorbell ring that 1 answer it for you. Would tha: be

all right? [IF NECESSARY, ASK ~ TO MOVE TO A sUITABLE LOCATION TO TAKE THE

BLOOO PRESSURE READING. 1

Various factors such as smoking, drinking alcohol and drinking coffee

can affect your pulse and blood pressure. Therefore,I would like to request

that you do not smoke or drink coffee (or alcohol)during this time. Also,

have you had any alcoholic beverages within the last 24 hours? [RECORD ON

PMR. ]

Now , I would like to explain what I am going to do. First, I will

find the pulse in your right arm. Next, I will wrap the blood pressure cuff

around your arm. At this point, we will finish the questicmaire. At the end

of the interview, I will take your pulse and then inflate the cuff. You will

feel a sensation of pressureon the arm when the cuff is inflated, and I will

be inflating the cuff a maximum of five times. While I am measuring your

blood pressure, I would like to avoid any conversation. I will be happy to

answeryour questions before or after measurements are taken.

Is there any medical reason you know of why this procedure should not

be done?

[IF YES, RECORD ON PMR AND DISCONTINUE PROCEDURE AND CONTINUE WITH THE

QUESTIONNAIRE.

OTHERWISE, ASK S TO REMOVE ANY OUTER CLOTHING/JEWELRY AND TO ROLL UP

SLEEVE . OBSERVE SUB~ECT’ S ARM FOR CONDITIONS PREVENTING MEASUREMENT. IF

CONDITIONS ARE PRESENT, RECOF.U ON PMR AND DISCONTINUE PROCEDURE. 1

Have you had any needles or tubes in any veins in your arms in the

last week? [IF YES, RECENKI ON PMR AND DISCONTINUE IF OQTH ARMS ARE AFFECTED. 1

Then I will go ahead and locate your pulse and place the cuff now.

[PLAcE cuFF.]

PART Q: PHYSICAL ACTIVITY

Begin QO

BOX N

INTERVIEWER:

IF S IS UNABLE TO WALK CHECK THIS BOX 1:1 ANO GO TO PART R;

OTH~RWISE CONTINUE.

These next few quest ions concern physical activity.

Q-1 . In things you do for recreation, Q-1

for example, sports, hiking, dancing,

etc. , do you get much exercise,

moderate exercise,little or no

exercise?

1

Q-2 . In your usual day, aside from Q-2

recreation,are you physically

very active,moderatelyactive,

or quite inactive?

Q-3. Do you followa regular programof Q-3

physicalexe~

Q-4. Do you regularly jog as part of Q-4

this program?

MJCH EXERCISE . . . . . . . . . . . . 1

M30ERATE EXERCISE . . . . . . . . 2

LITTLE OR NO EXERCISE . . . . 3

VERY ACTIVE . . . . . . . . . . . . . . 1

WJOERATELY ACTIVE . . . . . . . . 2

QUITE INACTIVE . . . . . . . . . . . 3

YES. . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2 (PART RI

11

12

13

14

YES. . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (PART R)

15

# MILES/WK: 1111 ———

OK. . . . . . . . . . . . . . 99B

16-18

65

66
PART R: TEETH

These next questions are about your teeth.

PART S: HEARING

!@w 1 ‘m going to ask you same questions about your hearing.

BeginEm Begin SO

-

.1

—

.2

—

-3

—

.4

—

-5

—

-6

—

-7

—

-8

—

-9

a

b

c

d

—

.

.1

—

-2

.

-3

—

-4

—

-5

—

-6

—

R-1 . Have you lost all your teeth from your

upper jaw?

YES ............... 1

No. . .............. 2 (Q. R-4) ~,

YES . . . . . . . . . . . . . . . 1 (Q. R-4)

NO . . . . . . . . . . . . . . . . 2

12

s-1. At any time over the past few years,

have you ever noticed a ringing in

your ears?

:s. . . . . . . . . . . . . . . 1 .

. . . . . . . . . . . . . . . . 2 (Q. S-4)

11

12

13

14

15

16

17

18

19

20

21

22

R-2 . Do YOU have a plate or false teeth

for your upper jaw?

s-2. Da yau natlce this ringing all the

time, every few days or less often?

.L THE TIME . . . . . . 1

IERY FEW OAYS. ... 2

:SS OFTEN ... .... . 3

R-3 . How long has lt been since you have

had any teeth to chew with, natural

or False, in your upper jaw? (REAO

CATEGORIES IF NECESSARY. )

LESS THAN A YEAR ......... O

1 BUT LESS THAN 5 YEARS.. 1

5 BUT LESS THAN

10 YEARS ............... 2

10 BUT LESS THAN

20 YEARS ............... 3

200 RNBRE ............... 4

OK ....................... 8 13

s-3 . When it does occur, does it

bothm yQIJ quite a bit, just

a little or not at all?

JITE A BET .. ..... 1

J5T A LITILE ..... 2

IT AT OIL ........ 3

:s............ ... 1

1................ 2 (Q.S-B)

s-4. Have you ever used a hearing aid?

s-5. Have you ever used a hearing aid for

your left ear, right ear or both

ears?

:FT EAR ..... ... .. 1

[GHT EAR . . . . . . . . . 2

)TH . . . . . . . . . . . . . . 3

R-4 . Have you lost all your teeth from your

lower jaw?

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (BOX O) ,U

R-5 . Oo you have a plate or false teeth For

your lower jaw?

YES ............... 1 (BOX O)

NO . ............... 2

15

S-6. Oo you use a hearing aid now? :s. . . . . . . . . . . . . . . 1

1. . . . . . . . . . . . . . . . 2

R-6. How long has it been since you have

hed any teeth to chew with, natural

or false, in your lower jaw? (REAO

CATEGORIES IF NECESSARY. )

LESS THAN A YEAR ......... 1

1 BuT LESS THAN 5 YEARS.. 2

5 BUT LESS THAN

IO YEARS...,, . . . . . . . . . . J

10 BUT LESS THAN

20 YEARS . . . . . . . . . . . . ...4

200 RNORE . . . . . . . . . . . . . . . 5

OK . . . . . . . . . . . . . . . . . . . . . . . 8

16

s-7 , (Ooes/Oid) it improve your hearing

not very much, somewhat or very

much?

IT VERY MUCH ..... 1

IMEWHAT .......... 2

;RY MUCH ......... 3

s-8. In a normal conversation with several

persons, are you able to hear well

enough to understand what is said,

without difficulty, with some difficult~, with much difficulty, or are

ITH NO DIFFICULTY . . . 1

ITH SOME DIFFICULTY. 2

ITH NUCH DIFFICULTY. 3

NOBLE . . . . . . . . . . . . . . . 4

you ~nable to understand a~” all (even

using your hearing aid)?

s-9 . (Without a hearing aid), can YOU Box o

INTERVIEWER: CHECK Q. R-2 ANO R-5 TO SEE IF S

HAS OENTAL PLATES ANO CIRCLE ORE:

R-2 OR R-5 = YES (1) . . . . . . 1 (Q. R-7)

OTHERWISE. . . . . . . . , . . . 2 (Q.R-B)

usually hear and understand what a

!xxson savs without seeino his or.

her face?” —YES NO ~

I (PART T) T 8

I (PART T) 2 8

a. If that person whispers to you

from across a q-m?

b. If that person talks in a

normal voice to you from

across a quiet room?

c, If that person shouts to you

from across a q=oom?

I (PART T) 2 8

I (PART T) 2 El

R-7. Oo you think that you need (a) new R-7

I

w, NEEO NEW pLATE. . 1 (PART s)

dental plate(s) or that the one(s)

you have need(s) refitting? YES, NEEO REFITTING. . 2 (PART S) d. If that person speaks loudly

into your better ear? II No ................... 3 (PART5)

OK . . . . . . . . . . . . . . . . . . . 8 (PART s)

17

R-8 . Oo you use fluoridated toothpaste? R-B YES..., . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . 2

18

03

m 67 68
co

0

S-@. (Without a hearing aid), can you

usually. . .

a. Tell the sound of speech from

other sounds or noises?

b. Tell one kind of noise from

snot her?

c. Hear loud noises?

—

-10

a

b

c

YES NO DK

. —

I (PART T) 2 8“ 23

I (PART T) 2 8

24

1 2 8

25

PART T: VISION

Now, 1 am going to ask you questions concerning your vision.

Begin TO

T-l’. Are you totally blind in either eye?

T-2 . Which one?

“(-3 . Do you wear eyeglasses or contact

lenses?

T-4. How old were you when you first

started wearing glasses or contact

lenses?

T-5. Do you use a magnifying glass for

reading?

T-6. Do you use a magnifying glass for

reading all the time, most of the

time, some of the time or hardly

ever?

T-7. (When wearing eyeglasses/contact

lenses) can you see well enough to

recognize a friend. ..

a. across the street?

b. across the room?

c. at arms length?

T-8 . (When wearing eyeglasses/contact

lenses) can you see well enough.. .

a. to recognize the letters in

ordinary newspaper print?

b. to recognize the letters in

a headline?

c. to tell if a light is on or

off in a room?

-1 YES ................I

No .................2 (Q.T-3)

DK .................LI (Q.T-3)

-2 RIGHT ..............I

LEFT ...............2

BoTH ...............3 (pA6T u)

-3 IYES

INO.::::::::::::::::; (Q.T-5)

I

-4 IAGE: I II

\DK ................98

I

-6 ALL THE TIME .......I

,W’T OF THE TIME...2

ISOME oF THE TIME...3

\HARDLY EVER ........4

-7 !YES

1– ‘M

dI (Q.T-B) 2 8

bl 2B

c 1 28

-B YES ~ u

—

a I (PART u) 2 8

b 1 (pART u) 2 8

c 1 2B

11

12

13

14-15

16

17

]8

19

20

21

22

23

(,~

70
PART U: BACKGROUND INFORMATION

In this section

I ‘m going to esk you scme questions about your

0UTIE5: # YR5: Ill——

EMPLOYER:

SELF EMPLOYED . . . . . . . . . . l_l

BUSINESS/INOUSTRY:

YES . . . . . . . . . . . . . . . 1 (Q. U-27)

NO . . . . . . . . . . . . . . . . 2

YES . . . . . . . . . . . . . . . 1

Nu . . . . . . . . . . . . . . . . 2 (Q. U-21)

YR:II 191 I t

YES . . . . . . . . . . . . . . . 1

NO., . . . . . . . . . . . . . . 2 (Q. U-20)

YES . . . . . . . . . . . . . . . 1

NO, . . . . . . . . . . . . . . . 2 (Q. U-20)

YEs . . . . . . . . . . . . . . . 1

FKl . . . . . . . . . . . . . . . . 2

YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2

WORKING . . . . . . . . . . . 1 (Q. U-23)

RETIRED . . . . . . . . . . . 2

KEEPING HOUSE . . . . . 3

STUDENT . . . . . . . . . . . 4

LOOKING FOR WORK..5

OTHER (SPECIFY) . . . 6

—

.10 —

.11

u-lo. What were your most important

activities or duties as a(n)

(OCCUPATIONI : For example, sell cars,

keep account books, sweep floors?

backgrmnd. Begin UO

u-1 . I.kJst oeoole in the United States have -1 01 02 03 04 05 06 07

mceskor; who came from other parts of

the world. Here is

a card listing somf

1

HANO ethnic backgrounds. hhich of these 5 groups best describe

C~Rf3 ground? (RECORO ALL L

OB 09 10 11 12 13 14

your ethnic backTHAT APPLY. )

15 16 17 It? 19 20 21

u-1 1. For how many years have you worked as

a(n) (occupation)?

26-29

,0-3Z

93

34

35-38

39

40

41

42

*3

1222324252627

OTHER (SPECIFY).. 2R I-L-III-12

L..LI13-14 U-12. While employed as a(n) (OCCLIpATION),

what was the name of the employer

far whom you worked the =?

.12

U15-16

Ix............... 98 -17-18

u-2 . Look at this card. Which of these

categories best describes you?

-2 AL’iUI, ESKIMO or AMERICAN

It.U)IAN.., . . . . . . . . . . . . 1

ASIAN/PACIFIC ISLANOER.2

BLACK . . . . . . . . . . . . . . . . . . 3

WHITE . . . . . . . . . . . . . . . . . . 4

n oTHER (spEcwy)

........5

HANO

C;ROn

U-13. What kind of business or industry

was that employer in, thati is, what

does the company or your part of the

company do or make? For example,

autmobile manufacturing, state labor

dept., dairy farming, retail shoe

sales?

-13

19

20

21

22

23

24

1

-3

-4

HARRIED . . . . . . . . . . . 1

WIDOWED . . . . . . . . . . . 2

DIVORCE., . . . . . . . . 3

SEPARATE . . . . . . . . . 4

U-Y. Are you now married, widowed, divorced,

separated or have you never been

married?

0-14. Do YQU still work for (EMPLOYER) 8S

a(n) (OCCIJPATION)?

-10

U-15. Have you stopped working at or

retired from your usual job or

occupation?

-15 z—

-17

NEVER MARRIED . . . . . 5

L&& Would you say that you have lived most

of your life ina rural area, in tcity or in the city suburbs?

ROR4L . . . . . . . . . . . . . 1

0-16. In what year was that?

CITY..,,.... ..o...2 (Q. u-6)

CITY SUBURBS . . . . . . 3 (Q. u-6) U-1?. Oid you stop working because of

reasons related to your health?

u+. When you lived in

a rural area did

you live ona farm?

-5 YEs . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 L!-18. Did you receive disability

benefits from Social Security

at that time?

-1E

—

-15 .

-2[ —

-21

W& In the area where you lived most of

your life, *at was your primary

source of drinkirq water: a canmunity supply, a private well,

a

spring or some other source?

-6

CDWtllNITY . . . . . . . . . 1

PRIVATE WELL . . . . . . 2

SPRING . . . . . . . . . . . . 3

OTHER (SPECIFY) . . . 4

-7 STATE:

-B YES . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . 2 (Q.u-21)

U-19. Are you still getting them?

U-20. Oid you stop work at your usual

occupation voluntarily?

U-z. In what state were you born? 0-21. These next questions are a!mut your

current status. During the last

three months, what have you been

doing most: working, retired,

keeping house, going to school or

looking for work?

~., Have YOU ever worked ata job ora

business full time or part time for a total of more than a year?

,= ~atkind ofhurkhave youdo”e for

the longest period of time? What was

your occupation or complete job title?

-9 OCCUPATION/JOB TITLE:

For examrJe, caroenter. secretacv. .

electrical engineer.

,,

w
U-22. During the last three months,

have you worked at all at a

job or business?

U-23. What kind of work are you doing?

What is your occupation or complete

job title? For example, carpenter,

secretary, electrical engineer.

U-24. What are your most important

activities or duties? For example,

sell cars, keep account books,

sweep floors.

U-29. What is the nmne of your employer?

U-26 . What kind of business or industry

is that employer in, that is, what

does the company or your part of the

company, do or make? For example,

automobile manufacturing, state labor

dept. , dairy farming, retail shoe

sales.

u-2?. On the average, how many hours a week

do YOU work W3 a(n) (occupation)?

.22 YES . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . 2 (BOX P) ‘U

.23 oCCUPATION/JOB TITLE:

~ ~5-b7

-24 oUT IES :

-25 EMPLOYER:

sELF EMPLOYEO. . . . . . . . ..l_l

-26 BUSINESS/INOUSTRY :

L.L—l.J 48-50

-2 7HR/wK: I—— I I

51-52

I

Inx P

INTERVIEWER: CHECK Q.U-8 ANO CIRCLE ONE:

Q. U-8= YES (l). . . . . . . . . 1 (Q.U-28)

Q. U-B =NO (2) . . . . . . . . . Z (Q.U-Z9)

I&$%. Have you ever worked at an occupation U-2B YES ............... 1

in which ~were heavily exposed to

dusts, fumes, or vapors? NO. . . . . . . . . . . . . . . . 2

OK. . . . . . . . . . . . . . . . 8

53

‘IJ-29.; Have y..~had a hobby in which YOU U-Z9 yEso.....c.....c.. 1

were heavily exposed to dusts, fumes,

or vapors?

NO. . . . . . . . . . . . . . . . 2

oK ................ 8

5U

U-30.

E

HPNO

s

C~RO

N

Please look at this card. Which Of

these income groups represents your

total combined family income for

1

the past 12 months? Include income

from all sources such ae wages,

salaries, social security or retirement benefits, help frOm relatives,

rent from property and so forth.

U-31 . Please look at this card again. Which

of these income groups represents your

personal income for the past 12 months?

~ncome fro~

such as wages, salaries, social security or retirement benefits, help from

relatives, rent from property and so

forth.

U-32. Ouring the past 12 months, did you

receive personal income frmn the

following sources?

a. Wages or salary?

b. Social security or railroad

ret irement?

c. Welfare payments or other

public assistance such

as aid to failies with

dependent children, old

age assistance or aid to

the blind or totally

disabled?

d. Unemployment ccinpensation

or workmen’s compensation?

e. Govemnent employee pensions

or private pensions?

f. Net inccme from a farm?

g. Veterans’ payments?

h. Alimony or child support?

i. Other money contributed frcm

persons not living in the

household?

j. Investments?

k. Anything else?

U-33. (IFS IS FEMALE, ASK:) Please tell

m your father’a last name?

1

}0

-

31

—

32

a

b

c

d

e

f

9

h

i

j

k

—

-33

—

.. 01 H... 08

. . 02 I... 09

.. 03 J... 10

.. 04 K... 11

.. 05 L... 12

.. 06 M... 13

.. 07 N... 14

OK.. 9B

.. 01 H... OB

.. 02 I... 09

.. 03 3... 10

.. ok K... 11

.. 05 L... 12

,.. 06 M... 13

.. 07 N... 14

DK.. 98

YE5 —

1

1

1

1

1

1

1

1

1

1

. i

—NO

2

2

2

2

2

2

2

2

2

2

2

OK —

8

8

8

8

8

8

8

8

8

8

8

(SPECIFY)

AME :

J5-56

57-5e

59

60

61

62

63

64

65

66

67

68

69

M 70

?: -85

I 1 1 I 1 r 1 I 1 1 1 1 1 r 1 I

73 74
u-34. My supervisor, as part of a validation procedure, may be contacting you

in the near future to make sure thot

I conducted this mtervlew. I’d like

to (con finm/have) your telephone

number, starting with the area code.

(IF NOPHONE, RECORD AREA CODE. ) I

u-34 I I I l-l I I l-l_ I_l_l_l

7EFUSE : 99vWY3W6 ,

KIXQ

INIERVIEiiER: CWECK PRIMARY RESPCNW)ENT AND IF P OR S WITH AS51S1ANCE, RECCIFTI

NAW, RELATIONSHIP AND TELEPHONE–NlJ4B~R AND WHY PROXY/

ASSISTANCE HAS ILISEII.

RELAIION- PHIMllRv

NAHE SHIP TO S IELEFHONE (f)

—

s ()

~ #l () ()

‘~#2 () ()

S WITH

iiSSISTANCE #l () I () I

I

I 1 I I

I

S WITH

%sIsTANCE #2 () I () I

I I i ,

IF PROXY OR ASSISTANCE: STATE REASON WHY PRf)XY/ASSISTANCE HAS NEEDED:

TIHE ENDED

AM

Pn

NWtUZAIItPJfWl STATEKNT

,lTha”k you very m~h for taking the time to participate in this

interview. In connection with the medical history that you have qiven us,

as part of this survey, it m8y be necessary to obtain additional or more

technical information frun staFf or records in hospitals or other in-patient

Facilities. This form authorizes the U.S. Public Health Service to obtain

this information. As with all of the information you have given us, this

information will be kept confidential and used only for statistical purposes. ” (HAVE ~ SIGN FORM)

[TAKE PHYSICAL 14cAsoREt4ENT REPOINGS]

WFICE USE ONLY:

PR : l_l

REL : I II

l_l

-,,

96-10?

101

102-103

10’.

OBSERVAT ION SHEET

I INTERVIEWER: COMPLETE AT CONCLUSION OF INTERVIEW I

:.:.., .,.........

~~~! Oo YOU feel that the information provided by the Subject or Proxy was ‘

sat iafactaryq

Was. . . . . . . . . . . . . . 1 (Q.OS-3)

NO . . . . . . . . . . . ...2 105

:,:.:.XSY.X

,.fW~: If not, why not?

. .......... ..

........ .,

!Mx$; Please circle the number that best de=ribe~ the subject’s awareness

““””””’”’”””””’”’”’”’ level during the intekview.

1 2 3 4 5

l—l —l— l— I

Very very

Alert Confused

g

SUBJECT NOT OBSERVED BY INTERVIEWER . . . . . . . . . 0

COMMENTS:

~,..,.,:...

.:~i: In regard to the questionnaire do you feel the questionnaire:

,,.,.,...............

. . . . . . . . . .

—YES

a, held the respondent’s attention

throughout the interview?. . . . . . . . . . . . . 1

b. was upsetting or depressing to

the respondent? . . . . . . . . . . . . . . . ...1

c. was boring or uninteresting to

the respondent? . . . . . . . . . . . . . . . . . .1

—NO

2

2

2

(IF YES TO bOR c):

fjii Was there a section that =med to be particularly uPsetting or PrOblem-

““’””””’””””” ““’ at ic for the respondent? 1 f so, note below.

fwi Record w relevant observations, cm~nts or iwre=i- YOU may have

‘“’”””””””’-”-””’””.’ had about this interview.

106

75

76 ,,, . . ?,”., ””,,,, ,,,,4,,,,, “,,1!3 : ,,!, , !1 <. !-*$ “
w

*

CHECK LIST FOR F!HYSICAL MEASUREMENTS

FUJIse & B1ood Pressure Preparation

1. Read the Physical Heasurmnts Introduction. Ask subject if has any

problems that would inhibft the reading.

2. Positicm the subject.

3. Locate radial and brach ial PU1se.

4. Select and PI ace the cuff.

5. Continue interview for fifteen minutes.

Pulse & B1ood Pressure Heasurment

6. Obtain resting pulse anrJ rec~~d.

7. Obtain HIL, deflate rapidly, disconnect the mancowter tubing a“d record.

8. Hait thirty seconds.

9. Place stethosco~ in ears, ear pieces turned forward, and diaphracjn over

brachlal pulse pint.

m.

11.

12.

13.

14.

15.

16.

17.

18.

Inflate rapidly to HIL.

Deflate 2h’m Hg per second, wes 1evel with midcmint of the mancmter COIIMIII.

Read the point on the manm?ter hen the first sound is heard (systol tc) and

sound disappears (diastolic).

Conttnue deflation to lllmn Hg below last sound.

Deflate rapidly to zero.

R~ve stethoscope frzm ears.

Disconnect m!anomter tubing.

Record readings on PM.

Hait thirty seconds.

Repeat steps 9-17 for two more readings.

Eis!!L

1. P1 ace scale on hard surfaced floor a“d adjust to zero if necessary.

2. Stand to one side of scale looking directly dohn onto face of scale.

3. Record wci ght on Pm.

Reporting to Subject

1. Record readings and identifying information on the Report of Physical

Heasurerent Finding and, using the Blood Pressure Value box, determine hiiich

stater!+?nt to mad to the subject.

2. Ask subject to sign form ard give the top copy to the subject to keep.

BLCWXIPRESSURE VALUE 8Dx

Elevated systolic blmf pressure of 230 by palpation of radial pulse

only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4

Diastolic

systolic Under 9D 90-94 95- 114 115- 129 130 or Here

Under 150 1 2 3 4 5

150-159 1 2 3. 4 5

160-239 3 .3 3 4 5

24o or uore 5 5 5 6 5
ID NUMBER m-rim-n PART C

LJM8 N. 09250161

A,,, s.:.1 EXDW 1231 83

I

U.S. DEPARTMENT OF HEALTH ANO HUMAN SERVICES

PUBLIC HEALTH SERVICE

NATIONAL CENTEK FCJFi HEAL IH S1 AT ISTIIX

NATIONAL INSTITUTE ON AGING

NATIONAL INSTITUTES OF HEALTH

.

NHANES I

EPIDEMIOLOGIC

FOLLOWUP SURVEY

SELF-ADMINISTRATION

SUBJECT INTERVIEW BOOKLET

LEEYL_-__l ASSURANCE OF CONFIDENTIALITY

All ,nfo)mannn wh,ch would ~tov[dc tde.ltftc.!,.n otth. (nd,vtduafwtll kh.lsltn sttoctr.nt<d,,t, c,s,

$wf! M .wf .nlv for LWWS9S of ,i,, d by II?IW.S ..ww4 m rhe mrvcy, .ncf w,ll not in. c[,%c!c,.,d~,t

relea,,’d ,. wht.,, far any !JU,DO,M ,,, WC,,,,I, K, w,, h S,c!, on 308(d) of ,!,, Publ, c H.d, h S,,, .,,,.

INTERVIEWER: RENJ INSTRUCTIONS TO RESPONDENT.

These next questions are about your pregnancy and menstrual history. I

can read these questions to you or you can fill thsm out yourself. Which

would you prefer? (IF SELF ADMINISTERED): Please circle one number next

to the answer that you choose or write in the correct response. A “GO TO”

statcntent will tell you which question to go to next. If there is no “GO

TO” statement just go to the next question. If you need any help ask me

for assistance.

c-1. Have you ever been pregnant? Include

live births, stillbirths, miscarriages

and abortions.

c-2. Are you pregnant now?

C-Y. How old were you when your first child

was born? This means the first child

born alive or stillborn.

C-b. How old were you when your last child

was born? Include etillbir~

c-5. How many —live births have you had?

C-6. Have you ever had a miscarriage?

C-7. How many miscarriages have you had?

c-s, Are you etill having periods?

c-9 . Are your periods regular or irregular?

By regular vte mean your periods come

abmt once a month. You can usually

predict when they will crone and they

usually last about the sane number of

days.

C-10. Are they irregular because you are

going through the change of life or

for some other reason?

c-l 1. At what age did you have your last —

period?

1 Yes (GO TO C-2)

2 No (GO TO C-8)

1 Yes

2 No

Age: _(GO TO C-4)

OR

O I had no births (GO TO

C-6)

Age:

Number of Live Births: —

OR

O I had no live births

1 Yes (GO TO C-7)

2 No (GO TO C-8)

Number of

Miscarriages:

1 Yes (GO TO C-9)

2 1 am pregnant now (GO TO

c-9 )

3 No (GO TO C-11)

1 My periods are regular

(GO TO C-21)

2 My periods are irregular

(GO TO C-10)

1 My periods are irregular

beceuse of the change of

—life (GO TO c-15)

2 My periods are irregular

for some other reason

(GO TO C-21)

Age:

[GO TO NEXT PAGE]

co PHSr-szl

m (782) 3
% C-’I2. Did your periods stop naturally,

because you had surgery or for some

other reason?

C-13. What was the reason?

c-l4. Do you still have your womb or uterus?

c-$ 5. Do you still have both your ovaries?

C-16 . Da you still have one ovary?

C-17. Did you ever take female hormone pills

for reasons rslated to menopause, ”

includinn hot flaahes or mood chanaes.

around the time you wers beginning the

change of life? This wuld include

hormone pills taken For natural

change of life or because your

periods stopped due to an operation.

C-13. How old were you when you first took

hormone pills?

C-19. How old were you when you laat took

hormone pills?

(MD. Altogether for about how many years

have you taken harmone pills?

1 My periods stopped naturally

(GO TO C-14)

2 My periods stopped because

of surgery (GO TO C-14)

3 My periods stopped for some

other reason (GII TO C-13)

REASON :

1 Yes

2 No

1 Yes (GO TO C-17)

2 NO (GO TO C-16)

1 Yes

2 No

1

2

—

Yes (GO TO C-18)

No (GO TO C-23)

Age:

Age:

OR

1 I am taking hormone pills

now

Yeara: _(GO TO C-23)

OR

Months: _ (GO TO C-23)

C-21. Do you still have ~ your ovaries?

C-22. On you still have —one ovary?

C-23. Have you ever taken birth control

pills for any reason?

C-24. How old were you when you first

took birth control pills?

C-2% How old were you when you”last

took birth control pills?

C-26. Altogether for about how many years

have you taken birth control pills?

%27. Which of these answers best describes

the reason or reasons that you took

birth control pills: for birth control; irregular periods; change of

life or for some other reason?

1 Yes (GO TO C-23)

2 No (GO TO C-22)

1 Yes

2 No

1 Yes (GO TO C-24)

2 No (STOP. RETURN BOOKLET

TO INTERVIEWER. )

Age:

Age :

OR

1 I am taking birth control

pills now

I took birth control pills

for:

Years:

OR

Months:

1

2

3

4

—

For birth control

Irregular periods

Change of life

Some other resson (What?)

[STOP. RETURN BOOKLET TO INTERVIEWER]

[GO TO NEXT PAGE]
SI

(

4

RESPONSE TO QUESTION D-17

,,,,,< \

1- %--6- -

I I

I

IA I

I LIcl

r

-. D

1

\;B~//.

LEFT

SIDE

DRIHKIt&

AMWNT

RESPONSE TO QESTIDN E-1OO

INSTRUCTIONS: Place “x” on the line to indicate the *verity of pain.

Ch the scale, the left side is no pain and the right side

is very severe pain.

VERY

NO SEVERE

PAIN PAIN

AICOHOL CHART

(SUBJECT)

LIFETIME ORINKING PATTERN

RESPONSES TO QuEsTIONS M-13 THROUGH M-18

KIRE

A

B

r.

15 25 35 45 55 65 75

LESS AGE

6

7
I

l% PART I

PART I (continued)

INSTRUCTIONS: Please circle one number for each question 1-21 through 1-39

which best answers or describes your feelings -- DURING THE

PAST NONTH.

INSTRUCTIONS: Please circle one number for each statement (Questions I-1

through 1-20) =ch best describes how often you felt or

behaved this way -- DURING THE PAST WEEK.

1-21. How have you been feeling in

general, during the past

month?

1 In excellent spirits

2 In very good spirits

3 In good spirits mostly

4 I have been up and down in

spirits a lot

5 In low spirits mostly

m 6 In very low spirits

Rarely or Some or a Occasionally Most or

(l-2 days) (3-4 days) (5-7 days)

DURING THE PAST WEEK:

-1- 1 2

1 2

1-1. I was bothered by things

that usually don’ t bother

me. . . . . . . . . . . . .

I-22 . Have you been under or felt

you were under any strain,

stress, or pressure, during

the past month?

o 3 1 Yes -- almost more than I

could bear or stand

2 Yes -- quite a bit of pressure

3 Yee -- some -- more than. usual

4 Yes -- some -- but about usual

5 Yes -- a little

6 Not at all

I-2 . I did not feel like

eating; my appetite was

poor . . . . . . . . . . . . o 3

I-3 . I felt that I could not

shake off the blues even

with help frmn my family

or Friends. . . . . . . . 0 1

+

2 3

2 3

I-23. How happy, satisfied, or

pleased have you been with

your personal life, during

the past month?

1-4. I felt that I was just as

good as other people. . . I

o I

1

1 Extremely happy -- could not

have been more satisfied or

pleased

2 Very happy

3 Fairly happy

4 Satisfied -- pleased

5 Somewhat dissatisfied

6 Very dissatisfied

1-5. I had trouble keeping my

mind on what 1 was doing. o 1 2 3

1-6, I felt depressed. . . . . 0 1 2 3

I-7. I felt that everything

I did was an effort . . . 0 1 2 3

1-8. I felt hopeful about the

future . . . . . . . . . . o 1 2 3 I-24. Have you been anxious, worried

or upset, during the pact

month?

1 Extremely so -- to the point

of being sick or almost sick

2 Very much so

3 Quite a bit

4 Some -- enough to bother me

5 A little bit

6 Not at all

1-9. I thought my life had been

a failure . . . . . . . . 0 1 2 3

1-10. I felt fearful. . . . . . 0 1 2 3

I-1 1. My sleep was restless . . 0 1 2 3

1-12. I was happy . . . . . . . 0 1 2 3

1-13. I talked less than usual. o 1 2 3

1-14. I felt lonely . . . . . . 0 1 2 3

I-25. Have you been bothered by

any illness, bodily disorder,

pains, or fears about your

health, during the past

month?

1 All the time

2 Most of the time

3 A good bit of the time

4 Some of the time

5 A little of the time

6 None of the time

1-15. People were unfriendly. . 0 1 2 3

1-16. I enjoyed life. . . . . . 0 1 2 3

1-17. I had crying spells . . . 0 1 2 3

1-18. I felt sad. ~ . . . . . . 0 1 2 3

1-19. 1 felt that people

disliked me . . . . . . . 0 1 2 3

1-20. 1 could not get “going” . 0 1 2 3

[GO TO NEXT PAGE]

8

I-26. Have you been feeling

emotionally stable and sure

of yourself, during the

past month?

1 All the time

2 Most of the time

3 A good bit of the time

4 Some of the time

5 A little of the time

6 None of the time

9
PART 1 (continued)

~

For quest ions 1-27 through 1->0 PI ease circle the number

t+ich best lndlcates your feelings -- DURING THE PAST MONTH.

I-27. How concerned or worried bout your HEALTH have you been, durirq the

past month?

o 1 2 34 5 6 7 8910

I I

Not Very

concerned concerned

at all

1-28. How RELAXED or TENSE have you been, during the past month?

D 1 2345678 9T0

I I

Very Very

relaxed tense

I-29. How mmh ENERGY, PEP, VITALITY have you felt, durinq the past month?

o 7234567 8910

I I

No energy Very

at all, energetic

listless dynanic

1-30. How DEPRESSEO or CHEERFUL have you been, during the past month?

D 1 2 345 6 7 8 9 ID

I I

Very Very

depressed cheerful

I

INSTRUCTIONS: Please circle the number thst is next to the answer that

best describes your situation. I

1-31. In general, about t!aw many relatives and friends do you have that you

feel close to? These are people with 1.410myou feel at ease, can talk

to about private matters, and can call on for help.

o None

1 One person

2 Twa people

3 Three or four people

4 Five to nine people

5 Ten to nineteen people

6 Twenty or more people

PART J

INSTRUCTIONS: These next questions are about bowel and bladder habits.

For each question, please circle the nutier next to the

answer that best describes your situation.

J-1 . Do you have trouble with your

bowels which makes you constipated or gives you

diarrhea?

3-2. How often do you usually have

a bowel movement?

J-3 . Which of the following best

describes your usual bowel

movement; is it normal,

loose or watery, or hard or

very firm?

J-4 . During the past few months,

hew often have you lost control over your bowels or had

an accident; often,

mcasionally, or nsver?

J-5 . How often do you use a

laxative or stool softener?

J-6 . Ouring the past few months,

how often have you lost control over your urine; often,

occasionally, or never?

J-7 . How often do you dribble,

leak, or lose urine when you

laugh, strain, or cough;

often, occasionally or

rever?

2-8. On you dribble or leak urine

only hen you laugh, strain,

or cough?

1 I get constipated

2 I get diarrhea

3 I do not have trokle with

my bowels

1 Once a week or less often

2 Two or three times a week

3 Four to six times a week

4 Once a day

5 Two or three times a day

6 Four or more times a day

1 Normal

2 Loose or watery

3 Hard or firm

1 Often

2 occasionally

3 Never

1 Every day

2 Every other day

3 Dnce or twice a week

4 Once or twice a month

5 Less than once a month

6 Never

1 Often

2 Ck2casionally

3 Nsver

1 Often

2 occasionally

3 Never (STOP. RETURN BDOKLET

TO INTERVIEWER. )

1 Yes

2 No, I dribble or leak urine

at other times

OFF ICE USE ONLY

FILLEO OUT BY: SJJBJECT. . . . . . . . .. I

SUBJECT WITH ASSISTANCE. . 2

INTERvIEWER. . . . . . . . 3

PROXY . . . . . . . . ...4

11
HOSPITAL AND HEALTH CARE FACILITY CHART

(suB3EcT)

au= #: CONDITION: YEAR :

FACILITY NAHE : TYPE :

P(XIRESS :

STREET

CITY STATE

COM!41NTS :

lllllllll_l

2. QUES #: CDNOITION: YEAR :

FACILITY NAt41: TYPE :

PDDRESS :

STREET

CITY STATE

COMKNTS:

1111111111

3. QUES #: CCWITION: YEAR :

FACILITY NAHE: TYPE :

PJIDRESS :

STREET

CITY STATE

C13WNTS:

l_l I I II I I I I

4. QUES #: CONOITION: YEAR :

FACILITY NAI.E: TYPE :

I$)DRESS:

STREET

CITY STATE

COMMENTS:

5. fJUES#: CONDITION: YEAR :

FACILITY NAK: TYPE :

WIRESS:

STREET

CITY ~ STATE

COMKNTS:

6. QUES #: CIJNDITION: YEAR :

FACILITY NAME: TYPE :

iWDRESS:

STREET

CITY STATE

COMMENTS:
NHANES 1 FOLLOWUP

HAND CARDS

SUBJECT QUESTIONNAIRE

CARD A

NO DIFFICULTY

SOME DIFFICULTY

MUCH DIFFICULTY

UNABLE TO DO

101

■ II
(

9 OR MORE lIRINKSA DAY CARD B (DRINKING PATTERNS)

A OR

60 OR MORE DRINKS A WEEK

(

ABOUT 6 TO 8 DRINKS A DAY

B OR

40 TO 59 DRINKS A WEEK

{

ABOUT 4 OR 5 DRINKS A DAY

c OR

25 TO 39 DRINKS A WEEK

(

ABOUT 2 OR 3 DRINKS A DAY

D OR

10 TO 24 DRINKS A WEEK

E 1 TO 9 DRINKS A WEEK

F LESS THAN 1 DRINK A WEEK

G DID NOT DRINK

CARDC

01 ‘ALL BRAN 12 = FRUITAND FIBER 24= QUAKER100%

02= BRANBUDS 13 = GRANOLA NATURALCEREAL

03= BRANCHEX 14 = GRAPENUTS 25 = RAISINBRAN

04 = BRANFLAKES 15 ‘GRAPE NUTSFLAKES 26= RAISIN,RICE

05 = BUC WHEATS 16 ‘ GOLDENCHARMS AND RYE

06 ‘CHEERIOS 17 = HEARTLANDCEREAL 27 = RICECHEX

07 ‘CORN BRAN 18 = LIFE 28 = RICEKRISPIES

08 ‘CORN CHEX 19 ‘MOST 29 = SHREDDEDWHEAT

09 ‘CORN FLAKES 20= NUTRI-GRAIN 30 = SPECIALK

10 = CRACKLINBRAN 21 = PRODUCT19 31 = TEAM

11 = CRISPYWHEATS 22 = PUFFEDRICE 32 = TOTAL

AND RAISINS 23= PUFFEDWHEAT 33 = WHEATCHEX

34 = WHEATIES

102
CARDD

01= CREAM OF WHEAT/FARINA

02 = OATMEAL

03 = DARK FARINA/RALSTON

04 = GRITS

05 = OTHER (SPECIFY)

CARDE

A. FRESHAPPLES K. CANTALOUPE

B= FRESHPEARS L. WATERMELON

c. BANANAS M. FRESHPLUMS

D. FRESHORANGESOR TANGERINES N= FRESHOR FROZENSTRAWBERRIES

E. ORANGEJUICE o. FRESH,CANIJEDOR DRIEDAPRICOTS

F= POWDEREIIORANGEJUICESUBSTITUTES

INCLUDINGNECTOR

SUCHAS TANG P. COOKEDOR DRIEDPRUNESINCLUDING

G. FRESHGRAPEFRUIT

PRUNEJUICE

Q. ALLCANNEDFRUITSUCHAS CANNED

H. GRAPEFRUITJUICE PEARS,PINEAPPLE,FRUITCOCKTAIL

1. VITANINC ENRICHEDFRUIT DRINKS

OR APPLE SAUCE

J. FRESHOR CANNEDPEACHESOR NECTARINES

103
JO

KO

L*

CARDF

GREEN PEAS

GREEN BEANS, GREEN LIMA BEANS OR

STRING BEANS

OTHER BEANS OR PEAS, IcE=, KIDNEY

OR PINTO BEANS, AND BLACKEYED

OR CHICK PEAS

OKRA

BROCCOLI

CAULIFLOWER

BR(JSSEL SPROUTS

CORN

SUMMER SQUASH SUCH AS ZUCCHINI,

YELLOW, OR CROOKNECK

WINTER SQUASH SUCH AS ACORN,

BUTTERNUT, HUBBARD OR PUMPKIN

RAW OR COOKED CARROTS

CUMCUMBER

SWEET RED PEPPERS

SWEET GREEN PEPPERS

ICEBERG OR HEAD LETTUCE IN A

SALAD

LEAF LETTUCE IN A SALAD

CABBAGE INCLUDING COLE SLAW

RAW OR COOKED GREENS, EoGo, SPINACH,

COLLARDS OR TURNIP GREENS

SWEET POTATOES OR YELLOW YAMS

INSTANT OR DEHYDRATED POTATOES

BAKED, BOILED OR MASHED WHITE

POTATOES

FRIED OR HASH BROWN POTATOES

FRESH TOMATOES

COOKED TOMATOES, TOMATO SOUP,

JUICE, SAUCE OR CANNED TOMATOES

VEGETABLE SOUP

.

CARD G

01.= OLIVE OIL

02 = LIQUID OIL OTHER THAN OLIVE OIL

03 = SOLID SHORTENING

04 = IIARGARINEIN A STICK

05 = MARGARINE IN A TUB

06 = BUTTER

07 = LARD

08 = BACON GREASE OR PORK FAT

09 = OTHER (SPECIFY)

104
COFFEE CARD

CUPS OF;

A. INSTANT DECAFFEINATED COFFEE

B= OTHER INSTANT COFFEE

C* GROUND DECAFFEINATED COFFEE

l)= OTHER GROUND COFFEE

~. HERB TEA

F. REGULAR TEA, INCLUDING ICEllTEA

(

CARD H

1 = WHOLE MILK

2 = SKIM MILK

3 = LOW FAT MILK

4 = HALF AND HALF

5 = CREAM

6 = NONDAIRY CREAMER

105
CARD I

COLUMN II

MUCH MORE NOW

SOMEWHAT MORE NOW

SOMEWHAT LESS NOW

MUCH LESS NOW

ABOUT THE SAME

COLUMN I

NEVER

RARELY

SOMETIMES

OFTEN

ALMOST ALWAYS

CARD J

DESCRIBES ME VERY WELL

DESCRIBES ME FAIRLY WELL

DESCRIBES ME SOMEWHAT

DESCRIBES ME NOT AT ALL
STRONGLY DISAGREE

DISAGREE

FEEL NEUTRAL

AGREE

STRONGLY AGREE

CARD K

I

i

(

CARDL

01= ENGLISH,WELSH 15 = AFRICAN

02= IRISH 16 ‘NIDDLE EASTERN

03= SCOTTISH 17 = INDIAN,PAKISTANI

04= CANADIAN 18 ‘CHINESE

05= GERMAN 19 = JAPANESE

06 = FRENCH 20= PACIFIC ISLANDS,POLYNESIAN

07 = ITALIAN 21 = ALEUT,ESKIMOOR AMERICANINDIAN

08 =DUTCH 22 =MEXICAN

09 = GREEK 23= PUERTO RICAN

10= PORTUGUESE 24= CUBAN

11= RUSSIAN 25 = SPAIN

12 = CZECHOSLOVAKIAN 26 ‘ALL OTHER SPANISH(CENTRALOR

13 = OTHER EASTERNEUROPEAN SOUTI-IAFIERICAN)

(POLISH,HUNGARIAN) 27 = BLACK

14= SCANDINAVIAN(NORWEGIAN, 28 = OTHER

SWEDISH,FINNISH,DANISH)

107
CARD M

01= ALEUT, ESKIMO OR AMERICAN INDIAN

02 = ASIAN/PACIFIC ISLANDER

03 = BLACK

04 = WHITE

CARD N

INCOME

UNDER $3,000. . . . . . . . A

$3,000 - $3,999 . . . ..B

$4,000 - $4,999 . . ..*C

$5,000 - $5,999 . . . ..D

$6,000 - $6,999 . . . ..E

$7,000 - $9,999 . . . ..F

$10,000 - $14,999 . . . . . G

$15,000 - $19,999 . . . . . H

$20,000 - $24,999 . . . . . I

$25,000 - $34,999 . . . . . J

$35,000 - $49,999 . . . . . K

$50,000 - $74,999 . . . . . L

$75,000 - $100,000 . . . . . M

OVER $100,0000 . . . . . . . N

108
OMB No C925.0161

Acwovd EXDICCS 12.343

Date:

Subject Name: Interviewer ID: I I I I —

U.S. kpartment of Health and Hwnan Serv Lees

Nat ional Center for Health Statistics

National Institute on ~mg

MMNES I Epldemiolcqic FOI1OW.JP Survey

PHYSICAL MEASUREMENTS RECORD (PMR)

INTERVIEWER: RECORD IN 3-5 BELOW ALL MEASUREMENTS ATTEMPTEO.

IF A MEASUREMENT WAS NOT ATTEMPTED, SKIP TO THE NEXT MEASUREMENT. IF NO MEASUREMENTS WERE ATTEMPTED, EXPLAIN IN 2. —

1. Pre-measurement Conditions: Yes No DK —. —

(ASK:)

Have you had an alcoholic beverage within the past

24hours?. . . . . . . . . . . . . . . . . . . . . . . . 1 2 8

(0B5ERvE:)

Has subject been smoking/drinking coffee within 15

minutes before measurement? . . . . . . . . . . . . . . . 1 28

2. Measurement Not Attempted: [If all measurements attempted, skip to 3.]

a.

b.

c.

d,

e.

hhich measurements? (CIRCLE ALL THAT APPLY)

Pulse. . . 1 Blood Pressure. . . . 2 Weight. . . . 3

Reason measurement was not attempted (CIRCLE ALL THAT APPLY)

%b.Je& broke off interview . . . . . . . . . . . . . . . . . . 1 [2.c]

SubJect refused measurement . . . . . . . . . . . . . . . . . . 2 [2. c]

Pre\ented by subject’s physical condition . . . . . . . . . . . 3 [2.e]

Pre\ented by equipment failure. . . . . . . . . . . . . . . . . 4 [2. e]

Pre\ented by other problem. . . . . . . . . . . . . . . . . . . 5 [2.e]

When dld breakoff/refusal occur?

Durinqinterview. . . . . . . . . . . . . . . . . . . . . . . .1

Just prior to physical measurements . . . . . . . . . . . . . . 2

State reason given for breakoff/refusal (RECORD VERBATIM)

Indicate measurement to which this applies.

Explaln physical condition, equipment failure, other problem.

Indicate measurement to which this applies.

3. Radial Pulse Measurement:

a. Arm used (MUST BE SAME FOR BOTH PULSE AND BLOOO PRESSURE)

Right. . . . . . . . . . .1

Left. . . . . . . . . . . 2 (EXPLAIN)

Attt.mpted but could

not measure. . . . . . . 3 (EXPLAIN)

(IF NOT MEASURED, TERMINATE PULSE AND BLOOD PRESSURE)

b. Pulse reading

Number of beats in 30 seconds x 2 = pulse rate

Comments/Explain

109
IDl): m-ma-n

4. Blood Pressure Measurement:

a. Cuff size used

Child . . . . ..l Large arm. . . . . . 3

Adult. . . ...2 No proper fit. . . . 4 (TERMINATE 6P)

b. MIL

#1 +30=

Reading MIL

#2 +30=

Reading MI L

Indicate any problem with reading:

(IF MIL 260 OR OVER, TERMINATE BP AND REPORT TO SUBJECT. IF SUBJECT HAS PAIN

OR BOTH ATTEMPTS UNSATISFACTORY, TERMINATE BP. )

c. Blood pressure reading

Systolic/Diastolic

BP#l /

BP#2 /

BP#3 /

Total (2+3) /

Average (+2) /

5. Weight Measurement:

a. Scale on:

Comments or Special Occurrences:

(USE SATISFACTORY REAOINGS ONLY)

b. Reading

#1

ii2

Bare floor/hardsurface . . . . . . . . . . . . . . . 1

Rug/soft surface.... . . . . . . . . . . . . . ..2

6. Additional Comments:

Indicate any problem with reading:

lbs.

lbs.

IF ANY MEASUREMENT WAS NOT ATTEMPTED, BE SURE SECTION 2

IS COMPLETED.

110
OMB”NO. 0925U161

IDl}: m-cum

Approval Expires 12.31-83

Name Date

U.S. Department of Health and Human Services

National Center for Health Statistics

National Institute on Aging

NHANES I Epidemiologic Followup Survey

REPORT OF PHYSICAL MEASUREMENT FINDINGS

Resting pulse rate: per minute Weight: pounds

Blood pressure: / l_l Average of two measurements.

Read the

(1)

(2)

(3)

(4)

(5)

I_ I Single measurement.

l_l Elevated systolic blood pressure

by palpation of radial pulse only.

statement circled below:

Your blood pressure today is within the normal* range.

Your blood pressure today is somewhat above normal.* We suggest you

see your doctor within the next three months to have your blood pressure rechecked. Present this form to your doctor.

Your blood pressure today is above normal.* We suggest you see your

doctor within the next 30 days to have your blood pressure rechecked.

Present this form to your doctor.

Your blood pressure today is U.* YOU SHOULD SEE YOUR DOCTOR WITHIN

THE NEXT FEW DAYS TO HAVE YOUR BLOOD PRESSURE RECHECKED. Present this

form to your doctor.

Your blood pressure today is quite high.* YOU SHOULD SEE YOUR DOCTOR

OR CLINIC TODAY, OR GO TO A HOSPITAL EMERGENCY ROOM TO HAVE YOUR BLOOD

PRESSURE RECHECKED. Present this form to your doctor.

* According to the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure.

Your pulse, blood pressure and weight were measured by a trained lay

interviewer. These measurements were obtained as part of a survey and do not

represent a medical diagnosis. Interpretationof these measurements must be

made by a physician.

Should your physician/medical care organization wish to contact Westat

they should be directed to:

NHANES I Epidemiologic Followup Survey

1650 Research Boulevard

Rockville, Maryland 20850 (800 - 638-8985)

DATE SIGNATURE

This form was presented to for signature, but he or

she refused to sign.

DATE SIGNATURE

111
ID,}: m-un-n

OMB No.: 09254161

Approval Expires 12-31-83

U.S. Department of Health and Human Services

National Center for Health Statistics

National Institute on Aging

NHAN ES I Epidemiologic Followup Survey

AUTHORIZATION TO OBTAIN INFORMATION

FROM MEDICAL RECORDS

In connection with the health history of —

given as part of the National Health and Nutrition Examination Followup Survey,

it may be necessary to obtain additional information from records and staff of

hospitals or other inpatient health facilities. I hereby authorize the release

of such information as the U.S. Public Health Service may need to request from

any of these sources.

I understand that all information obtained will be held strictly confidential

and will be used for statistical purposes only.

Hospital and inpatient health facility records could also be listed under the

following names: —

.

❑

OR

Check box if records would not be listed under any other name.

In case of death or disability:

SIGNATURE OF NEXT-OF-KIN SIGNATURE OF SUBJECT

RELATIONSHIP

DATE OF DEATH (MO/DAy/yEAR) INTERVIEWER SIGNATURE

COUNTY AND STATE OF DEATH DATE

112
Interview-Proxy

*SW% ~,

*6* %

{ 4

DEPARTMENT OF HEALTH& HUMAN SERVICES Public Health Service

8

%

+Jrv,,a National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

DearParticipant:

h youmayrecallwe havebeenin touchwithyouthispastyearconcerning

a nationalsurveythattheNationalCenterforHealthStatisticsisconducting.

participatedin thefirstNatiomlHealth

dNu ExaminationSurveyin 1971-1975.Theresultsof thatsurvey

%vep%v%~mch neededinformationaboutthehealthneedsandcharacteristicsof theAmericanpeople.To furtherusethisinformation,theNational

CenterforHealthStatisticsisfollowingup alltheadultswhotookpart

illthatstudy.

Youwillrememberfrm ourfirstcontactthatwe askedifyoucouldsupply

healthandhospitalcareinformationforthisperson.Youwillreceive

$10.00foryourparticipationithestudy.

We havecontractedwithWestat,a nationalresearchorganization, to conduct

theinterviewsforus. WithinthenexttwoweeksaWestatinterviewer

willcontactyouto setup a timeto visityoufortheinterview.When

theinterviewerarrives,be sureto askhimor herto showyouaWestat

identification card.

Thissurveyisauthorizedby Title42,UnitedStatesCode242k.Your

participationithissurveyiscmpletelyvoluntary.Thereareno~lties

forrefusingto answer8nyquestion.

As inthepreviousurvey,anyinformationyougivewillbe keptconfidential.

No informationthatcouldbeusedto identifyyouor anyotherindividual

willbe releasedorpublished.Resultsof thisstudywillrepublished

onlyas statisticalsumaries.

Yourparticipationisvitalto thesuccessof thissurvey,andyourcooperation

willbe appreciatedgreatly.

Sincerelyyours,

.

RobertA. Israel

ActingDirector

113
v

“9 se

:

-g

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

z PUBLIC HEALTH SERVICE

5

>

NATIONAL CENTER FOR HEALTH sTATISTICS

*++ NATIONAL INSTITUTE ON AGING

4

‘apdx,~

NATIONAL INSTITUTES OF HEALTH

NHANES I

EPIDEMIOLOGIC

FOLLOWUP SURVEY

PROXY QUESTIONNAIRE

ASSURANCE OF CONFIDENTIALITY

All information which would provide identification of theintividual will beheld instrict confidence,

will Lw used only for purposes of and by persons engaged i. thesurvey, andwill not bedisclo$edor

relmsedtoothsrs for any purposes in accordance with Section 308(dl of the Public HeAth Service

Act [42 USC 242 ml.

Begin AO

At.!

TIME BEGAN:

PM

PART A. HOUSEHOLD CHARACTERISTICS II II IU II-15

4-1. HOW was (sUB3ECT ) related A-1 SPOUSE/ROOMMATE . . . . . . . . . 1

to you?

MJTHER/FATHER . . . . . . . . . . 2

II CHILO . . . . . . . . . . . ...3

II BROTHER/SISTER. . . . . . . . . . 4

II FRIENO/NEIGHBOR . . . . . . . . . 5

II OTHER RELATIVE (5PEcIFy). . . . . 6

II

II OTHER (SPECIFY) . . . . . . . . . 7

VII

A-2 . In the ear prior to

(SUB3ECT+ s death, where

did (he/Bhe) live most

of the time: at home,

in a nursing home or

someplace else?

A-; AT HOME . . . . . . . . . t (Q.A-3)

SHELTERED HOUSING . . . . 2 (Q.A-3)

IN A NURSING HOME . . . . 3 (Q.A-4)

OTHER (SPECIFY) . . . . . 5 (Q.A-4)

21

A-3 . In the ear prior to

5

A-3 YES . . . . . . . . . . . I (Q.A-6)

(5U63ECT’S death, did YOU

live in the sane houBehold NO. . . . . . . . . ...2

with (him/her)?

V12

A-4. In the ear before

5-

A-4 EVERYDAY. . . . . . . . . . ...1

(SUBJECT died, about

how frequently did you LESS THAN OAILY BUT AT LEAST

visit or talk to (him/ ONCEAWEEK . . . . . . . . ...2

her)?

A-5. (IF! IS NOT RELATIVE,

ASK :)

Oo you think you can

mswer some questions

tbd the (su8JEcT’s)

household c~n

prior to (hisiher)

(institutionalizat iOn/

death)?

1

LESS THAN WEEKLY BUT MORE

THAN ONCE AMINTH . . . . . ...3

LESS THAN ONCE A M3NTH. . . . . . 4

V13

YES . . . . . . . . . ..l

NO . . . . . . . . . . . . 2 (PART B)

DK . . . . . . . . . ...8 V14

PHS
I

BOXA

I

INTERVIEWER: REVIEW Q. A-2

A-2 IS AT HOME/SHELTERED HOUSING, . . 1 (Q.A-6)

OTHERWISE . . . . . . . . . . . . . . 2 (Q. A-15)

The next series of questions asks about the people living in (SUBJECT’S)

householdat the time of (his/her) death.

ENTER NAt.E OF SON LINE a OF QUESTION A-n BELOW.

A-6. At the time of A-6 ONE . . . . . . . . ..OI

(SUBJECT’S) death, how

many people lived in

(his/her) household # OF PEOPLE: I I I (Q.A-B) 22-%3

including(5uBJECT)?

A-7. About how long had A-7 LESS THAN ONE YEAR . . 00 (Q.A-24)

(SUBJECT) lived alone?

# YEARS: I I I (Q. A-24)

OK . . . . . . . . . . 98( Q.A-24) Z*-’2S

A-B. What was the nane of the head of the household in which (he/she)

lived? (IF THE~WAS NOT HH, ENTER HH ON LINE llb ANO CIRCLE. )

26

A-9. hhat (was/were) the name(s) of the other person(s) who lived thera?

(Pleaae include Yourself.) (RECORO NAMES IN Q. A-11)

A-10. Have I miaaed anyone

usually lived there?

A-1 1.

AFTER LISTING HOUSEHOLD,

ASK FJ.A-12 THROUGH

Q.A-i4 FOR EACH PERSON

AS APPROPRIATE. NAIE

(FIRST, MIDOLE INITIAL,

IA-IoI YES......;..

A-12.

At the time

(SUB3ECT’S)

death, how

old was

(=)?

of

A-13.

(ASK SEX IF

QUESTIONABLE) Ie

(g)

male or

female?

. . I (RECORO NAME

IN Q. A-11)

. . 2

A-14.

How WaS

(pERSON)

related to

(SUBJECT)?

I I

NAnI YEARS OF AGE MF RELATIONSHIP

a. (5UBJECT)

b. YRS: I I I 12

c. YRS: I II 12

d. YRS: I II 12

e. YRS: I II 12

f. YRS: I II 12

9. YRS: I I I 12

——

h. YRS: I II 12

i. YRS : I II 12

j. YRS: I II 12

k. YRS: I II 12

1. YRS : I II 12

I

INTERVIEWER: GO TO Q .A-24

27-31

32-36

37-41

42-46

47-51

S2-56

57-61

62-66

67-71

72-76

77-81

32-38

The next series of questions asks about the people living in (SUBJECT lS)

housetmld at the time of (his/her) institutionalization.

ENTER N/NE OF ~ ON LINE a OF QUESTION A-20 BELOW.

A-15. At the time of (SUBJECT lS) A-1 5 ONE . . . . . . . . ..OI

institutionaliza~

how many paople lived

in (his/her) Iwusekld # OF PEOPLE: I i I (Q.A-17) 22-23

including(SUBJECT)?

A-16. About how long had A-16 LESS THAN ONE YEAR . . 00 (Q. A-24)

(SUBJEcT) lived alone?

# YEARS: I I I (Q. A-24)

DK . . . . . . . . ..98 (Q. A-24) 2U-27

A-17. Wnat was the nane of the head of the hou~ehnld in tihich(he!/she)

lived? (IF THE ~ WAS NOT HH, ENTER HH ON LINE 20b ANO CIRCLE. )

L6

A-18. that (was/were) the nae(s) of the other person(s) who lived there?

(please include vourself. ) (RECORD NAMES IN Q. A-2D)

A-19. Hava I missed anyone who A-1 9 YES . . . . . . . . . .. I(REC0R0 NAME

usual 1y lived there?

I k..........2’ NQ” A-20)

A-20. A-7.1. A-22.

AFTER LISTING HOUSEHOLD,

A-23 .

At the time of (ASK SEX IF How was

ASK Q.A-21 THROUGH (SUBJECT’s)

Q.A-23 FOR EACH PERSON

QUESTION- (PER5oN)

institution- ABLE) IS

As APPROPRIATE. NAHE

related to

(FIRST, MI~LE INITIAL,

alization, how (-) (SUBJECT)7

old was male or

LAST) . (-)? female?

NAW YEARS OF AGE MF RELATIONSHIP

a. (SUB3ECT)

b.

——

I

—

I I

c. YRS: I I II 1 2

d. YRS: I II 12

e. YRS: [ I ‘1 12

f. YRS: I II 12

9. YRS: I II 12

h. YRS: I II 12

i. YRS z I II 12

J. YRS: [ II 12

k. YRS: I II 12

1. YRS: I I I 12

27-31

,2-36

37-41

42-46

47-51

52-56

57-61

62-66

67-71

72-76

77-B1

82-86

m 2

3
: A-24. hhat is the highest grade

or year of school that

(HEAD OF HOUSEHOLO) ever

cmnpleted? Include trade

or vocational school.

A-25. At the time (SUB2ECT)

(was institutionalized/

died) how many children

did (he/she) have who

lived away from home?

A-26. At that time, how many of

(his/her) children lived. . .

a. less than 1/2 hour

May?

b. about 1/2 hour away?

c. about an hour away?

d. about two hours away?

e. more than two hours

away?

—

-24

—

A-25

—

A-2(

a

b

c

d

e

—

JONE. . . . . . . . . . . . ..1O

;RPDEI . . . . . . . . . . ..2 I

;RADE2. . . . . . . . . . . .22

;RADE3. . . . . . . . . . ..23

;RADE4. . . . . . . . . . . .24

;RAOE5. . . . . . . . . . . .25

;RADE6. . . . . . . . . . . .26

;RADE7. . . . . . . . . . . .27

;RADE8. . . . . . . . . . . .2B

;RADE9. . . . . . . . . . . .31

;RAOEIO. . . . . . . . . . . .32

;RPDEII. . . . . . . . . . . .33

;RPDE12. . . . . . . . . . . .34

LOCATIONAL

I YEAR. . . . . . . . . . . . .01

tYEARS. . . . . . . . . . . .02

>YEARS OR MORE . . . . . . . .03

;OLLEGE

I YEAR. . . . . . . . . . . ..41

2YEARS. . . . . . . . . . . .42

3YEARS. . . . . . . . . . . .43

i YEARS. . . . . . . . . . . .44

2RADUATE SCHOOL . . . . . . . . 45

ION’T KNOW. . . . . . . . . ..9B

!ONE. . . . . . . . . . 00 (pART 6)

R OF CHILOREN: I—.I I

# CHILOREN:

Ill

III——

Ill

Ill

Ill——

I I I I I I I

u

102-103

10%-105

106-107

108-109

110-111

112-113

11*-115

117-122

12*

PART B. FAMILY HISTORY

In this part of the questionnaire,I would like to ask you about

(sUB3ECT’S) relatives. This includes natural parents, sisters, brothers,

and children. Dor@ include adopted or step relatives but & include

half relatives. Begin BO

B-1 . (IF R IS NOT RELATIVE, B-1

ASK:~Do you think you can

answer sum questions

about (SUB3ECTIS) family?

B-2. How many brothers and !B-2

YES. . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . 2(PARTc)

OK. . . . . . . . . . . . . . . B

NONE. . . . . . . . . . 00 (Q. B-4)

sisters living or

deceased did (SUBJECT) II #SIBLINGS: I—— I I

have? DK. . . . . . . . . ..9B(Q.B-4)

11-12

B-3 . How many of these brothers B-3 SOLOEST . . . . . ...00

aud sisters were born

before (him/her)? ; OLDER: Ill

OK. . . . . . . . . . .9B

13-14

B-4 . How many children livina B-4 NONE. . . . . . . . . .00”

or decaased did (SUBJEC~)

have? Remember not to

include adopted or step

children.

#CHILoREN: I——I I

OK. . . . . . . . . . .98

B-5. Is (SUBJECTr S) mother B-5 I

YES. . . . . . . . . . I (Q. B-B)

still living? NO. . . . . . . . . . . 2

OK. . . . . . . . . . . 6 (Q. B-B)

17

B-6. In what year did she die? B-6 YR : 1119[11

(PROBE: How old was she

————

when she died?) OK. . . . . . . . . . . . . .9998

18-21

B-7. Was her death due to an B-7 YES. . . . . . . . . . . . . . 1

injury or accident? NO. . . . . . . . . . . . . . . 2

DK. . . . . . . . . . . . . . . B

22

B-8 . In what year was she B-B YR : 11111

born? (PROBE: tiOW .ld

is she now? How old was DK. . . . . . . . . . . . ..999B

she when she died?)

23-26

B-9. Is (SUBJECT’S)father B-9 VES. . . . . . . . . . 1 (Q. B-12)

still living? I INO . . . . . . . . ...2

E+(. . . . . . . . . . . B (Q. B-12) z,

B-10. In what year did he die? B-lD yR: I 1[9 I I I

(PROBE: HCIWold was he

—— ——

when he died?) OK. . . . . . . . . . . . . .9998

28-31

B-1 1. Was his death due to an B-1 1 YES. . . . . . . . . . . . . . . 1

injury or accident? NO. . . . . , . . . . . . . . . 2

OK. . . . . . . . . . . . . . . 8

32

B-1 2. In what year was he born? B-1 2 VR : 11111

(PROBE: How old is he

now? Hcm old .WaS he when OK. . . . . . . . . . . . . .999B

he died?)

33-36

4
PART C. FEMALE MEDICAL HISTDRY

B-1 3. Think about the relatives B-1 Begin CO

that you have included in

the previous questions

YES . . . . . . . . ...1

NO . . . . . . . . . ..2 (PART c)

DO . . . . . . . . . . . 8 (PART c) BOX B

INTERVIEWER: CIRCLE ONE:

~ WAS FEMALE . . . . . . . . . . . .. I(Q. C-1)

~ WAS MALE . . . . . . . . . . . . ..2 (PARTO)

that is, (SUB3ECT’S)

parents, brothers, sisters,

and children. Oid a doctor ?7

ever say that any of these

relatives had cancer? I

B-14. Could you tell me which r~lati$p< havp had canrFr7

[CIRCL.E RELATIONSHIP TO~INCOLUWN A.] These next questions are about (SUBJECT’S) Female medical history.

COLUFN A

CIRCLE

RELATIONSHIP TO SIUFIX17T

COLIJNN B

:ould you tell me the site or type

If cancrx which this (REI. AT TVE) had?

YES. . . . . . . . . . 1

NO . . . . . . . . . ..2 (PART D)

DK . . . . . . . . . ..fl

YES. . . . . . . . . . 1

NO. . . . . . . . . . . 2 (Q. c-B)

DK. .. 8( PA RT. .8(PART D)

c-l . (IF~Is NoT RELATIVE, c-1

ASK:) Do ytm think you cm

answpr qu@~tlnn~ ahm,t

this subject?

c-2 . Was she ever pregnant? c-2

Include live births, stillbirth, miscarriages and

abort ions.

c-3 . How old was she when her c-3

first child was born?

This means the first

child born alive or

stillborn.

a.t40THER. . . . . . . . . . 1

FATHER . . . . . . . ...2

SISTER . . . . . . . . ...3

@RoTHER . .,......4

SDN . . . . . . . . ...5

DAUGHTER. . . , . . . . . 6

38

b.t4TTHER. . . , . . . . . , 1

FATHER . . . . . . . ...2

SISTER . . . . . . . ...3

BROTHER . . . . . . ...4

SDN . . . . . . . . ...5

DAUGHTER . . . . . . ...6

115

511E:

DR

TYPE :

11

13-14

15-16

17-Is

19

do-zl

32

37-38

AGE : Ill

NO BIRTHS . . . . . . . 00 (Q. C-6)

DK . . . . . . . . . ..9B SITE:

OR

TYPE :

c-4 . HOW old was she when her c-4

laat child was born,

~n, including stillbirths?

AGE: t I I

DK. . . 0 .98....98

c-5. HOW many live births did c-5

she have?—

# LIVE BIRTHS: Ill

NO LIVE BIRTHS. . . . . 00

c.14JTHER . . . . . . . ...1 DK . . . . . . . . . ..9B

FATHER . . . . . . . . . . 2

SISTER . . . . . . . . . . 3

BROTHER . . . . . . ...4

SON . . . . . . . . ...5

DAUGHTER. .0......6

52

SITE:

OR

TYPE :

C-6. Oid she ever have a C-6

miscarriage?

YES . . . . . . . . .. I

NO . . . . . . . . . . . 2 (Q. c-B)

DO . . . . . . . . . . . 8 (Q. c-B)

# OF MISCARRIAGES: I I I

DK . . . . . . . . . ..9B

c-7. HOW many miscarriages c-7

did she have?

d.kKJTHER. .,.......

FATHER . . . . . . . . . .

SISTER . . . . . . . . . .

BROTHER . . . . . . . . .

SON . . . . . . . . . . .

DAUGHTER. . . . . . . . .

T.

1

2

3

4

5

6

SITE: C-B, Oid ahe ever take female C-8

hormone pills for reaaons

YES. .. I.. . . .. I

NO . . . . . . . . . ..2(Q. C-ID)

OK . . . . . . . . . .. B(Q. C-IO)

related to menopausa,

OR including hot flashes or I

TYPE :

mod changes around the

time she was beginning

the change of life? This

would include hormone pills

taken for natural chanoe of

SITE:

OR

TYPE :

e.t43THER . . . . . . . ...1

FATHER . . . . . . . ...2

SISTER . . . . . . . ...3

BROTHER . .,......4

SL)N . . . . . . . . ...5

DAUGHTER . . . . . . ...6

66

-4

YEARS: I I I

.—

DR

t+3NTHS: I t I ——

DK . . . . . . . . ...98 u 39

7

6
C-10. Oid she ever take birth c-1 o YES . . . . . . . . .. I

control pills for any

reason?

. No . . . . . . . . . . . 2 (PART o)

DK . . . . . . . . . ..8 (PARTO) 42

C-11. Altogether for about how c-1 1 YEARS : Ill 47-48

many years did she take

——

birth control pills?

OR

MONTHS : I—— II

I IOK . . . . . . . . . ..9I3 M ,,

PART O. HEALTH/OISEASES AND OPERATIONS

The quest ions I‘ m going to ask you now concern (SUB3ECT’ S ) health as well

as diseaees and operations (he/she) may have had.

0-1. (IF R IS NOT RELATIVE,

ASK:7 Do you think you

can answer questions about

(his/her) medical history?

D-2. Did a doctor ever say that

(he/she)had hypertension

or high blood pressure?

0-3. In what year was (he/she)

first told that (he/she )

had this condition?

D-4. Can you tell me if it was

less than a year before

(his/her) death, between

1 and 5 years, between

5 and 10 years, or 10 or

more years?

her) hypertension or high

blood pressure?

D-1

o-2

D-3

o-4

D-5

Begin D1

YES . . . . . . . . .. I

NO . . . . . . . . . . . 2 (Q. G-30)

OK . . . . . . . . . ..EI

YES. . . . . . . . . . 1

NO. . . . . . . . . . . 2 (Q. D-6a)

OK. . . . . . . . . . . 8 (Q. D-6a)

12

YEAR: II——_l—l 191 (Q.o-5)

OK. . . . . . . . . . .9998 13-16

LESS THAN ONE YEAR. . . 1

1 BUT LESS THAN

5YEARS . . . . ...2

5 BUT LESS THAN

10YEARS . . . . . . . 3

100RMDRE . . . . . . . 4

OK. . . . . . . . . . . 8

17

YES . . . . . . . . .. I(CHART)

NO. . . . . . . . . . . 2

OK. . . . . . . . . . . 8

18

‘9
INTERVIEWER INSTRUCTIONS: READ COLUMN a TO R. IF THE ANSWER

TO COLUMN a IS “YES,” ASK COLUMN b FOR THE CtiNOITION. IF ‘!NO,!]

ASK COLUMN a FOR THE NEXT CONDITION.

EuJxc

INTERVIEWER: CIRCLE ONE:

~ WAS FEMALE . . . . . . . . . . . .. I(Q.O-15)

SWASNALE . . . . . . . . . . . . . . 2 (Q.O-19)

—

COLUMN a

Oid (SUB3ECT) ever have (CONOITION):

COLUI.N b

Oid this condition last longer than

2.4 hours?

O-6b .

YES . . . . . . . . .. I

NO . . . . . . . . ...2

CU . . . . . . . . . ..EI

O-6a. A sudden loss of viaion?

YES . . . . . .. I

NO . . . . . ..7a) .D-7a)

ox . . . . . . . 6 (Q.D-7a)

-15

.

-16

0-15. Oid a doctor ever say YES . . . . . . . ...1

that (SUB3ECT) had a lump

or cyst M her breast? NO . . . . . . . . . . . 2 (Q.D-18)

OK. . . . . . . . . . . 8 (Q. D-IB)

9-?

D-16. Oid a doctor ever aay YES. . . . . . . . . . 1

that a lump or cyst in

her breast was cancerous

or mallgnant?

77-78

79-80

81-82

89-84

85

86-89

90

91-94

95

o-7a. A sudden loss of SDeeCh. D-7b . NO. . . . . . . . . . . 2

OK. . . . . . . . . . . B

1Q4

YES, ONE BREAST . . . . 1

YES, BOTH BREASTS . . . Z

NEITHER . . . . ...03

difficulty in speaking,’or

slurred speech?

YES . . . . . ..I

NO . . . . . .. Ba).O-Ba)

OK . . . . . .. Ba).D-Ba)

D-Ela. A sudden paralysis or weakness

of an arm and/or leg on the

same side of the body?

YES . . . . . .. I

NO . . . . . ..9a) .D-9a)

DK . . . . . ..9a) .D-9a)

O-9a. A sudden numbness on one side

of tha body?

YES . . . . . .. I

NO . . . . . . . 2 (Q.O-10)

OK. ., . . .. B(Q. O-1O)

YES . . . . . . . ...1

NO . . . . . . . . ...2

DK . . . . . . . . . ..tl

0-17. Oid she have one or both

of her breasts removed?

-1i’

OK . . . . . . . . ...8

105

YES . . . . . . . . ..1 (CHART)

O-Bb.

O-l B. Since 1970, was she ever

-t~ed overnight

for any type of breast

YES . . . . . . . . .. I

NO . . . . . . . . ...2

DK . . . . . . . . ...8

NO . . . . . . . . ...2

condition, female problems,

or a pregnancy?

0-19. Oid a doctor ever say that

(SUBJECT) had any cancer

(other than the cancer we

talked about.)? (00N’T

INCLUOE SKIN CANCER

UNLESS MELANOMA. )

OK . . . . . . . . . ..B

106

YES . . . . . . . . .. I

NO . . . . . . . . . . .

Begin D2

2 (PART G)

OK.. . . . . . . . . . 8 (PART G)

75

O-9b .

YES.. . , . . . . . . 1

NO. . . . . . . . . . . 2

DK. . . . . . . . . . . 8

ASK D-20 AND RECORO EACH

SEPARATE OIAGNOSIS OF Ist DIAGNOSIS I

2nd DIAGNOSIS I

3rd DIAGNOSIS

CANCER, THEN ASK 0-21 ANO

D-10. Did a doctor ever say Dthat (SUBJECT) had gall

bladde~se?

YES . . . . . . . . ..I

NO . . . . . . . . . ..2(BOX B) O-22 FOR EACH OIAGNOSIS.

0-20.

Where was the cancer or SITE: SITE:

what type of cancer was

it? [Did (h~/~he) have

any other cancer OR . OR

diagnosed?]

TYPE : TYPE :

I IDK . . . . . . . . . ..8(BoxB)

D-11. In what year was this 0-11 YR:I 1191 I I

condition first diagnosed? DK . . . . . . . . ..999B

D-12. Did (he/she) have surgery 0-12 YES. . . . . . . . . . 1

or a surgical procedure

for this condition? NO. . . . . . . . . . . 2 (Q.D-14)

SITE:

OR

TYPE :

I ]oK . . . . . . . . . ..8(Q.D-I4) I ,

OK ........... 9B OK ....... .... 98 OK .. ......... 98 D-13. In what year did (he/she)

first have surgery for

0-13 YR: [1191 ———— 1 1

-condition? OK. . . . . . . . ..9998 ?6-78 84-86 92-94

0-21. 0-14. Since 1970, was (SU6JECT) 0-14 YES. . . . . . . . . . 1 (CHART)

hospitalized overnight for

this condition? NO. . . . . . . . . . . 2

In what year was this YR:ll191t1 YR: 1119111 YR:1119111

(sITE/TypE) first

I IDK . . . . . . . . ...8 diagnosed? OK .......... 999B OK ....... ... 999B OK ..... ..... 999B

7’3-82 07-90 95-90

D-22.

Since 1970, was (he/she) YEs .... 1 (CHART) yEs .... 1 (CHART) YES .... I (CHART)

hospitalized overnight ~

for this condition? ..... 2 NO ..... 2 NO . .... 2

DK ......B OK ..... 8 OK . .... 8

I 83 I 91 I 99

10 -.,
.

g PART G. MEDICAL CONDITIONS

Now I ‘m going to read a list of medical conditions that (SUBJECT) may

have had.

INTERVIEWER INSTRUCTIONS : READ G-1 a THRDUGH G-29a FIRST. IF

In what year was

(CDNDITION) first

diagnosed?

Oid a doctor ever say

that (suB3ECT) had any

of the~ing

conditions?

Since ~, had (he/

-ever stayed ~

night in a hospital

-CONDITION)?

G-7B .

Urinary tract or

kidney infection mote

than 3 times

YES . . . . . . . .. I

ND . . . . . . ...2

OK. . . . . . . . .B

G-7b .

YR:II 19111

DK. . . . . . . 9998

G-7c .

RESPDNSE = YES (1), ASK b AND C.

Oid a doctor ever say

that (suBJECT) had any

of the~ing

conditions?

G-1 a.

Asthma

YES . . . . . . . ...1

ND . . . . . . ...2

OK . . . . . . . ..B

In what year was

(CONDITION) first

diagnosed? YES . . . . . I (cHART)

NO . . . ...2

OK. . . . . .8

Begin G1

11-16

17-22

23-28

29-311

95-40

41-46

47-52

53-58

59-6.

65-70

71-76

77-82

83-88

89-94

G-lb. G-lc.

YES . . . . . I (cHART)

NO. . . . . .2

OK. . . . . .8

G-2c .

yE5 . . . . . I (CHART)

NO. . . . . .2

DK. . . . . .B

G-8a.

Polyps or tumor of

the colon

YES. . . . . . . . .1

NO. . . . . . . . .2

OK. . . . . . . . .8

G-8b .

YR: II 19 I I I

OK. . . . . . . 9998

G-9b .

YR:II 19111

DK. . . . . . . 9998

G-10b.

YR:] 1191 II

OK. . . . . . . 9998

G-llb.

YR:I 1191 II

DK. . . . . . . 9998

G-8c

YR: II I 9 I t !

YES. . . . . 1 (cHART)

NO. . . . . .2

DK. . . . . .8

G-9c.

yEs . . . . . I (CHART)

NO. . . . . .2

DK. . . . . .8

G-1 OC .

YES. . . . . I (CHART)

NO. . . . . .2

OK. . . . . .8

G-llc.

YEs. . . . . 1 (CHART)

NO. . . . . .2

DK. . . . . .8

OK. . . . . . . 9998

G-2a. G-2b .

Chronic bronchitis,

enphysema

YES. . . . . . . . .1

NO. . . . . . . . .2

DK. . . . . . . . .B

G-3a.

Migraine

YES. . . . . . . . .1

NO. . . . . . . . .2

OK. . . . . . . . .8

G-ha.

Psoriasis

YES, . . . . . . . .1

No.. . . . . . . .2

OK. . . . . . . . .B

G-9e .

Cirrhosis of the liver

YES. . . . . . . . .1

NO. . . . . . . . .2

OK. . . . . . . . .8

G-lea.

Parkinson’s disease

YES. . . . . . . . .1

NO. . . . . . . ..2

OK. . . . . . . . .B

G-ha.

kidtiple sclerosis

YES. . . . . . . . .?

NO. . . . . . . ..2

DK. . . . . . . . .8

G-1 2a.

Nervous breakdown

YES. . . . . . . . .1

NO. . . . . . . . .2

OK. . . . . . . . .8

YR: 11191 II

OK. . . . . . . 9998

G-3b. G-3c.

YES. . . . . I (CHART)

NO. . . . . .2

OK. . . . . .8

G-4c.

YES. . . . . I (CHART)

NO . . . ...2

OK. . . . . .B

YR: 1119111

DK. . . . . . . 9998

G-4b .

YR:I 1191 II

DK. . . . . . . 999B

G-5a.

Ulcers: peptic,

stomach, or duodenal

,VES. . . . . . . . .1

NO.. . . . . . . .2

OK. . . . . . . . .B

G-6a.

Kidney disorder or

kidney stones

YES. . . . . . . . .1

No.. . . . . . . .2

OK. . . . . . . . .B

G-5b. G-SC.

yEs . . . . . 1 (CHART)

NO. . . . . .2

DK. . . . . .8

G-12b.

YR:II 191 II

DK. . . . . . . 999B

G-1 3b .

YR: 11191 II

OK. . . . . . . 9998

G-12c.

YES. . . . . I (CHART)

NO. . . . . .2

DK. . . . . .8

YR: 1119111

OK. . . . . . . 999B

G-6b. G-6C.

YES . . . . . I (cHART)

NO . . . ...2

DK. . . . . .B

G-1 3a.

Diverticulitis

YES. . . . . . . . .1

NO. . . . . . . . .2

OK. . . . . . . . .8

G-13c.

yEs . . . . . I (CHART)

NO. . . . . .2

DK. . . . . .8

YR:II 19111

OK. . . . . . . 9998

G-14a.

Colitis, enteritis

YES. . . . . . . . .1

NO. . . . . . . . .2

DK. . . . . . . . .8

G-1 4b .

YR:II 19111

DK. . . . . . . 9998

G-14c.

YES. . . . . 1 (cHART)

NO. . . . . .2

OK. . . . . .8

12 13
D1d a doctor ever say

that (SUB3ECT) had any

of the~ing

conditions?

In what year was

(CONDITION) first

diagnosed?

——Since 1970, had (he/

she) ever stayed over-

%+C~T%ta’

G-15c.

Did a doctor ever say

that (5uBJECT) had anY

of the followim

In what year was

(CONOITION) first

diagnosed?

——Since 1970, had (he/

she) ever stayed over-

. .

conditions? - %%C~~$T%+ta’

G-1 5a. G-15b.

Heart condition or heart

trouble

YES . . . . . . ...1

No . . . . . . ..az

DK. . . . . . . . .8

G-23a.

Diabetes or sugar

diabetes

G-23b .

YR: 1119111

DK . . . . . . . 9990

71-7U

G-23c.

YE5 . . . . . I (CHART)

NCI . . . ...2

DK . . . ...8

81

YR:[11911[ ———— YEs . . . . . I (CHART)

NO . . . ...2

DK . . . ...8 .,. _,o*

G-16c.

YES . . . . . . . ..l

NO . . . . . . . ..Z

DK. , . . . . . ..8

7Q

DK. . . . . . . 999sl

G-16a.

Angina

G-16b.

G-24a.

Thyroid disease

or goiter

YES. . . . . . . . .1

NO. . . . . . . . .2

G-2fib .

YR:II 19111

ox . . . . . . . 9998

83-86

G-25b .

YR:II19111

OK. . . . . . . 999B

95-99

G-26b .

YR: 1119111

DK. . . . . . . 999B

V16-V19

G-2hc .

YE5 . . . . . 1 (CHART)

NO. . . . . .2

cu... . . . . B

94

YES. . . . . . . . .1 itt: I 1 IYI I I ——— —

‘iIis . . . . . 1 (CHIIRI)

ND. . . . . .2

DK . . . ...8 101-106

NO. . . . . , . . .2

DK. . . . . . . . .8

G-1 763.

Heart attack

DK . . . . . . . 9998

G-17b. G-1 7C . OK. . . . . . . . .8

82

YE5 . . . . . . . ..I YR: 1119111 ————

YES . . . . . 1 (CHART)

NO. . . . . .2

DK. . . . . .8 107-112

G-25a.

Epilepsy

YES. . . . . . . . .1

NO . . . . . . ...2

G-25c.

yEs . . . . . I (CHART)

NO. . . . . .2

DK . . . . ..B

105

NO. . . . . . . . .2

DK. . . . . . . ..8 DK . . . . . . . 9998

G-lBa.

Cat aracts

YES . . . . . . ...1

NO . . . . . . ...2

G-1 8b . G-18c.

DK . . . . . . . ..B

95 YR: 1119111 ————

YEs . . . . . 1 (CHART)

NO. . . . . .2 G-26a.

Arthritis

G-26c .

yEs . . . . . 1 (CHART)

NO. . . . . .2

OK, . . . . .8

V20

DK . . . . . . ...8 DK . . . . . . . 999B DK . . . ...8 11?-118

YES. . . . . . . . .1

NO. . . . . . . . .2

G-19a.

Glauccma

YES. . . . . . . . .1

NO. . . . . . . . .2

DK . . . . . . ...8

G-19b. G-19c.

DK. . . . . . . . .B

V15

YR: 11191 II YEs . . . . . 1 (CHART)

NO. . . . . .2

DK . . . . . . . 9998

G-20b .

DK . . . ...8 119-124

G-2DC .

BOX D

INTERVIEWER: CIRCLE ONE

~WAS FEMALE . . . . . . . . . l(ASKbANDcFOR

ANY YES IN Q.G-la -

Q. G-26a, THEN GD

TO BOX E)

~WAS MALE. . . . . . . . . . 2 (Q. G-27a)

G-20a.

Ootached retina

YES. . . . . . . . .1 YR: 11191 II YES . . . . . 1 (CHART)

NO . . . ...2

Dx. . . . . .8 17~-130

ND. . . . . . . ..2

DK . . . . . . ...8

G-21a.

Small stroke smnetimes

known as TIA (transient

ischmlc attack)

DK. . . . . . . 9998

G-21b. G-21c. Beqin G2

G-27a.

Prostate trouble

YES. . . . . . . . .1

NO. . . . . . . . .2

DK. . . . . . . ..B

G-27b .

I

G-27c .

YES . . . . . . ...1

NO . . . . . . ...2

YR: 11191 II

DK. . . . . . . 9998

YES . . . . . t (CHART)

NO. . . . . .2

DK . . . ...8 11-16

~ 23-22

DK . . . . . . . ..B

G-22a.

Stroke (sometimes called

a CVA)

YES. . . . . . . . .1

NO. . . . . . . . .2

OK. . . . . . . . .8

G-22b . G-22C.

[FOR Q. G-la-Q .G-27a, IF YES, ASK b ANO c.]

YR: 11191 II

DK . . . . ...9998

YES . . . . . 1 (CHART)

NO. . . . . .2

DK. . . . . .B 17-22

14 15
N

i-ii

G-28a. Did (SUBJECT) have an G-28a YES . . . . . . . . .. I

oophorectomy or have

her ovaries removed?

NO . . . . . . . . . ..2(Q. G-29a

DO . . . . . . . . . . . 8 (Q. G-29a) V2 1

I t

G-28b . In what year was that? G-2EIb YR: 11191 II

DK. . . . . . . . . .9998 (Q. G-29a) “,, -,,

I

BOX F

I

INTERVIEWER: REVIEW Q. G-28b

G-28b IS 1970 OR LATER. . . . . . . . 1 (CHART)

G-2Elb IS BEFORE 1970. . . . . . . . . 2 (Q. G-29a)

G-29a . Did (SUBJECT) have a G-29a YES . . . . . . . ...1

hysterectomy or have

her womb ramoved?

NO . . . . . . . . . . . 2 (Q. G-30)

OK . . . . . . . . . . . 8 (Q. G-30) “2 6

G-29b . In what year was’that? G-29b YR : 11191 I I

OK . . . . . . . . . .9998 (Q. G-30) “27-90

BOX G

INTERVIEWER : REVIEW Q. G-29b

G-29b IS 1970 OR LATER. . . . . . . . I (CHART)

G-29b IS BEFORE 1970. . . . . . . . . 2 (Q. G-30)

G-30. (I have asked you about various G-30

illneseesthat (sUBJECT) had and

khether or not (~ was hospitalized for them). Now I would

like you to think back over the

time between 1970 and the time

(he/she) died, that is the last

(NUMBER) years of his/her life.

(-) would have been about

(AGE) in 1970. Was (he/she)

h~italized overni ht for q

(other) reason + .ncludlng pregn=a) since (he/she) was “(AGE)?

Was (he/she) hospitalized before

(he/she) died?

YES. . . . . . 1 (BOXH) Begin G3

NO. . . . . . . 2 (Q. G-31)

OK. . . . . . . B (Q.G-31)

82

BOX H

HOSPITAL ANO HEALTH CARE FACILITY QUESTIONS

(SEE CHART)

INTERVIEWER: ASK A-E FOR EACH OVERNIGHT STAY. RECORO ON

CHART.

A. What year WE4S (he/she) in the (INSTITUTION)? (RECORO

YEAR)

B. hhY was (he/she) in the (INsTITIJTION)? (REcORO CONOITION/ILLNESS)

c. what WES the name of th. (INSTITUTION)? (PROBE FoR

FULL NAME AND RECORD TYPE OF INSTITUTION) —

D. hat is the addreaa Of that (INSTITUTION)? (RECORD

STREET, CITY ANO STATE)

E. Oid (he/she) stay in (INSTITUTION) for any other

reason? (IF YES, RECORO ON CHART)

(IF No, GO TO Q.G-31 IF NOT YET ASKEO: OTHERWISE,

GO TO PART L)

G-31. Since 1970 when (he/she) waa (AGE), G-31 YES. . . . . . 1

did (he/she) ever stay ovarnig~

NO. . . . . . . 2 (PART L) in any other health care facility

such as a rest home, a nursing OK. . . . . . . B (PART L)

home, a mental health facilitv or

a health care rehabilitation ‘

center of any kind? I I

83

I

G-32. What type of facility was that? G-32

(RECORO TYPE OF FACILITY ON CHART

ANO ASK A-E IN BOX H FOR EACH

STAY. )

16 17
PART L. S+KIKING HISTORY

YES . . . . ...1

NO . . . . . ...2

~ 13K. . . . . . ..R

Did (he/she) ever smoke cigars

These next questions deal with (SUB2ECT!S) smoking history.

Begin LO

YES . . . . .. I

NO . . . . . ..2(PARTM)

L-1 . (IF IJIS NOTRELATIVE ASK:) L-1

0s you think you can answer some

questions about (his/her) smoking

habits?

L-10. Did (he/she) —ever use.. . L-1 [

8. Snuff? a

b. cl(~tilrq I.uhxu? b

YES No DK

1 2 8

1 2 8

YEs . . . . ...1

,ND. . . . . . . . 2

lX . . . . . . ..l3

OK . . . . . ..LI

L-2 . Did (SUBJECT) ever smoke at least L-Z

100 c-es~more in (his/her)

lifetime?

YES . . . ...1

No . . . . . . . 2 (Q. L-9) a

L-Il. Wm !he/&m) ever married to

somrmw? whn smoked clqarettes? I 10K . . . . . ..9)Q.L-9) ,,

READ L-3 TO L-6

FOR EACH SMOKING

PERIOD

Smoking Period

#1

%noking Period

#2

Smoking Period

#3

L-3 .

About how old WaS

(he/she) when

(he/she) (first/

next) began to

smoke cigarettes

regularly?

AGE: I I I

CK . . . ...98

AGE: I I I

DK . . . ...98

IGE: I II

)K. . . . . .98

DID NOT SMOKE

REGULARLY . . 00

(Q. L-7

010 NOT SMOKE

REGULARLY . . 00

(Q.L-7)

)ID NOT SMOKE

REGULARLY . . 00

(Q.L-7)

14-15 20-21 .6 -27

&~” (SUB3ECT )

ever stop

making cigarettes for at

least a yesr

(again)?

YES . . I (Q. L-5

NO. . . 2 (Q. L-7

OK. . . 8 (Q, L-7

YES . . I (Q.L-5)

NO. . . 2 (Q.L-7)

DK. . . 8 (Q.L-7)

YES . , I (Q.L-5)

!0. . . 2 (Q.L-7)

)K. . . 8 (Q.L-7)

22 28

L-5 .

At whst sge did

(he/she) (first/

next) strp for

at least a year?

AGE: I—— 1 I

DK. . . . . ,98

AGE: 1 I I ——

DK. . . . . .9EI

AGE: I—— I I

OK. . . . . .98

17-18 23-24 29-30

L-6.

Oid (he/she)

ever start

smoking cigarettes again?

VES . . I (Q. L-3

NO, . . 2 (Q. L-7

OK. . . 8 (Q. L-7

19

VES . . I (Q. L-3 YES . . I (Q.L-3)

No. . . 2 (Q. L-7

OK. . . 8 (Q. L-7

2s

NO. . . 2 (Q. L-7)

OK, . . 8 (Q. L-7)

31

L-7 . During the years when (he/she) was L-7

snaking, shout how msny cigarettes

a day, on the aversge, did (he/she)

smoke?

LESS THAN ONE

ADAV . ...00

# CIGARETTES: I i I ——

DK. . . . . . .98 32-34

41

19

L-8 . Were the cigaretteswhich (he/she) L-8 FILTER. . . . . 1

smoked for the longest period of

time filteredor nonfiltered? NONFILTER . . . 2

DK. . . . . . .8
$s

PART M. ALCOHOLIC BEVERAGES

These next questions are about (SLNXIECT’S) drinking of alcoholic beverages.

M-1 . (IFEIS NOTRELATIVE ASK:)

Oo you think you can

answer some questions

about (his/her) drinking

habits?

M-2. Did (SUBJECT) have at least

12 dr~ any kind of

alcoholic beverage in any

one year? This includes

liquor, beer or wine.

M-3. What was (his/her) main -

reason for not drinking?

4-1 —

+2

B-3 —

Begin MO

YE5 . . . . . . . . .. I

NO . . . . . . . . . . . 2 (PART u)

OK . . . . . . . . ...8

YES . . . . . . . . .. I(Q. M-4)

NO . . . . . . . ...2

DK . . . . . . . . . ..8 (PART U)

11

NO NEED/NOT NECESSARY . 1 (PART u)

OIDN’T CARE TO/

oISLIKEO IT......2 (PART u)

MEOICAL/HEALTH

REASONS . . . . . . . 3 (PART u)

RELIGIOUS/MORAL

REASONS . . . . . . . 4 (pART u)

BROUGHT UP NOT TO

ORINK . . . . . . . . 5 (PART u)

OTHER (SPECIFY) . . . . 6 (PART U)

DK . . . . . . . . . ..8 (PART U)12

M-4 . Now1 would like You to

think about (SUBJECT’S)

drinking at s~fferent

veriods in (his/her) life.

When (SUBJECT) was about 25

years old, would you say (he/

she) drank more than, less

than, or about2 to3 drinks

day?

(IF MORE, ASK:)

Would you say (he/she) drank 9 or more drinks a day,

about6 to8 drinksa day,

or about4 or5 drinksa

day?

(IF LESS, ASK:)

Would you say (he/she) drank 1 to 9 drinks a week, less

than1 drinka week, or did

(he/she) not drink at all?

M-5 .

(IF~WAS 35 OR OLDER, ASK:)

HOW about when (SUB3ECT) was

35, would yOU sa=he)

drank more than, less than,

or about2 to3 drinksa day?

(IF MORE, ASK:)

Would you say (he/she) drank 9 or more drinks a day,

about6 to8 drinksa day,

or about4 or5 drinksa

day?

(IF LESS, ASK:)

Would you say (he/she) drank 1 to 9 drinks a week, less

than1 drinka week, or

did (he/she) not drink at

all?

M-6 .

(IF~WAS 45 DR OLDER, AsK:)

And when (suBJECT) was 45,

would you -/she) drank

more than, less than, or

about2 to3 drinksa day?

(IF MORE, ASK:)

Would you say (he/she) drank 9 or more drinka a day,

about6 to8 drinksa day,

or about4 or5 drinkaa

day?

(IF LESS, ASK:)

Would you say (he/she) drank 1 to 9 drinks a week, less

than1 drinka week, or

did (he/she) not drink at

all?

—$—5—6.

i.9 or more drinksa

day (60 or mare

drinksa week):. .

1. About 6-8 drinks a day (40 to 59

drinksa week);. .

:. About4 or5 drinks

a day (25 to 39

drinksa week):. .

). About2 or3 drinks

a day (10 to 24

drinksa week);. .

:. About1 to9 drinks

a week ;......

“. Less than1 drink

aweek; or....

;. Oid not drink

st all......

OK. . . . . . . . . . .

01

02

03

04

05

06

07

9B >~_,?

!.

3.

r.

D.

E.

F.

G.

OK.

9 or more drinksa

day (60 or more

drinksa week);. . 01

About 6-8 drinks a day (40 to 59

drinksa week);. . 02

About4 or5 drinks

a day (25 to 39

drinkaa week);. . 03

About2 or3 drinks

a day (10 to 24

drinksa week):. . 04

About1 to9 drinks

sweek; . . . . ..O5

Less than1 drink

aweek:or . . ..D6

Oid not drink

stall......o7 . . . . . . . . . . 9B ?. _,:

A.9 or more drinksa

day (60 or more

drinksa week):. .

B. About 6-B drinks a day (40 to 59

drinksa week);. .

C. About4 or5 drinks

a day (25 to 39

drinksa week);. .

0. About2 or3 drinks

a day (10 to 24

drinksa week);. .

E. About1 to9 drinks

a week;......

F. Less than1 drink

aweek; or....

G. Oid not drink.

st all......

OK...........

01

02

03

04

05

06

07

9B

3$-?7

20

21
(IF

S WAS 55 OR OLOER, ASK:)

I!.7. And ~hen (SUBJECT) was 55,

would you =/she) drank

more than, less than, or

about2 to3 drinksa day?

(IF MORE, ASK:)

Would you say (he/she) drank 9 or mare drinks a day,

abo,ut6 to8 dr]nkha day,

or about4 or5 drinksa

day?

(IF LESS, ASK:)

Would you say (he/she) drank 1 to 9 drinks a week, less

th!+n1 dr~nka week, cm

,dlfl iht~ibtlr) rmt !Irld ,,!

~~1-1

(IFS WAS 65 OR OLOER, ASK:)

M-8 . And ~hen (SUB.3ECT) waa 65,

would you _/she) drank

more than, less than or

about2 to3 drinksa day?

(IF WORE, ASK:)

Would you say (he/she) drank 9 or more drinks a day,

about6 toB drinksa day,

or about4 or5 drinksa

day?

(IF LESS, ASK:)

Would you say (he/she) drank 1 to 9 drinks a week, less

than1 drinka week, or

did (he/she) not drink at

all?

(IF~ WAS 75 OR OLOER, ASK:)

M-Y . And when (SUBJECT) was 75,

would you -/she) drank

mare than, less than, or

about2 to} drinksa day?

(IF MORE, ASK:)

Would you say (he/she) drank 9 or more drinks a day,

about6 to8 drinksa day,

or about4 or5 drinkaa

day?

(IF LESS, ASK:)

Would you say (he/she) drank 1 to 9 drinks a week, leas

thsn1 drinka week, or

g;:?(he/she) not drink at

.7—

-8—

-9—

i.9 or more drinksa

day (60 or inert:

drinksa week): . . 01

4. About 6-B drink% a day (40 to 59

drinksa week);. . 02

?. About4 or5 drinks

a day (25 to 39

drinhsa weeh): . . 03

). About2 or3 drinks

a day (10 to 24

drinksa week);. . 04

i. About1 to9 drinks

aweek; ,.. . ..O5

:. LFS, thfin1 dr~r,L

aw}.~k: or . . . . 06

;. Did not drink

stall . . . . ..O7

X . . . . . . . . ...98 ?8 -37

4.9 or more drinkaa

day (60 or mare

drinkaa week);. .

B. About 6-B drinka a day (40 to 59

drinksa week);. .

C. About4 or5 drinks

a day (25 to 39

drinksa week);, .

D. About2 or3 drinks

a day (10 to 24

drinksa week):. .

E. About1 to9 drinks

a week; . . . . . .

F. Less than1 drink

aweek; or....

G. Did not drink

st all......

OK. . . . . . . . . . .

01

02

03

04

05

06

07

98 “0. ,1

A.9 or more drinksa

B.

c.

D.

E.

F.

G.

lx.

day (60 or more

drinksa week); . . 01

About 6-8 drinks a day (40 to S9

drinksa week):. . 02

About4 or5 drinks

a day (25 to 39

drinksa week); . . 03

About2 or3 drinks

a day (10 to 24

drinksa week);. . 04

About1 to9 drinks

aweek; . . . . ..O5

Leas than1 drink

aweek; or . . ..O6

Did not drink

stall......o7 . . . . . . . . . . 98 42-IL3

Box3

INTERVIEWER: REVIEW Q. M-4 THROUGH Q. H-9 AND

CIRCLE ONE

Q, M-4 THROUGH t3.M-9= DK (98) . . . . 1 (PART l-l)

OTHERWISE . . . . . . . . . . . . . . 2 (Q. M-1O)

(REAO AGE AND AF’COJNT AT

HIGHEST POINT OF DRINKING)

F!-10. You told me when (SUBJECT)

was (AGE) (he/she) drank

(AMou~. Did (he/she)

e-ink more than that

mount for3 months or

longer?

(IF HIGHEST POINT IS A,

CIRCLE 97)

M-11. Which of thsse drinkinq

categories beat describes

(SUB3ECT ‘S) drinking

during that period.

(READ CATEGORIES) . .

M-1 2. AbOut hOw Old was (SUB2ECT)

when (he/she) started

drinking that anount?

M-1 3. For about how long was this

typical of (SUB3ECT ‘s)

drinking?

—

-1—

-1—

l-l —

l-’ —

YES . . . . . . . . . . 1 (Q. k!-11)

No. . . . . . . . . . . 2 (PART u)

OK . . . . . . . . . . . 3 (PART u)

A.9 or more drinksa

day (60 or more

drinksa week);. .

B. About 6-B drinks a day (40 to 59

drinksa week);, .

C. About4 or5 drinks

a day (25 to 39

drinksa week);. .

D. About2 or3 drinks

a day (10 to 24

drinksa week);. .

E. About1 to9 drinka

awes; .. . . . .

F. Less than1 drink

aweek; or....

G. Did not drink

st all......

DO . . . . . . . . . . .

HIGHEST POINT IS A. . .

01

02

03

04

05

06

07

98

97

AGE : Ill

OK . . . . . . . . ...98 # YEARS: I I I (PART u)

OR

# 140NTHS: I I I (PART u)

Lx ,. ..,.. . . . 95 (PART u)

44

115-46

n’7-b8

4Y-5D u 51

22

23
M-14. (RECORO RESPONSES ON

ALCOHOL CHART)

NOW I would like You to

think about (SUBJECT ‘S)

o

drinking at several differen

HAND periods in (his/her) life.

R Look at this card. When

C~RD (SUBJECT) was about 25 years

A old, which category best

describes (his/her) drinking

pattern?

(IFs wtfs35 OR OLOER, ASK:)

M-15. HOW about when (he/she)

was 35?

(IF S WAS 45 OR OLDER, ASK):

M-16. And ;hen (he/she) was 45?

(IF S WAS 55 OR OLDER, ASK:)

M-17. And ;hen (he/she) was 55?

(IF s WAS 65 OR OLOER, ASK:)

M-IB. And ~hen (he/she) was 65?

.11

—

-15

—

-16

.18

.

! A . . . . . . . . . ..01

B . . . . . . . . . . . 02

c . . . . . . . . . . . 03

0 . . . . . . . . . . . 04

E . . . . . . . . . . . 05

F . . . . . . . . . . . 06

G . . . . . . . . . . . 07

32-33

DK . . . . . . . . . ..9B

(IF s WAS 75 OR OLDER, ASK:)

M-1 9. And ;hen (he/she) was 75?

A . . . . . . . . . . . 01

B . . . . . . . . . . . 02

c . . . . . . . . . . . 03

D . . . . . . . . . . . 04

E . . . . . . . . . . . 05

F . . . . . . . . . . . 06

G . . . . . . . . . . . 07

DK . . . . . . . . . ..9B

34-35

A . . . . . . . . . . . 01

B . . . . . . . . . . . 02

c . . . . . . . . . . . 03

D . . . . . . . . . . . 04

E . . . . . . . . . . . 05

F . . . . . . . . . . . 06

G . . . . . . . . . . . 07

DK . . . . . . . . . ..9B 36-37

A . . . . . . . . . . . 01

B . . . . . . . . . . . 02

c . . . . . . . . . . . 03

0 . . . . . . . . . . . 04

E . . . . . . . . . . . 05

F . . . . . . . . . . . 06

G . . . . . . . . . . . 07

DK . . . . . . . . . ..9B

38-39

A . . . . . . . . . . . 01

B . . . . . . . . . . . 02

c . . . . . . . . . . . 03

D . . . . . . . . . . . 04

E . . . . . . . . . . . 05

F . . . . . . . . . . . 06

G . . . . . . . . . . . 07

DK . . . . . . . . . ..9B

40-41

I

.19 A . . . . . . . . . . . 01

B . . . . . . . . . . . 02

c . . . . . . . . . . . 03

D . . . . . . . . . . . 04

I

E . . . . . . . . . . . 05

F . . . . . . . . . . . 06

IG . . . . . . . . . ..o7

OK . . . . . . . . . ..9B

~

: REVIEW Q.M-14 THROUGH Q.W-19 ANO CIRCLE ONE

(SHOW R THE HIGHEST POINT

ON THE–CHART ANO ASK Q .M-20)

M-20. Oid ( he/she) ever drink more

than the amount (he/she)

drank when (he/she ) was (AGE:

for three months or longer?

(IF HIGHEST POINT IS A,

CIRCLE 97)

N-21 . Which of the categories on

the chart best describes

(SUi33EcT’S) drinking during

t~d?

M-22. About hOw old was (SIKIECT)

*en (he/she) started

drinking that mount?

M-23. For about how long waa this

typical of (.51JBJEcTIs)

drinking?

—

-20

—

-21

z

—

-23

—

YES . . . . . . . . .. I

NO . . . . . . . . . ..2(PARTU)

OK . . . . . . . . . .. B(PARTU)

A . . . . . . . . . . . 01

B . . . . . . . . . . . 02

c . . . . . . . . . . . 03

D . . . . . . . . . . . 04

E . . . . . . . . . . . 05

F . . . . . . . . . . . 06

G . . . . . . . . . . . 07

DK . . . . . . . . . ..9B

HIGHEST POINT IS A. . . 97

AGE: Ill——

OK . . . . . . . . ..9B

#yEARS: I I I

OR

# !+3NTHS: I II

DK . . . . . . . . . ..9B

42-43

44

,s -46

!! 7-48

49-50

u 51

24 25
PART U. BACKGROUMI INFORMATION i4RRIED . . . . . . ..l

m’IDowED . . . . . ...2

)IVORCED. . . . . . . . 3

5EPARATED . . . . . . . 4

!EVER NARRIED . . . . . 5

3K . . . . . . . . ...8

RURAL . . . . . . . .. I

CITY . . . . . . . . ..2(Q. U-7)

CITY SUBURBS. . . . . . 3 (Q.U-7)

OK . . . . . . . . . . . 8 (Q.U-7)

U-4. (IF R IS x, CIRCLE 1

AND ~0 TO U-5, OTHERWISE

ASK: ) At the time of

(SUB3ECT ‘s) death, was (he/

s~ed, widowed,

divorced, separated or

had (he/she) never been

married?

These next questions are about ~SUB3ECT ‘S) background, for example,

(his/her) marital status and Occupation.

Begin UO

~ES . . . . . . . . ..1

JD. . . . . . . . . ..2(F’ARTV)

X . . . . . . . . ...8

—

1

F

—

.3

—

U-1. (IF~ IS NOT RELATIVE ASK:)

DO you think you can

answer questions about

(SUBJECT’S) background?

?n

21

22

2’3

2!4

u-5. Would you say that (he/

she) lived !rost of (his/

her) life in a rural area,

~ty or in the city

suburbs?

U-6 . When (he/she) lived in a

rural area dld (he/she)

li~e !:,rt u f.m?

11 D203D405D607

Xl 09 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27

3THER (sPE121Fy) . . . . 28

u-2 . Nest people in the United

States have anceators who

cane frcm other parta of

the world.

YES . . . . . . . ...1

NO . . . . . . . . ...2

OW . . . . . . . . ...8

T,I. What nationality or

ethqic backorouncl

were (suBJECT’S)

ancest~

I_l_l 11-12

~13-14

~15-16

M. . . . . . . . . . .98

u-7 . In the area where (he/she)

lived most of (his/her)

life, what was the primary

source of drinking water:

a comnunity supply, a

private well, a spring or

soma other source?

instance, Puerto

Rican, English,

African, Chinese,

etc.? (CIRCLE ALL

THAT APPLY)

COW4JNITY SUPPLY. . . . 1

PRIVATE WELL. . . . . . 2

SPRING . . . . . . ...3

OTHER (SPECIFY) . . . . 4

~17-18

— I.P. Look at this card.

u

HIV40 Wnich of these group!

R beat describes

Ciim (SUBJECT’S) ethnic

B background? (CIRCLE

ALL THAT APPLY)

CK. . . . . . . . . ..B

STATE :

DK . . . . . . . . . ..9B

YES. . . . . . . . . . 1

NO. . . . . . . . . . . 2 (Q. U-21)

OK . . . . . . . . . . . B (Q. U-21)

OCCUPATION/JOB TITLE:

U-B . In what state was (suBJECT)

born?

ALEUT, ESKIWD OR

AMERICAN INDIAN . . . 1

ASIAN/PACIFIC

ISLANDER. . . . . . . 2

BLACK. . . . . . . . .3

WITE . . . . . . ...4

OTHER (SPECIFY) . . . . 5

u-3 .

u

HPNO

R

cm

c

T,I. hhich of these

categories beat u-9 . Oid (he/she) ever work at a

job or busineaa full time

or part time for a total

of more than a year?

de$!c;ibea (su133E12T):

Aleut, Eskimo or

American Indian,

Asian, Pacific

Islander, Black

or White?

U-10. What kind of work did (he/

she) do for the longest

period of time? What was

(his/her) occupation or

corrplete job title? For

example, carpenter, secretary, electrical engineer.

I.P. Look at this card.

hhich of these categories best

describes (SUB3ECT)? OK. . . . . . . . . . .998 ~25-27 19

U-11. What were (SUB3ECT’S) moat

important a~ or

duties as a(n) (OCCUPATION)

for exarrole, sold cars,

DUTIES:

.

kept acc~unt books, swept

floors?

OK.. . . . . . . ...8

# YRS: Ill

DR. . . . . . . . . . .98

28-29

U-12. For how many years did

(he/she) work as Q(n)

(OCCUPATION )?

27 26
—

U-13. While employed as a(n)

(OCCUPATION) what was the

name of the enployer for

whom (he/she) worked the

=?

EMPLOYER :

YES . ., . . . . ...1 U-22. During the three months u-2

prior to (SUB3ECT1S) death,

was (he/she) working at all

at a job or business?

NO. . . . . . . . . .. Z(BOXF)

SELF EMPLOYED . . . . . , I I DK . . . . . . . . . .. E(Box F)

Vrl 7

OCCUPATION/JOB TITLE: U-23. What kind of work was u-2

(he/she) doing? What

was (his/her) occupation

or conplete job title:

for exa~le, carpenter,

secretary, electrical

engineer?

U-24. What were (5 UBJECT1S) U-2(

most import~ities

or duties: for example,

sold cars, kept account

books, swept floors?

U-14. What kind of business or

industry was that erployer

in, that is what did the

corpany or (SUBJECT’S) part

of the company do or make?

For exanple, automobile

manufacturing, state labor

department, dairy farming,

retail shoe sales?

BUSINESS/INDUSTRY :

OK. . . . . . . . . ..99B

l-u-i V$3-45

DUTIES: DK . . . . . . . . ...998

YES . . . . . . . . .. I(Q.U-Z7)

NO . . . . . . . . ...2

DK . . . . . . . . . .. B(Q. u-H)

V30 -32

V31

v32

V33-36

“37

“38

V99

“40-,41

U-15. In the three months prior

to (SUBJECT’ S~h, was

(he/she) still working for

(EMPLOYER) as a(n)

(OCCUPATION)?

U-16. At time of death had (he/

she) stopped working at or

waa (he/she) retired from

YES . . . . . . . . .. I

NO . . . . . . . . . ..2(Q. U-2I)

DK . . . . . . . . . ..8(Q. U-2I)

OK. . . . . . . . . ..B

(his/her) usual job or EMPLOYER :

occupation?

U-17. In what year was that? YR : 11191 II

DK . . . . . . . . ...9998 DK. . . . . . . . . ..B

U-18. Oid BUSINESS/INOUSTRY: (he/she) stop working

because of reasons

related to (his/her)

health?

U-26. What kind of business or U-26

industry was that employer

in, that is what did the

conpany or (sUi3JECTl S) part

of the company do or make:

for eXaTQh?, automobile

manufacturing, state labor

department, dairy farming,

retail shoe sales?

,

YES . . . . . . . . .. I

NO . . . . . . . . . ..2(Q. U-ZO)

DK . . . . . . . . . .. B(Q. u-zo)

YES . . . . . . . ...1

NO . . . . . . . . ...2

DK . . . . . . . . . ..I3

U-19. Was (he/she) receiving

disability benefits from

social security at that

tire? ~i(, . . . . . . . ...998

~ V4G-*8

U-20. Did (he/she) stop working

at (his/her) usual

occupation voluntarily?

YES . . . . . . . . .. I

NO . . . . . . . . ...2

OK . . . . . . . . . ..B

I

BOX L

U-21 . During the three months

prior tO (5UEIJECT IS) death

what was (“~oing

most : working, retired,

keeping house, going to

school, looking for work,

or sorething else?

WORKING . . . . . . . . 01 (Q. U-23)

RETIRED . . . . . ...02

KEEPING HOUSE . . . . . 03

STUDENT . . . . . . ..O4

LOOKING FOR wORK. . . . 05

NOT WORKING DUE TO

ILLNESS/INSTITUTIONALIZATION . . . . . . 06 (BOX L)

oTHER (SPECIFY)

07

DK . . . . . . . . . ..9B

U-27. Oid (he/she) ever work u-27 YEs . . . . . . . ...1 -,

at an Occupation 1“

which (he/she) was heavily NO . . . . . . . . . ..Z

exp==d to dusts, fumes, DK . . . . . . . . . ..B

or vapors? 53

U-2B. Did (he/she) ever have U-2B YES. . . . . . . . . , I

a hobby i“ which (he/~he)

was heavily exposed to No. . . . . . .’. . . . 2

dusts, fumes, or vapors? DK, . . . . . . . . . . 8

54

OFFICE USE ONLY: I

1“’’’’’’’’’’’”1171-85

I lll!!~l i ~k -loo

u 105

2B

29
PART v. CIRCUNSTANUSOf DEATH

These la8t fsn questions are shout (SUBJECT’S) death.

V-6. Was myons present at the time V-6 YES . . . . . . . . . . . . . . . 1

of death? No. . . . . . . . . . . . . . . . 2 (OOX N)

EM. . . . . . . . . . . . . . . . 8 (BOX N)

v-1 . tins (SU8JECT) ccmfinsd to hams or

m in-m dus to sn illness

or di~ility at sny tires within

ths four wseke prior to (his/her)

death?

v-2 . Was (SL18JECT) confinsd becsuse of

illne~isbility within the

72 hours prior to death?

v-3 . mere did (SU8JECT) die?

(CIRCLEML THATAPPLY)

v-4 . Csn yau tell wr the csuse or the

cimtmces of (wJEcT’s )

&ath?

v-5. that NS8 the cwss of death?

(PRtWI: mat caussd the accident/

injury? Was (SU8JECT ) sick before

dsath? Was tlili~ea chronic?

was the bath sdden or unsxpsct.rd

mat WSe (SLIBJECT’S) gensral healtl

m dsy of rbath?)

—

-1

—

-2

—

-3

—

-4

—

-5

—

YES . . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . . 2 (Q. V-3)

ox . . . . . . . . . . . . . . . . . 8

Yes . . . . . . . . . . . . . . . . 1

N1 . . . . . . . . . . . . . . . . . 2

ox . . . . . . . . . . . . . . . . . 8

AT Ilk. . . . . . . . . . . . 1

AT S131ETB4E

ELSE’ S tub...... 1

AT MOCK. . . . . . . . . . . . 1

ON THE STREET . . . . . . 1

IN M AUTLTK181LE. . . 1

IN TRANSIT TO

THE tKISPITM. . . . . 1

IN EKRGENCY

RDOA!/OLITpATIENT

FACILITY . . . . . . . . . 1

IN wowTAL . . . . . . . . 1 (cHART)

IN wwmc WE.. . . I (CHART)

oTHER (5PECIFY )

1

Lx . . . . . . . . . . . . . . . . . B

YES . . . . . . . . . . . . . . . 1

MT. . . . . . . . . . . . . . . . 2 (BOX P)

CAUSE :

Rox M

I

INTERVIEWER: REVIEN 0. V-5 Am CIRCLE ONE:

IBEATH WAS DUE TO #N ACCIDENT/INJLWTV. . . . . . . . 1 (BOX P)

OEATHWAS IXE TO ILLNESS . . . . . . . . . . ...2

DEATH WAS SLU)EN . . . . . . . . . . . . . . ...3

4

30

*9

50

51

5,!

53

54

55

56

57

58

59

60

61

62

v-7 . MIo wss present? (CIRCLE ALL v-7

THAT APPLY)

SPOUSE. . . . . . . . . . . . . 1

CHILDREN . . . . . . . . . . . 1

SISTER/BROTHER. . . . . 1

OTHER RELATIVE

(5PECIFY)

1

FRIEhO/NEIGHBOR. . . . 1

PHYSICIAN . . . . . . . . . . 1

NURSE. . . . . . . . . . . . . . 1

OTHER !SIDICAL

PERsONNEL

(5pEcIFv)

1

w . . . . . . . . . . . . . . . . . 8

MIX N

INTERVIEWER: REvIEW BOX M AND CIRCLE ONE:

DEATH WAS CUE TD ILLNESS. . . . . . . . . . . . 1 (Q. V-8)

DEATH WAS SLIDOEN, . . . . . . . . . . . . . . . 2( Q. V-11)

V-tl . Was (wJECT) receiving any V-8

medic~or pain during

the 24 hours preceding death?

V-9. [Even thou@ (he/ahs ) was receiv- V-9

ing medication] Did (he/she)

=@ain of pain or Bh My

evidence of pain during the 24

hours preceding dsath?

V-10. Within the hours prior to death, V-lc

(with medication) would you say

this pain was mild, moderate,

or severe?

1

31

YES . . . . . . . . . . . 1

NO. . . . . . . . . . . . 2

w . . . . . . . . . . . . B

YES . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . 2 (BOXP)

ox . . . . . . . . . . . . . B (BOX P)

63

6*

65

66

67

68

69

70

71

72

73

MILD . . . . . . . . . . . 1 (BOXP)

NDDERATE . . . . . . . 2 (80X P)

SEVERE . . . . . . . . . 3 (BOXP)

Cu . . . . . . . . . . . . . B (BOX P) 74
v-11. 10 your knowledqe, did ( SUB.TECT)

have any of the following symptams within the 72 hours prior

to (his/her) death?

a. Shortness of breath

b. Fainting

c. Chest pain

V-1 2. How many mirnkes or hours did

the chest pain last?

V-1 3. As far as you know, did (he/she)

get any medication to ease the

chest pain?

—

v-’

a

b

c

—

v-1

—

v-1

—

1 2 8 ?s

1 2 8 76

1 (V-12) 2 (BOX O) 8 (BOX O) 77

# HRS: I II 78-79

OR

# MINS: I II

fx . . . . . . . . . . . . . . 98 U 80

YES . . . . . . . . . . . . . 1

ml . . . . . . . . . . . . . . 2

w . . . . . . . . . . . . . . 8 81

BOX o

INTERVENER: REVIEW Q. V-l 1 AND CIRCLE ONE:

Q. V-ha, b ORC = YES (l). . . . . . . . . . . . . 1 (Q. V-14)

OTHERWISE . . . . . . . . . . . . . . . . . . . ..2(Q. V-15)

V-1 4. Please give me your best estimate V-14

of the mount of time that elamed

between (SUBJECT’ S) onset of

(SYN?TOMS~s/her ) death? I

INSTANT#lEDUS. . . . . . 1

5 MIN. OR LESS

W1 NOT

INSTANTANEMIS. . . 2

(REM) CATEGORIES IF NECESSARY 1 I I ‘“’- ‘“””-

1 HDIRI OR LESS

BUT NORE THAN

5 MIN . . . . . . . . . . . 3

24 HRS. OR LESS

EUT ~RE THAN

PN HR . . . . . . . . . . . 4

KIRE THAN 24 HRS. . 5

cu. . . . . . . . . . . . . . . . 8 02

V-1 5. Did you see or talk to Iv-151 YES . . . . . . . . . . . . . . 1 (BOX P)

(SUBJECT ) within the 24 hours

p~ (his/her) death? I I

NO. . . . . . . . . . . . . . . 2

1 i

V-1 6. We may need additional V-’I6 YES . . . . . . . . . . . . . 1

information about the circumstances of death. Can you give NO. . . . . . . . . . . . . . 2 (80XP)

me the names of any people who OK. . . . . . . . . . . . . . B (BOX P)

saw (him/her) wittrin 24 hours

before (his/her ) death?

83

V-17. Hay I have the nmne, address and telephone number of (this perscd

these persons )?

WAKE: INSTITUTION NANE :

85

IWJRESS:

CITY STATE 21P

RELATIONSHIP: TELEPHONE : ( )

NIM : INSTITUTION NAK:

PDDRESS :

CITY STATE 21P

RELATIONSHIP : TELEPHONE : ( )

NAW : INSTITUTION NAtE:

PL)ORESS :

CITY STATE ZIP

RELATIONSHIP: TELEPHONE: ( )

Comments:

32

33
Box P

I

INTERVIEWER: CIRCLEONE:

PROXY ANSWEREO ALL QUESTIONS . . . . . . 1 (BOX Q) I

I PROXY COULO NOT ANSWER ALL QUESTIONS . . 2 (Q. V-18) 1

06

v-la. IS there anyone else who mi@!t be able to answer came of the questions

about (SUBJECT ) thet you were unable to anewer? (RECORO NAHE, AEKIRESS,

TELEPHONE MMB.ER ANO RELATIONSHIP TO (SIKIECT ) . )

NAK :

IWORESS :

STREET

CITY STATE ZIP

TELEPHONE: ( )

RELATION5NIP TO 5UKIECT:

IF NO PERSON AVAILABLE, CHECK BOX: l—l ,,

Box Q

INTERVIEWER: CHECK PROBLEH SHEET TO SEE IF OEATH

CERTIFICATE WAS OBTAINEO ~ CIRCLE ONE:

OEATH CERTIFICATE WAS OBTAINEO . . . 1 (IKOICAL

AUTHORIZATION FORN

STATEMENTS)

OEATH CERTIFICATE WAS NOT OBTAINED . 2 (V-19)

V-19. As part of thie eurvey, we are

contacting vital records agencies

and requesting death certificates

on participants who heve died.

At preeent, we heve been uneble

to locate (sMJE12T ‘S) certificate.

1 would like to reconfirm soma

information with you.

When did (5LEIJECT) die?

V-20. In what city and state did

(su8.3ECT) die?

V-21. Was (he/she)buried in the saw

city?

v-22 . Mat was ( SEWECT’ S ) full name

including~itial?

(VERIFY SPELLING)

lii3t4TH : Ill

OAV : Ill

YEAR : 11191 I I

CITY:

STATE :

YES . . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . . 2

m . . . . . . . . . . . . . . . . . B

NAHE :

v-23 (IF s WAS FEHALE, ASK:) V-23 NAME :

PleaSe tell me (SUBJECT ‘S)

father’s last nm~

V-24. Can you think of any reason why V-24 CEMENTS :

(his/her) death certificate

may not be on file?

II

I

35

34
TELEPHONE INTERVIEW

tEOICAL AUTHORIZATION FORM STATEMENT

FOR RELATIVE OF SLXKIECT — —

Thank you very ❑wh for taking the time to participate in this interview.

As part of this survey it may be necessary to obtain additional or more

technical in fomat im fr.m staff or records in hospitals or other in-patient

facilities. 10 do this WE ❑ust have written permission from somecme related

to ( SIJB.TECT ) . I would like to send you a form that authorizes the U.S.

P@rlic Health service to obtain this infocmetion. As with all of the infer.

mation you have given us, this information will be kept confidential and

used only for statistical purposes. I ‘d like to (confirm/have) your

address.

PMXTESS:

STREET

When you receive this form please sign your nme md record your relationship to ( SUBJECT). Then return the fond in the pmtaga paid envelope.

You will receive your $10.00 check for participating in the survey ~out

two weeks after you .eail this form track to Westat.

TINE ENDED: AN

PM

TELEPHONE INTERVIEW

*DICAL NTHDRIZATIDN FORM STAIEKNT

FOR N3N-RELAT IVE OF SUBJECT

Thank you very ●uh for t~irq the time to participate in this interview.

k part of this survey it may be necessary to obtain additional or more

technical in fomatirm frcm staff or records in hospitale or other in-patient

facilities. To do this w must hme written permission frrn someone related

tO (SUBJECT). This permission form will authorize the U.S. Pblic Health

Service to tit ain ~dit icmal information. All information will be kept confidential and used only for statistical purpoaea. 00 you Irncmr a relative of

(SUBJECT ) who could sign this authorization? (RECDTO NAIE, ADDRESs, TELEPHONE -R PND RELATI~SHIP TO ~.)

IF NO RELATIvE AVAILABLE, CNECK @J3X: I— I

PLIDRESS:

STREET

I

CIT Y

I

TELEPHONE: ( )

A

I

RELAT IDNSHIP TO S:

You will be receiving your $10.00 check for participating in the survey

in &out two weeks. b

TINE EhklEO: AM

PM

IN-PERSON INTERVIEW

14iDICAL AUTHORIZATION FORM STATEIENT

FOR RELATIVE C$ SUBJECT

My supervisor, as part of a validation procedure, may be contacting you in

the near future to make sure I conducted this interview. I’d like to

(confirm/have ) your telephone number, starting with the area code. (IF NO

PHONE, RECD~ AREA CDOE. )

———I I l-l ———I I l-l ———I I I— I

REFuSE : 9999999996

Thank you very mmh for taking the time to participate in this interview.

Aa part of this survey it may be neceaeary to obtain additional or more

tecimical information frmn staff or records in hspitals or other in-patient

facilities. This form authorizes the U.S. Pblic Health Service to obtain

thla information. As with all of the in formatim you have given us, this

information will be kept confidential and used cmly for statistical purposes. (HAVE ~51GN Foffm.)

TINE EKED: AH

PM

IN-PERSON INTERVIEW

MEDICAL AUTHDRIZATI~ FORM STATEISINT

FOR WRELATIVE OF WJECT

NV supervisor, as part of a validation procedure, may be contacting you in

:he near future to make sure I conducted this interview. I’d like to

confirm/have) your telephone nunber, starting with tlw ❑rea code. (IF NO

‘HONE, RECDlt) AREA COOE. )

Ill——— l-l I I l-l I I I I

REFUSE: 9999999996

Thank you very much for t&ing the time to participate in this interview.

Is part of this survey it may be necessary to obtain ~ditional or more

:echnical information fran staff or records in hnspitale or other in-patient

~acilities. To do this we must have written permission fran scrneone related

:0 (suBJECT). This permission form will auttmrize the U.S. Ptilic Health

ierv~obtain additional information. All in fomatim will be kept confidential and ueed only for atatiatical purposes. b you know a relative of

‘SUBJECT) who could sign this authorization? (RECDFO NAIE, AMRESS, TELE-

‘~iiiR AND RELATIONSHIP TO ~.)

[F NO RELATIVE AVAILABLE, CHECK BOX: I—1

WIRESS:

STREET

CIT Y STATE ZIP

~ELEPHDNE: ( )

AREA CLTDE

IELATIDNSHIP TD>

TINE ENIED:

An

PM

36

37
OBSERVATION SHEET

INTERVIEWER: COMPLETE AT CONCLUSION OF INTERVIEW

OS-1. Do you feel that the

OS-2. If not, why not?

information provided by the Proxy was satisfactory?

Yes . . . . . . . . . . . .OI(Q. OS-3)

No . . . . . . . . . . . ..O2

OS-3. In regard to the questionnaire do you feel the questionnaire:

YES —

a. Held the respondent’s attention

throughout the interview . . . . . . . . . . . . . 1

b. Was upsetting or depressing to

the respondent . . . . . . . . . . . . . . . ...1

c. Was boring or uninteresting to

the respondent . . . . . . . . . . . . . . . ...1

d. Other (spEcIFy) 1

(IF YES TO b, c, or d)

—NO

2

2

2

2

OS-4. Was there a section that seemed to be particularly upsetting or problematic for the respondent? If so, note below.

OS-5. Record any relevant observation, comments or impressions you may have

had about this interview.
ID NUMBER

m--mu--n

1.

HOSPITAL AND HEALTH CARE FACILITY CHART

(PROXY)

QUES #: CONDITION : YEAR :

FACILITY NAME : TYPE :

ADDRESS:

STREET

CITY STATE

COMMENTS:

I Ill I I I I I 1

2. QUES #: CONOITION: YEAR :

FACILITY NAME : TYPE :

ADDRESS :

STREET

CITY STATE

COMtKNTS:

l_l_l ——I I— I I I I I

3. QUES #: CONDITION: YEAR :

FACILITY NAME : TYPE:

ADORESS:

STREET

CITY STATE

COMMENTS :

1111111111 —— —

4. QUES #: CONDITION: YEAR :

FACILITY NAME: TYPE :

ADDRESS:

STREET

CITY STATE

COMMENTS :

1111111111

5. QUES 1/: CONDITION : YEAR :

FACILITY NAME : TYPE :

AODRESS :

STREET

CITY STATE

COMMENTS :

1111111111

6. QUES #: CONDITION: YEAR:

FACILITY NAME : TYPE:

ADDRESS:

STREET

CITY STATE

COMMENTS:

I I I II I I I II

134
Hospital and Nursing Home Data

Collection

,*W.V!CES~

*4+

4

● f..

&

L

DEPARTMENT OF HEALTH& HUMAN SERVICES Public Health Service

s,

‘%

%+

Qvd,a National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

Dear Administrator:

I am writing to inform you of a request which has been made to your Medical

Records department. A new research study is being carried out by the

National Center for Health Statistics (NCHS), the National Institute on

Aging, and other components of the National Institutes of Health.

A selected sample of the United States population volunteered to participate

in the first National Health and Nutrition Examination Survey which NCHS

conducted from 1971-1975. We have recently reinterviewedthese participants

to provide new information about the etiology of chronic disease. A crucial

component of the study is a very limited hospital record data collection

to augnent information obtained fran these participants. Participants

who have been hospitalized have signed authorization forms to permit the

release of diagnostic information from their hospital record.

NCHS has contracted with Westat, a national survey organization,to conduct

the data collection operations of this survey. Westat has, therefore,

sent a packet to your Director of Medical Records on behalf of the patients

in the study. This survey is authorized by Title 42, United States Code

242k. Participation in this survey is completely voluntary. There are

no penalties for refusing to answer any question.

The American Hospital Association has endorsed this study and urges your

cooperation. Dr. Ross Mullner of the Association may be reached at (312)

280-6519 if you have any questions concerning this endorsement. If you

have any questions concerning the data collection, don’t hesitate to call

Kathleen Parkes at (301) 251-1500, ext. 8603.

Sincerely yours,

Manning Feinleib, M.D., Dr.P.H.

Director

135
#W,crs,o

*4+

4

s

. %

L

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

~

%

%,4

%,,.

National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

Director of Medical Records:

A new research study is being carried out by the National Center for Health

Statistics (NCHS), National Institute on Aging and other components of

the National Institutes of Health.

A selected sample of the United States population volunteered to participate

in the first National Health and Nutrition Examination Survey which NCHS

conducted from 1971-1975. We have recently reinterviewedthese participants

to provide new informationabout the etiology of chronic disease. A crucial

component of the study is a very limited hospital record data collection

to augment informationobtained from these participants. Enclosed are

signed authorizationforms specificallypermitting us to obtain diagnostic

data from their medical record.

This survey is authorized by Title 42, United States Code 242k. Participation

in this survey is completely voluntary. There are no penalties for refusing

to answer any question. NCHS has contracted with Westat, a national survey

organization,to conduct the data collection operations of this survey.

All informationobtained will be held strictly confidentialand will be

used for statisticalpurposes only. No information that could be used

to identify the participantsor your hospital will be released or published.

Results of this study will be published only as statistical summaries.

The American Hospital Association (AHA) has endorsed this study and urges

your cooperation. Your hospital’s participationis vital to the success

of this study. If you have any questions concerning this project, please

feel free to call Kathleen Parkes collect at (301) 251-1500, ext. 8603.

Sincerely yours,

Manning Feinleib, M.D., Dr.P.H.

Director

Enclosure

136
MB No.: 0925-0161

Expiration Date: 12/31/83

klCE z - Information cmt.md on thl. form I

ID#:

PATIENT NAME:

1.

2.

3.

4.

5.

PATIENT

(JAIL

WAS

‘“- OF

HE

L

*JchwcddPrmk dmtxric.tmn of ●ny

itiiv~duml or esttilis!mmt k.. ham collected

with 8 quarmt.. that It WL1l bd held in Strxct

con fidanm, WX1l k used C+TIY for purposes

stated for this study, .rd WL1l not be disclosed

or rdand to .tkw wltho.t the consent of the

mdi.idual or 8st8blisknt ,n 8ccordanm .Lth

section Y39(d) of thePubl*c H-lth $Xvlc. Act

•1 INFORMATION SHOWN ON LABEL

AGREES WITH HOSPITAL RECORDS

❑ OTHER (SPECIFY)

U.S. Department of Health and Human Services

National Center for tkalth Statistic

National Institute on Aging

NHANES I Epidemiologic FollowLIp Survey

HOSPITAL RECORD FORM

TO BE FILLED OUT BY MEDICAL RECORDS DEPARTMENT

MEDICAL RECORD NUMBER

ADMISSION / /

MONTH DAY YEAR

PA IENT IN: CARDIAC INTENSIVE CARE UNIT

NUMBER

❑ No

DISPOSITION OF PATIENT (Check One)

❑ Rout lne discharge/discharged home

❑ Left against medical advice

❑ Discharged/transferred to another

fac 11 it y or organization

ANY OTHER HOSPITALS LISTED IN AD+IISSIONNOTES

Name:

Nme:

Name:

(PLEASE

•1

•1

•1

DATE OF DISCHARGE / /

MONTH DAY YEAR

OTHER INTENSIVE CARE UNIT

u y==> Daya

NUMBER

•1 No

Discharged/referred to organized

bane care aerv ice

Died

Not stated

OR DISCHARGE SUt#4ARY

City/State:

City/State:

City/State:

TURN THE PAGE)

Year:

Year:

Year:

137
6. WHAT WERE THE DIAGNOSES ESTABLISHED AT TIME OF DISCHARGE? [Principaldiagnosisis the conditionafter

study chieflyresponsiblefor the hospitalstay.] (If mare apace is needed for additionaldiagnoses,

write the diagnoaesand the Westat ID number on a separatesheet of paper and attach to this form.)

PrincipalDiagnosis:

1.)

Other Diagnoses:

2.)

3.)

4.)

5.)

6.)

7. WHAT WERE THE SURGICAL PROCEDURES PERFORMED DURING THIS ADMISSION? (Includeall biopsy and

surgicalproceduresdiscuaaedor listed in the dischargesummary.)

SURGICAL PROCEDURES :

•1 Check ( f ) if none

1.

.

L.

3.

4.

8. PLEASE ATTACH A PHOTOCOPY OF THE FACE SHEET AND THE DISCHARGE SUMMARY FOR THIS INPATIENT STAY.

PLEASE ATTACH A PHOTOCOPY OF THE THIRD DAY EKG IF MYOCARDIAL INFARCTION DIAGNOSED DURING THIS STAY.

PLEASE ATTACH A PHOTOCOPYOF THE PATHOLOGYREPORT CONFIRMINGTHE DIAGNOSISOF CANCERMADE DURING

THIS STAY. (Writethe Westat 1.D. number on each photocopiedpage. If you do not have photocopyingcapabilities,please transcribethe informationfrom the face sheet, the discharge

summary,EKG report,and pathologyreport onto a separatesheet, record the Westat ID Number on

that sheet, and staple it to THIS form.)

Yes

a. Face Sheet

b. DischargeSummary

c. PathologyReport

d. Third Day EKG i

COMPLETED BY

No

i

(Why not? )

(Why not? )

(Why not? )

(Why not? )

OATE

138
#51W1C,,‘

*4+

4

$

● %

L

DEPARTMENT OF HEALTH& HUMAN SERVICES Public Health Service

~

-0

%+..,*,,a

National Center for Health Statistics

NURSINGHOMEADMINISTRATOR

3700 East-West Highway

Hyattsville MD 20782

Dear Administrator:

I am writing to request your assistance in a new National Center for Health

Statistics (NCHS) activity which is being supported by the National Institute

on Aging and other components of the National Institutes of Health. We

are conducting a followup study of the participants in the first National

Health and Nutrition Examination Survey (NHANES I) to provide new information

about the etiology of chronic disease.

A selected sample of the United States population volunteered to participate

in the first National Health and Nutrition Examination Survey which NCHS

conducted from 1971-1975. NCHS is now tracing and reinterviewingthose

14,407 persons to study the relationship between physical measures (e.9.,

blood pressure or functional vital capacity), behavioral variables (e.9.,

smoking or dietary intake), and other risk factors identified in the NHANES I

Survey and subsequent disease reported by the person at followup.

A crucial component of the study is a very limited nursing home record data

collection. Diagnostic information from the nursing home record will be

used to verify and supplement each respondent’s self-reportedmedical

history. Each person or next of kin (in cases of death) has signed a

form requesting the release of his/her nursing home care records to the

survey researchers. (Copies of these authorizations are enclosed.)

This survey is authorized by Title 42, United States Code 242k. Participation

in this survey is completely voluntary. There are no penalties for refusing

to answer any question. NCHS has contracted with Westat, a national survey

organization to conduct the data collection operations of this survey. All

informationobtained will be held strictly confidential and will be used

for statistical purposes only. No information that could be used to identify

the Dartici~antsor vour nursina home will be released or ~ublished. Results

of this study will b; published-onlyas statistical summaries

Your participationis vital to the success of this study. If

any questions concerning this project, please feel free to caParkes collect at (301) 251-1500, ext. 8603.

Sincerely yours,

~

you have

1 Kathleen

Manning Feinleib, M.D., Dr.P.H.

Director

Enclosures

139
MfI lD#i WESTAI ID#:

NURSING HOME NAME:

Please complete one form for each

inpatient care episode that terminated since January 1, for:

NAME:

BIRTHDATE:

SOCIAL SECURITY i?:

1.

2.

3.

4.

5.

PATIENT

DATE OF

PATIENT

0F9 No.: 0925-0161

Expiration Date: 12/31/83

•1 INFORMATION SHOWNON LABEL

AGREES WITH NURSING HOIE RECORDS —

U OTHER (SPECIFY)

U.S. Department of Health and Human Services

Nat’ional Center for Health Statistics

National Institute on Aging

NH4NES I Epidemiologic Followp Survey

NURSING HOME/PERSONAL CARE HOME RECORD FORM

TO BE FILLED OUT BY MEDICAL RECORDS DEPARTMENT

MEDICAL RECORD #

ADMISSION DATE OF DISCHARGE

73X?TR-+X7--%R--- ~’-DXY-’~

ADMITTED FROM: (Check One)

c1 Private residence c1 Chranic disease hospital (SPECIFY BELOW)

•1 “Acute care hospital (SPECIFY BELOW) n

Other nursing home (SPECIFY BELOW)

NAME OF FACILIT.Y: CITY/STATE:

OTHER HOSPITALS PROVIDING CARE DURING NURSING HOME/PERSONAL CARE HOME STAY

Name: City/State:

Name: City/State:

Name: City/State:

DISPOSITION OF PATIENT: (Check One)

n

Not discharged/still inpatient •1 Died

Year:

.—

Year:

.—

Year:

.—

•1 Discharged to private residence/

referral to organized home care

services

c1 Discharged to private residence/

no referral

Transferred to another health care facility (SPECIFY BELOW)

•1 Acute care hospital n

Chronic disease hospital

n Other nursing home c1 Other (SFECIFY)

NAME OF FACILITY: CITY/STATE:

(PLEASE TURN PAGE)

140
6. W+AT WERE THE DIAGNOSESESTABLISHEDAT ADMISSION?

PrincipalDiaqnosisat Admiesion:

1.)

Other Major Diseasesor ConditionsPresent

at Time of Admission:

2.)

3.)

4.)

5.)

7. R-EASE ATTACH

page. If YOU

admissionsheet

to THIS form.)

A PHOTOCOPY

do not have

AdmissionSheet

onto a

““;;’ I

4.

OF THE AD141SSION’SHEET. (Writethe liestatI.D. number on each photocopied

photocopyingcapabilities,please transcribethe informationfrom the

separatesheet, record

Yes No

the Westat ID Number an that sheet,and staple it

not? )

CJMPLETEDBY DATE

141
Appendix Vll

Corrections and revisions to the

NHANES I baseline data

Three demographic data items (date of birth, sex, and

race) from the NHANES I baseline data tapes were corrected

for a small number of subjects based on updated information

received during the NHANES I Epidemiologic Followup

Study. Consequently, the NHEFS Public Use Data Tapes

will reflect the corrections noted in this section.

Date of birth

Initially, the date of birth for each NHANES I respondent

was recorded during the household interview and subsequently

coded on the NHANES I data tapes. The household interview

was usually conducted with one (or more) members of the

household providing social and demographic information for

all household members. The NHANES I sample was then

drawn from these household listings. On arrival at the Mobile

Examination Center (MEC), the subject was asked to supply

his or her date of birth, which was entered on a record

and later microfilmed. The date of birth on the MEC record

was provided by the subject but was not coded on the

NHANES I data tape. Thus, the original NHANES I date

of birth is the one obtained during the household interview.

During the field work for the followup study, the MEC

record (when available) was used to update the date of birth

for all lost-to-followup respondents in the hope’that it would

improve tracing results. In addition, the MEC record was

used to update the date of birth for decedents and incapacitated

subjects who had been interviewed by proxy. Date of birth

was also updated for all confirmed respondents who, during

tracing, supplied a date of birth that differed from the date

of birth provided at baseline. As a result, date of birth was

corrected for a total of 677 subjects.

The age given at a baseline examination was then recalculated based on these corrected dates of birth. The recalculations

of age at baseline examination resulted in 224 age changes

of 1 year or more. For five respondents, recalculation resulted

in ages outside the designated age range of 25–74 years (two

subjects were determined to be 24 years of age, one was

76, and two were 77). Nonetheless, these respondents will

continue to be included in the cohort and are treated as 25

and 74 in cases where age is categorized. A cross-tabulation

of the recalculated age at baseline examination by the original

age at examination is presented below.

Revised age at baseline examination

Original age at 25-34 35-44 45-54 55-64 65-74

baseline examination years years years yeara years

25-34 years . . . . . . . . 3,508 4

35-44 years . . . . . . . . 1 2,937 :::

45-54 years . . . . . . . . - - 2,268

55-84 years . . . . . . . . - - 3 1,8: -

65-74 years . . . . . . . . - - - 5 3,85;

Sex

One baseline sex code was changed from female to male.

The original sex code was an error in the NHANES I Data

Set.

Race

A revised race variable was created to resolve cliscrepancies between the baseline interviewer-observed race and the

followup respondent-reported race. These race codes are determined by a case-by-case adjudication of baseline and followup

ethnicity responses and, in the case of deceased subjects,

race as coded on the death certificate. Race was revised for

186 subjects. A cross-tabulation of revised race by the original

baseline race variable follows.

Revised race

Baseline race White Black Other

White . . . . . . . . . . 11,996 25 30

Black . . . . . . . . . . 11 2,174 10

Other . . . . . . . . . . 27 132

142
Vital and Health Statistics 

series descriptions 

SERIES 1. 

SERIES 2. 

SERIES 3 

SERIES 4. 

SERIES 5 

SERIES 10 

SERIES 1 

SERIES 12 

Programs and Collection Procedures-Reports describing 

the general programs of the National Center for Health 

Statistics and its offices and divisions and the data collection methods used. They also include definitions and 

other material necessary for understanding the data. 

Data Evaluation and Methods Research-Studies of new 

statistical methodology including experimental tests of 

new survey methods, studies of vital statistics collection 

methods, new analytical techniques, objective evaluations 

of reliability of collected data, and contributions to 

statistical theory. Studies also include comparison of 

U.S. methodology with those of other countries. 

Analytical and Epidemiological Studies-Reports presenting analytical or interpretive studies based on vital 

and health statistics, carrying the analysis further than 

the expository types of reports in the other series. 

Documents and Committee Reports-Final reports of 

major committees concerned with vital and health statistics and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

Comparative International Vital and Health Statistics 

Reports-Analytical and descriptive reports comparing 

U.S. vital and health statistics with those of other countries. 

Data From the National Health Interview Survey-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other 

health-related topics, all based on data collected in the 

continuing national household interview survey. 

Data From the National Health Examination Survey and 

the National Health and Nutrition Examination SurveyData from direct examination, testing, and measurement 

of national samples of the civilian noninstitutionalized 

population provide the basis for (1) estimates of the 

medically defined prevalence of specific diseases in the 

United States and the distributions of the population 

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships 

among the various measurements without reference to 

an explicit finite universe of persons, 

Data From the institutionalized Population Surveys-Discontinued in 1975. Reports from these surveys are included in Series 13. 

SERIES 13. Data on Health Resources Utilization-Statrstrcs on the 

utilization of health manpower and facilities provrding 

long-term care, ambulatory care, hospital care, and family 

planning services. 

SERIES 14. Data on Health Resources: Manpower and FacilitiesStatistics on the numbers, geographic distribution, and 

characteristics of health resources including physicians, 

dentists, nurses, other health occupations, hospitals, 

nursing homes, and outpatient facilities. 

SERIES 15. Data From Special Surveys-Statistics on health and 

health-related topics collected in special surveys that 

are not a part of the continuing data systems of the 

National Center for Health Statistics, 

SERIES 20. Data on Mortality-Various statistics on mortality other 

than as included in regular annual or monthly reports. 

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses; 

and statistics on characteristics of deaths not available 

from the vital records based on sample surveys of those 

records. 

SERIES 21. Data on Natality, Marriage, and Divorce-Various statistics on natality, marriage, and divorce other than as 

included in regular annual or monthly reports. Special 

analyses by demographic variables; geographic and time 

series analyses; studies of fertility; and statistics on 

characteristics of births not available from the vital 

records based on sample surveys of those records. 

SERIES 22. Data From the National Mortality and Natality SurveysDiscontinued in 1975. Reports from these sample surveys 

based on vital records are included in Series 20 and 21, 

respectively. 

SERIES 23. Data From the National Survey of Family GrowthStatistics on fertility, family formation and dissolution, 

family planning, and related maternal and infant health 

topics derived from a periodic survey of a nationwide 

probability sample of ever-married women 1544 years 

of age. 

For answers to questions about thus report or for a list of titles of 

reports published in these series, contact 

Scientific and Technical lnformatron Branch 

National Center for Health Statistrcs 

Public Health Servrce 

Hyattsvrlle, Md. 20782 

301-436-8500 
U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Public Health Service 

National Center for Health Statistics 

3700 East-West Highway 

Hyattsvifle. Maryland 20782 

SPECIAL 4th CLASS RATE 

POSTAGE B FEES PAID 

PERMIT NO. G-281 

OFFICIAL BUSINESS 

PENALN FOR PRIVATE USE, $300 

DHHS Publication No. (PHS) 87-1324, Series 1, No. 22