Vital and

Health Statistics

Plan and Operation

of the NHANES I

Epidemiologic

FOIIOWUP Study, 1987

Series 1:

Programs and Collection Procedures

No, 27

This report describes the plan and operation for the 1987 data collection

wave of the Epidemiologic Followup to the first National Health and Nutrition

Examination Survey [NHANES l), Tracing and data collection were conducted

on 11,750 persons 25–74 years of age at NHANES I who were not known to be

deceased in the 1982-84 and 1986 data collection waves of the NHANES I

Epidemiologic Followup Study,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Sewice

Centers for Disease Control

National Center for Health Statistics

Hyattsville, Mayland

September 1992

DHHS Publication No. (PHS] 92-1303
Copyright Information 

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. 

Suggested Citation 

Cox CS, Rothwell ST, Madans JH. et al. Plan and operation of the NHANES I 

Epldemlologlc Followup Study, 1987. NatIonal Center for Health Statlstlcs Vltal 

Health Stat 1(27) 1992. 

Library of Congress Cataloging-in-Publication Data 

Plan and operation of the NHANES I Epidemlologlc Followup Study, 1987 

p. cm. - (VItaI and health statlstlcs. Senes 1, Programs and collectlon 

procedures: no. 27) (DHHS pubkation; no. (PHS) 92-1303) 

By Christme S. Cox and others. 

June 1992. 

Includes blbliographlcal references. 

ISBN O-8406-0460-2 

1. NatIonal Health and Nutntlon Examlnatlon Survey (U S ) 2 Health 

surveys-United States. 3. Epidemiology-United States-Stattstics I Cox. 

Chnstine S. II. Natlonal Center for Health Statlstlcs (U S ) Ill. Senes IV Senes 

Vital and health statistics. Senes 1, Programs and collectlon procedures: no 

27. 

[DNLM: 1, NatIonal Health and Nutntlon Exammatlon Survey (U S ) 2 

Epidemlologlc Methods. 3 Health Surveys-Unlted States 4 Nutntlon 

Surveys - Unlted States W2 A N148va no. 271 

RA409.U44 no 27 

[ RA408 51 

362.1’0723 S-dc20 

[614 4’2731 

DNLM/DLC 

for Library of Congress 92-l 2905 

CIP 
National Center for Health Statistics

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

Jack R. Anderson, Acting Depuo Director

Jacob J. Feldman, Ph. D., Amociate Director for Analysi~

and Epidemiology

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

Extramural Programs

Peter L. Hurley, Associale Director for Vital and Health

Stathtics Systems

Robert A. Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

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

and Methodology

David L. Larson, Assistant Director, Atlanta

Office of Analysis and Epidemiology

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

Division of Analysis

Jennifer H. Madans, Ph. D., Acting Director

Jennifer H. Madans, Ph. D., Deputy Director

Jennifer H. Madans, Ph. D., Acting ChieJ Demographic

Analysis Staff

Diane M. Makuc, Dr,P,H., Chief Analytical Coordination

Branch

Sandra T. Rothwell, ChieJ Longitudinal Ana@sis Branch
Contents

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

NHANESI (1971-75) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,,,..-.

1982–S4F0110wup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19S6F0110wup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Study design and tracing activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stud~ design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tracin g. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subjects lost to followmp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inten’iew data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interview procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Questionnaire types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Questionnaire content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interview nonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health care facilities data collection process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Identification ofstay reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Facility data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Matching records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results of the health camfacility data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Death certificate collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19S7ana1ytic cohort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ongoing activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

I. Study materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Corrections and revisions tothe NHANES I baseline data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of text figures

1,

7-.

3.

4.

5.

6.

7.

Followups of the N13A.NES I Epidemiologic Followup Study (NHEFS) cohort: 14,407 subjects 25–74 yearsof

age at NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Summary ofdata collection inthe NHANESI Epidemiologic Followup Study (NHEFS),1987 . . . . . . . . . . . . .

Questionnaire topics in the NHA.NES I Epidemiologic Followup Study (NTIEFS), 1987 . . . . . . . . . . . . . . . . . . .

Survey period, respondent recall period, and facili~ abstract request period, by previous interview status:

NHANESI Epidemiologic Followup Study (NHEFS), 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health care facility record layout: IWANES I Epidemiologic Followup Study (NHEFS), 19S7. . . . . . . . . . . . . .

Examples of matching process and record status codes: NHANES I Epidemiologic Followup Study (NHEFS),

19s7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..!

Tracing statusof the NHANES I Epidemiologic Followup Study (NHEFS) cohort . . . . . . . . . . . . . . . . . . . . . . . .

1

3

3

4

6

6

6

8

11

11

11

12

13

15

16

16

;:

21

22

25

26

28

189

2

2

12

15

17

1s

22

.,.

Ill
List of text tables

A

B,

Ic,

D.

E.

F,

1~.

H.

J.

Number and percent distribution of subjects in the NHANES I Epidemiologic Followup Study (NHEFS) 1987

Followup cohort by status at followup, according to race, sex, and age at NHANES I . . . . . . . . . . . , . . . . . . . . .

Odds ratios, confidence intervals, and statistical significance for selected health characteristics on loss to

followup for the NHANES I Epidemiologic Followup Study (NHEFS) 1987 Followup cohort. ., , , , , . . . . . . . .

Number and percent of traced members of the NHANES I Epidemiologic Followup Study (NHEFS) 1987

Followup cohort without a completed interview, by vital status at 1987 NHEFS and by race, sex, and age at

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of facility stays, distribution of subjects by number of stays, mean number of stays, and percent of

traced cohort with at least one stay in the NHANES I Epidemiologic Followup Study (NHEFS) 1987 Followup

cohort, byrace, sex, andageat NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,

Number and percent distribution of record status codes for the NHANES I Epidemiologic Followup Study

(NHEFS) 1987 FolIowup cohort, by type of record status code, according to race, sex, and age at

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of deaths and percent of decedents without an available death certificate among the NHANES I

Epidemiologic Followup Study (NHEFS), 1987 Followup cohort, by race, sex, and age at NHANES I . . . . . . .

Number and percent distribution of subjects in the NHANES I Epidemiologic Followup Study (NHEFS) 1987

analytic cohort by status at followup, according to race, sex, and age at NHANES 1. ... . . . . . . . . . . . , ., . . . . .

Odds ratios, confidence intervals, and statistical significance for selected health characteristics on loss to

followup for the NHANES I Epidemiologic Followup Study (NHEFS) 1987 analytic cohort. . . . . . . . . . . . . . . .

Number of deaths and percent of decedents without an available death certificate among the NHANES I

Epidemiologic Followup Study (NHEFS) 1987 analytic cohort, by race, sex, and age at NHANES I . . . . . . . . .

Symbols

. . . Data not available

. . . Catego~ not applicable

— Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

9

10

14

19

20

21

23

24

24

* Figure does not meet standard of

reliability or precision
Plan and Operation of the

NHANES I Epidemiologic

FOIIOWUP Study, 1987

by Christine S. Cox, M.A., Sandra T. Rothwell,

M.P.H,, Jennifer H. Madans, Ph. D., Fanchon F.

Finucane, M. H.S., Virginia M. Freid, M.S., Joel C.

Kleinman, Ph. D., Helen E. Barbano, M.S.P.H,, Jacob

J. Feldman, Ph. D., Office of Analysis and

Epidemiology’

Background

The NHANES I Epidemiologic Followup Study

(NHEFS) is a longitudinal study that uses as its baseline

those adult persons 25–74 years of age who were examined

in the first National Health and Nutrition Examination

Survey (NHANES I) (l-3). As shown in figure 1, NHEFS

comprises a series of followup surveys, three of which have

been conducted to date. The first wave of data collection,

the 1982–S4 NHEFS, included all persons who were 25–74

years of age at their NHA.NES I examination

(n = 14,407). The second data collection wave, the 19S6

NHEFS, was conducted for the members of the cohort

who were 55–74 years of age at their baseline examination

and not known to be deceased at the time of the 1982–84

NHEFS (n = 3,9S0). This series report focuses on the

tracing and data collection of the third wave, the 1987

Followup. During this third data collection wave, attempts

“The 19S7 data collection wave of the Epidemiologic Followup to the first

National Health and Nutrition Examination Survey (NHEFS) could not

have been accomplished without the valuable contribution and assistance

of many individuals and groups. Space does not permit the authors to

recognize all the persons who participated in the planning, development,

and conduct of the 19S7 data collection wave; nonetheless, they are

grateful for the support they received, and apologize to those they have

omitted.

Dr. Joan Comoni-Huntley, Ph.D, M.P.H., of the National Institute on

Aging, deserves special recognition for the important role she has played

in the development and continuation of the study. Without her persistence as advocate for this study and her dedication in seeking financial

support, NHEFS would not have been conducted. NHEFS was initiated

jointly by the National Institute on Aging and the National Center for

Health Statistics, and has been developed and funded by the following

Federal agencies: National Center for Health Statistics; National Institute on Aging; National Cancer Institute; National Center for Chronic

Disease Prevention and Health Promotion; National Heart, Lung, and

Blood Institute; National Institute on Afcohol Abuse and Alcoholism;

National Institute of Allerkgyand Infectious Diseases; National Institute

of Arthritis and Musculoskeletal and Win Diseases; National Institute of

Child Health and Human Development; National Institute of Diabetes

and Digestive and Kidney Diseases; National Institute of Mental Health;

National Institute of Neurological Disorders and Stroke.

The 19S7 survey was conducted by Westat, Inc., of Roclwil[e, Maryland,

under a contract with the U,S. Department of Health and Human

Services (Contract No. 2S2-S4+111) and was directed by Thomas

McKcnna and Diane Cadell.

were made to recontact the entire nondeceased NHEFS

cohort (n = 11,750). The entire nondeceased NHEFS

cohort is being recontacted again in 1992.

In NHANES 1, data were collected from a national

probability sample of the U.S. civilian noninstitutionalized

population 1–74 years of age (l–3). The survey, which

included a standardized medical examination and questionnaires that covered various health-related topics, took

place from 1971 through 1974 and was augmented by an

additional national sample in 1974-75. NHANES I included 20,729 persons 25–74 years of age, of whom 14,407

(70 percent) completed a medical examination.

Although NHANES I provided a wealth of information on the prevalence of health conditions and risk

factors, the cross-sectional nature of the original survey

limits its usefulness for studying the effects of clinical,

environmental, and behavioral factors and in tracing the

natural history of disease. Therefore, NHEFS was designed to investigate the association between factors measured at baseline and the development of specific health

conditions. Specifically, the three major objectives of

NHEFS are to study the following:

. Morbidi~ and mortality associated with suspected risk

factors

. Changes over time in participants’ characteristics,

such as blood pressure and weight

. The natural history of chronic disease and functional

impairments

Although information in NHANES I was gathered

from physical examinations, laboratory tests, and interviews, NHEFS is primarily a series of interview surveys

that rely on self-reporting of medical conditions. Attempts

were made, however, to supplement the followup interview information in NHEFS with health care facility

medical records and death certificates.

NHEFS originated as a joint project between the

National Center for Health Statistics and the National

Institute on Aging. It has been funded primarily by the

National Institute on Aging, with additional financial

support from the following components of the National

Institutes of Health and other Public Health Service

agencies: the National Cancer Institute; the National
—

NHANES I 4 Followup wave >

examination

1971–75 1982-84 1986

[ ~

1987

Nutrition examination All subjects 2%74

r.~

—

All nondeceased All nondeceased

only years of age at subjects 55-74 years

n = 7,494

subjects 25-74 years

NHANES I examination + of age at NHANES I + of age at NHANES I

n= 11,348 ------------------ + (n= ,4,4~7) examination examination

Nutrition and detailed (n= 3,980) (n= 11,750)

health examination Traced:

n = 3,854 Alive: 3,132

n = 6,913 ----------------- Traced: Dead: 635 Traced:

Detailed health Alive: 11,361 Not traced: 213 Alive: 10,463

examination only Dead: 2,022 Dead: 555

n = 3,059 Not traced: 1,024 Not traced: 732

—

n = 14,407

NOTE: NHANES I is first National Health and Nutrition Examination Survay.

—

Figure 1. Followups of the NHANES 1 Epidemiologic Followup Study (N HEFS) cohort: 14,407 subjects 25-74 years of age at NHANES 1.

Center for Chronic Disease Prevention and Health Promotion; the National Heart, Lung, and Blood Institute;

the National Institute on Alcohol Abuse and Alcoholism;

the National Institute of Allergy and Infectious Diseases;

the National Institute of Arthritis and Musculoskeletal

and Skin Diseases; the National Institute of Child Health

and Human Development; the National Institute of Diabetes and Digestive and Kidney Diseases; the National

Institute of Mental Health; and the National Institute of

Neurological Disorders and Stroke. 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 NHEFS cohort, as shown in figure 2, includes the

not known to be deceased at the time of the 1982–84 or

1986 NHEFS. Tracing and data collection in the 1987

Followup were undertaken only for the 11,750 subjects in

the latter group, even if a proxy interview had not been

conducted or collection of health care facility records had

not been undertaken for the decedent in a previous survey

wave. Hereinafter, they will be referred to as the “’1987

Followup cohort.” The 2,657 subjects who were dece:ased

at the time of the 1982–84 or 1986 NHEFS were excluded

from additional data collection in 1987 and thus were not

included as part of the 1987 Followup cohort. For analytic

purposes, though, information collected for this group

may be used in conjunction with the information collected

previously on subjects who were part of the 1987 Followup

2,657 subjects who were deceased at the time of the cohort.

1982-84 or 1986 NHEFS and the 11,750 subjects who were

NHEFS cohort:

14,407 subjects

25-74 years of age et NHANES I 11,750 not deceased in

examination —

2,657 deceased L :;&Q%X%l%: 100,0 percent

in 1982-84 or 1986 NHEFS —

18.4 percent

/

1987 NHEFS—

81.6 percent

\

11,018 traced — 732 lost to followup’1 —

~ ‘3’8percent \

6.2 percent

10,463 surviving — 555 deceased —

/

95.0 percent

\

9,526 interviewed — 937 not interviewed —

91.0 percent

~ 5.Operc~ \

/ > ,,odidno,panic;::en’

441 with proxy 31 with proxy 83 with death,

8,896 participated

interviews and interviews only— certificates only —

interviews (interview conducted death certificate —

in interview —

5.6 percent 15.0 percent

93,4 percent

with proxy) — 79.5 percent

6.6 percent

I

1 121 (16.5 parcent) of 732 had been successfully traced in the 19 B2-84 or 1986 NHEFS; 611 (63,5 percent) of 732 were lost to fcllowup in

both the 1982-84 and 1986 NHEFS.

NOTE: NHANES I is first National Health and Nutrition Examination Survey.

—

Figure 2. Summary of data collection in the NHANES I Epidemiologic Followup Survey (NHEFS), 1987

2
Tracing of subjects in the 19S7 Followup began in

June 19S6. As of January 25, 198S, the end of the 19S7

NHEFS survey, 1l,OLS (93.S percent) of the 11,750 members of the 19S7 Followup cohort had been successfully

traced. Interviews were conducted for 9,!39S subjects

(90.7 percent of those successfully traced). In addition,

7,361 facility stay records wwe collected for 3,472 subjects,

using information obtained from the interview, death

certificate, or some other source. Death certificates were

obtained for 524 (94.4 percent) of the 555 subjects who

were kno~vn to have died since the last contact.

To use the 19S7 Followup Study data most effectively,

it is necessaq’ to understand the study design and procedures of NHANES I and the 19S2–S4 and 19S6 Followups

of NHEFS. A brief ovemiew7 of these surveys is provided

below. More detailed information on these surveys is

presented in other publications (l-5).

NHANES I (1971-75)

NHANES I was designed to collect extensive demographic, medical history, nutritional, clinical, and Laboratory data on a probabili~ sample of the civilian

noninstitutionalized population of the United States

(l-3). The survey was a multistage, stratified probability

sample of clusters of persons 1–74 years of age. It was

conducted in 1971–74 and was extended in 1974-75 by an

additional sample of aduIt persons, called the “Augmentation Survey” (3), The NIWNES I survey design incIuded

oversarnpling of certain population subgroups, including

perscms living in poverty areas, women of childbearing age

(2544 years of age), and elderly persons (65 years of age

and over). A subsarnple CIf6,913 adult NHANES I participants 25–74 ytars of age, called the “detailed sample,”

consisted of a random sub~ample of subjects examined in

1971–74 and all subjecls in the Augmentation Survey.

Persons included in the del.ailed sample were examined in

greater depth and provided \!’ith additional questionnaire

components. The AuGmerttotion Survey did not include

oversamplin,g of any population subgroups. More information on the sampling frame and survey instruments used

for the detailed sample may be found in the plan and

operation series reports for the NHANES I survey (1–3).

As a result of the: c varied design features of

NHANES I, not all of the members of the NHEFS cohort

received the same questions or examinations at baseline.

For example, although a[l 14,407 adults in the NHEFS

cohort recei}cd the general medical examination, only

those 11,34S mdults who were not in the Augmentation

Survey were administered nutrition questionnaires in

NHANES 1, SimilarIy, the 6,913 participants included in

the detailed sample may have been administered supplementmy questionnaires ~for example, arthritis, cardiovascular, or respiratory questionnaires), depending on their

responses to screening questions.

1982–84 FOIIOWUP

The 19S2–S4 FoIIowup was the first data collection

wave of the NHEFS series (4). It included 14,407 persons

who were 25–74 years of age when they were examined in

NHANES I (1971-75). Tracing of subjects began in 19S1,

and data collection was conducted from 19S2 to 1984. At

the close of data collection in August 19S4, 93 percent

(n = 13,3S3) of the study population had been successfully traced. The basic design of the 1982–S4 NIIEFS

consisted of the following components:

. Tracing subjects or their proxies to a current address.

. Acquiring death certificates for deceased subjects.

. Performing indepth interviews with subjects or with

their proxies, including, for surviving subjects, taking

puIse, blood pressure, and weight measurements.

. Obtaining hospital and nursing home records, including pathology reports and electrocardiograms.

No attempt had been made to recontact any of the

NHANES I examinees until the inception of the 1982-84

Followup. Thus, the first step of the FolIowup was to trace

and locate all subjects in the NHEFS cohort and determine their vital status. Tracing sources included crisscross

and city directories, telephone contacts, direct mail, U.S.

Post Office address information requests, National Death

Index (6) checks, State department of motor vehicle

listings, State vital statistics files, and fieId visits to neighbors at last known address. A subject in the NHEFS

cohort was considered successfully traced if he or she [or

another informant, if the subject was deceased or was

incapacitated and thus unabIe to be contacted) responded

correctly to a set of verification questions establishing the

subject’s identity. A1l subjects whose vital status could not

be deter-mined ~vere considered lost to followup. A subject’s death had to be confirmed by means of either a

death certificate or pro,xy interview,

The information collected during tracing relating to

the death of a subject was used to request a copy of the

death certificate from the appropriate State vital statistics

office. Death certificates were obtained for 1,935

(95.7 percent) of the 2,022 decedents by the end of the

19S2–S4 survey period. (An additional 33 death certificates for 19S2–84 LNHEFS decedents were received after

the closeout of the 1982–S4 data collection period. These

death certificates are included on the Mortality Data

PubIic Use Tapes for followup waves subsequent to the

19S2-S4 NHEFS. For more information, see the 1987

NHEFS Mortaliv Data Public Use Tape Documentation,)

Efforts continue to locate all missing death certificates.

During tracing, efforts were made to obtain a current

address for surviving subjects and to identify a knowledgeable proxy respondent for deceased subjects and for surviving subjects who were incapacitated and unable to

participate in the 1982-84 NHEFS, Respondents (that is,

subjects or proxies who provided followup information)

who were identified and located through the tracing

3
procedure were then contacted and asked to participate in

an interview. In a few cases (n = 65), subjects who had

been traced successfully could not be relocated for the

interview. Only their vital status and the date when they

were last traced in the 1982–84 survey period are

available.

An attempt was made to interview all subjects (or

their proxies) identified during tracing. Interviews were

conducted wherever the subject resided, including nursing

homes, prisons, and mental health facilities. Occasionally

interviews were conducted at some other convenient location (for example, a parent’s home). In most instances,

however, the proxy interviews for deceased subjects were

conducted over the telephone.

The interview was designed to gather information on

selected aspects of the subject’s health history since the

time of the NHANES I examination. 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 the 1982–84 NHEFS in order

to measure changes over time. However, questionnaire

items were modified, added, or deleted when necessary to

talce advantage of current improvements in questionnaire

methodology. Physical measurements (blood pressure,

pulse rate, and weight) were obtained from surviving

subjects near the end of the interview.

Interviews with the subject or a proxy were collected

for 84.8 percent (n = 12,220) of the original NHEFS

cohort, or 91,3 percent of those successfully traced. Interviews were conducted for 10,523 (92.6 percent) of the

11,361 surviving subjects; 256 of the interviews were administered to a proxy respondent because the subject was

incapacitated, Proxy interviews were obtained for 1,697

(83.9 percent) of the 2,022 deceased subjects.

Information on overnight stays in hospitals and nursing homes was elicited during the interview for the period

from 1970 to the time of the 1982–84 NHEFS. Interviewers recorded the full name and address of the health care

facility and the approximate date of the stay. At the

conclusion of the interview, respondents were asked to

sign a medical authorization form that would be used to

request the release of information from the subject’s

medical records. These authorization forms were retained

on tie, and a photocopy was sent to each health care

facility that the respondent had identified during the

interview.

The health care facility data collection took place

from April 1983 through August 1984. Hospitals and

nursing homes for which stays had been reported (through

interviews, death certificates, and other sources) were

contacted and asked to abstract information from their

records for all stays occurring from January 1 of the year

of the person’s NHANES I examination to the date of the

followup interview. The major items requested were the

dates of admission and discharge, the discharge diagnoses

(if requesting from a hospital) or admitting diagnoses (if

requesting from a nursing home), and information on any

procedures performed.

1986 FO!lOWUp

The 1986 Followup was the second data collection

wave of the NHEFS series (5). In the 1986 NHE,FS,

information was collected on changes in health and functional status since the study’s last contact with the older

members of the NHEFS cohort. The 1986 Followup was

restricted to those subjects who were 55–74 years of age at

the time of their NHANES I examination (n = 5,6’77).

They represent almost 40 percent of the entire NH13FS

cohort, Tracing and data collection in the 1986 Followup

were undertaken only for the 3,980 subjects who were not

known to be deceased at the time of the 1982-84 NHEiFS.

Tracing of subjects began in 1984, and data collection was

conducted from 1985 through 1986. At the close of clata

collection in July 1986, 94.6 percent (n = 3,767) of the

study population had been successfully traced.

The basic design and data collection procedures of the

1986 NHEFS were similar to the ones developed in the

1982–84 study: Subjects (or their proxies) were traced,

subject and proxy interviews were conducted, and health

care facility abstracts and death certificates were collected. A major difference behveen the 1982-84 and 1986

Followups, however, was the manner in which the interviews were conducted. In the 1986 NHEFS, the interviews

were administered primarily by telephone rather than

through inperson interviews. In addition, because the

questionnaire was not administered in person, no physical

measurements were made in the 1986 NHEFS.

The first step of the 1986 Followup was to trace and

locate all subjects in the 1986 NHEFS Followup cohort

and determine their vital status, Different tracing strategies were employed, depending on the subject’s vital status

in the 1982–84 NHEFS. A subject in the NHEFS cohort

was considered successfully traced if he or she (or another

informant, if the subject was deceased or was incapacitated and thus unable to be contacted) responded correctly to a set of verification questions establishing the

subject’s identity. All subjects whose vital status could not

be determined were considered lost to followup, A subject’s death had to be confirmed by means of either a

death certificate or proxy interview.

The information collected during tracing relating to

the death of a subject was used to request a copy of the

death certificate from the appropriate State vital statistics

office. Death certificates were obtained for 616 of the 635

decedents by the end of the 1986 survey period. Efi%rts

continue to locate all missing death certificates.

Subject and proxy interviews were conducted over the

teIephone using a computer-assisted telephone interviewing system. The interview was designed to gather information on events that had occurred since last contact

regarding the subject’s living arrangement, occurrence and

4
recurrence of chronic diseases, functional limitations,

hospital and nursing home experience, and utilization of

community services. To retain item comparability among

NHANES I, the 19S2–S4 NHEFS, and the 19S6 NEU3FS, a

majority of the questions included on the 1986 questionnaire were the same as those used in the 1982–S4 NHEFS.

Questions on coronary bypass surgery, pacemaker procedures, and the utilization of community services were new

to the 19S6 NHEFS.

Interviews with the subject or a proxy were collected

for 90.7 percent (n = 3,60S) of the 1986 NI%EFS cohort,

or 95.S percent of those successfully traced. Interviews

were conducted for 3,027 (96.6 percent) of the 3,132

surviving subjects; 469 of these interviews were administered to a proxy respondent because the subject was

incapacitated. Proxy intemiews were obtained for 5S1

(91.5 percent) of the 635 deceased subjects.

Information on overnight stays in hospitals and nursing homes was elicited for any of the medical conditions

reported in the interview’. If the subject was interviewed in

the 19S2-S4 NHEFS, the respondent in the 19S6 NHEFS

was asked to recall any overnight hospitalizations since

19S0 for the medical conditions of interest. If the subject

had not been interviewed in the 19S2-S4 NHEFS, the

interviewer asked the respondent to recall any overnight

stays since 1970. Interviewers recorded the full name and

address of the health care facility and the approximate

date of the stay. At the conclusion of the interview,

respondents were asked to sign a medical authorization

form that would be used to request the release of information from the subject’s medical records. These authorization forms were retained on file, and a photocopy was

sent to each health care facili~ that the respondent had

identified during the interview.

All health care facilities for which overnight stays

were reported (through interviews, death certificates, and

other sources) were contacted by mail from September

19S5 through June 19S7 and asked to abstract information

from their records for all stays occurring since the date of

last NHEFS contact. Facilities were asked to abstract

information on exact dates of admission and discharge and

on diagnoses, and to include photocopies of selected

sections of the subject’s inpatient record.

5
Study design and tracing

activities

The 1987 Followup was conducted to extend the

followup period for the entire surviving NHEFS population, The main objectives of the 1987 Followup were as

follows:

. To continue monitoring changes over time in health,

functional status, and utilization of hospitals and

nursing homes.

. To track the incidence of various medical conditions.

The NHEFS cohort consists of the 14,407 persons

25-74 years of age at the time of their NHANES I

examination, Tracing and data collection in the 1987

Followup were undertaken for only a portion of the

NHEFS cohort, referred to as the 1987 Follow-up cohort,

The 1987 Followup cohort consisted of the 11,750 subjects

who were not known to be deceased in the 1982–S4 or

19S6 NHEFS, regardless of whether they had previously

been successfully traced or interviewed in either survey

period. No additional interview or health care facility stay

information was collected in the 1987 NHEFS for the

2,657 subjects who were known to be deceased at the time

of the 1982–84 or 1986 NHEFS, even if a proxy interview

had not been conducted or collection of health care

facility records had not been undertaken for the decedent

in a previous survey wave.

Study design

The design and data collection procedures adopted in

the 1987 Followup were very similar to the ones developed

in the previous NHEFS waves: Subjects (or their proxies)

were traced, subject and proxy interviews were conducted,

and health care facility abstracts and death certificates

were collected. A major difference between the 1982–84

and the 1986 and 1987 NHEFS waves, however, was the

manner in which the interviews were conducted, In the

1982–84 NHEFS, the 2-hour subject interview usually was

conducted in person; in the 1986 and 1987 NHEFS, each

interview averaged 30 minutes and was conducted primarily by telephone. In addition, because the questionnaire

was not administered in person, no physical measurements

were made in either the 19S6 or 1987 NHEFS. Copies of

all pertinent study materials for the 1987 NHEFS (tracing

materials, a brochure, letters, questionnaires, authorization forms, and health facility data collection forms) can

be found in appendix 1.

Each survey component (tracing, interviewing, collecting hospital and nursing home records, and obtaining

death certificates) conducted in the 1987 NHEFS represents a separate survey activity with its own set of procedures for data collection, processing, and reporting.

However, the information gathered for any one survey

component was used to direct activities in other components, Thus, data from different survey components were

intended to be used together when appropriate. Figure 2

summarizes the results from the data collection procedures for the 1987 NHEFS. The flowchart shows the

relationships among the data collection activities (except

for the health care facili~ record collection) and providles

information on the number of subjects in each component.

Tracing

The tracing procedures used for the 1987 NHEFS

were similar to those used in the previous surveys. Tracing

began in June 1986 and was conducted on all 11,750

subjects 25–74 years at their NHANES I examination who

were not known to be deceased prior to the last contact.

Because the validi~ of longitudinal studies depends c,n

the completeness of followup, a large variety of sources

were used to trace subjects in the 1987 Followup, For

example, throughout the tracing process, periodic matches

were made of all nondeceased NHEFS participants to thle

National Death Index (6) and to the enrollee file of the

Health Care Financing Administration.

Different tracing strategies were developed, depending on the survey wave in which the subject was last

contacted. Of the 11,750 subjects included in the 1987

NHEFS, 3,345 were also members of the 1986 NHEFS

cohort, Of this group, 3,114 persons (93 percent) were

successfully traced and found to be alive in the 1986

NHEFS. This number includes only the subjects in the

1986 NHEFS who were coded “1” (“Alive”) on the 1986

NHEFS Vital and Tracing Status Public Use Data Tape.

Because these 3,114 subjects had been successfully traced

within the past year, the decision was made to contact

them directly and attempt to conduct the 1987 interview.

If subjects could not be directly contacted for interviewing,

their information was reviewed and further tracing proce- -

dures were undertaken. Through these direct recontact

procedures, 3,092 subjects (99.3 percent) were successfully

traced again in the 1987 NHEFS,

6
Tracing procedures for the remaining 8,636 subjects

were developed based on their tracing status in the

1982–84 and 1986 NHEFS. One set of tracing procedures

was used for subjects who had last been successfully traced

alive in the 1982-84 NHEFS; another set was used for

subjects who had not been successfully traced in either the

1982-84 or 1986 NHEFS. The tracing procedures used for

each group are discussed in the following paragraphs,

Subjects and proxy respondents who were identified and

located through the tracing procedure were then contacted by telephone or mail (if a telephone number was

not available) and asked to participate in an interview.

Retracing subjects last traced

successfully in the 1982-84 NHEFS

Of the 8,636 subjects who required further tracing at

the start of the 1987 NHEFS data collection period, 7,654

had last been successfully traced and found to be alive in

1982-84. They inciude 7,530 subjects who were under 55

years of age at the time of the NHANES I examination

and coded as “l” (“Alive”) on the 1982-84 NHEFS Vital

and Tracing Status Public Use Data Tape and 124 subjects

eligible for inclusion in the 1986 NHEFS cohort who were

iast successfully traced in the 1982-84 NHEFS, Of these

7,654 subjects, 7,566 (98.8 percent) were successfully

traced again in the 1987 Followup.

The first step in retracing each subject was to conduct

an automated location verification procedure called

Teiematch, using a service that provides computerized

matching with a national communication company’s service records. Subjects were considered successfully identified if the last name, mailing address, and ZIP Code

recorded in their 1982-84 NHEFS tracing records

matched the information provided by Telematch services.

If the information provided by Telematch did not result in

a conclusive match or was later found to be inaccurate,

local area directory assistance was contacted. Subjects

were considered successfully identified if the first and last

names and either the address or telephone number recorded in their 1982-84 NHEFS tracing records matched

the information provided by directory assistance. Subjects

identified as a conclusive match through Telematch or

directory assistance were then contacted for interview. If

the attempted interview did not result in direct contact

with the subject (or a proxy respondent), the subject’s

information was reviewed and further tracing procedures

were undertaken.

Subjects who had matching information on first and

last names but who had a different address and a different

telephone number were designated as “possible matchc,s, “’

Information on the verification of possible matches is

found later in this section.

When efforts using directory assistance failed to p:cJduce a conclusive match, other tracing sources were used.

They included post office address inquiries, submission of

the person’s Social Security Number to the Social Security

Administration, and calls to the tracing reference provided in the 1982-84 NHEFS (typically, a person not living

in the subject’s household at the time of the 1982-84

NHEFS). In addition, persons included in the baseline or

1982–84 NHEFS household composition lists were cohtacted, if available, to locate the subject. All subjects

identified through these additional tracing sources were

considered “possible matches.”

Tracing subjects not traced successfully

in any previous NHEFS

Additional tracing sources were used to trace the

remaining 982 subjects in the 1987 Followup cohort, who

had not been successfully traced in any previous NHEFS.

This group includes 875 subjects who were 25-54 years of

age at the time of the NHANES I examination and were

not successfully traced during the 1982-84 NHEFS and an

additional 107 subjects eligible for inclusion in the 1986

NHEFS cohort who were not successfully traced during

either the 1982–84 or 1986 NHEFS, These 982 subjects

are assigned vital status codes of “4” (“Unknown”) or “5”

(“Traced alive but lost prior to interview period”) on the

1982-84 NHEFS Vital and Tracing Status Public Use

Data Tape and codes “4,” “5,” or “7” (“Traced alive but

without direct subject contact”) if eligible for inclusion on

the 1986 NHEFS Vital and Tracing Status Public Use

Data Tape.

Of these 982 subjects, more than one-third (n = 360)

were successfully traced in the 1987 Followup using the

following tracing procedures. The first step was to contact

directory assistance in the area where the subject had last

been known to live to determine whether he or she had

returned to that area. Other tracing sources used included

motor vehicle office and credit bureau checks for male

relatives and spouses of femaIe subjects who were included on the household composition listings obtained in

NHANES I. Furthermore, crisscross directory searching

was undertaken to locate residents Iiving on the block

where the subject was last known to have resided. When

found, these persons were contacted to determine

whether they were familiar with the subject and, if so,

whether they knew the whereabouts of the subject. A

subject identified through any of these tracing sources was

considered a possible match.

Verification of possibie matches

Respondents for possible-matched subjects were contacted and administered a tracing questionnaire to verify

the subject’s identity. A subject who was a possible match

was considered successfully traced if he or she or a proxy

respondent (if the subject was deceased or incapacitated

and unable to be interviewed) correctly responded to a set

of verification questions used to establish the subject’s

identity. (If the respondent did not have a telephone, he

or she was sent a mail update form to complete.) Once the

name of the subject was verified, the respondent had to

suppIy correct information for at least two of the following

three items:

. Subject’s date of birth. Date of birth was considered

verified if the subject’s month, day, and year of birth

7
exactly matched the information obtained in either

NHANES I or the 1982–S4 NHEFS, depending on

whether the subject had been successfully traced in

the 1982–84 NHEFS. If only the month and day

matched, the birth year had to be within 2 years of the

year listed in the tracing records for the date of birth

to be considered verified, In some cases, a proxy

respondent was administered the questions and did

not know the subject’s date of birth. This item, however, was considered verified if the age provided by

the proxy for the subject was within 2 years of the

deceased subject’s age at death or of the surviving

subject’s current age, as determined from the subject’s

tracing file. If the proxy did not know the subject’s

age, the interviewer requested the name of another

proxy respondent,

. SLLbject’saddress at time of the last NHEFS contact. The

address was considered verified if the street name,

city, and State reported at last contact matched the

information on record. Street number did not need to

match.

. Household composition at last contact. Questions on

household composition were asked only if the subject’s date of birth or address at the time of last

contact did not match information listed in the subject’s tracing records. The household composition at

the time of last contact was considered verified if the

respondent recalled the name and relationship of at

least one household member. If the respondent reported that the subject lived alone and this information agreed with the information in the tracing

records, this also was considered a match,

Subjects lost to followup

All subjects who could not be located through the

tracing procedures were considered lost to followup in the

1987 NHEFS, In five cases, even though information

about the death of a subject was obtained from a former

neighbor, a relative, or another tracing source, that subject

was considered lost to followup because the information

was not verified by means of a proxy interview or a death

certificate, (A subject’s death had to be confirmed by

either a death certificate or proxy interview.)

Two groups of subjects were considered alive for

analytic purposes in the 1987 Followup but are assigned a

special 1987 Follow-up vital status code. The first group

consists of seven subjects who were initially traced in

the 1987 NHEFS and found to be alive but were lost prior

to the 1987 interviewing period. Only their vital status and

the date when they were last traced in the 19S7 survey

period are available. The second group includes 3S6

subjects for whom a direct confirmation of vital status was

not obtained because of a failure to follow proper

tracing procedures. These subjects are identified by a 19S7

NHEFS vital status code of “7.” The date when they were

last known to be alive is the date that tracing was conducted. AnaIysts may want to consider these 3S6 subjects

lost to followup. However, the authors feel that the

available data indicate that there is a high probability that

these subjects were alive at the time of tracing in the 1.987

NHEFS.

As of January 25, 1988, the end of the 1987 survey

period, 93.S percent (n = 11,018) of the 11,750 subjects in

the 1987 Followup cohort had been successfully traced

(see figure 2). Only 22 (0.7 percent) of the 3,114 subjects

who had last been traced and found to be alive in the 1986

NHEFS and 88 (1,1 percent) of the 7,654 subjects who

had last been traced and found to be alive in the 19S2,-84

NHEFS were not successfully traced in the 1987 NHEFS.

However, 622 (63.3 percent) of the 982 subjects not tsuccessfully traced in any previous NHEFS wave were again

not successfully traced in the 1987 NHEFS.

The success of the tracing efforts in the 1987 Followup

according to age at baseline examination, race, and sex are

given in table A. (See appendix 11 for discussion of age,

race, and sex variables.) To summarize how these demographic factors were related to tracing success, a multiple

logistic model was fitted to the cross-classification of age

at baseline examination, race, and sex, with the proportion

of subjects who were lost to followup representing the

dependent variable. The analysis was limited to black :and

white subjects, because there were few subjects of other

races (n. = 149). Age at baseline examination -was categorized into five 10-year age groups (25–34 through 65–74

years). Interaction 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 0.12, The final model included interactions for race

and sex (p = 0.0045) and age and sex (p = 0.0777). Black

men were almost four times as likely to be lost to followup

as white men, but black women were only twice as Iikehyto

be lost as white women, Odds ratios relative to white

women were 1.09, 2.20, and 4.05 for white men, black

women, and black men, respectively. Rates of loss to

followup were highest among subjects 25–34 years of age

for both men and women. The lowest rates for men were

among those 45–54 years of age, but for women, the lowest

rates were among those 55–64 years of age, Rates increased again for the elderly subjects, 65–74 years of age,

of both sexes,

AnaIysis using a multiple logistic regression was conducted to determine whether those persons lost to :~ollowup were at relatively high risk of death, The regression

model included six health characteristics measured during

NHANES I (in addition to age at baseline examination,

race, and sex) that have been established as risk factors for

mortality: high blood pressure (systolic blood pressure of

140 millimeters of mercury or higher); high cholesterol

(260 milligrams per 100 milliliters or higher); self-reported

history of heart attack; self-reported history of diabetes;

smoking status at baseline examination (current smoker,

current nonsmoker, or unknown); and overweight (for

men, a body mass index greater than or equal to 27.8

kilograms per meter squared; for women, a body mass

index greater than or equal to 27,3 kilograms per meter

.9
Table A. Number and percent distribution of subjects in the NHANES I Epidemiologic Followup Study (NHEFS) 1987 Followup cohort by

status at followup, according to race, sex, and age at NHANES I

Status at fahvup

All Lost to All Lost to

Race, sex, and agel subjects Suwiv/ng Deceased followup subjects Surviving Deceased followup

Number Percent distribution

555 732

104

49

30

23

37

280

103

40

20

46

502

68

35

22

15

17

203

69

31

11

31

206

29

13

8

7

20

67

30

a

9

15

24

7

1

1

10

4

1

100.0 89.0 4,7 6,2

9.4

5.5

3,2

3.0

5.0

11.9

5.3

3.5

2.5

3.9

5.1

7.2

4.6

2.7

2.0

2.6

i 0.3

4.4

3.1

1.6

3.1

12.2

20.6

13.0

6.7

10.9

16.3

lB.7

8.7

5.6

7.6

6.5

16.1

36.8

5.3

10.0

—

30.3

10.3

16.7

—

All races2

Male:

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

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

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

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

6E-74years . . . . . . . . . . . . . . .

Female:

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

35-$4 yeara . . . . . . . . . . . . . . . .

4%54years . . . . . . . . . . . . . . . .

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

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

White

Both sexes . . . . . . . . . . . . . . . .

Male:

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

3E+14years . . . . . . . . . . . . . . . .

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

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

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

Female:

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

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

4S-54 years.........,..,.. .

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

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

Black

Both sexes . . . . . . . . . . . . . . . .

Male:

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

3544years . . . . . . . . . . . . . . . .

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

5S84years . . . . . . . . . . . . . . . .

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

Female:

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

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

4E-54years . . . . . . . . . . . . . . . .

55–64 years . . . . . . . . . . . . . . . .

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

Other

Both sexes...........,.,,.

Male:

2.5-34 years . . . . . . . . . . . . . . . .

3&44years . . . . . . . . . . . . . . . .

4S54years . . . . . . . . . . . . . . . .

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

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

Female:

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

35+4years . . . . . . . . . . . . . . . .

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

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

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

11,750 10,463

1,111

684

936

603

740

99B

B02

624

536

584

9

33

B2

44

119

100.0

100.0

100.0

100.0

100.0

89.8

90.7

86.0

88.9

76.9

0.6

3.7

8.6

1:::

2,356

1,959

1,159

Boa

1,194

2,061

1,806

1,076

758

1,018

15

50

43

30

130

100.0

100.0

100.0

100.0

100.0

67.5

92.2

92.8

93,6

65.3

0.6

2.6

3.7

3.7

10.9

9,913 6,966 425 100.0 90.6 4.3

951

765

807

529

611

878

703

719

475

500

5

27

66

39

94

100.0

100.0

100.0

100.0

100.0

92.3

91.9

89.1

69.8

81.8

0.5

3.5

6.2

7.4

15.4

1,965

1,576

1,009

686

1,014

1,752

1,472

948

653

BB6

10

35

30

22

97

100.0

100.0

100.0

100.0

100.0

89.2

93.4

94.0

95.2

87.4

0.5

2.2

3.0

3.2

9.6

1,68B 1,353 129 100.0 80.2 7,6

141

100

119

64

123

109

81

95

52

78

3

6

16

5

25

100.0

100.0

100.0

100.0

100.0

77.3

61.0

79.8

61.3

63.4

2.1

6.0

13.4

7.8

20.3

35B

344

144

119

176

266

299

123

102

128

5

15

13

8

33

100.0

100.0

100.0

100.0

100.0

79.9

B6.9

85.4

a5.7

72,7

1.4

4.4

9.0

6.7

18.8

149 124 1 100.0 83,2 0.7

19

19

10

10

6

11

16

10

9

6

i—

100.0

100.0

100.0

100.0

100.0

57.9

94.7

100,0

90.0

100.0

5.3

—

—

—

—

33

39

6

3

4

23

35

5

3

4

100.0

100.0

100.0

100.0

69.7

89.7

83.3

100,0

100,0

—

—

—

—

100.0

ISeeappendlx II fora discussion of revised race, corrected sex, and recalculated age at NHANES I examination,

‘Includes races other than white or black.

NOTE: NHANESl isthefirst National Health and Nutrition Examination Suwey, The1987Followup cohoticonsists ofll,750 subjects, ages 25-74 years at NHANESl

examination, who were not known to be deceaeed in the 1982-64 or 1966 NHEFS,

squared). (The thresholds for overweight represent the The results of the multiple logistic regression are

sex-specific S5th percentiles for persons 20–29 years of age presented in tabIe B. The baseline risk factors of high

(excluding pregnant women) in the 1976-S0 National cholesterol, overweight, and history of heart attack or

Health and Nutrition E~~mination SurJey (7).) diabetes did not have a statistically significant effect on

9
Table B. Odds ratios, confidence intervals, and statistical

significance for selected health characterlatics on loss to

iollowup for the NHANES I Epidemiologic Followup Study

(NHEFS) 1987 Fol!owUrI cohorl

95-percent confidence intewal

Odds Lower Upper

Baseline characteristic ratio bound bound p va/ue

High blood pressure 0,80 0,64 0.99 0,0417

High cholesterol . 0.88 0,69 1.14 0.3328

Overweight, ,, . . . . . . . . . 1.07 0,89 1.29 0.4839

Histoy of hearl attack 1.17 0.64 2.12 0,6162

Diabetes .,,,....,.,,,. 1,31 0.81 2,13 0.2719

Smoking, , . . . . . . . . . . . . 2.16 1.69 2,7B <0.0001

NOTE: NHANES I is the first National Health and Nutrition Examination Survey,

The 1967 Followup cohort consists of 11,750 subjects, ages 25–74 years at

NHANES I examination, who were not known to be deceased in the 1982-64 or

1986 NHEFS. Data are based on multiple logistic regression, with race, sex, age

at NHANES I examination, and race-sex and age-sex interaction terms included.

loss to followup. Of the six baseline risk factors, only high

bIood pressure and smoking status had a significant effect

on loss to followup. High blood pressure was inversely

related to loss to followup; NHANES I examinees with

high blood pressure were 20 percent less likely to be lost

to followup (p = 0.0417) than subjects with normal systoIic readings. Smoking status had the strongest effect on

loss to folIowup: Smokers at baseline were more than

twice as likely to be lost to followup compared with

nonsmokers (p c 0,0001). These results for smoking suggest that subjects who were lost to foIIowup in the 1987

NHEFS may be somewhat more likely to have died

compared with those who were successfully traced.

10
Interview data collection

Interview procedures

An attempt was made to obtain an interviewfor all

subjects w;ho were successfully traced in the 1987 hTHEFS.

The procedures used to obtain interviews in the 19S7

NHEFS were similar to those adopted in the previous

\\,al,es of the NNEFS:

. An advance letter describing the Followup Study was

sent to a surviving subject or a knowledgeable proxy

respondent (for a dcccmed subject or for a subject

~vho was incapticitated and unable to participate in

the interview), once that person was traced and

located.

. The intenriev,rer then czlled the subject or proxy to

schedule an app~intmtint for the interview.

. In contrast to the 19S2–S4 interview procedures, the

19S7 and 19S6 intcn’icfvs were administered by telephone. (In 1!3S2-S4, I.hc majority of the interviews

\’;ere conducted in person.) When a telephone number was not available, the respondent was sent a mail

questionnaire to cornp[cte. Any overnight health care

facility stays reportccl during the interview w’ere recorded on a hospital :rrid health care faciIity chart.

. At the end of the intc P:iew7,the respondent’s address

was coniirmcd. This ~!.1sdone for tracing purposes as

v’ell as to ensure thin. a medic~l authorization form

would bs sent to thu proper address to be signed and

returrmd. This form ~~r[sused to request that health

care facilities ruleasc information from the subject’s

medicol records to Elh L stud~’. It was mailed to the

respondent for his or her s~gnature (or to u blood

rclati~w if the pnmy ruqmndent wtis not related to the

subject) uhen at Icust one health care facilitv stav was . .

reported during thu )n~crvieiv and ~vm listed on the

subject’s hospit.d and health c:ire facility churt. Subjects and proxim were remunerated $5 for agreeing to

compktc and return Ihc medical authorization form.

The 1%7 NHEFS iritumim~s !!ere conducted over the

telephone using Qcompuler-assisted telephone interviewing (CATI) system. CATI allows the telephone intervieiver to enter directl~r Into the computer the answers

supplied by the responderit. Thus, editing and coding time

is reduced, md keypuncI-lirrg from a hard-copy questionnaire is eliminated. A computer program drives the questionnaire so that the curruct skip patterns are followed

and the appropriate questions are displayed on the

computer monitor. The skip patterns are based on information gathered either from previous data collection

waves or from responses provided during the interview.

For example, the several questions on pregnancy and

menstrual history in the 19S7 interview were programmed

to be skipped automatically if the subject was male or if

the female subject ilad a previous interview. Edit and logic

checks are incorporated into the data collection system

itself, thus improving the quality of the data.

The data collection period for the 19S7 Followup

began in mid-hlay 19S7 and ended in early Janua~ 19S8.

Fieldwork was conducted by di~’iding the sample into

three regions, with the first region having the largest and

the third region having the smallest sample size. Each

region contained States from each time zone. Interviews

were collected for 9,99S subjects; 9,901 (99 percent) were

conducted by telephone and 97 (1 percent) were conducted by mail.

Questionnaire types

The 19S7 NHEFS questionnaire was designed to

~ather information on events that had occurred since Iast

contact regarding the subject’s Iiving arrangement, occurrence and recurrence of selected chronic diseases, functiona[ limitations, and hospittil and nursing home

experiences. To retain item comparability wit h

NHANES I. the 19S2-S4 NHEFS, and the 19S6 NHEFS, a

majority of the questions incIuded on the 1987 NHEFS

questionnaire were the same m those used in the previous

NHEFS waves. Nmv questions concerning high blood

cholesterol, high b[ood pressure, and male sterilization, as

\vell as reworded questions on alcoholic beverage consumption and an expanded section on female hormone

use, wwre added to the 19S7 NHEFS. In addition, questions asked in the 19S2-S4 NHEFS concerning kidney

disorders and urinary infections were again included in

the 1?S7 NHEFS.

As in the 19S2-S4 and 1X6 Followups, two versions of

the questionnaire were used in the 19S7 NHEFS: the

subject questionnaire and the proxy questionnaire (see

appendix I). Surviving subjects were aIways administered

the subject questionnaire. If the subject was alive but

incapacitated, a slightly modified version of the subject

questionnaire was administered to a proxy respondent. A

separate prosy questionnaire was used only when the

subject was deceased. It consisted of a subset of the

11
questions from the subject questionnaire, with the addition of several questions related to the subject’s death.

Note the distinction between a proxy respondent and

the proxy questionnaire, A proxy respondent was the

informant who answered questions when the subject was

not able to participate in an interview, either because the

subject was alive and incapacitated or because the subject

was deceased. The proxy questionnaire, however, was the

type of questionnaire administered only to the person who

responded for a deceased subject. A total of 1,102 proxy

respondents were interviewed in the 1987 NHEFS. Of

these, 630 responded for an incapacitated subject and

were administered a modified version of the subject questionnaire, and 472 responded for a deceased subject and

thus were administered the proxy questionnaire,

Nearly all 9,998 interviews collected in the 1987

NHEFS were conducted by telephone. However, during

the main survey, when a subject or proxy could not be

contacted by telephone, the respondent was mailed an

abbreviated questionnaire (see appendix I). The mail

questionnaire for surviving subjects was designed to collect information on (a) tracing for future recontacts; (b)

subject’s current living arrangements and medical history

since last contact; (c) name and address of hospitals and

nursing homes in which the subject had stayed since last

contact and the admission date for each stay; and (d) if

the subject was female, reproductive and hormone use

history. The mail questionnaire sent to the proxy respondent when the subject was deceased was designed to

obtain the necessary information on (a) the subject’s

identity, (b) the name and address of hospitals and nursing homes in which the subject had stayed since last

contact and the admission date for each stay, and (c) the

locality of the subject’s death.

Of the 449 questionnaires mailed to respondents in

the 1987 Followup, 97 (21.6 percent) were returned.

hTinety-two were collected from surviving subjects, and five

were collected from proties for deceased subjects, Unlike

the 1982–84 NHEFS, a returned mail questionnaire in the

1987 (and the 1986) NHEFS constitutes an interview, and

data from the mail questionnaires are included on the

1987 NHEFS Interview Tape.

Cluestionnaire content

Both the subject and proxy telephone questionnaires

were divided into sections according to topic area. The

major topics are summarized in figure 3. Where appropriate, entire sections or specific questions in some sections

were omitted from the proxy questionnaire. In addition,

certain sections of the questionnaire were included or

omitted depending on whether an interview had been

collected for the subject in the 1982–S4 or 1986 NHEFS.

Part A of the subject and proxy questionnaires included questions on the subject’s household composition

and marital status. The subject’s race was ascertained only

if the subject had not had an interview in the 1982-84 or

1986 NHEFS.

Demographic ..................... Living arrangement, household

composition, marital status

Medical history .................. Arthritis, gout, bean attack, stroke,

diabetes, hypertension, cancer, male

sterilization, bone fractures,

cataracts, and other chronic

conditions

Health care facility stays ... History of overnight hospital and

nursing home stays since last contact

Functional status ............... Activities of daily living

Cigarette smoking ...... ...... History of use,l current use

Alcoholic beverages,, ........ Use in past year

Vision and hearing ............ Corrective lenses, hearing acuity

Exercise and weight .......... Activity level, history,l ctirrent

weight

Female medical history .... Hormone use, pregnancies,z births,z

breast examination and Pap smear

test, female sterilization

Death information ............. Place of death

1 Information collected only if the subject had not had an intewiew in

1982-84 or 1986 NHEFS sutvey period.

2 Information collected only if the subiect had not had an interview in a

previous survey pariod or was under age 45 at the 1982-84 NHEFS

interviaw.

NOTE: NHANES I is first National Heelth and Nutrition Examination Sutvey.

Figure 3. Questionnaire topics in the NHANES I Epidemiologic

Fo[[OWUP Study (NHEFS), 1987

Part B of the subject and proxy questionnaires contained a self-reported history of seIected medical ccmditions. Specific questions were asked about arthritis, gout,

heart attack, corona~ bypass surgery, pacemaker procedures, small stroke, stroke, cancer, hypertension, diabetes,

kidney disorders, urinary tract infections, hip and wrist

fractures, pneumonia, flu, vasectomy, and other types of

surgeries. The proxy questionnaire also included several

questions in part B that pertain to the subject’s place of

death.

The wording of the medical condition questions in

part B generally depended on whether the subject had had

an interview in the 1982–84 and/or 19S6 NHEFS and, if so,

whether a specific medical condition had been reported

for the subject during that interview. If a certain medical

condition had been reported in the 1982–84 or :1986

NHEFS interview, the respondent in the 1987 interview

was asked to recalI any recurrences of that medical condition since the date of that interview. The respondent was

asked to recall whether a doctor had ever told the subject

that he or she had the medical condition in question if the

condition had not been reported in a previous NHEFS

interview, the condition was never asked about in a

previous NHEFS interview, or an interview had not been

conducted for the subject in both 1982–84 and 1986.

12
Respondents also were asked to provide information

on any overnight health care facility stays for any of the

medical conditions reported in the interview. If the subject

had had an interview in the 19S6 NHEFS, the respondent

in the 19S7 NHEFS was asked to recall all overnight

hospitalizations for the medical conditions of interest

since 1985. If the subject was last interviewed in the

19S2–S4 NHEFS, the respondent in the 19S7 NHEFS was

asked to recall all overnight hospitalizations for the medical conditions of interest since 19S0. If the subject had not

had an interview in both the 19S2-S4 and 19S6 NHEFS,

then the interviewer asked the respondent to recall all

overnight hospital sta}s since 1970. If the respondent

reported that the subject was first told about having the

medical condition of interest before 19S0 or 19S5 and that

information contradicted information stored in the CATI

system obtained from the 19S2-S4 or 1986 NHEFS interview’, he or she was asked to provide information on all

overnight stays since 1970 for that condition.

The beginning of the respondent recall period was

defined as 1970, 19S0, or 1985 rather than the date of the

subject’s most recent interview (that is, baseline examination, 1982-S4 NHEFS, or 1986 NHEFS) for two reasons.

First, the beginning or midpoint of a decade may be an

easier reference point for recalling events than the date of

the subject’s most recent interview. Second, given that the

respondent might have difficul~ recalling exact dates of

facility stays, increasing the length of the recall period

maximizes the probability of collecting information on

health care facility stays that had occurred since the date

of the subject’s most recent interview,

All overnight stays in health care facilities reported

during the interview were recorded on the hospital and

health care facility chart. The full name and address of the

health care facili~, date of admission, and reason(s) for

the admission were obtained from the respondent for each

stay and transcribed onto the chart.

Part C of the subject questionnaire concerned functional impairment. First, several questions were asked on

paralysis, amputation, and severe arthritis of the limbs.

The battery of functional limitation questions consisted of

a modified subset of items from the Fries Functional

Disability Scale for arthritis (8), the Resow-Breslau Scale

(9), and the Katz Activities of Daily Living Scale (10). The

questions were designed to measure the subject’s level of

difficulty in performing a set of everyday activities without

the help of another person or mechanical device. Information also was collected on whether help had been received

and, if so, how this help affected the subject’s abili~ to

perform the activity. Thus, this information could be used

both to measure the impact of disease on functional ability

and to measure the actual functional level as affected by

the receipt of help or use of devices. Part C was omitted

from the proxy questionnaire.

Part D consisted of questions pertaining to the subject’s smoking and drinking habits. The questions were

designed to obtain a brief history of the subject’s lifetime

cigarette smoking behavior and an overview of the

subject’s smoking and alcohol consumption in the past

year. Smoking history questions were asked of the respondent only when a subject interview had not been conducted in the 19S2-S4 and 19S6 NHEFS.

Part E contained questions for surviving subjects on

physical activity and current body weight. A series of

questions regarding the subject’s weight history also was

included in Part E for those subjects not interviewed in

19S2–S4 or 19S6. Part E was not included in the proxy

questionnaire.

Part F consisted of questions designed to measure the

subject’s visual and audito~ abilities. Part F was omitted

from the proxy questionnaire.

Part G contained questions on female medical history,

including pregnancy and menstrual history, use of birth

control pills and postmenopausal hormones, and frequency of breast examination and Pap smear tests. The

questions concerning pregnancy were asked only of female

subjects (or their proxies) if the subject was under 45 years

of age at the time of the 19S2–S4 interview or had not

been previously interviewed.

Part H in the subject questionnaire contained a question to obtain the subject’s Social Security Number, if it

had not been obtained previously. Part H was also used to

confirm, for future tracing purposes, the name and address of all persons who participated in the interview (for

example, subject, proxy, or assistant). Confirmation of

name and address was also done so that a medical authorization form could be sent to the proper address to be

signed and returned. The form was used to request that

health care facilities release information from the subject’s medical records to the study. It was sent to the

subject or proxy (if the proxy was related to the subject

and the subject was too ill to sign the form) to obtain his

or her signature when at least one health care facility stay

was reported and had been listed on the subject’s hospital

and health care facili~ chart. When the proxy respondent

was not related to the incapacitated subject who was

unable to sign the medical authorization form, an attempt

was made in Part H to identify a relative who could sign it.

Part H in the proxy questionnaire included questions

designed to facilitate the receipt of the subject’s death

certificate if it had not yet been received.

Part I was used by the interviewer to give his or her

impressions regarding the quality of the interview and

responses provided by the informant.

Interview nonresponse

By the end of the 1987 NHEFS sumey period (January 25, 19SS), interviews had been conducted for 85.1 percent (n = 9,998) of the 11,750 subjects aged 25–74 years at

the time of NHANES I and not found to be deceased in

either the 19S2–S4 or 19S6 NHEFS (90.7 percent of those

successfully traced).

As shown in figure 2, an interview was conducted for

9,526 (91.0 percent) of the 10,463 surviving subjects; 630

interview’s were administered to a prosy respondent

13
Table C. Number and percent of traced members of the

hlHANES I Epidemiologic Followup Study (N HEFS) 19B7 Followup

cohort without a completed interview, by vital status at 1987

NHEFS and by race, sex, and age at NHANES I

Subjectswithoutccirnp/efeinterviekd

.%miving Deceased

Race, sex, and ag~ Number Percent Number Percent

All races3

Both sexes .,, ,. .,.,..,

Male:

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

3544 years . . . . . . . . . . . .

45–54 years. ,,, .,,.....

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

6%74 years . . . . . . . . . . . .

Female:

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

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

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

55–64 years.......,.,,,

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

Wh!te

Both hexes.......,,,..

Male:

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

3544 years, . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . .

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

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

Female:

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

36-44 years..,,,....,,.

45–54 years,..,,...,,,,

55+34 years. . .,, ,,, ,.. .

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

Black

Both sexes . . . . . . . .

Male:

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

35–44 years,,.,.,.,,,,.

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

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

65-74 yeara. , .,,,...,,,

Female:

25–34yeare. . .,, ,, . . . . .

3544 years. ,,, ,., , . . .

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

55-S4 years,.......,,..

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

937

104

67

77

39

B1

171

168

77

60

93

737

02

49

64

32

65

129

116

65

52

83

178

21

14

10

7

14

41

44

11

8

e

9.0

10.4

B.4

9.3

7.3

13.9

8.3

9.3

7.2

7.9

9.1

8.2

9.3

7,0

8.9

67

13.0

7.4

7.9

6.9

0,0

9,4

13.2

19.3

17,3

10,5

13,5

179

14.3

14.7

89

7,8

6.3

B3

1

6

7

5

20

1

a

a

9

1.9

52

5

4

4

11

5

4

6

13

30

1

3

1

9

1

3

4

3

5

15.0

11,1

18.2

E.5

11.4

16,8

6.7

16,0

18,6

30.0

13.0

12.2

16.5

6.1

10,3

11.7

14,3

13,3

27.3

13.4

23.3

—

16.7

10.8

20.0

360

20.0

20.0

30,.s

375

15.2

1 Percents are based on 10,463 surviving subjects and 555 deceased subjects at

the time of the 19B7 NHEFS.

‘See appendix II for a discussion of revised race, corrected sex, and racalculafed

age at NHANES I examination.

31ncludea races other than white or black,

NOTE: NHANES I is the first National Health and Nutrit!on Examination Sutvey,

The 1987 Followup cohort consists of 11,750 sub]ects, ages 25-74 years at

NHANES I examination, who were not known to be deceased in the 1962+34 or

1986 NHEFS,

because the subject was incapacitated. A proxy interview

was conducted for 472 (85.0 percent) of the 555 clecedents identified in the 1987 NHEFS. In the 1987 NHEFS,

only 9.0 percent (n = 937) of the traced surviving subjects

were not interviewed. Proxy interviews were not conducted for 15.0 percent of decedents in the 1987 NHEFS.

Table C shows the interview nonresponse rates for

the 1987 Followup by age at baseIine examination, race,

sex, and vital status. The lower interview success rate in

the 1987 Followup for decedents than for surviving subjects is apparent across almost all age-sex-race groups.

This difference occurs partly because many of the decedents were located from vital statistics files and no proxy

could be identified.

To summarize how demographic factors relate to

interview status, muItipIe logistic models were fitted to the

cross-classification of age at baseline examination, race,

and sex, with the proportion of 1987 Followup subjl:cts

without an interview as the dependent variable, The

analysis was limited to black and white respondents,

because there were few subjects of other races (n = 149).

Age at baseline examination was categorized into five

10-year age groups (25-34 years through 65-74 years), The

final modeI for surviving subjects includes interactions

between age and sex (p = 0.09S4) and sex and race (p =

0.0187). Thus, among survivors, black men were 2!/2 times

more Iikely not to be interviewed than white men, and

black women were slightly less than twice as likely not to

have a completed subject interview than white women.

Odds ratios relative to white women were 1.43 for white

men, 1,93 for black women, and 3.84 for black men, Men

in the youngest and oldest age groups were more likely

than men 45–64 years of age not to be interviewed. Anmng

women, nonintewiew rates were highest among thc]se

25-34 and 35-44 years of age and lowest for those 55-64

years of age. When examining the overall age effect, men

and women 25–34 years, as well as men 65–74 years of age,

were found to be almost twice as likely not to be interviewed than women 55–64 years of age, (Odds ratios

relative to women 55–64 years were 1,88, 2.04, and 1.86,

respectively.)

The final model for decedents includes only the main

effect terms for race @ c 0.0001), sex @ = 0.4766), and

age at baseIine examination @ = 0,4760). The resuits

from the multiple logistic regression indicated that black

decedents were 2.2 times more likely than white decedents

not to have a proxy interview.

14
Health care facilities

data collection process

A major objective of the 19S7 NHEFS is the collection

of information on all overnight stays in health care facilities for members of the 19S7 Followup cohort. The 19S7

FolIowup cohort consisted of the 11,750 subjects who were

not known to be deceased in the 19S2–S4 or 19S6 NHEFS,

Followup cohort members who have either an interview or

a death certificate on the 1987 NHEFS data files were

eligible for the health care facility records component.

The aim of this component was to develop a complete set

of health care facility (that is, hospital and nursing hcme)

records for each 19S7 Followup cohort member. This was

accomplished by identi~ing all overnight stays in health

care facilities through a series of reporting mechanisms.

Facilities were then contacted to obtain copies of medical

records. Reports and medical records were then linked,

and the 19S7 NHEFS Health Care Facili~ Stay file was

constructed. Critical time periods for the collection of

facili~ records in the 19S7 NHEFS are illustrated in

figure 4. The time Iine at the top of the figure identifies

the events or dates used to define reference periods. Each

panel below the time line defines the reference period for

an individual aspect of the facility data collection. Within

a panel, each line shows how that time period is defined

for subjects with different interview histories.

The 19S7 NHEFS Health Care Facility Stay file contains all information on overnight stays that are in scope

for the 19S7 NHEFS period. This in-scope period covers

the time between the most recent interview prior to the

19S7 NHEFS and the date of the 19S7 NHEFS interview.

The three possible in-scope periods are illustrated in the

first panel of figure 4. The in-scope period for surviving

subjects last interviewed in the 19S6 NHEFS begins on the

date of the 19S6 interview and ends on the date of the

19S7 interview. For deceased subjects last interviewed in

-------------------------------------------------------------------------------------------------------

Survey periods

-------------------------------------------------------------------------------------------------------

1970 exam 1975 1980 1982-84 1985 1986 1987

I I I 1

Interviewed in 1986

Lastprevious contact in 1982-84

}

in-sco~e periods

Last previous contact at baseline examination

-------------------------------------------------------------------------------------------------------

Respondent recall periods for hospitalizations

-------------------------------------------------------------------------------------------------------

Last contact in 1986

Last contact in 1982-84

Last contact at baseline examination

Condition first occurred in 1985 or later

Condition first occurred 1980-84

Condition first occurred before 1980

------------------------------------------------------------------------

}

I

---

When reported condition was

mentioned in a previous interview,

recall period depends on date of last

contact

When reported condition had not been

mentioned previously, recall period

depends on date condition first

occurred

--------------------- ——--— ——-

Abstract request periods

-------------------------------------------------------------------------------------------------------

Last contact in 1966

Last contact in 1982-84

Last contact at baseline examination

Stay reported in 1980 or later

Stay reported between 1970-79

NOTE: NHANES I is first National Health and Nutrition Examination Survey.

}

}

When reported date of stay is within 1

year of in-scope period or facility had

been reported at last contact, abstract

request period depends on last contact

When reported date of stay is prior to

last interview and facility had not been

contacted during followup period of

last interview, abstract request period

depends on reported date

Figure 4. Survey period, respondent recall period, and facility abstract request period, by previous interview status: NHANES I

Epidemiologic Followup Study (N HEFS), 1987

15

.
1986, the in-scope period runs from the date of the 1986

interview to the date of the subject’s death, For subjects

whose last interview was conducted during the 1982-84

Followup, the in-scope period begins on the date of the

,1982-84 interview and ends on the date of the 1987

intemiew for survivors or on the date of death for decedents, Subjects last contacted at the time of the

NHANES I examination have an in-scope period from the

date of the NHANES I examination until the date of the

1987 interview or the date of death. Stays that were

determined to have occurred prior to the in-scope period

were defined as out of scope. When information on stays

that occurred prior to the 1987 in-scope period that had

not been obtained during previous waves was collected

during the 1987 wave, it was placed on either the 1986

Health Care Facility Stay file, or the Revised 1982-84

Health Care Facility Stay file, as appropriate.

Identification of stay reports

Reports of overnight hospital or nursing home facili~

stays were obtained from various sources. Most reports

were elicited through a series of detailed questions in part

B of the interview, which includes questions about specific

medical conditions. If a respondent reported that the

subject had experienced a given condition, questions were

asked to determine whether the subject had ever been

admitted to a health care facility because of the condition.

If the condition had been reported in a previous interview,

the respondent was asked to report all overnight facili~

stays for that condition that had occurred since 1985 if the

subject was last interviewed in the 1986 NHEFS, since

1980 if the subject was last interviewed in the 1982-84

NHEFS, or since 1970 if the subject was last interviewed

at the time of the NHANES I examination. If the condition had not been previously reported, respondents were

asked to recall facility stays since 1970 if the condition first

occurred prior to 1980, since 1980 if the condition first

occurred from 1980 through 1985, or since 1985 if the

condition first occurred after 1985. For respondents who

provided inconsistent information during the 1987 interview (that is, information that contradicted the previous

interview), the respondent recaIl period was extended to

19’)0.

The respondent recall periods were defined to include

reports of facility stays that were technically out of scope

for the 1987 NHEFS (that is, facility stays that occurred

prior to the date of last NHEFS interview). This was done

for two reasons. First, the years 1970, 1980, and 1985 may

be more meaningful reference points for respondents than

the date of the last interview. Second, to the extent that

subjects misreport the dates of hospital or nursing home

stays, increasing the period of reporting will maximize the

probability of collecting information on all faciIity stays

that are truly in scope for 1987. The relationship between

in-scope and respondent recall periods is illustrated in

figure 4. In addition to interview information, data on

facility stays were gathered from other reporting sources:

death certificate, tracing sources, and other facility

abstracts, At the conclusion of the interview, authorization

was obtained to contact facilities,

Facility data collection

For each stay reported during the interview, the name

and address of the facility, the reported dates of the stay,

and the reason for the stay were recorded on the hospital

and health care facility chart, (See appendix 1,) A separate

log book was kept containing similar data for reports

gathered from the death certificates, tracing sources, and

other facility abstracts. All reports of facility stays were

compiled and entered into a computerized tracking system. For each subject, the list of reported stays was

checked against the list of facilities that were contacted

for the subject in previous NHEFS interviews, To avoid

duplication with previous NHEFS Health Care Facility

Stay files, reports were deleted from the tracking system if

the reported dates of admission on the 1987 NHEFS were

more than 1 year prior to the previous NHEFS interview

(that is, out of scope for the 1987 NHEFS), unless the

facility named in the report had not been contacted during

the followup corresponding to the previous interview. IFor

example, if a respondent reported being hospitalized since

the beginning of 1985 for a given condition and the

reported date of admission was more than 1 year prior to

the 1986 interview, the facility mentioned wouId not

normally be asked for information about the stay. However, if the facility had not been contacted in 1986, then

information about the stay would be requested from the

facility.

All facilities for which stays were reported were con.

tatted by mail during the period August 1987–January

1988 and asked to review the subject’s medical records; to

abstract information on exact dates of admission, discharge, and diagnoses; and to place the information on

standard forms. (See appendix I for copies of the facility

contact letters and the abstract forms.) Because many

respondents may not have remembered correctly the dates

of hospitalizations, the requests to the facilities did not

specify the reported dates of admission. Rather, facilities

were asked to complete abstract forms for all stays since

the date of last NHEFS contact. In some cases, an

out-of-scope report was obtained for a facility that had not

been contacted in a previous NHEFS. When this ioccurred, the facility was directed either to send all abstracts

since 1970 or 1980, depending on the time of the last

contact with the subject. The different facility abstract

request periods are illustrated in figure 4. These procedures sometimes resulted in the receipt of previously

unobtained abstracts that were out of scope for the l!~87

survey but in scope for other NHEFS followup periods.

The revised 1982-84 NHEFS Health Care Facility Stay file

or the 1986 NHEFS Health Care Facility Stay file will

include these records. In addition to completing abstract

forms, health care facilities were requested to submit

photocopies of selected sections of the subject’s inpatient

16
record—for example, the facesheet; the discharge

summa~ thethird-day electrocardiogram (for myocardial

infarction diagnoses, code 410 in the International Classification of Diseases, 9th Revision, Clinical Modification

(ICD-9-CM) (11)); and pathology reports (for any admission where a new malignancy was diagnosed).

Matching records

As the abstracts were received, they were checked

against report information in the tracking system to determine whether the abstract “matched” any of the reported

stays. Date of admission and diagnosis were used as

matching criteria, but exact matches on date or diagnosis

were not required for a stay to be considered matched.

Abstracts were matched to reports if the reported date of

admission was within a year before or after the actual date

of admission and if one reported reason for admission

involved the same body system as one of the diagnoses

present on the abstract. Because the matching rules allowed for an admission date of up to 1 year before or after

the reported date of admission, some abstracts are present

on the file with a match record status and an out-of-scope

report date. These records are identified by a type C flag

in position 199 of the file. Cases that did not meet the

matching criteria were reviewed by NCHS staff and

matched when appropriate.

Each record on the file represents an overnight facility

stay. Therefore, one or more records will exist for some

19S7 Followup cohort subjects, whereas other subjects will

have no records on the file. The structure of the data file

reflects the system used to obtain and process stay information. The record is diirided into four major sections: the

report section, the record status section, the abstract

section, and the rel~ted stay section. h example of the

record layout is provided in figure 5.

The first section of the record is the report section,

which contains information from the reporting source as

well as stay identification numbers assigned by NCHS. The

record status section contoins a code for the result of the

abstract request – that is, match or nonmatch status. The

abstract section contains the information obtained from

the faciIity records, including actual admission and discharge dates and diagncms. The diagnoses on the abstracts were coded using the ICD-9-CM (11) according to

the medical coding specifications detailed in the 19S7

NHEFS Health Care Facility Stay file documentation.

Discharge diagnoses were coded for hospitaIs, but admitting diagnoses were coded for nursing homes. The final

section of the record, the related stay section, is used to

identify stays that are contained within other stays. This

occurred most often when nursing home residents had a

brief hospital stay but then returned to the nursing home.

A detaiIed example of a related stay section is contained

in the introduction to the Health Care Facility Stay file

documentation.

Information will be present in one section or more of

the record depending on whether a report was obtained,

whether an abstract was received, and how the stay relates

to other stays on the file. The presence or absence of

information in the first three sections resuIts in three

different record profiles. Figure 6 illustrates these three

profiles. The first is the successfully matched stay record;

that is, when an abstract was received that matched a

report, Abstract information was added to the record for

that report and the code of MAT (match) was entered

into the record status section. Complete information is

available for these stays. The second type occurs when an

abstract was not matched to a report, and therefore no

data are contained in the abstract section. The appropriate nonmatch code was entered in the record status

section. The third type of record is one generated solely by

the receipt of a facility abstract. This type of record

resulted when the facility returned an in-scope abstract

that did not match any report on the tracking system,

When this occurred, the abstract was entered on the file,

stay identifiers were assigned in the report section of the

record, but no other information was given in the report

section. A code of ASF (additional stay found) was entered in the record status section.

Because of the procedures instituted for maximizing

the collection of reports of hospital or nursing home stays

(that is, deliberately requesting out-of-scope report information), it was necessary to devise rules for removing the

“correctIy reported” out-of-scope reports from the final

version of the file. This was possible only after the facilities submitted the abstract information. As was previously

mentioned, reports of stays with a reported date of admission more than 1 year before the last interview were

eliminated from the tracking system before contacting

Record Related

Report section status section Abstract section stay section

. Facility identifiers . Match or reason for nonmatch . Actual dates of admission

. Reported date of admission

D Codes assigned by the

and discharge National Center for Heakh

. Reported cause of . Diagnoses (krterrrational Statistics to identify stays

admission Classification of Diseases,

● Source of report

contained within other stays

9th Revision, Clinical

Modification)

. Discharge status from

hospitals and nursing

homes

NOTE NHANES I is first Nattona[ Health and Nutrition Examination Survey.

Figure 5. Health care facility record layout: NHANES I Epidemiologic Followup Study (N HEFS), 1987

17
Record status code

r

I

Match: Report

5

Match

5

Abstract

section section II / / I

I

I

)

.------- ..-----------

1

Nonmatch: Report

5

Nonmatch < Noabstr.set ~ I

section code / received I

~

NOTE: NHANES

‘--N’-;P:5EEZEE5 I is first National Health and Nutrition Examination Survey.

Figure 6. Examples of matching process and record status

codes: NHANES I Epidemiologic Followup Study (NH EFS), 1987

the facilities by mail if the facili~ had been contacted in

the previous intenriew period, However, if the facility had

not been contacted previously, the report was kept on the

tracking system and flagged with a “D” in position 199. If

an in-scope abstract was received from the facili~, it was

added to the file with a record status code of ASF, and the

type D report was deleted from the final version of the he.

If the facility responded to the request but no in-scope

abstracts were received from the facility, the type D report

was deleted from the file on the assumption that the date

was correctly reported and the stay was out of scope. In

some cases it was impossible to contact the fac~lity, and

these type D reports remain on the final version of the file,

These records for unconfirmed reports of out-of-scope

stays can be eliminated from analysis at the anaIyst’s

discretion. A type C flag was assigned in position 199 when

a reported date of admission was within 1 year of the

previous interview. If an in-scope abstract was returned

that matched the type C report, it was assigned a record

status code of MAT. (The matching rules permitted an

admission date of up to 1 year before or after the reported

date of admission.) If the facility responded to the request

but no in-scope abstracts were received from the facility,

the type C reports were removed from the file, the

assumption being that the correct date was reported and

that the stay was truly out of scope. When the facility

could not be contacted, refused to participate, or did not

respond or when the subject did not provide the necessary

authorization to obtain the records, type C reports were

retained on the file. These unconfirmed reports of out-ofscope stays are identified by a nonmatch status in positions

60-62 and a type C flag in position 199.

Results of the health care facility

data collection

The file contains a total of 7,361 records; 6,645

(93.0 percent) records are for hospital stays, 405

(5,5 percent) for nursing home stays, and 111 (1,5 percent) for stays in facilities of unknown types. The

distribution of stays is given in table D, Of the traced

FolIowup cohort, 31.5 percent (n = 3,472) have at least

one stay on the file; 3,298 subjects have at least one

hospital stay, 375 subjects have at least one nursing home

stay, and 98 subjects have at least one stay in a facility of

unknown type. Among the 3,472 subjects with at least one

stay on the file, 292 have a stay in more than one type of

facility and 7 have at least one stay in each of the three

classifications of facility.

The completeness of the data file can be assessed by

examining the codes in the record status section of the ile.

Of the 7,361 records on the file, 4,318 (58.7 percent)l are

matches, 1,446 (19.6 percent) are additional stays found,

and 1,597 (21.7 percent) are nonmatch codes (table E).

The match rate varies little by sex, with 59.2 percent of

the stays reported by men and 58,3 percent of the stays

reported by women being matched to a facility abstract.

Stays reported for black subjects had a lower match rate

(49.6 percent), compared with a match rate of 60.3 percent for white subjects. There was no consistent trend in

match rates by age group. The lowest rate was found for

stays reported for persons 45-54 years old at the tim,e of

examination (55 percent). Stays reported for those under

45 years of age at examination were matched in about

58 percent of the records, and for those 55 years and over,

at exam the match rate was about 63 percent. There are

1,597 records potentially missing from the file (that is:,no

abstract that matches a report on the tracking system was

received from the facility). The most common cause of

failure to obtain an abstract (70.3 percent, n = 1,122)

occurred because the facility did not return an abstract

that matched the report. In these cases, the facili~ may

have responded that the subject was never in that facility

(code of XNH in positions 60-62) or may have responded

to the survey but returned no abstract matching the

specifically reported stay (XNS), The next most common

reason was a facility’s refusal to send abstracts (9.9 percent, n = 158). These records are coded REF in positions

60-62. Other reasons for nonmatch include 6,9 perc,:nt

(n = 110) because the facility could not be contacted

(designated FNC), 6.3 percent because the facility did not

respond in any way to requests for abstracts (n = 101,

coded ONR), and 3.6 percent (n =57) because the participant refused to authorize data collection (ANO), For

28 stays the facility reported that the records were lost or

destroyed (XRD), and for 21 stays an administrative code

of CRX was assigned to indicate a missing abstract for a

stay that was in progress at the time of the last interview,

(These data are not shown in the tables.)
Table D. Number of facility stays, distribution of subjects by number of stays, mean number of stays, and percent of traced cohort with

at least one stay in the NHANES 1 Epidemiologic Followup Study (NHEFS) 1987 Followup cohort, by race, sex, and age at NHANES I

Number of subjects

by number of stays Percent of

treced cohort Mean

Total Total 1 2 3 stays with at number

Rece, sex, and age 1 stays stays stay stays or more least 1 stay of stays

All races2

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . .

Male:

23-34 years . . . . . . . . . . . . . . . . . . . . . . ..1......

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

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Female:

25-34 years . . . . . . . . . . . . . . . . . . . . . . 1........

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

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

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

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

White

Bolhsexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male:

25-34years . . . . . . . . . . . . . . . . . . . . . . 1.8......

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

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

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

65–74yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female:

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

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

45-54years . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . .

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

65-74yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

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

Male:

25-34yaars . . . . .. l...... . . . . . . . . . . . . . . . . . .

3%14years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45–54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Female:

2+34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

7,361

329

546

1,018

301

567

1,244

1,206

920

326

904

6,207

276

470

908

253

472

1,050

973

765

281

759

I ,066

49

72

102

46

93

1.90

202

154

45

145

3,472

203

244

391

179

280

626

5.S2

365

173

429

2,929

170

210

341

157

234

524

466

311

150

364

510

31

31

46

20

44

94

103

53

23

65

1,831

131

122

166

115

130

356

330

170

95

216

1,550

110

105

140

104

105

301

266

146

86

185

260

20

15

24

9

23

50

56

23

9

31

791

43

56

100

31

79

147

118

65

36

94

672

36

47

90

27

68

123

96

73

30

82

115

7

8

9

4

11

23

21

12

E

12

650 31.5 2.1

29 20,2 1,6

66 29.2 2.2

125 43.2 2.6

33 30.9 1,7

71 39.6 2.0

123 30.2 2,0

134 31.3 2.1

110 32,6 2,5

40 22.0 1.9

119 37.4 2,1

707 31.1 2,1

24 19.3 1.6

56 2B.6 2.2

111 43.4 2.7

26 30.5 1.6

61 39.4 2,0

100 29.7 2.0

i 04 31.0 2.1

92 31.6 2.5

34 22.2 1.9

97 37.0 2.1

135 34.4 2.1

4 27.7 1.6

a 35,6 2.3

13 41.4 2.2

7 35,1 2.3

10 42,7 2.1

21 32.3 1.9

26 32.8 2.0

16 39,0 2.9

6 20.9 2.0

22 40.3 2.2

lseea~~endi~ll foradis~~ssionof revised race, ~orrected sex, and reca[cu]ated ageat NHANES I examination.

‘Includes races other than white or black.

NOTE: NHANES I is the first National Health and Nutrition Examination Survey. The 19B7 Followup cohort consists of 11,750 subjects, agas 25–74 years at NHANES I

examination, who were not known to be deceased in the 198244 or 1966 NHEFS. The traced cohort consists of 11,016 subjects who were not lost to followup at the time

of the 1987 NHEFS interview.

19
Table E. Number and percent distribution of record status codes for the NHANES 1 Epidemiologic Followup Study (NHEFS) 1987

Followup cohort by type of record status code, according to race, sex, and age at NHANES I

Record status code

Total

Match Additional stay found Nonmatch

Race, sex, and agel number Percent Number Percent Number Percent Number Percent

All racesz

Both sexes . . . . . . . . . . . . . . . . . . . . . . . .

Male. . . . . . . . . . . . . . . . . . . . . . . . .

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

3S44 years,........,,,.. . . . . . .

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

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

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

Female, ,, . . . . . . . . . . . . . . . . . . . . .

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

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

45–54years . . . . . . . . . . . . . . . .

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

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

White

Both sexes.,,...,,..,,. . . . . . . . .

Male. .,, . . . . . . . . . . . . . . . . . . . . .

2$34years . . . . . . . . . . . .,, ,,,..,,

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

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

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

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

Female, . . . . . . . . . . . . . . . . . . . . . .

25–34years .,, ,, . . . . . . . . .

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

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

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

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

Black

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

Male. ,, . . . . . . . . . . . . . . . . . . . . . .

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

35-44yeare ..,,,....,,,. ..,l;;;;;;;;;

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

55–64years ..,,.....,.. . . . . . . . . .

65–74years .,......,,. . . . . . .

Female . . . . . . . . . . . . . . . . . ,,, ,, .

2.5-34years, ., ...,,,... . . . . . . . . . .

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

45–54years .,.....,,.. . . . . . . . . . . . .

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

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

7,361

2,761

329

546

1,018

301

567

4,600

1,244

1,206

920

326

904

6,207

2,379

276

470

906

253

472

3,S28

1,050

973

765

261

759

1,066

362

49

72

102

46

93

726

180

202

154

45

145

100.0

100.0

100,0

100,0

100,0

100,0

100,0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100,0

100,0

100,0

100,0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100,0

100,0

100,0

100,0

100,0

100.0

100.0

100.0

100.0

4,31 a

1,634

213

316

551

183

371

2,684

709

702

513

206

554

3,742

1,445

160

270

506

170

319

2,297

601

569

440

179

486

540

1El

31

44

43

13

50

359

96

95

73

27

66

56,7

59.2

64.7

57.9

54.1

60.6

65.4

58.3

57.0

56.2

55.6

63.2

61.3

60.3

60.7

65.2

57.4

55.7

67,2

67.6

60.0

57.2

60,5

57.5

63.7

64.3

49.6

50.0

63.3

61.1

42.2

26.3

53.6

49.4

54,4

47.0

47,4

60,0

45,5

1,446

551

39

117

26E

37

90

695

237

237

237

47

137

1,207

470

32

101

239

24

74

737

204

195

192

40

106

225

78

7

16

26

11

16

147

30

34

45

7

31

19.6

20.0

11.9

21.4

26.3

12.3

15.9

19.5

19,1

19.7

25.0

14.4

15.2

19.4

19.6

11.6

21.5

26.3

9.5

15.7

19.3

19.4

20.0

25.1

14,2

14,0

20,7

21,5

14.3

22.2

27.5

23.9

17.2

20.2

16.7

16.6

29.2

15,6

21.4

1,597

576

77

113

199

61

106

1,021

296

267

170

73

213

1,256

464

64

99

163

59

79

794

245

189

133

62

165

323

103

11

12

31

22

27

220

52

73

36

11

46

21.7

20.9

23.4

20.7

19.5

26.9

16,7

22,2

24,0

22.1

16.5

22.4

23.6

20.3

19.5

23.2

21.1

16.0

23.3

16,7

20.7

23.3

19.4

17.4

22,1

21.7

29.7

2B.5

22.4

16.7

30.4

47.6

29.0

30.3

26.9

36,1

23.4

24.4

33.1

Iseeappendixll foradlscussionof revised race, corrected sex, and recalculated age at NHANES I examination.

‘Includes races other than white or black.

NOTE: NHANES I is the first National Health and Nutrition Examination Survey. The 1967 Followup cohorl consists of 11,750 sublects, 25–74 years at NHANES 1

examination, who were not known to be deceased in the 1962–640r 1986 NHEFS.

20
Death certificate

collection

Deaths identified by the National Death Index (6),

Health Care Financing Administration, or other tracing

sources were verified by obtaining the death certificate

from the vital statistics office of the State of death. These

death certificates were coded by the National Center for

Health Statistics using the International Classification of

Diseases, Ninth Revision [ICD-9) multiple cause-of-death

codes (12).

A member of the 19S7 Followup cohort was considered deceased only if a death certificate was received or a

proxy interview was completed to veri~ the death. Both a

death certificate and a proq interview are available for

441 (79,5 percent) of the 555 subjects identified as having

died from the time of the last contact to the time of the

19S7 NT+EFS. Thirty-one (5.6 percent) of the decedents

have only a proxy interview, and S3 (15.0 percent) have

only a death certificate. CWrall, death certificates were

obtained for 524 (94.4 percent) of the decedents in the

19S7 Followup cohort. Efforts to locate all missing death

certificates continue.

The percent of decedents for whom a death certificate

was not available according to age at baseline examination, sex, and race is shown in table F. Death certificates

were obtained for a high percent of decedents among the

age-sex-race groups (from 73.3 to 100.0 percent among

cells with 10 or more deaths). Black decedents were three

times more likely than white decedents, and women were

almost twice as likely as men to be missing a death

certificate.

Table F. Number of deaths and percent of decedents without an

available death certificate among the NHANES I Epidemiologic

FolIowup Study (N HEFS), 1987 Followup cohort, by race, sex,

and age at NHANES I

Number of Percent without

Race, sex, and age7 deaths a death certificate

All Racesz

Bolh sexes . . . . . . . . . . . . . . .

Male:

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

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

45–54 years . . . . . . . . . . . . . .

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

65–74 years . . . . . . . . . . . . . .

Female:

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

3544 years . . . . . . . . . . . . . .

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

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

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

White

Both sexes . . . . . . . . . . . . . . .

Male:

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

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

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

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

65–74years ...,,,....,,.,

Female:

25–34years . . . . . . . . . . . . . .

3544years . . . . . . . . . . . . . .

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

55–64 years . . . . . . . . . . . . . .

65–74years . . . . . . . . . . . . . .

Black

Both sexes . . . . . . . . . . . . . . .

Male:

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

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

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

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

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

Female:

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

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

4554 years . . . . . . . . . . . . . .

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

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

555

9

33

02

44

119

15

50

43

30

130

425

5

27

66

39

94

10

35

30

22

97

129

3

6

16

5

25

5

15

13

a

33

5.6

3.7

9.1

3.4

12.0

7.0

—

0.5

3.8

4,5

10.3

2.1

5.7

6.7

3.1

11.6

—

E.o

—

26.7

7.7

24.2

‘See appendix II for a discussion of revised race, corrected sex, and recalculated

age at NHANES I examination,

%cludes races other than white or black.

NOTE: NHANES I is the first National Health and Nutrition Examination Survey.

The 1967 Followup cohort consists of 11,750 subjects, ages 25-74 years at

NHANES 1examination, who were not known to be deceased in the 1962–84 or

1986 NHEFS. Percents are based on the 555 deceased subjects in the 1987

NHEFS.

21
1987 analytic cohort

This document has focused on the tracing and data

collection results for those subjects 25–74 years of age at

the time of NHANES I who were not known to be

deceased at the time of the 1982-84 or 1986 NHEFS. In

this section the discussion is expanded to examine the

“1987 analytic cohort,” the entire cohort of subjects who

were 25–7’4 years at their NHANES I examination (n =

14,407), regardless of their previous vital status or interview status.

As shown in figure 7, definitive information on vital status

at followup, obtained from the 1982=84,1986,or 1987NHEFS,

is available for the vast majority of the 14,407 subjects in the

1987 analytic cohort. Only 4,2 percent (n = 611) of the members of the 1987 analytic cohort were lost to followup in all

three NHEFS surveys.In 1987,259 subjects who had been lost

to followup in previous NHEFS waves were successfullytraced;

however, an additional 121 subjects who had been traced and

found to be alive in previous waves were lost in 1987,Approximately 22 percent (n = 3,212) of the 1987 analytic cohort

were deceased; 2,657 subjects were identified as deceased in

the 1982-84 or 1986 NHEFS, and an additional 555 subjects

were identified as deceased in the 1987 NHEFS. A death

certificate is available for 3,108 (96.8 percent) of the decedents.

Total cohort

n = 14,407

(100 percent)

x’” \

Lost to followup Traced successfully

in all NHEFS surveys in at least one

rr =611 NHEFS suwev

(4.2 percent) n = 73,796

(95.B percent)

/ \

x“

Never interviewed Interviewed

Last interviewed Last interviewed Laat interviewed

in 1982-64 in 1986 in 1987

n = 2,224 n = 805 n = 9,998

, NOTE: NHANES I is first National Health and Nutrition Examination Survey.

Figure 7. Tracing status of the NHANES I Epidemiologic Followup

Study (NHEFS) cohort

22

The success of the tracing efforts for the 1987 analytic

cohort according to age at baseline examination, race, and

sex is shown in table G. To summarize how these demographic factors were related to tracing success, a multiple

logistic model was fitted to the cross-classification of age,

race, and sex, with the proportion of subjects who were

lost to followup as the dependent variable. The analysis

was limited to black and white subjects, because there

were few subjects of other races (n = 172). Additional

analytic definitions and parameters used for this analysis

of subjects lost to followup have been described previously

in the section of this report entitled “Study design and

tracing activities.” The final model included a main effect

for age at baseline examination (p < 0.0001) and an

interaction between race and sex @ = 0.0016), The smlallest p value for a deleted term was 0,37. Black men were

more than three times as likely as white men to be lost to

followup, and black women were 77 percent more likely

than white women to be lost. Odds ratios relative to white

men, the group with the lowest rates of loss to followup,

are 1,35 for white women, 3.38 for black men, and 2.39 for

black women. The rate of 10SSto followup was dramatically higher for subjects under 35 years of age at the time

of NHANES I and continued to decrease with ei~ch

10-year increase in age for all sex-race groups. Odds ratios

were 8.34, 3.47, 2.28, and 1.13 relative to subjects 65--74

years of age.

Analysis using a multiple logistic regression was conducted for black and white subjects to determine whether

those subjects lost to followup in the 1987 analytic cohort

were at relatively high risk of death. The regression molclel

included (in addition to age, race, sex, and the interaction

term for race and sex) six health characteristics measured

during NHANES I that have been established as risk

factors for mortality: high blood pressure, high cholesterol, overweight, history of heart attack, history of dial] etes, and smoking status. Definitions of these risk factors

are described in the section of this report entitled “Study

design and tracing activities.”

The results of this multiple logistic regression are

presented in table H. The baseline risk factors of high

cholesterol, overweight, and history of heart attack or

diabetes did not have a statistically significant effect on

loss to followup. Of the six baseline risk factors, only high

blood pressure and smoking status had a significant effect

on 10SSto followup. Subjects with high blood pressure
Table G. Number and percent distribution of subjects by status in the NHANES I Epidemiologic FoIlowup Study 1987 analytic cohort by

status at followup, according to race, sex, and age at NHANES 1

Sfatus at fohwup Status at fo//owup

All Lost to All Lost to

Race, sex, and agel subjects Sufbfiving Deceased fo//0wup subjects Sunfiving Deceased fdowup

Allracesz . . . . . . . . . . . . . . . .

Male:

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

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

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

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

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

Female:

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

3544years . . . . . . . . . . . . . . .

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

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

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

White

Both swes. . . . . . . . . . . . . . . . .

Male:

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

35+4years . . . . . . . . . . . . . . .

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

55-84 years . . . . . . . . . . . . . . .

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

Female:

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

3.5-44 years . . . . . . . . . . . . . . .

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

5E-64years . . . . . . . . . . . . . . .

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

Black

Both sexes . . . . . . . . . . . . . . . .

Male:

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

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

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

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

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

Female:

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

35+4 years....,.....,.. .

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

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

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

Other

Bolh sexes . . . . . . . . . . . . . .

Male’

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

35-$4 years . . . . . . . . . . . .

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

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

65-74 years.... .

Female:

2E-34years . . . . . ,,

3W4 years . . . . . . . . . . . . .

4&54)/ears, . . . . . . . . . . . .

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

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

14,407

1,127

928

1,060

860

1,836

2,382

2,013

1,220

964

2,017

12,036

964

802

895

741

1,501

1,980

1,609

1,047

819

1.670

2,199

144

107

154

105

313

369

365

167

142

333

172

19

19

11

14

22

33

39

6

3

6

I0,584 3,212

1,010

809

825

547

598

2,0B7

1,824

1,081

765

1,038

9,057

885

709

720

482

507

1,765

1,463

953

655

898

1,400

114

82

95

55

85

296

305

123

107

136

127

11

lE

10

10

6

24

36

5

3

4

25

77

206

301

1,215

41

104

104

166

953

2,548

18

64

154

251

984

25

60

68

155

761

640

6

13

51

46

215

16

36

36

31

190

24

1

1

4

16

2

611

92

42

29

12

23

254

65

35

13

26

431

61

29

21

8

10

190

56

26

9

19

159

24

12

8

4

13

55

24

6

4

7

21

7

1

9

3

1

Percent distribution

100.0

100,0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100,0

100,0

100.0

100.0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

i 00.0

100.0

100.0

100.0

100.0

1000

100,0

100,0

100,0

100,0

100,0

100,0

100.0

100,0

i 00.0

73.5

89.6

87,2

77.8

63.6

32.6

87.6

90.6

86.6

79.4

51.5

75,2

91.8

86.4

80.4

65.0

33.8

69.1

92.2

91,0

80.0

53.5

63.7

79.2

76.6

61.7

52.4

27.2

80.8

83.6

73.7

75.4

40.0

7L.6

57,9

94.7

90.9

71,4

27.3

72,7

92,3

63.3

100.0

66.7

22.3

2.2

8.3

19.4

35.0

66.2

1.7

5.2

8.5

19.3

47.2

21.2

1.9

8.0

17.2

33.9

65.6

1.3

4.2

6.5

18.9

45.4

29.1

4.2

12.1

33.1

43.6

6B.7

4,3

9.9

21.6

21.0

57.1

14.0

5.3

9.1

28.6

72,7

33.3

4.2

6.2

4.5

2.7

1.4

1.3

10.7

4.2

2.9

1.3

1.3

3.6

6.3

3.6

2.3

1.1

0.7

9.6

3.6

2.5

1.1

1.1

7.2

16.7

11.2

5.2

3.8

4.2

14.9

6.6

4.6

2.0

2.1

12,2

36.6

5.3

27.3

7.7

16.7

lSeeappendix llforad[scussionof ri?v!sed race, corrected sex, and recalculated ageal NHANES I examination.

‘Includes races other thrmwhieo, b’sck.

NOTE: NHANES I is the first Nat(on4 Health and Nutrition Examination Survey. The 1967 Analytlc cohort consists of 14,407 subjects, 25–74 years at NHANES I

examination.

were 24 percent less likely to be lost to followup 1987 NHEFS maybe somewhat more likely to have died

(p = 0.029S) than subjects \vIth normal systolic readings. than those who were successfully traced. However, beCurrent smokers were mvice as likely as nonsmokers to be cause the proportion lost to followup is relatively small

lost to followup (p c 0.0001). These results for smoking compared with the proportion deceased in the 19S7 anasuggest that subjects who were lost to folIowup in the lytic cohort (0.04 versus 0.22), there should be relatively

23
Table H. Odds ratios, confidence intervals, and statistical

significance for selected health characteristics on loss to

followup for the NHANES I Epidemiologic Followup Study

(NHEFS) 1987 analytic cohort

95-percenf

confidence interval

Odds Lower Upper

Baseline characteristic ratio bound bound p value

High blood pressure 0,76 0.59 0,97 0.029B

High cholesterol 0.B8 0.66 1,16 0.3690

Overweight . . . . . . . . . . . . 1.05 0.E5 1,28 0.6707

History of heart attack 0.71 0.33 1.52 0,3744

Diabetes, . . . . . . . . . . . . . 1.17 0.68 2.00 0,5752

Smoking . . . . . . . . . . . . . . 2.05 1.57 2.69 <0,0001

NOTE: NHANES I is the first Nabonal Health and Nutrition Examination Survey.

The 1987 analytic cohort consists of 14,407 subjects ages 2%74 years at the

NHANES I examination. Data are based on multiple logistic regression, with race,

sex, rsce-sex interaction, and age at NHANES I examination includad.

little bias in mortali~ findings as a result of 10SSto

folIowup,

Table J gives the results for death certificate data

collection for the analytic cohort by age at their

NHANES I examination, race, and sex. Death certificates

were obtained for a high percent of decedents among the

age-sex-race groups (from 83.3 to 100,0 percent). Black

decedents were 2,8 times more likely than white decedents to be missing a death certificate, and women were

53 percent more likely than men to be missing a death

certificatee.

Table J. Number of deaths and percent of decedents without an

aval[able death certificate among the NHANES I Epldenrlolclgic

Followup Study 19B7 (NHEFS) analytic cohort, by race, sex, and

age at NHANES I

Number of Percent without

Race, sex, and agei deaths a death certificate

All racesz

Both sexes .,, . . . . . . . . . . . .

Male:

25–34 years, . . . . . . . . . . . . .

3544years, . . . . . . . . . . . . .

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

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

65–74years .,......,,,,..

Female:

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

3544years . . . . . . . . . . . . . .

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

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

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

White

Both sexes, ,, . . . . . . . . . . . .

Male:

25–34years, . . . . . . . . . . . . .

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

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

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

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

Female:

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

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

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

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

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

Black

Both sexes .,, ,, . . . . . . . . . .

Male:

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

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

45–54 years,..........,,.

55–64 years...........,,.

65–74years . . . . . . . . . . . . . .

Female:, . . . . . . . . . . . . . . . .

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

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

45–54 years . . . . . . . . . . . . . .

55–64 years . . . . . . . . . . . . . .

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

3,212 3.2

25 4.12

77 1.:3

206 1.!5

301 3.3

1,215 2.’7

41 ..

104 7.7

104 5.13

186 2,”7

953 3,{3

2,548 2.4

18 ..

64 1.6

154 1,$

251 2.11

984 2.()

25 -.

68 2.9

66 4,4

155 1.3

761 3.2

640 6.6

6 16.7

13 -.

51 . .

46 6.5

215 6.CI

16 -.

36 16.7

36 8,:1

31 9,7

190 6,8

lSee appendix II for a discussion of revised rece, corrected sex, and recalculated

age at NHANES I examination.

‘Includes races other than white or black.

NOTE: NHANES I Is the first National Health and Nutrition Examination !Wruey.

The 1967 analytic cohort consists of all 14,407 subjects ages 25-74 years at

NHANES I examination. Percents are based on the 3,212 deceased subjects in

the 1967 analytlc cohort.

24
Ongoing activities

Four public use data tapes containing vital and tracing

status, interview, health care facility stay, and mortali~

data from the 1987 NHEFS are available from the National Technical Information Service. The Vital and Tracing Status Data Tape contains summary information from

all waves of followup for all 14,407 members of the

NHEFS cohort. The Interview Data Tape contains information from 9,998 interviews (9,526 subject and 472 proxy

interviews) collected during the 1987 NHEFS interview

data collection period. The Health Care Facility Stay Data

Tape contains 7,361 stay records. It has the same format

as the 19S2–S4 NHEFS Revised and the 19S6 NHEFS

Health Care Facility Stay Data Tapes. The Mortality Data

Tape includes information abstracted from the death

certificates from the three NHEFS survey periods for all

deceased subjects for whom a death certificate is available.

Of the 3,10S death certificates on the 1987 Mortality Data

File, 1,935 are for subjects who died and for whom death

certificates were obtained during the 19S2–S4 survey

period, 33 are for those who died during the 19S2-S4

NHEFS survey period but for whom death certificates

were not obtained until after the 19S2–S4 NHEFS ended,

616 are for deceased subjects for whom death certificates

were obtained during the 19S6 NHEFS, and 524 are for

subjects who died during the 19S7 NHEFS survey period.

The 1987 data tapes may be used in conjunction with

the data tapes from the NHANES I survey and the

19S2–S4 and 19S6 NHEFS tapes to investigate the effects

of baseline measures on subsequent health status. AU

these data tapes are available through the National Technical Information Service. The study identification number

(the Sample Sequence Number) can be used to link the

files from any of the followup surveys to all NHANES I

files.

Additional information on the NHEFS cohort wilI be

available in future years. Plans for 1992 are to recontact

and reintemiew the 11,195 nondeceased cohort members

or their pros.ies, to collect health care facility data, and to

collect death certificate information.

25
References

1. Miller HW. Plan and operation of the Health and Nutrition

Examination Survey, United States, 1971–1973. National

Center for Health Statistics. Vital Health Stat l(lOa), 1978,

2. National Center for Health Statistics. Plan and operation of

the Health and Nutrition Examination Survey, United

States, 1971-1973. National Center for Health Statistics.

Vital Health Stat l(lOb). 1977.

3. Engel A, Murphy RS, Maurer K, Collins E. Plan and

operation of the NHANES I Augmentation Survey of

Adults 25-74 years, United States, 1974-1975. National

Center for Health Statistics. Vital Health Stat 1(14). 197S.

4. Cohen BB, Barbano HE, Cox CS, et al. Plan and operation

of the NHANES I Epidemiologic Followup Study, 1982-84.

National Center for Health Statistics. Vital Health Stat

1(22). 19s7.

5. Finucane FF, Freid VM, Madans JH, et al. Plan and

operation of the NHANES I Epidemiologic Followup Study,

1986. National Center for Health Statistics. Vital Health

Stat 1(25). 1990,

6. National Center for Health Statistics. User’s manual: The

National Death Index. DH%fS pub no (PHS) S1-114S.

Washington: Public Health Service. 1981.

7. McDowell A, Engel A, Massey JT, Maurer K. Plan and

operation of the second National Health and Nutrition

Examination Survey, 1976-80. National Center for Haalth

Statistics, Vital Health Stat 1(15). 19S1.

8. Fries JF, spitz.p, Krains R(3, et al. Measurement of patient

outcome in arthritis. Arthritis Rheum 23:13745.1980.

9. ROSOW 1, Breslau N. A Guttman health scale for the aged. J

Gerontol 21(4):556-9, 1966.

10. Katz S, Afcpom CA. Index of ADL, Med Care (5th

SUpp1):l16-8. 1976.

11. Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision, clinical modification. Washington: Public Hcakh

Service. 1980.

12. World Health organization. Manual of the International

Statistical Classification of Diseases, Injuries, and Causes of

Death, based on the recommendations of the Ninth Revision Conference, 1975. Geneva: World Health Organization. 1977.

26
Appendixes

Contents

I.

11,

Study materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tracing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - . - --”....-”

Verification-subject previously interviewed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Verification-subjcct not previously interviewed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

\7erification-prox~ ..,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interview.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Brochure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - -------------

Advance Ietterto subject previously interviewed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Advance Ietterto subject not previously interviewed . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Advance Ietterto prosypreviously interviewed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Advance Ietterto proxy not previously interviewed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Advance letterto facility administrator with request tointewiew subject . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Advance letterto lkciIity administrator with request to interview facility staff member . . . . . . . . . . . . . . . . . . . .

Subject telephone questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Proxy telephone questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Questionnaire A(Suhject questionnaire–mail version), . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Questionnaire ASupplement (Female medical history-mail version) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Questionnaire B(Proxy questionnaire-mail version) . . . . . . . . . . . . . . . ------ . . . . . . . . . . . . . . . . . . . . . . . . . . .

verbala uthorization form to obtain information from medical records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Authorization forrnto obtain information from medical records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospital and health care facility chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health care facility data collection . . . . . . . . . . . . . . . . . . . . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Letter to hospital administrator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Letter to director ofmedical records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospital record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Letter to nursing home administrator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursimg or personal care home record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Corrections and revisions tothe NILWfES I baseline data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...........

Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28

28

28

30

32

34

34

36

37

38

39

40

41

1:

159

168

174

178

179

180

182

182

183

184

186

187

189

189

189

Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... 189

27
Appendix 1

Study materials

Tracing

‘Dr: m-m-cl

WXLJECT“NN!E : Date

U.S. Department of Health ~nd Human Services

National Center for Health Statistics

National lnsritu[e on Aging

NHANES I Epidemiologic FOIIOWUp Survey

Verification – Subjects previously interviewed

VERIFICATION QUESTIONS (TO BE ASKED OF SUBJECTS)

OMB NO.: 937-0134

Approval Expires: !0/31/S7

1.

2.

J.

4,,

In ( INTERVIEW YEAR) you took part in the National Health and Nutrition Examinat ion (NHANES)

Followup Survey conducted by the National Center for Heal,th Statistics, a part of the

U.S. Public Health Service. I’d hke to ask a Few questions to verify that you are the

parson *O participated in that Followup survey. I want to mention that the in Forine Lion

you give will be kept strictly confidential and will be used for statistical purposes only.

The interview is completely voluntary and ie authorized by the Public Health Service Act.

mat is ymr full name includlng your middle initial? (PROBE FOR HAIDEN NAME IF FEMLE. )

(lf &CHANCED NAME, EXPLAIN. )

NAME :

And your date of birth is (REPEAT BIRTHDATE). Is that correct?

YES. . . . . . . . I (9.4)

ND. .’. . . . . . 2 (11.J)

DDN’T KNOW . . . . a (a.41

What M your date of birth? BIRrHDATE: —— // —

IIDNTH DAY YEAR

Were you living at (LABEL ADDRESS) in (MONTH AND YEAR OF INTERVIEW)?

YES. . . . . . . . 1 (BOX A)

m.. . . . . . . 2 (Q.5)

DON’T KNOW . . . . El (BOX A)

28
5. At what addreas were you living in (MONTH AND YEAR OF INTERVIEW)?

ADDRESS:

SrREET APT. #

CITY STATE

r

I

BOX A

INTERVIEWER REVIEW 9.2 ANO U.4 w: 2!’!CIL ONE;

CI.2 ANO Q.4 VERIFY. . . . . . .

U.2 ANO 9.4 DO NOT VERIFY . . .

OTHER. . . . . . . . . . . . . .

.1

.2

. 3

(SET UP INTERVIEW)

(Thank you very much, I don’t belleve you are

the person we are looking For.) (TERMINATE)

(CI.6)

6. Can you give me the names of the people you were living with in (MONTH ANO YEAR OF INTERVIEW)?

[And how was (NAME) related to you?] (PROBE FOR FULL NAME ANO RELATIONSHIP.)

NAME RELATIONSHIP

1.

2.

3.

4.

OR

LIVED ALONE. . . . . . . m . . . . . .0

Thank you very much but I am not sure whether you are the person we are Looking For. I

will check the Information you have given me against our records and wIL1 call you back

iF you are the-correct person. (TERMINATE)

Harrcc: - [nfarmmLLOn COI_ILll IImd an thtm ram

~lch MWld D9C3Lt LdmnC1flC~LIO~ Of MIY lMLvbduml Or ●atrnllmti-ru hna bsm callmcced .Lth i

● quarantu thmc it -111 ba nmld In ZCrac: cm- I

fLdmncm, .111 b- u- enlv fOr PurDomms atmtti

ror tnlm Ycudy, and WLI1 noc bs ‘llsclosti or

rmlmammd :0 ocnmcs _Lthout Lho Consent lf ti’m

indi. Ldual or emtmlla-c Ln =corasnsm .LtnI

Ssctlon JCll(d; 3f the ?ubllc Aamlcn ~crwlCm :c:

fK/ USC 2~2m).

29
SUBJECT

ID,: m-cum

NAME:

OMB NO.: 937-0134

Approval Expires: 10/31 /87

Dste

Us. Depamment of Health and Human Services

Nationai Ccncer for Health Sratisrics

lNacional Institute on Aging

NHANES I Epidemiologic Followup Survey

Verification -subject not previously interviewed

1.

2.

s.

4.

VERIFICATION QUESTIONS (TO BE ASKED OF SUBJECTS) - NEVER INTERVIEWED

In (EXAJ4 YEAR) you took part in a medical examination survey conductad by the National Center For

liMth Statistics, a part of the U.S. Public Haalth ‘%rvicu. I’d like to aak a Few questions to

varify that yw arm the person *O particlpakad in that survay. I want to mention that the information you giva will ba kapt strictly confidential ad will bO uaad for statistical purpoaas only.

The intarviaw its ccqletaly voluntary and in uthorizad by the Public Haalth %rvice Act.

Mat ia your full n- including yar middle in.itinl? (PROBE FOR HAIDENNW If FEMALE. )

(IF~CWGED -, EXPLAIN.)

WE!

kd your date of birth ia (REPEAT BIRTtOATE~. IrI that cmrract?

YE!3. . . . . . ..1(Q.4)

m 2 (9.3)

m&”K~ : : : : 8 (12.4)

mat is your date of birth? EIIRTtK)ATE: —— // —

NONTH DAY YEAR

War?) you llvlnq ●t (LABEL AJXIRESS) in (NONTH Am YEAR W LAST CONTACT)?

YES. . . . ..*. .1(6OXA)

W . . . . 2 (Q. s)

OC@t;T”K& . . .. MOXA)

30
5. At uhat ddrem wre you living in (FUINTH ANI YEAR W LAST CONTACT)?

KmEsst

~REET APT. #

CITY .“ STATE

I 1

INTERVIEWER

Q.2 m 0.4

Q.z m 9.4

OTKR . . .

WX A

REVIEW 0.2 AM Q.4 AM CIRCLE OW:

VERIFY. . . . .

M MIT VERIFY .

.a**m moo

9.

.9

. .

.1

.2

.3

(SET UP INTERVIEW)

(menk you very inch, I

the pemon we are look.

(Qo6)

don’t believe you are

ng for. ) (TERMINATE)

60 Cm you give m the naea of the POW1O ym mm liviq with in (MONTH AM YFAR OF EXAM)?

[Whm- (W) relatd to you?] (PRm FORWLL N~C ~ RELATIONSHIP.)

RELATIONSHIP

1.

2.

3.

4.

m

LIVEO ALONE . . . . . . . . . . . . . ..0

Think you vary nuch but I am not aum *ether yW am the person we are looking for. I

will check the information you have given m againat our records and will call you back

if ywr are the correct pemon. (TERMINATE)

31
lD#: cn-cmzl-cl

OMB No.: 937-0134

Approval Expires: 10/3’I /s7

PROXY MANE: Date

Verification-proxy

I wuld like to

to mention that

for statistical

U.S. Deparzmcn[ of Health and Human Se,rvices

National center for Health Statistics

National Institute on Aging

NHANES I Epidemiologic Followup Survey

VERIFICATION QUESTIONS (TO BE ASKED OF PROXIES)

ask a few questions to verify that I have the correct person. I want

the information you give me will be kept confidential and will be used

purposes only. The interview is completely voluntary and is authorized

by the Public Health Service Act.

mat (is/was) (SUBJECT’S) full name including middle name? (IFj CHANGEDNAME, EXPLAIN)

WE:

Pmd (his/her) date of.birth (io/waa) (REPEAT BIRTHDATE). Is that correct?

YES. . . . . . . . 1 (Q.4)

Pull. . . . . . . . z (Q.3)

DON’T KNOW . . . . E (Q.3)

(IF INCAPACITATED) Mat is (his/her) (date ofbirth/age)?

BIRTHDATE: // Of/ AGE : —. —

MONTH DAY YEAR

(IF DECEASED) What was (his/her) (date of birthfqe at death)? [what year did (he/she) die?]

BIRTHDATE: ,_l_/— OR AGE AT DEATH:

HONTH DAY YEAR

YEAR OF DEATH:

Was (SUBJECT) living at (LABEL ADDRESS) in [f40NTH AND YEAR OF LAST CONTACT]?

Y125.. . . . . . . 1 (BOX A)

No . . . . . . . . 2 (9.5)

DON’T KNOW . . . . B (BOX A)
5. At what address was (he/she) living in (140NTH AND YEAR OF LAST CONTACT)?

ADDRESS :

STREET APT. #

CITY STATE ZIP CODE

BOX A

INTERVIEWER REVIEW 9.2 AND 9.4 AND CIRCLE ONE:

Q.2 AND U.4 VERIFY. . . . . . . . 1 (SET UP INTERVIEW; COt4PLETE SUF IF APPROPRIATE)

Q.2 AMI GI.4D0 NOT VERIFY . . . . 2 (Thank you very mmh, I don’t believe we are

talking about the same person.) (TERMIN4TE)

OTHER. . . . . . . . . . . . . . Y (Q:6)

6. Can you remember the names of the people (he/she) was living with in (MONTH AND YEAR OF INTERVIEW/EXAt4)? [And how was (NAHE) related to (him/her)?] (PROBE FOR FULL NAHE AND RELATIONSHIP.)

fVU4E RELATIONSHIP

1.

2.

3.

4.

OR

LIVED ALONE. . . . . . . . . . . . . .0

Thank you very much but I am not sure whether (he/she) is the person we are

I will check.the information you have given me against our records and will

iF (he/she) is the correct person. (TER141NATE)

looking For.

call you back

33
Study Schedule

● Original Survey:

National Health and Nutrition Exam ination

Survey (1971-75)

c Initial Followup:

Lengthy personal interviews, Blood pressure

and weight measures (1982-84).

. Continued Followup:

Short telephone contacts of the elderly

(1985438) and of the total population

{1988 and 1988).

Partic@atingAgencies

National Institute on Aging

National Center for Health Statistics

National Cancer Institute

National Institute of Mental Health

National Institute on Alcohol Abuse and Alcoholism

National Insti:ute of Arthritis, Diabetes, Digestive

and Kidney Dissases

National Heart, Lung, and Blood Institute

National Institute of Neurological and

Communicative Disorders and Stroke

National Institute of Allergy and Infectious Diseases

Epkkmmfiohgk

F’dnowup

study

Surwv

U.S. Department of Health and Human Services

Public Health Service

National Center for Health Statistics

PW3-.4 kWitti& cm Aging
CJ

(n

‘Ep-b!!wd.okygk

F(!mosNuQ-

~)t’illl(dl,y

What Is the NHANES 1

Epidemiologic FoL’owup Study?

The National Health and Nutrition Examination

Survey Epidemiologic Followup Study is designed to

collect information about an aging population which

includes:

IIlnessesthat have occurred.

Habits and personal characteristics that may

affect health, such aseating patterns and

blood pressure,

The ability to carW on routine activities of

daily living such as dressing oneself or

climbing stairs.

The information will allow scientists to study many

of the factors that cause disease and disability, Data

from this study will be used by health planners,

educators, and medical experts to improve present

programs and to initiate future programs for

prevention and treatment of disease.

Why Is the Study Important?

Because the Followup Study provides data on a large

national sample, it presents a unique opportunity for

health researchers to study chang+x in health status

and the factors that contribute to good health aswell

as illness.

It is the first U.S. investigation of its size and scope to

follow the respondents over a period of years, and the

first to have interviewers measure blood pressure on

a national basis.

Who Is Being Contacted?

Persons who participated in the NHANES survey are

being interviewed about their health stabm and

hospital care since the earlier study, [f the original

participant cannot be interviewed because of illness

or death, relatives or close friends will be contacted,

A very short intewiew will lx conducted by

telephone by specially trained intewiewers who

will ask questions about illness and any disability the

respondent may be experiencing.

Hospitals will be contacted to obtain technical

information from the hospital record, It is essential

that data be collected about all participants. No other

data can be substituted for the information desired.

Why Is Partic@ation Important?

Confidentiality Is Guamnteed

All information obtained in the suwey will be

protected by the confidentiality requirements of the

U.S. Public Health Service Act and the Privacy Act

of 1974.

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 wcu Id

permit identification of an individual will be released

or published. Survey results will be published only

as statistical summaries.

A Coopemtive Effort

The survey is a joint effort of the National Center for

Health Statistics and the National Institute on Aging,

agencies of the Public Health Service, U..%

The persons who took part in the first survey made Depatiment of Health and Human Sewices,

up a group that represented all types of people in all

areas of the United States, The Followup Study is

the first nationwide suwey that will provide

information on the changes in healti for people

from different backgrwnds and regions.

Each participant represents thousands of others

with similar characteristics. Although voluntatv,

participation is important so that the resul13will

continue to represent a true scientific sample of the

U.S. population.

All queries or correspondence should be

directed to

Helen E, Barbano

NHANES I Epidemiologic Followup Study

National Center for Health Statistics

3700 East-West Highway, Room 2-27

Hyattsville, Mar-yland 20782

(301 ) 436-5975

—
Advance letterto subject previouslyinterviewed

,mvlcr,

.+** %

●

: $

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

:

-.

%

+%.. > National Center for Health Statistics

3700 East-Wesr Highway

Hyattsville MD 20782

Dear Participant:

As you may recall , we have been in touch with you in recent years concerning

a national study that the National Center for Health Statistics is conducting.

You participated in the first National Health and Nutrition Examination

Survey in 1971-1975, and Followups in 1982-86. The results of those surveys

have provided much needed information about the health needs and characteristics

of the American people. We would like to express our appreciation to you

for your part in making those surveys a success, and 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 brief interview of all the adults

who took part in that study. We have contracted with Westat, a national

research firm, to conduct the survey for us. Within the next two weeks, a

Westat interviewer will call you on the telephone to conduct a very short

interview. It should take approximately 30 minutes.

The interview will include questions about your health status and any hospital

care you may have received since our last contact. We would appreciate it

if you have this information available when the interviewer calls.

This survey is authorized by Title 42, United States Code 242k. Your participation in the survey is completely voluntary. There are no penalties for

refusing to answer any question.

As in the previous survey, any information you give will be kept confidential.

No infomtation that could be used to identify you or any individual will be

released or published. Results of this study will be published only as

statistical surmnaries.

Your cooperation is vital to the success of this survey, and your cooperation

will be greatly appreciated.

Sincerely yours,

m ZL.L.4Lz’

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

Director

Enclosure

36
Advance letter to subject not previously interviewed

# *‘-v’‘“ c+ *.

.

5’ Jg DEPARTMENT OF HEALTH& HUMAN SERVICES

s

Public Health Service

.

-.

‘--

7

%.,”d,m

National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

Dear Participant:

As you may recal1, we have been in touch with you In recent years concerning

a national study that the National Center for Health Statistics is conducting.

You participated in the first National Health and Nutrition Examination

Survey in 1971-1975. The results of that survey has provided much needed

information about the health needs and characteristics of the American people.

He would like to express our appreciation to you for your part in making

that survey a success, and we would like to have your help again. Although

you were not available to participate in the Followups in 1982-86, we hope

you will be able to assist us at this time.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the adults

who took part in that study. We have contracted with Uestat, a national

research finff,to conduct the survey for us. Hithin the next two weeks, a

Westat interviewer will call you on the telephone to conduct a very short

interview. It should take approximately 30 minutes.

The interview will include questions about your health status and any hospital

care you may have received since our last contact. We would appreciate it

if you have this information available when the interviewer calls.

This survey is author~zed by Title 42, United States Code 242k. Your participation in the survey is completely voluntary. There are no penalties for

refusing to answer any question.

As in the previous survey, any information you give will be kept confidential.

No information that could be used to fdentify you or any individual will be

released or published. Results of this study will be published only as

statistical sumnaries.

Your participation is vital to the success of this survey, and your cooperation

will be greatly appreciated.

Sincerely yours,

2? 5ZZ

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

Director

Enclosure

37
Advance letter to proxy previously interviewed

,Lwlcrf ,

.+~” $

.*

;

#

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

:

.

5

“+,+

>

+.,.

National Center for Health statistics

3700 East-West Highway

Hyattsville MD 207B2

Dear Participant:

The National Center for Health Statistics is conducting a national health

study. participated in the first National

Health and Nutrition examinationSurvey in 1971-1975, and in the followups

for NHANES in 1982-86. The results of those surveys have provided much

needed informationabout the health needs and characteristics of the American

people. We would like to have your help in the NHANES I Continued Followup

Survey being conducted at this time.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the adults

who took part in the study. We have contracted with Westat, a national

research firm, to conduct the survey for us. Within the next two weeks, a

Uestat interviewerwill call you on the telephone to conduct a very short

interview. It should take approximately30 minutes.

The intervi~ will include questions about ‘s

health status and any hospitalizationsand nursing home stays he/she may

have had as early as 1980. We would appreciate it if you have this information

available when the interviewercalls.

This survey is authorized by Title 42, United States Code 242k. Your participation in the survey is completely voluntary. There are no penalties for

refusing to answer any question.

As in the previous survey, any informationyou give will be kept confidential.

No informationthat could be used to identifyyou or any individualwill be

released or published. Results of this study will be published only as

statistical sumnariesm

Your cooperation is vital to the success of this study.

Sincerely yours,

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

Director

Enclosure

38
Advance letterto proxy not previouslyinterviewed

$*KW C,$ *= #1

$

. . ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

3

.

-a

‘%

%“,,0 > National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

Dear Participant:

The National Center for Health Statistics is conducting a national health

study. participatedin the first National

Health and Nutritlon kxamlnatlon Survev in 1971-1975. The results of that

survey have provided much needed info~ation about the health needs and

characteristics of the American people. Ne hope you will be able to assist

us at this time in the NHANES I Continued Followup Survey.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the adults

who took part in that study. Me have contracted with Westat, a national

research fimf, to conduct the survey for us. Wthin the next two weeks, a

klestat interviewer will call you on the telephone to conduct a very short

interview. It should take approximately 30 minutes.

The interview will include questions about ‘s

health status and any hospitalizations and nursing bane stays he]she may

have had since 1970. He would appreciate it if you have this information

available when the interviewer calls.

This survey 7s authorized by Title 42, United States Code 242k. Your participation in the survey is completely voluntary. There are no penalties for

refusing to answer any question.

As in the previous survey, any information you give will be kept confidential.

No information that could be used to identify you or any individual will be

released or published. Results of this study will be published only as

statistical sumnaries.

Your cooperation is vital to the success of this study.

Sincerely yours,

~ q&

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

Director

Enclosure

39
Advance letter to facility administrator with request

to interview subject

#,mvl ,,,

*a* %<

.

$

$

DEPARTMENT OF HEALTH & HUMAN SERVICES

s

Public Health Service

,

-0

%+%..]a >

National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

Dear Adml nistrator:

The National Center for Heal th Statistics has joined with the National

Institute on Aging to conduct the National Health and Nutrition Examination

Fol1owup Survey, to study the eti01ogy of a number of chronic diseases.

A selected sample of the United States population participated in the first

National Health and Nutrition Examination Survey (NHANES I) In 1971-75 and

in its Initial Followup in 1982-84. The results of that survey have

provided much needed information about the health needs and characteristics

of the American people,

To further use the findings from the original survey, the National Center”

for Health Statistics is planning another brief interview of all the adults

who took part in the study. We have contracted with klestat, a national

research firm, to conduct the survey for us.

Recently, we learned one of the participants in

the survey, is living in your taclllty. we wl~l need to interview

Mr./Mrs. in order to obtain the followup

information. Wlthln t he next two weeks, a Westat interviewer will be

contacting him/her by telephone to conduct a short interview. An initial

letter has already been mai-led to him/her as well.

This survey is authorized by Title 42, United States Code 242k. All information given will be kept confidential. No information that could be used

to identify the individual or your institution will be released or

published. Results of this study will be published only as statistical

sunmaries.

If you have any questions concerning this survey, please feel free to

contact Ms. Kathleen Parkes, toll free at (800) 638-8985.

Thank you in advance for your cooperation.

Sincerely yours,

26LUW4U

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

Director

40
Advance letter to facility administrator with request

to interview facility staff member

*WRWC,Z ~

.# **

,.

●

: $

DEPARTMENT OF HEALTH& HUMAN SERVICES Public Health Service

s

F

-.

%,

%,,. > National Center for Health Statistics

3700 East-West Highway

Hyattsville MD 20782

Tear Administrator:

The National Center for Health Statistics has joined with the National Institute

on Aging to conduct the National Health and Nutrition Examination Followup

Survey, to study the etiology of a number of chronic diseases.

A selected sample of the United States population participated in the first

National Health and Nutrition Examination Survey (NHANES I) in 1971-75 and

in its Initial Followup in 1982-84. The results of that survey have provided

much needed information about the health needs and characteristics of the

American people.

To further use the findings from the original survey, the National Center

for Health Statistics is planning another brief interview of all the adults

who took part in the study. We have contracted with Westat, a national

research firm, to conduct the survey for us.

Recently, we learned , one of the participants in

the survey, is living in your facility. We have already interviewed

in order to obtain the followup information.

However, there were some questions which he/she could not answer concerning

health and functioning ability.

We would sincerely appreciate it if a member of your staff would be willing

to answer a few questions concerning this resident so that complete information can be obtained. A Westat interviewer will be calling you within

the next two weeks to arrange an appointment to collect the information.

This survey is authorized by Title 42, United States Code 242k. All information given will be kept confidential. No information that could be used

to identify the individual or your institution will be released or published.

Results of this study will be published only as statistical surrnnaries.

If you have any questions concerning this survey, please feel free to contact

Ms. Kathleen Parkes, toll free at (800) 638-8985.

Thank you in advance for your cooperation.

Sincerely yours,

“u..x3w~

Helen E. Barbano

Project Director

NH~~~~yI Epidemiologic Followup

41
Subject telephone questionnaire

November 9, 1987

OMB: 0937-0134

EXPIRES: June 30, 19SS

SUBJECT WELL AND PROXY INCAPACITATED

QUESTIONNAIRE

PART A: ❑ACKGROUND INFORMATION

TIME BEGAN: AM

PM

First, I would like to ask you a few questions about (your/SU BJECT’S) household.

A-1. (Do you/Does SU BJECT) currently live in a house or apartment, a nursing home or rest home, retirement

home, or (do you/does he/she) have some other arrangement?

PRIVATE HOUSE OR APARTMENT .............................. 1 (CLAAI)

NURSING OR CONVALESCENT OR REST HOME ...... 2 (RPI-1)

RETIREMENT HOME ..................................................... 3 (CI.AA)

BOARDING HOUSE, ROOMING HOUSE OR

RENTED ROOM ............................................................. 4 (Q .A+

FAMILY OR FOSTER CARE HOME .............................. 5 (Q.A+

ANOTHER HEALTH FACILllY ....................................... 6 (RPI-2)

OTHER ARRANGEMENT (SPECIFt’) ............................ 91 (Q.A4)

OTHER INSTITUTION (SPECII%’) .............................. 92 (Q.A-7)

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

I

RPI-1 I

REFERENCE TO= INTERVIEW: IF IN NURSING HOME IN ~ (A-3=2) ON

ECF) AND CURRENTLY IN NURSING HOME (A-1 = 2), THEN GO TO A-2.

OTHERWISE GO TO A-7.

A-2. Since (MONTH NEAR) (have you/has he/she) continuously lived in a nursing home?

YES .................................................................. 1

NO .................................................................... 2 (Q.A-7)

A-3. Is this the same nursing home (you were/he/she was) living in (MONTH/Y EAR)?

YES .................................................................. 1 (A-1 O)

NO .................................................................... 2 (A-7)

I

RPI-2 I

I

SKIP TO A-7 BUT DO NOT HAVE A CONSISTENCY CHECK IN

NURSING HOME SERIES (B-66). I

42
A-4. How many people live in (your/his/her) household including (yourself/$ UBJEC~?

ONE .................................................................. 01 (Q.A43)

NUMBER OF pEOpLE: I I I

A-5. What relationship to (you/SUBJECT) (is/are) the other person(s) who live(s) in (your/his/her) household?

[PROBE FOR SEX IF NOT OBVIOUS: Is (PERSON) male or female?]

PERSON # SEX RELATIONSHIP

1

2

3

4

5

6

7

8

9

10

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

SEX 1 = MALE RELATIONSHIP: 1 = HUSBAND~lFE

2 = FEMALE 2 = FATHER/MOTHER

(INCLUDING IN-WWS)

3 = GRANDPARENT

4 = SON/DAUGHTER

(INCLUDING IN-LAWS)

5 = GRANDCHILD

6 = BROTHER/SISTER

(INCLUDING IN-WWS)

7 = AUNT/UNCLE/COUSIN

8 = OTHER REL4TIVE

9 = FRIEND

10 = OTHER NON-REIATIVE

A-6. How long (have you/has he/she) lived alone?

NUMBER OF MONTHS: l_l_l (Q.A-1O)

m

NUMBER OF,YEARS: l_l_l (Q-A-1O)

LESS THAN ONE MONTH .............................. 95 (Q.A-1O)

43
A-7. These next questions are about the last household in which (you/he/she) lived. How many people lived in

(your/his/her) household including (yourself/SUBJECT)?

ONE .................................................................. 01 (Q.A-9)

NUMBER OF pEOpLE: l_l_l

A-6. What relationship to (you/SUBJECT) (was/were) the other person(s) who lived in (your/his/her)

household? [PROBE FOR SEX IF NOT OBVIOUS: 1s(PERSON) male or female?]

PERSON #

1

2

3

4

5

6

.

7

8

9

10

SEX 1 = MALE

2 = FEMALE

SEX REIATIONSHIP

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

RELATIONSHIP: 1 = HUSBAND/WIFE

2 = FATHER/MOTHER

(INCLUDING IN-LAWS)

3 = GRANDPARENT

4 = SON/DAUGHTER

(INCLUDING IN-UWS)

5 = GRANDCHILD

6 = BROTHER/SISTER

(INCLUDING IN-UWS)

7 = AUNT/UNCLE/COUSIN

8 = OTHER RELATIVE

9 = FRIEND

10 = OTHER NON-REIATIVE

I GO TO Q.A-10 I
A-9. HOWlong had (you/he/she) lived alone?

NUMBER OF MONTHS: l_l_l

m

NUMBER OF YEARS: l_l_l

LESS THAN ONE MONTH .............................. 95

A-10. ~ERIFY IF ALREADY KNOWN:]

(Are you/is he/she) currently married, widowed, divorced, separated, or (have you/has he/she) never been

married?

MARRIED ........................................................................ 1

WIDOWED ...................................................................... 2

DIVORCED ...................................................................... 3

SEPARATED ................................................................... 4

NEVER MARRIED ........................................................... 5

RPI-3

REFERENCE TO lF/ECF INTERVIEW: FOR THOSE NEVER INTERVIEWED, ASK A-11

AND 1-12, OTHERWISE GO TO BOX Al.

A-1 1. Which of these categories best describes (you/~ UBJECl_I - Aleut, Eskimo, American Indian, Asian, Pacific

Islander, Black or White?

ALEUT, ESKIMO OR AMERICAN INDIAN ..................... 1

ASIAN/PACIFIC ISLANDER ........................................... 2

BIACK ............................................................................. 3

WHITE ............................................................................. 4

OTHER (SPECIFY) ......................................................... 91

A-12. (Are you/is he/she) of Hispanic origin?

YES ................................................................................. 1

NO ................................................................................... 2

45
A-13.

A-14.

A-15.

A-16.

A-17.

BOX Al

IF EUGIBLE FOR ~ AND RETIRED OR KEEPING HOUSE

ON ~ (U21 =2,3) GO TO RPI-5.

OTHERWISE GO TO A13.

During the last three months what (have you/baa he/she) been doing most? That is, (have you/baa

he/she) been working, keeping house, going to school, looking for work, or (are you/is he/she) retired?

WORKING ....................................................................... 1

RETIRED ......................................................................... 2 (Q.A-15)

KEEPING HOUSE .......................................................... 3 (().A-15)

GOING TO SCHOOL ...................................................... 4 (Q.A-15)

LOOKING FOR WORK ................................................... 5 (Q.A-15)

LONG TERM lLLNESS/DISABILl~ .............................. 6 (Q.A-15)

LEISURE ACTIVITIES ..................................................... 7 (Q.A-15)

OTHER 91 (Q.A-15)

On the average, how many hOIJr6a week (do you/does he/6he) world

NUMBER OF HOURS: I I I (Rpl-5)

I CATI PROGRAMMER: Display phrase in brackets if A-2=1,2. I

plerify if not known.] During the last three month6, (have you/has he/she) worked at all at a job or

business?

YES ................................................................................. 1

NO ................................................................................... 2 (RPI+

On average, how many hours a week (did pu/did he/she) ~rW

NUMBER OF HOURS: l_l_.1

RPI+

REFERENCE TO ~ INTERVIEW IF ~ WAS WORKING ON THE ~ (U21 = 1) BUT IS NOT

WORKING NOW (A-13 = 2-7 AND A-15 = 2), THEN GO TO A-17 AND USE ~ INTERVIEW

DATE FOR ~MQNTH/YEA R). OTHERWISE, GO TO RPI-5.

Did (you/he/she) stop working at the job (you were/he/she was) working in (MONTH/YEAR) because of

reasons related to (your/his/her) health?

YES ................................................................................. 1

NO ................................................................................... 2

46
RPI-5

REFERENCE TO ~ INTERVIEW IF MOTHER WAS STILL ALIVE ON ~ OR NOT

INTERVIEWED ON ~ GO TO A-18. OTHERWISE GO TO RPI+.

A-18. 1s(your/his/her) natural mother still living?

YES ................................................................................. 1 (RPI%)

NO ................................................................................... 2

DK .................................................................................... 8 (RP14)

A-19. How old was she when she died?

AGE IN YEARS’ l._l_l_l

DK ................................................................................. 998

RPI%

REFERENCE TO ~ INTERVIEW IF FATHER WAS STILL ALIVE ON ~ OR NOT

INTERVIEWED ON ~ GO TO A-20. OTHERWISE GO TO PART B.

A-20. Is (your/his/her) natural father still living?

YES ................................................................................. 1 (PART B)

NO ................................................................................... 2

DK .................................................................................... 8 (PART B)

A-21 . How old was he when he died?

AGE IN =A~s: I I I I

DK ................................................................................. 998

TIME ENDED: AM

PM

47
B-1. [IF SPEAKING TO SUBJECT, ASK:] Would you say that your health

good, fair or poofl

EXCELLENT .......................

TIME BEGAN: AM

PM

in general is excellent, very good,

.............................. 1

VERY GOOD .................................................... 2

GOOD .............................................................. 3

FAIR ................................................................. 4

POOR ............................................................... 5

B-2. Wtihin the past year have (you/has he/she) had pain, swelling or stifFnessin your joints on most days for at

least one month?

YES ..................................................................

NO ....................................................................

DK .....................................................................

RPI-7

REFERENCE TO ~ INTERVIEW IF ~ HAD ARTHRITIS ON ~

(QB-2= 1 ON ~ AND THIS IS NOT A PROXY INTERVIEW, THEN

GO TO B4. OTHERWISE GO TO B-3.

B-3. Did a doctor ever tell (you/SUBJECT) that (you have/he/she has) arthritis?

YES ..................................................................

NO ....................................................................

DK .....................................................................

1

2

8

1 (Q.B+

2 (RPI-B)

8 (RPI-1O)

RPI-B

REFERENCE TO ~ INTERVIEW IF ~ HAD ARTHRITIS ON ~ (Q. B-2 = 1)

AND PROXY DOES NOT REPORT ANY ARTHRITIS (B4=2), THEN CODE B-3

AS ‘DISCREPANCY=9S.”

F==l

48
CATI PROGRAMMER

IF ~ IS THE ~ AND REPORTED ARTHRITIS ON THE ~ (B-2=1) THEN

INSERT [DISCREPANCY = 98] CODE FOR B4

B-4. Concerning (your/~ UBJECT’S) mhriiis, in tiat year (were you/was sUBJECT firs told (you/he/she) had

arthritis?

YEAR: 19 I_l_l (Rpl-9)

DISCREPANCY ............... 98 (RPI-1O)

DK .................................... 98 (RPI-9)

RPI-9

REFERENCE TO ~ INTERVIEW IF ~ HAD ARTHRITIS ON ~

(Q.B-2= 1) GO TO RPI-10. OTHERWISE GO TO B-5.

B-5. There are different kinds of arthriiis. Did a doctor ever tell (you/him/her) which kind (you have/he/she

has)?

YES .................................................................. 1

NO .................................................................... 2 (Q.B-7)

DK ...................m................................................. 8 (Q.B-7)

B-8. Concerning your arthritis, (do you/does he/she) have osteoarthritis, degenerative, rheumatoid or some

other type? [PROBE WITH CATEGORIES IF NECESSARY.]?

~ N ~

a. OSTEO/DEGENERATIVE ARTHRITIS ............... 1 1 2 8

b. RHEUMATOID ..................................................... 2 1 2“8

c. SOME OTHER lYPE (Specify) ............................ B 1 2 8

B-7. (Have you/Has he/she) ever had an x-ray for (your/his/her) afihriiis, that is, an x-ray of (your/his/her)

joints?

YES .................................................................. 1

NO .................................................................... 2 (RPI.1O)

B-8. How long ago did (you/he/she) M have an x-ray for afihritis? [PROBE WITH CATEGORIES IF

NECESSARY.]

LESS THAN ONE YEAR AGO ......................... 1

1 BUT LESS THAN 5 ....................................... 2

5 BUT LESS THAN 10 ..................................... 3

10 OR MORE YEARS AGO ............................. 4

DK ..................................................................... 8

49
B-9. How long ago did (you/he/she) last have an x-ray for arthritis? [PROBE WITH CATEGORIES IF

NECESSARY.]

LESS THAN ONE YEAR AGO ......................... 1

1 BUT LESS THAN 5 ....................................... 2

5 BUT LESS THAN 10 ..................................... 3

10 OR MORE YEARS AGO ............................. 4

ONLY ONE X-RAY EVER ................................ 95

DK ..................................................................... s

RPI-10

REFERENCE TO ~ INTERVIEW IF ~ REPORTED AN EPISODE OF GOUT

ONW(B43=1),THENGOTOB-11. OTHERWISE GO TO B-10.

B-10.

B-n.

B-12.

B-13.

B-14.

Did a doctor ever tell (you/him/her) that (you have/he/she has) gout?

YES .................................................................. 1 (Q.B-12)

NO .................................................................... 2 (BOX A)

DK ..................................................................... 8 (BOX A)

BORDERLINE .................................................. 95 (CI.B-12)

Since (MONTH/YEAR), (have you/had he/she) had an episode of gout?

YES .................................................................. 1 (BOX A)

NO .................................................................... 2 (BOX A)

DK ..................................................................... 8 (BOX A)

What year (were you/was he/she) first told that (you/he/she) had gout? [DO NOT PROBE A “DON’T

KNOW RESPONSE.]

YEAR: 19 I I I (Q. B-14)

DK .......................................... 96

REFUSED ............................. (Q. B-14)

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 AGO ......................... 1

I BUT LESS THAN 5 ....................................... 2

5 BUT LESS THAN 10 ..................................... 3

10 OR MORE YEARS AGO ............................. 4

DK ..................................................................... 8

What year did (you/he/she) have (your/his/her) last episode of gout? [DO NOT PROBE A “DON’T KNOW

RESPONSE.]?

YEAR: 191 I I (clB-16)

~ HAD ONLY ONE EPISODE OF GOUT ........95 (Q.B-16)

DK ..................................................................... 96

REFUSED ........................................................ (Q. B-16)

50
B-15.

B-16.

B-17.

Can you remember if itwas less than a year ago, between 1 and 5 years ago, between 5 and 10 yearxi ago,

or 10 or more years ago?

LESS THAN ONE YEAR AGO ......................... 01

1 BUT LESS THAN 5 ....................................... 02

5 BUT LESS THAN 10 ..................................... 03

10 OR MORE YEARS AGO ............................. 04

ONLY ONE EPISODE OF GOUT EVER .........95

DK ..................................................................... 96

(Have you/Has he/she) ever had an attack of arthritisthat the doctor says was caused by gout?

YES ..................................................................

NO ....................................................................

DK .....................................................................

BOX A

IF B-3= IJGOTO B-17

IF ~ REPORTED ARTHRITIS ON ~ (B-2= 1) THEN GO TO B-17

IF B-10 = 1 OR B-11 = 1, GO TO B-17; OTHERWISE GO TO RPI-I 1

1

2

8

HOSPITAL DATES

FOR PERSONS THAT REPORT A YEAR OF FIRST OCCURRENCE USE:

,

1970 if year of first occurrence is prior to 1960.

1960 if year of first occurrence is behveen 1980 and 1965.

1985 if year of first occurrence is in 1965 or later.

IF NO DATE OF FIRST OCCURRENCE IS REPORTED OR PERSONS THAT

HAVE NEVER BEEN INTERVIEWED, USE

1970 if never interviewed

1960 if last interview was the ~.

1965 if last interview was the ~.

Since (1965/1 960/1970), (were you/waa he/she) hospitalized for (your/his/her) (arthritis/gout/arthritis or

gout)? [PROBE: (Were you/Waa he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-11

REFERENCE TO lF/ECF INTERVIEW IF ~ REPORTED A HEART AIT_ACK ON

lF(G17a=l) 0RE3(B14 = 1 OR B-15=1), GO TO B-18. OTHERWISE GO TO B-19.

51
B-18.

B-19.

B-20.

B-21.

B-22.

B-23.

B-24.

Since (MONTH/YEAR) (have you/has he/she) had a heatt attack, (sometimes called coronary thrombosis

or myocardial infarction)?

Did a doctor ever tell (you/him/her)

thrombosis or myocardial infarction)?

YES.................................................................. 1 ((). B-22)

NO .................................................................... 2 (Q. B-24)

DK ..................................................................... 8 (~. B-24)

that (you/he/she) had a heart attack, (sometimes called carona~

YES ,................................................................. 1

NO .................................................................... 2 (Q. B-24)

DK ..................................................................... 8 (Q.B-24)

In what year (were you/was he/she) first told that (you/he/she) had a heafl attack, (coronay thrombosis or

myocardial infarction)?

YEAR: 19 I

II

DK .................................... 98

(Have you/Has he/she) had an additional heart attack since then?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-23)

DK ..................................................................... B (CLB-23)

In what year was that heart attack? [PROBE: Did (you/SIJBJEC~ have any others since then? PROBE

FOR ALL YEARS.]

YEAR: 191 I I

YEAR: 191 I I

YEAR: 19 l_l_l

YEAR: 191 ——I I

DK .................................... 93

Since (19B5/19B0/1970), (were you/waa he/she) hospitalized for (your/his/her) heatt attack? [PROBE:

(Were you/Was he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

Since (19B5/1 9S0/1970), (were you/waa he/she) hospitalized for any type of heart condition (other than a

heart attack)? [PROBE: (Were yoq%%a he/she) there for more than a dav]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

52
RPI-12

REFERENCE TO lF/ECF INTERVIEW IF ~ REPORTED CORONARY BY-PASS ON U (B-20a= 1) GO TO

B-25. IF ~ REPORTED HE4RT AITACK OR OTHER HEART CONDITION ON lF/ECF AND DID NOT

REPORT A CORONARY BY-PASS IN ~ THEN GO TO B-26. OTHERWISE GO TO BOX B.

B-25. Since (MONTH/YEAR) have you had corona~ by-pass surge~

YES .................................................................. 1

NO .................................................................... 2

BOX B

IF B-19 = 1 OR B-24 =1, GO TO B-26 OTHERWISE GO TO RPI-14.

B-26. (Have you/Has he/she) ever had coronary by-pass surge~

YES .................................................................. 1

NO .................................................................... 2

(B-27)

(RPI-13)

(RPI-13)

B-27. Since (1985/1980/1970), (were you/was he/she) hosptialized for corona~ by-pass surge~ [PROBE:

(Were you/Waa he/she) there for more than a day’?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-13

REFERENCE TO ~ INTERVIEW IF ~ REPORTED PACEMAKER ON

U (B-20c=1), GO TO B-29. OTHERWISE GO TO B-28.

B-28. Some people with heati rhythm problems have a pacemaker insetted to control the heattbeat. (Have

you/Has he/she) ever had a paamaker insemd?

YES .................................................................. 1

NO .................................................................... 2 (RPI-14)

53
B-29. Since (1935/1 980/1 970), (were you/was he/she) Imspitalized for pacemaker insenion,

replacement? [PROBE: (Were you~as he/she) there for more than a day?]

YES .................................................................. 1

NO .................................................................... 2

RPI-14

REFERENCE TO lF/ECF INTERVIEW: IF ~ REPORTED A STROKE

ON ~ (B-28= 1) OR ~ (G22a= 1), GO TO B-30. OTHERWISE GO

TO B-31.

B-30. Since (MONTH/YEAR) (have you/has he/she) had a stroke (sometimes called a CVA)?

YES .................................................................. 1

NO .................................................................... 2

VOLUNTEERS SMAU STROKE .................... 3

VOLUNTEERS POSSIBLE STROKE .............. 4

VOLUNTEERS TIA .......................................... 5

DK ..................................................................... 8

B-31 . Did a doctor ever tell (you/him/her) that (you/he/she) had a stroke (sometimes called a CVA)?

YES .................................................................. 1

NO .................................................................... 2

VOLUNTEERS SMALL STROKE .................... 3

VOLUNTEERS POSSIBLE STROKE .............. 4

VOLUNTEERS TIA .......................................... 5

DK ..................................................................... 8

CATI PROGRAMMER

IF B-30 = 1 OR B-31 = 1 THEN USE ‘STROKE IN B-32 - B-36.

IF B-30 = 3 OR B-31 = 3 THEN USE ‘TIA IN B-32 - B-33.

IF B-30 = 4 OR B-31 = 4 THEN USE “SMALL STROKE” IN B-32 - B-36.

IF B-30 = 5 OR B-31 = 5 THEN USE ‘POSSIBLE STROKE” IN B-32 - B-36.

repair, or

(CHART)

(Q. B-34)

(BOX C)

(Q. B-34)

(Q.B-34)

(Q-B-34)

(BOX C)

(RPI-15)

(RPI-15)

B-32. In what year (were you/was

STROKE/POSSIBLE STROKE)?

he/she) first told that (you/he/she) had a (TIA/STROKE/SMALL

YEAR: 19 l_l_l

DK .................................... 9B

54.
B-33.

B-w.

B-35.

B-38.

(Have you/Has he/she) had an additional (TIA/stroke/small stroke/possible stroke) sinca then?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-35)

DK ..................................................................... 8 (Q. B-35)

In what year was that (stroke/lIA/small stroke/possible stroke)? [PROBE: Did (you/~ LIBJECT) have any

others since then? PROBE FOR ALL YEARS.]

YEAR: 19 l_l_l

YEAR: “91 I I

DK .................................... 98

Since (1985/1980/1 970), (were you/was he/she) hospitalized for a (strokefllA/small stroke/possible

stroke)? [PROBE: (Were you/Was he/she) there for more than a day?]

YES .................................................................. 1

NO .................................................................... 2

BOX C

IF B-30 = 2,8 AND THIS IS NOT A PROXY INTERVIEW, GO TO B-36.

IF B-30 = 1,3-5, THEN B-%.

IF B-31 = 1,3,4,5, THEN 0-38.

OTHERWISE GO TO RPI-15.

(CHART)

CATI PROGRAMMER

IF ~ REPORTED A STROKE LAST TIME BUT DID NOT REPORT ONE NOW (030=2), THEN FOR

B-36 INSERT THE PHRASE IN BRACKETS AND USE “STROKP IN (STROKES/STROKE/SMALL

STROKE/POSSIBLE STROKE/TIA). IF ~ REPORTED A STROKE IAST TIME AND REPORTED

ANOTHER ONE NOW (B30= 1), THEN FOR B-38 USE “STROKES IN (STROKES/STROKE/

SMALL STROKE/POSSIBLE STROKE/TIA).

[Concerning the stroke you told us about last time we talked,] (Do you/Does SUBJECTI now have any

problems as a resutt of (your/his/her) (STROKES/STROKE/SMALL STROKE/POSSIBLE STROKE/llA)?

That is, (do you/does he/she) have . . .

~

Trouble w“ti (your/his/her) arm and leg being weak or hard to use? ......................... 1

Trouble walking due to (your/his/her) stroke? ............................................................. 1

Trouble with speech? ..................................................................................................... 1

Some other trouble as a resutt of (your/his/her) stroke? (SPECl~ ........................... 1

RPI-15

REFERENCE TO lF/ECF INTERVIEW IF REPORTED DIABETES

ON ~ (0S=1) OR ~ (G-38=1), THEN GO TO B-37.

OTHERWISE GO TO B-38.

55
B-37.

B-38.

B-39.

B-43.

B41.

0+2.

B42a.

(Are you/is SUBJECT now taking medication for diabetes?

YES ..................................................................

NO ....................................................................

DK .....................................................................

DISCREPANCY ................................................

Did a doctor ever tell (you/him/her) that (you/he/she) had diabetes or sugar diabetes?

YES ..................................................................

NO ....................................................................

DK .....................................................................

BORDERLINE ..................................................

1 (ClB40)

2 (CI.B-42)

8 (GLB-42)

96 (Q. B+2a)

1

2 (B42-a)

8 (B42-a)

95

In what year (were you/was he/she) firsttold that (you/he/she) had diabetes or sugar diabetes?

YEAR: 191 ——I I

DK .................................... 98

(Are you/is he/she) now taking insulin injections for (your/his/her) diabetes?

YES .................................................................. 1 (Q.B+2)

NO .................................................................... 2

DK ..................................................................... 8

(Are you/is he/she) now taking pills for (your/his/her) diabetes?

YES .................................................................. 1

NO .................................................................... 2

Since (1965/19S0/1 970), (were you/was he/she) hospitalized for (your/his/her) diabetes? [PROBE: (Were

you/Was he/she) there for more than a da~]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

(Have you/Has SUBJECl_I ever been told by a doctor or health professional that (your/his/her) blood

cholesterol is high?

YES .................................................................. 1

NO .................................................................... 2 (RPI-16)

DK ..................................................................... 8 (RPI-16)

BORDERLINE ..............................................i... 95

56
B42b. Has a doctor or other heaith professional ever prescrikd any of the following treatments for high blood

cholesterol?

mm

a. Taking prescribed medicine ..................................................... 1 2

b. Controlling (your/his/her) weight ............................................. 1 2

c. Eating fewer high fat foods ....................................................... 1 2

d. Eating fewer high cholesterol fwds ......................................... 1 2

e. Exercising .................................................................................. 1 2

CATI PROGRAMMER

FOR EVERY QUESTION ANSWERED YES IN B42b, ASK B42c. INSERT THE APPROPRIATE

TREATMENTS FROM B42b IN THE “(TREATMENT)” SPACE PROVIDED IN B42c.

B42c. (Are you/is he/she) currently (TREATMENT) to Imver (your/his/her) blocd cholesterol?

~~

a. Taking prescribed medicine ..................................................... 1 2

b. Controlling (your/his/her) weight ............................................. 1 2

c. Eating fewer high fat tbods ....................................................... 1 2

d. Eating fewer high cholesterol foods ......................................... 1 2

e. Exercising .................................................................................. 1 2

RPI-16

REFERENCE TO ~ INTERVIEW

IF ~ REPORTED TAKING MEDICATION FOR HIGH BLOOD PRESSURE ON ~ (B40 OR

B-43 = 1), THEN GO TO S47.

IF ~ DID NOT REPORT HIGH BLOOD PRESSURE ON ~ (B41 =2,8), THEN GO TO B44.

IF ~ NOT ON ~ AND DID NOT REPORT HIGH BLOOD PRESSURE ON ~ (D2=2,8, THEN

GO TO B44.

IF ~ WAS NEVER INTERVIEWED ON ~ OR ~ GO TO B44.

IF ~ REPORTED HIGH BLOOD PRESSURE BUT WAS NOT TAKING MEDICATION ON ~

[(B-IO-2,8) OR (Ml =1 AND B-43=2,8)], THEN GO TO B-43.

IF ~ NOT ON ~ AND REPORTED HIGH BLOOD PRESSURE ON ~ (D-2= 1) THEN GO TO 643.

B+3. Has the dodor ever prescribed medicine for (you/~ UBJECT) for high blood pressure?

YES .................................................................. 1 (CLB-47)

NO .................................................................... 2 (Q. B+7a)

DK ..................................................................... 8 (Q. B-47a)

DISCREPANCY ................................................ 96 (RPI-17)

57
. . . .. .

U41.

B-45.

B-46.

B47.

B47a.

B47b.

(Have you/Hae SUBJECT) ever been told

hypertension?

by the doctor that (you/he/she) had high blood pressure or

YES .................................................................. 1

NO .................................................................... 2 (RPI-17)

DK ..................................................................... 8 (RPI-17)

BORDERLINE .................................................. 95

In what year (were you/wae he/she) first told that (you/he/she) had high blood pressure or hypertension?

YEAR: 19 l_l_l

DK .................................... 98

Has the doctor ever prescribed medicine for (your/his/her) high blood pressure?

YES..................................................................

NO ....................................................................

DK .....................................................................

(Are you/is SUBJECT) now taking medication for high blood pressure?

YES..................................................................

NO ....................................................................

DK .....................................................................

(Have you/Has SUBJECTj ever been advised by a doctor or other health professional to

following because of hypertension or high blood pressure?

a. Control (your/his/her) weight ................................................... 1

b. Cut down on satt or sodium ...................................................... 1

c. Increase (your/his/her) exercise .............................................. 1

1

2 (Q. B47a)

8 (Q. B+7a)

1

2

8

do any of the

CATI PROGRAMMER

FOR EVERY QUESTION ANSWERED YES IN B47a, ASK B47b. INSERT THE APPROPRIATE

ADVICE FROM B47a IN THE “(ADVICE)’ SPACE PROVIDED IN B47b.

(Are you/is he/she) currently (ADVICE) to lower (your/his/her) blind pressure?

~ ~

a. Controlling (your/his/her) weight ............................................. 1 2

b, Cutting down on satt or sodium ................................................ 1 2

c. Increasing (your/his/her) exercise ........................................... 1 2

50
B4B. Since (1985/1 980/1970), (were you/was he/she) hospitalized for high blood pressure? [PROBE: (Were

you/Was he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-I 7

REFERENCE TO lF/ECF INTERVIEW IF REPORTED BREAST CANCER ON ~

(D-52 =1) AND NOT A PROXY, THEN GO TO B-49. IF ~ DID REPORT OTHER

TYPES OF CANCER ON ~ (D5B=1 OR D+2= 1) OR ON THE ~ (B47=1),

THEN GO TO B-5o. IF REPORTED BREAST CANCER ON ~ AND A PROXY GO

TO B-5o. OTHERWISE GO TO B-51.

B49. In what year were you firsttold that you had breast cancer’?

YEAR: 191 ——I I

DISCREPANCY ............... %

DK .................................... 93

B-50. Since (MONTH NEAR) (have you/has he/she) had any type of cancer diagnosed including skin cancer?

YES .................................................................. 1 (Q. B-53)

NO .................................................................... 2 (Q. B-52)

DK ..................................................................... 8 (Q. B-52)

B-51 . Did a doctor ever tell (you/him/her) that (you/he/she) had cancer of any sort including skin cancer?

YES .................................................................. 1 (Q. B-53)

NO .................................................................... 2 (RPI-18)

DK ..................................................................... 8 (RPL18)

B-52. Since (19B5/19BO), (have you/has he/she) been hospitalized for ~ cancer condition? [PROBE: (Were

you~as he/she) there for more than a day?]

YES .................................................................. 1 (CHART. THEN

GO TO RPI-18)

NO .................................................................... 2 (RPI-18)

59
CATI PROGRAMMER

SUBSTITUTE ‘SINCE (MONTHNEAR)” IN THE PROBE FOR

B-53 IF ~ REPORTED A CANCER ON THE ~ (D52= 1 OR

D-5B= 1 OR D+2) OR ON THE ~ (B417= 1).

1ST DIAGNOSIS 2ND DIAGNOSIS 3RD DIAGNOSIS

B-53. Where was the LUNG ,,,.,,,,, ............................... 1 LUNG ,.,..,..,,.,,,,,,,,,.,,,,,,.,.........,. 1 LUNG .,,,,,,,,,,,, ........................... 1

cancer or what COLON (RECTUM, BOWEL) .... 2 COLON (RECTUM, BOVWL) .... 2 COLON (RECTUM, BOWEL) ,,,, 2

type of wcer BREAST ,,,,,,.,,,.,,,,,,,,,,,.,.,,,.,..,.,. 3 BREAST ..................................... 3 BREAST .................................... 3

was “N SKIN (MEL4NOMA) .................. 4 SKIN (MELANOMA) .................. 4 SKIN (MELANOMA) ,,..,,,,,,,,., .... 4

[PROBE: SKIN (NON-MEMNOMA) ........ 5 SKIN (NON-MEUV40MA) ........ 5 SKIN (NON-MELANOMA) ........ 5

(Have you/ (Q. B-55) (0.555) (CW55)

Has he/she) SKIN (DON’T KNOW) ............... 6 SKIN (DON’T KNOW) ............... 6 SKIN (DON’T KNOW) ............... 6

had any UTERUS.................................... 7 UTERUS .................................... 7 UTERUS .................................... 7

other cancer PROSTATE ............................... a PROSTATE ............................... 8 PROSTATE ............................... s

diagnosed STOMACH ................................ 9 STOMACH ................................ 9 STOMACH ................................ 9

since (month/ LEUKEMIA ................................ 10 LEUKEMIA ................................ 10 LEUKEMIA ................................ 10

year)?] OTHER (SPECltV) ................... 91 OTHER (SPECl~ ................... 91 OTHER (SPECIFY) ................... 91

SITE: SITE SITE

m Q!3 ~

TYPE: TYPE TYPE:

B-54. In what year

(were you/ YE4R: 19 l_l_l YEAR: 19 l_l_l YEAR 19 l_l_l

was he/she)

firsttold DK ........................... 96 DK ......................... 96 DK ........................... 96

that (you~

he/she) had

~?

B-55. Since (19B5/

19s0/1970),

(were you/

was he/she)

hospitalized

for (CANCER)?

[PROBE: YES ..................... 1 (cHAR1-J YES .................... 1 (CHART) YES .....................

(Were you/

1 (CHART)

Was he/she) NO ...................... 2 NO ..................... 2 NO ...................... 2

there for more

than a day?]

—

60
B-56.

B-57.

B-58.

B-59.

B-60.

RPI-18

REFERENCE TO lF\ECF INTERVIEW IF ~ REPORTED FRACTURED OR

BROKEN HIP ON ~ (B-53=1) OR ~ (E8=1 OR E90=1), GO TO B-56.

OTHERWISE GO TO B-57.

Since (MONTH /YEAR) (have you/has he/she) had a broken or or fractured hip?

YES .................................................................. 1 (Q.B+O)

NO .................................................................... 2 (Q. B-62)

DK ..................................................................... 8 (Q. B-62)

(Have you/Has SUBJECT ever been told by the doctor that (you/he/she) had a broken or fractured hip?

YES .................................................................. 1

NO .................................................................... 2 (CLB-62)

DK ..................................................................... 8 (Q.B%2)

In what year (were you/was he/she) first told that (you/he/she) had a broken or fractured hip?

YEAR: 19 l_l_l

DK .................................... 98

(Have you/Has he/she) had an additional fractured hip since then?

YES .................................................................. 1

NO .................................................................... 2 (Q.B+l)

DK ..................................................................... 8 (Q.B+l)

In what year did (you/he/she) have that break or fracture of (your/his/her)

he/she) had another fractured hip sinca then? PROBE FOR ALL YEARS.]

YEAR: 19 I II

YEAR: 191 ——I I

YEAR: 19 l_l_l

YEAR: 19 l_l_l

hip? [PROBE: (Have you/Has

DK .................................... 98

61
B$l .

B+2.

B-63.

B=.

B-B5.

B-&.

Since (1965/1960/1970), (were you/was he/she) hospitalized for a broken or fractured hip? [PROBE:

(Were you/Was he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

Did a doctor ever tell (you/him/her) that (you/he/she) had osteoporosis?

YES .................................................................. 1

NO .................................................................... 2 (RPI-I 9)

In what year (were you/was he/she) firsttold that (you/he/she) had osteoporosis?

YEAR: 191 ] I

.—

DK .................................... 96

RPI-19

REFERENCE TO ECF/NHANES 1: IF ~ INTERVIEWED ON ~F, THEN GO TO B64.

IF ~ WAS NOT INTERVIEWED ON ~ AND WAS AT LEAST 45 YEARS OLD AT TIME

OF NHANES I EXAM, THEN GO TO B=. OTHERWISE GO TO B-71.

Since (MONTH/YEAR) (have you/has SUBJECT) broken or fractured (your/his/her) wrist?

YES ..................................................................

NO ....................................................................

DK .....................................................................

Since 1970, (have you/has SUBJECT) broken or fractured (your/his/her) wrist’?

YES ..................................................................

NO ....................................................................

DK .....................................................................

CATI PROGRAMMER

IF ~ WAS INTERVIEWED ON ~ THEN SUBSTITUTE

‘SINCE (MONTH/YEAR)” IN PROBE FOR B-%

OTHERWISE SUBSTITUTE “SINCE 1970.”

1

2 (RPI-20)

8 (RPI-20)

1

2 (RPI-20)

8 (RPI-20)

In what year was that wrist broken or fractured? (PROBE: [(Since 1970/Since (MONTH/YEAR)], did

(you/SUBJEC~ have any other wrist breaks or fractures of your wrist’?)

YEAR: 191 ——I I

YEAR: 191 II

YEAR: 191 ——I I

YEAR: 191 ——I I

DK .................................... 98

62
RPI-20

REFERENCE TO ~ INTERVIEW IF ~ ELIGIBLE FOR ~, GO

TO B-B7. OTHERWISE GO TO B-71.

B-67.

B%B.

The next few questions are about falls. I’m interested in falls where (you have/SUBJECT has) fallen and

landed on the floor or ground or hit an object like a table or stair. During the past 12 months, (have you/has

~ had this kind of ~ll?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-71)

DK ..................................................................... 8 (CI.B-71)

How many times (have you/has he/she) fallen like this during the past 12 months?

NUMBER OF TIMES: I——I I

B-69. (Did this fall/Did any of these falls) . . .

a. cause a broken bone? .............................................................. 1 2

b. cause (you/him/her) to hit or injure

(your/his/her) head? ................................................................ 1 2

c. cause (you/him/her) to seek medical care? ............................ 1 2

B-70. During the past 12 months, (were you/was he/she) hosp-tilized for any of these falls? [PROBE: (Were

you/was he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

B-71 . Since (19B5/19B0/1970), (have you/has he/she) been hospitalized for pneumonia, bronchitis, or the flu?

[PROBE: (Were you/Was he/she) there for more than a da~]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

63
RPI-21

REFERENCE TO ~ INTERVIEW: IF ~ REPORTED KIDNEY DISEASE OR KIDNEY STONES ON ~ (G6a=l),

GO TO B-72 AND USE ~ INTERVIEW DATE FOR ‘( MONTHflEAR)-. OTHERWISE GO TO B-73a.

B-72. Since (MONTH/YEAR) (have you/has he/she) had a kidney disorder or kidney stone(s)? Please do not

include kidney infections,

YES ........ .

. ........................................................ 1 (QIB-73C)

NO ............ .

, ...........................................4.......... 2 (Q.B-73C)

DK ..................................................................... 8 (Q.B-73c)

B-73a. (Have you/Has SUBJECT) ever been told by the doctor that (you/he/she) had a kidney disorder or kidney

stone(s)? Please do not include kidney infections.

YES .................................................................. 1

NO .................................................................... 2 (Q.B-73q

DK ..................................................................... 8 (Q. B-73C)

B-73b. What year were you first told (you/he/she) had a kidney disorder or kidney stones?

YEAR: 19 l_l_l

DK .................................... 96

B-73c. Have (you/he/she) ever been told by a doctor that you had a urinary tract or kidney infection more than

three times?

YES .................................................................. 1

NO .................................................................... 2 (BOX Cl)

B-73d. What year were you first told that you had a urinary tractor kidney infection?

YEAR: 19 I_l_l

DK .................................... w

BOX Cl

IF ~ REPORTED KIDNEY DISORDER/KIDNEY STONES (B72=1 OR B73a= 1) OR URINARY

TRACT/KIDNEY INFECTION (B73c= 1) THEN GO TO B74. OTHERWISE GO TO RPI-22.

B-74. Since (1965/1 9B0/1970) have you been hospitalized for a kidney condition or urinary tract infection?

[PROBE: (Were you/Was he/she) there for more than one day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

64
B-75,

B-76.

B-77.

B-78.

B-79.

B-8(3.

RPI-22

REFERENCE TO ~ INTERVIEW IF ~ HAD CATARACT SURGERY ON ~

(BOX E= 1 OR F-3=1) THEN GO TO B-75. OTHERWISE GO TO B-76.

Since (MONTH/YEAR) (have you/has he/she) had cataract surge@

YES .................................................................. 1 (Q. B-78)

NO .................................................................... 2 (BOX D)

Has a doctor ever told (you/SUBJEC~ that (you/he/she) had cataracts?

YES .................................................................. 1

NO .................................................................... 2 (BOX D)

(Have you/Haa he/she) ever had surge~ for (your/his/her) cataracts?

YES .................................................................. 1

NO .................................................................... 2 (BOX D)

What year did (you/he/she) have (your/his/her) cataract surge~ [PROBE: Did (you/he/she) have any

other cataract surge~ RECORD AU YEARS].

Since (1985/1980/1 970), (were you/waa

YEAR: 19 l_l_l

YEAR: 191 I I

DK .................................... 98

he/she) hospitalized for (your/his/her) cataract surge@

[PROBE: (Were you/kVaa he/she) here for more than a day]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

BOX D

S IS MALE .............................................................. 1 (B#)

S IS FEMALE ......................................................... 2 (B-83)

(Have you/Haa sUBJECT) ever had an operation in order to be sterilized, also known as a vasectomy?

YES .................................................................. 1

NO .................................................................... 2 (0.9-83)

65
B-81. How old (were you/waa he) when (you/he) had this vasectom~

AGE IN ‘fEARS: l_l_l

B-82 NOT ASKED THIS VERSION.

B-83. [1have recorded that (you were/sUBJECT was) hospitalized (READ DATES. CONDITIONS AND FACILITY

NAMES FROM CHART).]

Now, i would like you to think back over the time between (1985/1980/1970) and the present.

(You/He/She) would have been about (&Q in (1985/l B80/1970). (Have you/Has he/she) stayed in a

hospital for ~ (other) reason including surgery, tests or for observation since (you were/he/she was)

W? [PROBE: (Were you/Was he/she) there for more than a dafl]

YES .................................................................. 1

NO .................................................................... 2 (BOX E)

ASK B-84 AND THEN B-85

FOR EACH CONDITION CONDITION # 1 CONDITION # 2 CONDITION # 3

B-84. For what condi- TESTSAND/OR TESTSAND/OR TESTSAND/OR

tion was that? OBSERVATION........... 1 OBSERVATION.............. 1 OBSERVATION .............. 1

[PROBE: Did DIGESTIVE/ULCERS DIGESTIVE/ULCERS DIGESTIVE/ULCERS

(you/he/she) PROBLEMS................. 2 PROBLEMS.................... 2 PROBLEMS .................... 2

have any other RESPIRATORY/ RESPIRATORY/ RESPIRATORY/

hospitaliza- BREATHING BREATHING BREATHING

tions since PROBLEMS................. 3 PROBLEMS.................... 3 PROBLEMS .................... 3

(1985/1980/ INFECTIONS...................... 4 INFECTIONS...................... 4 INFECTIONS...................... 4

1970)?] SURGERYFOROTHER SURGERYFOROTHER SURGERYFOR OTHER

[GO TO CHART CONDITIONS .............. 5 CONDITIONS ................. 4 CONDITIONS ................. 4

AFTER CODING OTHER (SPECIFY) ............ 91 OTHER (SPEWW) ............ 91 OTHER (SPECIPY) ............ 91

CONDITION.]

(CHART) (CHART) (CHART)

B-85. [INTERVIEWER MONTH: MONTH: MONTH:

FILL IN THE DAY: DAY DAY

YEAR OF THIS YEAR YEAR YEAR

ADMISSION SPECIW. SPECIW. SPECIIW

FROM HOSPITAL

CHART.]
L!ML!!A

B-B6. Since (19B5/19B0/1970), (have you/baa SUBJECT) ever stayed in a rest home, a nursing home, a mental

health facility, or anything like thaf? [PROBE: (Were you/VVas he/she) there for more than a day?]

YES .................................................................. 1

NO .................................................................... 2 (BOX H)

B-B7. To what type

of place was the

(moat recent/this)

B-SB. Did (you/he/she)

enter the ~

9F FACILITY)

directty from

(your/his/her)

own home, from

a hospital, or

from some

other place?

B-89. In wtmt year

did (you/he/she)

enter the ~

$)F FACILIW)?

ADMISSION# 1

NURSING HOME/

REST HOME ................... 1

MENTAL HEALTH

FACILITY ,..,.,,,,,,.,,,,, ........ 2

HEALTH CARE

REHABILITATION

CENTER ......................... 3

OTHER (SPECIFY) ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME/

REST HOME ................... 03

MENTAL HEALTH

FACIUTY ......................... 04

HEALTH CARE

REHABILITATION

CENTER ......................... 05

FRIEND/REblTIVE’S

HOME ............................. 06

OTHER (SPECl~ ............ 91

Y* 19 l_l_l

ADMISSION# 2

NURSING HOME/

REST HOME ................... 1

MENTM HEALTH

FACILITY ......................... 2

HEALTH CARE

REHABILITATION

CENTER ......................... 3

OTHER (SPECIFY) ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME/

REST HOME ................... 03

MENTAL HEALTH

FACILITY ......................... 04

HEALTH CARE

REHABILITATION

CENTER ......................... w

FRIEND/REIATIVE’S

HOME ............................. 06

OTHER (SPECIFY) ............ 91

ADMISSION# 3

NURSING HOME/

REST HOME ................... I

MENTM HEALTH

FACILITY ......................... 2

HEALTH CARE

REHABILITATION

CENTER ......................... 3

OTHER (SPECIFY) ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME/

REST HOME ................... 03

MENTAL HEALTH

FACILIT Y,....................... 04

HEAITH CARE

REHABIUTATION

CENTER ......................... 05

FRIEND/REUTIVE’S

HOME ............................. 06

OTHER (SPECIW) ............ 91

67
BOX F

IF B-87=2 THEN GO TO B-92.

OTHERWISE, GO TO BOX G.

BOX G

THIS IS SECOND ADMISSION ................................ B-SUa

OTHERWISE ......................................................o...... B.~

B-90a. Was this admission for the same reasons and medical conditions as you just reported?

B-9o. There are many

reasons why

people enter

a (TYPE OF

FACILl~.

Please tell

me if (you/

SUBJECT

entered the

(TYPE OF

FACILl~

for any of

the following

reasons.

(CIRCLE YES

OR NO FOR

EACH.)

ADMISSiON# 1

BI!Q

Required skilled

nursing care? ............ 1 2

Recuperation from

surgery? .................... 1 2

Needad help with

bathing, eating,

or dressing? .............. 1 2

Required special

medical or

physicalthera@ ...... 1 2

Too confused to live

independently? ......... 1 2

ADMISSION# 2

YES NO

Required skilled

nursing care? ............ 1 2

Recuperation from

surge~ .................... 1 2

Needed help with

bathing, eating,

or dressing? .............. 1 2

Required special

medical or

physicaltherap~ ...... 1 2

Too confused to live

independently? ......... 1 2

1 (B-92)

2 (B-8o)

8 (B-%3)

ADMISSION# 3

ml

Required skilled

nursing care? .......... 1 2

Recuperation from

surge~ .................. t 2

Needed help with

bathing, eating,

or dressing? ............ 1 2

Required special

medical or

physical therapfl .... 1 2

Too confused to live

independentlfl ....... 1 2

68
I

ADMISSION# 1

B-91, Please tell me

the name of

the disease

or medical

condition that

(you/he/she)

had at the time

of admission

that affected

(your/his/her)

abilii to live

independent?

(CIRCLE ALL

THAT APPLY)

ALZHEIMER’S DISEASE .......... 01

CANCER ....................>.............. 02

DEPRESSION .......................... 03

FRAIL/OLD AGE ....................... 04

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... 05

INCONTINENCE ...................... C6

NO MEDICAL CONDITION ...... 07

SENILITY .................................. 08

STROKE ................................... 09

OTHER DISEASE OR

CONDITION (SPECW) ... .... 91

ADMISSION# 2

ALZHEIMER’SDISEASE ........... 01

CANCER .................................. 02

DEPRESSION ........................... 03

FRAIL/OLD AGE ....................... 04

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... 05

INCONTINENCE ....................... @

NO MEDICAL CONDITION ....... 07

SENILITY ................................... OS

STROKE ................................... 09

OTHER DISEASE OR

CONDITION (SPECIFY) ........ 91

ADMISSION# 3

ALZHEIMER’S DISE4SE .......... 01

CANCER .................................. 02

DEPRESSION .......................... 03

FRAIL/OLD AGE ...................... 04

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS . ... . 05

INCONTINENCE ...................... 06

NO MEDICAL CONDITION .... . 07

SENILITY .................................. OS

STROKE .................................. 09

OTHER DISEASE OR

CONDITION (SPECIFf) .,...... 91

CATI PROGRAMMER:

SPACE SHOULD BE LE~ IN 8-91 FOR ALL THE MULTIPLE RESPONSE

CATEGORIES USED IN ~.

69

.
B-92. How long did

(you/he/she)

stay? (GO

TO CHART

AFTER CODING

LENGTH OF

STAY.)

B-93. Since (19BS/

1983/1970)

werethere other

admissionsto

a resthome, a

nursinghome,

a mentalhealth

facility,a

rehabilitation

centeror any

place likethat?

ADMISSION# 1

g: l_l_l

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

STIU THERE ................ 94

LESSTHAN

ONE WEEK ................ 95

(CHART)

YES ......... 1 (Q.B47)

NO ........... 2

ADMISSION# 2

#: Ill

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

STIU THERE ................ 94

LESSTHAN

ONE WEEK ................ 95

(CHART)

YES ......... 1 (Q.B47)

NO ........... 2

ADMISSION# 3

#: l_l_,l

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

STILL THERE ................ 94

LESS THAN

ONE WEEK ................ 95

(CHART)

YES ......... 1 (Q.B-B7)

NO ........... 2

70
I BOX H I

IF A-1 # 2 ................................................... 1 (B-94)

A-2 = 2 ....................................................... 2 (B-95)

OTHERWISE GO TO PART C.

B-94. What haa been happening to (your/his/her) health during the past 12 months? Has it improved, remained

the same, gradually worsened, or suddenly worsened?

IMPROVED ...................................................... 1

REMAINED THE SAME ................................... 2

GRADUALLY WORSENED .............................. 3 (PART C)

SUDDENLY WORSENED ................................ 4

DK ..................................................................... ~

B-95. During the month before (your/SUBJECT’S) admission to the nursing home, was there a significant change

in (your/his/her) health?

YES .................................................................. 1

NO .................................................................... 2

B-96. During the 12 months prior to that, what was happening to (your/his/her) health? Had it improved,

remained the same, gradually worsened, or suddenly worsened?

IMPROVED ...................................................... 1

REMAINED THE SAME ................................... 2

GRADUALLY WORSENED .............................. 3

SUDDENLY WORSENED ................................ 4

DK ..................................................................... 93

TIME ENDED: AM

PM
PART C: ACTIVITIES OF DAILY LIVING

TIME BEGAN: AM

PM

NURSING HOME INSTRUCTIONS:

RESPONDENT CAN ANSWER THIS SECTION .................. 1

RESPONDENT CANNOT ANSWER THIS SECTION

ASK OF NURSING HOME STAFF .................................. 2 (RECORD NAME, ADDRESS AND

TELEPHONE NUMBER ON IS.

THEN, GO TO PART D.)

These nexl questions ask about physical problems (you/~ lJBJECT) may or may not have. First. . .

c-1. (Do you/Does SUBJECT) usually have to stay in bed for most of the day?

YES .................................................................. 1

NO .................................................................... 2 (Q.G3)

c-2. How long (have you/has he/she) had to stay in bed for most of the day?

I I I NUMBEROFMONTHS............................. 1

NUMBER OF YEARS ...................................... 2

LESS THAN ONE MONTH .............................. 95

72

n
G3. (Do you/Does he/she) have any problems that prevent the use of one or more of (your/his/her) arms or

legs?

YES .................................................................. 1

NO .................................................................... 2 (Box HI)

w. Is this due to. . .

a. Paralysis? ...................................... 1 2

b. Amputation? ................................. 1 2

c. Severe arthritis? ............................ 1 2

d. Some other reason? .................... 1 2

(SPECIFY)

C-5. [IF YES TO Q.C-la, ASK]

Which limbs are paralped?

a. RIGHT HAND/ARM ..................... 1 2

b. LEFT HAND/ARM ........................ 1 2

c. RIGHT FOOT/LEG ....................... 1 2

d. LEfl FOOT/LEG ......................... 1 2

c-6. [IF YES TO Q.C4b, ASK]

Which limbs have been amputated?

a. RIGHT HAND/ARM ..................... 1 2

b. LEFT HAND/ARM ........................ 1 2

c. RIGHT FOOT/LEG ....................... 1 2

d. LEFT FOOT/LEG ......................... 1 2

G7. [IF YES TO Q.~c OR G4d, ASK]

Which limbs are involved?

a. RIGHT HAND/ARM ..................... 1 2

b. LEFT HAND/ARM ........................ 1 2

c. RIGHT FOOT/LEG ....................... 1 2

d. LEFT FOOT/LEG ......................... 1 2

73
BOX HI

IF ~ IS NOT ELIGIBLE FOR THE ECF AND IS NOT BEDRIDDEN (C-3 = 2) THEN GO TO

C-8a. OTHERWISE GO TO C9.

C-8a. (Do you/Does he/she) usually use any special equipment to get around, bathe, walk, dress or eat such as

canes, artificial limbs or grab bars?

YES ..................................................................

NO ....................................................................

DK .....................................................................

C-8b. Do you usually use:

a.

b.

c.

d.

e.

f.

9.

h.

m

Special devices in the bathroom such as hand

rails or grab bars ....................................................................... I

Cane .......................................................................................... 1

Artificial limb .............................................................................. I

Walker or crutches .................................................................... I

Wheelchair ................................................................................. I

Devices used for dressing such as button hooks,

zipper pulls, etc ......................................................................... 1

Special or built-up chair or toilet ............................................... 1

Special eating devices .............................................................. 1

1 (C-8b)

2 (RPI-23)

8 (RPI-23)

!@

2

2

2

2

2

2

2

2

I GO TO RPI-23 I

c-9. get (Do you/Does he/she) usually use

around, bathe, walk, dress or eat?

any of the following special equipment to help (you/him/her)

m ~

a. Special devices in the bathroom such as hand

b.

c.

d.

e.

f.

9.

h.

rails or grab bars .......................................................................

Cane ..........................................................................................

Artificial limb ..............................................................................

Walker or crutches ....................................................................

Wheelchair .................................................................................

Devices used for dressing such as button hooks,

zipper pulls, etc .........................................................................

Special or built-up chair or toilet ...............................................

Special eating devices ..............................................................

1 2

1 2

1 2

1 2

1 2

1 2

1 2

1 2

74

Ir”

— —— 
RPI-23

REFERENCE TO HJ&

IF ~ CANNOT USE ANY LIMBS (ALL CATEGORIES IN C5, C-6 OR C-7

ARE CODED YES) ....................................................................................................... 1

IF ~ IS BEDRIDDEN (C-1 =1) ...................................................................................... 2

IF ~ CANNOT USE BOTH LOWER LIMBS (AT LEAST ONE ‘C’ CATEGORY

~ONE “V CATEGORY IS CODED YES IN C-5, C-6 OR C-7) .............................. 3

IF ~ WAS ELIGIBLE FOR THE ~ AND CAN USE AT LEAST ONE LOWER

LIMB (EITHER ‘C OR “D” IS NOT CODED YES IN C5, C-6 Or C-7) AND

IS NOT BEDRIDDEN (C-14) ..................................................................................... 4

IF ~ WAS NOT ELIGIBLE FOR THE ~ AND CAN USE AT LEAST ONE

LOWER LIMB (EITHER ‘C’ OR ‘DmIS NOT CODED YES IN C5, C-6 OR

C-7) AND ~ IS NOT BEDRIDDEN (c-l#l) AND EITHER S USES AT

LEAST ONE TYPE OF SPECIAL EQUIPMENT (C-6a= 1, C-6b= 1,

C-6c=l, C-6d=l, C-6e=l, C-6f=l, C-6g=l, C-6h=l OR C-9=1)OR

HAS ARTHRITIS (B-3=1) ............................................................................................ 5

IF ~ WAS NOT ELIGIBLE FOR THE E&& AND DOES NOT HAVE

ARTHRITIS (B-3=/1) ................................................................................................... 6

(PART D)

(GO TO 10a AND ASK

* QUESTIONS ONLY)

(GO TO 10a AND

ASK ● AND **

QUESTIONS ONLY)

(GO TO 10a AND ASK

ALL QUESTIONS)

(GO TO 10a

AND ASK ALL

QUESTIONS)

(GO TO 10a AND

ASK *** QUESTIONS

ONLY)
INTERWIFWER lNSIRUCTIONS: ASK Q.G1O THROUGH O.C-@. IF ANY RESPONSE TO 0- 3 OR 4 ~ ANY

RES~NSE TO ● -3, M Q.GIOc/O,CIOd THROUGN (3.qC/().GXld. IF C OR d - YES [USES HELP

EITHER FROMANOTHER PERSON OR AN AJO)ASK O.C-IM THROUGH 0.C420 WHERE INDICATED.

b.

[IF YES (COOE f) IN & ASK:]

(Do w/Ooa ~ have

mm dlmcdry, much dAfku~,

or (am you/is lw/she) utIabl@ to

a,

Iamgolngto fasdaiistofaaivti P!uMtdmoii

(YW tuuo/~ haa)~ diilty clang than things

wlwl (yw are/~ is) bf (your8dt/hkn8M/ha8aif)

and noI uamg apdd oquipmom [PROBE. IF NECESSARY

(00 WW/Ocma ho/aho) havo MY diity dmn (yeu/ho/shc

WI!uwl

(ENTER ONE CODE FOR EACN ACT~

1 - YES (OIFFICUL~. MK b

2 = NO DIFFICULW

3- NEVER 00ES WITHOUT HELP

4- NEVER00ES ACIMIY

s - INAPPROPRIATEACTMTY

da mm?

SOME

OIFFICULIY

2

2

MUCH

OIFFlCULW

UNABLE

TO DO

4

4

4

DK

8

.9

9

..

●☛

✎✎

✎

●

●

●☛☛

●☛✎

● ☛

● ☛ ●☛☛

✎✎

●

●✎✌☛✎☛

✎☛☛

● ☛

●

●☛

✎☛☛

●✎✎

✎✎☛

✎✎☛

G1O. Orns (yuumd/htmsd/lwm+, mddng tyng

alma. ding Zl!lpam ald dmg butrom? l_l 3

3

Gil. st=@uph’c+n anafmlaG4aIrwht **(sdaa

diiing rown char)? l—l

G12 *inlQmd0W04bad l_l

G13. Pfopwo maa14? l_l

2 3

2

2

3

3

4

G14. Cut (ycur/hi8/twf) m4w? 4- l—l

GIS. U? ● Ml WP u glsu m (yxr/hm/bar)’moulh? l_l 2

2

3

3

4

4

8

C-IS.Opul● m ITIIlhawl? l_l 8

G17. WaIk a qwwr mda (m- is. w or ttvaa mocks)? l_l

(IF CODE 2, GO TO 0.C19)

2

(0.C19)

2

3 4 3

cla wakffomon.roo mtoancmorpmmcaamnoc+? ‘_] 3

3

4

4

3

G19. ‘wdlrwmd-stiwsaw? l_l 9

G20. Gainandouofma balnub? l—l

2

2

2

3

3

4

4

8

G21. Wash and dV (ywr/hm/bar) MUM body? l_l a

c-22. G4r Onaldofrrhoroiti l—l 2 3

3

8

9

4

8

8

3

8

9

G23. CUnb(ywr/hm/bar)Iwf? I_]

G24. R- - gat dowI a S lb. ObIOU (bag Of Wgw) from

I-a @ur/hm/hu) hod l_l

2

2

2

3

4

4

Czs. Sanddemtand pc+rwdcahmgfrofnmanm? l—l

Wm. opaljamVAldl Itaw baan pravvwsty 0wuu7 l_l

8

2

2

3

3

4

G27. Uaoapancfpanol mwtowih? l_l

G28. G9tinandaxofac@ [_l

4

4

4

2

2

3

(X?S. Run arrmda ad shop? 3 l—l

~. ~ lqM UKWea(= aD duamngor taking ou!

ltm gafbag,)? l—l 2

2

3

WI. LAandc=rya ftdlbagofgrcc-3a7 3

l—l

-. ti haavyC)KW- wound tha hOUS@Oryard (WCilu

Waahlng wlndmw. WauaOr noom? 1—1 2 3 4 -19

76
SOX J

ANY RESPONSE IN O.G1O THROUGH 0.C.32m -3 ................................... 1 (O.G1OC)

ANY RESPONSE IN O.G1O THROUGH O.GQb -3 OR 4 ........................ 2 ((3.G1OC)

AU RESPONSES, 9.G1O THROUGH 0.C-32b = 8WW 2, OR 8 ............ 3 (PART D)

I [

9.

[IF COOE 3 IN a ASK] [ASKONLY IF HAVE HEI %] Wti hdQ how

Yoaa8idtmyw rwmr(x’nvl~wmo lJih@a - diflbkY (do @/don ~

haw (dtwq Ibis a@viiy)? (DO yuu/L)oea

[IF ~ IS SUSJEC7 ANO COOE 3 OR 4 IN b. ASK] ho/ahO) hM no dkuky, some dff!cuily,

You w III* yuu (IIM dlwty@m unabla 10)(,4CTlvlTy by@umait, mud difflcuky,or (arc you/is ha/$ho} unable

rodolt?

[IF ~ IS PROXY ANO COOE 3 OR 4 IN b, ASK]

You sud th9 (ho/she) (* diMcuRy/iaunaoloto) @211Vl~ by

(himaaa/tlamdf).

d (Do P#oou M/ah.) uaa ~ oquipmam.

audtasa. . [FOR G1O, lFtXa-YES,

7HEN USE %UT70N HOOKS,”OTHERWISE,

c. (00 you/ooa W/*) uSE 71PPER EX7ENOER.’ FOR G11, 12,

It8v9holph 17-19,27, If ~-YES. USEWALKER,”

mum panonr 07HERWISE USE ‘C4NE.q NO SOME MUCH UNA8LE

OIFFl- DIFFl- DIFFI. To

YES NO YES NO CULIV cunY CuTLY 00

Glo. (emal M/

1 2 Zlppu atandu) 1 2 1 2 3 4

C-11.

1 2 (Walker/cw) 1 2 1 2 3,*

G12 1 2 (W&Ikw/arm) 1 2 1 2 3 4

>13. 1 2 1 2 1 2 3 A

G14. 1 2 1 2 1 2 3 “4

Gla 1 2 1 2 1 2

c-la 1 2 1 2 1 2

: 1:

>17. 1 2 (w#k9r/-) 1 2 1 2 3 4

>1s. 1 2 @valkof/cane) 1 2 1 2 3 a

>19. 1 2 (w*4r/cwm) 1 2 1 2 3

X!O. 1 2 (Hind @ 1 2 1 2 31:

:21. 1 2 1 2 1 2

31’

>=. 1 2 (Hand @ 1 2 1 2 3 4

$2a 1 2 1 2 1 2 3 a

>24.

1 2 (Gnbbarj 1 2 1 2 3 4

G2S. 1 2 (Gfabbuj 1 2 1 2 314

$2s! 1 2 (J= VVPW) 1 2 1 2 314

>27. 1 2 1 2 1 2 3

>a 1 2 @Yalkar/caw) 1 2 1 2 31:

>2s. 1 2 1 2 1 2 3 d

240.

1 2 1 2 1 2 3 4

xl. 1 2 1 2 1 2 3

X2. 1’

1 2 1 2 1 2

31A

TIME ENOED: AM

Pi.!

77
PART D: SMOKING AND ALCOHOLIC BEVERAGES

TIME BEGAN: AM

PM

I

RPI-24 I

REFERENCE TO lF/ECF INTERVIEW IF NEVER INTERVIEWED OR ~ REPORTED

‘NEVER SMOKEIY AT ~ INTERVIEW ~ (D-1 = 2) OR ~ (L-1 =2)] THEN GO

TO Q. D-l . OTHERWISE GO TO RPI-25.

D-1.

D-2.

D-3.

DA.

D-5.

These nex3 few questions are about (your/SIJBJECT’~ smoking and drinking habts. Did (you/SUBJECT)

ever smoke at least 100 cigarettes in (your/his/her) Iitilme?

YES .................................................................. 1

NO .................................................................... 2 (CLD-11)

(Do you/Does he/she) smoke cigarettes now?

YES .................................................................. 1

NO .................................................................... 2 (Q.D-5)

DK ..................................................................... 8 (Q. D-11)

About how many cigarettes a day (do you/does he/she) now smoke?

PACKS, MULTIPLY BY 20 AND VERIH.]

NUMBER OF CIGARETTES:

[IF ANSWER IS NUMBER OF

1111

LESS THAN ONE A DAY .............................. 995

For how many years (have you/has he/she) smoked cigarettes?

NUMBER OF YEARS:

When did (you/he/she) stop smoking cigarettes?

I I I (Q.D-I 1)

MONTH: Ill

~

YEAR: 191 ——I I

D-6. During the years when (you were/he/she was) smoking, about how many cigarettes a day did

(you/he/she) smoke? [IF ANSWER IS NUMBER OF PACKS, MULTIPLY BY 20 AND VERIFY.]

NUMBER OF CIGAREITES: l_l_l_l

LESS THAN ONE A DAY .............................. 995

78

I
D-7.

D-8.

D-9.

D-10.

D-11.

For how many years (did you/hae he/she) smoke cigarettes?

NUMBER OF YEARS: I I I (D-11)

RPI-25

IF ~ WAS A CURRENT OR FORMER SMOKER ON THE ~ (L2a = 1, 2)

OR WAS A CURRENT OR FORMER SMOKER ON THE ~ (D-2 = 1,2)

THEN GO TO Q.D-B. OTHERWISE GO TO Q. D-l 1.

These next few questions are about (your/$ UBJECT’S) smoking and drinking habits. (Do you/Does

he/she) smoke cigarettes nov/?

YES ..................................................................

NO ....................................................................

REFUSED ........................................................

About how many cigarettes a day (do you/does he/she) now smoke? [IF ANSWER IS

PACKS, MULTIPLY BY 20 AND VERIFY.]

NUMBER OF CIGARETTES: Ill

1

2 (BOXJ1)

8 (Q. D-I 1)

NUMBER OF

I (D-11)

LESS THAN ONE A DAY .............................. 995 (D-1 1)

BOX J1

IF ~ IS A PROXY AND D-8 = 2 THEN GO TO D-1 1.

When did (you/he/she) last stop smoking cigarettes?

MONTH: l_l_l

~

YEAR: 19 l_l_l

DISCREPANCY (NEVER SMOKED) ...............98

Now I would like to talk to you about drinking beer, or wine, or liquor. (Have you/Hae SUBJECT) had at

least one drink of beer, or wine, or liquor during the past yeat?

YES .................................................................. 1

NO .................................................................... 2 (PART E)

–—

79
D-12. During the past year, how often did (you/he/she) drink beefl

NUMBEROFDAYS: l_l_l PER: WEEK ............... 1

MONTH ............ 2

MORE THAN 3 BUT LESS THAN 12 TIMES PER YEAR .............94

NO MORE THAN 3 TIMES PER YEAR ......................................... 95

NONE ............................................................................................. 00 (D-14)

DK ................................................................................................... 96 (D-13)

D-13. On the daya (you/he/she) drank beer, how many cans, bottles or glasses did (you/he/she) drink?

NUMBEROFDRINKS: l_l_l

LESS THAN ONE DRINK .............................................................. *

D-14. During the past year, how often did (you/he/she) drink wine?

NUMBEROFDf+ys: I 1 I PER: WEEK ............... 1

MONTH ............ 2

MORE THAN 3 BUT LESS THAN 12 TIMES PER YEAR ............. 94

NO MORE THAN 3 TIMES PER YEAR ......................................... 95

NONE ............................................................................................. Cxl (D-16)

DK ................................................................................................... 96 (D-15)

D-15. On the daya (you/he/she) drank wine, hovvmany glasses did (you/he/she) drinK?

NUMBEROFDRINKS:I I I

LESS THAN ONE DRINK .............................................................. ~

D-16. During the past year, how often did (you/he/she) drink Iiquofl

NUMBEROFDA’fs: l_l_l PER: WEEK ............... 1

MONTH ............ 2

MORE THAN 3 BUT LESS THAN 12 TIMES PER YEAR .............94

NO MORE THAN 3 TIMES PER YEAR ......................................... 95

NONE ............................................................................................. 00 (SECTION E)

DK ................................................................................................... 96 (D-17)

D-17. On the daya (you/he/she) drank liquor, how many drinks did (you/he/she) have?

NUMBEROFDRINKS: l_l_l

LESS THAN ONE DRINK .............................................................. 95

TIME ENDED: AM

PM
PART E: EXERCISE AND WEIGHT

TIME BEGAN: AM

PM

BOX I

INTERVIEWER: CHECK Q.G1 , C5, C-6, C7, C18b AND CIRCLE ONE:

Q.G1 = YES&IS BEDRIDDEN) ~ Q.C18b = 4 (UNABLE TO DO) ................. 1

Q.G5c OR C1.C-BcOR Q.G7c = YES ~ ().C5d OR Q.C-6d OR (RPI-28)

Q.C-7d = YES@ UNABLE TO USE LOWER LIMBS) ...................................... 2

ALL OTHERS ............................................................................................................ 3

The next few questions are about physical activity.

E-1. (Do you/does ~UBJECT) exercise or play sports on a regular basis?

YES ..................................................................

NO ....................................................................

E-2. For how many months or years (have you/has he/she) exercised or played sports regularl~

I I I MONTHS .................................

YEARS .....................................

1

2 (RPI-27)

1

2

LESS THAN 1 MONTH .................................... 95

RPI-27

REFERENCE TO ~ INTERVIEIM IF ELIGIBLE FOR ~ THEN GO TO Q.E-5.

IF NOT ELIGIBLE FOR ~ GO TO E-3.

E-3. How often (do you/does he/she) participate in active physical exercise or sports (such as aerobics,

running, swimming, bicycling, etc.)?

I I I TIMES/wEEK .......................... 1

TIMES/MONTH ....................... 2

NEVER ............................................................. m (CI.E-5)

LESS THAN 1 TIME/MONTH ......................... 95 (Q.E-5)

81
E-4,

E-5.

E-6.

E-7.

E-8.

When (you/SIJBJEC~ exercise(s) or participate(s) in an active physid sport, about how many minutes (do

you/does he/she) spend each time (on average)?

LESS THAN 15 MINUTES ............................... 1

15 BUT LESS THAN 30 ................................... 2

30 BUT LESS THAN 45 ................................... 3

45 BUT LESS THAN 60 ................................... 4

60 OR MORE ................................................... 5

How often (do you/does SUBJECT participate in light physical activity (such as walking,

gardening, golfing, bowling, etc.)?

l_l_l TIMES~EEK .......................... 1

TIMES/MONTH ....................... 2

dancing,

NEVER .............................................................. 00 (RPI-2S)

LESS THAN 1 TIME/MONTH ......................... 95 (Rpl-2s)

When (you/SUBJECT) exercise or participate in light physical activity, about how many minutes (do

you/does he/she) spend each time (on average)?

LESS THAN 15 MINUTES ............................... 1

15 BUT LESS THAN 30 ................................... 2

30 BUT LESS THAN 45 ................................... 3

45 BUT LESS THAN 60 ................................... 4

60 OR MORE ................................................... 5

RPI-213

REFERENCE TO lF/ECF INTERVIEW

IF ~ WAS INTERVIEWED ON THE ~ OR ~ THEN SUBSTITUTE “WEIGHT’ IN Q.E-7.

IF ~ WAS NEVER INTERVIEWED THEN SUBSTITUTE WVEIGHT AND HEIGH~ IN Q.E-7.

These next questions are about (your/SUBJECT’S) (weight/weight and height). How does

(your/SUBJECTS) weight now cmmpare to (your/his/her) weight 12 months ago? Is it at least 10 pounds

more, at least 10 pounds less, or about the same?

AT LEAST 10 POUNDS MORE ....................... 1

AT LEAST 10 POUNDS LESS ......................... 2

ABOUT THE SAME ......................................... 3

DK ..................................................................... B

About how much (do you/does SUBJECT) weigh now?

NUMBER OF POUNDS: I I I I

DK ...................................................... 996

82
E-9.

E-10.

E-II.

E-12.

E-13.

RPI-29

~ PREVIOUSLY INTERVIEWED ............................................................ 1 (PART F)

~ NEVER INTERVIEWED AND R IS SUBJECT ..................................... 2 (Q.E-9)

~ NEVER INTERVIEWED AND R IS PROXY ......................................... 3 (Q. E-I 1)

When you were about 12 to 13 years old, compared to other (boys/girls) of the same age, were you

considered to be. . .

Skinny, ............................................................. 1

Somewhat slender, .......................................... 2

Average, ........................................................... 3

Chubby, or ....................................................... 4

Very hea~ ...................................................... 5

/

DK ..................................................................... 8

When you were about 12 to 13 years old, compared to other (boys/girls) of the same age, were you

considered to be . . .

Very tall, -........................................................... 1

Somewhat taller than average, ........................ 2

About average, ................................................ 3

Somewhat shorter than average, or ................ 4

Very short? ....................................................... 5

DK ..................................................................... 8

What was (your/his/her) usual weight at the age of 25?

NUMBER OF pOUNDS: I I l_l

DK ...................................................... 998

[IF ~ IS 41 OR OLDER, ASK] What was (your/his/her) usual weight at the age of 40?

NUMBER OF pOUNDS: l._l_l_,l

DK ...................................................... 9%

[IF ~ IS 86 OR OLDER, ASK] What was (your/his/her) usual weight at the age of 85?

NUMBER OF POUNDS: I_l_l_l

DK ...................................................... 99B

TIME ENDED: AM

PM

83
PART F VISION AND HEARING

TIME BEGAN: AM

PM

These next few questions cmncern (your/SUBJECT’S) vision and hearing.

F-1.

F-2.

F-3.

F4

F-5.

F-6.

(Do you/Does SUBJECTI wear eyeglasses or contact lenses? [PROBE YES RESPONSE]

EYEGlASSES .................................................. 1

CONTACT LENSES ......................................... 2

BOTH ............................................................... 3

NEITHER .......................................................... 4

~ IS BLIND ....................................................... 5 (F+

(When wearing eyeglasses/contact lenses/eyeglasses or cmtact lenses,) Can (you/he/she) ~ well

enough to recognize a tiend across the street?

YES .................................................................. 1

NO .................................................................... 2

(When wearing eyeglasses/contact lenses/eyeglasses or contacl lenses,) Can (you/he/she) ~ well

enough to recognize the letters in ordinary newspaper print?

YES .................................................................. 1

NO .................................................................... 2

(Have you/Has he/she) ever worn a hearing aid?

YES .................................................................. 1 (Q.F4)

NO .................................................................... 2

Can (you/he/she) usually hear and understand what a person saw if that person talks to (you/him/her) in a

normal voice from across a quiet room?

YES .................................................................. 1 (PART G)

NO .................................................................... 2 (PART G)

Wtihout a hearing aid, can (you/he/she) usually hear and understand what a person says if that person

talks to (you/him/her) in a normal voice from across a quiet room?

YES .................................................................. 1

NO .................................................................... 2

TIME ENDED: AM

PM

84
PARTG: PREGNANCY AND MENSTRUAL HISTORY

TIME BEGAN: AM

PM

BOX J

INTERVIEWER: CIRCLE ONE.

IFS IS MALE ........................................... 1 (PART H)

IFS IS FEMALE ...................................... 2

The next few questions are about (your/S UBJEC13 reproductive and menstrual history.

RPI-30

REFERENCE TO lF/ECF INTERVIEW IF 45 OR OLDER AT LAST INTERVIEW,

THEN GO TO RPM2.

RPI-31

REFERENCE TO ~ INTERVIEW IF REPORTED “NEVERmPREGNANT OR ‘DON’T KNOW

ON ~ (GI =2,8) AND DID HAVE INTACT UTERUS OR DON’T KNOW ON ~ (G14= 1,8),

GO TO Q.G-l . IF NOT INTERVIEWED ON THE ~ GO TO Q.G-l . IF “EVER” PREGNANT

ON ~ (Cl =1) AND HAD INTACT UTERUS OR DON’T KNOW ON ~ (C14=1,8), GO TO

Q.G+. OTHERWISE, GO TO RPK32.

G-1 . (Have you/Haa she) ever bean pregnant’? Include live births, stillbitis, miscarriages or abortions.

YES .................................................................. 1

NO .................................................................... 2 (RPI-32)

G-2. (Are you/is she) pregnant now?

YES .................................................................. 1

NO .................................................................... 2

85
G-3.

G+.

How old (were you/was she) when (your/her) @ child was born? This means the first child born alive or

stillborn.

AGE IN YEARS: .......................

l_l_l (Q.G-6)

HAD NO BIRTHS ............................................. O (Q,G-6)

Since (MONTH/YEAR) (have you/has she) been pregnant?

YES .................................................................. 1

NO .................................................................... 2 (RPI-32)

G-5. (Are you/is she) pregnant now?

YES .................................................................. 1

NO .................................................................... 2

G-6.

G-7.

G-B.

G-9.

How old were you when (your/her) & child was born? Include stillbirths.

AGE IN YEARS: .......................

l_l_l

ONLY ONE BIRTH ........................................... 95

HAD NO BIRTHS ............................................. O (Q.G-8)

How many Jv& births (have you/has she) ever had?

NUMBER OF LIVE BIRTHS: ............

l_l_l

(Have you/Has she) ever had a miscarriage?

YES .................................................................. 1

NO .................................................................... 2 (RPI-32)

How many miscarriages (have you/baa she) had?

NUMBER OF MISCARRIAGES: ..-...- I I I

RP1412

REFERENCE TO ~ INTERVIEW IF HAD INTACT UTERUS OR ‘DON’T KNOW

ON ~ (C14=1, 8), GO TO BOX Il. IF PROXY GO TO BOX Il. IF NEVER

INTERVIEWED ON IF, GO TO BOX Il. IF DID NOT HAVE INTACT UTERUS ON

~ (C-14=2), GO TO CI.G-11.

86
BOX 11

IF PREGNANT NOW (G-2=1 OR G-5=1) THEN GO TO RPI-33.

G-10. (Do you/Does she) still have (your/her) womb or uterus?

YES .................................................................. 1 (RPI-33)

NO .................................................................... 2

DK .....m............................................................... 8 (RPI-33)

CATI PROGRAMMER

IF ~ IS PROXY AND G-10=1 AND ~ DID NOT HAVE INTACT UTERUS ON ~

(C14=2) THEN CODE G-10 AS “DISCREPANCY =%.

G-1 1. How old (were you/was she) when (your/her) uterus or womb was removed?

AGE: ......................................... l_l_l

[DISCREPANCY ........................................... 96]

CATI PROGRAMMER

IF ~ DID NOT HAVE A UTERUS ON ~ (C14=2) THEN DISPIAY

“DISCREPANCY. . ...96’ in G-1 1.

RPI-33

REFERENCE TO ~ INTERVIEW IF HAD BOTH OVARIES OR ‘DON’T KNOMf ON

~ (C15= 1, 8) OR NOT INTERVIEWED ON ~ OR IF PROH, GO TO Q.G-12.

OTHERWISE, GO TO RPL34.

G-12. Do you still have ~ your ovaries?

YES .................................................................. 1 (RPI-35)

NO .................................................................... 2

DK ..................................................................... 8 (RPI-2SI)

RPI-34

REFERENCE TO ~ INTERVIEW IF PREGNANT NOW (G-2=1 OR G-5=1) THEN GO

TO G-14. IF HAD ONE OVARY OR ‘DON’T KNOW ON ~ (C16= 1, 8) OR DOES NOT

HAVE BOTH OVARIES NOW (G-12=2) THEN GO TO Q.G-13. IF ~ DID NOT HAVE

ANY OVARIES ON ~ (G16=2) THEN GO TO Q.G14.

87
G-13. (Do you/Does she) still have on. ovary?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 0

CATI PROGRAMMER

IF ~ DID NOT HAVE ANY OVARIES ON ~ (C-16=2) THEN

DISPLAY DISCREPANCY CODE IN G-14.

G-14. How old (were you/was she) when (your/her) (ovary/last ovary) (were/was) removed?

AGE: .........................................

Ill

[DISCREPANCY ........................................... 96]

RPI-35

REFERENCE TO lF/ECF INTERVIEW: IF PREGNANT NOW (G-2=1 OR G-5=1) GO TO BOX L

IF ~ WAS NOT ELIGIBLE FOR THE ECF AND WAS STILL HAVING PERIODS, WAS PREGNANT

OR DIDN’T KNOW MENSTRUAL STATUS ON ~ (C-6= 1,2,s), GO TO C1.G15. IF NEVER

INTERVIEWED ON ~ AND NOT ELIGIBLE FOR ~ THEN GO TO CLG-15. IF ~ WAS NOT

HAVING PERIODS ON IF (C-6=3) OR WAS ELIGIBLE FOR THE ECF THEN GO TO RPI-36. IF ~

HAS NO UTERUS (G-1o=2) OR HAS NO OVARIES (G13=2) THEN GO TO RPI-36.

G-15. (Are you/is she) still having periods’?

YES ..................................................................

NO ....................................................................

DK .....................................................................

G-15a. At what age did (you/she) have (your/her) last period?

AGE: .................................................. II

1 (CLG-16)

2

8 (RPI-36)

-l (RPI-36)

Never Had Periods .......................................... 95 (RPI-36)

G-16. Are (your/her) periods regular or irregulafl By regular we mean (your/her) periods come about once a

month. (You/She) can usually predict when they will come and they usually last about the same number of

days.

REGULAR .............................m.......................... 1 (BOX 12)

IRREGUIAR ..................................................... 2 (CLG-17)

DK ..................................................................... 8 (RPI-36)

BOX 12

IF s IS 55 YEARS OR OLDER AND HAS REGUIAR PERIODS (G-16=1) THEN GO

TO G21 . OTHERWISE GO TO BOX L

88
G-17.

G-18.

G-19.

G-20a

Are they irregular because (you are/she is) going through the change of life or for some other reason?

CHANGE OF UFE ........................................... 1

OTHER REASON ............................................. 2

RPI-38

REFERENCE To lF/EcF INTERVIEW IF EVER TAKEN HORMONE PILLS ON ~

(C19= 1) OR ~ (G9= 1), GO TO Q.G-18. OTHERWISE, GO TO RPI-37.

(Are you/is she) currently taking hormone pills such as estrogen or premarin for reasons related to the

menopause or change of life such as hot flashes, mood changes or bone loss?

YES .................................................................. 1 (Q.G-20a)

NO .................................................................... 2

DON’T KNOW TYPE OF PILL ......................... 3 (Q.G-20a)

DON’T KNOW .................................................. 8 (Q.G-20a)

I

RP1-36a I

REFERENCE TO lF/ECR IF FORMER USER ON ~ (C19=25-82,98,99) OR

~ (GI 1 =2$93,4) THEN GO TO G-20a OTHERWISE, GO TO G-19.

How old (were you/was she) when (you/she) last took hormone pills?

AGE IN YEARS: .......................

l_l_l

NEVER TOOK PILLS (DISCREPANCY) .......... 96 (BOX L)

Thinking abut your past use of (hormone pills/these pills), whet is the longest period of time that (you

have/she has) com-nuously taken them? That is, without stopping for at least one month.

l_l_l

1.

2.

3.

9s.

%.

(AND I_l_t):

Years and months

Months

Years

Less than one month

Never took pill (Discrepancy) (BOX L)

89
G-20b. Now thinking about the @&l amount of time (you have/she has) taken these pills, how many months or

G-21,

G-22a.

years (have you/has she) actually used them? Please do not include the times when (you/she) might have

stopped taking the pill for at least one month.

l_l_l (ANDI

1. YearsyJ;r!hs

2. Months

3. Years

95. Less than one month

CATI PROGRAMMER

DISPLAY BOTH OPTIONS WHEN SELECTING ‘YEARS AND MONTHS.” OTHERWISE

ONLY DISPLAY ONE SET OF OPTIONS.

RP147

REFERENCE TO lF\ECF INTERVIEW: IF ‘NEVER’ USER OF HORMONE PILLS OR ‘DON’T

KNOW ON ~ (C17=2,8) OR ON ~ (G-9=2,8) OR NEVER INTERVIEWED, GO TO G-21.

OTHERWISE, GO TO BOX K.

(Did you/Has she) ever take female hormone pills such as estrogen or premarin for reasons related to the

menopause or change of life such as hot flashes, mood changes or bone loss?

YES .................................................................. 1

NO .................................................................... 2 (BOX L)

DON’T KNOW lYPE OF PILL ......................... 3

DON’T KNOW .................................................. 8 (BOX L)

What is the longest period of time that (you have/she has) cmtinuousl~ taken (hormone pills/these pills)?

That is, without stopping for at least one month.

Ill

1.

2.

3.

9s.

(AND I

I l):

Years and months

Months

Years

LW6 than one month

90
G-22b. Now thinking aboti the ~ amount of time (you have/she has) taken these pills, how many months or

years (have you/has she) actually used them? Please do not include the times when (you/she) might have

stopped taking the pill for at least one month.

l_l_l (ANDI_l_l)’

1. Years and months

2. Months

3. Years

95. Less than one month

CATI PROGRAMMER

DISPIAY BOTH OPTIONS WHEN SELECTING ‘MONTHS AND YEARS.” OTHERWISE ONLY

DISPIAY ONE SET OF OPTIONS.

G-23. (Are you/is she) currently taking hormone pills?

YES .................................................................. 1

NO .................................................................... 2 (BOX L)

DON’T KNOW lYPE OF PILL ......................... 3

BOX K

IF CURRENT USER OF HORMONE PILLS OR DON’T KNOW TYPE OF PILL (Q-G-18= 1,3

or CLG-23 = 1,3), GO TO Q.G-24. OTHERWISE, GO TO BOX L

G-24. What is the color of the hormone pill (you are/she is) taking?

PURPLE/BLUE ................................................ 1

YELLOW/ORANGE ......................................... 2

WHITE .............................................................. 3

MAROON/BROWN/RED ................................ 4

GREEN ............................................................. 5

DON’T KNOW .................................................. 8

G-25. How long (have you/has she) been taking this same color pill?

NUMBER OF MONTHS: .........

l_l_l

OR

NUMBER OF YEARS: ............. I——I I

LESS THAN ONE MONTH .............................. 95

DK ..................................................................... 9E

91
G-26. In addition to estrogen, sometimes women also use the female hormone progestin sometimes dad

PROVERA at the change of life or after a hysterectomy. These pills are often taken along with an estrogen

pill for only part of the month. (Have you/has she) ever taken progestin or PROVERA?

YES .................................................................. 1

NO .................................................................... 2 (BOX L)

DON’T KNOW TYPE OF PILL ......................... 3

DK ...........,......................................................... 8 (BOX L)

G-27. Are you currently taking these pills?

YES .................................................................. 1

NO .................................................................... 2

CATI PROGRAMMER

IF ~ IS CURRENTLY TAKING PILLS (G-27=1) THEN USE “(HAVE You/HAs SHE)”

IN G-28. IF ~ IS NOT CURRENTLY TAKING PILLS OR DOESN’T KNOW (G-27=2,8)

USE ‘(HAD YOU/WAS SHE)’ IN G-28.

G-28. How long (have you/has she)/(had you/was she) been taking these pills?

NUMBER OF MONTHS: .........

l_l_l

NUMB:OF YEARS:............- I I I

LESSTHAN ONE MONTH .............................. 95

DK. .................................................................... 96

BOX L

IF PRE-MENOPAUSAL (G-2=1 g G-5=1 Q G-16=1 or G17=2), THEN GO TO RPI-38,

IF NEVER INTERVIEWED THEN GO TO RPI-36. OTHERWISE, GO TO RP140.

RPI-36

REFERENCE TO ~ INTERVIEW: IF CURRENT USER OF BIRTH CONTROL ON ~

(C25= 1) OR FORMER USER OF BIRTH CONTROL PILLS ON ~ (C-23= 1) THEN

GO TO BOX K1. OTHERWISE, GO TO RPI-39.

92
G-29.

G-30.

G-31 a.

G-31 b.

BOX K1

IF PREGNANT NOW (G-2=1 OR G-5=1) THEN GO TO RP1-3Ba.

(Are you/is she) currently taking birth control pills?

YES .................................................................. 1 (Q.G-31 a)

NO .................................................................... 2

RPI-3Ba

IF ~ WAS A FORMER USER ON ~ (C25 = 12+5,90,99) THEN GO TO G-31a.

OTHERWISE GO TO G30.

How old (were you/was she) when (you/she) last took bhth control pills?

AGE ......................................... Ill

DISCREPANCY ................................................ 96 (BOX K3)

What is the longest period of time that (you have/she has) continuously taken birth control pills? That is,

without stopping for at least one month.

l—l_l (ANDI I I):

1.

2.

3.

95.

96.

Years and months

Months

Years

Less than one month

Discrepancy (BOX K3)

Now thinking about the ~ amount of time (you have/she has) taken these pills, how many months or

years (have you/has she) actually used them? Please do not include the times when (you/she) might have

stopped taking the pill for at least one month.

!_l_! (AND I——I I):

1. Years and months

2. Months

3. Years

95. Less than one month

CATI PROGRAMMER

DISPIAY BOTH OPTIONS WHEN SELECTING “MONTHS AND YEARS: OTHERWISE ONLY

DISPIAY ONE SET OF OPTIONS.

93
RPI-39

REFERENCE TO ~ INTERVIEW: IF ~ HAD NEVER TAKEN BIRTH CONTROL PILLS OR

‘DON’T KNOW ON ~ (C23=2,8) OR WAS NEVER INTERVIEWED ON IF, GO TO Q,G-32.

OTHERWISE, GO TO RP141.

G-32. Did (you/she) ever take birth control pills for any reason?

YES .................................................................. 1

NO .................................................................... 2 (Q.G40)

G-33. How old (were you/was she) when (you/she) first tmk bifih control pills?

AGE: .........................................

l_l_l

BOX K2

IF PREGNANT NOW (G-2=1 OR G-5=1) THEN GO TO G-35.

IF ~ IS 55 OFI OLDER THEN GO TO G-35,

G-34. Are you currently taking birth control pills?

YES .................................................................. 1 (Q.G-3B)

NO .................................................................... 2

G-35. How old (were you/was she) when (you/she) last tmk birth mntrol pine?

AGE: .........................................

l_l_l

G-36a. What is the longest period of time that (you have/she

pills)? That is, without stopping for at least one month.

l_l_l

1.

2.

3.

95.

has) txmtinuously taken (birth control pills/these

(AND I I 1):

Years and months

Months

Yeare

Less than one month

94
G-36b.

G-37.

Now thinking about the ~ amount of time (you have/she has) taken these pills, how many months or

years (have you/has she) actually used them? Please do not include the times when (you/she) might have

stopped taking the pill for at least one month.

I I IWDI I l):

1. Years and months

2. Months

3. Years

95. Less than one month

CATI PROGRAMMER

DISPLAY BOTH OPTIONS WHEN SELECTING ‘MONTHS AND YEARS.” OTHERWISE ONLY

DISPIAY ONE SET OF OPTIONS.

RP140

REFERENCE TO lF/ECF INTERVIEW IF HAD EVER USED BIRTH CONTROL

PILLS BEFORE THE AGE OF 25 ON ~ (C-24 < 25) OR ~ (G-14 c 25), GO TO

Q.G-37. IF Q.G-33 <25, GO TO CI.G-37. OTHERWISE, GO TO RP141 .

How many months or years (did you/she) use birth control pills prior to the age of 25? Please do not

include the times when (you/she) might have stopped taking the pill for at least one month.

I I I (AND l_l_l)’

1. Years and months

2. Months

3. Years

95. Less than one month

96 Discrepancy

RPI-41

REFERENCE TO lF/ECF: IF HAD REPORTED EVER TAKEN BIRTH CONTROL PILLS

~ (C23=1 OR G25=1, 12435) OR G-32=1] AND HAD AT LEAST ONE LIVE BIRTH ~

(C-5> =1), ~ (G-4> =1) OR G-7> =1)] THEN GO TO G-33. OTHERWISE GO TO

BOX K3.

95
G-w.

G-39.

G-43.

G-41 .

G<2.

Did (you/she) use birth control pills before (your/her) first child was born?

YES .................................................................. 1

NO .................................................................... 2 (BOX K3)

DISCREPANCY ................................................ 96

How many years or months before (your/her) first child was born did (you/she) use birth control pills?

Please do not include the times when (you/she) might have stopped taking the pill for at least one month.

l_l_l (AND l_l_l):

1. Years and months

2. Months

3. Years

95. Less than one month

CATI PROGRAMMER

DISPIAY BOTH OPTIONS WHEN SELECTING “YEARS AND MONTHS.” OTHERWISE ONLY

DISPIAY ONE SET OF OPTIONS.

BOX K3

IF PREGNANT NOW (G-2=1 OFI G-5=1) THEN GO TO G-42.

(Have you/Has she) ever had an operation to be sterilized also known as a tubal ligation or having your

tubes tied?

YES ..................................................................

NO ..........................................r.........................

How old (were you/was she) when (you/she) had this procedure?

(Have you/Has she) ever regularly taken

purpose of calcium supplementation?

AGE: ......................................... l_l_l

1

2 (Q.G-42)

calcium pills or calcium rich antacids such as Turns for the

YES .................................................................. 1

NO .................................................................... 2 (Q.G-44)

96
G-Kit How long did (you/she) take alcium regularly?

NUMBER OF MONTHS: .........

l_l_l

OR

NUMBER OF YEARS: ............. I I I

LESS THAN ONE MONTH .............................. 95

DK ..................................................................... 98

G-41. (Have you/Has she) ever had a Pap smear teat? (This is a special test that a doctor or other health

professional conducts as part of a pelvic exam that looks for abnormal cells.)?

YES .................................................................. 1

NO .................................................................... 2 (Q.G-47)

G45. About how long has it been since (you/she) had a Pap smear test’?

NUMBER OF YEARS: .............

l_l_l

LESS THAN 1 YEAR ........................................ 95

BOX L1

IF G-45 z 5 YEARS THEN GO TO G*7.

G*. On about how many occasions (have you/has she) had a Pap smear test in the past 5 years?

NUMBER OF OCCASIONS: ... I I I

DON’T KNOW .................................................. 98

G+7. (Have you/Has she) ever had a breast examination by a doctor or other health professional?

YES .................................................................. 1

NO .................................................................... 2 (Q.G-50)

REFUSED ........................................................ 97 (SECTION W

DK ..................................................................... 98 (Q.G-50)

G-48. On how many different occasions (have you/has she) had such a breast examination in the past 5 years?

PAST 5 YEARS: I——I I

97
G-49. About how long has it been since (you/she) had a breast examination by a doctor or other health

professional?

NUMBER OF YEARS: .............

l_l_l

LESS THAN l YEAR ........................................ 95

G-50. (Do you/Does she) know how to examine (your/her) own breasts for lumps?

YES .................................................................. ‘ 1

NO .................................................................... 2 (0. G-53)

G-51. (Have you/Has she) ever examined (your/her) own breasts for lumps?

YES .................................................................. 1

NO .................................................................... 2 (Q.G-53)

G-52. During the past year, how often (did you/did she) examine (your/her) own breasts for lumps?

NUMBER OF TIMES/YEAR: ... I I I

NEVER ............................................................. 00

MORE THAN ONCE A WEEK BUT LESS

THAN EVERYDAY ........................................ 94

EVERY DAY OF THE YEAR (365 times) ......... 95

G-53. (Have you/Has she) ever had a mammogram? (A mammogram is when an x-ray is taken only of the

breasts by a machine that presses against the breast while the picture is taken.)

YES .................................................................. 1

NO .................................................................... 2 (PART H)-

DK ..................................................................... 8 (PART H)

G-54. On how many different ocasions in the past 5 years (have you/has she) had a mammogram?

NUMBER OF TIMES: .............. I I I

NONE ............................................................... 00

DON’T KNOW .................................................. 98

G-55. In what year did (you/she) have (your/her) last mammogram?

YEAR: ................................. 191 I I

DON’T KNOW .................................................. 6

98
PART H: SOCIAL SECURITY/MEDICARE NUMBER

AND CLOSING STATEMENTS

TIME BEGAN: AM

PM

BOX L?

IF ~ IS 65 OR OLDER INSERT ‘AND HEALTH INSURANCE

STATUS- IN THE FOLLOWING INTRODUCTION.

Before finishing the interview, I have a few questions about your background [and heaith insurance status].

BOX M

.$jAT LE4ST B5 YEARS OLD .............................. 1 (H-1)

~ LESS THAN 65 YEARS OLD .......................... 2 (RPI+2)

H-1. Medicare is a social security health insurance program for persons 65 years old or older. People who are

covered by Medicare have a red, white and blue Medicare card. (Are you/is he/she) covered by Medicare?

YES .................................................................. 1

NO .................................................................... 2

RPI+2

REFERENCE TO lF/ECF: IF ~ SUPPLIED A SOCIAL SECURITY NUMBER ON lF/ECF AND

IS ON MEDICARE (H-1 =1), THEN SUBSTITUTE “MEDICARE NUMBER” IN THE FOLLOWING

INTRODUCTION. IF A SOCIAL SECURITY NUMBER WAS NOT COLLECTED ON THE

!!Z&E AND THE S IS ON MEDICARE) THEN SUBSTITUTE “MEDICARE NUMBER AND

SOCIAL SECURITY NUMBERm IN THE FOLLOWING INTRODUCTION. IF A SOCIAL

SECURllY NUMBER WAS NOT SUPPLIED ON THE lF/ECF AND THE PERSON IS NOT ON

MEDICARE THEN SUBSTITUTE ‘SOCIAL SECURITY NUMBER- IN THE FOLLOWING

INTRODUCTION. IF THE ~ SUPPLIED A SOCIAL SECURITY NUMBER ON THE lF/ECF AND

IS NOT ON MEDICARE, THEN GO TO RPI+I.

As part of this survey, I’d like to have (your/SUBJECl%) (Social Securfly number/Medicare number/

Medicare and Social Security numbers). This information is voluntary and is collected under the authority of

the Public Health Service Act. There will be no effect on any benefrts that are being received whether or not

(you/he/she) decide(s) to provide the number(s). (The Public health Service Act is title 42, United States

Code, Section 242k).

RPI-43

REFERENCE TO lF/ECF INTERVIEW IF DID NOT SUPPLY SOCIAL SECURITY

NUMBER ON lF/ECF, GO TO RPI+. OTHERWISE, GO TO BOX N.

99
RPI-$4

IF ~ IS LESS THAN B5 OR IS &+ AND NOT ON MEDICARE (H-1 =2) THEN ASK FOR SOCIAL

SECURITY NUMBER IN H-2. IF ~ IS S5+ AND IS ON MEDICARE (H-1 =1) THEN ASK FOR

SOCIAL SECURllY NUMBER AND MEDICARE NUMBER IN H-2.

H-2. What is (your/SUBJECT’S) social securii number [and health insurance claim number on

(your/SUBJECT’S] Medicare Card] [READ IF NECESSARY I’ll wait while you get your (social security

number/social securii number and medicare ~rd).

Social security numbec I

I I I -1_l_l-1 I l_l_l

Medi=renumbe~I I I I - l_l_l - l_l_l_l_l L) (J (RPI-$5)

BOX N

IF H-1 = 1 THEN GO TO H-3. OTHERWISE GO TO RPI-45.

H-3. What is the health insurance claim number on (your/SUBJECT’S) Medicare card? (READ IF NECESSARY

I’ll wait while you get your Medicare card.)

Medicare”ur-rlbe’l_l_l_l - l_l_l - l_l_l—l_l (-) L)

I

RP145 I

REFERENCE TO ECF/lF INTERVIEW IF ~ IS FEMALE AND DID NOT SUPPLY FATHER’S

IA-ST NAME ON ~ (l-2) OR ~ (U-33) GO TO Q.H-4. OTHERWISE, GO TO BOX O.

H-4. Please tell me (your/SUBJECT’S) father’s last name,

FATHER’S IAST NAME:

BOX O

I INTERVIEWER: CIRCLE ONE: I

HIS SUBJECT ........................................... 1

~ IS PROXY ............................................... 2 (CLH+)

I BOX P I

IF ~ SAID YES TO ANY HOSPITALIZATION QUESTIONS (B-17=1, B-23=1, B-24=1,

B-27=1, B-29=1, B-35=1, B-42=I, B-48=1, B-52=1, B-55 (Ist, 2nd, or 3rd

diagnosis)=l, B*l=I, B-70=1, B-71=1, B-74=1, B-79=1, B-B3=1, B-%=1), THEN

GO TO H-5. OTHERWISE HAVE INTERVIEWER FILL IN BOX Q.

I 00
BOX Q

PLEASE CHECK THE HHCFCHART. ARE THERE ANY STAYS RECORDED?

YES ......................................................... 1 (CONDITION SECTION)

NO ........................................................... 2 (OH-11)

H-5. As part of this survey, I would like to send you a form that authorizes the United States Public Health Service

to obtain information from hospital or nursing home records. To do this, I need to confirm your name and

address. ~ERIFY SPELLING.]?

NAME:

FIRST MIDDLE LAST

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

cm STATE ZIP CODE

And 1need to confirm your telephone number.

TELEPHONE NUMBER: J )

When you receive this form please sign your name. Then return the form in the postage paid envelope.

You will receive a $5.00 check for participating in the survey about two weeks after you sign and mail back this form.

BOX R

INTERVIEWER CIRCLE ONE:

AGREES TO SIGN ........................................ 1 (H-11)

~ REFUSES TO SIGN .................................. 2 (H-1 1)

101
H-6. I would like to (confirm/have) (SUBJECT’S] name, address and telephone number.

NAME:

FIRST MIDDLE IAST

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

Clw STATE ZIP CODE

TELEPHONE NUMBER: f )

BOX S

IF ~ SAID YES TO AN{ HOSPITALIZATION QUESTIONS (B-17=1, B-23=1, B-24=1,

B-27=1, B-29=1, B-35=1, B-42=1, B-48=1, B-52=1, B-55 (Ist, 2nd, or 3rd

diagmxis)=l, E+l=l, B-70=1, B-71=1, B-74=1, B-79=1, B-63=1, B-66=1), THEN

GO TO H-7. OTHERWISE HAVE INTERVIEWER FILL IN BOX T.

BOX T

ARE THERE ANY STAYS RECORDED?

YES ....................................... 1 (CONDITION SECTION)

NO ......................................... 2 (CLH-11)

I

102
H-7. As part of this survey, I would like to send you a form that authorizes the United States Public Health Service

to obtain information from hospital or nursing home records. To do this, I need to (confirm/have) your

name, address, telephone number and relationship to &lJBJEC~.

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

cm’ STATE ZIP CODE

What is your relationship to (SU BJECT)?

HUSBAND/WIFE ............................................. 1

FATHEF1/MC)THER ......................................... 2

FATHER-lN-UW/MOTHER-lN-L4W .............. 3

GRANDPARENT .............................................. 4

SON/DAl~GHTER ........................................... 5

SON-lN-UW/DAUGHTER-lN-L4W ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER-lN-LAW/SISTER-lN-WW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER RELATIVE [SPECIFYl ........................ 91

OTHER NON-REIATIVE [SPECl~ ..............92

And I need to confirm your telephone number.

TELEPHONE NUMBER: J )

103
H-S. Will (SUBJEC~ be able to sign this form?

YES .................................................................. 1

NO (EXPIAIN) .............-.................o................. 2 (BOX V)

[IF YES:] When you receive the form please have (SUBJECT sign (his/her) name. Then return the form in

the postage paid envelope. You will receive a $5.00 check for returning the form about two weeks after

(SUBJECT) signs and mails back this form.

~

......o........................................... 2 (H-11)

~

CREATE A FLAG THAT INDICATES WHO THE FORM

SHOULD BE SENT TO, AS INDICATED IN BOX U.

INTERVIEWER:

BOX V

CIRCLE ONE:

~ IS REIATIVE ........................................... 1

~ IS NON-RELATIVE ................................. 2 (Q.H-9)

When you receive the form please sign your name. Then return the form in the

You will receive a $5.00 check for returning the form about two weeks after you

form.

postage paid envelope.

sign and mail back this

BOX W

INTERVIEWER CIRCLE ONE:

~ AGREES TO SIGN .......................................... 1 (( I.H-l 1)

~ REFUSES TO SIGN ........................................ 2 (Q. H-1 1)

104
H-9. Do you know a relative of (!3UBJECl_I who could sign this authorization?

YES .................................................................. 1

NO .......... ......................................................... 2 (Q. H-1O)

I need to have the name, address and relationship of a relative of (SUBJECT) who could sign this

authorization. ~ERIFY ALL SPELLING.]

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE NUMBER: 1 )

What is (REIATIVES) relationship to (SUBJECl_I?

HUSBAND/WIFE .............................................

FATHER/MOTHER .........................................

GRANDPARENT ..............................................

SON/DAUGHTER ...........................................

GRANDCHILD ..................................................

BROTHER/SISTER .........................................

AUNT/UNCLE/COUSIN .................................

NIECE/NEPHEW .............................................

1

2

3

4

5 (H-11)

6

7

8

OTHER RELATIVE [SPECIFYj ........................ 91

H-10. Do you know someone else who has the power of attorney and could sign this authorization form?

YES .................................................................. 1

NO .................................................................... 2 (H-1 1)

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE NUMBER:

What is (AITORNEY NAME) relationship to (SUBJECT)?

Attorney ............................................................ 1

Friend ............................................................... 2

Other (SPECIFYI .............................................. 91

105
H-II. Please give me the name, address, and telephone number of a relative or friend of yours who would know

how to get in touch with you in case we need to contact you again and have a hard time getting in touch

with YOU? [DO NOT PROBE FOR APT. NUMBER AND ZIP CODE. VERIFY ALL SPELLING.]

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE NUMBER: f )

Under what name is that telephone number likely to be listed?

SAME AS REFERENCE NAME ....................... 1

UNLISTED ........................................................ 2

NEW TELEPHONE LISTING

NAME [SPECIFYl ................................... 3

How is {REFERENCE NAME) related to @JBJECT)?

HUSBAND~lFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER-lN-LAW/MOTHER-lN-MW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON-lN-lAW/DAUGHTER-lN-LAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER-lN-UW/SISTER-lN-LAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NiECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER RELATIVE [SPECIFYl ........................ 91

OTHER NON-RELATIVE [SPECIFYl ..............92

BOX X

PLEASE CHECK THE HHCF CHART.

ARE THERE ANY STAYS RECORDED?

YES AND ~ IS SUBJECT .......................... 1 (Q.H-14)

YES AND ~ IS PROXY .............................. 2

NO AND Q IS SUBJECT ............................ 3 (Q.H-12)

NO AND ~ IS PROXY ................................ 4 (Q-H-13)

Thank you very much for taking the time to participate in this interview. (TERMINATE.)

106

- .—
H-12. Finally, I would like to confirm your name, address and talephone number,

FIRST MIDDLE IAST

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

And 1need to confirm your telephone number.

TELEPHONE NUMBER: J )

I

GO TO Q.H-14 I

H-13. Finally, I would like to confirm your name, address and telephone number and relationship to (SUBJECT).

NAME:

FIRST MIDDLE IAST

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE NUMBER: J )

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER-lN-L4W/MOTHER-lN-lAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON-lN-UW/DAUGHTER-lN-WW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER-lN-LAW/SISTER-lN-MW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER REIATIVE [SPECl~ ........................ 91

OTHER NON-REIATIVE [SPECl~ ..............92

Thank you very much for taking the time to participate in this interview. (TERMINATE)

T07
H-14. DID THE SUBJECT RECEIVE ASSISTANCE?

YES. ................................................................. 1

NO .................................................................... 2 (CONCLUSION)

HOW MANY ASSISTANTS?

ONE .................................................................. 1

MORE THAN ONE ........................................... 2

RECORD NAME AND TELEPHONE NUMBER OF (EACH) ASSISTANT AND ASK FIEIATIONSHIP.

ASSISTANT #1

FIRST MST

TELEPHONE NUMBER: f )

HOW IS (ASSISTANT REIATED TO (SUBJECT]?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER-lN-b4W/MOTHER4 N-b4W .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON-lN-lAW/DAUGHTER-lN-UW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... E

BROTHER-lN-lAW/SISTER-lN-b4W .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER REIATIVE [SPECl~ ........................ 91

OTHER NON-REIATIVE [SPECIFYl ..............92

108
NAME:

FIRST IAST

TELEPHONE NUMBER: ( )

HOW IS (ASSISTANT REIATED TO (SUBJECT)?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER-lN-UW/MOTHER-lN-L4W .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON-lN-WW/DAUGHTER4 N-lAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER-lN-MW/SISTER-lN-LAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER REIATIVE [SPECl~ ........................ 91

OTHER NON-REIATIVE [SPECIFYl ..............92

Thank you very much for taking the time to participate in this interview. ~ERMINATE.]

109
PART I: OB.SERVATION SHEET

(TO BE COMPLETED AT CONCLUSION OF INTERVIEW)

BOX ‘f

INTERVIEWER: IF ~ WITH ASSISTANCE, ANSWER Q. I-l AND C!.I-2; IF ~, ANSWER Q.I-2.

1-1. IF ASSISTANCE: WHO WAS THE PRIMARY RESPONDENT?

1-2. IF PROXY OR ASSISTANCE: WHY WAS

EACH CATEGORYl

a.

b.

c.

d.

e.

f.

9.

h.

SUBJECT ................................................... ...... 1

ASSISTANT #1 ................................................ 2

ASSISTANT #2 ................................................ 3

UNCERTAIN .................................................... 4

(PROXY/ASSISTANT) NEEDED? [CODE YES OR NO FOR

HEARING PROBLEM ................................................................

SPEECH PROBLEM .................................................................

IANGUAGE PROBLEM (INTERPRETER) ................................

POOR MEMORY, SENILITY, OR CONFUSION ......................

INSTITUTIONALIZED ...............................................................

ALZHEIMER’S DISEASE ..........................................................

OTHER MENTAL CONDITION (SPECII%) ..............................

........

OTHER PHYSICAL ILLNESS AND/OR DISABILIW

(SPECW)

1

1

1

1

1

1

1

1

1

i,

j.

OTHER NON-HEALTH (SPECl~

........

OTHER (SPECIFY)

........

1

1

yQ

2

2

2

2

2

2

2

2

2

2

2

110
I-3.DO YOU FEEL THAT THE INFORMATION PROVIDED BY THE (SUBJECT/PRO~ WAS SATISFACTORY?

YES .................................................................. 1 (Q.I-5)

No .................................................................... 2

I-4. WHY NOT?

1-5. [IF SUBJECT OR SUBJECT WITH ASSISTANCE:]

PLEASE CIRCLE THE NUMBER THAT BEST DESCRIBES THE SUBJECT’S AWARENESS LEVEL DURING

THE INTERVIEW.

‘~

VERY VERY

ALERT CONFUSED

I-B. IN REGARD TO THE QUESTIONNAIRE, DO YOU FEEL IT . . .

~

a. HELD THE RESPONDENT’S AITENTION THROUGHOUT

THE INTERVIEW? .................................................................................... 1

b. WAS UPSETTING OR DEPRESSING TO THE RESPONDENT? ........... 1

c. WAS BORING OR UNINTERESTING TO THE RESPONDENT’? ........... 1

1-7. WITH REGARD TO THE (SUBJECT/PROXY), DO YOU FEEL THE. . .

~

a- RESPONDENT WAS INTEUECTUALLY CAPABLE OF

RESPONDING? ........................................................................................ 1

b. RESPONDENT’S ANSWERS WERE REASONABLY ACCURATE? ....... 1

c. RESPONDENT UNDERSTOOD THE QUESTIONS? ............................. 1

UNCERTAIN

3

3

3

UNCERTAIN

3

3

3

11-1
1-8. (IF YES TO I+b OR I+c, OR IF NO TO 1-7a, l-7b OR I-7c)

WAS THERE A SECTION THAT SEEMED TO BE PARTICULARLY UPSElllNG OR PROBLEMATIC FOR

THE RESPONDENT?

YES .................................................................. 1

NO .................................................................... 2 (C).1-9)

WHICH SECTION AND WHY?

1-9. WAS THE (SUBJECT/PRO~ HARD OF HEARING?

YES ..................................................................

NO ....................................................................

1-10. WAS THE INTERVIEW CONDUCTED IN SPANISH?

1-11. RECORD ANY

INTERVIEW.

YES ..................................................................

NO ....................................................................

OR IMPRESSIONS YOU MAY HAVE HAD

1

2

1

2

ABOUT THIS

I-12. RECORD ANY

RESPONSE.

YOU MAY HAVE HAD WHEN

I-13, Did you record the ID number [(ID NUMBERj] and the name [(SU BJECT’S NAME)] on the hospital chart?

YES .................................................................. 1

NO .................................................................... 2

112
Proxy telephone questionnaire

November 0, 1937

OMB: 09374134

EXPIRES: June 20, 1998

NHANES I EPIDEMIOLOGIC FOLLOWUP STUDY

CONTINUED FOLLOWUP

PROXY - DECEASED QUESTIONNAIRE

WESTAT ID: I I l-l_l I l-l_l

Hello, may I please speak to (RESPC)NDENn?

■ IF RESPONDENT NOT AVAILABLE, ASK: Can you suggest a convenient time when I could reach

(him/her)? TERMINATE CONTACT AND RECORD RESULTS ON CALL RECORD.

■ IF RESPONDENT NOT AT THIS TELEPHONE NUMBER, VERIIV NUMBER AND REDIAL

■ IF RESPONDENT AVAILABLE, CONTINUE.

My name is (YOU R NAME) and I am calling from Washington, D.C. on behalf of the United States Public

Heailh SeNice with regard to the National Health and Nutrition Examination Survey. Recently you were sent a letter

from the Public Heatth Service explaining that someone would contact you. Did you receive our Iettefl

YES .................................................................. 1

NO .................................................................... 2 (BOX 1)

1would like to cmnduct the intervimv now if it is convenient.

.

(It will take approximately W minutes. In order to evaluate my performana, my supervisor may monitor this

interview.)

BOX 1

(IF RESPONDENT DID NOT RECEIVE LEITER, READ:)

Let me tell you what it says. In (DATE OF EXAM YEAR), (SUBJECT) participated in the National Heatth and

Nutrition Examination Suwey. At this time, we are mntacting relatives (or friends) of pxaons who participated wt10

are now deceased to conduct a very short intewiew by telephone. Questions will be asked abcwt illnesses,

disabikties and hospitalizations. This study is authorized by the Public Heafth Service Act. The information you

give me will be kept strictly confidential and till be used for statistical purposes only. The interview is mmpletely

volunta~ and there are no penalties fbr refusing to answer any questions. (CHECK BOX. I_ I)

1would like to conduct the interview now if it is convenient.

(It will take approximately 30 minutes. In order to evaluate my performance, my supervisor may monitor

this intewiew.)

113
PARTA: BACKGROUND INFORMATION

TIME BEGAN: AM

PM

AJJa. First, 1would like to verify (SU BJECT’S ] NAME. (His/Her) first name was (FIRST NAME), middle name

(MIDDLE NAME), and last name was (LAST NAME).

FIRST NAME MIDDLE NAME LAST NAME

A4b, How were you related to (SUBJECTj?

HUSBAND/WIFE/SPOUSE EQUIVALENT ...................01

FATHER/MOTHER ........................................................ r32

FATHER lN-LAW/MOTHER IN-LAW ............................. 03

SON/DAUGHTER .......................................................... 04

SON lN-lAW/DAUGHTER IN-LAW ............................... 05

BROTHER/SISTER ........................................................ ~

BROTHER lN-LAW/SISTER IN-LAW ............................. 07

FRIEND/NEIGHBOR/ROOMMATE .............................. 08

OTHER RELATIVE (SPECIFY) ....................................... 91

OTHER REIATIVE IN-LAW (SPECIFY) ......................... 92

OTHER NON-REIATIVE (SPECIFY) .............................. 93

A-1. In the year prior to (SUBJECT’S) death, where did (he/she) live most of the time - in a house or apartment,

a nursing home or rest home, retirement home, or (do you/does he/she) have some other arrangement?

HOUSE OR APARTMENT .............................................. 1

NURSING OR CONVALESCENT OR REST HOME ...... 2 (A-lc)

RETIREMENT HOME ..................................................... 3

BOARDING HOUSE, ROOMING HOUSE OR

RENTED ROOM .......................................................... 4

FAMILY OR FOSTER CARE HOME .............................. 5

ANOTHER HEALTH FACILITY ....................................... 6 (A-lc)

OTHER ARRANGEMENT (SPECl~ ............................ 91

OTHER INSTITUTION (SPECIFY) ................................. 92 (A-lc)

114
A-1 a.

A-1 b.

A-1 C.

Was (SU EJECT) living in a nursing home or other health care I%cility at the time of (his/her) death?

YES .................................................................. 1

NO .................................................................... 2

In the ~r prior to (SUBJECT’S) death, did you live in the same household with (him/her)?

In the ~ prior to (SUBJECT’S) death,

YES ...............s...............n.................................. 1 (RPI-1)

NO .................................................................... 2

about how hequently did you visit or talk to (him/her)? [PROBE

WITH CATEGORIES IF NECESSARY.]

EVERYDAY ...................................................... 1

LESS THAN DAILY BUT AT LEAST

ONCE A WEEK ............................................. 2

LESS THAN WEEKLY BUT MORE

THAN ONCE A MONTH ............................... 3

LESS THAN ONCE A MONTH ........................ 4

RPI-I

REFERENCE TO ~ INTERVIEW IF IN NURSING HOME IN ~ (A-3=2) AND IN NURSING HOME

EITHER ONE YEAR PRIOR TO DEATH (A-1 =2) OR AT THE TIME OF DEATH (Ala= 1) THEN GO TO

A-2. IF NOT IN NURSING HOME ON THE ~ (A-3 # 2) AND IN NURSING HOME EITHER ONE YEAR

PRIOR TO DEATH (A-1 =2) OR AT THE TIME OF DEATH (Ala=l) THEN GO TO A-7. IF DID NOT DIE

IN A NURSING HOME AND WAS UVING IN EITHER A HOUSE/APARTMENT, RETIREMENT HOME,

BOARDING HOUSE, FOSTER CARE HOME OR OTHER ARRANGEMENT (A-1= 1,3,4,5,91) THEN GO

TO A-4. IF IN ANOTHER HEALTH FACILITY OR OTHER INSTITUTION (A-1 =6, 92) ONE YEAR PRIOR

TO DEATH THEN GO TO A-7.

A-2. Since (MONTH/YEAR) did (SUBJECT) continuously lived in a nursing home?

YES .................................................................- 1

NO .................................................................... 2 (Q.A-7)

A-3. ISthis the same nursing home (SUBJECT) was living in (MONTH/YEAR)?

YES .................................................................. 1 (RPI-3)

NO .................................................................... 2 (A-7)

115
A-4. At the time of (his/her) death, how many people lived in (his/her) household including (SUBJECT)?

ONE .................................................................. 01 (Q.A%)

NUMBER OF PEOPLE: I——I I

A-5. What relationship to (SUBJECTI (was/were) the other person(s) who lived in (his/her) household? [PROBE

FOR SEX IF NOT OBVIOUS: IS (PERSON) male or female?]

PERSON # SEX RELATIONSHIP

1 l_l I_

2 l_l I_

3 l_l I_

4 l_l I_

5

6

7

8

9

10

SEX 1 = MALE

2 = FEMALE

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

l_l l_l

RELATIONSHIP 1 = HUSBAND/WIFE

2 = FATHER/MOTHER

(INCLUDING IN-LAWS)

3 = GRANDPARENT

4 = SON/DAUGHTER

(INCLUDING IN-WWS)

5 = GRANDCHILD

6 = 13ROTHER/SlSTER

(INCLUDING IN-IAWS)

7 = AUNT/UNCLE/COUSIN

8 = OTHER REIATIVE

9 = FRIEND

10 = OTHER NON-REIATIVE

1==1

116
A6. How long had (he/she) lived alone?

NUMBER OF MONTHS: I 1 I (Rpl-3)

~

NUMBER OF YEARS: I I 1 (Rpl-3)

LESS THAN ONE MONTH .............................. 95 (RPI-3)

A-7. At the time (he/she) entered the (nursing home or rest home/heatth care facility/institution), how many

people lived in (his/her) household including (SUBJECTI?

ONE .................................................................. 01 (Q.A-9)

NUMBEROFPEOPLE:l—l—l

A-6. What relationship to (SUBJECTI (was/were) the other person(s) who lived in (his/her) household? [PROBE

FOR SEX IF NOT OBVIOUS: Is (PERSON) male or female?]

PERSON # SEx RELATIONSHIP

1

2

3

4

5

6

7

8

9

10

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

l_l

SEX 1 = MALE RELATIONSHIP: 1 = HUSBAND/WIFE

2 = FEMALE 2 = FATHER/MOTHER

(INCLUDING IN-LAWS)

3 = GRANDPARENT

4 = SON/DAUGHTER

(INCLUDING IN-UWS)

5 = GRANDCHILD

6 = BROTHER/SISTER

(INCLUDING IN-LAWS)

7 = AUNT/UNCLE/COUSIN

8 = OTHER REIATIVE

9 = FRIEND

10 = OTHER NON-REIATIVE

117
A-9. How long had (he/she) lived alone?

NUMBER OF MONTHS: l_l_l

~

NUMBER OF YEARS: l_l_l

LESS THAN ONE MONTH .............................. 95

I

RPI-3

IF R IS SPOUSE OF DECEASED (AJ3b= 1) CODE A-10=1 AND GO TO RP1-3a.

OTHERWISE ASK A-10.

A-10. ~ERIFY IF ALREADY KNOWN:]

At the time of (SUBJECT’S) death, was (he/she) ma[ked, widowed, divorced, separated, or has (he/she)

never been married?

MARRIED ......................................................... 1

WIDOWED ....................................................... 2

DIVORCED ....................................................... 3

SEPARATED .................................................... 4

NEVER MARRIED ............................................ 5

RP1-3a

REFERENCE TO lF/ECF INTERVIEW FOR THOSE NEVER INTERVIEWED,

ASK A-1 1 AND A-12. OTHERWISE GO TO SECTION B.

A-II. Which of these categories best dt,scribes (S1IEJECT) - Aleut, Eskimo, American Indian, Asian, Pacific

Islander, Black or White?

ALEUT, ESKIMO OR AMERICAN INDIAN ...... 1

ASIAN/PACIFIC ISIANDER ............................ 2

@LACK .............................................................. 3

WHITE .............................................................. 4

OTHER (SPECIFY) .......................................... 91

A-12. Was (SUBJECT) of Hispanic origin?

YES .........................................................n........ 1

NO .................................................................... 2

A-13 THROUGH A-21 FROM SUBJECT/PROXY INCAPACITATED ~ NOT ASKED.

118
PART B: MEDICAL CONDITIONS

TIME BEGAN: AM

PM

B-1 AND B-2 FROM ~ NOT ASKED ON THIS VERSION.

B-la.

B-3.

B4.

BOX A2

IF ~ IS A RELATIVE (A4b= 1-7,91 ,92) GO TO B-3.

IF ~ IS NOT A RELATIVE GO TO B-la.

Do you think you can answer questions about (his/her) medical history?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-93g)

DK ..................................................................... 8

Did a doctor ever tell (SUBJECT) that (he/she) had arthritis?

YES .................................................................. 1 (Q.B4)

NO .................................................................... 2 (RPI-B)

DK ..................................................................... 8 (RPI-11)

RPI-B

REFER TO ~ INTERVIEW IF ~ HAD ARTHRITIS ON ~ (Q. B-2 =1) AND PROXY

DOES NOT REPORT ANY ARTHRITIS (B-3=2), THEN CODE B-3 AS

“DISCREPANCY=%%”

Ir==l

Concerning (SU BJECT’S) arthritis, in what year was (SUBJECT) first told (he/she) had atihriiis?

YEAR 191 I I

.—

DK .................................... 9S

119
RPI-9

REFERENCE TO ECF INTERVIEW: IF S HAD ARTHRITIS ON ECF

(Q.B-2= 1) GO TO B-17. OTHERWISE GO TO B-5.

B-5. There are different kinds of arthriiis. Did a dootor ever tell (SUBJECT) which kind (he/she) had?

YES .................................................................. 1

No .................................................................... 2 (RPI-11)

DK ..................................................................... 8 (RPI-11)

B+. Concerning (his/her) arthritis, did she have oseteoarthriiis, degenerative, rheumatoid or some other type?

(PROBE WITH CATEGORIES IF NECESSARY,)

a. Osteo/Degenerative ..................... 1 2 8

b. Rheumatoid .................................. 1 2 8

c. Some other fype (SPECIFY) ........ 1 2 8

B-7 THROUGH B-16 ON ~ NOT ASKED.

HOSPITAL DATES:

FOR PERSONS THAT REPORT A YEAR OF FIRST OCCURRENCE USE:

~ IF YEAR OF FIRST OCCIJRRENCE IS BETWEEN 1~ AND 1985 OR

~ WAS NEVER INTERVIEWED.

~ IF YEAR OF FIRST OCCURRENCE IS BETWEEN 1980 AND 1985 OR

THE IAST INTERVIEW WAS THE ~.

lQ& IF YEAR OF FIRST OCCURRENCE IS IN 1985 OR IATER AND THE

IAST INTERVIEW WAS THE ~.

FOR PERSONS THAT DO NOT REPORT A YEAR OF FIRST OCCURRENCE

USE:

~ IF ~ WAS NEVER INTERVIEWED.

1980 IF IAST INTERVIEW WAS THE ~.

~ IF IAST INTERVIEW WAS THE E(J.

B-17. Since (1985/1 980/1970), was

there for more than a da~]

w BJECT) hospitalized for (his/her) (arthritis)? [PROBE: Was (he/she)

YES .............................s.................................... 1 (CHART

NO .................................................................... 2

120
B-18.

B-19.

B-20.

B-21.

B-22.

RPI-I 1

REFERENCE TO lF/ECF INTERVIEW IF S REPORTED A HEART A~ACK ON K

(G17a=l) OR ~ (B-14=1 OR B-15=1), GO TO B-18. OTHERWISE GO TO B-19.

Since (MONTH/YEAR)

myocardial infarction)?

did (he/she) have

Did a doctor ever tell (him/her) that (he/she)

a heart attack, (sometimes ailed coronary thrombosis or

YES .................................................................. 1 (Q-B-22)

NO .................................................................... 2 (Q. B-24)

DK ..................................................................... 8 (Q. B-24)

had a bean attack, (sometimes called coronay thrombosis or

myocardial intirction)?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-24)

DK ..................................................................... 8 (Q. B-24)

In what year was (he/she) first told that

infarction)?

(he/she) had a heart attack, (coronary thrombosis or myocardial

YEAR: 19 l_l_l

DK .................................... 9B

Did (he/she) have an additional heart attack since then?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-23)

DK ..................................................................... 8 (Q. B-23)

In what year was that heart attacK? [PROBE: Did (SUBJECT) have any others since then? PROBE FOR

ALL YEARS.]

YE4R: 191 ——] I

YEAR: 19 I

II

YEAR: 19 I

II

YEAR: 19 I

II

DK .................................... 9B

121
B-23. Since (1965/19&l/1970), was (he/she) hospitalized for (his/her) heart attack? [PROBE: Was (he/she)

there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

B-24. Sinca (1965/1960/1970), was (he/she) hospitalized for any type of heart condition (other than a heart

attack)? [PROBE: Was (he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-12

REFERENCE TO IF ECF INTERVIEW: IF ~ REPORTED CORONARY BY-PASS ON ~ (B-20a= 1) GO TO

B-25. IF ~ REPORTED HEART AITACK OR HEART CONDITION K (G17a= 1 OR G15a=l) OR w

(B14=1 OR B15= 19] AND DID NOT REPORT CORONARY BY-PASS SURGERY ON ~ (G-20ad) THEN

GO TO B-26. OTHERWISE GO TO BOX B.

1

B-25. Since (MONTH/YEAR) did (SUBJECT) have any coronary by-pass surge@

YES .................................................................. 1 (B-27)

NO .................................................................... 2 (RPI-13)

B-26,

B-27.

BOX B

IF R-18 =1, B-19 = 1 OR B-24 =1, GO TO B-26; OTHERWISE GO TO RPI-14.

Did (he/she) ever have coronay by-pass surgery?

YES .................................................................. 1

NO .................................................................... 2 (RPI-13)

Since (1965/19B0/1970), was (he/she) hospitalized for coronay by-pass surgery? [PROBE: Was (he/she)

there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-13

REFERENCE TO ECF INTERVIEW IF S REPORTED PACEMAKER ON ECF

(B-2oc= 1), GO TO B-29. OTHERWISE GO TO B-28.

122
B-28.

B-29.

B-30.

B-31 .

Some people with heart rhythm problems have a pacemaker insened to control the heartbeat. Did (he/she)

ever have a pacemaker inserted?

YES .................................................................. 1

NO .................................................................... 2 (RPI-14)

Since (19B5/1 980/1970), was (he/she) hospitalized for pacemaker insertion, repair, or replacement?

[PROBE: Was (he/she) there for more than a day’?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-14

REFERENCE TO lF/ECF INTERVIEW IF ~ REPORTED A STROKE

ON ~ (B-28=1) OR K (G22a=l), GO TO B-30. OTHERWISE

GO TO B-31 .

Since (MONTH/YEAR) did (he/she) have a stroke (sometimes called a CVA)?

YES .................................................................. 1 (Q. B-34)

NO .................................................................... 2 (BOX Bl)

VOLUNTEERS SMALL STROKE .................... 3 (Q. B-34)

VOLUNTEERS POSSIBLE STROKE .............. 4 (Q. B-34)

VOLUNTEERS TIA .......................................... 5 (Q. B-34)

DK ..................................................................... 8 (BOXB1)

Did a doctor ever tell (him/her) that (he/she) had a stroke (sometimes died a CVA)?

YES .................................................................. 1

NO .................................................................... 2 (RPI-15)

VOLUNTEERS SMAU STROKE .................... 3

VOLUNTEERS POSSIBLE STROKE .............. 4

VOLUNTEERS TIA .......................................... 5

DK ..................................................................... 8 (RPI-15)

CATI PROGRAMMER

IF B-30 = 1 OR B-31 = 1 THEN USE ‘STROKE IN B-32 - B-35.

IF B-30 = 3 OR B-31 = 3 THEN USE ‘TIA’ IN B-32 - B-35.

IF B-30 = 4 OR B-31 = 4 THEN USE “SMALL STROKd IN B-32 - B-35.

IF B~ = 1 OR B-31 = 5 THEN USE ‘POSSIBLE STROKE’ IN B-32 - B-35.

123
B-32.

B-33.

B-34.

B-35.

In what year was (he/she) first told that (he/she) had a (llA/STROKE/SMALL STROKE/POSSIBLE

STROKE)?

YEAR: 19 l_l_l

DK .................................... 9B

Did (he/she) have an additional (llA/.stroke/small stroke/possible stroke) sinm then?

YES .................................................................. 1

NO .................................................................... 2 (Q.B-35)

DK ..................................................................... 8 (Q.B-35)

In what year was that (llA/stroke/small stroke/possible stroke)? [PROBE: Did (SU BJECT) have any

others since then? PROBE FOR ALL YEARS.]

YEAR: 19 ]

II

YEAR: 19 I

II

DK .................................... 98

Since (19&5/1 9B0/1970), was (he/she) hospitalized for a (llA/stroke/small stroke/possible stroke)?

[PROBE: Was (he)she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

I

BOX B1

CAN RESPONDENT ANSWER MORE QUESTIONS ABOUT SUBJECT’S HEALTH?

YES ................................................... 1

NO ..................................................... 2 (Q.B-93g)

B-26 FROM ~ NOT ASKED.

RPI-15

REFERENCE TO lF/EcF INTERVIEW IF REPORTED DIABETES ON ~ (B-35=1)

OR ~ (G-36= 1), THEN GO TO B-37. OTHERWISE GO TO B-33.

124
B-37.

B-38.

B-39.

B40.

B-41.

B-42.

In the year prior to (his/her) death, was (he/she) taking medication for diabetes?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

DISCREPANCY ................................................ 96

Did a doctor ever say that (he/she) had diabetes or sugar diabetes?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

BORDERLINE .................................................. 95

In what year was (he/she) firsttold that (he/she) had diabetes or sugar diabetes?

YEAR: 191 ——I I

DK .................................... 98

In the year prior to (his/her) death, was (he/she) taking insulin injections for (his/her) diabetes?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

In the year prior to (his/her) death, was (he/she) taking pills for (his/her) diabetes?

YES .................................................................. 1

NO .................................................................... 2

(Q. B-40)

(Q.B42)

(Q. B-42)

(RPI-16)

(RPI-16)

(RPI-16)

(Q. B-42)

Since (1985/1980/1 970), was (he/she) hospitalized for diabetes? [PROBE: Was (he/she) there for more

than a dafl]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-16

REFERENCE TO ~ INTERVIEW IFS REPORTED TAKING MEDICATION FOR HIGH BLOOD

PRESSURE ON ~ (640 OR B-43 = 1), THEN GO TO B-47.

IF ~ DID NOT REPORT HIGH BLOOD PRESSURE ON ~ (B-41 =2,8), THEN GO TO B-44.

IF ~ NOT ON ~ AND DID NOT REPORT HIGH BLOOD PRESSURE ON ~ (D2 =2,8, THEN

GO TO B-44.

IF ~ WAS NEVER INTERVIEWED ON ~ OR ~, GO TO B-44.

IF ~ REPORTED HIGH BLOOD PRESSURE BUT WAS NOT TAKING MEDICATION ON W

[(B-40=2,8) OR (B-$1=1 AND B43=2,8)], THEN GO TO B-43.

IF ~ NOT ON ~ AND REPORTED HIGH BLOOD PRESSURE ON ~ (D-2 = 1) THEN GO TO B-43.

125
B43.

B-44.

B45.

B-48.

B-47.

Did the doctor ever prescribe medicine for (SUBJECT) fcr high blood pressure?

YES .................................................................. 1 (Q.B47)

NO .................................................................... 2 (Q.B48)

DK ..................................................................... 8 (Q.B48)

DISCREPANCY ................................................ W (RPI-17)

Has (SUBJECT) ever been told by the doctor that (he/she) had high blood pressure or hypertension?

YES .................................................................. 1

NO .................................................................... 2 (RPI-17)

DK ..................................................................... 8 (RPI-17)

BORDERLINE .................................................. 95

In what year was (he/she) firsttold that (he/she) had high blood pressure or hypertension?

YEAR: 19 l_l_l

DK .................................... 88

Did the doctor ever prescribe medicine for (his/her) high blood pressure?

YES .................................................................. 1

NO .................................................................... 2 (Q.B48)

DK ..................................................................... 8 (Q.B48)

In the year prior to (SUBJECT’S ) death, was (he/she) taking medication for high blood pressure?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

B47a AND B47b FROM fj&l NOT ASKED THIS VERSION.

126
B4B. Since (19B5/19B0/1970), was (he/she) hospitalized for high blood pressure? [PROBE: Was (he/she) there

for more than a da~]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-17

REFERENCE TO lF/ECF INTERVIEW: IF ~ REPORTED ANY TYPE @F CANCER ON

~ (D-52=1, D-58=1, D-62=1) OR ~ (B47= 1), THEN GO TO B-5@. OTHERWISE

GO TO B-51.

B49 ON ~fl NOT ASKED.

B-50.

B-51.

B-52.

Since (k*ONTH/YEAR) did (SUBJECT) have any type of cancer dh!JflGS@ including skin cancet?

YES .................................................................. 1 (CM3-53)

NO .................................................................... 2 (Q. B-52)

DK ..,.................................................................. 8 (Q. B-52)

Did a doctor ever tell (SUBJECT) that (he/she) had cancer of any sort, including skin cancef?

YES .................................................................. 1 (Q-B-53)

NO .................................................................... 2 (BOX B2)

DK ..................................................................... 8 (BOX B2)

Since (19B5/l!3B0), was (he/she) hospitalized for a can~r condition? [PROBE: Was (he/she) there for

more than a day?]

YES .................................................................. 1 (CHART. THEN

GO TO BOX B2)

NO .................................................................... 2 (BOX B2)

127
SUBSTITUTE ‘SINCE

‘AT’pROGRAM~ (MONTH~EAR)’ IN THE PROBE FOR

B-53 IF ~ REPORTED A CANCER ON THE ~ (D52=I OR

D-53=1 OR D@) OR ON THE ~ (S-47=1).

—

1ST DIAGNOSIS 2ND DIAGNOSIS 3RD DIAGNOSIS

—

B-53. Where was the LUNG ........................................ 1 LUNG ........................................ 1 LUNG ........................................ 1

cancer or what COLON (RECTUM,BOWEL) ,,.. 2 COLON (RECTUM,BOWEL) .... 2 COLON (RECTUM, BOWEL) .... 2

type of cancer BW4ST .................................... 3 BR~ST .......................(............. 3 BREAST.................................... 9

was it? SKIN (MELANOMA).................. 4 SKIN (MELANOMA).................. 4 SKIN (MEWNOMA) .................. 4

[PROBE: Did SKIN (NON-MELANOMA)........ 5 SKIN (NON-MEUU’JOMA)........ 5 SKIN (NON-MEUNOMA) .,,,..,, :5

(he/she) have (CI.E55) (a.B55) (Q,E55)

any other SKIN (DON’T KNOW) ............... 6 SKIN (DON’T KNOW) ............... 6 SKIN (DON’T KNOW) ............... 16

cancer UTERUS.................................... 7 UTERUS...................................- 7 UTERUS.................................... 7

diagnosed PROSTATE............................... B PROSTATE............................... 8 PROSTATE............................... B

since (month/ STOMACH ................................ 9 STOMACH ................................ 9 STOMACH ................................ ‘9

year)?] LEUKEMIA................................ 10 LEUKEMIA................................ 10 LEUKEMIA................................ IID

OTHER (SPECIFYI .................. 91 OTHER (SPECFY_j ................... 91 OTHER (SPECIWj ................... 91

SITE: SITE: SITE

m E m

TYPE: TYPE: TYPE

— —

B-54. In what year

was (he/she) YEAR 191 I I Y* 19 l_l_l Ym 19 l_l_l

firsttold that

(he/she) had DK ........................... 99 DK ......................... 93 DK ........................... 99

(CANCER)?

— —

B-55. Since (1900/

1970), was

(he/she)

hospitalized

for (CANCER)?

[PROBE: Was YES ..................... 1 (CHART)YES .................... 1 (CHART) YES ........s............ 1 (CHART)

(he/she) there

for more than NO ...................... 2 NO ..................... 2 NO ...................... 2

a day?]

—

128
BOX B2

CAN RESPONDENT ANSWER MORE QUESTIONS ABOUT SUBJECT’S HEALTH?

YES ...................................................... 1

NO ........................................................ 2 (Q. B-93g)

RPI-18

REFERENCE TO lF/ECF INTERVIEW IF ~ REPORTED FRACTURED OR

BROKEN HIP ON ~ (B-53=1) OR ~ (E8 OR E90==1), GO TO B-56.

OTHERWISE GO TO B-57.

B-56. Since (MONTH/YEAR) did (he/she) have a broken or or fractured hip?

YES .................................................................. 1 (Q.B~)

NO .................................................................... 2 (Q. B-62j

DK ..................................................................... 8 (Q. B432)

B-57. Was (SUBJECT ever told by the doctor that (he/she) had a broken or fractured hip?

YES .................................................................. 1

NO .................................................................... 2 (Q. B432)

DK ..................................................................... 8 (Q.B+2)

B-58. In what year was (he/she) first told that (he/she) had a broken or fractured hip?

YEAR: 19 l_l_l

DK .................................... 96

B-59. Has (he/she) had an additional fractured hip since then?

YES .................................................................. 1

NO .................................................................... 2 (CI.B41)

DK ..................................................................... 8 (Q.B41)

129
B+O.

B+l .

B-62.

B-B3.

In what year did (he/she) have that break or fracture of (his/her) hip? [PROBE:

fractured hip since then? PROBE FOR ALL YEARS.]

YEAR: 19 l_l_l

YEAR: 191 I I

YEAR: 19 I

II

YEAR: 191 II

DK .................................... 9B

Did (he/she) have another

Since (19B5/19B0/1970), was (he/she) hospitalized for a broken or hactured hip? [PROBE: Was (he/she)

there for more than a day?]

YES ..................................................................

NO ....................................................................

Did a doctor ever tell (him/her) that (he/she) had osteoporosis?

YES ..................................................................

NO ....................................................................

In what year was (he/she) first told that (he/she) had osteoporosis?

YEAR: 191 I I

DK .................................... 98

1 (CHART)

2

1

2 (RPI-20)

B-M THROUGH B&ON ~ NOT ASKED.

RPI-20

REFERENCE TO ~ INTERVIEW IF ~ ELIGIBLE FOR ~, GO TO B+7.

OTHERWISE GO TO B-71 .

130
B%7. The next few questions are about falls. I’m interested in falls where (SUBJEC T) has fallen and landed on

the floor or ground or hit an object like a table or stair. In the year prior to (SIJBJECl%] death, did (he/she)

have this kind of fall?

YES ..................... ........................................... 1

NO .................................................................... 2 (CLB-71)

DK ..................................................................... 8 (Q. B-71)

B-88 FROM ~ NOT ASKED.

B-ES.

B-7o.

B-71.

B-72.

Did any of these falls . . .

Y= ~

a. cause a broken bone? .............................................................. 1 2

b. cause (him/her) to hit or injure (his/her) head? ...................... 1 2

c. cause (him/her) to seek medical care? .................................... 1 2

In the year prior to (SUBJ ECRS) death, was (he/she) hospitalized for any of these falls? [PROBE: Was

(he/she) there for more than a da~]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

Since (1985/1 980/1 970), was (he/she) hospitalized for pneumonia, bronchitis, or the flu? [PROBE: Was

(he/she) there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

RPI-21

REFERENCE TO ~ INTERVIEW: IF ~ REPORTED KIDNEY DISEASE OR

KIDNEY STONES ON ~ (G8a= 1), GO TO B-72 AND USE ~ INTERVIEW

DATE FOR “(MONTH/YEAR)”. OTHERWISE GO TO B-73a.

Simx (MONTH/YEAR) did (he/she) have a kidney disorder or kidney stones? Please do not include

kidney infections.

YES .................................................................. 1 (Q. B-73c)

NO .................................................................... 2 (CLB-73C)

DK ..................................................................... 8 (Q. B-73c)

131
B-73a. Was (SUBJECT) ever told by the doctor that (he/she) had a kidney disorder or kidney stone(s)? Please do

not include kidney infections.

YES .................................................................. 1

NO .................................................................... 2 (Q. B-73c)

DK ..................................................................... 8 (C).B-73C)

B-73b. What year was (he/she) firsttold that (he/she) had a kidney disorder or kidney stones?

YEAR: 19 l_l_l

DK .................................... 98

B-73c. Was (he/she) ever told by a doctor that (he/she) had a urinary tract or kidney infection more than three

times?

YES .................................................................. 1

NO .................................................................... 2 (BOX Cl)

B-73d. What year was (he/she) first told that (he/she) had a urinary tractor kidney infection?

YEAR: 19 l_l_l

DK .................................... 98

BOX Cl

IF ~ REPORTED KIDNEY DISORDER/KIDNEY STONES

(B-72 =1 OR B-73a= 1) OR URINARY TRACT/KIDNEY

INFECTION (B-73c= 1) THEN GO TO 674. OTHERWISE

GO TO RPI-22.

B-74. Since (1985/1980/1970) was (he/she) hospitalized for a kidney condition? [PROBE:

for more than one da~]

Was (he/she) there

YES .................................................................. 1 (CHART)

NO .................................................................... 2

132
RPI-22

REFERENCE TO~lNTERVIEW lF~HADCATARACT SURGERYON~

(BOX E=l OR F-3=1) THEN GO TO B-75. OTHERWISE GO TO B-76.

B-75.

B-76.

B-77.

B-78.

Sinoe (MONTH/YEAR) did (he/she) have cataract surge~

YES .................................................................. 1 (Q. B-7B)

NO .................................................................... 2 (Q. B432)

Did the doctor ever tell (SUBJECT) that (he/she) had cataracts?

YES .................................................................. 1

NO .................................................................... 2 (Q.B+2)

Did (he/she) ever have surge~ for (his/her) @araots?

YES .................................................................. 1

NO .................................................................... 2 (Q. B-62)

What year did (he/she) have (his/her) cataract surgery’? [PROBE: Did (he/she) have any other cataract

surge@ RECORD ALL YEARS].

YEAR: 19 I

II

YEAR: 19 I_l_l

DK .................................... 96

B-79. Since (19S5/19&3/l 970), was (he/she) hospitalized for (his/her) cataract surgery? [PROBE: Was (he/she)

there for more than a day?]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

B-60 THROUGH B-62 FROM ~ NOT ASKED.

133
B-W. [1 have recmrded that (SUBJECl_I was hospitalized (READ DATES, CONDITIONS AND FACILITY NAMES

FROM CHART),]

Now, I would like you to think back over the time between (19@5/19BO{I 970) and the time (he/she) died.

(He/She) would have been about ~ in (19S5/19S0/1970). Did (he/she)stay in a hospital for anv (other)

reason including surgery, tests or for obsewation since (he/she) was ~?

[PROBE: Was (he/she) there for more than a da~]

YES .................................................................. 1

NO .................................................................... 2 (BOX E)

ASK B-B4 AND THEN B-W

FOR EACH CONDITION CONDITION # 1 CONDITION # 2 CONDITION # 3

—

B-84, For what condi- TESTS AND/OR TESTS AND/OR TESTS AND/OR

tion was that? OBSERVATION ........... 1 OBSERVATION ............. 1 OBSERVATION .............. 1

(PROBE: Did DIGESTIVE/ULCERS DIGESTIVE/ULCERS DIGESTIVE/ULCERS

(he/she) have PROBLEMS ................. 2 PROBLEMS .................... 2 PROBLEMS .................... 2

any other RESPIRATORY/ RESPIRATORY/ RESPIRATORY/

hospitaliza- BREATHING BREATHING BREATHING

tions since PROBLEMS ................. 3 PROBLEMS ..... .... ......... 3 PROBLEMS .................... 3

(1985/19Bo/ INFECTIONS ..,.,,,,,,,..,,,.,,... 4 INFECTIONS .......... ........... 4 INFECTIONS ...................... 4

1970)?] SURGERY FOR OTHER SURGERY FOR OTHER SURGERY FOR OTHER

[GO TO CHART CONDITIONS . . 5 CONDITIONS ................. 4 CONDITIONS ................. 4

AFTER CODING OTHER (SPECl~ ........... 91 OTHER (SPECl~ . ........ 91 OTHER (SPECIFY) ............ 91

CONDITION.]

(CHART) (CHART) (CHAR~

B-BS, [INTERVIEWER MONTH: MONTH: MONTH:

FILL IN THE

YEAR OF THIS DAY: DAY: DAY:

ADMISSION

FROM HOSPITAL YEAR: YEAR YEAR

CHART.]

SPECl~ SPECIIW: SPECl~

—

134
BOX E

IF A-3 = 1 THEN GO TO Q. B-93a.

B-SS. Since (19B5/19B0/1970), had (SU BJECT) ever stayed in a rest home, a nursing home, a mental health

facility, or anything like that? [PROBE: Was (he/she) there for more than a day?]

YES .................................................................. 1

NO .................................................................... 2 (Q. B-93a)

047. To what type

of place was the

(most recant/this

admission?

B-8B. Did (ha/she)

enter the ~

OF FACILllY)

directly from

(his/her) own

home, from a

hospital, or

from some

other place?

B-09. In what year

did (he/she)

enter the (lYPE

OF FACILITY)?

ADMISSION# 1

NURSING HOME/

REST HOME ................... 1

MENTAL HE4LTH

FACILITY ......................... 2

HEALTH CARE

REHABILITATION

CENTER ......................... 3

OTHER (SPECIW) ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME/

REST HOME ................... 03

MENTAL HEALTH

FACILITY ......................... 04

HEALTH CARE

REHABILITATION

CENTER ......................... IX

FRIEND/RELATIVES

HOME ............................. rX

OTHER (SPECl~ ............ 91

y- 19 l_l_l

ADMISSION# 2

NURSINGHOME/

REST HOME ................... 1

MENTALHEALTH

FACILITY......................... 2

HEALTH CARE

REHABILITATION

CENTER ......................... 3

OTHER (SPECIFY_J ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME/

REST HOME ................... 03

MENTAL HEALTH

FACILllY ......................... 04

HEALTH CARE

REHABILITATION

CENTER ......................... 05

FRIEND/RELATIVE’S

HOME ............................. M

OTHER (SPECIFY) ............ 91

ADMISSION# 3

NURSING HOME/

REST HOME ................... 1

MENTALHEALTH

FACILITY......................... 2

HEALTH CARE

REHABIIJTATION

CENTER ......................... 3

OTHER (SPECIFY) ............ 91

OWN HOME ...................... 01

HOSPITAL .......................... 02

NURSING HOME/

REST HOME ................... 03

MENTAL HEALTH

FACILllY ......................... 04

HE4LTH CARE

REHABILITATION

CENTER ......................... 05

FRIEND/REUTIVE’S

HOME ............................. 06

OTHER (SPECIIYI ............ 91

YE4R: 191 —— I I

135
BOX F

IF B-B7 =2 THEN GO TO B-92.

OTHERWISE, GO TO BOX G.

~

THIS IS SECOND ADMISSION ................................ B-SOa

B-90a. Was this admission for the same reasons and medical renditions as you just reported?

YES .................................................................. 1 (B-92)

NO .................................................................... 2 (B-90)

DK ..................................................................... 8 (B-90)

B-90. There are many

reasons why

people enter

a (TYPE OF

~.

Please tell me

if (SUBJECT)

entered the

~

FACILl~

for any of

the following

reasons.

(CIRCLE YES

OR NO FOR

EACH.)

ADMISSION# 1

YES NO

Required skilled

nursing care? ............ 1 2

Recuperation from

surge@ .................... 1 2

Needed help with

bathing, eating,

or dressing? .............. 1 2

Required special

medical or

ph~ical therapfi ...... 1 2

Too confused to live

independently? ......... 1 2

ADMISSION# 2

YES!!Q

Required skilled

nursing care? ............ 1 2

Recuperation from

surge~ .................... 1 2

Needed help with

bathing, eating,

or dressing? .............. 1 2

Required special

medid or

ph~ical therapfi ...... 1 2

Too confused to live

independentlfl ......... 1 2

ADMISSION# 3

YES NO

Required skilled

nursing care? .......... 1 2

Recuperation from

surge~ .................. 1 2

Needed help with

bathing, eating,

or dressing? ............ 1 2

Required special

medical or

physical therapfl .... 1 2

Too confused to live

independentl~ ....... 1 2

136
B-91. Please tell me

the name of

the disease

or medical

condition that

(he/she) had

at the time

of admission

that affected

(his/ her)

abil”~to live

independently’?

(CIRCLE ALL

THAT APPLY)

ADMISSION# 1

AIZHEIMER’SDISEASE.......... 01

CANCER................................... 02

DEPRESSION........................... 03

FRAIL/OLDAGE ....................... W

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... 05

INCONTINENCE ...................... m

NO MEDICAL CONDITION ...... 07

SENILITY .................................. 09

STROKE ................................... C9

OTHER DISEASE OR

CONDITION (SPECIFYJ ........ 91

ADMISSION# 2

AUI+EIMER’S DISE4SE ........... 01

CANCER ................................... 02

DEPRESSION ........................... 03

FRAIL/OLD AGE ....................... 04

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS ........... 05

INCONTINENCE ....................... 06

NO MEDICAL CONDITION ....... 07

SENILITY ................................... oa

STROKE .................................... C9

OTHER DISIZ4SE OR

CONDITION(SPECI!W)........ 91

ADMISSION# 3

AIZHEIMER’SDISEASE.......... 01

CANCER ................................... 02

DEPRESSION .......................... 03

FRAIL/OLD AGE ...................... 04

HARDENING OF THE

ARTERIES OR

ARTERIOSCLEROSIS .......... 05

INCONTINENCE ...................... C6

NO MEDICAL CONDITION .,..., 07

SENILITY.................................. os

STROKE................................... 09

OTHER DISEASE OR

CONDITION (SPECIW) .,...... 91

CATI PROGRAMMER:

SPACE SHOULD BE LE~ IN B-91 FOR ALL THE MULTIPLE RESPONSE

CATEGORIES USED IN ~.

137
B-92. How long did

(he/she) star

GO TO CHART

A17ER CODING

LENGTH OF

STAY.)

B-93. Since (1935/

1980/1970) were

there other

admissions to

a rest home, a

nursing home,

a mental heakh

facility, a

rehabilitation

center or any

place like that?

B-93a.

B-93b.

B-93c.

ADMISSION# 1

#: l_l_l

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

STILL THERE ................ 94

LESS THAN

ONE WEEK ................ 95

(CHART)

YES ......... 1 (Q. B-B7)

NO ........... 2

ADMISSION# 2

#: Ill——

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

STILL THERE ................ 94

LESS THAN

ONE WEEK ................ 95

(CHART)

YES ......... 1 (Q. B437)

NO ........... 2

ADMISSION# 3

#: Ill

OF WKS ............... 1

MOS ............... 2

YRS ................ 3

STILL THERE ................ W

LESS THAN

ONE WEEK ................ 95

(CHART)

YES ......... 1 (Q. B-B7)

NO ........... 2

During the month before (his/her) death, was there significant change in (his/her) heatth?

YES .................................................................. 1

NO .................................................................... 2

During the 12 months prior to that, what was happening to (his/her) health? Had it improved, remained the

same, gradually worsened, or suddenly worsened?

IMPROVED ...................................................... 1

REMAINED THE SAME ................................... 2

GRADUALLY WORSENED .............................. 3

SUDDENLY WORSENED ................................ 4

Did (SUBJECT die in a hospital or nursing home?

YES .................................................................. 1 (CHART)

NO .................................................................... 2

138
B-93d. What was the cause of (SU BJECT’S) death?

HEART AITACK .............................................. 01

OTHER HEART CONDITION .......................... 02

STROKE, SMALL STROKE, TIA,

POSSIBLE STROKE ..................................... 03

DIABETES ........................................................ 04

HIGH BLOOD PRESSURE .............................. 05

CANCER .......................................................... 06

KIDNEY CONDITION ...................................... 07

PNEUMONIA OR FLU ..................................... W

OLD AGE ......................................................... 09

OTHER ............................................................. 10 (SECTION D)

DON’T KNOW .................................................. EM

B-93f. Did a doctor say that (CO NDITION) was the cause of death?

YES .................................................................. 1

NO .................................................................... 2 (SECTION D)

DON’T KNOW .................................................. 8

CATI PROGRAMMER

PUT IN A CONSISTENCY CHECK SO THAT THE CAUSE LISTED IN B-93e IS

CONSISTENT WITH THE APPROPRIATE ‘CONDITION” QUESTIONS ASKED EARLIER.

B-93g - B-93j ARE ASKED OF PEOPLE THAT COULD NOT

COMPLETE ALL OF SECTION B.

B-93g. [1 have recorded that (SUBJECT) was hospitalized (READ DATES, CONDITIONS AND FACILITY NAMES

FROM CHART).] Now, I would like you to think back over the time between (19B5/1 980/1970) and the time

(he/she) died. (He/She) would have been about ~ in (19B5/19B0/1970). Had (he/she) stayed in a

hospital for anv (other) reason including tests or for observation since (he/she) was ~? [PROBE: Was

(he/she) there for more than a dafl]

YES .................................................................. 1 (CHART)

NO .................................................................... 2

139
B-93h. Since (19S5/19B0/1970),had (SU BJECl_) ever stayed in a rest home, a nursing home, a mental health

facility, or anything like that? [PROBE: Was (he/she) there for more than a dafl]

YES ......................u...n............................n.......... 1 (CHART)

NO .................................................................... 2

B-93i. Did (SUBJECTl die in a hospital or nursing home?

YES .................................................................. 1 (CHART)

NO .................................................................... 2

B-93j. What was the cause of (SUBJECT’S) death?

HEART AITACK .............................................. 01

OTHER HEART CONDITION .......................... 02

STROKE, SMALL STROKE, TIA,

POSSIBLE STROKE ..................................... 03

DIABETES ........................................................ 04

HIGH BLOOD PRESSURE .............................. 05

CANCER .......................................................... 06

KIDNEY CONDITION ...................................... 07

PNEUMONIA OR FLU ....................................- 08

OLD AGE ......................................................... ~

OTHER ............................................................. 10

DON’T KNOW .................................................. 96

B-94 THROUGH B-9B ON ~ NOT ASKED.

TIME ENDED: AM

PM

PART C NOT ASKED THIS VERSION.

140
PART D: SMOKING AND ALCOHOLIC BEVERAGES

TIME BEGAN: AM

PM

These next few questions are about (SUBJECT’S) smoking and drinking habits.

BOX HI

IF ~ IS A RELATIVE (A4a= 1-7,91 ,92) THEN GO TO RPI-24.

IF ~ 1S NOT A REIATIVE GO TO D4.

D-O. Do you think you can answer questions about this subject?

YES .................................................................. 1

NO .................................................................... 2 (SECTION G)

RPI-24

REFERENCE TO lF/ECF INTERVIEW IF NEVER INTERVIEWED OR ~ REPORTED

“NEVER SMOKED” AT ~ INTERVIEW ~ (D-1 = 2) OR ~ (L-1 =2)] THEN GO

TO Q.D-l . OTHERWISE GO TO RPI-25.

D-1. Did ~UBJECl_I ever smoke at least lIX cigarettes in (his/her) lifetime?

YES .................................................................. 1

NO .................................................................... 2 (Q.JI-11)

D-2. During the year prior to (his/her) death, did (he/she) smoke cigarettes?

YES .................................................................. 1

NO .................................................................... 2 (Q.D-5)

DON’T KNOW .................................................. 8 (Q-D-I 1)

D-3. About how many cigarettes a day did (he/she) smoke? [IF ANSWER IS NUMBER OF PACKS, MULTIPLY

BY 20 AND VERIFY.]

NUMBER OF CIGARETTES: l_l_l_l

LESS THAN ONE A DAY .............................. 995

141
D-& For how many years did (he/she) smoke cigarettes?

NUMBER OF YEARS:

D-5. When did (he/she) stop smoking cigarettes?

MONTH:

~

l_l_l (Q-D-11)

l_l_l

YEAR: 191 _l_l

D+. During the years when (he/she) was smoking, about how many cigarettes a day did (he/she) smoke? [IF

ANSWER IS NUMBER OF PACKS, MULTIPLY BY 20 AND VERIFY.]

NUMBER OF CIGAREITES: I_l_l_l

LESS THAN ONE A DAY .............................. 995

D-7. For how many years did (he/she) smoke cigarettes?

NUMBER OF YEARS: l_l_l (Q.D-20)

RPI-25

IF ~ WAS A CURRENT OR FORMER SMOKER ON THE ~ (L-2a=l,2) OR WAS A CURRENT

OR FORMER SMOKER ON THE ~ (D-2= 1,2) THEN GO TO D-B OTHERWISE, GO TO D-1 1.

D-B. During the year prior to (his/her) death, did (he/she) smoke cigarettes?

YES .................................................................. 1

NO .................................................................... 2 (Q.D-11)

REFUSED ........................................................ 7 (Q.D-11)

D-9. About how many cigarettes a day did (he/she) smoke? [IF ANSWER IS NUMBER OF PACKS, MULTIPLY

BY 20 AND VERIH.]

NUMBER OF CIGAREITES: I I l_l

LESS THAN ONE A DAY .............................. 995

D-10 ON ~ NOT ASKED.

142
D-II. Now 1would like to talk to you about drinking beer, or w“ne, or liquor. Did (SUBJEC~ have at least one

drink of beer, wine, or liquor during year prior to (his/her) death?

YES .................................................................. 1

NO .................................................................... 2 (PART E)

D-12. During the year prior to (SUBJECTI death, how often did (he/she) drink beef?

NUMBER OF DAYS: I I I PER: WEEK ............... 1

MONTH ............ 2

MORE THAN 3 BUT LESS THAN 12 TIMES PER YEAR ............. 94

NO MORE THAN 3 TIMES PER YEAR ......................................... 95

NONE ............................................................................................. m (D-14)

DK ................................................................................................... 96 (D-13)

D-13. On the days (he/she) drank beer, how many cans, bottles or glasses did (he/she) drink?

NLJMBE~OFDRINKS:l_l_l

LESS THAN ONE DRINK ................................ 95

D-14. During the year prior to (SU BJECT) death, how often did (he/she) drink wine?

NUMBEROFDAYS: l_l_l PER: WEEK ............... 1

MONTH ............ 2

MORE THAN 3 BUT LESS THAN 12 TIMES PER YEAR ............. 94

NO MORE THAN 3 TIMES PER YEAR ......................................... 95

NONE ............................................................................................. 00 (D-16)

DK ................................................................................................... 96 (D-15)

D-15. On the days (he/she) drank wine, how many glasses did (he/she) drink?

NUMBEROFDRINKS:I I I

LESS THAN ONE DRINK ................................ 95

D-16. During the year prior to (SUBJECT) dealh, how often did (he/she) drink Iiquot?

NUMBER OF DAYS: I I I PER: WEEK ............... 1 _—

MONTH ............ 2

MORE THAN 3 BUT LESS THAN 12 TIMES PER YEAR ............. 94

NO MORE THAN 3 TIMES PER YEAR ......................................... 95

NONE ............................................................................................. ~ (SECTION E)

DK ................................................................................................... 96 (D-17)

D-17. On the days (he/she) drank liquor, how many drinks did (he/she) have?

NUMBEROFDRINKS:l_l_l

LESS THAN ONE DRINK ................................ 95

TIME ENDED: AM

PM

PARTS E AND F NOT ASKED.

143
PARTG: PREGNANCY AND MENSTRUAL HISTORY

TIME BEGAN: AM

PM

I

BOX J

INTERVIEWER: CIRCLE ONE.

IFS IS MALE ........................................... 1 (PARTH)

lFSIS FEMALE ...................................... 2

These next few questions are about (SUBJECTS) reproductive and menstrual history.

BOX J1

IF ~ IS A REIATIVE (A4a= 1-7,91 ,92) THEN GO TO RP1-29a.

IF ~ IS NOT A REIATIVE GO TO G4.

G-O. Do you think you can answer queetions about this subject’?

YES .................................................................. 1

NO .................................................................... 2 (SECTION H)

I RP1-29a I

IF ~ WAS INTERVIEWED ON EITHER THE ~ OR ~ THEN GO TO G-10.

IF ~ WAS NEVER INTERVIEWED THEN GO TO G-1 .

G-1 . Was she ever pregnant? Include live births, stillbifihs, miscarriages or abortions.

YES .................................................................. 1

NO .................................................................... 2 (Q.G-1o)

G-2 ON ~ NOT ASKED.

144
G-3 How old was she when her ~ child was born? This means the first child born alive or stillborn.

AGE IN YEARS: .......................

Ill (Q.GJ3)

HAD NO BIRTHS ............................................. 00 (Q.Gi3)

G-4 AND G-5 FROM ~ NOT ASKED.

G-6. How old was she when her ~ child was born? Include stillbirths.

AGE IN YEARS: .......................

Ill

ONLY ONE BIRTH ........................................... 95

G-7. How many ~ births did she have?

G-8, Did she ever have a miscarriage?

NUMBER OF LIVE BIRTHS: ............

l_l_l

YES .................................................................. 1

NO .................................................................... 2 (Q.G-1O)

G-9. How many miscarriages did she have?

NUMBER OF MISCARRIAGES: .......

l_l_l

G-10. At the time of her death, did she still have her womb or uterus?

YES .................................................................. 1 (Q.G-12)

NO .................................................................... 2

DK ..................................................................... B (Q.G-I 2)

DISCREPANCY ................................................ * (Q.G-12)

CATI PROGRAMMER

IF G-10=1 AND ~ DID NOT HAVE INTACT UTERUS ON

~ (C14=2) THEN CODE G-1o AS “DISCREPANCY= %.”

145
G-II.

G-12.

How old was she when her uterus or womb was removed?

AGE: .........................................

Ill

DISCREPANCY ................................................ 96

At the time of her death, did she still have QotJ of her ovaries?

YES .................................................................. 1 (RP1-34a)

NO .................................................................... 2 (Q.G-13)

DK ..................................................................... 8 (RP1-34a)

G-13. Did she still have one ovary’?

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8 (flP1-34a)

G-14. How old was she when her (ovary/last ovary) (were/was) removed?

AGE: ..........................s..............

l_l_l

DISCREPANCY ................................................ 96

RP1-34a

REFERENCE TO lF/ECF. IF NEVER INTERVIEWED GO TO G-21.

OTHERWISE GO TO SECTION H.

G-15 THROUGH G-20 ON —SPI NOT ASKED.

146
G-21 .

G-22a.

G-22b.

Did she ever take female hormone pills such as estrogen or premarin for reasons related to the menopause

or change of life such as hot flashes, mood changes or bone loss?

YES .................................................................. 1

NO .................................................................... 2 (Q.G-32)

DON’T KNOW 11’PE OF PILL ......................... 3

DON’T KNOW .................................................. 8 (G-32)

What is the longest period of time that she continuously took (hormone pills/these pills)? That is, without

stopping for at least one month.

I I IWDI I 1)

YEARS AND MONTHS .................................... 1

MONTHS ......................................................... 2

YEARS ............................................................. 3

LESS THAN ONE MONTH .............................. 95

Now thinking about the t- amount of time she had taken these pills, how many months or years had she

actually used them? Please do not include the times when she might have stopped taking the pill for at

Iea.slone month.

l_l_l (ANDI I 1)

YEARS AND MONTHS .................................... 1

MONTHS ......................................................... 2

YEARS ............................................................. 3

LESS THAN ONE MONTH .............................. 95

CATI PROGRAMMER

HAVE INTERVIEWER FILL IN BOTH “MONTHS AND WEARS FOR G22a AND G22b.

IF G-21=3 THEN FILL IN ‘THESE PILLS” FOR G22a

G-23 THROUGH G-31 b ON ~ NOT ASKED.

G-32. Did she ever take birth control pills for any reason?

YES .................................................................. 1

NO .................................................................... 2 (Q.G40)

147
G-33.

G-34

G-35.

G-36a.

G-36b.

How old was she when she first tmk bitth control pills?

AGE: ..................................................

Ill

BOX K2

IF ~ WOULD HAVE BEEN 55 NOW GO TO G-35.

In the year prior to her death, was she taking birth control pills?

YES .................................................................. 1 (Q.G-36a)

NO .................................................................... 2

HOWold was she when she last took birth control pills?

AGE: ..................................................

l_l_l

What is the longest period of time that she continuously took (birth mntrol pills/these pills)? That is, without

stopping for at least one month.

l_l_l (AND I I 1)

YEARS AND MONTHS .................................... 1

MONTHS ......................................................... 2

YEARS ............................................................. 3

LESS THAN ONE MONTH .............................. 95

Now thinking about the ~ amount of time she had taken these pills, how many months or years had she

actually used them? Please do not include the periods when she might have stopped taking the pill for at

least one month.

I I I(ANDI I 1)

YEARS AND MONTHS .................................... 1

MONTHS ......................................................... 2

YEARS ............................................................. 3

LESS THAN ONE MONTH .............................. 95

14a
G-37 THR9UGH G-39 ON ~ NOT ASKED.

G40. Did she ever have an operation to be sterilized also known aa a tubal ligation or having your tubes tied?

YES .................................................................. 1

NO .................................................................... 2 (SECTION H)

G41 . How old was she when she had this procedure?

AGE: .................................................. Ill

G42 THROUGH G-55 ON ~ NOT ASKED.

149
PART H: DEATH CERTIFICATE, SOCIAL SECURITY/MEDICARE

NUMBER AND CLOSING STATEMENTS

TIME BEGAN: AM

PM

BOX K4

DEATH CERTIFICATE ~ OBTAINED ...................................................... BOX L2

DEATH CERTIFICATE WAS NOT OBTAINED BUT SUF ~

COMPLETED RIGHT BEFORE THIS INTERVIEW ................................ BOX W

DEATH CERTIFICATE WAS NOT OBTAINED AND SUF WAS NOT

COMPLETED RIGHT BEFORE THIS INTERVIEW..., ............................. H43a

H4a. As part of this survey, we are contacting vital records agencies and requesting death cmificates on

participants who have died. At present, we have been unable to locate (SUBJECT’S) certificate. I would

like to reconfirm some information wkh you. When did @UBJECll die?

MONTH: Ill

DAY Ill

YEAR: 19 I_l_l

H-Oh. [n what city, county, and state did (SUBJEC~ die? [IF LOUISIANA, PROBE FOR PARISH.]

CITY:

COUNTY/PARISH:

STATE

H4c, Was (he/she) buried in the same cm

YES .................................................................. 1

NO .................................................................... 2

DK ..................................................................... 8

150
BOX IJ2

IF ~ WOULD HAVE BEEN B5 OR OLDER INSERT “AND HEALTH INSURANCE

STATUS IN THE FOLLOWING INTRODUCTION

Before finishing the interview, I have a few questions about (SUBJECT’S) background [and health

insurance status].

BOX M

~ WOULD HAVE BEEN AT LEAST S5 YEARS OLD NOW ............. 1 (H-1)

~ WOULD HAVE BEEN LESS THAN 65 YEARS OLD NOW .......... 2 (RPI+2)

H-1 . Medicare is a social securii health insurance program for people S5 years old or over. People who are

covered by Medicare have a red, white and blue Medicare card. Was (SUBJECTI covered by Medicare?

YES .................................................................. 1

NO .................................................................... 2

RPI-42

REFERENCE TO lF/ECF IF ~ SUPPLIED A SOCIAL SECURITY NUMBER ON lF/ECF AND

IS ON MEDICARE (H-1 =1), THEN SUBSTITUTE “MEDICARE NUMBER” IN THE FOLLOWING

INTRODUCTION. IF A SOCIAL SECURITY NUMBER WAS NOT COLLECTED ON THE

~ AND THE S IS ON MEDICARE, THEN SU~TITLJTE ‘MEDICARE NUMBER AND

SOCIAL SECURITY NUMBERm IN THE FOLLOWING INTRODUCTION. IF A SOCIAL

SECURITY NUMBER WAS NOT SUPPLIED ON THE lF/ECF AND THE PERSON IS NOT ON

MEDICARE THEN SUBSTITUTE “SOCIAL SECURllY NUMBER” IN THE FOLLOWING

INTRODUCTION. IF THE ~ SUPPLIED A SOCIAL SECURITY NUMBER ON THE lF/ECF AND

IS NOT ON MEDICARE,THEN GO TO RP145.

As part of this survey, I’d like to have (SUBJE Cl%) (Social Security number/Medicare number/Medime

and Social Securii numbers). This information is voluntary and is collected under the authority of the

Public Health Service Aot. There will be no effect on any bene~s that are being received whether or not you

decide to provide the number(s). (The Public heafttr Servim Ad is title 42, United States Code, Section

242k).

RPI-43

REFERENCE TO lF/ECF INTERVIEW IF DID NOT SUPPLY SOCIAL SECURIW

NUMBER ON lF/ECF, GO TO RP14.4. OTHERWISE, GO TO BOX N.

151
RP144

IF ~ IS LESS THAN B5 OR IS 65+ AND NOT ON MEDICARE (H-1 =2) THEN ASK FOR SOCIAL

SECURITY NUMBER IN H-2. IF ~ IS 65+ AND IS ON MEDICARE (H-1 =1) THEN ASK FOR

SOCIAL SECURITY NUMBER AND MEDICARE NUMBER IN H-2.

H-2. What is (SU BJECT’S) social securii number (and health insurance claim number on (his/her) Medicare

card) [READ IF NECESSARY I’ll wait while you get your records for (his/her) (social securii

number/social securky number and medicare card).

Social security numbec

Medicare number I—

_l_

I

_l-1_l_l-1 I I I 1

- l_l_l - I I I l_l (_) (_) (Rp~-@

BOX N

I

IF H-1 = 1 THEN GO TO H-3. OTHERWISE GO TO RPI-45.

H-3. What is the health insurance claim number on (SUBJECT’S) Medicare card? (READ IF NECESSARY I’ll

wait while you get your records.)

Medicare numbec I_l_l_l - l_l_l - l_l_l_l_l (J(J

RP141

REFERENCE TO ECF/lF INTERVIEW IF ~ IS FEMALE AND DID NOT PREVIOUSLY

SUPPLY FATHER’S IAST NAME GO TO Q.H-4. OTHERWISE, GO TO BOX N1 .

H4 Please tell me (SUBJECT~ father’s last name.

FATHER’S LAST NAME:

152
BOX N1

PROXY ANSWERED ALL QUESTIONS1 ......................... 1 (BOX S)

PROXY COULD NOT ANSWER ALL QUESTIONS .......... 2

f

H4a. Is there anyone else who might be able to answer some of the questions about (SUBJECT) that you were

unable to answer?

YES .................................................................. 1 (BOX S)

NO .................................................................... 2

I need this person’s name, address, telephone number and relationship to &UBJECT).

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

cl-w STATE ZIP CODE

TELEPHONE: J )

What W@3 @ECO ND PROXYS) relationship to &~n?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

FATHER UWAW/MOTHER N-IAW .............. 3

GRANDPARENT .............................................. 4

SON/DAUGHTER ........................................... 5

SON lN-MW/DAUGHTER IN-IAW ................ 6

GRANDCHILD .................................................. 7

BROTHER/SISTER ......................................... 8

BROTHER lN-lAW/SISTER IN-LAW .............. 9

AUNT/UNCLE/COUSIN ................................. 10

NIECE/NEPHEW ............................................. 11

ROOMMATE/FRIEND/NEIGHBOR ............... 12

OTHER RELATIVE (SPECIW) ........................ 91

OTHER NON-REIATIVE (SPECIFY) ...............92

.–r —
H-5 AND H-B ON SPI NOT ASKED.

BOX S

IF ~ SAID YES TO ANY HOSPITALIZATION QUESTIONS (B-17=1, B-23=1, B-24=1,

B-27=1, B-29=1, B-35=1, B-2=1, B-4=1, B-52=1, B-55 (Ist, 2nd, or 3rd

diagnosis)=l, B-BI=l, B-70=1, B-71=1, B-74=1, B-79=1, B-B3=I, B-BB=l, B-93g),

THEN GO TO BOX V. OTHERWISE HAVE INTERVIEWER FILL IN BOX T.

BOX T

ARE THERE ANY STAYS RECORDED?

YES ....................................... 1 (CONDITION SECTION)

NO ......................................... 2 (Q. H-13)

BOX V

INTERVIEWER: CIRCLE ONE:

~ IS REIATIVE ........................................ I

~ IS NON-REIATIVE .............................. 2 (Q.H-9)

H-7. As part of this survey, I would like to send you a form that authorizes the United States Public Health Service

to obtain information from hospital or nursing home records. To do this, I need to (confirm/have) your

name and address.

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

And 1need to confirm your telephone number.

TELEPHONE: f )

H-B ON SPI NOT ASKED.

When you receive the form please sign your name. Then return the form in the postage paid envelope.

You will receive a $5.(iXl check for returning the form about lwo weeks after you sign and mail back this

form.

154
BOX W

INTERVIEWER CIRCLE ONE:

~ AGREES TO SIGN ....................................... 1

~ REFUSES TO SIGN ..................................... 2

Thank you very much for taking the time to participate in this interview. (TERMINATE)

H-9. Do you know a relative of (SUBJECTI who could sign this authorization?

YES .................................................................. 1

NO .................................................................... 2 (Q. H-1O)

I need to have the name, address and relationship of a relative of (SUBJECT) who could sign this

authorization. ~ERIFY ALL SPELLING.]

NAME

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: I 1

What is (REIATIVES) relationship to (SU BJECT)?

HUSBAND/WIFE ............................................. 1

FATHER/MOTHER ......................................... 2

GRANDPARENT .............................................. 3

SON/DAUGHTER ........................................... 4

GRANDCHILD .................................................- 5 (H-11)

BROTHER/SISTER ......................................... 6

AUNT/UNCLE/COUSIN ................................. 7

NIECE/NEPHEW ............................................. 8

OTHER REIATIVE [SPECl~ ........................ 91

H

155
H-10. Do you know someone else who has the power of attorney and oould sign this authorization form?

YES .................................................................. 1

NO .................................................................... 2 (H-11)

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: J )

What is (ATTORNEY NAME) relationship to (SUBJECT)?

Attorney ............................................................

Friend ...............................................................

Other (SPECIFY) ..............................................

1

2

3

H-12 NOT ASKED.

H-13. Finally, I would like to confirm your name, address and telephone number.

NAME:

ADDRESS:

STREET NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: J )

Thank you very much for taking the time to patiicipate in this interview. (TERMINATE)

H-14 NOT ASKED.

156
PARTI: OBSERVATION SHEET

(10 BE COMPLETED AT CONCLUSION OF INTERVIEW)

l-l AND I-2 FROM fWJ NOT ASKED.

1-3. DO YOU FEEL THAT THE INFORMATION PROVIDED BY THE RESPONDENT WAS SATISFACTORY?

YES .................................................................. 1 (Q.14)

NO .................................................................... 2

I-4. WHY NOT?

I-5 FROM ~ NOT ASKED.

I-B. IN REGARD TO THE QUESTIONNAIRE, DO YOU FEEL IT . . .

~

a. HELD THE Respondent% AITENTION THROUGHOUT

THE INTERVIEW? ................................................................................- 1

b. WAS UPSE17NG OR DEPRESSING TO THE RESPONDENT? ........ 1

c. WAS BORING OR UNINTERESTING TO THE RESPONDENT? ........ 1

1-7. WITH REGARD TO THE RESPONDENT, DO YOU FEEL THE.. .

~

a- RESPONDENT WAS INTELLECTUALLY CAPABLE OF

RESPONDING? ..................................................................................... 1

b. RESPONDENT’S ANSWERS WERE REASONABLY ACCURATE? .... 1

c. RESPONDENT UNDERSTOOD THE QUESTIONS? .......................... 1

UNCERTAIN

3

3

3

UNCERTAIN

3

3

3

157
I-B. (IF YES TO l-6b OR I+c, OR IF NO TO l-7~ l-7b OR I-7c)

WAS THERE A SECTION THAT SEEMED TO BE PARTICULARLY UPSEl_HNG OR PROBLEMATIC FOR

THE RESPONDENT?

YES .................................................................. 1

NO .................................................................... 2 (QJ-9)

WHICH SECTION AND WHY?

1-9.

1-1o.

1-11,

I-12.

I-13.

WAS THE RESPONDENT HARD OF HEARING?

YES .................................................................. 1

NO .................................................................... 2

WAS THE INTERVIEW CONDUCTED IN SPANISH?

YES .................................................................. 1

NO .................................................................... 2

RECORD ANY RELEVANT COMMENTS OR IMPRESSIONS YOU MAY HAVE HAD ABOUT THIS

INTERVIEW.

RECORD ANY COMMENTS OR PROBLEMS YOU MAY HAVE HAD WHEN RECORDING THE

RESPONSE.

Did you record the ID number [(ID NUMBER)] and the name [(SU BJECT’S NAME)] on the hospital chart?

YES .................................................................. 1

NO .................................................................... 2

158
Questionnaire A (subject mail)

OMB #: 0s37-0134

Expires: June 198B

NHANES 1 EPIDEMIOLOGIC FOLLOWUP STUDY

QUESTIONNAIRE A

PLEASE READ INSTRUCTIONS FIRST

A. Please complete the following questions either by placing a check (/) in

the box next to the answer that best fits your situation QI by writing your

answer in the space provided.

B. Unless the instructions tell you otherwise, check only ~ box.

c. Some questions have instructions next to the answer telling you to skip

questions which do not apply to you. First check the box, then follow the

skip as directed,

D. Please follow all instructions carefully. Instructions are in CAPITAL letters.

E. If you are filling out this questionnaire for a person who is too illto answer

for herself/himself, when reading the questions please substitute the

participant’s name for the word “your.” For example, A-3 would read,

“Does Mr. Jones currently live in a house or apartment, a nursing home or

rest home, or does@ have some other arrangement?”

F. Ifthe person named in A-1 is deceased, do mJJfill out this form. Instead fill

out Questionnaire B. If you are answering questions for a female

participant, please fill out the Questionnaire A supplement - Female

Medical History in addition to fillingout Questionnaire A.

G. If you have any questions about how to fill out the questionnaire or if you

would prefer to answer the questions over the telephone, please call our

toll-free number, 800-423-6754: and ask for Lee Smith, the National

HANES Followup Survey Supervisor.

ASSURANCEOFCONFIDENTIAUIY

All information which would provide identification of the individual will be held in strict

confidence, will be used only for purposes of and by persons engaged in the survey, and will

not be disclosed or released to others for any purposes in accordance with Section 308(d) of

the Public Health Service Act (42 USC 242m),

159
A. GENERAL INFORMATION

A-1 Please review the information in the box below and correct any data that is incorrect or

NAME OF PARTICIPANT:

FIRST MIDDLE LAST

CURRENT ADDRESS:

STREET

Clw STATE ZIP

TELEPHONE NUMBER: ~)

-------------- .......-__ —----.------------------- --------------------- .----------- ..........................

CORRECTIONS: (RECORD CORRECTIONS OR MISSING DATA BELOW)

NAME OF PARTICIPANT:

FIRST MIDDLE LAST

CURRENT ADDRESS:

STREH

cl-n’ STATE ZIP

TELEPHONE NUMBER: ~)

A-2. What is your date of birth?

MONTH DAY YEAR

A-3. Do vou currentlv live in a house or apartment, a nursing home or rest home, or do you have

some other arra-ngement?

❑

House or

1

apartment

❑

Nursing or convalescent

2

or rest home

A-4. Do you live alone?

1 u Yes

2 U No (SKIP TO QUESTION A%)

4❑

Boarding house, rooming

house or rented room

Some other arrangement?

(DESCRIBE)

4

A-5. How long have you lived alone?

#OF YEARS: (SKIP TO QUESTION A-7)

OR #OF MONTHS: (SKIP TO QUESTION A-7)

160
A-6. What is the sex and relationship tow of the other people who live in your household? If

you do not live in a household (for example, you live in a nursing home), tell us who you

~ved with - you entered the nursing home.

RELATIONSHIP OF

HOUSEHOLD MEMBERS (e.g., HUSBAND)

.

1.

2,

3.

4.

5.

6

7

8.

SEX (MALE OR FEMALE)

A-7. Are you currenlly married, widowed, divorced. separated, or have you never been married?

1❑ Married 4❑ Separated

2❑ Widowed 5❑ Never married

3❑ Divorced

A-8. As pan of this survey, we would like to have your social security number and your health

insurance claim number on your Medi~re card (if you have one). Provision of these

numbers is voluntary and not providing these numbers will not have any effect on your

receipt of benefits from the Federal Government. These numbers will be useful in

conducting future followup studies. They 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 numbefl What is your Medi~re number?

Social Security #: m-m-urn

Medicare #:

B. YOUR HEALTH

These next questions are about your health.

B-I. Would you say that your health in general is excellent, very good, good, fair or poor?

1 I I Excellent 4 I I Fair

2❑ Very good 5❑ Poor

B-2. Did a doctor ~ tell you that you have arthritis?

Yes

NO (SKIP TO QUESTION B-5)

Don’t know (SKIP TO QUESTION B-5)

161
B-3. What type of arthritis do you have?

1

•1 Rheumatoid 5D

z ❑ Osteoarthritis 6D

3 U Lupus

4❑ Gout 13n

Degenerat”we

Another type (qESC#+lBE)

Don’t know

04, In what year were you@ told you had arthritis?

YEAR

B-5. Since hasadoctor told youthat youhadany of the following conditions? If

you have, please also tell ustheyears youhad the condition. (CHECK AI-J THAT APPLY

AND RECORD YEARS HAD CONDITION.)

CONDITION

1.

•1

Heart attack

2.

•1

TIA

3.0 Stroke

4u Broken or fractured hip

Kidne stones o~kidney disorder

5.D other 7“hanmfectlons

YEARS HAD CONDITION I

B-6, Have you ~ had any of the following surgeries or procedures performed? If you have,

please tell us the years that you had the surgery or procedure, (CHECK ~ THAT APPLY

AND RECORD YEARS HAD SURGERY/PROCEDURE,)

3. ❑

4.❑

SURGERY

Coronay by-pass

Pacemaker replacement, inseition or repair

Cataract surgery

I

MALES ONLY) vasectomy

operation to be sterilized)

B-7. Have you -r been told by the doctor that you had either of the following conditions If

vou have. Dlease tell us the vear vou were @l told You had the condition. (CHECK U

iHAT APPLY AND RECORD iEAIi FIRST TOLD.)

CONDITION YEAR FIRST TOLD

1.❑ Osteoporosis

20 more%anthreetimes

Urina tractor kidney infection

162
B-8.

B-9.

B-1O.

B-1 1.

B-12.

B-13.

B-14.

B-15.

Did a doctor qg tell you you have diabetes or sugar diabetes?

1❑ Yes

2❑ NO (SKIP TO QUESTION B-12)

8❑ Don’t know (SKIP TO QUESTION B-12)

In what year were you m told that you had diabetes or sugar diabetes?

YEAR

Are you ~w taking insulin injections for your diabetes?

1

•1

Yes (SKIP TO QUESTION B-12)

2D No

8❑ Don’t know

Are you ~ taking pills for your diabetes?

1❑ Yes

Zn No

8

•1

Don’t know

Have you w been told by the doctor that you had high blood pressure or hypertension?

Yes

No (SKIP TO QUESTION B-16)

Don’t know (SKIP TO QUESTION B-16)

In what year were you f- told that you had high blood pressure or hypertension?

YEAR

Has the doctor ~ prescribti medicine for your high blood pressure?

1u ‘es

2❑ No (SKIP TO QUESTION B-16)

8❑ Don’t know (SKIP TO QUESTION B-16)

Are you ~ taking medication for high blomi pressure?

1❑ Yes

2D No

8❑ Don’t know

163
B-16

0-17,

B-I 8,

B-19,

B-20,

B-21

B-22.

Since have you had any type of cancer diagnosed includlng skin cancer?

1❑ Yes

2❑ No (SKIP TO QUESTION B-18)

B U Don’t know (SKIP TO QUESTION B-18)

Where was the cancer or what type of cancer was it? In what year were you !@ told that

you had this type of cancer?

I

lYPE OF CANCER

I 1.

3.

Since j.xQ, have you broken or fractured your wrist?

1❑ Yes

2U NO(SI(IPTOCWESTION B-2CI)

8 I I Don’t know (SKIP TO QUESTION B-20)

YEAR FIRST TOLD I

Since ~ in what yeare was your wrist broken or fractured? Please list all years

YEARS BROKEN

1,

2,

3.

(IF YOU ARE AGE 64 OR OLDER, ANSWER B-20 - B-22. OTHERWISE SKIP TP B-23.)

During the past 12 months, have you had a fall where you have fallen and landad on the

floor or ground or hit an object Ilke a table or stair?

2 U No (SKIP TO QUESTION B-23)

B U Don’t know (SKIP TO QUESTION B-23)

How many times have you fallen like thieduring the past 12 months?

#OF TIMES:

Did any of these falls:

WJW

1. cauee a broken bone? LID

2. cause you to hit or injure your head? EID

3, cause you to seek medical care? ❑ O

4, cause you to be hospitalized

for more than one da~ ❑ 0

164
B-23. Since , have you stayed in a hospital gv.erniohtor [onaer for any reason? For

each stay, please record the date you went to the hospital, the reason or reasons you went

to the hospital and the name ad address of the hospital.

1❑ Yes - RECORD ALL STAYS BELOW

2 m NO (SKIP TO QUESTION B-24)

STAY #1:

STAY #2:

STAY #3:

STAY #4:

STAY #5:

DATE OF ADMISSION:

REASON FOR STAY

NAME OF HOSPITAL:

ADDRESS OF HOSPITAL

STRE~

cm’ STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

~— DA YR

REASON FOR STAY

NAME OF HOSPITAL:

ADDRESS OF HOSPITAL

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

‘~ MO YR

REASON FOR STAY

NAME OF HOSPITAL:

ADDRESS OF HOSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

‘~ MO YR

REASON FOR STAY

NAME OF HOSPITAL

ADDRESS OF HOSPITAL

STREEf

cm’ STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

NAME OF HOSPITAL:

ADDRESS OF HOSPITAL

STREET

CITY STATE

OTHER COMMENTS:

(IF YOU HAVE STAYED IN A HOSPITAL OVERNIGHT OR LONGER FOR MORE THAN FIVE

TIMES, PLEASE CONTINUE RECORDING INFORMATION ABOUT STAYS ON A SHE~ OF

PAPER AND INCLUDE IT IN THE REWRN ENVELOPE.)

165
B-24. Since , have you ever stayed overnight or longer in a rest home, a nursing

home, a mental health facility, or anything like that? For each stay, please record the date

you went into the facility, the reason or reasons you went to the facility, the type of facility

(e.g., nursing home) and the name and address of the facility.

1u Yes-RECORD ALL STAYS BELOW

2 U NO (SKIP TO QUESTION B-25)

STAY #1: DATE OF ADMISSION: / /

MO DA ‘fR

REASON FOR STAY:

TfPE OF FACILITY:

NAME OF FACILITY

ADDRESS OF FACILITY:

STREEf

CITY STATE

OTHER COMMENTS:

STAY #2: DATE OF ADMISSION: M. /__& YR

REASON FOR STAY

TYPE OF FACILITY:

NAME OF FACILllY:

ADDRESS OF FACILITY

STREET

CITY STATE

OTHER COMMENTS:

STAY #3: DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY

TYPE OF FACILITY:

NAME OF FACILIW.

ADDRESS OF FACILITY:

STREH

cl-l-f STATE

OTHER COMMENTS:

STAY #4: DATE OF ADMISSION: I I

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILITY

ADDRESS OF FACILllY:

STREH

CITY STATE

OTHER COMMENTS:

(IF YOU HAVE STAYED IN ANY HEALTH CARE FACILITY OVERNIGHT OR LONGER FOR

MORE THAN FOUR TIMES, PLEASE CONTINUE RECORDING INFORMATION ABOUT STAYS

ON A SHE~ OF PAPER AND INCLUDE IT IN THE RZWRN ENVELOPE.)

166
B-25. (IF YOU ARE CURRENTLY IN A NURSING HOME, ANSWER B-25 AND B-26; OTHERWISE,

SKIP TO B-27.) During the month before your admission to the nursing home, was there a

significant change in your health?

1

•1 Yes

2U No

B-26. During the 12 months prior to that, what was happening to your health? Had ft improved,

remained the same, gradually worsened, or suddenly worsened?

1❑ Improved 3❑ Gradually worserm’

2❑ Remained the same 4❑ Suddenly worsened

B-27, (IF YOU ARE NOT CURRENTLY IN

m

A NURSING HOME, ANSWER B-27; OTHERWISE SKIP

TO B-28.) What has been happening to your health during the past 12 months? Has it

Improved, remained the same, gradually worsened, or suddenly worsened?

1•1 Improved 3❑ Gradually worsened

2❑ Remained the same 4

•1

Suddenly worsened

B-26, As part of this survey, it maybe necessary to obtain additional information from hospital or

nursing home records. The enclosed form entitled “Authorization to Obtain Information

from Medical Records” authorizes the U.S. Public Health Service to obtain this information.

Please read the form and record any other names under which hospital or in-patient health

facility records could be listed. If the records would not be listed under any other name,

check the box Sign your name on the signature of subject line if you are answering the

questionnaire for yourself, If you are answering the questionnaire on behalf of the

Pafiicipant because he/she Is incapacitated, please have the participant fill out his/her

name. Also, be sure to date the form.

Please return all forms in the postage-paid envelope. You will receive a $5.00 check for

returning the questionnaire and a signad form about Wo weeks after you mail us these

forms.

B-29. Please give me the name, address, and telephone number of a relalfve or friend who would

know how to get in touch with you in case we need to contact you again and have a hard

time reaching you.

NAME:

ADDRESS:

STRE~ NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: ( )

How is that parson related to you?

B-3o. (IF YOU ARE ANSWERING THIS QUESTIONNAIRE FOR ANOTHER PERSON):

Please record your name. address and telephone number and your relationship to the

participant.

NAME:

ADDRESS:

STRE~ NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: ( )

REUTIONSHIP TO PARTICIPANT:

Thank you very much for taking the time to participate in this interview. Please continue

with the Questlonnalre A Supplement if you are answering questions about a female

pafiicipant.

167
Chestionnaire A Supplement (Female Medical History– mail version)

OMB #: 0937.0134

Expires: Juno 19BS

NHANES I EPIDEMIOLOGIC FOLLOWUP STUDY

QUESTIONNAIRE A - SUPPLEMENT

(TO BE ANSWERED ABOUT FEMALE PARTICIPANTS ONLY)

C. FEMALE MEDICAL HISTORY

c-1.

c-2.

c-3.

C4.

c-5.

C-6.

c-7.

c-8.

Have you ever been pregnant? Include live births, stillblrlhs, miscarriages and abortions.

1 ❑ yes

2 u No (SKIPTO QUESTION C-7)

How old were you when your ~ child was born? This means the first child born alive or

stillborn. (IF NONE, RECORD NONE ON LINE BELOW,)

AGE

How old were you when your ~ child was born? Include stlllbkths. (IF NONE, RECORD

NONE ON LINE BELOW.)

AGE

How many ~ births have you had? (IF NONE, RECORD NONE ON LINE BELOW.)

AGE

Have you ever had a mk.arriage?

1 ❑ Yes

2 ❑ NO(SKIPTOQUEST,ON C-7)

How many miscarriages have you had?

# OF MISCARRIAGES

Do you still have your womb or uterus?

❑ Yes (SKIP TO QUESTION C-9)

:D No

en Don’t know (SKIP TO QUESTION C-9)

How old were you when your uterus or womb was removed?

AGE

168
c-9. Do you still have both your ovaries, only one ovary or no ovaries?

c-lo.

c-1 1.

C-12.

c-1 3.

C-14.

c-1 5.

C-16.

c-1 7.

1❑ Both ovaries (SKIP TO QUESTION C-II)

2 ❑ Only one ovary

3 ❑ No ovaries

How old were you when your ovaiy or ovaries were removed?

AGE

AGE

Are you still having periods?

1 •1 Yes (SKIP TO QUESTION C-13)

2 ❑ No

At what age did you have your ~ period?

(SKIP TO QUESTION C-15)

AGE

Are your periods regular or irregular? By regular we mean that your pericds come abom

once a month; you can usually predict when they will come and they usually last about the

same number of days.

1 ❑ Regular (SKIP TO QUESTION C15)

2 ❑ Irregular

Are they irregular because you are going through the change of life or for some other

reason?

1 ❑ Change of life

2 ❑ Other reason

B❑ Dent’ know

Did you M take hormone pills such as estrogen or premarin For reasons related to

menopause or change of life such as hot flashes, mood changes or bone loss?

2 •1 No (SKIP TO QUESTION C-26)

3 ❑ Not menopausal (SKIP TO QUESTION C-26)

8 ❑ Don’t know (SKIP TO QUESTION C-26)

How old were you when you fJQ took hormone pills?

AGE

How old were you when you ~ took hormone pills?

~ ❑ Stilltaking hormone pills

A,-.e

169
C-18.

C-19.

C-20.

C-21.

c-22.

C-23.

What Is the longest pericd of time that you have go ntinuously taken hormone pills? That is,

without stopping for at least one month.

AND

YEARS MONTHS

~ U Less than one month

Now thinking about the total amount of time you have taken these pills, for how many years

and months have you actually used them? Please do not include the times when you might

have stopped taking the pill for at least one month.

AND

YEARS MONTHS

~ ❑ Less than one month

Are you currently taking hormone pills?

1 ❑ Yes

2 •1 NO (SKIP TO QUESTION C-26)

8 ❑ Don’t know (SKIP TO QUESTION C-26)

What is the color of the hormone pill you are taking?

1 ❑

2❑

3❑

4❑

5❑

a❑

Purple/Blue

Yellow/Orange

White

Maroon/Brown/Red

Green

Don’t know

How long have you been taking this same color pill?

#OF YEARS

#OF MONTHS

~ ❑ Less than one month

In addition to estrogen, sometimes women also use the female hormone progestin

sometimes called PROVERA at the change of life or after a hysterectomy. These pills are

often taken along with an estrogen pill for only parI of the month. Have you ever taken

progestin or PROVERA?

1 ❑ Yes

2 ❑ NO (SKIP TO QUESTION C-26)

8 ❑ Don’t know (SKIP TO QUESTION C-26)

170
C-24. Are you currently taking these pills?

1 U ‘fes

2 ❑ No

C-25. How long have you taken these pills?

#OF YEARS

#OF MONTHS

~ ❑ Less than one month

C-26. Did you N take birth control pills for any reason?

1 ❑ Yes

2 ❑ No (SKIP TO QUESTION C-34)

8 •1 Don’t know (SKIP TO QUESTION C-34)

C-27.

C-28.

C-29.

C-30.

C-31

How old were you when you f~ took birth control pills?

AGE

How old were you when you ~ took birth control pills?

QB ❑ Still taking bitth control pills

AGE

What is the longest pericd of time that you have continuously taken birth control pills? That

is, without stopping for at least one month.

AND

YEARS MONTHS

❑ Less than one month

Now, thinking about the total amount of time you have taken these pills, for how many

years and months have you actually used them? Please do not include the times when you

might have stopped taking the pill for at least one month.

AND

YEARS MONTHS

~ ❑ Less than one month

How many months and yeacs did you use birth control pills prior to the age of 25? Please

do not include the times when you might have stopped taking the pill for at least one

month. (IF NONE, RECORD NONE ON LINE BELOW

AND

YEARS MONTHS

~ ❑ Less than one month

171
C-32. Did you use birth control pills before your f~ child was born?

1 ❑ Yes

2 ❑ No (SKIP TO QUESTION C-34)

8 •1 Don’t know (SKIP TO QUESTION C-34)

C-33. How many years and months before your first child was born did you use birth control

pills? Please do not include the times when you might have stopped taking the pill for at

C-34,

c-35.

C-36,

c-37.

c-38.

least one month.

AND

YEARS MONTHS

~ ❑ Less than one month

Have you ~ had an operation to be sterilized, also known as a tubal ligation or having

your tubes tied?

1❑

2 ❑

8 •1

Yes

NO (SKIP TO QUESTION C-36)

Don’t know (SKIP TO QUESTION C-36)

How old were you when you had thk procedure?

AGE

Have you ~ regularfy taken calcium pills or calcium-rich antacids such as Turns for the

purpose of calcium supplementation?

1 ❑

2 ❑

8 ❑

Yes

No (SKIP TO QUESTION C-38)

Don’t know (SKIP TO QUESTION C-38)

How long did you take calcium regularly?

# OF YEARS

# OF MONTHS

~ ❑ Less than one month

Have you -r had any of the following procedures performed? If so, please tell us how

many times you had this procedure done within the past 5 vea r$ and in what month and

year did you @ have the procedure performed? (IF YES, RECORD # OF TIMES AND

DATE LAST DONE)

Ever Had Procedure # of Times bst Month/Year Done

mm in Past 5 Years

10 ❑ Pap Smear test /_

2 ❑ ❑ B,SSSI /—

examination by

doctor

3 ❑ ❑ Mammogram /—

172
C-39. Do you know how to examine your own breasts for lumps?

1 •1 Yes

2 c1 No (SKIP TO END)

C40. Have you ever examined your own breasts for lumps?

1❑ Yes

2 •1 No (SKIP TO END)

C-41. During the past vea r, how often did you examine your own breasts for lumps? (IF NEVER,

RECORD O)

#OF TIMES

Thank you very much for taking the time to participate in this interview.

173
Questionnaire B (proxy mail)

OMB #: 0937-0134

Eupiras: JurIE 19SS

NHANES I EPIDEMIOLOGIC FOLLOWUP STUDY

QUESTIONNAIRE B

PLEASE READ INSTRUCTIONS FIRST

A. Please complete the following questions only if the person named in the

box below is deceased.

B. Please complete the following questions either by placing a check (J ) in

the box nexl to the answer that best fits the situation Q by writing your

answer in the space provided.

c. Unless the instructions tell you otherwise, check only ~ box.

D. Some questions have instructions next to the answer telling you to skip

questions which do not apply to you. First check the box, then follow the

skip as directed.

E. Please follow all instructions carefully. Instructions are in CAPITAL letters.

F. If you have any questions about how to fill out the questionnaire or if you

would prefer to answer the questions over the telephone, please call our

toll-free number, 800-423-6754, and ask for Lee Smith, the National

HANES Followup Suwey Supervisor, J

1. Please review the information in the box below and correct if Incorrect or missing.

NAME OF DECEASED

PARTICIPANT:

FIRST MIDDLE L4ST

DATE OF BIRTH:

MONTH DAY WAR

CORRECTIONS: (RECORD CORRECTIONS OR MISSING DATA BELOW

NAME OF DECEASED

PARTICIPANT:

FIRST MIDDLE AST

DATE OF BIRTH:

MONTH OAY YEAR

1

I

ASSURANCE OF CONFIDENTIALIW

I

All Information which would provide Identification of the individual will be held In strict

confidence, will be used only for purposes of and by persons engaged In the suwey, and will

not be disclosed or releasd to others for any purposes in accordance with Section 30S(d) of

the Public Health Service Act (42 USC 242m).

174
MEDICAL HISTORY

9L. Since , had the participant stayed in a hospital cwemiaht or Ionaer far any

reason? For each stay, please record the date he/she went to the hospital, the reason or

reasons he/she went to the hospital and the name and address of the hospital.

1 •1 Yes - RECORD ALL STAYS BELOW

2 ❑ No (SKIP TO QUESTION 3)

STAY #1:

STAY #2

STAY #3:

STAY #4

STAY #5.

DATE OF ADMISSION: / /

‘~ MO YR

REASON FOR STAY

NAME OF HOSPITAL

ADDRESS OF HOSPITAL

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

~— DA YR

REASON FOR STAY

NAME OF HOSPITAL

ADDRESS OF HOSPITAL:

STRE=

Clw STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

‘~ MO YR

REASON FOR STAY

NAME OF HOSPITAL

ADDRESS OF HOSPITAL:

STREET

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION:

REASON FOR STAY:

NAME OF HOSPITAL

/ /

‘~ MO YR

ADDRESS OF HOSPITAL.

STRE=

CITY STATE

OTHER COMMENTS:

DATE OF ADMISSION: / /

‘~ MO ‘fR

REASON FOR STAY

NAME OF HOSPITAL

ADDRESS OF HOSPITAL

STREET

CITY STATE

OTHER COMMENTS:

(IF HE/SHE STAYED IN A HOSPITAL OVERNIGHT OR LONGER FOR MORE THAN FIVE

TIP,IES, PLEASE CONTINUE RECORDING INFORMATION ABOUT STAYS ON A SHE~ OF

PAPER AND INCLUDE IT IN THE RETURN ENVELOPE, )

175
3. Since , had the participant ever stayed overniaht or Ionaer in a rest home, a

nursing home, a mental health facility, or anything like that? For each stay, please record

the date he/she went into the facility, the reason or reasons he/she went to the facility, the

type of facility (e.g., nursing home) and the name and address of the facility.

1 ❑ Yes - RECORD ALL STAYS BELOW

2 ❑ No (SKIP TO QUESTION 4)

STAY #1:

STAY #2:

STAY #3:

STAY #4:

DATE OF ADMISSION: / /

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACIU~

ADDRESS OF FACILITY:

STREET

OTHER COMMENTS:

DATE OF ADMISSION:

REASON FOR STAY:

TYPE OF FACIU~

NAME OF FACILl~

ADDRESS OF FACILITY:.

OTHER COMMENTS:

DATE OF ADMISSION:

REASON FOR STAY

TYPE OF FACILITY:

NAME OF FACILITY:

ADDRESS OF FACILITY

OTHER COMMENTS:

DATE OF ADMISSION:

CIYY STATE

/ /

MO DA YR

CITY STATE

M. /+ ~R

STRE~

CITY STATE

/ /

MO DA YR

REASON FOR STAY:

TYPE OF FACILITY:

NAME OF FACILIW

ADDRESS OF FACILITY: -

STRE~

CITY STATE

OTHER COMMENTS:

(IF HE/SHE HAD STAYED IN ANY HEALTH CARE FACILITY OVERNIGHT OR LONGER FOR

MORE THAN FOUR TIMES, PLEASE CONTINUE RECORDING INFORMATION ABOUT STAYS

ON A SHEH OF PAPER AND INCLUDE IT IN THE REHJRN ENVELOPE.)

176
4. Did the participant die in either a hospital or nursing home?

1 ❑ Yes

2 •1 NO (SKIP TO QUESTION 6)

8 •1 DON’T KNOW (SKIP TO QUESTION 6)

5. Please record the name and address of the hospital or nursing home.

NAME:

ADDRESS:

STRE~

CITY STATE

6.

7.

8.

9.

10.

What was his/her date of death?

MONTH DAY YEAR

In what city, county and state did he/she die?

CITY:

COUNTY OR PARISH:

STATE:

As pert of this suwey, it maybe necessary to obtain additional information from hospital or

nursing home records. The enclosed form entitled “Authorization to Obtain Information

from Medical Records” authorizes the U.S. Public Health Service to obtain Ibis information.

Please read the form and record any other names under which hospital or in-patient health

facility records could be listed. If the records would not be listed under any other name,

check the box. Sign your name on the signature of next-of-kin line. Also record the date

you signed the form and the date, county and state of death of the participant.

Please return all forms in the postage-paid envelope. You will receive a $5,00 check for

returning the questionnaire and a signed form about two weeks after

forrrs.

Please record your name, address, and telephone number and your

participant.

you mail us these

relationship to the

ADDRESS:

STRE13 NAME AND NUMBER APT. NUMBER

CITY STATE ZIP CODE

TELEPHONE: ( )

RELATIONSHIP TO PARTICIPANT

FEMALEONLY: Please record the participant’s father’s last name.

FATHER’S IAST NAME:

Thank you very much for taking the time to pafiicipate inthis interview.

177
Verbal authorization form to obtain information from

medical records

NHANES I EPIDEMIOLOGIC

FOLLOWLJP STUDY

OMB No. : 0937-0134

Expires: October 1967

Verbal Authorization to Obtain Information

From Medical Records

SUBJECT

This is to certify that has verbally consented

SUBJECT NAME

to sign a medical authorization Form thereby authorizing the release OF

pertinent information regarding hospitalizations, illnesses and health

care.

INTERVIEWER’S SIGNATURE

NEXT-OF-KIN

This is to

DATE —

certify that , who is the

RESPONDENT NAME

RELATIONSHIP TO SUBJECT

consented to sign a medical

of 7 has verbally

SUBJECT NAME

authorization form, thereby authorizing the

release of pertinent information regarding hospitalizations, illnesses and

health care.

INTERVIEWER’S SIGNATURE DATE”—”--”-’-

PHS-62E3

178
Authorization form to obtain information from

medical records

Pla- Ram b: NnaNCW

Epldamlologla FOIlowup amdy

I15U Homaarch Blvd.

!Aockwllla, MD 20Ls0

U.S. Oopa-nt of HodtlI and Human Semlcos

Nstlonsl Contor for HOWI Statistics

National lnstMto on Aging

NHMES I S@damlologle Followup SurYay

AUTHORIZATION TO OBTAIN INFORMATION

FROM MEDICAL RECORDS

OMB Ho: 0m741M

EUPIN: Juna 1s11

NOTICE - Inb-mallon ca+alned on Ihla form ‘.Wch

vauld parmil Id.nllliallen of q Ind#ud a

astmbllshman! h- b-n collecled ~“lh R guuml- lh~

Rwill h haH In XIIICI =nfidanco, will b wed only fm

w.70w sldd for bhlssludy, md till ml b disclmed

w rnlauad 10 olhem Mhout Iha can=nl of Iha

lndMdunl or -Ilshmanl In ncmrdance with Sncliw

338(4 oftlw Publk HedUI Serdco Ad (42 USC 242m).

L

In connection with the health histoy of given as part of the

National Health and Nutrition Examination Followup Suwey, it maybe 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 Sewice may need to request from any of these sources. I understand that I

may revoke this consent at any time except to the extent that action has already been taken. I afso understand

that this authorization expires one year from the date of signature.

I understand that all information obtained will be held strictly confidential.

My records may also be listed under the following first and last names (e.g., name change due to marriage):

OR

Check box ❑ if records would not be Iistti under any other name.

SIGNATURE OF NEXT-OF-KIN SIGNATURE OF SUBJECT

DATE DATE

RELATIONSHIP ~

DATE OF DEATH (MO/DAY/YEAR)

COUNTY AND STATE OF DE4TH

PNS-S2U .

alla

179
Hospital and health care facility chart

Ho5P1 7AL AVO HEALr H CARE FACIL lrf cHARr

lNTERVIEWE~: ASK 08 VE,=IIFY A-F FOR EACH OVERNIGHT STAY, 8ECORD BELOW, 1 A, Wh,r w,, the “am. of the lhm.,,#~YPE OF FACIL(TY)7 (PROBE FOR FULL NAMEI

B, wh. IW=re “Ou,wa, ~TI ,. ,hrS ihOsD,,dny~ OF FACILITY I? IPf108E FOfl DATE I

c, (IF SAME HOSPITAL NAME AND SAME OATE, ASK:) Is IIVS the -me lh.sp,raltzat,.. i,ravl v.. told me about b. f.r. ~

D, what ,, me addre=~ .f ,hls (h05p,,amypE OF FACILTyl? IRECOFID STREET, cmy ANDSTATE I

E.

J

WhV lwm,. w.,w., SUSJECTI m the lhosP,MllTYPE OF FACILITYI? (PROBE FOfl ALL CONDITIONS ANO RECOfl D RUESTION NuMBERS ANO

CONOITIONS)

F. Ond IYO.ISUWECTI h.v. any lothnrl surg.w d.nng W..rlhislhw Ihosp,mlizar$.nls rav)? IIF YES, PflOEE: Whm was tin surg. v,)

PCC6ESS r —

sTREET

CITY

—

STATE

w: l_l-lJJ coNoITIo~~ l_l_l_l_l_l_l-l-l-l-l-l_t_l-l_l-l-l-l-t_l-l-l-l-l.-l

W: l_l-l_l_~ CONO1710N: I——I j———I I I—————— I I I I I !——I I— ]— I— I— I——I l_l_l_l_l_]_l

Q#, l_/-l_l_l CDNOITION: I I I I I I I I I I i [ I I I I I I I l_l_l_]_l_l_l

Q~: I_ I-l ——I I CONDITIOM:IIIIIIIII lt!lll[lll_lll [_l_]_l

COIWENTS: —

—

STAY l_l_l FACILITY NAME: I I I I I I I I I I I I I i i I t I l_l_l_l_l_l_l_l_ l_l_l_l_J

Mmmh

~TE : l_l_l l_”i_l 19 l_l_l AHA/MFI s: I I I I l_l_l_l—1—l

PSOP@s: —

STREET

CITY STATE

Q~: M - l_l_l cOM31TION:IIIIIIIII Il!il!llll!!l i_l_l_-1

Q~: l_l -l_l_l cONOITION: l_l_l_l_l_[_l_l_ l_l_l_l_l_l_l_t_ l_l_l_l_l_l_]_l_ l_-l

Q~: I_ I-l ——I I mrdorrIoN: l_l_l_j_l_l_l_l_ l_l_l_i_l_l_l_l_ l_l_l_l_l_l_l_l_ l_-l

~: l_ I-l_l_I CUNOITION: I I I I I I I I I I I I I I I I I l_l_l_i_l_l_l_l_.1

C~NTS:

STAY I——[ \ FACILITY N4ME, II II II II III]IIII!IIII ]llll!_i_l_l_.1 ——- ——— ————

Mmwh D.”

OATE: !_l_l l—l_l “ l–l–l PJ+A/MFI 9: I i I I I I I l_l_l

&MREsS :

STRfEr

clr Y STAIE

w:l_l.l_]_J mNoIr IoN:lll Illllllllltll 11111 Il_l_l_.1

O*: l_l-l_l_l CUNOIr ION: I——__—— I I I I I !— I I i [ I—+—I I ]_]_]_l_l_l_l_l_l_]_l_.1

w: l_l-1_l—1 CDNDITION: I———I I I— l_l_l_l_l_[_l_j_ l_[_l_l_l_]_!_l_ l_l_l_l_l_,l

~, l_l-l_l_l CUNOITION: 1———I I I I I I I I I I I I I t I I [ l_j._l_l_l_i_l_,l

COt4ifNTS:

NOTICE, Inlorrnacmn co.lm. ea on Yh#s Iorm wh!cn would petrmr ,de. r,lmat,on of anv md,.,dt,al or Mml>l,snm.n, ha, been colleclea wlrh a guarantee

Ihar N wdlbeheld, nsm.rco.thience bv me contractor and NCHS. w,llbe ..~ OW f., P.m.sp,st.led I. rh,. SWdv. ..d ‘IllnOc be d,scfosed

or released w any.”. other rhan a.rhor wed stall of NCHS. Wth..l <he .?..5 ... ot th? mawd. al ., .Sr. bkhmenr m acc. rc..ce wmh %cn..

30B1d1 .1 lh. PubIO. Healrh Sew,.. Acr 142 US C. 2d2ml

PwS G2~E

180
F4CILITy WE: I I I I I I I I I l_l_l_l_l_l_l—1 _l—!—!—l_l_l—l_ l—1—[_l_l—]_l

.,3. ”,11 0.”

ME: 191]! l_l_l l_!_l —— PJIA/HFI 1: I ! [ I I l_[_l_l_l

Pm+lfss:

STREET

M: [_[-l_l_] CDNDITIDN:

~: l_l-I_l_I mNDITION:

w: l_[-l_l_l C0NOITIDF4:

w: I_ I-l ——I I mwIrIom

CITY STAIE

I I I l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l

l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l

l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_!

l_l_l_l_l_l_!_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l

cotWENT5:

STAYl_l_J FACILITYNAHE:lll 111111111111 II llllll_I lll_l_l_I_l

Mamh

DATE:llllD~l ——— — 19111—— AilA/nFI#:l — I———I I I——I I— I——[ I

KXIRESS:

STREET

CITY STATE

c4:l_l-l_l_l mNDITIotd:l — I———I I I— I———II I———_— I I I I I— I——I I————————— I I I I ] I I I I

W:]_l-l_l_l mrWITIDN:l — I——I I— ]——_—I I I I— I— I— I I I I I I I II I j [ I I I

_——— — ———— — ————

W: l_l-l_l_l CUNOITIDN: 1 I I I I I I I I I I I I ! I I I [_l_i I I I I_I_!

W: l_l-l_l_l CONDITION: l_l I I I I I I I [ “1 I I I I I I !_!_l_t_l_l_l_l_l

mmENTs:

FACILITY NANE: I I I I I I I I I I ]_l_l_l_l_i_[_l_l_l—1_!_l_l—l_l—l_l—l_l—1

MTE: l_l_l I ‘~ 1

m

1911! —- ——

KWE5S:

STREfT

w: l_l-l_l_l CDMITION:

Q~: u—l ——I 1 CDNLIITION:

w: I_I-l ——: I mNDITIoN:

w: l_l-1 ——I I CUNDITION:

COflMENTS:

CITY STATE

l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_!_l_l_l_I_l

l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_i

l_l_l_l_l_l_l_l_l_l_l_l_l_!_l_l_l_l_l_l_l_l_l_l_l_l

l_l_l_l_l_l_l_l_l I I I l_l_l_l_l_l_l_l_l_l_l_l_l_l

SIAYl_l_l FACILITYMK:lll llllll[ll”ll_l_l ll\l[illl!{l l_[_l

Mmlh Dw

CATE: l_l_l l_l_l 19111—— .WA/MFI ~: I I I l_l_l_l_l_l_l

woREss :

STREET

CITY STATE

w: l_l-l_l_l CUWITIDN:I 1 I I I I I [ I l_l_l_l_l_l_l_l_[_l_l_l_!—]—l—[_i

w: I_ I-l ——I I COWITION: [———I I I——I I I I I I l_l_[_l_!_[_l_l_[_l_l_l—1—l—l—l

w: l_l-l_l_l CUNDIrION: I———I I I— I——I [——I I———I I l_l_l I \ l_l_l_l_!_l—l_l—h

u: l_l-l_l_l CUNDITION:I I II I I I I [ I I I I I [ I I I I [ ! I I i[_l ———————— —_————

CCMKNT5:

181
Health care facility data collection

Lettertohospitaladministrator

,*,,1.1,,,,,,

#

ii4

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

%&

National Center for Health SIatisljc~

3700 East-West Highway

Hyattaville MD 20782

Dear AcMnlstrator:

I am writing to infotm you of a request which has been made to your Medical

Records department. The NHANES I Epfdemfologic Followup Study: 1987 Followup

fs befng carried out by the National Center for Health Statistics (NCHS),

the National Institute on Aging, and other components of the Natfonal Institutes

of Health.

A selected sample of the United States population volunteered to participate

in the first National Health and Nutrftfon Examination Survey which NCHS

conducted from 1971-1975. liehave recently contacted these participants to

provfde new information about the etiology of chronic disease. A crucfal

component of the study is a very limited hospital record data collection to

augment infonrrationobtafned from these participants. Participants who

have been hospitalized have signed authorization forms to permit the release

of diagnostic information fran thefr hospftal records.

NCHS has contracted wfth Westat, a national survey organization, to conduct

the data collection operations of this survey. Westat has, therefore, sent

a packet to your Director of Medfcal Records on behalf of the patients fn

the stuc&. This survey is authorized by Title 42, United States Code 242k.

Partfcfpatfon in thfs survey fs completely voluntary. There are no penaltfes

for refusfng to answer any question. All information obtained wfll be held

strictly confidential, No information that could be used to identffy your

hospftal or any individual will be released or published. Results of this

study wfll be publfshed only as statistical sumnaries.

The American Hospital Association has endorsed this study and urges your

cooperation. Mr. Peter Kralovec of the Association may be reacheci at (312)

280-6523 if you have any questions concerning thfs endorsement. If you

have any questions concerningthe data collection, don’t hesitate to call

Rebecca Manning at 80&937-828L

Sinc~rely yours,

77 7?@A-kL@

Manning Fefnleib, M.D., Dr.P.H.

Director

182
Letterto directorof medical records

*./ i-m, .,,

~“ Jg DEPART%IENT OF HEALTH & HU(~l.AN SERVICES Public Health Semite

a

:

%

*+,

●34 b, ,a National Center for Health Statistic:

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 (ilCHS), 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 reinterviewed these 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 augment information obtained from these participants. Enclosed are

signed authorization forms specifically permitting 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 information obtained will be held strictly confidential and will be

used for statistical purposes only. No information that could be used

to identify the participants or your hospital will be released or published.

Results of this study will be published only as statistical surmnaries.

The American Hospital Association (AHA) has endorsed this study and urges

your cooperation. Your hospital’s participation is 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) 251-4351.

Sincerely yours,

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

Director

Enclosure

183
Hospital record form

OME NO.: w37-c11J4

Explrw JuII.19M

❑ INFORMATION SHOWN ON IAEEL

AGREES WITH HOSP~Al RECORDS

U OTHER (SPECl!=fI _

US Oapmtmwl of Hdth md Human Sewkoc

Nmdonsl C6nkf for Hmldr Smkdm

Flmtloml Inltltum m Aslng

NHANES 1 mblqk FOlkWUp Stmmy

HOSPITAL RECORO FORM

(TO ❑E COMPfJTEO BY MEDICAL RECORDS DEPARTMENT)

1. PATIENT MEDICAL RECORO NUMBER —

2. DATEOF #J3MlSS0N ~~—

MONTH DAY YEAR

z’ WAS THE PATIEN7 IN .CMO14C INTENSIVE CAFIE UN~

•1 y~~ Ow

NuMEER

❑ Nu

4, OiWXIITION OF PATlENT (ChwA Chic)

❑ Mrw clkch8rga/dlschw@ homa

❑ IA mgtinsl tiled Wvka

•1 Ckh8rgmd/trmnskt-mcl !0 mothar

kdly w nrgmlzallon

DATE OF OKCHARGE ~~—

MONTH OAY YEAR

OTHFR INTENSVE CARE UN~

❑ Okchmged/refeffed m orgmrizmd

homo cam som”w

—

~ NDt diac4w@/still i. ho.pital

❑ M wad

s. ANY OTHER HOSWWS/HE4LTH C,ME FACILITIES USTED IN ADMISSION NOTES OR DISCI+AJ+GE SUMMARY

km,:

C41y

YOmc

slmh

Namm:

city

Year

slate

(PLEASE TURN THE PAGEI

184
w

7.

8.

9,

z

3.

4.

s

s.

7.

h

9.

10,

‘m

EEEEEF

tEfEEP

‘EEEEEP

‘EEEEEP

fEEEEP

WEEP

tEEEEP

u Chdrifnona

1.

2,

3.

4.

s.

~ ATTACH A PHOTOCOIW W THE THIRD DAY EKG IF MYCCARDW. INFARCTION DLA13WSED DUPWG THIS STAY. PLE4SE

ATTACH A wl~ OF THE PAT’l@L~ REPoU’T ~FIRMIF@ THE ~NCS1.S OF -R ~ WRING THIS STAY. (Wits

* W89w I.D. numbw on mch ~ Pm

NQ!w

a. mkd cbY B(G

w

(%amfl NO/NA )

b. ~m lRlmal N@NA )

PLEASE ATTACH A PHOTCCGPY OF THE FACE SHEET AND THE DISCHARGE SUMMARY FOR THIS INPATIENT STAY, (W’fih Ihs

I85
Letterto nursing home administrator

+,*5 E mw .,,

*.

%,

.

4

‘DEPARTMENT OF HEALTH& HUMAN SERVICES $:

c

Public Health Service

.+

%

%.,,,,,

National Center for Health Stati!;tics

3700 East-West Highway

Hyattsville MD 20702

Dear Administrator:

The National Center for Health Statistics (NCHS) is conducting a followup

study of the participants in the first National Health and Nutrition

Examination Survey (NHANES 1) to provide new inforination about the etiology

of chronic disease. He need your assistance.

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 re~nterviewing those

14,407 persons to study the relationship between physical measures (e.g.,

blood pressure or functional vital capacity), behavioral variables (e.g.,

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-reported medical history.

Each person or next of kin (in cases of death or disability) has signed a

form requesting the release of his/her nursing home care records to the

survey researchers. (Copies of these authorizations are enclosed. ) Nursing

homes will be reimbursed for the cost incurred.

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 information obtained will be held strictly

confidential and will be used for statistical purposes only. No

information that could be used to identify the participants or your nursing

home will be released or published. Results of this study will be

published only as statistical sumnaries.

Your participation is vital to the success of this study. If you have any

questions concerning, this project, please feel free to call Rebecca Manning

EIIO-937-1328~

Sincerely yours,

Manning Feinleib, M.D”.,Dr.P.H.

Director

Enclosures

186
Nursing or personaI care home record form

1.

2

3.

4.

5.

AGREES WITH NURSING HOME RECORDS

U OTHER (SPECIFY)

U.S. DeP-xIIuit of t+edlh and Humeri Sawkes

Nmknal titer for Haetth StMI@-

?htlonel Inettlute on A@rrg

NHANES 1Epldamlologic Followup Sumoy

NURSING HOME/PERSONAL CARE HOME RECORD FORM

(TO BE COMPLETED BY MEDICAL RECORDS OEP-TMENTj

PATENT MEDICAL RECORD NUMBER

DATE OF AOMISSION ~~

DATE OF DISCHARGE ~~

MONTH DAY Y* MONTH DAY YEhR

PATIENT AOMilTED FROM (Ohack One)

m %iv.tu r.kidm- O Chronic di=ese hospital (SPECIW BELOWI

n kuto -. ho.pital (SPEClt7 SELm m Oth.r nursing horn. (SPECIFf BELOW)

WE OF FACILITY: CrTY/STATE

OTHER HOSPITALS PROVIOING C4RE DURING NURSING HOME/PERSOFLAL CARE HOME STAY

Neme:

Nemo:

Nemo:

DISPOSITION OF PATlENT (Check One)

n W’dise41mged/.till inp. . ..t

U Disdmrgedto private r.aidmce/

referral to orgenized horn. core ssMws

Transferred m wmther health core facility (SPECIFY BELOW)

n kutecare hospita.lfa.iiity ororganizati.n

= Other nursi.g honw

NAME OF FACILI_W

city/sine:

Chy/State:

Ciwqe:

Yew.

Yew

Year

n mod

—

U ~sctmrged to private residence/

no refm-ral

U Chronic disea- hospitel

u OUwr (SpEClm

C~/STATE:

~ klum m: NHNIEE-I (PMSE TURN lHE PAGE)

107
6, WHAT WERE THE DLAGNOSES ESTASUSHED AT ADMISSION?

Principal Dlagnosia at Admission :

1,

@her Maior Diseases or Canditiorm Presant

at Time of Admission :

2

4.

5.

6.

7. PLEASE AITACH A PHOTOCOPY OF THE ADMISSION SHE~. (Write the Weatat I.D. number on each photompiad page. if you do not

have photocopying capabilities, pleaae transcribe the information from the admission sheet onto a separate sheat, record the Westat ID

Numbar on that sheet, and staple it to THIS form.)

~~

Admission Sheet Included: ❑ 0

COMPLETED BY DATE

“108
Appendix II

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 19S2–S4 NHANES I

Epidemiologic Followup Study (NHEFS). Consequently,

all subsequent NHEFS Followup Public Use Data Tapes

reflect the corrections noted in this section.

Date of birth

Initially, the date of birth for each NHANES I respondent \vas recorded during the household interview and

subsequently coded on the NHANES I data tapes. The

household intemiew usually was conducted with one member (or more) of the household, who provided social and

demographic inforrrmtion far all household members. The

NHANES I sample was then drawn from these household

listings. On arrival ot the mobile examination center

(MEC), the subject J!as 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 fieldwork for the Followup Study, the

MEC record (when available) was used to update the date

of birth for all respondents lost to followup 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. Information on date of birth also was

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, information on

date of birth was corrected for 677 of the 14,407 subjects

in the NHEFS cohort.

The age given at baseline examination was then recalculated based on these corrected dates of birth. The

recalculations of age at baseIine examination resulted in

224 age changes of 1 year or more. For 31 respondents,

recalculation resulted in ages outside the designated age

range of 2.5-74 years. (Two subjects were determined to be

24 years of age, 26 were 75 years of age, 1 was 76 years of

age, and 2 were 77 years of age. ) Nonetheless, these

respondents will continue to be included in the cohort and

are treated as 25 or 74 years of age in cases in which age

is categorized. A cross-tabulation of the recalculated age

at baseline examination by the original age at examination

is presented below.

Original age

at baseline

examination

25-34 years . .

3544years . . . .

45–54 years . .

55–64 years .

65–74 years . .

Rew”sed age at baseline examination

25-34 3544 45-54 55–64 65-74

years years years years years

3,508 4 1

1 2,937 B--

2,26B 15 -

3 1,804 1

5 3,052

Additional information on date of birth was collected

if the respondent was administered the tracing questionnaire in the 1986 or 19S7 NHEFS. This information,

though, was not used to amend the date of birth or age at

NHANES I variables that appear on the NHEFS public

use data tapes. (In other words, date of birth and the age

at NHANES I variables were not revised using data

co!lected from the 19S6 or 19S7 NHEFS. Furthermore,

these variables will never be updated from any information collected from the subsequent followups of the

NHEFS.) Any new information obtained on date of birth

is used solely for tracing purposes.

Sex

The baseline sex code was changed from female to

male for one subject. The original sex code was an error in

the NHANES I data set.

Race

A revised race variable was created to resolve discrepancies between the baseline interviewer-observed race and

the followup respondent-reported race. These race codes

are determined on 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 changed for 1S6 subjects. A cross-tabulation of

revised race by the original baseline race variable follows.

(For a number of subjects, however, although race was

revised, baseline race and revised race still remain

grouped in the “Other” category.)

189
Revised race

Information on race of the subject was collected

Base/ine race White Black

during the interview in the 1986 or 1987 NHEFS if the

Other subject had not been previously interviewed. This infc)rmaWhite 11,998 25 30 tion, however, was not used to amend the revised race

Black,::::::::;: 11 2,174 10

Other .,, ,., . . . . . 27 132

variabIe that appears on the NHEFS public use data

tapes.

i? U.S. GOVEHNMEtW PRINTING OFFICE: 1SS? –3 12 – o s 2 / 6 () o 1 ]

190
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

1

SERIES 4.

SERIES 5,

SERIES 6.

SERIES 10.

SERIES 11,

SERIES 12.

SERIES 13.

Programs and Collection Procedures –These reports

deecrbe the data colkcticm programs of the National Center

for Health Statistics. They include descriptions of the

methods used to coflect and process the data, definitions,

and other material nemssay for understanding the data.

Data Evatuatkwr and Mathoda Research – These reports

ereatudii ofrrewa@aticd methods and include ~

technques, objectiw evaluations of reliability of collected

data, and contributions to statistical theory. These studies

also include experimental teats of new survey methods and

comparisons of U.S. methodology with those of other

Counbies.

Analytical and Epidemiological Studies –These reports

present analytical or interpretive studies based on vital end

health a@atica .Theaerepona carry fheandyaea futiherthan

the expository types of reports in the other series.

Documents and Committee Reports –These are final

reporta of major committees concerned with vital and health

statiabce and documents such as recommended model vifal

registration laws and revised birth and death certificates.

International Vftel and Health Statistics Reports – These

reporta are analytical or descriptive reports that compare US.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

Cognition and Survey Measurement – These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement, They use methods of

cognitive science to design, evaluate, and test survey

instruments.

Data From the National Health Interview Survey– These

reports contain statistics on illness: unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination

Survey– Data from direct examination, testing, and

measurement on representative samples of the civilian

noninstitutionalized population provide the basis for (1)

medically defined total prevalence of specific diseases or

conditions in the United States and the distributions of the

population with respect to physical, physiological, and

psychological characteristics, and (2) analyses of trends and

relationships among various measurements and between

survey periods.

Data From the Institutionalized Population

Surveys– Discontinued in 1975. Repotis from these surveys

are included in Series 13,

Data From the Netional Health Care Survey– These

reports contain statistics on health resources and the Public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14.

SERIES 15.

SERIES 16.

SERIES 20.

SERIES 21,

SERIES 22.

SERIES 23,

SERIES 24.

Data on Health Resources: Manpower and

Facilities – Discontinued in 1990. Reports on the numbers,

geographic distribution, and characteristics of health

resources are now included in Series 13.

Data From Special Surveys –These reports contain

statistics on health and health-related topics collected in

special survays that are not part of the continuing data

systems of the National Center for Health Statistics.

Compilations of Advance Data From Vital and Health

Statistics– Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

msY be ~lowed by detailed repons in series I o-I 3.

Data on Mortality-These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Data on Natality, Marrlsge, and Divorce –These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic end trend analyses are included.

Dsta From the National Mortality and Natsllty

Surveys – Discontinued in 1975. Reporta from these sample

surveys, based on vital records, are now published in series

20 or 21.

Data From the National Survey of Family Growth –These

reports contain statistics on factors that affect birth rates,

including contraception, infertility, cohabitation, marriage,

divorce, and remarriage; adoption; use of medical care for

family planning and infertili~ and related maternal and infant

health topics, These statistics are based on national surveys

of childbearing age.

Compilation of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy–These

include advance reports of births, deaths, marriages, and

divorces based on final data from the National WSI statistics

System that were published as supplements to the Morrfh/y

Vita/ Statistics Report (M VSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National vital Statistics

System and may be followed by detailed reports in series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

sCiWItifiC and Technical Information Branch

National Center for Health Statistics

Centers for Disease Control

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436-8500
DEPARTMENT OF

HEALTH & HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

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