[p. 203]
NATIONAL HEALTH INTERVIEW SURVEY
EPIDEMIOLOGY STUDY
Segment ____
Serial ____
2 [] p.m.
b. Hispanic oversample
Person ____
Name ____
Age ____
[] "X" if Hisp.
Hisp No. Marked Line No
.
2 [] Hisp.
3 [] Hisp.
4 [] Hisp.
5 [] Hisp.
6 [] Hisp.
7 [] Hisp.
8 [] Hisp.
9 [] Hisp.
Refer to the appropriate section of the sample person selection and label and circle as applicable. THEN circle "SP1" Line No. in item 6a and mark "SP" box in HIS-1 for the selected sample person. THEN go to Section AA.
Interview
2 [] Partial interview (some but not all appropriate sections completed) - Explain ________
4 [] SP temporarily absent
5 [] SP mentally or physically incapable
8 [] Other - Explain ________
2 [] p.m.
2 [] Telephone
2 [] Spanish
3 [] Both English and Spanish
8 [] Other
11. Interviewer identification
Code ____
TRANSCRIPTION FROM COMPLETED HIS-1
12. Sex of SP (Page 2 or 55, question 3)
2 [] F
13. Education of SP (Page 42 or 43, question 2a)
Elem:
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 10
[] 11
[] 12
[] 2
[] 3
[] 4
[] 5
[] 6+
Finish grade/year
2 [] No
14. Main race of SP (Page 42 or 43, question 3a/b)
[] 2
[] 3
[] 4
[] 5 - Specify ____
15. Marital status (Page 46 or 47, question 7)
2 [] Married - spouse not in HH
3 [] Widowed
4 [] Divorced
5 [] Separated
6 [] Never married
16. Family income (Page 46, question 8b)
01 [] B
02 [] C
03 [] D
04 [] E
05 [] F
06 [] G
07 [] H
08 [] I
09 [] J
10 [] K
11 [] L
12 [] M
13 [] N
14 [] O
15 [] P
16 [] Q
17 [] R
18 [] S
19 [] T
20 [] U
21 [] V
22 [] W
23 [] X
24 [] Y
25 [] Z
26 [] ZZ
28 [] Less than $20,000
2[x] Epidemiology study
[p. 204]
Section AA - ACCULTURATION
AA1
SP Status at initial interview
2 [] Callback required (Household page)
8 [] Noninterview (Cover page)
AA2
Refer to hispanic origin from family roster and expected language for this supplement.
2 [] Hispanic/Spanish Supp. Interview (1b)
8 [] Other (section BB)
Read to respondent:
I'm going to be asking questions that are related to health concerns, such as smoking, eating practices, doctor visits and so forth. Before I ask these questions I would like to ask a few questions about the language you use most often.
2 [] No (4)
Read to respondent:
I'm going to be asking questions that are related to health concerns, such as smoking, eating practices, doctor visits and so forth. Before I ask these questions I would like to ask a few questions about the language you use most often.
2 [] No (4)
2. Would you say that you speak mostly Spanish, mostly English, or do you speak Spanish and English about the same?
2 [] Mostly English
3 [] Both about the same
3. What language do you prefer: Spanish only, mostly Spanish, mostly English, English only, or Spanish and English about equally?
2 [] Mostly Spanish
3 [] Mostly English
4 [] English only
5 [] Spanish and English equally
2 [] No
2 [] No
If "Yes" to both 4 and 5 ask?
6. In which language do you read better?
2 [] English
3 [] Both the same
2 [] No
2 [] No
If "Yes" to both 7 and 8 ask:
9. In which language do you write better?
2 [] English
3 [] Both the same
If self-reported on HIS-1, mark box without asking.
HAND CARD O, read categories if telephone interview.
CARD O
2 - Cuban
3 - Mexican/Mexicano
4 - Mexican American
5 - Chicano
6 - Other Latin American
7 - Other Spanish
10. Which of these groups best describes your ethnic identification?
2 [] Cuban
3 [] Mexican/Mexicano
4 [] Mexican American
5 [] Chicano
6 [] Other Latin American
7 [] Other Spanish
8 [] Other (specify) ____
11. Which of these groups best describes your mother's ethnic identification?
2 [] Cuban
3 [] Mexican/Mexicano
4 [] Mexican American
5 [] Chicano
6 [] Other Latin American
7 [] Other Spanish
8 [] Other (Specify) ____
12. Which of these groups best describes your father's ethnic identification?
2 [] Cuban
3 [] Mexican/Mexicano
4 [] Mexican American
5 [] Chicano
6 [] Other Latin American
7 [] Other Spanish
8 [] Other (Specify)
[p. 205]
Section AA - ACCULTURATION - Continued
If self-reported on HIS-1, mark box without asking.
13. In what country or state were you born?
2 [] Puerto Rico
3 [] Cuba
4 [] Mexico
8 [] Other (Specify) ____
14. In what country or state was your father born?
2 [] Puerto Rico
3 [] Cuba
4 [] Mexico
8 [] Other (Specify) ____
15. In what country or state was your mother born?
2 [] Puerto Rico
3 [] Cuba
4 [] Mexico
8 [] Other (Specify) ____
[p. 206]
Section BB - FOOD FREQUENCY
Read to respondent: (I'm going to be asking questions that are related to health concerns, such as smoking, eating practices, vitamin use and so forth.) These next questions are about the foods you eat. Please tell me how often you eat each one, for example, twice a week, three times a month and so forth. Also tell me whether you usually eat a small, medium, or large portion of each food. Remember I'm only interested in the foods YOU eat.
HAND FOOD FLASHCARD BOOKLET. Please look at List 1 as I ask these first questions.
LIST 1 : Fruits and Juices
Other fruit juices or fortified fruit drinks?
Oranges?
Grapefruit?
Cantaloupe in season? Medium (1/4 cant.)
Apples or applesauce?
During the past year or so, how often do you usually (eat/drink) -
1. Orange juice or grapefruit juice?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (2)
2 [] Medium (6 oz.)
3 [] Large
2. Other fruit juice or fortified fruit drinks?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (3)
2 [] Medium (6 oz.)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (4)
2 [] Medium (1 med.)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (5)
2 [] Medium (1/2 grapefruit)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (6)
2 [] Medium (1/4 med.)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (7)
2 [] Medium (1 med. or ½ cup)
3 [] Large
Now look at List 2.
LIST 2 : Vegetables
Carrots or mixed vegetables containing carrots?
Tomatoes, including in salad?
Green salad?
Salad dressing or mayonnaise, Including on sandwiches?
Broccoli?
Spinach?
Collards, mustard greens, turnip greens, etc?
Cole slaw, cabbage, or sauerkraut?
Frenchfries or fried potatoes?
Potatoes, baked, boiled, or mashed?
Sweet potatoes or yams?
Rice?
During the past year or so, how often did you usually eat -
7. Beans, such as baked, pinto, kidney beans, or in chili? Do not include green beans.
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (8)
2 [] Medium (1 med. or ½ cup)
3 [] Large
8. Carrots, or mixed vegetables containing carrots?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (9)
2 [] Medium (1 med. or ½ cup)
3 [] Large
9. Tomatoes, including in salad?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (10)
2 [] Medium (1 tomato)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (11)
2 [] Medium (1 med. bowl)
3 [] Large
11. Salad dressing or mayonnaise, including on sandwiches?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (12)
2 [] Medium (2 tbs.)
3 [] Large
[p. 207]
Section BB - FOOD FREQUENCY - Continued
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (13)
2 [] Medium (1/2 cup)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (14)
2 [] Medium (1/2 cup)
3 [] Large
14. Mustard greens, turnip greens or collards?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (15)
2 [] Medium (1/2 cup)
3 [] Large
15. Coleslaw, cabbage or sauerkraut?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (16)
2 [] Medium (1/2 cup)
3 [] Large
16. French fries or fried potatoes?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (17)
2 [] Medium (3/4 cup)
3 [] Large
17. Potatoes, baked, boiled or mashed?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (18)
2 [] Medium (1 potato or 1/2 cup)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (19)
2 [] Medium (1/2 cup)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (20)
2 [] Medium (1/2 cup)
3 [] Large
Now look at List 3.
LIST 3 : Meats and mixed dishes
Beef, such as steaks, or roasts?
Beef stew or potpie containing vegetables?
Liver, including chicken liver?
Pork, such as chops, Medium (2 chops or or roasts? 4oz. of roast)
Fried chicken? Medium (2 small or 1 large piece)
Chicken or turkey, baked, Medium (2 small or 1 stewed or broiled? large piece)
Fried fish or fish sandwiches?
Spaghetti, lasagna, or pasta with tomato sauce?
During the past year or so, how often did you usually eat -
20. Hamburgers, cheeseburgers, or meatloaf?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (21)
2 [] Medium
3 [] Large
21. Beef, such as steaks or roasts?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (22)
2 [] Medium (4 oz.)
3 [] Large
22. Beef stew or potpie with vegetables?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (23)
2 [] Medium (1 cup)
3 [] Large
23. Liver, including chicken liver?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (24)
2 [] Medium (4 oz.)
3 [] Large
[p. 208]
Section BB - FOOD FREQUENCY - Continued
24. Pork, such as pork chops or roasts?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (25)
2 [] Medium (2 pork chops of 4 oz. of roast)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (26)
2 [] Medium (2 sm. or 1 lg. piece)
3 [] Large
26. Chicken or turkey, baked, stewed or broiled?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (27)
2 [] Medium (2 sm. or 1 lg. piece)
3 [] Large
27. Fried fish or fish sandwiches?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (28)
2 [] Medium (4 oz.)
3 [] Large
28. Spaghetti, lasagna or pasta with tomato sauce?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (29)
2 [] Medium (1 cup)
3 [] Large
Now look at List 4.
LIST 4 : Breakfast foods
High fiber cereals like brand, granola, or shredded wheat?
Highly fortified cereals like Product 19, Total, or Most?
Other cold cereals like Rice Krispies or corn flakes?
Eggs? How many eggs?
Bacon? How many slices?
Sausage? How many patties or links?
During the past year or so, how often did you usually eat -
29. Cooked cereals like oatmeal?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (30)
2 [] Medium (1 med. bowl)
3 [] Large
30. High fiber cereals like bran, granola, or shredded wheat?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (31)
2 [] Medium (1 med. bowl)
3 [] Large
31. Highly fortified cereals like Product 19, Total, or Most?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (32)
2 [] Medium (1 med. bowl)
3 [] Large
32. Other cold cereals like Rice Krispies or corn flakes?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (33)
2 [] Medium (1 med. bowl)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (34)
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (35)
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (36)
[p. 209]
Section BB - FOOD FREQUENCY PAGE - Continued
Now look at List 5.
LIST 5: Breads, Lunches and snacks
Do not include other kinds of soups.
Hot dogs? How many hot dogs?
Ham or lunch meats?
White bread, rolls, or crackers, Medium including sandwiches, bagels, (2 slices or 4 crackers) and so forth?
Dark breads like whole Medium (2 slices) wheat, rye, or pumpernickel?
Corn bread, corn muffins, corn tortillas, or grits?
Butter on bread, rolls, or Medium (2 pats) vegetables?
Margarine on breads, rolls, or Medium (2 pats) on vegetables?
Cheese or cheese spreads, not including cottage cheese?
Peanuts or peanut butter?
Salty snacks like chips or popcorn?
During the past year or so, how often did you usually eat -
36. Vegetable soup, vegetable beef, minestrone or tomato soup? Do not include other kinds of soup.
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (37)
2 [] Medium (1 med. bowl)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (38)
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (39)
2 [] Medium (2 slices)
3 [] Large
39. White bread, rolls or crackers, including sandwiches, bagels, and so forth? I'm going to ask about dark bread and corn bread next.
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (40)
2 [] Medium (2 slices or 4 crackers)
3 [] Large
40. Dark breads like whole wheat, rye or pumpernickel?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (41)
2 [] Medium (2 slices)
3 [] Large
41. Corn bread, corn muffins, corn tortillas, or grits?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (42)
2 [] Medium (1 piece or 1/2 cup grits)
3 [] Large
42. Butter on bread, rolls or vegetables? I'll ask about margarine next.
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (43)
2 [] Medium (2 pats)
3 [] Large
43. Margarine on bread, rolls or vegetables?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (44)
2 [] Medium (2 pats)
3 [] Large
44. Cheese or cheese spreads, not including cottage cheese?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (45)
2 [] Medium (2 slices or 2 oz.)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (46)
2 [] Medium (2 tbs.)
3 [] Large
46. Salty snacks like chips or popcorn?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (47)
2 [] Medium (1 handful)
3 [] Large
Now look at List 6.
LIST 6: Sweets and beverages
How often did you eat or drink - what size portion did you usually eat or drink?
Pie?
Doughnuts, cookies, cakes, or pastry?
Chocolate candy?
Sugar in coffee or tea, Medium (2 tsp.) or on cereal?
Whole milk or drinks made with whole milk, NOT including on cereal?
2% milk or drinks made with
2% milk, NOT including on cereal?
Skim milk or 1% milk or buttermilk, NOT including on cereal?
Milk or cream in coffee or tea?
Soda or soft drinks containing sugar?
Beer?
Wine?
Liquor?
b. On the days you drank it, how many cans, glasses, or drinks?
c. Small, medium or large?
During the past year or so, how often did you usually (eat/drink) -
47. Ice cream?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (48)
2 [] Medium (1 med. scoop)
3 [] Large
[p. 210]
Section BB - FOOD FREQUENCY - Continued
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (49)
2 [] Medium (1 med. slice)
3 [] Large
49. Doughnuts, cookies, cake or pastry?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (50)
2 [] Medium (1 piece or 3 cookies)
3 [] Large
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (51)
2 [] Medium (1 oz.)
3 [] Large
51. Sugar in coffee or tea or on cereal?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (52)
2 [] Medium (2 tsp.)
3 [] Large
52. Whole milk or drinks made with whole milk, not including on cereal? I'm going to ask about 1%, 2% and skim milk separately.
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (53)
2 [] Medium (8 oz. glass)
3 [] Large
53. 2% milk or drinks made with 2% milk, not including on cereal?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (54)
2 [] Medium (8 oz. glass)
3 [] Large
54. Skim milk, 1% milk or buttermilk, not including on cereal?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (55)
2 [] Medium (8 oz. glass)
3 [] Large
55. Milk or cream in coffee or tea?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (56)
2 [] Medium (1 tbs.)
3 [] Large
56. Soda or soft drinks with sugar?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (57)
2 [] Medium (12 oz.)
3 [] Large
57a. During the past year or so, how often did you drink beer?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (58)
99 [] DK
2 [] Medium (12 oz.)
3 [] Large (16 oz.)
[p. 211]
Section BB - FOOD FREQUENCY - Continued
58a. During the past year or so, how often did you drink wine?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (59)
99 [] DK
2 [] Medium (1 med. wine glass)
3 [] Large
59a. During the past year or so, how often did you drink liquor?
2 [] Week
3 [] Month
4 [] Year
0000 [] Less than 6 a year or never (60)
99 [] DK
2 [] Medium (1 shot)
3 [] Large
60a. Was there ever a period in your life when you drank five or more drinks of any alcoholic beverage almost every day?
2 [] No (61)
9 [] DK (61)
b. For how long did that period last?
2 [] Weeks
3 [] Months
4 [] Years
9999 [] DK
61. When you eat chicken or other poultry, how often do you eat it with the skin on? Would you say often, sometimes, rarely or never?
2 [] Sometimes
3 [] Rarely
4 [] Never
0 [] Don't eat chicken or poultry
62. When you eat red meat, how often do you eat the fat? Would you say often, sometimes, rarely or never?
2 [] Sometimes
3 [] Rarely
4 [] Never
0 [] Don't eat red meat
63a. On most weekdays, how many meals do you usually eat each day?
____ Meals
9 [] DK
b. On most weekdays, how many snacks do you usually eat each day, including snacks after dinner?
____ Snacks
9 [] DK
c. On most Saturdays or Sundays, how many meals do you usually eat each day?
____ Meals
9 [] DK
d. On most Saturdays or Sundays, how many snacks do you usually eat each day?
____ Snacks
9 [] DK
64. In a typical week, how many meals do you usually get in restaurants, cafeterias, or fast food places?
____ Meals
99 [] DK
[p. 212]
Section CC - VITAMIN AND MINERAL INTAKE
1. During the past 12 months, that is, since (12 month date) a year ago, did you take any vitamin or mineral supplements of any kind?
2 [] No (section DD)
2a. During the past 12 months, that is, since (12 month date) a year ago, did you take any MULTIPLE vitamins?
2 [] No (3)
b. What is the brand name of the multiple vitamins?
What is the name of the brand you took most often during the past 12 months?
[] DK/Refused (Ask probe for type)
If known, mark without asking, otherwise ask:
Is that a therapeutic type, a stress-tab type or a one-a-day type?
Mark first type listed
2 [] Stress-tabs
3 [] One-a-day
8 [] None of these
9 [] DK
c. For how many of the past 12 months did you take [(name in 2b)/multiple vitamins]?
12 [] All of them
____ Number of months
d. During (the/those) (number in 2c) month(s), about how many days per months did you take [(name in 2b)/ multiple vitamins]?
____ Number of days per month
88 [] Other
e. On the days you took [(name in 2b)/ multiple vitamins], how many pills did you take per day?
99 [] DK
If less than 12 in 2c, ask:
f. Did you take any multiple vitamins in the past month?
2 [] No
(The following questions are about vitamins not including the multiple vitamins you already told me about.)
3a. During the past 12 months, did you take any vitamin A?
2 [] No (4)
b. For how many of the past 12 months did you take vitamin A?
12 [] All of them
____ Number of months
c. During (the/those) (number in 3b) month(s), about how many days per months did you take Vitamin A?
___ Number of days per month
88 [] Other
d. On the days you took vitamin A, how many pills did you usually take per day?
99 [] DK
e. How many milligrams of vitamin A are in each of the pills you took?
99999 [] DK
If less than 12 in 3b, ask:
f. Did you take any vitamin A in the past month?
2 [] No
4a. During the past 12 months, did you take any vitamin C?
2 [] No (5)
b. For how many of the past 12 months did you take vitamin C?
12 [] All of them
____ Number of months
c. During (the/those) (number in 4b) month(s), about how many days per months did you take Vitamin C?
____ Number of days per month
88 [] Other
d. On the days you took vitamin C, how many pills did you usually take per day?
99 [] DK
e. How many milligrams of vitamin C are in each of the pills you took?
99999 [] DK
If less than 12 in 4b, ask:
f. Did you take any vitamin C in the past month?
2 [] No
[p. 213]
Section CC - VITAMIN AND MINERAL INTAKE - Continued
5a. During the past 12 months, did you take any vitamin E?
2 [] No (6)
b. For how many of the past 12 months did you take vitamin E?
12 [] All of them
____ Number of months
c. During (the/those) (number in 5b) month(s), about how many days per months did you take Vitamin E?
____ Number of days per month
88 [] Other
d. On the days you took vitamin E, how many pills did you usually take per day?
99 [] DK
e. How many units of vitamin E are in each of the pills you took?
99999 [] DK
If less than 12 in 5b, ask:
f. Did you take any vitamin E in the past month?
2 [] No
6a. During the past 12 months, did you take any calcium?
2 [] No (section DD)
b. For how many of the past 12 months did you take calcium?
12 [] All of them
____ Number of months
c. During (the/those) (number in 6b) month(s), about how many days per months did you take calcium?
____ Number of days per month
88 [] Other
d. On the days you took calcium, how many pills did you usually take per day?
99 [] DK
e. How many milligrams of calcium are in each of the pills you took?
99999 [] DK
If less than 12 in 6b, ask:
f. Did you take any calcium in the past month?
2 [] No
[p. 214]
Section DD - FOOD KNOWLEDGE
1a. Have you ever made any LASTING and MAJOR changes in what you eat and drink for health reasons?
2 [] No (2)
b. In making these changes, what foods do you eat MORE of?
Enter responses verbatim, one food per line. Do not probe.
MORE
________
________
________
000 [] None
999 [] DK
c. What foods do you eat LESS of?
Enter responses verbatim, one food per line. Do not probe.
LESS
________
________
________
000 [] None
999 [] DK
d. Have you made these changes in what you eat and drink in the past 5 years?
2 [] No
9 [] DK (1f)
e. Did you make these changes in the past year?
2 [] No
9 [] DK
f. Have there been any changes in the ways your food is cooked?
2 [] No
9 [] DK (2)
2 [] Less
2 [] Less
2 [] Less
2 [] Less
2 [] Less
2 [] Less
2 [] Less
2 [] Less
2 [] Less
2 [] Less
2 [] Less
1 [] DK
2. I am going to read two statement. Please tell me which one you agree with the most.
(a) What people eat or drink has little effect on whether they will develop major diseases.
OR
(b) By eating certain kinds of foods, people can reduce their chances of developing major diseases.
2 [] b (3)
9 [] DK (4)
3. Which major diseases do you think may be related to what people eat and drink?
1 [] Heart disease
1 [] Obesity/Overweight
1 [] Diabetes
1 [] Hypertension/ High Blood Pressure
1 [] Other
1 [] None
1 [] DK
[p. 215]
Section DD - FOOD KNOWLEDGE
8 [] Other (4)
4. Do you think cancer may be related to what people eat and drink?
2 [] No
3 [] Probably/maybe/could be/etc.
9 [] DK
5a. Some foods contain fiber. Have you heard of fiber?
2 [] No
9 [] DK (6)
b. Overall, would you say your diet is high, medium, or low in fiber?
2 [] Medium
3 [] Low
9 [] DK
6. Overall, would you say your diet is high, medium or low in fat?
2 [] Medium
3 [] Low
9 [] DK
7. Have you gone on a diet for weight loss or any other medical reason during the past 12 months?
2 [] No
[p.216]
Section EE - SMOKING HABITS
These next questions are about cigarette smoking.
1. Have you smoked at least 100 cigarettes in your entire life?
If asked: approximately 5 packs
2 [] No
9 [] DK (section FF)
2. How old were you when you first tried starting smoking cigarettes fairly regularly?
00 [] Never smoked regularly (section FF)
99 [] DK
3. Do you smoke cigarettes now?
2 [] No
4. How old were you when you stopped smoking cigarettes?
99 [] DK
5. On the average, how many cigarettes (did/do) you usually smoke a day?
____ Cigarettes per day
99 [] DK
6. For how many years (have you/were you) a regular smoker, do not include the times you may have stayed off cigarettes?
____ Years
99 [] DK
[p. 217]
Section FF - OTHER TOBACCO USE
These next questions are about the use of other tobacco products.
1a. Have you ever used chewing tobacco, such as Redman, Levi Garrett, or Beechnut?
2 [] No (6)
9 [] DK Chewing tobacco (6)
b. Have you used chewing tobacco at least 20 times?
2 [] No
9 [] DK (6)
2. How old were you when you first used chewing tobacco?
99 [] DK
3. Do you use chewing tobacco now?
2 [] No
4. Altogether, about how long (did you use/have you used) chewing tobacco?
______
2 [] Years
999 [] DK
5a. On the average, how many days per month (did/do) you use chewing tobacco?
97 [] Never used regularly (6)
98 [] Everyday
Days per month ____
99 [] DK
b. On the days that you use(d) chewing tobacco, how many times (did/do) you use it?
99 [] DK
6a. Have you ever used snuff, such as Skoal, Skoal Bandits, or Copenhagen?
2 [] No
9 [] DK Snuff (12)
b. Have you used snuff at least 20 times?
2 [] No
9 [] DK (12)
7. How old were you when you first used snuff?
99 [] DK
2 [] No
9. Altogether, about how long (did you use/have you used) snuff?
______
2 [] Years
999 [] DK
10a. On the average, how many days per month (did/do) you use snuff?
97 [] Never used regularly (12)
98 [] Everyday
____ Days per month
99 [] DK
b. On the days you use(d) snuff, how many times (did/do) you use it?
99 [] DK
11. (Did/Do) you use snuff by sniffing it or by placing it in your mouth?
2 [] Mouth
3 [] Both
12a. Have you ever smoked a pipe?
2 [] No (17)
b. Have you smoked a pipe at least 50 times?
2 [] No
9 [] DK (17)
13. How old were you when you first smoked a pipe?
99 [] DK
[p.218]
Section FF - OTHER TOBACCO USE - Continued
2 [] No
15. Altogether, about how long (did you smoke/have you smoked) a pipe?
______
2 [] Years
999 [] DK
16a. On the average, how many days per month (did/do) you smoke a pipe?
97 [] Never used regularly (17)
98 [] Everyday
____ Days per month
99 [] DK
b. On the days you smoke(d) a pipe, how many pipefuls of tobacco (did/do) you smoke?
99 [] DK
17a. Have you ever smoked cigars?
2 [] No (section GG)
b. Have you smoked at least 50 cigars in your entire life?
2 [] No
9 [] DK (section GG)
18. How old were you when you first smoked cigars?
99 [] DK
2 [] No
20. Altogether, about how long (did you use/have you smoked) cigars?
______
2 [] Years
999 [] DK
21a. On the average, how many days per month (did/do) you smoke cigars?
97 [] Never smoked cigars regularly (Section GG)
98 [] Everyday
____ Days per month
99 [] DK
b. On the days you smoke(d) cigars, how many times (did/do) you smoke?
____ Cigars per day
99 [] DK
[p. 219]
Section GG - REPRODUCTION AND HORMONE USE
GG1
Refer to sex
2 [] Female (1)
These next questions are about pregnancy and reproduction.
1a. Have you ever given birth to a liveborn infant?
2 [] No (2)
b. How many live births have you had?
c. How old were you when your (first) child was born?
99 [] DK (1d)
d. Were you 20 or younger, or older than 20?
2 [] Older than 20 (1e)
9 [] DK (2)
e. Were you 21 to 24, 25 to 29, 30 to 34, or 35 or older?
2 [] 25-29
3 [] 30-34
4 [] 35+
9 [] DK
2a. (Besides (that pregnancy/those pregnancies)), Have you ever had any (other) pregnancies that lasted six months or more?
2 [] No (GG2)
b. How many of those (other) pregnancies have you had?
c. How old were you at the end of (that pregnancy/the first of those pregnancies)?
99 [] DK (2d)
d. Were you 20 or younger, or older than 20?
2 [] Older than 20
9 [] DK (GG2)
e. Were you 21 to 24, 25 to 29, 30 to 34, or 35 or older?
2 [] 25-29
3 [] 30-34
4 [] 35+
9 [] DK
GG2
Refer to 1a
8 [] Other (4)
3. Did you breastfeed any of your children?
2 [] No
4a. How old were you when your menstrual cycles began?
00 [] Never menstruated (7)
99 [] DK (4b)
b. Were you younger than 10, 10 to 12, 13 to 15, or 16 or older?
2 [] 10-12
3 [] 13-15
4 [] 16+
9 [] DK
5. Have your menstrual cycles stopped permanently?
2 [] No (8)
6a. How old were you when they completely stopped?
99 [] DK (6b)
b. Were you younger than 20, 20 to 29, 30 to 39, 40 to 44, 45 to 49, 50 to 54, or 55 or older?
2 [] 20-29
3 [] 30-39
4 [] 40-44
5 [] 45-49
6 [] 50-54
7 [] 55+
9 [] DK
7. (Did they stop/Was this) due to surgery?
2 [] No
[p. 220]
Section GG - REPRODUCTION AND HORMONE USE - Continued
8a. Have you ever had an operation to remove a lump from your breast that was found to be NONCANCEROUS?
2 [] No (9)
3 [] Lumps removed that were cancerous (9)
9 [] DK (9)
b. How many of these operations have you had?
9 [] DK
c. How old were you when you had the (first) operation?
99 [] DK
We are interested in learning about the relationship between birth control pills and health.
9. Have you ever used birth control pills?
2 [] No (GG3)
10a. How old were you when you started using birth control pills?
99 [] DK (10b)
b. Were you younger than 25, or 25 or older?
2 [] 25+ (10d)
9 [] DK (11)
c. Were you 18 or younger, 19 to 21, or 22 to 24?
2 [] 19-21 (11)
3 [] 22-24 (11)
9 [] DK (11)
d. Were you 25 to 29, 30 to 34, or 35 older?
2 [] 30-34
3 [] 35+
9 [] DK
11a. Altogether, about how long did you take birth control pills? Include any breaks in usage that lasted less than one month.
2 [] Months (GG3)
3 [] Years (GG3)
000 [] Less than one month (GG3)
888 [] Other - Specify ____ (GG3)
999 [] DK (11b)
b. Was it less than a year, or a year or more?
2 [] One year or more (11c)
9 [] DK (GG 3)
c. Was it 3 years or less, more than 3 but less than 5, or 5 or more years?
2 [] More than 3, less than 5 years
3 [] 5 or more years
9 [] DK
2 [] 40 and over (12)
12. Estrogen is a female hormone that may be taken after a hysterectomy or during menopause. Have you ever taken estrogen pills for any reason?
2 [] No (section HH)
9 [] DK (section HH)
13a. How old were you when you started using estrogen pills?
99 [] DK (13b)
b. Were you younger than 20, 20 to 29, 30 to 39, 40 to 44, 45 to 49, 50 to 54, or 55 or older?
2 [] 20-29
3 [] 30-39
4 [] 40-44
5 [] 45-49
6 [] 50-54
7 [] 55+
9 [] DK
[p. 221]
Section GG - REPRODUCTION AND HORMONE USE - Continued
14a. Altogether, about how long did you take estrogen pills? Include any breaks in usage that lasted less than one month.
2 [] Months (15)
3 [] Years (15)
000 [] Less than one month (15)
888 [] Other - Specify ____ (15)
999 [] DK (14b)
b. Was it less than a year, or a year or more?
2 [] One year or more (14c)
9 [] DK (15)
c. Was it 3 years or less, more than 3 but less than 5, or 5 or more years?
2 [] More than 3, less than 5 years
3 [] 5 or more years
9 [] DK
15. What was the brand name of the estrogen pills?
[] DK
[p . 222]
Section HH - FAMILY HISTORY OF CANCER
These next questions are about your natural or birth mother and father. Do not include step or adoptive parents.
Ask 1-2 for mother, then for father.
1a. In what year was your natural (mother/father) born?
b. Is your (mother/father) still living?
2 [] No (1c)
9 [] DK (2)
7 [] Never knew natural mother (1 for father)
2 [] No (1c)
9 [] DK (2)
7 [] Never knew natural mother (3)
c. At what age did your (mother/father) die?
2a. Was your (mother/father) ever diagnosed by a doctor as having cancer?
2 [] No (1 for father)
9 [] DK (1 for father)
2 [] No (3)
9 [] DK (3)
b. What kind of cancer was it?
799 [] DK (2c)
799 [] DK (2c)
c. what part of the body was affected?
d. Did your (mother/father) have any other kind of cancer that was diagnosed by a doctor?
2 [] No (2g)
9 [] DK (2g)
2 [] No (2g)
9 [] DK (2g)
e. The FIRST time (she/he) was diagnosed with cancer, what kind of cancer was it?
____ (2g)
799 [] DK (2f)
____ (2g)
799 [] DK (2f)
f. What part of the body was affected?
g. how old was your (mother/father) when cancer was first diagnosed by a doctor?
99 [] DK (1 for father)
[p. 223]
Section HH - FAMILY HISTORY OF CANCER - Continued
Read to respondent: Now I'm going to ask about your sisters and brothers who have the same natural or birth mother AND father as you. Do not include step, half, or adoptive sisters and brothers.
3a. How many sisters do you have, including any that may have died?
____ Sisters
99 [] DK
b. How many brothers do you have, including any that may have died?
____ Brothers
99 [] DK
If "None" in 3a and 3b, skip to 9.
4. Have any of your (brothers/(or) sisters) ever been diagnosed by a doctor as having cancer?
2 [] No
9 [] DK (9)
5. What are the first names of your (brothers/(or) sisters) who had cancer?
Record each person in a separate column
Anyone else?
Sex:
2 [] Female
9 [] DK
________ Name
Sex:
2 [] Female
9 [] DK
Ask 6-8 for the first person listed in 5 before asking 6-8 for the next person.
6a. What kind of cancer did (name in 5) have?
799 [] DK (6b)
________ (6c)
799 [] DK (6b)
b. What part of the body was affected?
[] DK
____
[] DK
c. Did (name in 5) have any other kind of cancer that was diagnosed by a doctor?
2 [] No (7)
9 [] DK (7)
1 [] Yes
2 [] No (7)
9 [] DK (7)
d. The FIRST time (he/she) was diagnosed with cancer, what kind of cancer was it?
____ (7)
799 [] DK (6e)
000 [] Same as 6a/b (7)
____ (7)
799 [] DK (6e)
e. What part of the body was affected?
[] DK
____
[] DK
7. How old was (name in 5) when cancer was first diagnosed by a doctor?
99 [] DK
____ Age
99 [] DK
8a. In what year was (name in 5) born?
9999 [] DK
____ Year
9999 [] DK
If known, mark without asking.
b. Is (name in 5) still living?
2 [] No (8c)
9 [] DK (HH1)
1 [] Yes (HH1)
2 [] No (8c)
9 [] DK (HH1)
c. At what age did (name in 5) die?
99 [] DK
____ Age
99 [] DK
HH1
Refer to entries in 5.
2 [] No more siblings (9)
1 [] Additional siblings (6)
2 [] No more siblings (9)
[p. 224]
Section HH - FAMILY HISTORY OF CANCER - Continued
Read to respondent: These questions are about your natural or birth children. Do not include any children for whom you are an adoptive, step, or foster parent.
9a. How many daughters do you have, including any that may have died?
____ Daughters
99 [] DK
b. How many sons do you have, including any that may have died?
____ Sons
99 [] DK
If "None" in 9a and 9b, skip to section II.
10. Have any of your children ever been diagnosed by a doctor as having cancer?
2 [] No (15)
9 [] DK (15)
11. What are the first names of your children who had cancer?
Record each person in a separate column
Anyone else?
Sex:
2 [] Female
________ Name
Sex:
2 [] Female
Ask 12-14 for the first person listed in 11 before asking 12-14 for the next person.
12a. What kind of cancer did (name in 11) have?
799 [] DK (12b)
________ (12c)
799 [] DK (12b)
b. What part of the body was affected?
[] DK
____
[] DK
c. Did (name in 11) have any other kind of cancer that was diagnosed by a doctor?
2 [] No
9 [] DK (13)
1 [] Yes
2 [] No
9 [] DK (13)
d. The FIRST time (he/she) was diagnosed with cancer, what kind of cancer was it?
____ (13)
799 [] DK (12e)
000 [] Same as 12a/b (13)
____ (13)
799 [] DK (12e)
e. What part of the body was affected?
[] DK
____
[] DK
13. How old was (name in 11) when cancer was first diagnosed by a doctor?
99 [] DK
____ Age
99 [] DK
14a. In what year was (name in 11) born?
9999 [] DK
____ Year
9999 [] DK
If this child in household, mark "Yes" box without asking.
b. Is (name in 11) still living?
2 [] No (14c)
9 [] DK (HH2)
1 [] Yes (HH2)
2 [] No (14c)
9 [] DK (HH2)
c. At what age did (name in 11) die?
99 [] DK
____ Age
99 [] DK
HH2
Refer to entries in 11.
2 [] No more siblings (15)
1 [] Additional siblings (12)
2 [] No more siblings (15)
[p. 225]
Section HH - FAMILY HISTORY OF CANCER - Continued
15. Has the natural (father/mother) of (any of your (other) children/your child) ever been diagnosed by a doctor as having cancer?
2 [] No (section II)
9 [] DK (section II)
16a. What is the (father's/mother's) name?
b. Is (name in 16a) the (father/mother) of all your (other) children?
2 [] No
17a. What kind of cancer did (name in 16a) have?
799 [] DK (17b)
b. What part of the body was affected?
[] DK
c. Did (name in 16a) have any other kind of cancer that was diagnosed by a doctor?
2 [] No
9 [] DK (18)
d. The FIRST time (he/she) was diagnosed with cancer, what kind of cancer was it?
____ (18)
799 [] DK (17e)
e. What part of the body was affected?
[] DK
18. How old was (name in 16a) when cancer was first diagnosed by a doctor?
99 [] DK
19a. In what year was (name in 16a) born?
9999 [] DK
If person in household, mark "Yes" without asking.
b. Is (name in 16a) still living?
2 [] No (19c)
9 [] DK (20)
c. At what age did (name in 16a) die?
99 [] DK
20a. How many children did you and (name in 16a) have together, including any that may have died?
b. How many of these children are sons and how many are daughters?
____ No. of daughters
c. What are the children's first names?
HH3
Refer to 16b.
8 [] "Yes" in 16b (section II)
Section II - CANCER SURVIVORSHIP
1. Has a doctor or other health professional ever told you that you had cancer of any kind (including any cancer you have already mentioned)?
2 [] No (Section JJ)
2a. What kind of cancer was it?
799 [] DK (2b)
b. What part of the body was affected?
3. How old were you when this cancer was first diagnosed by a doctor?
99 [] DK
4. Besides this cancer, has a doctor ever told you that you had any other kind of cancer?
2 [] No (Section JJ)
5a. What kind of cancer was it?
799 [] DK (5b)
b. What part of the body was affected?
6. How old were you when THIS cancer was first diagnosed by a doctor?
99 [] DK
[p. 227]
Section JJ - OCCUPATIONAL EXPOSURE
These next questions are about the kind of work you have done the longest, not counting work around the house.
1. Thinking of all the jobs or businesses you have ever had, what kind of work have you done the longest? Include work in the Armed Forces. For example, electrical engineer, stock clerk, typist, farmer.
________ Occupation/kind of work
2. When you were doing this kind of work, what were your most important activities or duties? For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete.
3a. How long did you do this kind of work?
____ Years
99 [] DK
b. How old were you when you started doing this kind of work?
99 [] DK
4. What kind of business or industry did you work in the longest as (entry in 1)? (For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.)
Complete from entries 1, 2, and 4. If not clear ask:
5. Were you-
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
0 [] WP
[p. 228]
Section KK - HEIGHT, WEIGHT, RELATIONSHIPS, SOCIAL ACTIVITIES
1. About how tall are you without shoes?
____ Inches
2. About how much do you weigh without shoes?
3. When you weighed the most, how much did you weigh (not including pregnancy)?
These questions are about social activities and relationships.
4a. (Not including your [husband/wife]) Of all your friends, how many are there that you can talk to about private matters or can call on for help?
00 [] None
b. (Not including your [husband/wife]) Of all your relatives, how many are there that you can talk to about private matters or can call on for help?
00 [] None
If None in 4a and b, skip to 5.
c. How many of these friends and relatives do you see or talk to at least once a month?
00 [] None
5a. How often do you participate in or attend group meetings or activities, for example, social clubs, PTA, sporting events, church groups or other community service groups?
3 [] Month
4 [] Year
000 [] Never
b. How often do you go to church, temple, or other religious services?
3 [] Month
4 [] Year
000 [] Never