Data Dictionary for marint

Number of Blaise fields: 921

Seq # Var Question Data Type/Coding
1 ivisit visit
2 projid MARS Baseline Interview (v6.0 Rev 02/21/2022) Project ID number. String[8]
3 folder Type in folder color. F/U Year Folder Baseline (manilla) String[8]
4 visit Enter visit code (check folder color): CODE F/U Year Folder 00 = Baseline (manilla) String[2]
5 vervisit Please verify visit and folder color. visit = ^visitnum folder = ^folder1 Is this correct? If not, please page up and correct folder color. 1= Yes
6 formno Form Number. String[6]
7 version Version number String[4]
8 autodate Automatic Date. Date type
9 autotime Automatic Time. TimeType
10 autolog Automatic Logged Date. Date type
11 intid CLINICIAN ID. 100 .. 997
12 compid Laptop ID String[20]
13 dateint Date of evaluation. Date type
14 autotm [COMPUTER CLOCK TIME] String[8]
15 gender Enter participant's gender. 1= Male 2= Female
16 pfname Participant First name String[12]
17 pmiddl Participant Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
18 plname Participant Last name String[18]
19 padrnum Participant's PERMANENT ADDRESS Street number String[9]
20 padrdir PERMANENT ADDRESS Street direction [HIT ENTER IF NOT APPLICABLE] String[4]
21 pstreet PERMANENT ADDRESS Street name String[55]
22 papt PERMANENT ADDRESS Apartment/Unit/Room number [HIT ENTER IF NOT APPLICABLE] String[25]
23 pcity PERMANENT ADDRESS City or Town String[18]
24 pstate PERMANENT ADDRESS State String[2]
25 pzip PERMANENT ADDRESS Zip Code String[5]
26 reskind PERMANENT ADDRESS What kind of residence is this? 1= Home [Single family dwelling] 2= Apartment/Condominium [even if affiliated with CCRC] 3= Retirement home/CCRC-independent living 4= Assisted living/Sheltered care 5= Nursing home - unskilled care 6= Nursing home - skilled care
27 facname PERMANENT ADDRESS Name of facility String[40]
28 facdate PERMANENT ADDRESS Enter date that participant entered facility, like this MM-DD-YYYY. [Use '-' to separate] [USE 88 IF MONTH OR DAY UNKNOWN] String[10]
29 phphone PERMANENT ADDRESS Home telephone including area code [Use '-' to separate] String[20]
30 pwphone PERMANENT ADDRESS Work telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[20]
31 pcphone PERMANENT ADDRESS Cell/mobile telephone inlcluding area code [Use '-' to separate] [Press enter if none.] String[12]
32 pemail PERMANENT ADDRESS E-mail address? [Press enter if none.] String[50]
33 tempor Are you currently staying at an address that is different from your permanent address? 1= Yes 2= No
34 tadrnum Participant's TEMPORARY ADDRESS Street number String[9]
35 tadrdir TEMPORARY ADDRESS Street direction [HIT ENTER IF NOT APPLICABLE] String[4]
36 tstreet TEMPORARY ADDRESS Street name String[55]
37 tapt TEMPORARY ADDRESS Apartment/Unit/Room number [HIT ENTER IF NOT APPLICABLE] String[25]
38 tcity TEMPORARY ADDRESS City or Town String[18]
39 tstate TEMPORARY ADDRESS State String[2]
40 tzip TEMPORARY ADDRESS Zip Code String[5]
41 treskind TEMPORARY ADDRESS What kind of residence is this? 1= Home [Single family dwelling] 2= Apartment/Condominium [even if affiliated with CCRC] 3= Retirement home/CCRC-independent living 4= Assisted living/Sheltered care 5= Nursing home - unskilled care 6= Nursing home - skilled care
42 tfacname TEMPORARY ADDRESS Name of facility String[40]
43 tfacdate TEMPORARY ADDRESS Enter date that participant entered facility, like this MM-DD-YYYY. [Use '-' to separate] [USE 88 IF MONTH OR DAY UNKNOWN] String[10]
44 thphone TEMPORARY ADDRESS Home telephone including area code [Use '-' to separate] String[20]
45 twphone TEMPORARY ADDRESS Work telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[20]
46 ssnmedneeded Do we need to obtain SSN and/or Medicare# from this participant? [INTERVIEWER: Check the face sheet. Enter NO if both SSN and Medicare# have been collected. Enter NO if participant refuses to provide both SSN and Medicare#. Enter 'Yes, both' if participant is able to provide both SSN and Medicare#. Enter 'Yes, SSN only' if participant is able to provide only the SSN. Enter 'Yes, Medicare# only' if participant is able to provide only the Medicare#.] 2= No 1= Yes, both 3= Yes, SSN only 4= Yes, Medicare# only
47 q5loc What is your social security number? 0 .. 999999999
48 q5aloc [ENTER R. SOCIAL SECURITY NUMBER AGAIN] 0 .. 999999999
49 q6loc What is your medicare number? Please show me your card. String[11]
50 q6aloc [ENTER R. MEDICARE NUMBER AGAIN] String[11]
51 validated
52 validateerror
53 errorposition
54 validated_hicn_cms
55 validated_rrb_pre1964
56 validated_rrb_post1964
57 hicnformats
58 hicn_alpha
59 hicn_numbers
60 strlen
61 hicn_trimmed
62 ssn_br Do we need to obtain SSN from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the SSN. Enter NO if SSN is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
63 ssn What is your social security number? [INTERVIEWER: Please enter the SSN in 000-00-0000 format.] String[11]
64 ssn_c [ENTER R. SOCIAL SECURITY NUMBER AGAIN] String[11]
65 hicn_br Do we need to obtain the old Medicare#(HICN) from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the HICN. Enter NO if HICN is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
66 hicn What is your old medicare number(HICN) ? Please show me your card. [INTERVIEWER: valid HICN formats include 000000000A, 000000000C1, A000000000 or A000000.] String[11]
67 hicn_c [ENTER R. MEDICARE NUMBER(HICN) AGAIN] String[11]
68 hicn_type HICN Type: ^hicnFormats String[15]
69 mbi_br Do we need to obtain the new Medicare#(MBI) from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the MBI. Enter NO if MBI is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
70 mbi What is your new medicare number(MBI) ? Please show me your card. [INTERVIEWER: Please enter the MBI in 01EG4-TE5-MK73 format.] String[13]
71 mbi_c [ENTER R. MEDICARE NUMBER(MBI) AGAIN] String[13]
72 cntry DEMOGRAPHICS First, we would like to get some general information about your background. 1. In what state or country were you born? 1= U.S.A. 2= Other 3= Argentina 4= Belize 5= Bolivia 6= Brazil 7= Chile 8= Colombia 9= Costa Rica 10= Cuba 11= Dominican Republic 12= Ecuador 13= El Salvador 14= French Guiana 15= Guatemala 16= Guyana 17= Haiti 18= Honduras 19= Mexico 20= Nicaragua 21= Panama 22= Paraguay 23= Peru 24= Puerto Rico 25= Suriname 26= Uruguay 27= Venezuela
73 specfy Specify Country: String[30]
74 howlong How many years have you lived in the United States? 1 .. 130
75 state In what state were you born? String[30]
76 city 2. In what city or town? String[30]
77 county 3. And in what county (or province) were you born? String[30]
78 addnumbr Street Address at Birth I'd like you to tell me the street address where you lived when you were born, or the first street address that you remember where you lived? Participant's birth address Street number String[6]
79 dirbr Participant's birth address Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
80 streetbr Participant's birth address Street name String[18]
81 unitbr Participant's birth address Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
82 addcom Participant birth address [Interviewer: If the address is not complete, ask participant to describe location, e.g. cross streets, nearby public buildings/facilities, etc.] [Press enter if none.] String[250]
83 firstres How old were you when you moved into this residence? 0 .. 18
84 same12 Is this the same address you lived at when you were 12 years old? 1= Yes 2= No
85 addnum12 What was the street address where you lived when you were 12 years old? Participant's address at 12 years old Street number String[6]
86 dir12 Participant's address at 12 years old Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
87 street12 Participant's address at 12 years old Street name String[18]
88 unit12 Participant's address at 12 years old Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
89 city12 Participant's address at 12 years old City or Town String[18]
90 state12 Participant's address at 12 years old State String[2]
91 zip12 Participant's address at 12 years old Zip Code String[5]
92 addcom12 Participant's address at 12 years old [Interviewer: If the address is not complete, ask participant to describe location, e.g. cross streets, nearby public buildings/facilities, etc.] [Press enter if none.] String[250]
93 race 7. With which group do you most closely identify yourself? 1= White 2= Black, Negro, African-American 3= Native American, Indian 4= Eskimo 5= Aleut 6= Asian or Pacific Island
94 q4dem What is your date of birth? (mo/day/yr) Date type
95 spanish : Are you of Spanish, Hispanic or Latino origin? That is, having origins from a Spanish-speaking or Latin American country? 1= Yes 2= No
96 hispor Are you of Mexican/Chicano/Mexican American, Puerto Rican, Cuban, Dominican, Central American, or South American origin? 1= Mexican/Chicano/Mexican American 2= Puerto Rican 3= Cuban 4= Dominican 5= Central American(Belizean, Costa Rican, Guatemalan, Honduran, Nicaraguan, Panamanian, Salvadorian) 6= South American(Argentinian, Bolivian, Brazilian, Chilean, Columbian, Ecuadorian, Paraguayan, Peruvian, Uruguayan, Venezuelan) 50= Other
97 hisporx Other (specify, please write in English): String[30]
98 racepri What is your race? [Please read options 1-5 to the participant] 1= White 2= Black or African-American 3= American Indian or Alaska Native 4= Native Hawaiian or Other Pacific Islander 5= Asian 6= Other 7= Unknown
99 raceprix Other, specify String[30]
100 racesec_br Did the participant indicate a second race? [You are not to ask this question of the participant. Only click yes to this question if the participant offered this information to you during the previous question.] 1= Yes 2= No
101 racesec Indicate the participant's second race 1= White 2= Black or African-American 3= American Indian or Alaska Native 4= Native Hawaiian or Other Pacific Islander 5= Asian 6= Other 7= Unknown
102 racesecx Other, specify String[30]
103 raceter_br Did the participant indicate a third race? [You are not to ask this question of the participant. Only click yes to this question if the participant offered this information to you during the previous question.] 1= Yes 2= No
104 raceter Indicate the participant's third race 1= White 2= Black or African-American 3= American Indian or Alaska Native 4= Native Hawaiian or Other Pacific Islander 5= Asian 6= Other 7= Unknown
105 raceterx Other, specify String[30]
106 heart MEDICAL HISTORY - CARDIOVASCULAR DISEASE Now, I have some questions about a number of specific medical conditions. 1. Have you ever been told by a doctor, nurse or therapist that you had a heart attack or coronary, or coronary thrombosis, or coronary occlusion, or myocardial infarction? 1= Yes 2= Suspect or possible 3= No
107 multiple 1a. Did you have only one or more than one? 1= Only one 2= More than one
108 inhosp 1b Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
109 chf CONGESTIVE HEART FAILURE Have you ever been told by a doctor, nurse or therapist that you had congestive heart failure? 1= Yes 2= Suspect or possible 3= No
110 chfhosp Were you hospitalized overnight or longer for this? 1= Yes 2= No
111 chfnum How many times have you been hospitalized for this? 0 .. 10
112 cancer CANCER OR MALIGNANCY 1. Have you ever been told by a doctor, nurse or therapist that you had ... Cancer, malignancy or tumor of any type? 1= Yes 2= Suspect or possible 3= No
113 ca1a 1a. Where was it? [OR: Where was the most recent cancer that you had?] [SPECIFY] String[20]
114 diabetes DIABETES Have you ever been told by a doctor, nurse or therapist that you had ... 1. Diabetes, or sugar in the urine, or high blood sugar? 1= Yes 2= Suspect or possible 3= No
115 db1 2. Has a doctor, nurse or therapist, ever told you to take insulin or injections for your high blood sugar? 1= Yes 2= No
116 db3 3 Has a doctor, nurse, or therapist ever told you to take medicine by mouth for your high blood sugar? 1= Yes 2= No
117 highbp HIGH BLOOD PRESSURE Have you ever been told by a doctor, nurse or therapist that you had ... 1. High blood pressure? 1= Yes 2= Suspect or possible 3= No
118 bp3 2 Has a doctor, nurse, or therapist ever told you to take medicine by mouth for your high blood pressure? 1= Yes 2= No
119 thyroid THYROID DISEASE Have you ever been told by a doctor, nurse or therapist that you had ... 1. Thyroid disease? 1= Yes 2= Suspect or possible 3= No
120 th3 2. Has a doctor, nurse, or therapist ever told you to take medicine by mouth for your thyroid condition? 1= Yes 2= No
121 arthritis Arthritis Have you ever been told by a doctor, nurse or therapist that you had osteoarthritis? 1= Yes 2= Suspect or possible 3= No
122 gout Have you ever been told by a doctor, nurse or therapist that you had gout? 1= Yes 2= Suspect or possible 3= No
123 osteoporosis Have you ever been told by a doctor, nurse or therapist that you had osteoporosis? 1= Yes 2= Suspect or possible 3= No
124 joint_disease Have you ever been told by a doctor, nurse or therapist that you had other joint disease (excluding cancer)? 1= Yes 2= Suspect or possible 3= No
125 hormones HORMONE REPLACEMENT - Now I'd like to ask you about hormonal medications you may have used. Hormones are sometimes used by women around the time of their change of life, after surgery on their ovaries, to control heavy or irregular menstrual periods, or for prevention of disease such as bone loss. These medications include pills, injections, vaginal creams or suppositories, or skin patches. 1. Did you ever take any type of estrogen hormonal medication, for example Premarin, Ogen or Estrace, or progesterone hormonal medication, for example, Provera? 1= Yes 2= Suspect 3= No
126 agefirst 6. How old were you when you first took this/these medications? 1 .. 115
127 current 7. Are you currently taking this/these medications? 1= Yes 2= No
128 agelast 7a. How old were you when you last took this/these medications? 1 .. 115
129 mensage 8. At what age did you begin menstruating? 1 .. 99
130 menoage 9. At what age did you stop menstruating? 1 .. 99
131 natura 10. Was your menopause natural or caused by surgery? 1= Natural 2= Surgery
132 whatwas 10a. What was the surgery? 1= Full Hysterectomy 2= Hysterectomy (partial) 3= Other
133 othspe00 10b. Specify: String[40]
134 chespain CHEST PAIN Now some questions about pains in your chest. 1. Do you get pain or discomfort in your chest? 1= Yes 2= No
135 pressure 1a. Do you get pressure or heaviness in your chest? 1= Yes 2= No
136 uphill0 2. Do you get this pain (or discomfort) when you walk uphill or hurry? 1= Yes 2= No 3= Never walks uphill or hurries
137 level0 3. Do you get this pain (or discomfort) when you walk at an ordinary pace on level ground? 1= Yes 2= No
138 legpain CLAUDICATION Now some questions about pains in your legs. 1. Do you get pain in either leg while walking? 1= Yes 2= No
139 standsit 2. Does this pain ever begin when you are standing still or sitting? 1= Yes 2= No
140 calf 3. In what part of your leg do you feel it? [IF CALVES NOT MENTIONED ASK: `Anywhere else?' IF STILL NOT MENTIONED, CODE 2] 1= Pain includes calf/calves 2= Pain does not include calf
141 shrtbrth 9. Do you get short of breath at night if you sleep flat or only on one pillow? 1= Yes 2= No
142 pillows 9a. How many pillows do you need to sleep on to not be short of breath? 1 .. 9
143 grspbrth 9b. Do you wake up at night gasping for breath? 1= Yes 2= No
144 hoftshrt 9c. About how often did you have shortness of breath at night in the last month? 1= Several times/week 2= Once every night 3= A few times a week 4= Less often than once a week
145 headinj HEAD INJURY Now I have some questions about injuries. 1. Have you EVER had a head injury? 1= Yes 2= No
146 lostcons 3. Have you EVER lost consciousness because of a head injury? 1= Yes 2= Suspect or possible 3= No
147 howlong1 3c. How long were you unconscious for this (last) head injury? Would you say less than 5 seconds, between 5 seconds and 5 minutes, between 5 minutes and 1 hour, between 1 hour and 2 days, or more than 2 days? [If more than one head injury, ask about the worst head injury only.] 1= < 5 seconds 2= 5 seconds - 5 minutes 3= > 5 minutes - 1 hour 4= > 1 hour - 2 days 5= > 2 days
148 hdrvehicle
149 hdrhitbyobject
150 hdrfalling
151 hdrsports
152 hdrabuse
153 hdrmilitary
154 hdrother
155 prevbisqdone BRAIN INJURY SCREENING QUESTIONNAIRE Have the BISQ questions been previously completed for this participant? ^prevBisqDoneText 1= Yes 2= No
156 bisqveh BRAIN INJURY SCREENING QUESTIONNAIRE Now I have some questions about head injuries. ^lastInterviewText0en 1. Vehicle accident?(ex: MVA, pedestrian accident, motorcycle/ATV crash) 1= Yes 2= No
157 bisqvehnum ^hdrVehicle How many times did you receive a blow to the head, in a vehicle accident? 1 .. 30
158 bisqvehloc ^hdrVehicle Did you lose consciousness? 1= Yes 2= No
159 bisqvehlocnum ^hdrVehicle How many times have you lost consciousness? 1 .. 30
160 bisqvehlocdur ^hdrVehicle What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
161 bisqvehlocyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
162 bisqvehlocyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
163 bisqvehlocyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
164 bisqvehlocyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
165 bisqvehlocyr5 ^hdrVehicle In what year did this occur (5)? 1900 .. 2050
166 bisqvehdaze ^hdrVehicle Were you dazed or confused? 1= Yes 2= No
167 bisqvehdazenum ^hdrVehicle How many times have you been dazed or confused? 1 .. 30
168 bisqvehdazedur ^hdrVehicle What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
169 bisqvehdazeyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
170 bisqvehdazeyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
171 bisqvehdazeyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
172 bisqvehdazeyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
173 bisqvehdazeyr5 ^^hdrVehicle In what year did this occur (5)? 1900 .. 2050
174 bisqhit ^lastInterviewText1en 2. Hit by an object?(ex: equipment, falling object) 1= Yes 2= No
175 bisqhitnum ^hdrHitByObject How many times did you receive a blow to the head, from a falling object? 1 .. 30
176 bisqhitloc ^hdrHitByObject Did you lose consciousness? 1= Yes 2= No
177 bisqhitlocnum ^hdrHitByObject How many times have you lost consciousness? 1 .. 30
178 bisqhitlocdur ^hdrHitByObject What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
179 bisqhitlocyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
180 bisqhitlocyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
181 bisqhitlocyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
182 bisqhitlocyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
183 bisqhitlocyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
184 bisqhitdaze ^hdrHitByObject Were you dazed or confused? 1= Yes 2= No
185 bisqhitdazenum ^hdrHitByObject How many times have you been dazed or confused? 1 .. 30
186 bisqhitdazedur ^hdrHitByObject What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
187 bisqhitdazeyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
188 bisqhitdazeyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
189 bisqhitdazeyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
190 bisqhitdazeyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
191 bisqhitdazeyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
192 bisqfall ^lastInterviewText2en 3. Falling? (ex: down stairs, during a fainting spell, from a high place) 1= Yes 2= No
193 bisqfallnum ^hdrFalling How many times did you receive a blow to the head, in a fall? 1 .. 30
194 bisqfallloc ^hdrFalling Did you lose consciousness? 1= Yes 2= No
195 bisqfalllocnum ^hdrFalling How many times have you lost consciousness? 1 .. 30
196 bisqfalllocdur ^hdrFalling What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
197 bisqfalllocyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
198 bisqfalllocyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
199 bisqfalllocyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
200 bisqfalllocyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
201 bisqfalllocyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
202 bisqfalldaze ^hdrFalling Were you dazed or confused? 1= Yes 2= No
203 bisqfalldazenum ^hdrFalling How many times have you been dazed or confused? 1 .. 30
204 bisqfalldazedur ^hdrFalling What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
205 bisqfalldazeyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
206 bisqfalldazeyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
207 bisqfalldazeyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
208 bisqfalldazeyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
209 bisqfalldazeyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
210 bisqsprt ^lastInterviewText3en 4. Sports/Leisure?(ex: sports, biking, skiing, on the playground) 1= Yes 2= No
211 bisqsprtnum ^hdrSports How many times did you receive a blow to the head, during a sports or leisure activity? 1 .. 30
212 bisqsprtloc ^hdrSports Did you lose consciousness? 1= Yes 2= No
213 bisqsprtlocnum ^hdrSports How many times have you lost consciousness? 1 .. 30
214 bisqsprtlocdur ^hdrSports What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
215 bisqsprtlocyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
216 bisqsprtlocyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
217 bisqsprtlocyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
218 bisqsprtlocyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
219 bisqsprtlocyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
220 bisqsprtdaze ^hdrSports Were you dazed or confused? 1= Yes 2= No
221 bisqsprtdazenum ^hdrSports How many times have you been dazed or confused? 1 .. 30
222 bisqsprtdazedur ^hdrSports What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
223 bisqsprtdazeyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
224 bisqsprtdazeyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
225 bisqsprtdazeyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
226 bisqsprtdazeyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
227 bisqsprtdazeyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
228 bisqphys ^lastInterviewText4en 5. Physical Abuse/Assault?(ex: mugged) 1= Yes 2= No
229 bisqphysnum ^hdrAbuse How many times did you receive a blow to the head, from abuse or assault? 1 .. 30
230 bisqphysloc ^hdrAbuse Did you lose consciousness? 1= Yes 2= No
231 bisqphyslocnum ^hdrAbuse How many times have you lost consciousness? 1 .. 30
232 bisqphyslocdur ^hdrAbuse What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
233 bisqphyslocyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
234 bisqphyslocyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
235 bisqphyslocyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
236 bisqphyslocyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
237 bisqphyslocyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
238 bisqphysdaze ^hdrAbuse Were you dazed or confused? 1= Yes 2= No
239 bisqphysdazenum ^hdrAbuse How many times have you been dazed or confused? 1 .. 30
240 bisqphysdazedur ^hdrAbuse What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
241 bisqphysdazeyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
242 bisqphysdazeyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
243 bisqphysdazeyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
244 bisqphysdazeyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
245 bisqphysdazeyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
246 bisqmil ^lastInterviewText5en 6. Military Service?(ex: training, blast injury) 1= Yes 2= No
247 bisqmilnum ^hdrMilitary How many times did you receive a blow to the head, during military service? 1 .. 30
248 bisqmilloc ^hdrMilitary Did you lose consciousness? 1= Yes 2= No
249 bisqmillocnum ^hdrMilitary How many times have you lost consciousness? 1 .. 30
250 bisqmillocdur ^hdrMilitary What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
251 bisqmillocyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
252 bisqmillocyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
253 bisqmillocyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
254 bisqmillocyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
255 bisqmillocyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
256 bisqmildaze ^hdrMilitary Were you dazed or confused? 1= Yes 2= No
257 bisqmildazenum ^hdrMilitary How many times have you been dazed or confused? 1 .. 30
258 bisqmildazedur ^hdrMilitary What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
259 bisqmildazeyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
260 bisqmildazeyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
261 bisqmildazeyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
262 bisqmildazeyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
263 bisqmildazeyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
264 bisqoth ^lastInterviewText6en 7. In any other circumstances? 1= Yes 2= No
265 bisqothsp ^hdrOther Please specify: String[255]
266 bisqothnum ^hdrOther How many times did you receive a blow to the head, in a situation I have not mentioned? 1 .. 30
267 bisqothloc ^hdrOther Did you lose consciousness? 1= Yes 2= No
268 bisqothlocnum ^hdrOther How many times have you lost consciousness? 1 .. 30
269 bisqothlocdur ^hdrOther What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
270 bisqothlocyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
271 bisqothlocyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
272 bisqothlocyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
273 bisqothlocyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
274 bisqothlocyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
275 bisqothdaze ^hdrOther Were you dazed or confused? 1= Yes 2= No
276 bisqothdazenum ^hdrOther How many times have you been dazed or confused? 1 .. 30
277 bisqothdazedur ^hdrOther What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
278 bisqothdazeyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
279 bisqothdazeyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
280 bisqothdazeyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
281 bisqothdazeyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
282 bisqothdazeyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
283 grow1 The next questions are about your first 18 years of life. 2. When you were growing up, was your family a source of strength and support to you? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
284 grow2 4. When you were growing up, was there someone to take you to the doctor if you needed it? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
285 grow3 5. When you were growing up, how often was there not enough to eat? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
286 grow4 6. When you were growing up, how often did you have to wear dirty clothes? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
287 grow5 7. When you were growing up, how often did an adult living in (or visiting) your home say mean or hurtful things to you? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
288 grow6 8. When you were growing up, how often did an adult living in (or visiting) your home act in a way that made you afraid you might be physically hurt? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
289 grow7 11. When you were growing up, how often did an adult living in (or visiting) your home push, grab, slap, or throw something at you? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
290 grow8 12. When you were growing up, how often were you punished with a belt, board, cord, or some other hard object? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
291 grow9 13. When you were growing up, how often did adults living in (or visiting) your home argue with each other? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
292 grow10 14. When you were growing up, how often did physical fights occur between adults living in (or visiting) your home? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
293 grow11 15. When you were growing up, was a household member depressed or mentally ill? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
294 grow12 16. When you were growing up, was there a member of your household who was very ill (physically ill)? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
295 grow13 17. When you were growing up, was a household member a problem drinker or alcoholic? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
296 grow14 18. When you were growing up, did a household member go to prison? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
297 grow15 19. When you were growing up, were you ever hospitalized for two weeks or more? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
298 grow16 20. When you were growing up, did you ever have an experience that was so frightening that you thought about it for years? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
299 q1edu EDUCABILITY The next questions are about your early education. 1. Did you have difficulty attending regular schools, i.e., did you ever attend special schools or special classes in school? [INTERVIEWER: IGNORE SPECIAL SCHOOLS OR CLASSES RELATED TO HIGH ACADEMIC ACHIEVEMENT, E.G., ADVANCED PLACEMENT.] 1= No problem in schools 2= Attended special classes 3= Attended special schools
300 q2edu 2. For most of your education up to 8th grade, what type of school did you attend? 1= Public 2= public Magnet 3= private Catholic 4= private Other 5= home-Schooled 6= other
301 q4edu 4. Up through 8th grade did you attend school full-time (e.g., for the full school year) or part-time (e.g. because you had to work)? 1= full-time 2= part-time
302 q5edu 5. The next question is about your schooling up through 12th grade. Up through 12th grade for how ever many years you were in school, did you ever attend a legally segregated school? 1= Yes, attended a legally segregated school 2= No, did not attend a legally segregated school
303 q5aedu 5a. How many years? 1 .. 12
304 reada Present Time Now I have some questions about how you spend your time currently. 1. About how much time do you spend reading each day? 1= None 2= Less than one hour 3= One to less than two hours 4= Two to less than three hours 5= Three or more hours
305 diarya 10. In the last ten years, did you ever keep a diary or journal? 1= Yes 2= No
306 diaryb 10a. How many years? [Estimate total years.] 1 .. 120
307 museum 11. In the last ten years, how many times did you visit a museum? 1= Never 2= 1-2 times 3= 3-9 times 4= 10-19 times 5= More than 20 times
308 concer 12. In the last ten years, how many times did you attend a concert, play, or musical? 1= Never 2= 1-2 times 3= 3-9 times 4= 10-19 times 5= More than 20 times
309 lib 13. In the last ten years, how often did you visit a library? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
310 newpap 14. Thinking of the last year, how often do you read newspapers? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
311 magaz 15. During the past year, how often did you read magazines? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
312 readc 16. During the past year, how often did you read books? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
313 letter 17. During the past year, how often did you write letters? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
314 usepc 18. During the past year, how often did you use a personal computer (for example, for e-mail, to search the internet or other reasons)? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
315 games 19. During the past year, how often did you play games like checkers or other board games, cards, puzzles, word games, mind teasers, or any other similar games? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
316 q9act 9. During the past year, how often did you go to restaurants, sporting events or teletract, or play bingo? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
317 q10act 10. During the past year, how often did you go on day trips or overnight trips? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
318 q11act 11. During the past year, how often did you do unpaid community/volunteer work? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
319 q12act 12. During the past year, how often did you do paid community work? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
320 q13act 13. During the past year, how often did you visit at relatives' or friends' houses? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
321 q16act 16. During the past year, how often did you participate in any groups such as senior center, church related groups, charity, public services, or community groups? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
322 q15act 15. During the past year, how often did you attend church or religious services? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
323 q17act 17. During the past year, how often did you go shopping with friends (like to a mall)? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
324 q18act 18. During the past year, how often often did you go to parties or other social events (e.g., senior dances, nightclubs)? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
325 comfort The next questions are about spiritual feelings that you may experience in your daily life. I find comfort in my religion or spirituality. (Would you say that you feel this way--many times a day, everyday, most days, some days, once in a while, or never or almost never?) 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never
326 inpeace I feel deep inner peace or harmony. (Would you say that you feel this way--many times a day, everyday, most days, some days, once in a while, or never or almost never?) 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never
327 oftpray How often do you pray or meditate? (Would you say--many times a day, everyday, most days, some days, once in a while, or never or almost never?) 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never
328 self12 HANDEDNESS 1. Which hand do you usually use to write a letter? 1= Right 2= Left 3= Both
329 recogfr1 VISION/HEARING Now I have some questions about your vision and hearing. 1. (When wearing eyeglasses/contact lenses) Can you see well enough to recognize a friend across a room? 1= Yes 2= No
330 recogfr2 2. (When wearing eyeglasses/contact lenses) Can you see well enough to recognize a friend across the street? 1= Yes 2= No
331 hearing1 3. (With/without a hearing aid) Can you usually hear and understand what a person says without seeing his face if that person talks in a normal voice to you in a quiet room? 1= Yes 2= No
332 hearing2 4. (With/without a hearing aid) How often do you have difficulty understanding people over the telephone? 1= Almost always 2= Occaisonally 3= Rarely or never
333 glasses [If subject uses glasses, instruct him or her to wear them during test.] 1. Test taken with: 1= Glasses 2= Contact lenses 3= Neither
334 trial1 Now I would like to check your eyesight. [INTERVIEWER: Visual acuity should be checked with both eyes open. Hold card 14 inches from subject and ask him or her to read the number on the card. Record number of correct responses.] 2. First trial: 20/70 1= All three correct 2= Two correct 3= One correct 4= None correct
335 trial1a 2a. Second trial: 20/100 1= All three correct 2= Two correct 3= One correct 4= None correct
336 trial1b 2b. Third trial: 20/200 1= All three correct 2= Two correct 3= One correct 4= None correct
337 trial1c 2c. Fourth trial: 20/400 1= All three correct 2= Two correct 3= One correct 4= None correct
338 trial2 3. Second trial: 20/50 1= All three correct 2= Two correct 3= One correct 4= None correct
339 trial3 3a. Third trial: 20/40 1= All three correct 2= Two correct 3= One correct 4= None correct
340 ivisit2 visit
341 midarm BLOODPRESSURE Now I would like to take some measurements of your arm, hips, and waist, as well as height, weight and blood pressure. 1. MID-ARM CIRCUMFERENCE [IN cm] 15.0 .. 78.0
342 midfore 1a. MID FOREARM CIRCUMFERENCE [IN cm] 10.0 .. 78.0
343 midleg 1b. MID LEG CIRCUMFERENCE [IN cm] 15.0 .. 99.0
344 tricep1 2. FIRST TRICEPS SKINFOLD MEASUREMENT [IN mm] CODE 72 IF MEASUREMENT >= 67 mm] 1 .. 72
345 cuff BLOODPRESSURE Now I would like to take some height and weight measurements, and blood pressure readings. 3. IS CUFF SIZE AVAILABLE? [IF CUFF NOT AVAILABLE, AT END OF INTERVIEW SET UP TIME TO RETURN FOR BLOOD PRESSURE MEASUREMENT] 1= Yes 2= No
346 tricep2 4. SECOND TRICEPS SKINFOLD MEASUREMENT [IN mm] [CODE 72 IF MEASUREMENT >=67mm] 1 .. 72
347 pulsept 5. PULSE OBLITERATION POINT [IN mmHg] 50 .. 270
348 pul THE PEAK INFLATION LEVEL IS ^pulse [HIT ENTER FOR NEXT QUESTION] 80 .. 300
349 bp11 6. FIRST SITTING BLOOD PRESSURE READING [INTERVIEWER: The subject should be seated for five minutes prior to obtaining the seated blood pressure readings. ENTER SYSTOLIC/DIASTOLIC] String[7]
350 bp2 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] String[7]
351 bp31 8. STANDING BLOOD PRESSURE READING [INTERVIEWER: ASK THE SUBJECT TO STAND. WAIT 60 SECONDS THEN REPEAT BLOOD PRESSURE READING. ENTER SYSTOLIC/DIASTOLIC] String[7]
352 weight 9. MEASURED WEIGHT [IN LBS] [CODE 333 IF MEASUREMENT IS >=300 lbs. CODE 888 IF PHYSICALLY UNABLE TO WEIGH] 30 .. 888
353 height 10. MEASURED HEIGHT [IN FEET & INCHES] [CODE 888 IF PHYSICALLY UNABLE TO MEASURE HEIGHT] String[5]
354 waist Measured waist circumference [IN cm] [To measure waist circumference (WC), place a measuring tape in a horizontal plane around the abdomen – midway between the bottom of the rib cage and the top of the iliac crest.] [Code 333 IF MEASUREMENT >= 125 cm. CODE 888 IF PHYSICALLY UNABLE TO measure] 50 .. 888
355 hipcirc Measured hip circumference [IN cm] [To measure hip circumference (HC), place a measuring tape in a horizontal plane around the largest part of the hips – the widest part of the buttocks.] [Code 333 IF MEASUREMENT >= 125 cm. Code 888 IF PHYSICALLY UNABLE TO measure] 50 .. 888
356 gaitremind For each exercise: Say, 'Remember to look straight ahead and stay as still as possible until I say, Begin. Ready? Begin.' Say, 'Begin' and press the forward button on the remote to start the measurement (time will start on the program) Count Steps (when applicable) Say, 'Stop' and press the Forward button a second time to end the measurement. Stop Stopwatch (when applicable) If the measurement was accurately performed, press the Slideshow button on the remote to move onto the next measurement (once Slideshow button is pressed, you CANNOT repeat the measurement) If the measurement needs to be repeated, press the Back button on the remote or select 'cancel current trial' on the computer screen. Check device to ensure green light is still flashing. [Press enter to continue]
357 dynaintro Say I'm going to place this belt around your waist. The belt contains a recording device that will track your movements. I'm going to press a button on a remote before and after each task. It is important that you don't begin the task until I say 'Begin' and don't stop until I say 'stop'. Before starting each task I want you to look straight ahead and stay as still as possibel until I say 'Begin' [Press enter to continue]
358 walkint1 8 foot walk (trial 1) Place the DynaPort device around the waist of the participant, like a belt. DynaPort device should be located on the waistline, in center of the participant's back. Insert the scan disk with the participant's ID number labeled on it into the DynaPort device. Check that the green light on the DynaPort is on and then slide the device into the belt. Open the Dyrector MT program on your computer. Select the Perform tab. Make sure the COM port is selected and you have selected 'gait' under protocol. When you are ready to begin the gait test, select 'Start Measurement'. Check that the green light on the DynaPort is blinking. [Press enter to continue]
359 walkint2 8 foot walk (trial 1) Now I am going to observe how you walk at your normal pace. This is our walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking to the store. I want you to walk all the way past this line until I say 'Stop.' Let me show you what my normal pace would be if I were to walk the course. [Demonstrate and then ask the participant:] Do you feel it would be safe for you to walk this course with me? [Have the participant stand with both feet together on top of the line.] Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue]
360 sidebysintro POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN For the next exercise, I would like you to place one foot beside the other in a comfortable position in front of this line. [Demonstrate the position.] [Optional prompt if needed:] You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Now you try it. [Extend hands palm side up for the participant to use for balance.] I'm going to support your arms while you get into the position. Try to hold this position until I say 'Stop'. [Once the position is attained, the examiner's place is to the side and slightly behind the participant.] [Press enter to continue]
361 turn1intro 360° TURN Now I would like you to make a complete turn at your normal walking pace and turn until you reach your starting point. [Demonstrate] Now you try it. Line your feet on top of the tape and begin turning when I say 'Begin' and turn until you reach your starting point. Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue]
362 poststndintro POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Now I want you to do this again, but this time I want you to do it with your eyes closed. I'm going to support your arms while you get into the position. Try to hold the position until I say 'Stop.' [Press enter to continue]
363 getup1intro GET UP AND GO (trial 1) Place a chair behind the start line for the eight foot walk. Now I'm going to have you walk this course again but this time you're going to be seated in this chair with your back rested agains the back of the chair. Then, you're going to stand up from this chair, walk to the other end of the course at your normal pace past the line, turn around, walk back to the chair and sit down. [Demonstrate exercise] [Press enter to continue]
364 tandemintro TANDEM WALK (HEEL-TOE WALK) Now I want you to walk this course again but this time I want you to place one foot in front of the other with the heel touching the toe of the other foot like this, alternating feet. [Demonstrate exercise.] If you feel you are losing your balance, step out like this and then resume walking again. I want you to continue this walk all the way past this line before you stop. Participant should start with both feet on top of the line of tape. Remind participant to stay as still as possible until you say 'begin'. Ready? Begin [Press enter to continue]
365 walk8intro BACK AND FORTH 8 FOOT WALK TWICE I would like you to walk this course again. I want you to walk to the other end of the course at your usual speed, just as if you were walking to the store. This time, however, I want you to walk all the way past this line, turn around and walk back to the starting line. When you pass the starting line I want you to turn around and walk to the other end of the course, turn around and walk back. [Demonstrate] Do you feel it would be safe for you to walk this course with me? Participant should start with both feet on top of the line of tape. Remeber to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue]
366 gaitquip Is the Gait Test Equipment Available? 1= Yes 2= No
367 domove2 [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] 1= Yes 2= No
368 dynaid DynaPort Device id String[10]
369 diskid Disk ID String[10]
370 walk1 8 foot Walk (trial 1) Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start Stopwatch Count Steps Say, 'Stop'. Press M to stop recording Check device to ensure green light is still flashing. Is test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
371 move7b Time (seconds): 1.0 .. 60.0
372 move7c Number of steps taken: 1 .. 60
373 walk2 8 foot Walk (trial 2) Is test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
374 move7d Time (seconds): 1.0 .. 60.0
375 move7e Number of steps taken: 1 .. 60
376 move7a Record Aid used for 8 foot walk: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair as walking aid 6= Other
377 move7a1 [SPECIFY] String[20]
378 sidebys POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
379 turn1 360° TURN Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Press M on the DynaPort device when the turn is completed. Check device to ensure green light is still flashing. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
380 move6f Number of steps taken: 1 .. 60
381 move6e Time (seconds): 1.0 .. 60.0
382 turn2 360° TURN Second trial Is test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
383 move6h Number of steps: 1 .. 60
384 move6g Time (seconds): 1.0 .. 60.0
385 move6i Record Aid used for 360 turn: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
386 move6i1 [SPECIFY] String[20]
387 poststnd POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
388 getup1 GET UP AND GO (trial 1) Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Press M on the DynaPort device when the participant has returned and sat back down in the chair. Check device to ensure green light is still flashing. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
389 getup2 GET UP AND GO (trial 2) Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
390 getaid Record Aid used for GET UP AND GO: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
391 getaid_specify [SPECIFY] String[20]
392 tandem TANDEM WALK (HEEL-TOE WALK) Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Say, 'Stop' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
393 move8 Interviewer: Record number of errors, e.g. Sidesteps: 0 .. 60
394 tandaid Record Aid used for Tandem Walk: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
395 tandaid_specify [SPECIFY] String[20]
396 walk8 BACK AND FORTH 8 FOOT WALK TWICE Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Say, 'Stop' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
397 walk8aid Record Aid used for BACK AND FORTH WALK: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
398 walk8aid_specify [SPECIFY] String[20]
399 sttoeopen Toe Stand (Eyes Open) Describe the position while demonstraiting. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
400 move6 Time (seconds) : 1.0 .. 10.0
401 strlopen Standing on Right Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
402 move6a Time (seconds) : 1.0 .. 10.0
403 stllopen Standing on Left Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
404 move6c Time (seconds) : 1.0 .. 10.0
405 pegboardrt PURDUE PEGBOARD Is the test performed with right hand? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
406 pegboardlt PURDUE PEGBOARD Is the test performed with left hand? 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test)
407 admin1 PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH RIGHT HAND IN RIGHT-HAND COLUMN.] Now for practice you try it with your right hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< String[1]
408 admin2 [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO RIGHT-HAND COLUMN] with your RIGHT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< String[1]
409 admin3 PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH LEFT HAND IN LEFT-HAND COLUMN.] Now for practice you try it with your left hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< String[1]
410 admin4 [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO LEFT-HAND COLUMN] with your LEFT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< String[1]
411 trial11 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
412 trial21 [AT COMPLETION OF TRIAL 1, REPLACE PEGS AND SAY:] `Now I want you to do the same thing with your LEFT HAND. Pick up the pegs one at a time and place them in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 2. Trial 2, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
413 trial301 [AT COMPLETION OF TRIAL 2, REPLACE PEGS AND SAY:] `Now I want you to do this again with your RIGHT HAND. Place the pegs one at a time in this column [POINT TO RIGHT-HAND COLUMN COLUMN] with your right hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 3. Trial 3, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
414 trial4 [AT COMPLETION OF TRIAL 3, REPLACE PEGS AND SAY:] `Now I want you to do this again with your LEFT HAND. Place the pegs one at a time in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 4. Trial 4, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
415 introp PHYSICAL ACTIVITIY We are also interested in any physical activities that you do. I have a list of different types of activities that we ask of everyone, but most people do only one or two. [PRESS ENTER TO CONTINUE.] String[1]
416 q1phy In the past 14 days, have you done any of the following exercises, sports, or physically active hobbies: 1. Walking for exercise? 1= Yes 2= No
417 q1aphy 1a. How many times in the past 14 days did you go walking for exercise? [ENTER NUMBER OF TIMES] 1 .. 87
418 q1bphy 1b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
419 q11phy In addition to walking for exercise, in the past 14 days, have you done any other walking, for example, to go to the store, to visit someone in the neighborhood, or to go to church? 1= Yes 2= No
420 q11aphy 2a. How many times in the past 14 days did you go walking like that? [ENTER NUMBER OF TIMES] 1 .. 87
421 q11bphy 2b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
422 q3phy (In the past 14 days have you done) 3. Gardening or yard work? 1= Yes 2= No
423 q3aphy 3a. How many times in the past 14 days did you do gardening or yard work? [ENTER NUMBER OF TIMES] 1 .. 87
424 q3bphy 3b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
425 q5phy (In the past 14 days have you done) 5. Calisthenics or general exercise? 1= Yes 2= No
426 q5aphy 5a. How many times in the past 14 days did you do calisthenics or general exercise? [ENTER NUMBER OF TIMES] 1 .. 87
427 q5bphy 5b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
428 q8phy (In the past 14 days have you done) 8. Bicycle riding (including stationary bikes)? 1= Yes 2= No
429 q8aphy 8a. How many times in the past 14 days did you go bicycle riding? [ENTER NUMBER OF TIMES] 1 .. 87
430 q8bphy 8b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
431 q9phy (In the past 14 days have you done) 9. Swimming or water exercises? 1= Yes 2= No
432 q9aphy 9a. How many times in the past 14 days did you go swimming or do water exercises? [ENTER NUMBER OF TIMES] 1 .. 87
433 q9bphy 9b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
434 q10phy 10. Have you done any other exercises, sports, or physically active hobbies in the past 2 weeks other than the ones listed above? 1= Yes 2= No
435 q101phy 10.1 [SPECIFY] String[40]
436 q10aphy 10a. How many times in the past 14 days did you do this? [ENTER NUMBER OF TIMES] 1 .. 87
437 q10bphy 10b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
438 joints JOINTS Now a question about your joints. 1. In the past year, that is, since ^yearago have you had pain or aching in any of your joints on most days for at least one month? 1= Yes 2= No
439 q1md MOODS Now let me ask some questions about your current moods and feelings. The next few questions are about your feelings during the past week. For each of the following statements, please tell me if you felt that way much of the time during the past week. 1. I felt that everything I did was an effort. Have you felt this way much of the time during the past week? 1= Yes 2= No
440 q2md 2. My sleep was restless. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
441 q3md 3. I felt depressed. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
442 q4md 4. I was happy. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
443 q5md 5. I felt lonely. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
444 q6md 6. People were unfriendly. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
445 q7md 7. I enjoyed life. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
446 q8md 8. I felt sad. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
447 q9md 9. I felt that people disliked me. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
448 q10md 10. I could not get 'going'. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
449 howfeel DEPRESSION Now I have a few more questions about how you feel. 1. In the past month, has there been a period of two weeks or more during which you felt sad, blue, depressed, or when you lost interest and pleasure in things you usually cared about or enjoyed? 1= Yes 2= No
450 aptite During this period during which you felt depressed, did you experience any of the following problems? 2. A change in your appetite. 1= Yes 2= No
451 sleep 3. A change in your pattern of sleeping. 1= Yes 2= No
452 enrgy 4. A decrease in your energy level. 1= Yes 2= No
453 concen 5. Trouble concentrating. 1= Yes 2= No
454 guilt 6. Felt extremely guilty or worthless. 1= Yes 2= No
455 restls 7. Felt extremely restless or agitated. 1= Yes 2= No
456 activt 8. Lost your interest in favorite activities. 1= Yes 2= No
457 living 9. Felt that life was not worth living. 1= Yes 2= No
458 teldoc 9a. Did you tell a doctor or any other professional about it? 1= Yes 2= No
459 q1cc COGNITIVE COMPLAINTS Now I have some questions about your memory. 1. People find that they sometimes have more trouble remembering things as they get older. About how often do you have trouble remembering things? Would you say it is very often, often, sometimes, rarely or never? 1= Very often 2= Often 3= Sometimes 4= Rarely 5= Never
460 q2cc 2. Compared to 10 years ago, would you say that your memory is much worse, a little worse, the same, a little better or much better? 1= Much worse 2= A little worse 3= The same 4= A little better 5= Much better
461 q1func FUNCTIONAL STATUS We would also like to know how well you are able to do some physical activities that are important in day-to-day living but which many people have problems doing. 1. Are you able to do heavy work around the house, like washing windows, walls, or floors without help? 1= Yes 2= No
462 q2func 2. Are you able to walk up and down stairs to the second floor without help? 1= Yes 2= No
463 q3func 3. Are you able to walk a half mile without help? 1= Yes 2= No
464 q4func Next, I would like to know if you need help doing some different kinds of activities. At the present time, do you need help either from another person or a special equipment or device... 4. Walking across a small room? 1= No help 2= Help 3= Unable to do
465 q5func 5. Do you need help, either from another person or a special equipment or device... Bathing, either a sponge bath, tub bath or shower? 1= No help 2= Help 3= Unable to do
466 q6func 6. Do you need help, either from another person or a special equipment or device... Dressing, like putting on a shirt, buttoning and zipping, or putting on shoes? 1= No help 2= Help 3= Unable to do
467 q7func Do you need help, either from another person or a special equipment or device... 7. Eating like holding a fork, cutting food, or drinking from a glass? 1= No help 2= Help 3= Unable to do
468 q8func Do you need help, either from another person or a special equipment or device... 8. Getting from a bed to a chair? 1= No help 2= Help 3= Unable to do
469 q9func Do you need help, either from another person or a special equipment or device... 9. Using the toilet? 1= No help 2= Help 3= Unable to do
470 q10func Now I have a few more questions about activities people may or may not do. Although some things may actually be performed by someone else, just tell me whether you think you are able to do them. 10. Are you able to use the telephone - including looking up numbers and dialing - completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
471 q12func 12. Are you able to prepare your own meals completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
472 q13func 13. Are you able to do routine light housekeeping completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
473 q14func 14. Are you able to do periodic heavy housekeeping completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
474 q16func 16. Are you able to take your own prescribed medicines completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
475 q17func 17. Are you able to take care of your own finances - including paying bills, writing checks, keeping track of income (but not necessarily preparing your own taxes) - completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
476 q20func 20. Are you able to do your own personal shopping, like for clothes, for personal things, or for household needs completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
477 q21func 21. Are you able to travel around in your community to the places you might want to go, like to church or just to be outside completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
478 q1urin Next we would like to ask a few questions about common problems that people have as they grow older. We would appreciate your answers to these questions even though you may not have any problems. URINARY INCONTINENCE 1. How often during the last month have you leaked urine or lost control of your urine - almost everyday (5-7 days/week), several times a week (2-4 days/week), several times a month (2-4 days/month), once a month, less than once a month, or never? 1= Almost everyday (5-7 days/week) 2= Several times a week (2-4 days/week) 3= Several times a month (2-4 days/month) 4= Once a month 5= Less than once a month 6= Never
479 fecal1 FECAL INCONTINENCE 1. How would you describe your usual bowel pattern? 1= Normal 2= Constipated 3= Diarrhea 4= Alternating constipation and diarrhea
480 fecal2 2. In the past few months, have you ever lost control of your bowels when you did not want to? 1= Yes 2= Suspect 3= No
481 fecal3 3. How often in the past year have you seen your doctor for problems with your bowels? 1= None 2= 1-2 times 3= More than 3 times
482 falls FALLING 1. How many times would you say you have fallen over the past year? That is, how many times have you unintentionally come to rest on the ground or floor? 0 .. 99
483 fallinj 2. Did you suffer any injury that required you to go to your doctor, an emergency room or an urgent care center? 1= Yes 2= No
484 fallhelp 3. When you fell this past year were you ever not able to get up without help from someone? 1= Yes 2= No
485 fallnear 6. Have you had any near falls in the past year? That is, where you almost fell but were able to catch yourself or stop the fall? 1= Yes 2= No
486 married SOCIAL NETWORK Now some questions about your social network. Have you ever been married? 1= Yes 2= No
487 marrnum How many times have you been married? [Enter a number between 1-10.] 1 .. 10
488 married2 Are you now married, separated, divorced, or widowed? 1= Married 2= Separated 3= Divorced 4= Widowed
489 livewith Does your spouse/significant other live with you? 1= Yes 2= No
490 q1sn Do you have any living children? If so, how many do you have? Please include adopted children as well as children you have raised. [ENTER No. OF CHILDREN] 0 .. 30
491 q2sn How many of your children do you see at least once a month? [ENTER No. OF CHILDREN] 0 .. 30
492 q2asn Do you see your child at least once a month? 1= Yes 2= No
493 q3sn Now I'd like to ask you about your other relatives (besides your spouse and children), people that you are related to by blood or marriage. Please include grandchildren, brothers, sisters, sons-in-law and daughters-in-law, parents, aunts and uncles, and cousins. How many relatives do you have that you feel really close to - people you feel at ease with, can talk to about private matters or call upon for help? [ENTER No. OF CLOSE RELATIVES] 0 .. 76
494 q3asn How many of these close relatives do you usually see at least once a month? [ENTER No. OF CLOSE RELATIVES] 0 .. 76
495 q3bsn Do you see your close relative at least once a month? 1= Yes 2= No
496 q4sn Besides people that you are related to, how many close friends do you have; that is, people that you feel at ease with, can talk to about private matters and can call upon for help? [ENTER No. OF CLOSE FRIENDS] 0 .. 76
497 q4asn How many of these close friends do you see at least once a month? [ENTER No. OF CLOSE FRIENDS] 0 .. 15
498 q4bsn Do you see your close friend at least once a month? 1= Yes 2= No
499 spanishbr Is the participant of Spanish/Hispanic origin? 1= Yes 2= No
500 spanish_fluent Are you fluent in Spanish? 1= Yes 2= No
501 safe_accult_6 Ask question #6 in the SAFE - Acculturation Stress Scale? 1= Yes 2= No
502 description_acc Acculturation Although you may speak many languages, the following questions refer to only English and Spanish. [PRESS ENTER TO CONTINUE]
503 acc_langreadspeak 1. In general, what language(s) do you read and speak? 1= Only Spanish 2= Spanish better 3= Both equally 4= English better than Spanish 5= Only English
504 acc_langchild 2. What was the language(s) you used as a child? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
505 acc_langhome 3. What language(s) do you usually speak at home? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
506 acc_langthink 4. In which language(s) do you usually think? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
507 acc_langfriend 5. What language(s) do you usually speak with your friends? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
508 acc_langmedia 6. In general, what language(s) are the movies, T.V. and radio programs you prefer to watch and listen to? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
509 acc_friends 7. Your close friends are... 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino
510 acc_social 8. You prefer going to social gatherings/parties at which people are... 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino
511 acc_visitors 9. The persons you visit or who visit you are... 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino
512 acc_kidsfriend 10. If you could choose your children's friends you would want them to be... 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino
513 description_fam Familism Please indicate how much you agree or disagree with these statements by choosing the answer from 1 (disagree a lot) to 5 (agree a lot) which best shows how you feel about each statement. [PRESS ENTER TO CONTINUE]
514 fam_grandchild 1. One should have the hope of living long enough to see his/her grandchildren grow up. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
515 fam_parliverel 2. Aging parents should live with relatives. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
516 fam_helprel 3. When someone has problems he/she can count on help from his/her relatives. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
517 fam_pleasepar 4. Much of what a son or daughter does should be done to please the parents. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
518 fam_embrass 5. One should be embarrassed about the bad things done by his/her brothers and sisters. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
519 fam_livepar 6. Children should live in their parents' house until they get married. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
520 pnes_description PNES Perception I'm going to read you a list of statements about neighborhoods. Please tell me how much you agree or disagree with each statement as it relates to the neighborhood you live in now. In answering these questions, please think of your neighborhood as the area within about a 20 minute walk (or about a mile) from your house. [PRESS ENTER TO CONTINUE]
521 pnes_wellmaintain 1. In my neighborhood the buildings and homes are well-maintained. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
522 pnes_attractive 2. My neighborhood is attractive. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
523 pnes_noise 3. There is a lot of noise in my neighborhood. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
524 pnes_freshproduce 4. A large selection of fresh fruits and vegetables is available in my neighborhood. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
525 pnes_fastfood 5. There are many opportunities to purchase fast foods in my neighborhood. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
526 pnes_active 6. My neighborhood offers many opportunities to be physically active. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
527 pnes_facilities 7. Local sports clubs and other facilities in my neighborhood offer many opportunities to get exercise. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
528 pnes_walk 8. It is pleasant to walk in my neighborhood. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
529 pnes_traffic 9. My neighborhood has heavy traffic. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
530 pnes_help 10. People around here are willing to help their neighbors. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
531 pnes_getalong 11. People in my neighborhood generally get along with each other. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
532 pnes_trusted 12. People in my neighborhood can be trusted. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
533 pnes_howlong_year How long have you lived in your neighborhood? _____ years, 0 .. 199
534 pnes_howlong_month and/or _____ months 0 .. 11
535 pnes_howlong1_year How long have you lived at your current address? _____ years, 0 .. 199
536 pnes_howlong1_month and/or _____ months 0 .. 11
537 safe_description I'm going to read you a list of statements describing some potentially stressful experiences. Regardless of whether you've experienced these situations yourself, please tell me how stressful you might find each situation. [PRESS ENTER TO CONTINUE]
538 safe_pressure 1. People pressuring you to fit in. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
539 safe_stereo 2. People having stereotypes about your culture or ethnic group and treating you as if they are true. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
540 safe_credit 3. Not getting enough credit for the work you do. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
541 safe_exlude 4. Being excluded from participating in things. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
542 safe_custom 5. Being looked down upon for practicing customs of your culture 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
543 safe_english 6. People thinking you are unfriendly when in fact you have trouble communicating in English. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
544 safe_loosen 7. People pressuring you to loosen ties with your cultural background. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
545 safe_ignore 8. Feeling ignored by people who are supposed to assist you. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
546 myob PARENTAL HISTORY Now some questions about your natural or biologic parents. 1. In what year was your mother born? [ENTER YEAR] 1840 .. 1960
547 mfname PARENTAL HISTORY Now some questions about your natural or biologic parents. What is/was your mother's full name? [ENTER LAST/FIRST/MIDDLE/ MAIDEN NAME] String[40]
548 mage_bir 1a. How old was your mother when you were born? [ENTER YEARS OF AGE] 10 .. 50
549 mage_br2 1b. Do you know if she was less than 15 years old, 15 to 20 years, in her 20's, 30's or in her 40's? 1= Less than 15 years 2= 15 to 20 years 3= 20's 4= 30's 5= 40's
550 mlive2 From the time of your birth until you were 18, how many years did your mother live in the same home with you? [Enter a number between 0-18] 0 .. 18
551 mlive 2. Is your mother still living? 1= Yes 2= No
552 myod 2a. In what year did she die? [ENTER YEAR] 1893 .. 2040
553 mage_die 2b. How old was your mother when she died? [ENTER YEARS OF AGE] 10 .. 115
554 mage_cur 2c. How old is she now? [ENTER YEARS OF AGE] 75 .. 115
555 cmyob2 Calculated year of birth for mother 1829 .. 1919
556 meduc 6. What was the highest grade or year of regular school your mother completed? Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... 0 .. 30
557 meduc2 6a. Would you say that she had no schooling, a few years, finished grammar school, had any high school, or any college? 1= No schooling 2= A few years 3= Finished grammar school 4= Any high school 5= Any college
558 mpark 7. ^diddoesm your natural or biologic mother have Parkinson's disease with shaking tremors of the hands and/or slowness in walking and moving? 1= Yes 2= Suspect or possible 3= No
559 mdement2 8. ^diddoesm she (your natural or biologic mother) have a problem with memory loss, confusion, dementia, or hardening of the arteries? 1= Yes 2= Suspect or possible 3= No
560 ffname What is/was your father's full name? [ENTER LAST/FIRST/MIDDLE] String[30]
561 fyob 9. In what year was your father born? [ENTER YEAR] 1810 .. 1960
562 fage_bir 9a. How old was your father when you were born? [ENTER YEARS OF AGE] 10 .. 115
563 fage_br2 9b. Do you know if he was less than 15 years old, 15 to 20 years, in his 20's, 30's, 40's, or 50 or older? 1= Less than 15 years 2= 15 to 20 years 3= 20's 4= 30's 5= 40's 6= 50+
564 flive2 From the time of your birth until you were 18, how many years did your father live in the same home with you? [Enter a number between 0-18] 0 .. 18
565 flive 10. Is your father still living? 1= Yes 2= No
566 fyod 10a. In what year did he die? [ENTER YEAR] 1820 .. 2040
567 fage_die 10b. How old was your father when he died? [ENTER YEARS OF AGE] 10 .. 115
568 fage_cur 10c. How old is he now? [ENTER YEARS OF AGE] 75 .. 115
569 cfyob2 Calculated year of birth for father 1764 .. 1919
570 fwork 11. What kind of work did your father do most of his life?(What was his job called?) [SPECIFY] String[30]
571 feduc 12. What was the highest grade or year of regular school your father completed? Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... 0 .. 30
572 feduc2 12a. Would you say that he had no schooling, a few years, finished grammar school, had any high school, or any college? 1= No schooling 2= A few years 3= Finished grammar school 4= Any high school 5= Any college
573 fpark 13. ^diddoesf your natural or biologic father have Parkinson's disease with shaking tremors of the hands and/or slowness in walking and moving? 1= Yes 2= Suspect or possible 3= No
574 fdement2 14. ^diddoesf he (your natural or biologic father) have a problem with memory loss, confusion , dementia, or hardening of the arteries? 1= Yes 2= Suspect or possible 3= No
575 school How important was it to your parents that you be successful in school? 1= Extremely important 2= Moderately important 3= Somewhat important 4= Not at all important
576 sibnum How many natural or biological brothers and sisters did you have? [Interviewer: Include those currently living and those who have already died.] 0 .. 30
577 sibpark1 Did any of your natural or biological siblings have Parkinson's disease with shaking tremors of the hands and/or slowness in walking and moving? 1= Yes 2= Suspect or Possible 3= No
578 sibpark2 How many? 1 .. 9
579 sibmem1 Did any of your natural or biological siblings have a problem with memory loss, confusion, dementia, or hardening of the arteries? 1= Yes 2= Suspect or Possible 3= No
580 sibmem2 How many? 1 .. 9
581 drive1 DRIVING Are you currently licensed to drive? 1= Yes 2= No
582 drive2 Have you driven in the past 12 months? 1= Yes 2= No
583 drive3 Approximately how many days during a typical week are you likely to drive? 1= 6 or 7 days 2= 3 to 5 days 3= 1 or 2 days 4= less than once per week
584 worrier PERSONALITY-NEO Now I'd like to read some statements that may or may not describe you as a person. For each statement, please tell me how well you think the statement describes you. Please use this card to help with your responses. [READ FIRST STATEMENT, THEN ASK: Do you strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree that this statement describes you? I am not a worrier. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
585 inferior I often feel inferior to others. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
586 tense I often feel tense and jittery. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
587 getangry I often get angry at the way people treat me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
588 discourg Too often, when things go wrong, I get discouraged and feel like giving up. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
589 helpless I often feel helpless and want someone else to solve my problems. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
590 neo18str 18. When I'm under a great deal of stress, sometimes I feel like I'm going to pieces. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
591 neo3lon 3. I rarely feel lonely or blue. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
592 neo9wrth 9. Sometimes I feel completely worthless. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
593 neo13anx 13. I rarely feel fearful or anxious. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
594 neo15sad 15. I am seldom sad or depressed. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
595 neo16ash 16. At times I have been so ashamed I just wanted to hide. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
596 purpos1 PURPOSE IN LIFE 1. I feel good when I think of what I've done in the past and what I hope to do in the future. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
597 purpos2 2. I live life one day at a time and don't really think about the future. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
598 purpos3 3. I tend to focus on the present, because the future nearly always brings me problems. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
599 purpos4 4. I have a sense of direction and purpose in life. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
600 purpos5 5. My daily activities often seem trivial and unimportant to me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
601 purpos6 6. I used to set goals for myself, but that now seems like a waste of time. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
602 purpos7 7. I enjoy making plans for the future and working them to a reality. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
603 purpos8 8. I am an active person in carrying out the plans I set for myself. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
604 purpos9 9. Some people wander aimlessly through life, but I am not one of them. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
605 purpos10 10. I sometimes feel as if I've done all there is to do in life. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
606 emptins SOCIAL ISOLATION I experience a general sense of emptiness. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
607 misspeop I miss having people around. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
608 friends I feel like I don't have enough friends. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
609 abandon I often feel abandoned. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
610 missfrnd I miss having a really close friend. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
611 edanx53 Anxiety In the past 7 days ... 1. I felt uneasy. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
612 edanx46 Anxiety 2. I felt nervous. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
613 edanx48 Anxiety 3. Many situations made me worry. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
614 edanx41 Anxiety 4. My worries overwhelmed me. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
615 edanx54 Anxiety 5. I felt tense. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
616 edanx55 Anxiety 6. I had difficulty calming down. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
617 edanx18 Anxiety 7. I had sudden feelings of panic. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
618 nqanx07 Anxiety 8. I felt nervous when my normal routine was disturbed. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
619 q1mdb DISCRIMINATION Now I would like to ask you about certain experiences or feelings you have had in your daily life. In your daily life how often have you had the following experiences: 1. You are treated with less courtesy than other people. Would you say that you have had this experience...? 1= Often 2= Sometimes 3= Rarely 4= Never
620 q2mdb 2. You are treated with less respect than other people. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
621 q3mdb 3. You receive poorer service than other people at restaurants or stores. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
622 q4mdb 4. People act as if they think you are not smart. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
623 q5mdb 5. People act as if they are afraid of you. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
624 q6mdb 6. People act as if they think you are dishonest. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
625 q7mdb 7. People act as if they're better than you are. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
626 q8mdb 8. You or your family members are called names or insulted. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
627 q9mdb 9. You are threatened or harassed. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
628 q11mdb 11. The color of your skin is a problem for White people. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
629 q14mdb 14. White people act as if they are better than you. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
630 q18mdb 18. You are treated with less respect than a White person. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
631 q19mdb 19. White people try to avoid you in public, such as on elevators or on public transportation. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
632 q20mdb 20. White people act as if they are afraid of you. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
633 q21mdb 21. You are treated as if you fit a racial stereotype (e.g., Blacks are violent; Blacks are lazy). [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
634 q28mdb 28. If I need legal or medical help, the fact that I am Black will not influence the type of help I receive. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
635 q30mdb 30. Blacks have as many opportunities as Whites to live a middle class life. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
636 q33mdb 33. Blacks have the same opportunities as Whites to get a college education. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
637 q1smoreg SMOKING We are interested in whether smoking or drinking beverages containing alcohol are linked to certain health problems and also whether they may have some beneficial effects. First, some questions about smoking. 1. Do you regularly smoke cigarettes now? 1= Yes 2= No
638 q2smo 2. Did you ever smoke cigarettes regularly? 1= Yes 2= No
639 q2smoa 2a. For how long ^didhave you regularly ^didsmoke? [ENTER YEARS: 01 = 1 YEAR OR LESS] 1 .. 115
640 q3smo 3. During that period of your life when you were smoking the most, about how many cigarettes a day did you usually smoke? [ENTER NUMBER OF CIGARETTES: 1 PACK = 20 CIGARETTES] 1 .. 200
641 q4smo 4. Altogether, about how many years did you smoke this much? [ENTER YEARS: 01 = 1 YEAR OR LESS] 1 .. 115
642 q1alc ALCOHOL USE We also have some questions on beverages that contain alcohol which may have good or bad effects on health. Included among alcoholic beverages are beer, wine and liquor, such as whiskey, rum, gin, or vodka, or any other type of alcoholic beverages. 1. In your entire life, have you had at least 12 drinks of any kind of alcoholic beverage? 1= Yes 2= No
643 q2alc 2. In the past 12 months, did you have at least 12 drinks of any kind of alcoholic beverage? 1= Yes 2= No
644 q3alc There are different types of alcoholic beverages and we would like to talk about one type at a time.3. During the past 12 months, on average, how much beer did you drink? Six or more bottles or cans per day, 4 to 5 bottles or cans per day, 2 to 3 bottles or cans per day, 1 bottle or can per day, 5 to 6 bottles or cans per WEEK, 2 to 4 bottles or cans per week, 1 bottle or can per week, 1 to 3 bottles or cans per MONTH, or less than one bottle or can per month? 1= 6+ bottles or cans per day 2= 4-5 bottles or cans per day 3= 2-3 bottles or cans per day 4= 1 bottle or can per day 5= 5-6 bottles or cans per week 6= 2-4 bottles or cans per week 7= 1 bottle or can per week 8= 1-3 bottles or cans per month 9= Less than one bottle or can per month
645 q4alc 4. During the past 12 months, on average, how much wine did you drink? Six or more 4-oz. glasses per day, 4 to 5 4-oz. glasses per day, 2 to 3 4-oz. glasses per day, 1 4-oz. glass per day, 5 to 6 4-oz. glasses per WEEK, 2 to 4 4-oz. glasses per week, 1 4- oz. glass per week, 1 to 3 4-oz. glasses per MONTH, or less than one 4-oz. glass per month? 1= 6+ glasses per day 2= 4-5 glasses per day 3= 2-3 glasses per day 4= 1 glass per day 5= 5-6 glasses per week 6= 2-4 glasses per week 7= 1 glass per week 8= 1-3 glasses per month 9= Less than one glass per month
646 q5alc 5. During the past 12 months, on average, how much liquor did you drink? That is, drinks made with whiskey, vodka, gin, brandy or liqueurs. 1= 6+ drinks per day 2= 4-5 drinks per day 3= 2-3 drinks per day 4= 1 drink per day 5= 5-6 drinks per week 6= 2-4 drinks per week 7= 1 drink per week 8= 1-3 drinks per month 9= Less than one drink per month
647 q6alc 6. In your entire life, when you drank the most, about how often did you drink any type of alcoholic beverage, including beer, wine and liquor? 1= 6+ drinks per day 2= 4-5 drinks per day 3= 2-3 drinks per day 4= 1 drink per day 5= 5-6 drinks per week 6= 2-4 drinks per week 7= 1 drink per week 8= 1-3 drinks per month 9= Less than one drink per month
648 robbed Now I would like to ask some questions about the neighborhood you live in. Neighborhood Stress a. In the last 12 months, in your neighborhood, have you heard of or do you know about a house which was robbed? 1= Yes, several times 2= Yes, once or twice 3= No
649 assault In the last 12 months, have you heard of or know about a person who was beat up or assaulted? 1= Yes, several times 2= Yes, once or twice 3= No
650 shot In the last 12 months, have you heard of or know about a person who was shot or killed? 1= Yes, several times 2= Yes, once or twice 3= No
651 safe1 Now we would like to ask you how safe you feel in your neighborhood, house, or apartment. How safe from crime would you say your neighborhood is? Would you say it is...... 1= Very safe 2= Fairly Safe 3= Somewhat safe 4= Not too safe 5= Not safe at all
652 safe2 Thinking about the building (house) you live in; how safe from crime would you say it is? 1= Very safe 2= Fairly Safe 3= Somewhat safe 4= Not too safe 5= Not safe at all
653 sidewalk Please indicate whether the following conditions exist in your neighborhood. a. Sidewalks? 1= Present 2= Absent
654 traffic b. Heavy traffic? 1= Present 2= Absent
655 stlght d. Streetlights? 1= Present 2= Absent
656 dogs e. Unattended dogs? 1= Present 2= Absent
657 scenery f. Enjoyable scenery? 1= Present 2= Absent
658 exercse g. People exercising? 1= Present 2= Absent
659 unemploy These questions are about problems in your neighborhood. I am going to name different problems and I want you to tell me whether these things are a big problem in your neighborhood, somewhat of a problem, or not a problem. 1. high unemployment? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
660 tension 2. tension between people of different races or cultures? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
661 steal 3. stealing? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
662 destprop 4. destroying property? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
663 disresp 5. disrespect for laws, rules, or authority? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
664 abandon2 6. abandoned houses or buildings? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
665 rape 7. rape or sexual assault? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
666 prostit 8. prostitution? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
667 gamble 9. illegal gambling? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
668 attacked 11. getting attacked and/or robbed on the street? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
669 gangs 12. gangs? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
670 homeless 13. homeless people? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
671 druguse 14. drug use or drug dealing out in the open? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
672 cityoff 15. city officials ignoring problems in the neighborhood? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
673 unsupch 16. unsupervised children? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
674 guns 17. guns and violence? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
675 pubtran 18. public transportation not available? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
676 medserv 19. medical services are too far away? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
677 police 20. police do not care about problems in the neighborhood? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
678 carenum Now I would like to ask you some questions about people you take care of. How many people are you currently taking care of (include children, grandchildren, spouse, sick relative or friend? 0 .. 10
679 carediff How often would you say that taking care of your family member(s) is very difficult? 0= Never 1= Rarely 2= Sometimes 3= Much of the time 4= Always
680 q40inc In order for us to have a clear understanding about what kinds of things affect our health, we need to get some information about income. This information will help us understand why some people do not get the health services they need. Please look at this card. Which of these income groups represents your household income at age 40? Just give me the letter that best represents your income category at that age.[ENTER LETTER] 1= Q 2= R 3= S 4= T 5= U 6= V 7= W 8= X 9= Y 10= Z
681 q1inc Which of these income groups represents ^husbwife2 personal income for the past year? Include income from all sources such as wages, salaries, social security or retirement benefits, help from relatives, rent from property, and so forth. Just give me the letter that represents your income category.[ENTER LETTER] 1= Q 2= R 3= S 4= T 5= U 6= V 7= W 8= X 9= Y 10= Z
682 q2inc Think of all the income from persons who live in the same home with you currently. Which of the following is closest to your total household income for the past year? Just give me the letter that represents your income category.[ENTER LETTER] 1= Q 2= R 3= S 4= T 5= U 6= V 7= W 8= X 9= Y 10= Z
683 q3inc How many people are supported in your household by the income circled above? [Interviewer: Include income provider in total number.] 1 .. 30
684 q4inc How often does it happen that you do not have enough money to afford the kind of food you should have? 1= Never 2= Once in a while 3= Fairly often 4= Very often
685 q5inc How often does it happen that you do not have enough money to afford the kind of medical care you should have? 1= Never 2= Once in a while 3= Fairly often 4= Very often
686 q6inc How much difficulty do you have in meeting the monthly payments on your bills? 1= Never 2= Once in a while 3= Fairly often 4= Very often
687 q7inc In general, how do your finances usually work at the end of the month? Do you find that.... 1= you ususally end up with money left over 2= you usually end with just enough money left over to make ends meet 3= you don't have enough money to make ends meet
688 contr1 These next questions ask you about your feelings and thoughts during the last month. 0 = never, 1 = almost never, 2 = sometimes, 3= fairly often, 4 = very often 234. In the last month, how often have you felt you were unable to control the important things in your life? 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often
689 contr2 235. In the last month, how often have you felt confident about your ability to handle your personal problems? 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often
690 contr3 236. In the last month, how often have you felt that things were going your way? 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often
691 contr4 237. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often
692 lifesp1 LIFE SPACE For the next set of questions, please think of all the places you have been during the past week. During the past week, have you been to other rooms of your apartment (or home) besides the room where you sleep? 1= Yes 2= No
693 lifesp2 During the past week, have you been to an area immediately outside your apartment (or home) such as your porch, deck, or patio, hallway or garage? 1= Yes 2= No
694 lifesp3 During the past week, have you been to an area outside your apartment building (or home) such as the courtyard, yard, driveway, or parking lot? 1= Yes 2= No
695 lifesp4 During the past week, have you been to places within your immediate neighborhood but beyond your own apartment building or property? 1= Yes 2= No
696 lifesp5 During the past week, have you been to places outside your immediate neighborhood, but within your own town or community? [INTERVIEWER: For persons living in CCRC's or other facilities with multiple buildings, this means beyond the buildings on the facility's property. We're looking for other places beyond walking distance, e.g., more than half a mile.] 1= Yes 2= No
697 lifesp6 During the past week, have you been to places outside your town or community? 1= Yes 2= No
698 currjob OCCUPATION 1. The kind of work we do can also affect our health, so we would like to get some information about your occupations. We would like to know if you are currently working at a job? 1= Yes 2= No
699 ftpt 2. Full-time or part-time? 1= Part-time 2= Full-time
700 cjobname 3. What kind of work are you doing? (What is your job called?) (For example, registered nurse, personnel manager, supervisor, a teacher...) [JOB NAME] String[30]
701 cjobduty 4. What are your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
702 retired 5. Are you retired? (from a job?) 1= Yes 2= No
703 yr_ret 5a. In what year did you retire? 1894 .. 2040
704 lifejob 6. What kind of work have you done most of your life? (What was your job called?) (For example, registered nurse, personnel manager, supervisor, teaching...) 1= Same as current occupation 2= Not currently working; occupation specified 3= Different occupation from current one; 4= Never worked/disabled
705 ljobname 6a. Specify occupation String[30]
706 ljobduty 6b. What were your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
707 work30 9. What kind of work did you do when you were 30 years of age? (What is your job called?) (For example, registered nurse, personnel manager, supervisor, teacher...) 1= Same as current occupation 2= Same as work done most of life 3= Different occupation from job(s) described previously 4= Other, not working
708 job30 9a. [SPECIFY OCCUPATION] String[30]
709 oth30 9b. [SPECIFY REASON FOR NON-WORKING STATUS AT 30 YEARS OF AGE] String[30]
710 duty30 9c. What were your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
711 aamusic We have just a few more questions. Now I have some statements about being a Black/African American person and I want you to tell me whether you agree or not with the statements. Most of the music I listen to is by Black artists. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree 5= Not applicable
712 aashows Mostly I try to watch all the Black shows on TV. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree 5= Not applicable
713 aafriend Most of my friends are Black. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree
714 aaneigh I grew up in a mostly Black neighborhood. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree
715 aaorgs I am active in Black organizations and social groups. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree
716 c1fname CONTACT PERSON: We will test you once a year for the next few years, so we need to be able to contact you. In the event that we are unable to contact you, can you give me the name, address, and phone number of two people who would have information about you? Please, think of people who do not live in the same household as you. First Contact Person First name [ENTER DONTKNOW IF NONE.] String[12]
717 c1middl First Contact Person Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
718 c1lname First Contact Person Last name String[18]
719 c1gender ^c1fname ^c1lname First Contact Person's gender 1= Male 2= Female
720 c1live Does ^c1heshe live with you? 1= YES 2= NO
721 c1see How often do you see ^c1himher? 1= <2 days per week 2= 2-3 days per week 3= 4-5 days per week 4= 6-7 days per week
722 c1addnum ^c1fname ^c1lname First Contact Person's current address Street number String[6]
723 c1dir ^c1fname ^c1lname Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
724 c1street ^c1fname ^c1lname Street name String[55]
725 c1unit ^c1fname ^c1lname Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
726 c1city ^c1fname ^c1lname City or Town String[18]
727 c1state ^c1fname ^c1lname State String[2]
728 c1zip ^c1fname ^c1lname Zip Code String[5]
729 c1hphone ^c1fname ^c1lname Home Telephone including area code [Use '-' to separate] String[20]
730 c1wphone ^c1fname ^c1lname Work Telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[20]
731 c1relshp ^c1fname ^c1lname First Contact Person's relationship to the participant? 1= Spouse 2= Son/daughter (including stepchildren) 3= Son-in-law/ Daughter-in-law 4= Grandchild 5= Parent 6= Brother or sister 7= Other
732 c1relspc ^c1fname ^c1lname Specify String[40]
733 c2fname Second Contact Person [THIS PERSON MAY NOT RESIDE AT THE SAME ADDRESS AS THE PARTICIPANT OR THE FIRST CONTACT PERSON] First name [ENTER DONTKNOW IF NONE.] String[12]
734 c2middl Second Contact Person Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
735 c2lname Second Contact Person Last name String[18]
736 c2gender ^c2fname ^c2lname Second Contact Person's gender 1= Male 2= Female
737 c2live Does ^c2heshe live with you? 1= YES 2= NO
738 c2see How often do you see ^c2himher? 1= <2 days per week 2= 2-3 days per week 3= 4-5 days per week 4= 6-7 days per week
739 c2addnum ^c2fname ^c2lname Second Contact Person's current address Street number String[6]
740 c2dir ^c2fname ^c2lname Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
741 c2street ^c2fname ^c2lname Street name String[55]
742 c2unit ^c2fname ^c2lname Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
743 c2city ^c2fname ^c2lname City or Town String[18]
744 c2state ^c2fname ^c2lname State String[2]
745 c2zip ^c2fname ^c2lname Zip Code String[5]
746 c2hphone ^c2fname ^c2lname Home Telephone including area code [Use '-' to separate] String[20]
747 c2wphone ^c2fname ^c2lname Work Telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[20]
748 c2relshp ^c2fname ^c2lname Second Contact Person's relationship to the participant? 1= Spouse 2= Son/daughter (including stepchildren) 3= Son-in-law/ Daughter-in-law 4= Grandchild 5= Parent 6= Brother or sister 7= Other
749 c2relspc ^c2fname ^c2lname Specify String[40]
750 study1 STUDY INFORMATION We think that it's important for your family and friends to know about the study. Is it OK for us to send these people information about the study such as an information packet and newsletter? 1= Yes 2= No
751 primphyf 3. What is the first name of your primary physician? [ENTER FIRST NAME. NO MD or DR.] String[15]
752 primphym 3. What is the middle initial of your primary physician? [ENTER M.I.] String[1]
753 primphyl 3. What is the last of your primary physician? [ENTER LAST NAME. NO MD or DR.] String[20]
754 phaddnum Physician- ^primphyf ^primphyl Physician's current address Street number String[6]
755 phdir Physician- ^primphyf ^primphyl Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
756 phstreet Physician- ^primphyf ^primphyl Street name String[55]
757 phunit Physician- ^primphyf ^primphyl Suite or office number [HIT ENTER IF NOT APPLICABLE] String[5]
758 phcity Physician- ^primphyf ^primphyl City or Town String[18]
759 phstate Physician- ^primphyf ^primphyl State String[2]
760 phzip Physician- ^primphyf ^primphyl Zip Code String[5]
761 physophn Physician- ^primphyf ^primphyl Telephone Number including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[20]
762 physhphn 8. Physician's home phone? [HIT ENTER IF NOT APPLICABLE] String[20]
763 phyvisit 9. How often do you usually see him/her? 1= Every 6 months 2= Every 6 to 12 months 3= Less than once/year
764 livingwl 10. Do you have a living will or Durable Power of Health Care? 1= Yes 2= No
765 represen 11. Who have you designated as you representative? [ENTER NAME] String[30]
766 liklyhos 12. If you were to become ill and require hospitalization, which hospital would you most likely use? [ENTER HOSPITAL NAME:] String[20]
767 lhosaddr 13. Hospital's Address? String[30]
768 wherlive 14. If you were unable to care for yourself, where would live? (i.e. intermediate care) [ENTER LOCATION] String[30]
769 funerhme 15. At the time of your death, what funeral home would you most likely use? [ENTER FUNERAL HOME NAME] String[20]
770 faddnum Funeral Home Address? Address Number String[6]
771 fdir Funeral Home Address? Direction: [Press enter if none.] String[4]
772 fstreet Funeral Home Address? Street: String[55]
773 funit Funeral Home Address? Department, Building, or Office Number: [Press enter if none.] String[25]
774 fcity Funeral Home Address? City: String[18]
775 fstate Funeral Home Address? State: String[2]
776 fzip Funeral Home Address? Zip Code: String[5]
777 fphone What is the Funeral Home telephone number (including area code)? [Use '-' to separate] String[20]
778 agreeaut Has the participant agreed to autopsy in this study? [Check the participant data sheet in the chart.]? 1= Yes 2= No
779 toldfam Have you told your family, other relatives, any friends, or your power of attorney about your participation in this study? 1= Yes 2= No
780 funname Has the participant given us a name and address of a funeral home they intend to use? 1= Yes 2= No
781 arrange Has the participant made pre-arrangements with this funeral home? 1= Yes 2= No
782 giveperm Has the participant already given us permission to contact their funeral home of choice? [Check the participant data sheet in the chart.] 1= Yes 2= No
783 contfun Is it OK with you if we contact this funeral home and let them know that you are a participant in the study, so we can give them information about the study? 1= Yes 2= No
784 howwell 1. INTERVIEWER OBSERVATIONS How well do you think the participant understood the questions? 1= Quite well 2= Fairly well 3= Somewhat 4= Very Little 5= Not at all
785 hearimp 2. Does the participant have a substantial hearing impairment? 1= Yes 2= No
786 visimp 3. Does the participant have a SUBSTANTIAL visual impariment? 1= Yes, completely blind 2= Yes, very poor 3= Yes, poor 4= No, not substantial
787 phyeffrt 4. How great an effort do you think the participant put into the physical function items? 1= A great deal 2= A considerable amount 3= A moderate amount 4= A little bit 5= Hardly any
788 comments Enter any comments. [PRESS ENTER IF NONE.] String[150]
789 vegsign 0 .. 8
790 mvegsign 0 .. 8
791 cesd 0 .. 10
792 mcesd 0 .. 10
798 formcode Please enter status code. 11 = COMPLETE 13 = COMPLETE, portion with proxy 12 = INCOMPLETE, refused 14 = INCOMPLETE, too impaired 21 = INCOMPLETE interim, complete later 73 = NOT TESTED, out of town 31 = NOT TESTED, moved 33 = NOT TESTED, refused 75 = NOT TESTED, hospitalized 76 = NOT TESTED, other 42 = DECEASED 43 = WITHDRAWN 44 = WITHDRAWN, Autopsy OK 11 .. 76
799 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
800 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
801 statid Please enter you staff id. 100 .. 997
802 formch Has the form been modified? 1= Yes 2= No
803 revidate Enter the date that the form was modified. Date type
804 revintd Enter your staff id number. 100 .. 997
805 anydev Are there any protocol deviations or missing data items to enter? 1= Yes 2= No
806 numdev How many total protocol deviations and tests with missing items to enter? 1 .. 20
807 reas00 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
808 test00 Enter test or procedure. String[15]
809 item00 List items involved. [SEPARATE BY A COMMA] String[20]
810 code00 Enter data code used. 1= Don't Know 2= Refusal 3= other
811 oth00 Enter other code used. String[20]
812 expl00 Explain what happened String[100]
813 reas01 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
814 test01 Enter test or procedure. String[15]
815 item01 List items involved. [SEPARATE BY A COMMA] String[20]
816 code01 Enter data code used. 1= Don't Know 2= Refusal 3= other
817 oth01 Enter other code used. String[20]
818 expl01 Explain what happened String[100]
819 reas02 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
820 test02 Enter test or procedure. String[15]
821 item02 List items involved. [SEPARATE BY A COMMA] String[20]
822 code02 Enter data code used. 1= Don't Know 2= Refusal 3= other
823 oth02 Enter other code used. String[20]
824 expl02 Explain what happened String[100]
825 reas03 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
826 test03 Enter test or procedure. String[15]
827 item03 List items involved. [SEPARATE BY A COMMA] String[20]
828 code03 Enter data code used. 1= Don't Know 2= Refusal 3= other
829 oth03 Enter other code used. String[20]
830 expl03 Explain what happened String[100]
831 reas04 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
832 test04 Enter test or procedure. String[15]
833 item04 List items involved. [SEPARATE BY A COMMA] String[20]
834 code04 Enter data code used. 1= Don't Know 2= Refusal 3= other
835 oth04 Enter other code used. String[20]
836 expl04 Explain what happened String[100]
837 reas05 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
838 test05 Enter test or procedure. String[15]
839 item05 List items involved. [SEPARATE BY A COMMA] String[20]
840 code05 Enter data code used. 1= Don't Know 2= Refusal 3= other
841 oth05 Enter other code used. String[20]
842 expl05 Explain what happened String[100]
843 reas06 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
844 test06 Enter test or procedure. String[15]
845 item06 List items involved. [SEPARATE BY A COMMA] String[20]
846 code06 Enter data code used. 1= Don't Know 2= Refusal 3= other
847 oth06 Enter other code used. String[20]
848 expl06 Explain what happened String[100]
849 reas07 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
850 test07 Enter test or procedure. String[15]
851 item07 List items involved. [SEPARATE BY A COMMA] String[20]
852 code07 Enter data code used. 1= Don't Know 2= Refusal 3= other
853 oth07 Enter other code used. String[20]
854 expl07 Explain what happened String[100]
855 reas08 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
856 test08 Enter test or procedure. String[15]
857 item08 List items involved. [SEPARATE BY A COMMA] String[20]
858 code08 Enter data code used. 1= Don't Know 2= Refusal 3= other
859 oth08 Enter other code used. String[20]
860 expl08 Explain what happened String[100]
861 reas09 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
862 test09 Enter test or procedure. String[15]
863 item09 List items involved. [SEPARATE BY A COMMA] String[20]
864 code09 Enter data code used. 1= Don't Know 2= Refusal 3= other
865 oth09 Enter other code used. String[20]
866 expl09 Explain what happened String[100]
867 reas10 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
868 test10 Enter test or procedure. String[15]
869 item10 List items involved. [SEPARATE BY A COMMA] String[20]
870 code10 Enter data code used. 1= Don't Know 2= Refusal 3= other
871 oth10 Enter other code used. String[20]
872 expl10 Explain what happened String[100]
873 reas11 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
874 test11 Enter test or procedure. String[15]
875 item11 List items involved. [SEPARATE BY A COMMA] String[20]
876 code11 Enter data code used. 1= Don't Know 2= Refusal 3= other
877 oth11 Enter other code used. String[20]
878 expl11 Explain what happened String[100]
879 reas12 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
880 test12 Enter test or procedure. String[15]
881 item12 List items involved. [SEPARATE BY A COMMA] String[20]
882 code12 Enter data code used. 1= Don't Know 2= Refusal 3= other
883 oth12 Enter other code used. String[20]
884 expl12 Explain what happened String[100]
885 reas13 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
886 test13 Enter test or procedure. String[15]
887 item13 List items involved. [SEPARATE BY A COMMA] String[20]
888 code13 Enter data code used. 1= Don't Know 2= Refusal 3= other
889 oth13 Enter other code used. String[20]
890 expl13 Explain what happened String[100]
891 reas14 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
892 test14 Enter test or procedure. String[15]
893 item14 List items involved. [SEPARATE BY A COMMA] String[20]
894 code14 Enter data code used. 1= Don't Know 2= Refusal 3= other
895 oth14 Enter other code used. String[20]
896 expl14 Explain what happened String[100]
897 reas15 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
898 test15 Enter test or procedure. String[15]
899 item15 List items involved. [SEPARATE BY A COMMA] String[20]
900 code15 Enter data code used. 1= Don't Know 2= Refusal 3= other
901 oth15 Enter other code used. String[20]
902 expl15 Explain what happened String[100]
903 reas16 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
904 test16 Enter test or procedure. String[15]
905 item16 List items involved. [SEPARATE BY A COMMA] String[20]
906 code16 Enter data code used. 1= Don't Know 2= Refusal 3= other
907 oth16 Enter other code used. String[20]
908 expl16 Explain what happened String[100]
909 reas17 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
910 test17 Enter test or procedure. String[15]
911 item17 List items involved. [SEPARATE BY A COMMA] String[20]
912 code17 Enter data code used. 1= Don't Know 2= Refusal 3= other
913 oth17 Enter other code used. String[20]
914 expl17 Explain what happened String[100]
915 reas18 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
916 test18 Enter test or procedure. String[15]
917 item18 List items involved. [SEPARATE BY A COMMA] String[20]
918 code18 Enter data code used. 1= Don't Know 2= Refusal 3= other
919 oth18 Enter other code used. String[20]
920 expl18 Explain what happened String[100]
921 reas19 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
922 test19 Enter test or procedure. String[15]
923 item19 List items involved. [SEPARATE BY A COMMA] String[20]
924 code19 Enter data code used. 1= Don't Know 2= Refusal 3= other
925 oth19 Enter other code used. String[20]
926 expl19 Explain what happened String[100]

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