Data Dictionary for mp2int

Number of Blaise fields: 1120

Seq # Var Question Data Type/Coding
1 projid MAP 2001 Baseline Interview (v5.1 Rev 01/14/2021) Project ID number. String[8]
2 folder Type in folder color. F/U YearFolder Baseline(manilla) String[8]
3 visit Enter visit code (check folder color): CODEF/U YearFolder 00=Baseline(manilla) String[2]
4 vervisit Please verify visit and folder color. visit = ^visitnumfolder = ^folder1 Is this correct? If not, please page up and correct folder color. 1= Yes
5 formno Form Number. String[6]
6 version Version number String[4]
7 autodate Automatic Date. Date type
8 autotime Automatic Time. TimeType
9 autolog Automatic Logged Date. Date type
10 intid CLINICIAN ID. 100 .. 997
11 compid Laptop ID String[20]
12 dateint Date of evaluation. Date type
13 autotm [COMPUTER CLOCK TIME] String[8]
14 gender Enter participant's gender. 1= Male 2= Female
15 pfname Participant First name String[12]
16 pmiddl Participant Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
17 plname Participant Last name String[18]
18 paddnum Participant's PERMANENT ADDRESS Street number String[6]
19 pdir PERMANENT ADDRESS Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
20 pstreet PERMANENT ADDRESS Street name String[18]
21 punit PERMANENT ADDRESS Apartment/Unit/Room number [HIT ENTER IF NOT APPLICABLE] String[5]
22 pcity PERMANENT ADDRESS City or Town String[18]
23 pstate PERMANENT ADDRESS State String[2]
24 pzip PERMANENT ADDRESS Zip Code String[5]
25 preskind 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 7= Other
26 sptypp Specify: String[40]
27 phphone PERMANENT ADDRESS Home telephone including area code [Use '-' to separate] String[12]
28 pwphone PERMANENT ADDRESS Work telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
29 pcphone PERMANENT ADDRESS Cell/mobile telephone inlcluding area code [Use '-' to separate] [Press enter if none.] String[12]
30 pemail PERMANENT ADDRESS E-mail address? [Press enter if none.] String[50]
31 tempor Are you currently staying at an address that is different from your permanent address? 1= Yes 2= No
32 taddnum Participant's TEMPORARY ADDRESS Street number String[6]
33 tdir TEMPORARY ADDRESS Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
34 tstreet TEMPORARY ADDRESS Street name String[18]
35 tunit TEMPORARY ADDRESS Apartment/Unit/Room number [HIT ENTER IF NOT APPLICABLE] String[5]
36 tcity TEMPORARY ADDRESS City or Town String[18]
37 tstate TEMPORARY ADDRESS State String[2]
38 tzip TEMPORARY ADDRESS Zip Code String[5]
39 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 7= Other
40 sptypt Specify: String[40]
41 thphone TEMPORARY ADDRESS Home telephone including area code [Use '-' to separate] String[12]
42 twphone TEMPORARY ADDRESS Work telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
43 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
44 q5loc What is your social security number? 0 .. 999999999
45 q5aloc [ENTER R. SOCIAL SECURITY NUMBER AGAIN] 0 .. 999999999
46 q6loc What is your medicare number? Please show me your card. String[11]
47 q6aloc [ENTER R. MEDICARE NUMBER AGAIN] String[11]
48 validated
49 validateerror
50 errorposition
51 validated_hicn_cms
52 validated_rrb_pre1964
53 validated_rrb_post1964
54 hicnformats
55 hicn_alpha
56 hicn_numbers
57 strlen
58 hicn_trimmed
59 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
60 ssn What is your social security number? [INTERVIEWER: Please enter the SSN in 000-00-0000 format.] String[11]
61 ssn_c [ENTER R. SOCIAL SECURITY NUMBER AGAIN] String[11]
62 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
63 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]
64 hicn_c [ENTER R. MEDICARE NUMBER(HICN) AGAIN] String[11]
65 hicn_type HICN Type: ^hicnFormats String[15]
66 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
67 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]
68 mbi_c [ENTER R. MEDICARE NUMBER(MBI) AGAIN] String[13]
69 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
70 specfy Specify Country: String[30]
71 howlong How many years have you lived in the United States? 1 .. 130
72 state In what state were your born? String[30]
73 city 2. In what city or town? String[30]
74 county 3. And in what county (or province) were you born? String[30]
75 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]
76 dirbr Participant's birth address Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
77 streetbr Participant's birth address Street name String[18]
78 unitbr Participant's birth address Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
79 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]
80 firstres How old were you when you moved into this residence? 0 .. 18
81 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
82 q4dem What is your date of birth? (mo/day/yr) Date type
83 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
84 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
85 hisporx Other (specify, please write in English): String[30]
86 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
87 raceprix Other, specify String[30]
88 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
89 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
90 racesecx Other, specify String[30]
91 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
92 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
93 raceterx Other, specify String[30]
94 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
95 multiple 1a. Did you have only one or more than one? 1= Only one 2= More than one
96 inhosp 1b Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
97 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
98 chfhosp Were you hospitalized overnight or longer for this? 1= Yes 2= No
99 chfnum How many times have you been hospitalized for this? 0 .. 10
100 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
101 ca1a 1a. Where was it? [OR: Where was the most recent cancer that you had?] [SPECIFY] String[20]
102 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
103 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
104 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
105 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
106 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
107 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
108 th3 2. Has a doctor, nurse, or therapist ever told you to take medicine by mouth for your thyroid condition? 1= Yes 2= No
109 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
110 gout Have you ever been told by a doctor, nurse or therapist that you had gout? 1= Yes 2= Suspect or possible 3= No
111 osteoporosis Have you ever been told by a doctor, nurse or therapist that you had osteoporosis? 1= Yes 2= Suspect or possible 3= No
112 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
113 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
114 pill Were these estrogen or progesterone hormones in the form of a pill, injection, vaginal cream or suppository, or skin patch? 2. pill or other oral dosage form 1= Yes 2= Suspect 3= No
115 shot 3. injection (shot) 1= Yes 2= Suspect 3= No
116 cos 4. vaginal cream or suppository 1= Yes 2= Suspect 3= No
117 patch 5. skin patch 1= Yes 2= Suspect 3= No
118 agefirst 6. How old were you when you first took this/these medications? 1 .. 115
119 current 7. Are you currently taking this/these medications? 1= Yes 2= No
120 agelast 7a. How old were you when you last took this/these medications? 1 .. 115
121 mensage 8. At what age did you begin menstruating? 1 .. 99
122 menoage 9. At what age did you stop menstruating? 1 .. 99
123 natura 10. Was your menopause natural or caused by surgery? 1= Natural 2= Surgery
124 whatwas 10a. What was the surgery? 1= Full Hysterectomy 2= Hysterectomy (partial) 3= Other
125 othspe00 10b. Specify: String[40]
126 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
127 pressure 1a. Do you get pressure or heaviness in your chest? 1= Yes 2= No
128 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
129 level0 3. Do you get this pain (or discomfort) when you walk at an ordinary pace on level ground? 1= Yes 2= No
130 legpain CLAUDICATION Now some questions about pains in your legs. 1. Do you get pain in either leg while walking? 1= Yes 2= No
131 standsit 2. Does this pain ever begin when you are standing still or sitting? 1= Yes 2= No
132 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
133 shrtbrth 9. Do you get short of breath at night if you sleep flat or only on one pillow? 1= Yes 2= No
134 pillows 9a. How many pillows do you need to sleep on to not be short of breath? 1 .. 9
135 grspbrth 9b. Do you wake up at night gasping for breath? 1= Yes 2= No
136 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
137 headinj HEAD INJURY Now I have some questions about injuries. 1. Have you EVER had a head injury? 1= Yes 2= No
138 headyear 2. What year was the last time? 1878 .. 2020
139 lostcons 3. Have you EVER lost consciousness because of a head injury? 1= Yes 2= Suspect or possible 3= No
140 howmany 3a. How many times? 1 .. 50
141 lasttime 3b. What year was the last time? 1878 .. 2020
142 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? 1= < 5 seconds 2= 5 seconds - 5 minutes 3= > 5 minutes - 1 hour 4= > 1 hour - 2 days 5= > 2 days
143 hihosp 4. Were you EVER hospitalized overnight or longer for a head injury? 1= Yes 2= No
144 same1 4a. Was this the same event we just spoke about? 1= Yes 2= No
145 hihospyr 4b. When was it? [ENTER YEAR] 1878 .. 2020
146 hihospnm 4c. What was the name of the (last) hospital? [HOSPITAL NAME] String[40]
147 hihosloc [LOCATION:] String[40]
148 memory0 Were any of the following signs/symptoms associated with this (last) event? [INTERVIEWER: `Last' event refers to the most recent hospitalization, or, if not hospitalized, most recent event with loss of consciousness.] 1. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
149 speech0 2. Language or speech change? 1= Yes 2= Suspect 3= No
150 weaknes0 3. Weakness or paralysis of face, arms or legs? 1= Yes 2= Suspect 3= No
151 side0 3a. Which side(s)? 1= right only 2= left only 3= both
152 other00 4. Were there any other signs or symptoms associated with this (last) event? 1= Yes 2= Suspect 3= No
153 othspe01 4a. Specify String[40]
154 hiscan 5. Did you EVER have a CT, MRI or other type of brain scan because of a head injury? 1= Yes 2= No
155 same2 Was this the same event we just spoke about? 1= Yes 2= No
156 hiscanyr 5a. When was this (the last time)? [ENTER YEAR] 1878 .. 2020
157 hiscanam 5b. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? [NAME:] String[40]
158 hiscanlc [LOCATION:] String[40]
159 memory1 Were any of the following signs/symptoms associated with this (last) event? [INTERVIEWER: `Last' event refers to the event associated with the CT, MRI, or brain scan.] 1. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
160 speech1 2. Language or speech change? 1= Yes 2= Suspect 3= No
161 weaknes1 3. Weakness or paralysis of face, arms or legs? 1= Yes 2= Suspect 3= No
162 side1 3a. Which side(s)? 1= right only 2= left only 3= both
163 other01 4. Were there any other signs or symptoms associated with this (last) event? 1= Yes 2= Suspect 3= No
164 othspe02 4a. Specify String[40]
165 troubles 6. Do you have any left over troubles from your head injury(s)? 1= Yes 2= Suspect 3= No
166 specify 6a Specify? String[40]
167 hdrvehicle
168 hdrhitbyobject
169 hdrfalling
170 hdrsports
171 hdrabuse
172 hdrmilitary
173 hdrother
174 prevbisqdone BRAIN INJURY SCREENING QUESTIONNAIRE Have the BISQ questions been previously completed for this participant? ^prevBisqDoneText 1= Yes 2= No
175 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
176 bisqvehnum ^hdrVehicle How many times did you receive a blow to the head, in a vehicle accident? 1 .. 30
177 bisqvehloc ^hdrVehicle Did you lose consciousness? 1= Yes 2= No
178 bisqvehlocnum ^hdrVehicle How many times have you lost consciousness? 1 .. 30
179 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.
180 bisqvehlocyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
181 bisqvehlocyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
182 bisqvehlocyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
183 bisqvehlocyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
184 bisqvehlocyr5 ^hdrVehicle In what year did this occur (5)? 1900 .. 2050
185 bisqvehdaze ^hdrVehicle Were you dazed or confused? 1= Yes 2= No
186 bisqvehdazenum ^hdrVehicle How many times have you been dazed or confused? 1 .. 30
187 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.
188 bisqvehdazeyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
189 bisqvehdazeyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
190 bisqvehdazeyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
191 bisqvehdazeyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
192 bisqvehdazeyr5 ^^hdrVehicle In what year did this occur (5)? 1900 .. 2050
193 bisqhit ^lastInterviewText1en 2. Hit by an object?(ex: equipment, falling object) 1= Yes 2= No
194 bisqhitnum ^hdrHitByObject How many times did you receive a blow to the head, from a falling object? 1 .. 30
195 bisqhitloc ^hdrHitByObject Did you lose consciousness? 1= Yes 2= No
196 bisqhitlocnum ^hdrHitByObject How many times have you lost consciousness? 1 .. 30
197 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.
198 bisqhitlocyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
199 bisqhitlocyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
200 bisqhitlocyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
201 bisqhitlocyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
202 bisqhitlocyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
203 bisqhitdaze ^hdrHitByObject Were you dazed or confused? 1= Yes 2= No
204 bisqhitdazenum ^hdrHitByObject How many times have you been dazed or confused? 1 .. 30
205 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.
206 bisqhitdazeyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
207 bisqhitdazeyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
208 bisqhitdazeyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
209 bisqhitdazeyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
210 bisqhitdazeyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
211 bisqfall ^lastInterviewText2en 3. Falling? (ex: down stairs, during a fainting spell, from a high place) 1= Yes 2= No
212 bisqfallnum ^hdrFalling How many times did you receive a blow to the head, in a fall? 1 .. 30
213 bisqfallloc ^hdrFalling Did you lose consciousness? 1= Yes 2= No
214 bisqfalllocnum ^hdrFalling How many times have you lost consciousness? 1 .. 30
215 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.
216 bisqfalllocyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
217 bisqfalllocyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
218 bisqfalllocyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
219 bisqfalllocyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
220 bisqfalllocyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
221 bisqfalldaze ^hdrFalling Were you dazed or confused? 1= Yes 2= No
222 bisqfalldazenum ^hdrFalling How many times have you been dazed or confused? 1 .. 30
223 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.
224 bisqfalldazeyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
225 bisqfalldazeyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
226 bisqfalldazeyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
227 bisqfalldazeyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
228 bisqfalldazeyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
229 bisqsprt ^lastInterviewText3en 4. Sports/Leisure?(ex: sports, biking, skiing, on the playground) 1= Yes 2= No
230 bisqsprtnum ^hdrSports How many times did you receive a blow to the head, during a sports or leisure activity? 1 .. 30
231 bisqsprtloc ^hdrSports Did you lose consciousness? 1= Yes 2= No
232 bisqsprtlocnum ^hdrSports How many times have you lost consciousness? 1 .. 30
233 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.
234 bisqsprtlocyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
235 bisqsprtlocyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
236 bisqsprtlocyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
237 bisqsprtlocyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
238 bisqsprtlocyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
239 bisqsprtdaze ^hdrSports Were you dazed or confused? 1= Yes 2= No
240 bisqsprtdazenum ^hdrSports How many times have you been dazed or confused? 1 .. 30
241 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.
242 bisqsprtdazeyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
243 bisqsprtdazeyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
244 bisqsprtdazeyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
245 bisqsprtdazeyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
246 bisqsprtdazeyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
247 bisqphys ^lastInterviewText4en 5. Physical Abuse/Assault?(ex: mugged) 1= Yes 2= No
248 bisqphysnum ^hdrAbuse How many times did you receive a blow to the head, from abuse or assault? 1 .. 30
249 bisqphysloc ^hdrAbuse Did you lose consciousness? 1= Yes 2= No
250 bisqphyslocnum ^hdrAbuse How many times have you lost consciousness? 1 .. 30
251 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.
252 bisqphyslocyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
253 bisqphyslocyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
254 bisqphyslocyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
255 bisqphyslocyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
256 bisqphyslocyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
257 bisqphysdaze ^hdrAbuse Were you dazed or confused? 1= Yes 2= No
258 bisqphysdazenum ^hdrAbuse How many times have you been dazed or confused? 1 .. 30
259 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.
260 bisqphysdazeyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
261 bisqphysdazeyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
262 bisqphysdazeyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
263 bisqphysdazeyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
264 bisqphysdazeyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
265 bisqmil ^lastInterviewText5en 6. Military Service?(ex: training, blast injury) 1= Yes 2= No
266 bisqmilnum ^hdrMilitary How many times did you receive a blow to the head, during military service? 1 .. 30
267 bisqmilloc ^hdrMilitary Did you lose consciousness? 1= Yes 2= No
268 bisqmillocnum ^hdrMilitary How many times have you lost consciousness? 1 .. 30
269 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.
270 bisqmillocyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
271 bisqmillocyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
272 bisqmillocyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
273 bisqmillocyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
274 bisqmillocyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
275 bisqmildaze ^hdrMilitary Were you dazed or confused? 1= Yes 2= No
276 bisqmildazenum ^hdrMilitary How many times have you been dazed or confused? 1 .. 30
277 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.
278 bisqmildazeyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
279 bisqmildazeyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
280 bisqmildazeyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
281 bisqmildazeyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
282 bisqmildazeyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
283 bisqoth ^lastInterviewText6en 7. In any other circumstances? 1= Yes 2= No
284 bisqothsp ^hdrOther Please specify: String[255]
285 bisqothnum ^hdrOther How many times did you receive a blow to the head, in a situation I have not mentioned? 1 .. 30
286 bisqothloc ^hdrOther Did you lose consciousness? 1= Yes 2= No
287 bisqothlocnum ^hdrOther How many times have you lost consciousness? 1 .. 30
288 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.
289 bisqothlocyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
290 bisqothlocyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
291 bisqothlocyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
292 bisqothlocyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
293 bisqothlocyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
294 bisqothdaze ^hdrOther Were you dazed or confused? 1= Yes 2= No
295 bisqothdazenum ^hdrOther How many times have you been dazed or confused? 1 .. 30
296 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.
297 bisqothdazeyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
298 bisqothdazeyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
299 bisqothdazeyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
300 bisqothdazeyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
301 bisqothdazeyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
302 reada Present Time Now I have some questions about how you spend your time. 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
303 diarya 10. In the last ten years, did you ever keep a diary or journal? 1= Yes 2= No
304 diaryb 10a. How many years? [Estimate total years.] 1 .. 120
305 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
306 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
307 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
308 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
309 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
310 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
311 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
312 games 18. 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
313 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
314 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
315 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
316 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
317 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
318 q14act 14. During the past year, how often did you participate in groups (such as senior center, VFW, Knights of Columbus, Rosary Society or something similar)? 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 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
320 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]
321 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
322 q1aphy 1a. How many times in the past 14 days did you go walking for exercise? [ENTER NUMBER OF TIMES] 1 .. 87
323 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
324 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
325 q11aphy 2a. How many times in the past 14 days did you go walking like that? [ENTER NUMBER OF TIMES] 1 .. 87
326 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
327 q3phy (In the past 14 days have you done) 3. Gardening or yard work? 1= Yes 2= No
328 q3aphy 3a. How many times in the past 14 days did you do gardening or yard work? [ENTER NUMBER OF TIMES] 1 .. 87
329 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
330 q5phy (In the past 14 days have you done) 5. Calisthenics or general exercise? 1= Yes 2= No
331 q5aphy 5a. How many times in the past 14 days did you do calisthenics or general exercise? [ENTER NUMBER OF TIMES] 1 .. 87
332 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
333 q8phy (In the past 14 days have you done) 8. Bicycle riding (including stationary bikes)? 1= Yes 2= No
334 q8aphy 8a. How many times in the past 14 days did you go bicycle riding? [ENTER NUMBER OF TIMES] 1 .. 87
335 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
336 q9phy (In the past 14 days have you done) 9. Swimming or water exercises? 1= Yes 2= No
337 q9aphy 9a. How many times in the past 14 days did you go swimming or do water exercises? [ENTER NUMBER OF TIMES] 1 .. 87
338 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
339 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
340 q101phy 10.1 [SPECIFY] String[40]
341 q10aphy 10a. How many times in the past 14 days did you do this? [ENTER NUMBER OF TIMES] 1 .. 87
342 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
343 joints JOINTS Now a few questions 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
344 neckpain 2. ...Pain in your neck or back on most days for at least one month? 1= Yes 2= No
345 hippain 3. ...Pain in or around either hip joint including the buttock, groin, and side of the upper thigh on most days for at least one month? 1= Yes 2= No
346 kneepain 4. ...Pain in or around the knees including the back of the knee on most days for at least one month? 1= Yes 2= No
347 swelling 5. ...Swelling at a joint, with pain present in the joint when touched, on most days for at least one month? 1= Yes 2= No
348 stiff 6. ...Stiffness in the joints and muscles when getting out of bed in the morning lasting for at least 15 minutes? 1= Yes 2= No
349 feetpain 7. ...Pain or aching in either of your feet on most days for at least one month? 1= Yes 2= No
350 handpain 8. ...Pain or aching in either of your hands, wrists or fingers on most days for at least one month? 1= Yes 2= No
351 q1neuro Now I have some questions about numbness and tingling. 1. In the past month, have you had numbness or tingling [or asleep or burning] feeling of your feet or toes? 1= Yes 2= Suspect 3= No
352 q2neuro 2. Was this ___ on the right side, left side, or both sides? 1= Right 2= Left 3= Both
353 q3neuro 3. In the past month, have you had numbness or tingling [or asleep or burning] feeling of your hands or fingers? 1= Yes 2= Suspect 3= No
354 q4neuro 4. Was this ___ on the right side, left side, or both sides? 1= Right 2= Left 3= Both
355 q1cervi 1. Now I have some questions about neck pain. Have you ever had neck pain that lasted days, weeks or months? 1= Yes 2= Suspect 3= No
356 q2cervi 2. At a time while you were having pain in the neck, did you also have pain, numbness or tingling, or weakness in the arms or hands? 1= Yes 2= Suspect 3= No
357 q3cervi1 3. Which of these problems did you have, pain, numbness or tingling, or weakness? 1= Pain 2= Numbness or tingling 3= Weakness
358 q3cervi2 3. Which of these problems did you have, pain, numbness or tingling, or weakness? See previous question
359 q3cervi3 3. Which of these problems did you have, pain, numbness or tingling, or weakness? See previous question
360 q4cervi 4. Did this ___ occur on the right side, left side, or both sides? 1= Right 2= Left 3= Both
361 q5cervi 5. Now, when you have neck pain, how long, on average, does the neck pain typically last? Would you say less than a week, between one week and one month, between one and two months, between two and six months, or greater than six months? 1= < a week 2= 1 week - 1 month 3= > 1 month - 2 months 4= > 2 months - 6 months 5= > 6 months
362 q6cervi 6. How many different times have you had neck pain? enter number ___ ___ ___ 1 .. 999
363 q7cervi 7. How severe, on average, is the neck pain? Would you say it is usually not severe at all, slightly severe, somewhat severe, very severe, or extremely severe? 1= not severe at all 2= slightly severe 3= somewhat severe 4= very severe 5= extremely severe
364 q8cervi 8. Have you ever seen a doctor because of neck pain? 1= Yes 2= No
365 q9cervi 9. Have you ever had an x-ray or scan [CT or MRI] of the neck because of pain? 1= Yes 2= No
366 q9acervi 9a. When was the last time? ENTER YEAR ____ 1928 .. 2040
367 q9bcervi What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? NAME ________________________________________ String[40]
368 q9ccervi LOCATION________________________________________ String[40]
369 q1lumbar 1. Now some questions about low back pain. Have you ever had low back pain that lasted days, weeks or months? 1= Yes 2= Suspect 3= No
370 q2lumbar 2. At a time while you were having low back pain, did you also have pain, numbness or tingling, or weakness in the feet or toes? 1= Yes 2= Suspect 3= No
371 q3lumba1 3. Which of these problems did you have, pain, numbness or tingling, or weakness? 1= Pain 2= Numbness or tingling 3= Weakness
372 q3lumba2 3. Which of these problems did you have, pain, numbness or tingling, or weakness? See previous question
373 q3lumba3 3. Which of these problems did you have, pain, numbness or tingling, or weakness? See previous question
374 q4lumbar 4. Did this occur on the right side, left side, or both sides? 1= Right 2= Left 3= Both
375 q5lumbar 5. Now, when you have low back pain, how long, on average, does the low back pain typically last? Would you say less than a week, between one week and one months, between one and two months, between two and six months, or greater than six months? 1= < a week 2= 1 week - 1 month 3= > 1 month - 2 months 4= > 2 months - 6 months 5= > 6 months
376 q6lumbar 6. How many different times have you had low back pain? enter number ___ ___ ___ 1 .. 999
377 q7lumbar 7. How severe, on average, is the low back pain? Would you say it is usually not severe at all, slightly severe, somewhat severe, very severe, or extremely severe? 1= not severe at all 2= slightly severe 3= somewhat severe 4= very severe 5= extremely severe
378 q8lumbar 8. Have you ever seen a doctor because of low back pain? 1= Yes 2= No
379 q9lumbar 9. Have you ever had an x-ray or scan [CT or MRI] of the low back because of pain? 1= Yes 2= No
380 q9alumba 9a. When was the last time? ENTER YEAR ____ 1928 .. 2040
381 q9blumba What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? NAME ________________________________________ String[40]
382 q9clumba LOCATION________________________________________ String[40]
383 falls 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
384 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
385 fallhelp 3. When you fell this past year were you ever not able to get up without help from someone? 1= Yes 2= No
386 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
387 brokenhp BROKEN HIP Have you been told by a doctor, nurse or therapist that you had ...) 1. A broken or fractured hip? 1= Yes 2= Suspect or possible 3= No
388 hip6a 1a. Were you ever hospitalized overnight or longer for this? 1= Yes 2= No
389 q1slp SLEEP Now I would like to get some information about how well you sleep. 1. How often do you have trouble falling asleep? Would you say it is - very often, often, sometimes, rarely or never? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= Never
390 q2slp 2. How often are you troubled by waking up during the night? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= Never
391 q4slp 3. How often do you get so sleepy during the day or evening that you have to take a nap? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= Never
392 q5slp 4. How often do you feel really rested when you wake up in the morning? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= Never
393 q6slp 5. In the past month, how many hours do you usually sleep at night? [ENTER AVERAGE HOURS] 0 .. 24
394 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
395 q2md 2. My sleep was restless. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
396 q3md 3. I felt depressed. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
397 q4md 4. I was happy. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
398 q5md 5. I felt lonely. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
399 q6md 6. People were unfriendly. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
400 q7md 7. I enjoyed life. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
401 q8md 8. I felt sad. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
402 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
403 q10md 10. I could not get 'going'. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
404 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
405 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
406 sleep 3. A change in your pattern of sleeping. 1= Yes 2= No
407 enrgy 4. A decrease in your energy level. 1= Yes 2= No
408 concen 5. Trouble concentrating. 1= Yes 2= No
409 guilt 6. Felt extremely guilty or worthless. 1= Yes 2= No
410 restls 7. Felt extremely restless or agitated. 1= Yes 2= No
411 activt 8. Lost your interest in favorite activities. 1= Yes 2= No
412 living 9. Felt that life was not worth living. 1= Yes 2= No
413 teldoc 9a. Did you tell a doctor or any other professional about it? 1= Yes 2= No
414 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
415 recogfr2 2. (When wearing eyeglasses/contact lenses) Can you see well enough to recognize a friend across the street? 1= Yes 2= No
416 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
417 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
418 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
419 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
420 trial1a 2a. Second trial: 20/100 1= All three correct 2= Two correct 3= One correct 4= None correct
421 trial1b 2b. Third trial: 20/200 1= All three correct 2= Two correct 3= One correct 4= None correct
422 trial1c 2c. Fourth trial: 20/400 1= All three correct 2= Two correct 3= One correct 4= None correct
423 trial2 3. Second trial: 20/50 1= All three correct 2= Two correct 3= One correct 4= None correct
424 trial3 3a. Third trial: 20/40 1= All three correct 2= Two correct 3= One correct 4= None correct
425 midarm BLOODPRESSURE Now I would like to take some arm, height and weight measurements, and blood pressure readings. 1. MID-ARM CIRCUMFERENCE [IN cm] 15.0 .. 78.0
426 midfore 1a. MID FOREARM CIRCUMFERENCE [IN cm] 10.0 .. 78.0
427 midleg 1b. MID LEG CIRCUMFERENCE [IN cm] 15.0 .. 99.0
428 tricep1 2. FIRST TRICEPS SKINFOLD MEASUREMENT [IN mm] CODE 72 IF MEASUREMENT >= 67 mm] 1 .. 72
429 cuff 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
430 tricep2 4. SECOND TRICEPS SKINFOLD MEASUREMENT [IN mm] [CODE 72 IF MEASUREMENT >=67mm] 1 .. 72
431 pulsept 5. PULSE OBLITERATION POINT [IN mmHg] 50 .. 270
432 pul THE PEAK INFLATION LEVEL IS ^pulse [HIT ENTER FOR NEXT QUESTION] 80 .. 300
433 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]
434 bp2 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] String[7]
435 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]
436 weight 9. MEASURED WEIGHT [IN LBS] [CODE 333 IF MEASUREMENT IS >=300 lbs. CODE 888 IF PHYSICALLY UNABLE TO WEIGH] 30 .. 888
437 height 10. MEASURED HEIGHT [IN FEET & INCHES] [CODE 888 IF PHYSICALLY UNABLE TO MEASURE HEIGHT] String[5]
438 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]
439 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]
440 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]
441 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]
442 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]
443 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]
444 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]
445 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]
446 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]
447 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]
448 gaitquip Is the Gait Test Equipment Available? 1= Yes 2= No
449 domove2 [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] 1= Yes 2= No
450 dynaid DynaPort Device id String[10]
451 diskid Disk ID String[10]
452 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)
453 move7b Time (seconds): 1.0 .. 60.0
454 move7c Number of steps taken: 1 .. 60
455 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)
456 move7d Time (seconds): 1.0 .. 60.0
457 move7e Number of steps taken: 1 .. 60
458 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
459 move7a1 [SPECIFY] String[20]
460 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)
461 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)
462 move6f Number of steps taken: 1 .. 60
463 move6e Time (seconds): 1.0 .. 60.0
464 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)
465 move6h Number of steps: 1 .. 60
466 move6g Time (seconds): 1.0 .. 60.0
467 move6i Record Aid used for 360 turn: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
468 move6i1 [SPECIFY] String[20]
469 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)
470 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)
471 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)
472 getaid Record Aid used for GET UP AND GO: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
473 getaid_specify [SPECIFY] String[20]
474 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)
475 move8 Interviewer: Record number of errors, e.g. Sidesteps: 0 .. 60
476 tandaid Record Aid used for Tandem Walk: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
477 tandaid_specify [SPECIFY] String[20]
478 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)
479 walk8aid Record Aid used for BACK AND FORTH WALK: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
480 walk8aid_specify [SPECIFY] String[20]
481 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)
482 move6 Time (seconds) : 1.0 .. 10.0
483 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)
484 move6a Time (seconds) : 1.0 .. 10.0
485 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)
486 move6c Time (seconds) : 1.0 .. 10.0
487 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)
488 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)
489 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]
490 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]
491 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]
492 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]
493 trial11 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
494 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
495 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
496 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
497 self12 HANDEDNESS 1. Which hand do you usually use to write a letter? 1= Right 2= Left 3= Both
498 self13 2. Which hand do you usually use to cut paper or cloth with scissors? 1= Right 2= Left 3= Both
499 games6 In order to learn how experiences early in life affect health later in life, we are asking questions about experiences at different points in your life. Childhood - Age 6 - My first questions are about when you were 6 years old, or thereabouts. I know it may be hard to remember that far back; I just want your best recollection. 1. When you were 6, how often did you play games like tic-tac-toe, checkers, or other board games, cards, or word 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
500 read6 2. How often did someone in your home read to you when you were 6? 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
501 stories6 3. How often did someone in your home tell you stories when you were 6? 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
502 read12a Teens - Age 12 Now I have some questions about when you were 12 years old, or thereabouts. 1. When you were 12, about how much time did 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
503 read12b 1a. How much of this reading was for school? 1= None 2= Some 3= Half 4= Most 5= All
504 news12 2. Did you family subscribe to a daily newspaper when you were 12? 1= Yes 2= No
505 mag12 3. Did your family subscribe to any magazines when you were 12? 1= Yes 2= No
506 dict12 4. Did your family have a dictionary when you were 12? 1= Yes 2= No
507 ency12 5. Did your family have an encyclopedia when you were 12? 1= Yes 2= No
508 atlas12 6. Did your family have a world atlas when you were 12? 1= Yes 2= No
509 globe12 7. Did your family have a globe when you were 12? 1= Yes 2= No
510 libcar12 8. Did you or a member of your family have a library card when you were 12? 1= Yes 2= No
511 books12 9. When you were 12, about how many books do you think were in your family home? Would you say less than 20, 20-49, 50-100, 101-250, or more than 250? 1= Less than 20 2= 20 - 49 3= 50 - 100 4= 101 - 250 5= More than 250
512 lib12 10. When you were 12, 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
513 newpap12 11. When you were 12, how often did 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
514 magaz12 12. When you were 12, 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
515 read12c 13. When you were 12, 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
516 letter12 14. When you were 12, 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
517 games12 15. When you were 12, how often did 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
518 homwk12a 16. When you were 12, how much time did you spend on homework each day? Would you say none, less than 1/2 hour, 1/2 hour to less than 1 hour, 1 hour to less than 2 hours, or 2 or more hours? 1= None 2= Less than 1/2 hour 3= 1/2 hour to less than 1 hour 4= 1 hour to less than 2 hours 5= 2 or more hours
519 homwk12b 17. How often did a parent or older sibling help you with your homework when you were 12? Would you say none of the time, some of the time, half of the time, most of the time, or all of the time? 1= None 2= Some 3= Half 4= Most 5= All
520 teamsp12 18. When you were 12, how often did play team sports, such as basketball, baseball, football, softball, soccer, or hockey? 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
521 othspr12 19. When you were 12, how often did you engage in other sports or physically active games of any kind? 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
522 calis12 20. When you were 12, how often did you engage in activities like calisthenics, running, or weight lifting? 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
523 dust12 21. When you were 12, how often did you do household work like dusting, sweeping, or laundry? 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
524 kitch12 22. When you were 12, how often did you do kitchen work like preparing food or washing dishes? 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
525 yard12 23. When you were 12, how often did you do yard work like raking, weeding, gardening, or cutting grass? 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
526 walk12a 24. When you were 12, how often did you walk or ride a bike to school? 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
527 walk12b 25. About how far was it from your home to school when you were 12? Would you say less than 1/2 mile, 1/2 mile to less than 1 mile, 1 mile to less than 2 miles, 2 miles to less than 3 miles, or more than 3 miles? 1= Less than 1/2 mile 2= Half mile to less than 1 mile 3= 1 mile to less than 2 miles 4= 2 miles to less than 3 miles 5= 3 or more miles
528 phys12 26. How physically active were you when you were 12? Would you say were one fo the most physically active, above average, average, less than average, or one of the least physically active? 1= One of the most physically active 2= Above average 3= Average 4= Less than average 5= One of the least physically active
529 lang18a Teens - Age 18 Now, I have some questions about when you were 18 years old, or thereabouts. 1. By the age of 18, had you received any instruction in a foreign language? 1= Yes 2= No
530 lang18b 1a. How many years? [Estimate total years.] 1 .. 18
531 music18a 2. By the age of 18, had you taken any music lessons? 1= Yes 2= No
532 music18b 2a. How many years? [Estimate total years.] 1 .. 18
533 art18a 3. By the age of 18, had you taken any art, dance, or theater lessons? 1= Yes 2= No
534 art18b 3a. How many years? [Estimate total years.] 1 .. 18
535 diary18a 4. By the age of 18, had you ever kept a diary or journal? 1= Yes 2= No
536 diary18b 4a. How many years? [Estimate total years.] 1 .. 18
537 museum18 5. By the age of 18, how many times had you visited a museum? 1= Never 2= 1-2 times 3= 3-9 times 4= 10-19 times 5= More than 20 times
538 concer18 6. By the age of 18, how many times had you attended a concert, play, or musical? 1= Never 2= 1-2 times 3= 3-9 times 4= 10-19 times 5= More than 20 times
539 read18a 7. When you were 18, about how much time did 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
540 read18b 7a. How much of this reading was for school? 1= None 2= Some 3= Half 4= Most 5= All
541 lib18 8. When you were 18, 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
542 newpap18 9. When you were 18, how often did 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
543 magaz18 10. When you were 18, 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
544 read18c 13. When you were 18, 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
545 letter18 14. When you were 18, 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
546 games18 15. When you were 18, how often did 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
547 friend18 How many of the friends you had when you were 18 graduated from high school? 1= None 2= Some 3= Half 4= Most 5= All
548 read40a Adulthood - Age 40 Now I have some questions about when you were 40 years old, or thereabouts. 1. When you were 40, about how much time did 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
549 read40b 1a. How much of this reading was work-related? 1= None 2= Some 3= Half 4= Most 5= All
550 news40 2. Did you or a member of your family subscribe to a daily newspaper when you were 40? 1= Yes 2= No
551 mag40 3. Did you or a member of your family subscribe to any magazines when you were 40? 1= Yes 2= No
552 libcar40 4. Did you or a member of your family have a library card when you were 40? 1= Yes 2= No
553 dict40 5. Did your home have a dictionary when you were 40? 1= Yes 2= No
554 ency40 6. Did your home have an encyclopedia when you were 40? 1= Yes 2= No
555 atlas40 7. Did your home have a world atlas when you were 40? 1= Yes 2= No
556 globe40 8. Did your home have a globe when you were 40? 1= Yes 2= No
557 books40 9. About how many books do you think were in your home when you were 40? Would you say less than 20, 20-49, 50-100, 101-250, or more than 250? 1= Less than 20 2= 20 - 49 3= 50 - 100 4= 101 - 250 5= More than 250
558 diary40a 10. From age 30 to 40, had you ever kept a diary or journal? 1= Yes 2= No
559 diary40b 10a. How many years? [Estimate total years.] 1 .. 40
560 museum40 11. From age 30 to 40, 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
561 concer40 12. From age 30 to 40, 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
562 lib40 13. From age 30 to 40, 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
563 newpap40 14. When you were 40, how often did 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
564 magaz40 15. When you were 40, 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
565 read40c 16. When you were 40, 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
566 letter40 17. When you were 40, 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
567 games40 18. When you were 40, 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
568 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
569 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
570 q1edu EDUCABILITY 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
571 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
572 q2func 2. Are you able to walk up and down stairs to the second floor without help? 1= Yes 2= No
573 q3func 3. Are you able to walk a half mile without help? 1= Yes 2= No
574 q4func Next, I would like to know if you need help do 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
575 q4bfunc 4b. How much difficulty, on average, do you have walking across a small room? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
576 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
577 q5bfunc 5b. How much difficulty, on average, do you have bathing? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
578 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
579 q6bfunc 6b. How much difficulty, on average, do you have dressing? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
580 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
581 q7bfunc 7b. How much difficulty, on average, do you have eating? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
582 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
583 q8bfunc 8b. How much difficulty, on average, do you have getting from a bed to a chair? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
584 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
585 q9bfunc 9b. How much difficulty, on average, do you have using the toilet? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
586 q10func Now I have a few more questions about activities people may or may not do. Although some things may acutually 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
587 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
588 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
589 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
590 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
591 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
592 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
593 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
594 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
595 married SOCIAL NETWORK Now some questions about your social network. Have you ever been married? 1= Yes 2= No
596 married2 Are you now married, separated, divorced, or widowed? 1= Married 2= Separated 3= Divorced 4= Widowed
597 livewith Does your ^huswife live with you? 1= Yes 2= No
598 spfname Spouse What is his/her name? First Name: String[12]
599 spmiddl Spouse Middle intial: [Press enter if none.] String[2]
600 splname Spouse Last Name: String[18]
601 q2soci 1. How many members, other than yourself, are in your household? 0 .. 30
602 q1sn How many living children do you have? Please include adopted children as well as children you have raised. [ENTER No. OF CHILDREN] 0 .. 30
603 q2sn How many of your children do you see at least once a month? [ENTER No. OF CHILDREN] 0 .. 30
604 q2asn Do you see your child at least once a month? 1= Yes 2= No
605 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
606 q3asn How many of these close relatives do you usually see at least once a month? [ENTER No. OF CLOSE RELATIVES] 0 .. 76
607 q3bsn Do you see your close relative at least once a month? 1= Yes 2= No
608 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
609 q4asn How many of these close friends do you see at least once a month? [ENTER No. OF CLOSE FRIENDS] 0 .. 15
610 q4bsn Do you see your close friend at least once a month? 1= Yes 2= No
611 spanishbr Is the participant of Spanish/Hispanic origin? 1= Yes 2= No
612 spanish_fluent Are you fluent in Spanish? 1= Yes 2= No
613 safe_accult_6 Ask question #6 in the SAFE - Acculturation Stress Scale? 1= Yes 2= No
614 description_acc Acculturation Although you may speak many languages, the following questions refer to only English and Spanish. [PRESS ENTER TO CONTINUE]
615 acc_langreadspeak Although you may speak many languages, the following questions refer to only English and Spanish. 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
616 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
617 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
618 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
619 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
620 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
621 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
622 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
623 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
624 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
625 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]
626 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
627 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
628 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
629 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
630 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
631 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
632 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]
633 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
634 pnes_attractive 2. My neighborhood is attractive. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
635 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
636 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
637 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
638 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
639 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
640 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
641 pnes_traffic 9. My neighborhood has heavy traffic. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
642 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
643 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
644 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
645 pnes_howlong_year How long have you lived in your neighborhood? _____ years, 0 .. 199
646 pnes_howlong_month and/or _____ months 0 .. 11
647 pnes_howlong1_year How long have you lived at your current address? _____ years, 0 .. 199
648 pnes_howlong1_month and/or _____ months 0 .. 11
649 pnes_safe1 13. How safe from crime would you say your neighborhood is? 1= Very Safe 2= Fairly Safe 3= Somewhat Safe 4= Not too safe 5= Not Safe at all 0= Does not apply
650 pnes_safe2 14. 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 0= Does not apply
651 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]
652 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
653 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
654 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
655 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
656 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
657 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
658 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
659 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
660 q1supx SOCIAL SUPPORT Now we are interested in knowing how you feel about the following statements. Please indicate how much you agree or disagree with each statement. 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? 1. There is a special person who is around when I am in need. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
661 q2supx 2. There is a special person with whom I can share joys and sorrows. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
662 q5supx 5. I have a special person who is a real source of comfort to me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
663 q10supx 10. There is a special person in my life who cares about my feelings. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
664 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
665 people I like to have a lot of people around me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
666 waste I don't like to waste my time daydreaming. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
667 courtes I try to be courteous to everyone I meet. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
668 belong I keep my belongings neat and clean. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
669 inferior I often feel inferior to others. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
670 laugh I laugh easily. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
671 talking I really enjoy talking to people. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
672 tense I often feel tense and jittery. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
673 alone I usually prefer to do things alone. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
674 getangry I often get angry at the way people treat me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
675 cheerful I am a cheerful, high-spirited person. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
676 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
677 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
678 active I am a very active person. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
679 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
680 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
681 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
682 purpos4 4. I have a sense of direction and purpose in life. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
683 purpos5 5. My daily activities often seem trivial and unimportant to me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
684 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
685 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
686 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
687 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
688 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
689 emptins SOCIAL ISOLATION I experience a general sense of emptiness. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
690 misspeop I miss having people around. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
691 friends I feel like I don't have enough friends. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
692 abandon I often feel abandoned. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
693 missfrnd I miss having a really close friend. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
694 q1mdb DISCRIMINATION 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
695 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
696 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
697 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
698 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
699 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
700 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
701 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
702 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
703 q10mdb 10. People ignore you or act as if you are not here. [OPTIONAL: Would you say that you have had this experience...?] 1= Often 2= Sometimes 3= Rarely 4= Never
704 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
705 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
706 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
707 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
708 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
709 lifesp6 During the past week, have you been to places outside your town or community? 1= Yes 2= No
710 drive1 DRIVING Are you currently licensed to drive? 1= Yes 2= No
711 drive2 Have you driven in the past 12 months? 1= Yes 2= No
712 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
713 q1smo 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 smoke cigarettes now? 1= Yes 2= No
714 q1asmo 1a. On the average, how many cigarettes a day do you usually smoke? [ENTER NUMBER OF CIGARETTES: 1 PACK = 20 CIGARETTES] 1 .. 200
715 q1bsmo 1b. How old were you when you first smoked cigarettes regularly? [ENTER AGE] 0 .. 115
716 q2smo 2. Did you ever smoke cigarettes regularly? 1= Yes 2= No
717 q2asmo 2a. On the average, how many cigarettes a day did you usually smoke? [ENTER NUMBER OF CIGARETTES: 1 PACK = 20 CIGARETTES] 1 .. 200
718 q2bsmo 2b. How old were you when you last smoked cigarettes regularly? [ENTER AGE] 0 .. 115
719 q2csmo 2c. How old were you when you first smoked cigarettes regularly? [ENTER AGE] 0 .. 115
720 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
721 q4smo 4. Altogether, about how many years did you smoke this much? [ENTER YEARS: 01 = 1 YEAR OR LESS] 1 .. 115
722 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
723 q2alc 2. In the past 12 months, did you have at least 12 drinks of any kind of alcoholic beverage? 1= Yes 2= No
724 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
725 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
726 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
727 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
728 myob PARENTAL HISTORY Now some questions about your natural or biologic parents. 1. In what year was your mother born? [ENTER YEAR] 1840 .. 1960
729 mage_bir 1a. How old was your mother when you were born? [ENTER YEARS OF AGE] 10 .. 50
730 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
731 mlive 2. Is your mother still living? 1= Yes 2= No
732 myod 2a. In what year did she die? [ENTER YEAR] 1893 .. 2040
733 mage_die 2b. How old was your mother when she died? [ENTER YEARS OF AGE] 10 .. 115
734 mage_cur 2c. How old is she now? [ENTER YEARS OF AGE] 75 .. 115
735 cmyob2 Calculated year of birth for mother 1829 .. 1919
736 children 3. How many children did your mother have? [PROBE: Please include only those children born alive.] 1 .. 30
737 oldersib 4. How many of these children were older than you? 0 .. 30
738 mwork 5. What kind of work did your mother do most of her life?(What was her job called?) [SPECIFY] String[30]
739 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
740 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
741 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
742 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
743 fyob 9. In what year was your father born? [ENTER YEAR] 1810 .. 1960
744 fage_bir 9a. How old was your father when you were born? [ENTER YEARS OF AGE] 10 .. 115
745 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+
746 flive 10. Is your father still living? 1= Yes 2= No
747 fyod 10a. In what year did he die? [ENTER YEAR] 1820 .. 2040
748 fage_die 10b. How old was your father when he died? [ENTER YEARS OF AGE] 10 .. 115
749 fage_cur 10c. How old is he now? [ENTER YEARS OF AGE] 75 .. 115
750 cfyob2 Calculated year of birth for father 1764 .. 1919
751 fwork 11. What kind of work did your father do most of his life?(What was his job called?) [SPECIFY] String[30]
752 feduc 12. What was the highest grade or year of regular school your father completed? Elementary0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional17 18 19 20 21 ... 0 .. 30
753 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
754 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
755 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
756 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
757 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
758 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
759 sibpark2 How many? 1 .. 9
760 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
761 sibmem2 How many? 1 .. 9
762 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
763 ftpt 2. Full-time or part-time? 1= Part-time 2= Full-time
764 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]
765 cjobduty 4. What are your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
766 retired 5. Are you retired? (from a job?) 1= Yes 2= No
767 yr_ret 5a. In what year did you retire? 1894 .. 2040
768 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
769 ljobname 6a. Specify occupation String[30]
770 ljobduty 6b. What were your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
771 jobsuper 7. Considering the time when you worked most recently and thinking of the person in your organization who had the most control over what you did on the job - which of these statements best describes how closely you were supervised - my supervisor decided both what I did and how I did it; my supervisor decided WHAT I did, but I decided HOW to do it; I had some freedom in deciding both what I did and how to do it; I was my own boss within general policies. 1= Supervisor decided both what I did and how I did it. 2= Supervisor decided what I did, but I decided how to do it. 3= I had some freedom in deciding what I did and how to do it. 4= I was my own boss within general policies.
772 jobfree 8. How free ^dodid you feel to disagree with him or her? Would you say you ^feelfelt completely free to disagree, quite a bit free to disagree, a little bit free to disagree or hardly free at all to disagree? 1= Completely free 2= Quite a bit free 3= A little bit free 4= Hardly free at all
773 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
774 job30 9a. [SPECIFY OCCUPATION] String[30]
775 oth30 9b. [SPECIFY REASON FOR NON-WORKING STATUS AT 30 YEARS OF AGE] String[30]
776 duty30 9c. What were your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
777 addnum40 What was your street address when you were 40? Street number String[6]
778 dir40 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
779 street40 Street name String[18]
780 unit40 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
781 city40 City or Town String[18]
782 state40 State String[2]
783 zip40 Zip Code String[5]
784 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
785 q1inc Which of these income groups represents ^husbwife2 personal income for the past month or 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
786 c1fname CONTACT PERSON: 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]
787 c1middl First Contact Person Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
788 c1lname First Contact Person Last name String[18]
789 c1gender ^c1fname ^c1lname First Contact Person's gender 1= Male 2= Female
790 c1live Does ^c1heshe live with you? 1= YES 2= NO
791 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
792 c1addnum ^c1fname ^c1lname First Contact Person's current address Street number String[6]
793 c1dir ^c1fname ^c1lname Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
794 c1street ^c1fname ^c1lname Street name String[18]
795 c1unit ^c1fname ^c1lname Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
796 c1city ^c1fname ^c1lname City or Town String[18]
797 c1state ^c1fname ^c1lname State String[2]
798 c1zip ^c1fname ^c1lname Zip Code String[5]
799 c1hphone ^c1fname ^c1lname Home Telephone including area code [Use '-' to separate] String[12]
800 c1wphone ^c1fname ^c1lname Work Telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
801 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
802 c1relspc ^c1fname ^c1lname Specify String[40]
803 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]
804 c2middl Second Contact Person Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
805 c2lname Second Contact Person Last name String[18]
806 c2gender ^c2fname ^c2lname Second Contact Person's gender 1= Male 2= Female
807 c2live Does ^c2heshe live with you? 1= YES 2= NO
808 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
809 c2addnum ^c2fname ^c2lname Second Contact Person's current address Street number String[6]
810 c2dir ^c2fname ^c2lname Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
811 c2street ^c2fname ^c2lname Street name String[18]
812 c2unit ^c2fname ^c2lname Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
813 c2city ^c2fname ^c2lname City or Town String[18]
814 c2state ^c2fname ^c2lname State String[2]
815 c2zip ^c2fname ^c2lname Zip Code String[5]
816 c2hphone ^c2fname ^c2lname Home Telephone including area code [Use '-' to separate] String[12]
817 c2wphone ^c2fname ^c2lname Work Telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
818 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
819 c2relspc ^c2fname ^c2lname Specify String[40]
820 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
821 study2 Are there any other family members and/or friends that we can send information about the study? If yes, how many? [Enter number from 1 to 9] [If none, enter 0 and continue.] 0 .. 9
822 fname Can you give me their name and address? First name String[12]
823 middl Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
824 lname Last name String[18]
825 gender2 Gender 1= Male 2= Female
826 live Does he/she live with you? 1= YES 2= NO
827 addnum Current address Street number String[6]
828 dir Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
829 street Street name String[18]
830 unit Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
831 city2 City or Town String[18]
832 state2 State String[2]
833 zip Zip Code String[5]
834 relshp 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
835 relspc Specify String[40]
836 fname2 Can you give me their name and address? First name String[12]
837 middl2 Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
838 lname2 Last name String[18]
839 gender3 Gender 1= Male 2= Female
840 live2 Does he/she live with you? 1= YES 2= NO
841 addnum2 Current address Street number String[6]
842 dir2 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
843 street2 Street name String[18]
844 unit2 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
845 city3 City or Town String[18]
846 state3 State String[2]
847 zip2 Zip Code String[5]
848 relshp2 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
849 relspc2 Specify String[40]
850 fname3 Can you give me their name and address? First name String[12]
851 middl3 Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
852 lname3 Last name String[18]
853 gender4 Gender 1= Male 2= Female
854 live3 Does he/she live with you? 1= YES 2= NO
855 addnum3 Current address Street number String[6]
856 dir3 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
857 street3 Street name String[18]
858 unit3 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
859 city4 City or Town String[18]
860 state4 State String[2]
861 zip3 Zip Code String[5]
862 relshp3 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
863 relspc3 Specify String[40]
864 fname4 Can you give me their name and address? First name String[12]
865 middl4 Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
866 lname4 Last name String[18]
867 gender5 Gender 1= Male 2= Female
868 live4 Does he/she live with you? 1= YES 2= NO
869 addnum4 Current address Street number String[6]
870 dir4 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
871 street4 Street name String[18]
872 unit4 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
873 city5 City or Town String[18]
874 state5 State String[2]
875 zip4 Zip Code String[5]
876 relshp4 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
877 relspc4 Specify String[40]
878 fname5 Can you give me their name and address? First name String[12]
879 middl5 Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
880 lname5 Last name String[18]
881 gender6 Gender 1= Male 2= Female
882 live5 Does he/she live with you? 1= YES 2= NO
883 addnum5 Current address Street number String[6]
884 dir5 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
885 street5 Street name String[18]
886 unit5 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
887 city6 City or Town String[18]
888 state6 State String[2]
889 zip5 Zip Code String[5]
890 relshp5 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
891 relspc5 Specify String[40]
892 fname6 Can you give me their name and address? First name String[12]
893 middl6 Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
894 lname6 Last name String[18]
895 gender7 Gender 1= Male 2= Female
896 live6 Does he/she live with you? 1= YES 2= NO
897 addnum6 Current address Street number String[6]
898 dir6 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
899 street6 Street name String[18]
900 unit6 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
901 city7 City or Town String[18]
902 state7 State String[2]
903 zip6 Zip Code String[5]
904 relshp6 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
905 relspc6 Specify String[40]
906 fname7 Can you give me their name and address? First name String[12]
907 middl7 Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
908 lname7 Last name String[18]
909 gender8 Gender 1= Male 2= Female
910 live7 Does he/she live with you? 1= YES 2= NO
911 addnum7 Current address Street number String[6]
912 dir7 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
913 street7 Street name String[18]
914 unit7 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
915 city8 City or Town String[18]
916 state8 State String[2]
917 zip7 Zip Code String[5]
918 relshp7 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
919 relspc7 Specify String[40]
920 fname8 Can you give me their name and address? First name String[12]
921 middl8 Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
922 lname8 Last name String[18]
923 gender9 Gender 1= Male 2= Female
924 live8 Does he/she live with you? 1= YES 2= NO
925 addnum8 Current address Street number String[6]
926 dir8 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
927 street8 Street name String[18]
928 unit8 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
929 city9 City or Town String[18]
930 state9 State String[2]
931 zip8 Zip Code String[5]
932 relshp8 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
933 relspc8 Specify String[40]
934 fname9 Can you give me their name and address? First name String[12]
935 middl9 Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
936 lname9 Last name String[18]
937 gender10 Gender 1= Male 2= Female
938 live9 Does he/she live with you? 1= YES 2= NO
939 addnum9 Current address Street number String[6]
940 dir9 Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
941 street9 Street name String[18]
942 unit9 Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
943 city10 City or Town String[18]
944 state10 State String[2]
945 zip9 Zip Code String[5]
946 relshp9 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
947 relspc9 Specify String[40]
948 mfname 1. What is/was your mother's full name? [ENTER LAST/FIRST/MIDDLE/ MAIDEN NAME] String[40]
949 ffname 2. What is/was your father's full name? [ENTER LAST/FIRST/MIDDLE] String[30]
950 primphyf 3. What is the first name of your primary physician? [ENTER FIRST NAME. NO MD or DR.] String[15]
951 primphym 3. What is the middle initial of your primary physician? [ENTER M.I.] String[1]
952 primphyl 3. What is the last of your primary physician? [ENTER LAST NAME. NO MD or DR.] String[20]
953 phaddnum Physician- ^primphyf ^primphyl Participant's current address Street number String[6]
954 phdir Physician- ^primphyf ^primphyl Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
955 phstreet Physician- ^primphyf ^primphyl Street name String[18]
956 phunit Physician- ^primphyf ^primphyl Suite or office number [HIT ENTER IF NOT APPLICABLE] String[5]
957 phcity Physician- ^primphyf ^primphyl City or Town String[18]
958 phstate Physician- ^primphyf ^primphyl State String[2]
959 phzip Physician- ^primphyf ^primphyl Zip Code String[5]
960 physophn Physician- ^primphyf ^primphyl Telephone Number including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
961 physhphn 8. Physician's home phone? [HIT ENTER IF NOT APPLICABLE] String[12]
962 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
963 livingwl 10. Do you have a living will or Durable Power of Health Care? 1= Yes 2= No
964 represen 11. Who have you designated as you representative? [ENTER NAME] String[30]
965 liklyhos 12. If you were to become ill and require hospitalization, which hospital would you most likely use? [ENTER HOSPITAL NAME:] String[20]
966 lhosaddr 13. Hospital's Address? String[30]
967 wherlive 14. If you were unable to care for yourself, where would live? (i.e. intermediate care) [ENTER LOCATION] String[30]
968 funerhme 15. At the time of your death, what funeral home would you most likely use? [ENTER FUNERAL HOME NAME] String[20]
969 faddnum Funeral Home Address? Address Number String[6]
970 fdir Funeral Home Address? Direction: [Press enter if none.] String[4]
971 fstreet Funeral Home Address? Street: String[18]
972 funit Funeral Home Address? Department, Building, or Office Number: [Press enter if none.] String[25]
973 fcity Funeral Home Address? City: String[18]
974 fstate Funeral Home Address? State: String[2]
975 fzip Funeral Home Address? Zip Code: String[5]
976 fphone What is the Funeral Home telephone number (including area code)? [Use '-' to separate] String[12]
977 agreeaut Has the participant agreed to autopsy in this study? [Check the participant data sheet in the chart.]? 1= Yes 2= No
978 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
979 funname Has the participant given us a name and address of a funeral home they intend to use? 1= Yes 2= No
980 arrange Has the participant made pre-arrangements with this funeral home? 1= Yes 2= No
981 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
982 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
983 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
984 hearimp 2. Does the participant have a substantial hearing impairment? 1= Yes 2= No
985 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
986 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
987 comments Enter any comments. [PRESS ENTER IF NONE.] String[150]
988 vegsign 0 .. 8
989 mvegsign 0 .. 8
990 cesd 0 .. 10
991 mcesd 0 .. 10
997 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
998 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
999 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
1000 statid Please enter you staff id. 100 .. 997
1001 formch Has the form been modified? 1= Yes 2= No
1002 revidate Enter the date that the form was modified. Date type
1003 revintd Enter your staff id number. 100 .. 997
1004 anydev Are there any protocol deviations or missing data items to enter? 1= Yes 2= No
1005 numdev How many total protocol deviations and tests with missing items to enter? 1 .. 20
1006 reas00 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1007 test00 Enter test or procedure. String[15]
1008 item00 List items involved. [SEPARATE BY A COMMA] String[20]
1009 code00 Enter data code used. 1= Don't Know 2= Refusal 3= other
1010 oth00 Enter other code used. String[20]
1011 expl00 Explain what happened String[100]
1012 reas01 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1013 test01 Enter test or procedure. String[15]
1014 item01 List items involved. [SEPARATE BY A COMMA] String[20]
1015 code01 Enter data code used. 1= Don't Know 2= Refusal 3= other
1016 oth01 Enter other code used. String[20]
1017 expl01 Explain what happened String[100]
1018 reas02 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1019 test02 Enter test or procedure. String[15]
1020 item02 List items involved. [SEPARATE BY A COMMA] String[20]
1021 code02 Enter data code used. 1= Don't Know 2= Refusal 3= other
1022 oth02 Enter other code used. String[20]
1023 expl02 Explain what happened String[100]
1024 reas03 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1025 test03 Enter test or procedure. String[15]
1026 item03 List items involved. [SEPARATE BY A COMMA] String[20]
1027 code03 Enter data code used. 1= Don't Know 2= Refusal 3= other
1028 oth03 Enter other code used. String[20]
1029 expl03 Explain what happened String[100]
1030 reas04 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1031 test04 Enter test or procedure. String[15]
1032 item04 List items involved. [SEPARATE BY A COMMA] String[20]
1033 code04 Enter data code used. 1= Don't Know 2= Refusal 3= other
1034 oth04 Enter other code used. String[20]
1035 expl04 Explain what happened String[100]
1036 reas05 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1037 test05 Enter test or procedure. String[15]
1038 item05 List items involved. [SEPARATE BY A COMMA] String[20]
1039 code05 Enter data code used. 1= Don't Know 2= Refusal 3= other
1040 oth05 Enter other code used. String[20]
1041 expl05 Explain what happened String[100]
1042 reas06 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1043 test06 Enter test or procedure. String[15]
1044 item06 List items involved. [SEPARATE BY A COMMA] String[20]
1045 code06 Enter data code used. 1= Don't Know 2= Refusal 3= other
1046 oth06 Enter other code used. String[20]
1047 expl06 Explain what happened String[100]
1048 reas07 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1049 test07 Enter test or procedure. String[15]
1050 item07 List items involved. [SEPARATE BY A COMMA] String[20]
1051 code07 Enter data code used. 1= Don't Know 2= Refusal 3= other
1052 oth07 Enter other code used. String[20]
1053 expl07 Explain what happened String[100]
1054 reas08 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1055 test08 Enter test or procedure. String[15]
1056 item08 List items involved. [SEPARATE BY A COMMA] String[20]
1057 code08 Enter data code used. 1= Don't Know 2= Refusal 3= other
1058 oth08 Enter other code used. String[20]
1059 expl08 Explain what happened String[100]
1060 reas09 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1061 test09 Enter test or procedure. String[15]
1062 item09 List items involved. [SEPARATE BY A COMMA] String[20]
1063 code09 Enter data code used. 1= Don't Know 2= Refusal 3= other
1064 oth09 Enter other code used. String[20]
1065 expl09 Explain what happened String[100]
1066 reas10 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1067 test10 Enter test or procedure. String[15]
1068 item10 List items involved. [SEPARATE BY A COMMA] String[20]
1069 code10 Enter data code used. 1= Don't Know 2= Refusal 3= other
1070 oth10 Enter other code used. String[20]
1071 expl10 Explain what happened String[100]
1072 reas11 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1073 test11 Enter test or procedure. String[15]
1074 item11 List items involved. [SEPARATE BY A COMMA] String[20]
1075 code11 Enter data code used. 1= Don't Know 2= Refusal 3= other
1076 oth11 Enter other code used. String[20]
1077 expl11 Explain what happened String[100]
1078 reas12 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1079 test12 Enter test or procedure. String[15]
1080 item12 List items involved. [SEPARATE BY A COMMA] String[20]
1081 code12 Enter data code used. 1= Don't Know 2= Refusal 3= other
1082 oth12 Enter other code used. String[20]
1083 expl12 Explain what happened String[100]
1084 reas13 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1085 test13 Enter test or procedure. String[15]
1086 item13 List items involved. [SEPARATE BY A COMMA] String[20]
1087 code13 Enter data code used. 1= Don't Know 2= Refusal 3= other
1088 oth13 Enter other code used. String[20]
1089 expl13 Explain what happened String[100]
1090 reas14 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1091 test14 Enter test or procedure. String[15]
1092 item14 List items involved. [SEPARATE BY A COMMA] String[20]
1093 code14 Enter data code used. 1= Don't Know 2= Refusal 3= other
1094 oth14 Enter other code used. String[20]
1095 expl14 Explain what happened String[100]
1096 reas15 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1097 test15 Enter test or procedure. String[15]
1098 item15 List items involved. [SEPARATE BY A COMMA] String[20]
1099 code15 Enter data code used. 1= Don't Know 2= Refusal 3= other
1100 oth15 Enter other code used. String[20]
1101 expl15 Explain what happened String[100]
1102 reas16 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1103 test16 Enter test or procedure. String[15]
1104 item16 List items involved. [SEPARATE BY A COMMA] String[20]
1105 code16 Enter data code used. 1= Don't Know 2= Refusal 3= other
1106 oth16 Enter other code used. String[20]
1107 expl16 Explain what happened String[100]
1108 reas17 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1109 test17 Enter test or procedure. String[15]
1110 item17 List items involved. [SEPARATE BY A COMMA] String[20]
1111 code17 Enter data code used. 1= Don't Know 2= Refusal 3= other
1112 oth17 Enter other code used. String[20]
1113 expl17 Explain what happened String[100]
1114 reas18 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1115 test18 Enter test or procedure. String[15]
1116 item18 List items involved. [SEPARATE BY A COMMA] String[20]
1117 code18 Enter data code used. 1= Don't Know 2= Refusal 3= other
1118 oth18 Enter other code used. String[20]
1119 expl18 Explain what happened String[100]
1120 reas19 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
1121 test19 Enter test or procedure. String[15]
1122 item19 List items involved. [SEPARATE BY A COMMA] String[20]
1123 code19 Enter data code used. 1= Don't Know 2= Refusal 3= other
1124 oth19 Enter other code used. String[20]
1125 expl19 Explain what happened String[100]

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