Data Dictionary for marint

Number of Blaise fields: 901

Seq # Var Question Data Type/Coding
1 projid MARS Baseline Interview (v5.1 Rev 05/07/2021) Project ID number. String[8]
2 folder Type in folder color. F/U Year Folder Baseline (manilla) String[8]
3 visit Enter visit code (check folder color): CODE F/U Year Folder 00 = Baseline (manilla) String[2]
4 vervisit Please verify visit and folder color. visit = ^visitnum folder = ^folder1 Is this correct? If not, please page up and correct folder color. 1= Yes
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 padrnum Participant's PERMANENT ADDRESS Street number String[9]
19 padrdir PERMANENT ADDRESS Street direction [HIT ENTER IF NOT APPLICABLE] String[4]
20 pstreet PERMANENT ADDRESS Street name String[18]
21 papt PERMANENT ADDRESS Apartment/Unit/Room number [HIT ENTER IF NOT APPLICABLE] String[25]
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 reskind PERMANENT ADDRESS What kind of residence is this? 1= Home [Single family dwelling] 2= Apartment/Condominium [even if affiliated with CCRC] 3= Retirement home/CCRC-independent living 4= Assisted living/Sheltered care 5= Nursing home - unskilled care 6= Nursing home - skilled care
26 facname PERMANENT ADDRESS Name of facility String[40]
27 facdate PERMANENT ADDRESS Enter date that participant entered facility, like this MM-DD-YYYY. [Use '-' to separate] [USE 88 IF MONTH OR DAY UNKNOWN] String[10]
28 phphone PERMANENT ADDRESS Home telephone including area code [Use '-' to separate] String[12]
29 pwphone PERMANENT ADDRESS Work telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
30 pcphone PERMANENT ADDRESS Cell/mobile telephone inlcluding area code [Use '-' to separate] [Press enter if none.] String[12]
31 pemail PERMANENT ADDRESS E-mail address? [Press enter if none.] String[50]
32 tempor Are you currently staying at an address that is different from your permanent address? 1= Yes 2= No
33 tadrnum Participant's TEMPORARY ADDRESS Street number String[9]
34 tadrdir TEMPORARY ADDRESS Street direction [HIT ENTER IF NOT APPLICABLE] String[4]
35 tstreet TEMPORARY ADDRESS Street name String[18]
36 tapt TEMPORARY ADDRESS Apartment/Unit/Room number [HIT ENTER IF NOT APPLICABLE] String[25]
37 tcity TEMPORARY ADDRESS City or Town String[18]
38 tstate TEMPORARY ADDRESS State String[2]
39 tzip TEMPORARY ADDRESS Zip Code String[5]
40 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
41 tfacname TEMPORARY ADDRESS Name of facility String[40]
42 tfacdate TEMPORARY ADDRESS Enter date that participant entered facility, like this MM-DD-YYYY. [Use '-' to separate] [USE 88 IF MONTH OR DAY UNKNOWN] String[10]
43 thphone TEMPORARY ADDRESS Home telephone including area code [Use '-' to separate] String[12]
44 twphone TEMPORARY ADDRESS Work telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
45 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
46 q5loc What is your social security number? 0 .. 999999999
47 q5aloc [ENTER R. SOCIAL SECURITY NUMBER AGAIN] 0 .. 999999999
48 q6loc What is your medicare number? Please show me your card. String[11]
49 q6aloc [ENTER R. MEDICARE NUMBER AGAIN] String[11]
50 validated
51 validateerror
52 errorposition
53 validated_hicn_cms
54 validated_rrb_pre1964
55 validated_rrb_post1964
56 hicnformats
57 hicn_alpha
58 hicn_numbers
59 strlen
60 hicn_trimmed
61 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
62 ssn What is your social security number? [INTERVIEWER: Please enter the SSN in 000-00-0000 format.] String[11]
63 ssn_c [ENTER R. SOCIAL SECURITY NUMBER AGAIN] String[11]
64 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
65 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]
66 hicn_c [ENTER R. MEDICARE NUMBER(HICN) AGAIN] String[11]
67 hicn_type HICN Type: ^hicnFormats String[15]
68 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
69 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]
70 mbi_c [ENTER R. MEDICARE NUMBER(MBI) AGAIN] String[13]
71 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
72 specfy Specify Country: String[30]
73 howlong How many years have you lived in the United States? 1 .. 130
74 state In what state were your born? String[30]
75 city 2. In what city or town? String[30]
76 county 3. And in what county (or province) were you born? String[30]
77 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]
78 dirbr Participant's birth address Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
79 streetbr Participant's birth address Street name String[18]
80 unitbr Participant's birth address Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
81 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]
82 firstres How old were you when you moved into this residence? 0 .. 18
83 same12 Is this the same address you lived at when you were 12 years old? 1= Yes 2= No
84 addnum12 What was the street address where you lived when you were 12 years old? Participant's address at 12 years old Street number String[6]
85 dir12 Participant's address at 12 years old Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
86 street12 Participant's address at 12 years old Street name String[18]
87 unit12 Participant's address at 12 years old Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
88 city12 Participant's address at 12 years old City or Town String[18]
89 state12 Participant's address at 12 years old State String[2]
90 zip12 Participant's address at 12 years old Zip Code String[5]
91 addcom12 Participant's address at 12 years old [Interviewer: If the address is not complete, ask participant to describe location, e.g. cross streets, nearby public buildings/facilities, etc.] [Press enter if none.] String[250]
92 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
93 q4dem What is your date of birth? (mo/day/yr) Date type
94 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
95 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
96 hisporx Other (specify, please write in English): String[30]
97 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
98 raceprix Other, specify String[30]
99 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
100 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
101 racesecx Other, specify String[30]
102 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
103 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
104 raceterx Other, specify String[30]
105 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
106 multiple 1a. Did you have only one or more than one? 1= Only one 2= More than one
107 inhosp 1b Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
108 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
109 chfhosp Were you hospitalized overnight or longer for this? 1= Yes 2= No
110 chfnum How many times have you been hospitalized for this? 0 .. 10
111 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
112 ca1a 1a. Where was it? [OR: Where was the most recent cancer that you had?] [SPECIFY] String[20]
113 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
114 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
115 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
116 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
117 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
118 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
119 th3 2. Has a doctor, nurse, or therapist ever told you to take medicine by mouth for your thyroid condition? 1= Yes 2= No
120 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
121 gout Have you ever been told by a doctor, nurse or therapist that you had gout? 1= Yes 2= Suspect or possible 3= No
122 osteoporosis Have you ever been told by a doctor, nurse or therapist that you had osteoporosis? 1= Yes 2= Suspect or possible 3= No
123 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
124 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
125 agefirst 6. How old were you when you first took this/these medications? 1 .. 115
126 current 7. Are you currently taking this/these medications? 1= Yes 2= No
127 agelast 7a. How old were you when you last took this/these medications? 1 .. 115
128 mensage 8. At what age did you begin menstruating? 1 .. 99
129 menoage 9. At what age did you stop menstruating? 1 .. 99
130 natura 10. Was your menopause natural or caused by surgery? 1= Natural 2= Surgery
131 whatwas 10a. What was the surgery? 1= Full Hysterectomy 2= Hysterectomy (partial) 3= Other
132 othspe00 10b. Specify: String[40]
133 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
134 pressure 1a. Do you get pressure or heaviness in your chest? 1= Yes 2= No
135 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
136 level0 3. Do you get this pain (or discomfort) when you walk at an ordinary pace on level ground? 1= Yes 2= No
137 legpain CLAUDICATION Now some questions about pains in your legs. 1. Do you get pain in either leg while walking? 1= Yes 2= No
138 standsit 2. Does this pain ever begin when you are standing still or sitting? 1= Yes 2= No
139 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
140 shrtbrth 9. Do you get short of breath at night if you sleep flat or only on one pillow? 1= Yes 2= No
141 pillows 9a. How many pillows do you need to sleep on to not be short of breath? 1 .. 9
142 grspbrth 9b. Do you wake up at night gasping for breath? 1= Yes 2= No
143 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
144 headinj HEAD INJURY Now I have some questions about injuries. 1. Have you EVER had a head injury? 1= Yes 2= No
145 lostcons 3. Have you EVER lost consciousness because of a head injury? 1= Yes 2= Suspect or possible 3= No
146 howlong1 3c. How long were you unconscious for this (last) head injury? Would you say less than 5 seconds, between 5 seconds and 5 minutes, between 5 minutes and 1 hour, between 1 hour and 2 days, or more than 2 days? [If more than one head injury, ask about the worst head injury only.] 1= < 5 seconds 2= 5 seconds - 5 minutes 3= > 5 minutes - 1 hour 4= > 1 hour - 2 days 5= > 2 days
147 hdrvehicle
148 hdrhitbyobject
149 hdrfalling
150 hdrsports
151 hdrabuse
152 hdrmilitary
153 hdrother
154 prevbisqdone BRAIN INJURY SCREENING QUESTIONNAIRE Have the BISQ questions been previously completed for this participant? ^prevBisqDoneText 1= Yes 2= No
155 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
156 bisqvehnum ^hdrVehicle How many times did you receive a blow to the head, in a vehicle accident? 1 .. 30
157 bisqvehloc ^hdrVehicle Did you lose consciousness? 1= Yes 2= No
158 bisqvehlocnum ^hdrVehicle How many times have you lost consciousness? 1 .. 30
159 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.
160 bisqvehlocyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
161 bisqvehlocyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
162 bisqvehlocyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
163 bisqvehlocyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
164 bisqvehlocyr5 ^hdrVehicle In what year did this occur (5)? 1900 .. 2050
165 bisqvehdaze ^hdrVehicle Were you dazed or confused? 1= Yes 2= No
166 bisqvehdazenum ^hdrVehicle How many times have you been dazed or confused? 1 .. 30
167 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.
168 bisqvehdazeyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
169 bisqvehdazeyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
170 bisqvehdazeyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
171 bisqvehdazeyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
172 bisqvehdazeyr5 ^^hdrVehicle In what year did this occur (5)? 1900 .. 2050
173 bisqhit ^lastInterviewText1en 2. Hit by an object?(ex: equipment, falling object) 1= Yes 2= No
174 bisqhitnum ^hdrHitByObject How many times did you receive a blow to the head, from a falling object? 1 .. 30
175 bisqhitloc ^hdrHitByObject Did you lose consciousness? 1= Yes 2= No
176 bisqhitlocnum ^hdrHitByObject How many times have you lost consciousness? 1 .. 30
177 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.
178 bisqhitlocyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
179 bisqhitlocyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
180 bisqhitlocyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
181 bisqhitlocyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
182 bisqhitlocyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
183 bisqhitdaze ^hdrHitByObject Were you dazed or confused? 1= Yes 2= No
184 bisqhitdazenum ^hdrHitByObject How many times have you been dazed or confused? 1 .. 30
185 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.
186 bisqhitdazeyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
187 bisqhitdazeyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
188 bisqhitdazeyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
189 bisqhitdazeyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
190 bisqhitdazeyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
191 bisqfall ^lastInterviewText2en 3. Falling? (ex: down stairs, during a fainting spell, from a high place) 1= Yes 2= No
192 bisqfallnum ^hdrFalling How many times did you receive a blow to the head, in a fall? 1 .. 30
193 bisqfallloc ^hdrFalling Did you lose consciousness? 1= Yes 2= No
194 bisqfalllocnum ^hdrFalling How many times have you lost consciousness? 1 .. 30
195 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.
196 bisqfalllocyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
197 bisqfalllocyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
198 bisqfalllocyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
199 bisqfalllocyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
200 bisqfalllocyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
201 bisqfalldaze ^hdrFalling Were you dazed or confused? 1= Yes 2= No
202 bisqfalldazenum ^hdrFalling How many times have you been dazed or confused? 1 .. 30
203 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.
204 bisqfalldazeyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
205 bisqfalldazeyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
206 bisqfalldazeyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
207 bisqfalldazeyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
208 bisqfalldazeyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
209 bisqsprt ^lastInterviewText3en 4. Sports/Leisure?(ex: sports, biking, skiing, on the playground) 1= Yes 2= No
210 bisqsprtnum ^hdrSports How many times did you receive a blow to the head, during a sports or leisure activity? 1 .. 30
211 bisqsprtloc ^hdrSports Did you lose consciousness? 1= Yes 2= No
212 bisqsprtlocnum ^hdrSports How many times have you lost consciousness? 1 .. 30
213 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.
214 bisqsprtlocyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
215 bisqsprtlocyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
216 bisqsprtlocyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
217 bisqsprtlocyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
218 bisqsprtlocyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
219 bisqsprtdaze ^hdrSports Were you dazed or confused? 1= Yes 2= No
220 bisqsprtdazenum ^hdrSports How many times have you been dazed or confused? 1 .. 30
221 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.
222 bisqsprtdazeyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
223 bisqsprtdazeyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
224 bisqsprtdazeyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
225 bisqsprtdazeyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
226 bisqsprtdazeyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
227 bisqphys ^lastInterviewText4en 5. Physical Abuse/Assault?(ex: mugged) 1= Yes 2= No
228 bisqphysnum ^hdrAbuse How many times did you receive a blow to the head, from abuse or assault? 1 .. 30
229 bisqphysloc ^hdrAbuse Did you lose consciousness? 1= Yes 2= No
230 bisqphyslocnum ^hdrAbuse How many times have you lost consciousness? 1 .. 30
231 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.
232 bisqphyslocyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
233 bisqphyslocyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
234 bisqphyslocyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
235 bisqphyslocyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
236 bisqphyslocyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
237 bisqphysdaze ^hdrAbuse Were you dazed or confused? 1= Yes 2= No
238 bisqphysdazenum ^hdrAbuse How many times have you been dazed or confused? 1 .. 30
239 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.
240 bisqphysdazeyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
241 bisqphysdazeyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
242 bisqphysdazeyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
243 bisqphysdazeyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
244 bisqphysdazeyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
245 bisqmil ^lastInterviewText5en 6. Military Service?(ex: training, blast injury) 1= Yes 2= No
246 bisqmilnum ^hdrMilitary How many times did you receive a blow to the head, during military service? 1 .. 30
247 bisqmilloc ^hdrMilitary Did you lose consciousness? 1= Yes 2= No
248 bisqmillocnum ^hdrMilitary How many times have you lost consciousness? 1 .. 30
249 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.
250 bisqmillocyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
251 bisqmillocyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
252 bisqmillocyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
253 bisqmillocyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
254 bisqmillocyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
255 bisqmildaze ^hdrMilitary Were you dazed or confused? 1= Yes 2= No
256 bisqmildazenum ^hdrMilitary How many times have you been dazed or confused? 1 .. 30
257 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.
258 bisqmildazeyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
259 bisqmildazeyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
260 bisqmildazeyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
261 bisqmildazeyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
262 bisqmildazeyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
263 bisqoth ^lastInterviewText6en 7. In any other circumstances? 1= Yes 2= No
264 bisqothsp ^hdrOther Please specify: String[255]
265 bisqothnum ^hdrOther How many times did you receive a blow to the head, in a situation I have not mentioned? 1 .. 30
266 bisqothloc ^hdrOther Did you lose consciousness? 1= Yes 2= No
267 bisqothlocnum ^hdrOther How many times have you lost consciousness? 1 .. 30
268 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.
269 bisqothlocyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
270 bisqothlocyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
271 bisqothlocyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
272 bisqothlocyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
273 bisqothlocyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
274 bisqothdaze ^hdrOther Were you dazed or confused? 1= Yes 2= No
275 bisqothdazenum ^hdrOther How many times have you been dazed or confused? 1 .. 30
276 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.
277 bisqothdazeyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
278 bisqothdazeyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
279 bisqothdazeyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
280 bisqothdazeyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
281 bisqothdazeyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
282 grow1 The next questions are about your first 18 years of life. 2. When you were growing up, was your family a source of strength and support to you? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
283 grow2 4. When you were growing up, was there someone to take you to the doctor if you needed it? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
284 grow3 5. When you were growing up, how often was there not enough to eat? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
285 grow4 6. When you were growing up, how often did you have to wear dirty clothes? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
286 grow5 7. When you were growing up, how often did an adult living in (or visiting) your home say mean or hurtful things to you? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
287 grow6 8. When you were growing up, how often did an adult living in (or visiting) your home act in a way that made you afraid you might be physically hurt? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
288 grow7 11. When you were growing up, how often did an adult living in (or visiting) your home push, grab, slap, or throw something at you? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
289 grow8 12. When you were growing up, how often were you punished with a belt, board, cord, or some other hard object? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
290 grow9 13. When you were growing up, how often did adults living in (or visiting) your home argue with each other? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
291 grow10 14. When you were growing up, how often did physical fights occur between adults living in (or visiting) your home? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
292 grow11 15. When you were growing up, was a household member depressed or mentally ill? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
293 grow12 16. When you were growing up, was there a member of your household who was very ill (physically ill)? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
294 grow13 17. When you were growing up, was a household member a problem drinker or alcoholic? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
295 grow14 18. When you were growing up, did a household member go to prison? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
296 grow15 19. When you were growing up, were you ever hospitalized for two weeks or more? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
297 grow16 20. When you were growing up, did you ever have an experience that was so frightening that you thought about it for years? 1= Not at all 2= Somewhat 3= Moderately so 4= Very much so
298 q1edu EDUCABILITY The next questions are about your early education. 1. Did you have difficulty attending regular schools, i.e., did you ever attend special schools or special classes in school? [INTERVIEWER: IGNORE SPECIAL SCHOOLS OR CLASSES RELATED TO HIGH ACADEMIC ACHIEVEMENT, E.G., ADVANCED PLACEMENT.] 1= No problem in schools 2= Attended special classes 3= Attended special schools
299 q2edu 2. For most of your education up to 8th grade, what type of school did you attend? 1= Public 2= public Magnet 3= private Catholic 4= private Other 5= home-Schooled 6= other
300 q4edu 4. Up through 8th grade did you attend school full-time (e.g., for the full school year) or part-time (e.g. because you had to work)? 1= full-time 2= part-time
301 q5edu 5. The next question is about your schooling up through 12th grade. Up through 12th grade for how ever many years you were in school, did you ever attend a legally segregated school? 1= Yes, attended a legally segregated school 2= No, did not attend a legally segregated school
302 q5aedu 5a. How many years? 1 .. 12
303 reada Present Time Now I have some questions about how you spend your time currently. 1. About how much time do you spend reading each day? 1= None 2= Less than one hour 3= One to less than two hours 4= Two to less than three hours 5= Three or more hours
304 diarya 10. In the last ten years, did you ever keep a diary or journal? 1= Yes 2= No
305 diaryb 10a. How many years? [Estimate total years.] 1 .. 120
306 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
307 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
308 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
309 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
310 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
311 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
312 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
313 usepc 18. During the past year, how often did you use a personal computer (for example, for e-mail, to search the internet or other reasons)? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
314 games 19. During the past year, how often did you play games like checkers or other board games, cards, puzzles, word games, mind teasers, or any other similar games? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
315 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
316 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
317 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
318 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
319 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
320 q16act 16. During the past year, how often did you participate in any groups such as senior center, church related groups, charity, public services, or community groups? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
321 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
322 q17act 17. During the past year, how often did you go shopping with friends (like to a mall)? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
323 q18act 18. During the past year, how often often did you go to parties or other social events (e.g., senior dances, nightclubs)? 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less
324 comfort The next questions are about spiritual feelings that you may experience in your daily life. I find comfort in my religion or spirituality. (Would you say that you feel this way--many times a day, everyday, most days, some days, once in a while, or never or almost never?) 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never
325 inpeace I feel deep inner peace or harmony. (Would you say that you feel this way--many times a day, everyday, most days, some days, once in a while, or never or almost never?) 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never
326 oftpray How often do you pray or meditate? (Would you say--many times a day, everyday, most days, some days, once in a while, or never or almost never?) 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never
327 self12 HANDEDNESS 1. Which hand do you usually use to write a letter? 1= Right 2= Left 3= Both
328 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
329 recogfr2 2. (When wearing eyeglasses/contact lenses) Can you see well enough to recognize a friend across the street? 1= Yes 2= No
330 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
331 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
332 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
333 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
334 trial1a 2a. Second trial: 20/100 1= All three correct 2= Two correct 3= One correct 4= None correct
335 trial1b 2b. Third trial: 20/200 1= All three correct 2= Two correct 3= One correct 4= None correct
336 trial1c 2c. Fourth trial: 20/400 1= All three correct 2= Two correct 3= One correct 4= None correct
337 trial2 3. Second trial: 20/50 1= All three correct 2= Two correct 3= One correct 4= None correct
338 trial3 3a. Third trial: 20/40 1= All three correct 2= Two correct 3= One correct 4= None correct
339 midarm BLOODPRESSURE Now I would like to take some measurements of your arm, hips, and waist, as well as height, weight and blood pressure. 1. MID-ARM CIRCUMFERENCE [IN cm] 15.0 .. 78.0
340 midfore 1a. MID FOREARM CIRCUMFERENCE [IN cm] 10.0 .. 78.0
341 midleg 1b. MID LEG CIRCUMFERENCE [IN cm] 15.0 .. 99.0
342 tricep1 2. FIRST TRICEPS SKINFOLD MEASUREMENT [IN mm] CODE 72 IF MEASUREMENT >= 67 mm] 1 .. 72
343 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
344 tricep2 4. SECOND TRICEPS SKINFOLD MEASUREMENT [IN mm] [CODE 72 IF MEASUREMENT >=67mm] 1 .. 72
345 pulsept 5. PULSE OBLITERATION POINT [IN mmHg] 50 .. 270
346 pul THE PEAK INFLATION LEVEL IS ^pulse [HIT ENTER FOR NEXT QUESTION] 80 .. 300
347 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]
348 bp2 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] String[7]
349 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]
350 weight 9. MEASURED WEIGHT [IN LBS] [CODE 333 IF MEASUREMENT IS >=300 lbs. CODE 888 IF PHYSICALLY UNABLE TO WEIGH] 30 .. 888
351 height 10. MEASURED HEIGHT [IN FEET & INCHES] [CODE 888 IF PHYSICALLY UNABLE TO MEASURE HEIGHT] String[5]
352 waist Measured waist circumference [IN cm] [To measure waist circumference (WC), place a measuring tape in a horizontal plane around the abdomen ? midway between the bottom of the rib cage and the top of the iliac crest.] [Code 333 IF MEASUREMENT >= 125 cm. CODE 888 IF PHYSICALLY UNABLE TO measure] 50 .. 888
353 hipcirc Measured hip circumference [IN cm] [To measure hip circumference (HC), place a measuring tape in a horizontal plane around the largest part of the hips ? the widest part of the buttocks.] [Code 333 IF MEASUREMENT >= 125 cm. Code 888 IF PHYSICALLY UNABLE TO measure] 50 .. 888
354 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]
355 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]
356 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]
357 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]
358 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]
359 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]
360 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]
361 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]
362 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]
363 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]
364 gaitquip Is the Gait Test Equipment Available? 1= Yes 2= No
365 domove2 [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] 1= Yes 2= No
366 dynaid DynaPort Device id String[10]
367 diskid Disk ID String[10]
368 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)
369 move7b Time (seconds): 1.0 .. 60.0
370 move7c Number of steps taken: 1 .. 60
371 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)
372 move7d Time (seconds): 1.0 .. 60.0
373 move7e Number of steps taken: 1 .. 60
374 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
375 move7a1 [SPECIFY] String[20]
376 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)
377 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)
378 move6f Number of steps taken: 1 .. 60
379 move6e Time (seconds): 1.0 .. 60.0
380 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)
381 move6h Number of steps: 1 .. 60
382 move6g Time (seconds): 1.0 .. 60.0
383 move6i Record Aid used for 360 turn: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
384 move6i1 [SPECIFY] String[20]
385 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)
386 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)
387 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)
388 getaid Record Aid used for GET UP AND GO: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
389 getaid_specify [SPECIFY] String[20]
390 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)
391 move8 Interviewer: Record number of errors, e.g. Sidesteps: 0 .. 60
392 tandaid Record Aid used for Tandem Walk: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
393 tandaid_specify [SPECIFY] String[20]
394 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)
395 walk8aid Record Aid used for BACK AND FORTH WALK: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
396 walk8aid_specify [SPECIFY] String[20]
397 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)
398 move6 Time (seconds) : 1.0 .. 10.0
399 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)
400 move6a Time (seconds) : 1.0 .. 10.0
401 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)
402 move6c Time (seconds) : 1.0 .. 10.0
403 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)
404 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)
405 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]
406 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]
407 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]
408 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]
409 trial11 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
410 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
411 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
412 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
413 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]
414 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
415 q1aphy 1a. How many times in the past 14 days did you go walking for exercise? [ENTER NUMBER OF TIMES] 1 .. 87
416 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
417 q11aphy 2a. How many times in the past 14 days did you go walking like that? [ENTER NUMBER OF TIMES] 1 .. 87
418 q3phy (In the past 14 days have you done) 3. Gardening or yard work? 1= Yes 2= No
419 q3aphy 3a. How many times in the past 14 days did you do gardening or yard work? [ENTER NUMBER OF TIMES] 1 .. 87
420 q5phy (In the past 14 days have you done) 5. Calisthenics or general exercise? 1= Yes 2= No
421 q5aphy 5a. How many times in the past 14 days did you do calisthenics or general exercise? [ENTER NUMBER OF TIMES] 1 .. 87
422 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
423 q101phy 10.1 [SPECIFY] String[40]
424 q10aphy 10a. How many times in the past 14 days did you do this? [ENTER NUMBER OF TIMES] 1 .. 87
425 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
426 q2md 2. My sleep was restless. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
427 q3md 3. I felt depressed. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
428 q4md 4. I was happy. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
429 q5md 5. I felt lonely. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
430 q6md 6. People were unfriendly. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
431 q7md 7. I enjoyed life. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
432 q8md 8. I felt sad. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
433 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
434 q10md 10. I could not get 'going'. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
435 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
436 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
437 sleep 3. A change in your pattern of sleeping. 1= Yes 2= No
438 enrgy 4. A decrease in your energy level. 1= Yes 2= No
439 concen 5. Trouble concentrating. 1= Yes 2= No
440 guilt 6. Felt extremely guilty or worthless. 1= Yes 2= No
441 restls 7. Felt extremely restless or agitated. 1= Yes 2= No
442 activt 8. Lost your interest in favorite activities. 1= Yes 2= No
443 living 9. Felt that life was not worth living. 1= Yes 2= No
444 teldoc 9a. Did you tell a doctor or any other professional about it? 1= Yes 2= No
445 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
446 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
447 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
448 q2func 2. Are you able to walk up and down stairs to the second floor without help? 1= Yes 2= No
449 q3func 3. Are you able to walk a half mile without help? 1= Yes 2= No
450 q4func Next, I would like to know if you need help doing some different kinds of activities. At the present time, do you need help either from another person or a special equipment or device... 4. Walking across a small room? 1= No help 2= Help 3= Unable to do
451 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
452 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
453 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
454 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
455 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
456 q10func Now I have a few more questions about activities people may or may not do. Although some things may actually be performed by someone else, just tell me whether you think you are able to do them. 10. Are you able to use the telephone - including looking up numbers and dialing - completely by yourself or does someone else help you? 1= No help 2= Help 3= Unable to do
457 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
458 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
459 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
460 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
461 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
462 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
463 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
464 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
465 fecal1 FECAL INCONTINENCE 1. How would you describe your usual bowel pattern? 1= Normal 2= Constipated 3= Diarrhea 4= Alternating constipation and diarrhea
466 fecal2 2. In the past few months, have you ever lost control of your bowels when you did not want to? 1= Yes 2= Suspect 3= No
467 fecal3 3. How often in the past year have you seen your doctor for problems with your bowels? 1= None 2= 1-2 times 3= More than 3 times
468 married SOCIAL NETWORK Now some questions about your social network. Have you ever been married? 1= Yes 2= No
469 marrnum How many times have you been married? [Enter a number between 1-10.] 1 .. 10
470 married2 Are you now married, separated, divorced, or widowed? 1= Married 2= Separated 3= Divorced 4= Widowed
471 livewith Does your ^huswife live with you? 1= Yes 2= No
472 q1sn Do you have any living children? If so, how many do you have? Please include adopted children as well as children you have raised. [ENTER No. OF CHILDREN] 0 .. 30
473 q2sn How many of your children do you see at least once a month? [ENTER No. OF CHILDREN] 0 .. 30
474 q2asn Do you see your child at least once a month? 1= Yes 2= No
475 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
476 q3asn How many of these close relatives do you usually see at least once a month? [ENTER No. OF CLOSE RELATIVES] 0 .. 76
477 q3bsn Do you see your close relative at least once a month? 1= Yes 2= No
478 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
479 q4asn How many of these close friends do you see at least once a month? [ENTER No. OF CLOSE FRIENDS] 0 .. 15
480 q4bsn Do you see your close friend at least once a month? 1= Yes 2= No
481 spanishbr Is the participant of Spanish/Hispanic origin? 1= Yes 2= No
482 spanish_fluent Are you fluent in Spanish? 1= Yes 2= No
483 safe_accult_6 Ask question #6 in the SAFE - Acculturation Stress Scale? 1= Yes 2= No
484 description_acc Acculturation Although you may speak many languages, the following questions refer to only English and Spanish. [PRESS ENTER TO CONTINUE]
485 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
486 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
487 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
488 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
489 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
490 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
491 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
492 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
493 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
494 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
495 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]
496 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
497 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
498 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
499 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
500 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
501 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
502 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]
503 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
504 pnes_attractive 2. My neighborhood is attractive. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
505 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
506 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
507 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
508 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
509 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
510 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
511 pnes_traffic 9. My neighborhood has heavy traffic. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
512 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
513 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
514 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
515 pnes_howlong_year How long have you lived in your neighborhood? _____ years, 0 .. 199
516 pnes_howlong_month and/or _____ months 0 .. 11
517 pnes_howlong1_year How long have you lived at your current address? _____ years, 0 .. 199
518 pnes_howlong1_month and/or _____ months 0 .. 11
519 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]
520 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
521 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
522 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
523 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
524 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
525 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
526 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
527 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
528 myob PARENTAL HISTORY Now some questions about your natural or biologic parents. 1. In what year was your mother born? [ENTER YEAR] 1840 .. 1960
529 mage_bir 1a. How old was your mother when you were born? [ENTER YEARS OF AGE] 10 .. 50
530 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
531 mlive2 From the time of your birth until you were 18, how many years did your mother live in the same home with you? [Enter a number between 0-18] 0 .. 18
532 mlive 2. Is your mother still living? 1= Yes 2= No
533 myod 2a. In what year did she die? [ENTER YEAR] 1893 .. 2040
534 mage_die 2b. How old was your mother when she died? [ENTER YEARS OF AGE] 10 .. 115
535 mage_cur 2c. How old is she now? [ENTER YEARS OF AGE] 75 .. 115
536 cmyob2 Calculated year of birth for mother 1829 .. 1919
537 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
538 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
539 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
540 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
541 fyob 9. In what year was your father born? [ENTER YEAR] 1810 .. 1960
542 fage_bir 9a. How old was your father when you were born? [ENTER YEARS OF AGE] 10 .. 115
543 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+
544 flive2 From the time of your birth until you were 18, how many years did your father live in the same home with you? [Enter a number between 0-18] 0 .. 18
545 flive 10. Is your father still living? 1= Yes 2= No
546 fyod 10a. In what year did he die? [ENTER YEAR] 1820 .. 2040
547 fage_die 10b. How old was your father when he died? [ENTER YEARS OF AGE] 10 .. 115
548 fage_cur 10c. How old is he now? [ENTER YEARS OF AGE] 75 .. 115
549 cfyob2 Calculated year of birth for father 1764 .. 1919
550 fwork 11. What kind of work did your father do most of his life?(What was his job called?) [SPECIFY] String[30]
551 feduc 12. What was the highest grade or year of regular school your father completed? Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... 0 .. 30
552 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
553 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
554 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
555 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
556 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
557 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
558 sibpark2 How many? 1 .. 9
559 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
560 sibmem2 How many? 1 .. 9
561 drive1 DRIVING Are you currently licensed to drive? 1= Yes 2= No
562 drive2 Have you driven in the past 12 months? 1= Yes 2= No
563 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
564 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
565 inferior I often feel inferior to others. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
566 tense I often feel tense and jittery. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
567 getangry I often get angry at the way people treat me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
568 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
569 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
570 neo18str 18. When I'm under a great deal of stress, sometimes I feel like I'm going to pieces. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
571 neo3lon 3. I rarely feel lonely or blue. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
572 neo9wrth 9. Sometimes I feel completely worthless. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
573 neo13anx 13. I rarely feel fearful or anxious. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
574 neo15sad 15. I am seldom sad or depressed. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
575 neo16ash 16. At times I have been so ashamed I just wanted to hide. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
576 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
577 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
578 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
579 purpos4 4. I have a sense of direction and purpose in life. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
580 purpos5 5. My daily activities often seem trivial and unimportant to me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
581 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
582 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
583 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
584 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
585 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
586 emptins SOCIAL ISOLATION I experience a general sense of emptiness. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
587 misspeop I miss having people around. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
588 friends I feel like I don't have enough friends. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
589 abandon I often feel abandoned. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
590 missfrnd I miss having a really close friend. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
591 edanx53 Anxiety In the past 7 days ... 1. I felt uneasy. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
592 edanx46 Anxiety 2. I felt nervous. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
593 edanx48 Anxiety 3. Many situations made me worry. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
594 edanx41 Anxiety 4. My worries overwhelmed me. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
595 edanx54 Anxiety 5. I felt tense. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
596 edanx55 Anxiety 6. I had difficulty calming down. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
597 edanx18 Anxiety 7. I had sudden feelings of panic. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
598 nqanx07 Anxiety 8. I felt nervous when my normal routine was disturbed. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
599 q1mdb DISCRIMINATION Now I would like to ask you about certain experiences or feelings you have had in your daily life. In your daily life how often have you had the following experiences: 1. You are treated with less courtesy than other people. Would you say that you have had this experience...? 1= Often 2= Sometimes 3= Rarely 4= Never
600 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
601 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
602 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
603 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
604 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
605 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
606 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
607 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
608 q11mdb 11. The color of your skin is a problem for White people. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
609 q14mdb 14. White people act as if they are better than you. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
610 q18mdb 18. You are treated with less respect than a White person. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
611 q19mdb 19. White people try to avoid you in public, such as on elevators or on public transportation. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
612 q20mdb 20. White people act as if they are afraid of you. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
613 q21mdb 21. You are treated as if you fit a racial stereotype (e.g., Blacks are violent; Blacks are lazy). [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
614 q28mdb 28. If I need legal or medical help, the fact that I am Black will not influence the type of help I receive. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
615 q30mdb 30. Blacks have as many opportunities as Whites to live a middle class life. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
616 q33mdb 33. Blacks have the same opportunities as Whites to get a college education. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
617 q1smoreg SMOKING We are interested in whether smoking or drinking beverages containing alcohol are linked to certain health problems and also whether they may have some beneficial effects. First, some questions about smoking. 1. Do you regularly smoke cigarettes now? 1= Yes 2= No
618 q2smo 2. Did you ever smoke cigarettes regularly? 1= Yes 2= No
619 q2smoa 2a. For how long ^didhave you regularly ^didsmoke? [ENTER YEARS: 01 = 1 YEAR OR LESS] 1 .. 115
620 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
621 q2alc 2. In the past 12 months, did you have at least 12 drinks of any kind of alcoholic beverage? 1= Yes 2= No
622 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
623 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
624 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
625 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
626 robbed Now I would like to ask some questions about the neighborhood you live in. Neighborhood Stress a. In the last 12 months, in your neighborhood, have you heard of or do you know about a house which was robbed? 1= Yes, several times 2= Yes, once or twice 3= No
627 assault In the last 12 months, have you heard of or know about a person who was beat up or assaulted? 1= Yes, several times 2= Yes, once or twice 3= No
628 shot In the last 12 months, have you heard of or know about a person who was shot or killed? 1= Yes, several times 2= Yes, once or twice 3= No
629 safe1 Now we would like to ask you how safe you feel in your neighborhood, house, or apartment. How safe from crime would you say your neighborhood is? Would you say it is...... 1= Very safe 2= Fairly Safe 3= Somewhat safe 4= Not too safe 5= Not safe at all
630 safe2 Thinking about the building (house) you live in; how safe from crime would you say it is? 1= Very safe 2= Fairly Safe 3= Somewhat safe 4= Not too safe 5= Not safe at all
631 sidewalk Please indicate whether the following conditions exist in your neighborhood. a. Sidewalks? 1= Present 2= Absent
632 traffic b. Heavy traffic? 1= Present 2= Absent
633 stlght d. Streetlights? 1= Present 2= Absent
634 dogs e. Unattended dogs? 1= Present 2= Absent
635 scenery f. Enjoyable scenery? 1= Present 2= Absent
636 exercse g. People exercising? 1= Present 2= Absent
637 unemploy These questions are about problems in your neighborhood. I am going to name different problems and I want you to tell me whether these things are a big problem in your neighborhood, somewhat of a problem, or not a problem. 1. high unemployment? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
638 tension 2. tension between people of different races or cultures? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
639 steal 3. stealing? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
640 destprop 4. destroying property? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
641 disresp 5. disrespect for laws, rules, or authority? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
642 abandon2 6. abandoned houses or buildings? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
643 rape 7. rape or sexual assault? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
644 prostit 8. prostitution? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
645 gamble 9. illegal gambling? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
646 attacked 11. getting attacked and/or robbed on the street? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
647 gangs 12. gangs? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
648 homeless 13. homeless people? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
649 druguse 14. drug use or drug dealing out in the open? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
650 cityoff 15. city officials ignoring problems in the neighborhood? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
651 unsupch 16. unsupervised children? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
652 guns 17. guns and violence? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
653 pubtran 18. public transportation not available? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
654 medserv 19. medical services are too far away? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
655 police 20. police do not care about problems in the neighborhood? 1= Big problem 2= Somehwhat of a problem 3= Not a problem
656 carenum Now I would like to ask you some questions about people you take care of. How many people are you currently taking care of (include children, grandchildren, spouse, sick relative or friend? 0 .. 10
657 carediff How often would you say that taking care of your family member(s) is very difficult? 0= Never 1= Rarely 2= Sometimes 3= Much of the time 4= Always
658 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
659 q1inc Which of these income groups represents ^husbwife2 personal income for the past year? Include income from all sources such as wages, salaries, social security or retirement benefits, help from relatives, rent from property, and so forth. Just give me the letter that represents your income category.[ENTER LETTER] 1= Q 2= R 3= S 4= T 5= U 6= V 7= W 8= X 9= Y 10= Z
660 q2inc Think of all the income from persons who live in the same home with you currently. Which of the following is closest to your total household income for the past year? Just give me the letter that represents your income category.[ENTER LETTER] 1= Q 2= R 3= S 4= T 5= U 6= V 7= W 8= X 9= Y 10= Z
661 q3inc How many people are supported in your household by the income circled above? [Interviewer: Include income provider in total number.] 1 .. 30
662 q4inc How often does it happen that you do not have enough money to afford the kind of food you should have? 1= Never 2= Once in a while 3= Fairly often 4= Very often
663 q5inc How often does it happen that you do not have enough money to afford the kind of medical care you should have? 1= Never 2= Once in a while 3= Fairly often 4= Very often
664 q6inc How much difficulty do you have in meeting the monthly payments on your bills? 1= Never 2= Once in a while 3= Fairly often 4= Very often
665 q7inc In general, how do your finances usually work at the end of the month? Do you find that.... 1= you ususally end up with money left over 2= you usually end with just enough money left over to make ends meet 3= you don't have enough money to make ends meet
666 contr1 These next questions ask you about your feelings and thoughts during the last month. 0 = never, 1 = almost never, 2 = sometimes, 3= fairly often, 4 = very often 234. In the last month, how often have you felt you were unable to control the important things in your life? 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often
667 contr2 235. In the last month, how often have you felt confident about your ability to handle your personal problems? 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often
668 contr3 236. In the last month, how often have you felt that things were going your way? 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often
669 contr4 237. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often
670 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
671 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
672 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
673 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
674 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
675 lifesp6 During the past week, have you been to places outside your town or community? 1= Yes 2= No
676 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
677 ftpt 2. Full-time or part-time? 1= Part-time 2= Full-time
678 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]
679 cjobduty 4. What are your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
680 retired 5. Are you retired? (from a job?) 1= Yes 2= No
681 yr_ret 5a. In what year did you retire? 1894 .. 2040
682 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
683 ljobname 6a. Specify occupation String[30]
684 ljobduty 6b. What were your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
685 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
686 job30 9a. [SPECIFY OCCUPATION] String[30]
687 oth30 9b. [SPECIFY REASON FOR NON-WORKING STATUS AT 30 YEARS OF AGE] String[30]
688 duty30 9c. What were your most important activities or duties? (For example, patient care, directing hiring policies, supervising, teaching...) [SPECIFY] String[60]
689 aamusic We have just a few more questions. Now I have some statements about being a Black/African American person and I want you to tell me whether you agree or not with the statements. Most of the music I listen to is by Black artists. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree 5= Not applicable
690 aashows Mostly I try to watch all the Black shows on TV. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree 5= Not applicable
691 aafriend Most of my friends are Black. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree
692 aaneigh I grew up in a mostly Black neighborhood. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree
693 aaorgs I am active in Black organizations and social groups. 1= Stongly agree 2= Agree 3= Disagree 4= Strongly disagree
694 c1fname CONTACT PERSON: We will test you once a year for the next few years, so we need to be able to contact you. In the event that we are unable to contact you, can you give me the name, address, and phone number of two people who would have information about you? Please, think of people who do not live in the same household as you. First Contact Person First name [ENTER DONTKNOW IF NONE.] String[12]
695 c1middl First Contact Person Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
696 c1lname First Contact Person Last name String[18]
697 c1gender ^c1fname ^c1lname First Contact Person's gender 1= Male 2= Female
698 c1live Does ^c1heshe live with you? 1= YES 2= NO
699 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
700 c1addnum ^c1fname ^c1lname First Contact Person's current address Street number String[6]
701 c1dir ^c1fname ^c1lname Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
702 c1street ^c1fname ^c1lname Street name String[18]
703 c1unit ^c1fname ^c1lname Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
704 c1city ^c1fname ^c1lname City or Town String[18]
705 c1state ^c1fname ^c1lname State String[2]
706 c1zip ^c1fname ^c1lname Zip Code String[5]
707 c1hphone ^c1fname ^c1lname Home Telephone including area code [Use '-' to separate] String[12]
708 c1wphone ^c1fname ^c1lname Work Telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
709 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
710 c1relspc ^c1fname ^c1lname Specify String[40]
711 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]
712 c2middl Second Contact Person Middle initial [HIT ENTER IF NOT APPLICABLE] String[1]
713 c2lname Second Contact Person Last name String[18]
714 c2gender ^c2fname ^c2lname Second Contact Person's gender 1= Male 2= Female
715 c2live Does ^c2heshe live with you? 1= YES 2= NO
716 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
717 c2addnum ^c2fname ^c2lname Second Contact Person's current address Street number String[6]
718 c2dir ^c2fname ^c2lname Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
719 c2street ^c2fname ^c2lname Street name String[18]
720 c2unit ^c2fname ^c2lname Apartment/Unit number [HIT ENTER IF NOT APPLICABLE] String[5]
721 c2city ^c2fname ^c2lname City or Town String[18]
722 c2state ^c2fname ^c2lname State String[2]
723 c2zip ^c2fname ^c2lname Zip Code String[5]
724 c2hphone ^c2fname ^c2lname Home Telephone including area code [Use '-' to separate] String[12]
725 c2wphone ^c2fname ^c2lname Work Telephone including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
726 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
727 c2relspc ^c2fname ^c2lname Specify String[40]
728 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
729 mfname 1. What is/was your mother's full name? [ENTER LAST/FIRST/MIDDLE/ MAIDEN NAME] String[40]
730 ffname 2. What is/was your father's full name? [ENTER LAST/FIRST/MIDDLE] String[30]
731 primphyf 3. What is the first name of your primary physician? [ENTER FIRST NAME. NO MD or DR.] String[15]
732 primphym 3. What is the middle initial of your primary physician? [ENTER M.I.] String[1]
733 primphyl 3. What is the last of your primary physician? [ENTER LAST NAME. NO MD or DR.] String[20]
734 phaddnum Physician- ^primphyf ^primphyl Participant's current address Street number String[6]
735 phdir Physician- ^primphyf ^primphyl Street direction [HIT ENTER IF NOT APPLICABLE] String[2]
736 phstreet Physician- ^primphyf ^primphyl Street name String[18]
737 phunit Physician- ^primphyf ^primphyl Suite or office number [HIT ENTER IF NOT APPLICABLE] String[5]
738 phcity Physician- ^primphyf ^primphyl City or Town String[18]
739 phstate Physician- ^primphyf ^primphyl State String[2]
740 phzip Physician- ^primphyf ^primphyl Zip Code String[5]
741 physophn Physician- ^primphyf ^primphyl Telephone Number including area code [Use '-' to separate] [HIT ENTER IF NOT APPLICABLE] String[12]
742 physhphn 8. Physician's home phone? [HIT ENTER IF NOT APPLICABLE] String[12]
743 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
744 livingwl 10. Do you have a living will or Durable Power of Health Care? 1= Yes 2= No
745 represen 11. Who have you designated as you representative? [ENTER NAME] String[30]
746 liklyhos 12. If you were to become ill and require hospitalization, which hospital would you most likely use? [ENTER HOSPITAL NAME:] String[20]
747 lhosaddr 13. Hospital's Address? String[30]
748 wherlive 14. If you were unable to care for yourself, where would live? (i.e. intermediate care) [ENTER LOCATION] String[30]
749 funerhme 15. At the time of your death, what funeral home would you most likely use? [ENTER FUNERAL HOME NAME] String[20]
750 faddnum Funeral Home Address? Address Number String[6]
751 fdir Funeral Home Address? Direction: [Press enter if none.] String[4]
752 fstreet Funeral Home Address? Street: String[18]
753 funit Funeral Home Address? Department, Building, or Office Number: [Press enter if none.] String[25]
754 fcity Funeral Home Address? City: String[18]
755 fstate Funeral Home Address? State: String[2]
756 fzip Funeral Home Address? Zip Code: String[5]
757 fphone What is the Funeral Home telephone number (including area code)? [Use '-' to separate] String[12]
758 agreeaut Has the participant agreed to autopsy in this study? [Check the participant data sheet in the chart.]? 1= Yes 2= No
759 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
760 funname Has the participant given us a name and address of a funeral home they intend to use? 1= Yes 2= No
761 arrange Has the participant made pre-arrangements with this funeral home? 1= Yes 2= No
762 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
763 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
764 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
765 hearimp 2. Does the participant have a substantial hearing impairment? 1= Yes 2= No
766 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
767 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
768 comments Enter any comments. [PRESS ENTER IF NONE.] String[150]
769 vegsign 0 .. 8
770 mvegsign 0 .. 8
771 cesd 0 .. 10
772 mcesd 0 .. 10
778 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
779 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
780 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
781 statid Please enter you staff id. 100 .. 997
782 formch Has the form been modified? 1= Yes 2= No
783 revidate Enter the date that the form was modified. Date type
784 revintd Enter your staff id number. 100 .. 997
785 anydev Are there any protocol deviations or missing data items to enter? 1= Yes 2= No
786 numdev How many total protocol deviations and tests with missing items to enter? 1 .. 20
787 reas00 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
788 test00 Enter test or procedure. String[15]
789 item00 List items involved. [SEPARATE BY A COMMA] String[20]
790 code00 Enter data code used. 1= Don't Know 2= Refusal 3= other
791 oth00 Enter other code used. String[20]
792 expl00 Explain what happened String[100]
793 reas01 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
794 test01 Enter test or procedure. String[15]
795 item01 List items involved. [SEPARATE BY A COMMA] String[20]
796 code01 Enter data code used. 1= Don't Know 2= Refusal 3= other
797 oth01 Enter other code used. String[20]
798 expl01 Explain what happened String[100]
799 reas02 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
800 test02 Enter test or procedure. String[15]
801 item02 List items involved. [SEPARATE BY A COMMA] String[20]
802 code02 Enter data code used. 1= Don't Know 2= Refusal 3= other
803 oth02 Enter other code used. String[20]
804 expl02 Explain what happened String[100]
805 reas03 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
806 test03 Enter test or procedure. String[15]
807 item03 List items involved. [SEPARATE BY A COMMA] String[20]
808 code03 Enter data code used. 1= Don't Know 2= Refusal 3= other
809 oth03 Enter other code used. String[20]
810 expl03 Explain what happened String[100]
811 reas04 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
812 test04 Enter test or procedure. String[15]
813 item04 List items involved. [SEPARATE BY A COMMA] String[20]
814 code04 Enter data code used. 1= Don't Know 2= Refusal 3= other
815 oth04 Enter other code used. String[20]
816 expl04 Explain what happened String[100]
817 reas05 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
818 test05 Enter test or procedure. String[15]
819 item05 List items involved. [SEPARATE BY A COMMA] String[20]
820 code05 Enter data code used. 1= Don't Know 2= Refusal 3= other
821 oth05 Enter other code used. String[20]
822 expl05 Explain what happened String[100]
823 reas06 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
824 test06 Enter test or procedure. String[15]
825 item06 List items involved. [SEPARATE BY A COMMA] String[20]
826 code06 Enter data code used. 1= Don't Know 2= Refusal 3= other
827 oth06 Enter other code used. String[20]
828 expl06 Explain what happened String[100]
829 reas07 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
830 test07 Enter test or procedure. String[15]
831 item07 List items involved. [SEPARATE BY A COMMA] String[20]
832 code07 Enter data code used. 1= Don't Know 2= Refusal 3= other
833 oth07 Enter other code used. String[20]
834 expl07 Explain what happened String[100]
835 reas08 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
836 test08 Enter test or procedure. String[15]
837 item08 List items involved. [SEPARATE BY A COMMA] String[20]
838 code08 Enter data code used. 1= Don't Know 2= Refusal 3= other
839 oth08 Enter other code used. String[20]
840 expl08 Explain what happened String[100]
841 reas09 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
842 test09 Enter test or procedure. String[15]
843 item09 List items involved. [SEPARATE BY A COMMA] String[20]
844 code09 Enter data code used. 1= Don't Know 2= Refusal 3= other
845 oth09 Enter other code used. String[20]
846 expl09 Explain what happened String[100]
847 reas10 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
848 test10 Enter test or procedure. String[15]
849 item10 List items involved. [SEPARATE BY A COMMA] String[20]
850 code10 Enter data code used. 1= Don't Know 2= Refusal 3= other
851 oth10 Enter other code used. String[20]
852 expl10 Explain what happened String[100]
853 reas11 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
854 test11 Enter test or procedure. String[15]
855 item11 List items involved. [SEPARATE BY A COMMA] String[20]
856 code11 Enter data code used. 1= Don't Know 2= Refusal 3= other
857 oth11 Enter other code used. String[20]
858 expl11 Explain what happened String[100]
859 reas12 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
860 test12 Enter test or procedure. String[15]
861 item12 List items involved. [SEPARATE BY A COMMA] String[20]
862 code12 Enter data code used. 1= Don't Know 2= Refusal 3= other
863 oth12 Enter other code used. String[20]
864 expl12 Explain what happened String[100]
865 reas13 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
866 test13 Enter test or procedure. String[15]
867 item13 List items involved. [SEPARATE BY A COMMA] String[20]
868 code13 Enter data code used. 1= Don't Know 2= Refusal 3= other
869 oth13 Enter other code used. String[20]
870 expl13 Explain what happened String[100]
871 reas14 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
872 test14 Enter test or procedure. String[15]
873 item14 List items involved. [SEPARATE BY A COMMA] String[20]
874 code14 Enter data code used. 1= Don't Know 2= Refusal 3= other
875 oth14 Enter other code used. String[20]
876 expl14 Explain what happened String[100]
877 reas15 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
878 test15 Enter test or procedure. String[15]
879 item15 List items involved. [SEPARATE BY A COMMA] String[20]
880 code15 Enter data code used. 1= Don't Know 2= Refusal 3= other
881 oth15 Enter other code used. String[20]
882 expl15 Explain what happened String[100]
883 reas16 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
884 test16 Enter test or procedure. String[15]
885 item16 List items involved. [SEPARATE BY A COMMA] String[20]
886 code16 Enter data code used. 1= Don't Know 2= Refusal 3= other
887 oth16 Enter other code used. String[20]
888 expl16 Explain what happened String[100]
889 reas17 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
890 test17 Enter test or procedure. String[15]
891 item17 List items involved. [SEPARATE BY A COMMA] String[20]
892 code17 Enter data code used. 1= Don't Know 2= Refusal 3= other
893 oth17 Enter other code used. String[20]
894 expl17 Explain what happened String[100]
895 reas18 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
896 test18 Enter test or procedure. String[15]
897 item18 List items involved. [SEPARATE BY A COMMA] String[20]
898 code18 Enter data code used. 1= Don't Know 2= Refusal 3= other
899 oth18 Enter other code used. String[20]
900 expl18 Explain what happened String[100]
901 reas19 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
902 test19 Enter test or procedure. String[15]
903 item19 List items involved. [SEPARATE BY A COMMA] String[20]
904 code19 Enter data code used. 1= Don't Know 2= Refusal 3= other
905 oth19 Enter other code used. String[20]
906 expl19 Explain what happened String[100]

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