Questionnaires & Forms
The files on this page are archived and provided for reference purposes only.
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Baseline Risk Factor Questionnaires
- Baseline Form 1
- Name, Address, Personal Identifiers, Phone Number
- Residence
- Marital Status
- Education
- Vocational Training
- Occupation
- Medical History
- Dental Health
- Physical Activity
- Smoking History
- Drug and Vitamin Use
- Baseline Form 2
- Height, Weight, Blood Pressure, Heart Rate, Visual Acuity
- Medical Symptoms (dyspnea, chest pain, claudication, cough, phlegm)
- Number of Cigarettes Smoked
- Administrative information (checklist of exclusion criteria, indication of fasting, indication of blood sample taken, indication of chest x-ray taken)
- Baseline Form 3
- Administrative information (difficulty in coming to visit, return dietary history form, return picture book, return toenail sample, estimate of greyness of hair, capsules ID number, indication of extra blood, indication of fasting hours)
Dietary History
- Food Frequency Questionnaire (long form)- All food and nutrient data are based on this questionnaire
- Food Frequency Questionnaire (short form) - Used mainly for methods work
- Picture Booklet (PDF) (4.73 MB)
Follow-up Questionnaires
- Follow-up Form A
- Illnesses
- Physician contact
- Symptoms
- Bedridden
- Smoked
- Vitamin/mineral use past 2 weeks
- Changes in prescription drugs
- Follow-up Form B
- Difficulty in coming to visit
- Symptoms participants suspects due to capsules
- Cancer diagnosis
- Capsule compliance
- Chest x-ray
- Follow-up Form C
- Weight, Blood Pressure, Heart Rate, Visual Acuity
- Medical Symptoms (dyspnea, chest pain, claudication, cough, phlegm)
- Estimate of hair greyness
- Difficulty in coming to visit
- Symptoms participant suspects due to capsules
- Cancer
- Capsule compliance information
- Chest x-ray
- Follow-up Form E
- Hair color
- Eye color
- Tanning ability of skin
- Trips to south
- Time outdoors
- Work history
- Physical activity at work
- Physical activity at leisure
- Weight at age 25
- Medical diagnoses told by physician
- Medical procedures
- Pain medication
- Parent history of diseases
- Number of siblings
- Sibling history of diseases
- Use of smoke sauna
- Years smoked regularly (filter/non-filter)
- Any radon measurement in residence