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Question Index: Personal and Physical Characteristics

Questions

Year(s) Asked on Long Forms

(Click on year to view PDF of questionnaire.)
Date of birth x x x x x x x x x x x x x x
Major Ancestry x
Current marital status x x x x
Academic/professional degrees earned x
Husband's highest level of education x
Current employment status x x x x x
Living arrangement (ie alone, with spouse) x x x
Years worked in OR x x
Number of years working rotating shifts (at least 3 nights/month) x x
Height x
Current weight x x x x x x x x x x x x x x
Weight at age 18 x
How many times (in the past 10 years) have you donated blood? x
Blood type / RH factor x
Weight change over last 2 years--difference between min/max x x x x
Weight in last 20 years:
- Minimum lbs at age
- Maximum lbs at age		 x
Times in the last 20 years you've lost:
- 5-9 lbs.
- 10-19 lbs.
- 20-49 lbs.
- 50+ lbs.		 x
Weight in last 4 years:
- Minimum lbs at age
- Maximum lbs at age		 x
Times in the last 4 years you've lost:
- 5-9 lbs.
- 10-19 lbs.
- 20-49 lbs.
- 50+ lbs.		 x
Methods of weight loss of 10+ lbs. x x x x
Waist measurement x x x
Hip measurement x x x
Upper arm measurement x
In which state were you born? x
Where did you live at age 15? x
How many natural teeth do you have? x
In the last 2 years, have you had periodontal surgery? x
How many teeth have you lost in the last 2 years? x
How many teeth have you lost in the last 4 years? x
How many of your teeth have had root canal therapy? x
In the past 2 years, did you forego any of the following for financial reasons? (medical care, dental, screening, eye care, mental health care) x
During the last month, how often did you have pain or discomfort in your knee? x
When did knee pain begin? x
During the last year, did you have any knee pain/discomfort doing the following activities: walking, bending/squatting, getting up from chair w/o using arms? x
Have you ever had a knee injury due to traumatic event that was treated with cane, brace, crutches, etc.? x
Have you ever noticed pain/ stiffness/ enlargement/ swelling of the joints nearest your fingernails? x
Are you naturally right or left handed (or forced to change or ambidextrous)? x
How frequently do you have a bowel movement? x
How often do you have difficulty holding your urine until you can get to a toilet? x x
During the last 12 months, how often have you leaked urine or lost control of your urine? x x x
When you lose your urine, how much do you usually lose? x x x
Have you ever regularly had heartburn/acid reflux 1 or more times/week?
- How long did this last?		 x
In the past year, how often have you had heartburn/acid reflux? x
How many years have you worked in operating rooms? x
Number of moles on your left arm (>3mm) x
Total hours of sleep per day (24hr) x x x
Usual sleeping position x
Do you snore? x x x
Do you have difficulty with your balance? x x
# times you've fallen to the ground in the past year x x
DIAGRAM of women's body sizes - which fits you at each age? What about parents (age 50)? x
Between the ages of 18-30, how many times did you purposefully lose 10 or more pounds (excluding illness or pregnancy)? x

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