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8-55. What is the name of this problem?
96-97
OK ••••••••••• 98
8-56. In what year waa it firat diagnosed?
OK. 9
• 98 18-99
8-57. At any time aince 1978, have you ever received a blood transfusion?
YES NO OK
1 (8-58) 2 (8-60) 8 (8-60) lOO
8-58. How many times since 1978 have you received a transfusion?
OK •••
'_'_I, TIMES
••• 98
1[11-102
8-59. In what year did you !!!t receive a tranafuaion?
OK. 9
• 98 1:3-104
8-60. At any time since 1978, have you ever had kidney dialysia?
YES NO OK
(8-61) 2 (8-63) 8 (8-63)
,,)5
168
Ii! J
8-61. How .any ti.as since 1978 hsve you had dialysis?
OK ••
1_1_1_1 , TIMES
• 998
106-108
8-62. In whet yesr did you last hsve dislysis?
1 1 1 9 1 STILL IN DIALYSIS OK ••••••••
• 96 • 98
109-110
8-6J. At any time since 1978, hsve you received any other blood products, such es clotting factors or plasms?
YES NO OK
1 (8·54) 2 (8·51) 8 (8 ·(;1)
111
8-64. What were these products?
a. ____________________
112-113
114-115
b. __________________ 116-117
c. ____________________ 118-119
OK ••••••••••• 98
8-65. How many times since 1918 have you received (this/these) other product(s)?
OK •••
1_1_1 , TIMES
••• 98
120-121
8-66. In what year did you ~ receive (this/them)?
OK. 9
• 98
122-123
169
Iloal
In the 2ast five ~ears have you In what year did During the 2aat five ~ears, how aeen a doctor more than once you ~see a many times has this problem for (CONDITION)? doctor for this occurred?
problem, even if it was more than five ~ears ago?
8-67a. Sinus infections? 8-67b.
YES . 1 (8-67b) , 1 , 9 , , , 8-67c. , , -'- 16-20
# TIMES NO 2 (8-68a)
. CONTINUOUSLY
. . · 96 OK 8 (8-68a) OK • 98 OK
(8-67c) (8-68a) · 98
8-68a. Other sin~8 problems? 8-68b.
, , 8-68c. , , 21-25
YES 1 (8-6Bb) , 1 , 9 , -'-# TIMES NO · 2 (8-69a) CONTI NUOUSl Y · 96 OK 8 (8-69a) OK. . 98 OK .
(8-68c) (8-69a) · 98
8-69a. Skin infections? 8-69b.
YES 1 (8-69b) ,8-69c. , , 26-30
1 , 9 , I I -'-# TIMES NO 2 (8-70a) CONTINUOUSl Y 96 OK 8 (8-70a) OK 98 OK 98
(8-69c) (8-70a)
8-70a. lung infections? B-70b.
YES · 1 (B-70b) ,B-70e.
11-35 1_1, 1 , 9 , , , # TIMES
NO 2 (B-71a) CONTINUOUSLY 96 OK · 8 (B-71a) OK. 98 OK . 98
(8-70c) (B-71a)
170
At anX tile in xour life, have In what yaar did you During the eeat five xears, IIIW
you aeen a doctor for (CONDITION)? .!!m. aee a doctor often has this problem occur ~ Id? for thie problem?
8-71a. frequent noae bleeda? 8-71b. B-71c. YES · · · 1 (B-71b) I 1 I 9 I I I I_1_1 36-40 NO · · · 2 (8-72a) DK . · 8 (8-72a) DK. . . . .
,
· 98 DK . ·TIlES
... • 98 (8-71c) (8-72a)
8-72a. Nasal polyps, noncancerous B-72b. 8-72c. growtha inaide the nose?
YES · · · 41-45 • 1 (B-72b) I 1 I 9 I I I I_I-I NO DK
· . ,
· 2 (B-7Ja) TIlES
· • 8 (B-7Ja) DK. . .. 98 DK · ... • 98 (B-72c) (8-73a)
B-7Ja. Any other nose problem? B-7Jb. B-nc. YES ... • 1 (8-7Jb)
46-52 (SPECIfY) I 1 I 9 I I I I_I-I
NO , DK
· · 2 (B-74e) TIlES
· · . • B (B-74e) DK • 98 DK · ... •• 98 (B-7Jc) (B-74e)
B-74e. Enlsrged lymph nodes or B-74b. B-74c. glands that lasted at l!!!!It s mnth? 53-57 I_I-I
YES · 1 (B-74b) I I 9 I I I , TIMES NO · ·
1 2 (B-75) CONTI NUOUSl
· Y
8 (B-75) DK. 98 .... . . 96 DK DK 98
(B-74c) (B-7S)
B-75. Did you ever use nose dropa or aprays on a regular basis, that is, en average of st least once a week for a year or longer?
YES (I, .76) NO 2 0,,·78) 58 DK 8 (Ii ·78)
8-76. In what year did you firat atart uaing noae dropa or sprays regularly?
9 59-60 DK. • 98
171
B-77. In what year did you stop?
I 1 I 9 I STILL USING 96 OK 98 f 1-62
B-78. Before two years ago, did you ever receive radiation such ,as cobalt or radioisotopea for treatment of a medical problem? Include radiosctive material that was implanted in your body. (Do not include x-rays done to diagnoae s problem, only thoae for treatment.)
YES (B-79) NO 2 (B-83)
63 OK 8 (B-83)
-
a. b. c. 1ST TREATMENT 2M) TREATMENT 3RD TREATMENT
B-79. ror what reason ANGIOMA .. · 01 ANGIOMA 01 ANGIOMA 01 were you (first/ CANCER • 02 CANCER • 02 CANCER • 02 next) given THYMUS TROUBLE . 03 THYMUS TROUBLE 03 THYMUS TROUBLE 03 radiotherapy THYROID TROUBLE 04 THYROID TROUBLE 04 THYROID TROUBLE 04 treatment? TONSILS 0') TONSILS 0') TONSILS 0')
OTHER · . 06 OTHER 06 OTHER . . 06
(SPECIrY) (SPECIrv) (SPECIrv) OK • · • 98 OK • • 98 OK • • 98
B-80. To which parts of 1. 1. 1. your body was the BODY SITE BODY SITE BODY SITE treatment given? Ili-83 (PROBE rOR SIDE 2. 2. 2. or BODY) BODY SITE BODY SITE BODY SITE
B-81. In what year did I 1 I 1 191 81-89 I 1 I 9 I I I I 9 I I I I I you .!l!:!!!:. rece i ve this treatment? OK • 98 OK • . . 98 OK • . . . . 98
B-82. Have you received YES. 1 (8-79b) YES. 1 (B-79c) YES. 1 (B-79d) any ~ radia NO 2 (B-83) NO 2 (B-83) NO 2 (B-83) 9:-92 tion treatments OK • 8 (B-83) OK • 8 (B-B3) OK • 8 (B-83) before two yeers ago?
9)-118
172
B-B3. Did you ever receive injections or shots on a regular basis for a medical condition suc~ as allergies, diabetes, anemia, pernicious anemia, asthma or something else?
YES 1 (B-BI: NO 2 (B-91: OK B (B-91: 16
17-18
a. b. 1ST CONDlTION 2ND CONDITION
B-B4. For what condition did ALLERGY 01 ALLERGY I
you receive regular DIABETES 02 DIABETES injections? ANEMIA 03 ANEMIA .
I I' ~
I I'
I PERNICIOUS ANEMIA 04 PERNICIOUS ANEMIA I 1,1
ASTHMA 05 ASTHMA I Ii
OTHER 06 OTHER I Ii
19-22 (SPECIFY) (SPECIFY)
OK 9B OK . B-85. What medication did you 1. 1. 23-28
get? MEDICATION MEDICATION
2. 2. 29-34 MEDICATION MEDICATION
OK
, , OK
In what year did you ,1 ,9B lB
B-B6. 9 , , 1 , 9 , , , 35-38 receive these ~
injections? OK 9B OK . 5B
B-87. How often did you usually receive these , ,-'-,
DAY 1 DAYWEEK. 2 , , WEEK. 39-44
injections? TIMES MONTH 3 -'- 2 , TIMES MONTH 3
PER YEAR 4 PER YEAR 4 OK 9B OK
B-BB. For how many years did , , , , ~ 8
you receive these -'-1# YEARS -'-# YEARS injections? LESS THAN 1
. YEAR
. 00 LESS THAN 1 YEAR . 45-46
OK 98 OK ,( 0
8
B-B9. In which parts of your ARMS . 1 ARMS . 49-50 body were these shots THIGHS 1 THIGHS 51-52 usually given? (PROBE BUTTOCK 1 BUTTOCK 53-54 FOR ALL PARTS OF BODY) STOMACH 1 STOMACH 55-56 (CIRCLE ALL THAT APPLY) OTHER 1 OTHER 57-58
59-62 (SPECIFY) (SPECIFY)
OK 8 OK B
B-90. Have you received shots YES. 1 (B-B4b) YES. 1 (B-B4c I
on a regular basis for NO 2 (B-91) NO 2 (B-91 ) 63,64 any other medical OK B (B-91) OK B (B-91) conditions?
65-109
173
1101
8-91. Did you ever use drugs prescribed by 8 doctor to help you lose weight?
YES • 1 (B-928) NO 2 (B-96) 1iK. 8 (B-96) 16
Did you ever use: What year did you What year did you How often did you uae .!!!!!!. atart? ~ uae it? the (DRUG)?
B-92s. Dexedrine? B-92b. B-92c. B-92d.
YES • 1 (B-92b) I 1 I 9 I I I I 1 I 9 I I I DAY. NO 2 (B-93a) I I WEEK
· 1 17-24
OK 8 (8-93s) OK. . 98 OK. · . _I- 2
· 98 , TIMES MONTH PER
· 3 YEAR · • 4 OK '98
(B-92c) (B-92d) (B-93a)
B-938. Benzedrine? B-93b. B-93c. B-9Jd.
YES. 1 (B-93b) I DAY NO .
1 I 9 I I I I 1 I 9 I I I • (B-948)
· 1 ?5-32 2 I_I-I WEEK 2
OK 8 (B-948) OK. 98 OK. · . · 98 , TIMES MONTH · 3 PER YEAR 4
OK '98 (B-9Jc) (B-9Jd) (B-94e)
8-948. Other B-94b. B-94c. B-94d. A~hetamine8?
YES 1 (B-94b) I 1 I 9 I I I I 1 I 9 I I I DAY • • 1 :3-40 NO 2 (B-958) I_I-I WEEK • 2 DK 8 (B-95a) OK. 98
· . OK • . . 98 , TIMES MONTH • • J PER YEAR • 4
OK · '98 (B-94c) (B-94d) (B-958)
B-958. Something elae B-95b. B-95c. B-95d. preacribed by a doctor for losing weight?
YES • . 1 (B-95b) \1-50 I 1 I 9 I I I I 1 I 9 I I I DAY • • 1
(SPECIFY) . I_I-I WEEK 2
NO 2 (B-96) OK • • 9B OK • · . , TIMES • 98 MONTH · • • 3
DK . 8 (B-96) PER YEAR • 4 OK
(B-95d) · '98
(B-95c ) (B-96)
174
HUll
8-96. Did you ever take a drug to lower your cholesterol?
8-97. Was the drug:
YES NO OK
YES NO
1 18-97) 2 18-98) 8 18-98)
IlK
51
CLofibrate? • • Atromid-S? • • • Something else?
2 2
2
8 8 8
52 53 54
55-56
(SPECiFY)
8-98. Did you ever have malaria?
YES NO OK
1 18-99) 2 18-105) 8 18-105)
57
I 175
8-99. Did you ever take medication to treat Of cure .alaria?
YES. 1 (8-100) NO 2 (8-105)
58 DK • 8 (8-105)
59-60
a. b. 1ST MEDICATION 2ND MEDICATION
8-100. What color were the WHITE pilla? PINK •
· · · · 01 WHITE 01
· 02 PINK • · 02 YELLOW. · · OJ YELLOW • · · ·
OJ RED · · 04 RED · · ORANGE
· · 04
OTHER · · · · • 05 ORANGE .06 OTHER · · · · 05
· · · · · · · 06 61-64
(SPECIfY) (SPECIfY) OK. · • 98 DK. · · · • 98
8-101. What wee the name of DAPSONE 01 DAPSONE 01 the medication that CHLOROQUINE
· · · · · you took?
· · 02 CHLOROQUINE · · ·
ARALEN • · · · 02
DARAPRIM · ARALEN • • · · · · ·
OJ OJ
· · 04 DARAPRIM • · · ·
fANSIDAR • 05 fANSIDAR · · · 04
OTHER · · · · · · · · · ·
• 05
· · 06 OTHER · ·
· · 06 65-68
(SPECIfY) (SPECIfY) OK. · · · · · • 98 DK. · · · • 98
8-102. In what year did you I 1 I 9 I I I I 1 I 9 I I I 69-72 ~take
(MEDICATION)? OK . · · • 98 DK • · · · · • 98
8-1OJ. Altogethef, how long DAYS 1 DAYS 1 73-78 did you take I_I-, I WEEKS · · · 2 I_I-I WEEKS. 2
(MEDICATION)? t«lNTHS · · 3 , I4JNTHS J YEARS · .
4 .
YEARS 4 OK
· · · · · · · 98 OK · · '98
8-104. Have you taken any ~ medication to YES · • 1 (B-10Ob) YES 1 (B-100c) 79-80 treat or cure NO • · ·
OK. · · • 2 (8-105) NO.
· · malaria? ·
• 8 (8-105) OK · · · 2 (8-105)
· · · · · 8 (B-l05)
111-99
176
[iF IS!MMP]
B-105. Did you ever take Medication to prevent you fra. getting malaria?
YES. 1 (8-116) t«! 2 (8-112) 16 OK. 8 (B-II2)
17-18
a. b.1ST MEDICATION 2ND MEDICATION
B-106. What color were the WHITE pille? PINK • · · · · · · · · · 01
· · · · • 01 WHITE ·
· · · PIN( • · · · · · · · 02
YELLOW • · · · · ·
RED · · · · • 02• 03 YELLOW. .04 RED · · · · ·
ORANGE · • · · · • 05 ORANGE · · · · ·· · · · ·
· 03, 04
OTliER · · · · · · · .06 OTIiER · · · · · · .
· 05
· · · · · · · · · 19-22 • 06
·(SPECIfY) (SPECIfY)
OK. · · · · · · 98• 98 OK. · · · · · · · · B-107. What waa the n8MB of DAPSONE · · · · · · · 01• 01 DAPSONE
the medication thet Cll..OROQUINE · · · · ·CHlOROQUINE · · · · · · 02
you took? ARALEN • · · · ·
DARAPRIM ·• · · · · · • 02• 03 ARALEN • · · · 03
· · · · • 04 DARAPRIM • · · · 04fANSIDAR
· 05• 05 fANSIDAR OrHER · · · · · · · · · · · · · · · · · · · · · .06 OTIiER · · · · · · · 06 23-26
(SPECIfY) (SPECIfY) OK. · · · · 98• 98 OK. · · · · ·
B.108. How many times a week I_I-I 1_1_' 27-30 did you take the pille? , TIMES PER WEEK , TIMES PER WEEK
LESS THAN 1 PER WEEK · 00 LESS THAN 1 PER WEEK • 00 DK • · · . · · 98 OK · · · · · · 98
B-109. In what year did you I 1 I 9 I I I I 1 I 9 I I I 31-34 firat take (MEDICATION)? OK. · · · · • 98 OK. · 98
8-110. Altogether, how long DAYS · 1 DAYS · 1 did you take I_I-, I WEEKS. · 2 I_1_1 , WEEKS. 2 }5-40 (MEDICATION)? MONTHS 3 MONTHS 3
YEARS. · · · ·
4 YEARS • 4 OK · · · · · · 98 OK · · · · · 98
B-111. Have you taken any ~ medication to YES · · · 1 (B-106b) YES 1 (B-1I
·16c) 41-42
prevent getting NO . · · · • 2 (8-112) NO . · · · · , · · · · 2 (8-1' 2)malaria? OK. · B (B-112) OK · · · 8 (B-1' 2)
43-65
117
Have you ever taken: In what year did you ~ take thelll?
8-112a. Drugs to build muscles? 8-112b. >6-68 YES 1 (8-112b) I 1 I 9 I I I NO 2 (8-113a) DK .
YEAR 8 (8-1"a) OK. . 98
(8-113a)
8-113a. Testosterone or other male hormones? 8-113b. /,9-71 YES 1 (8-11Jb) I 1 I 9 I I I
NO 2 (8-114) YEAR OK 8 (B-114) OK. . 98
(8-114)
B-114. Did you ever take drugs for seizures or epilepsy?
YES 1 (8-115)
NO 2 (BOX B) 72 DK 8 (BOX B)
B-11~. What drugs did you take? (CIRCLE ALL THAT APPLY)
DILANTIN 73 HYDANTOIN 74 ~SANTOIN 75 PHENOBARBITAL 76 OTHER • • • • 77
~ :1-79
(SPECIFY) OK ••• • •• 8
B-116. In what year did you ~ begin taking these drugs?
9 8[-81
OK. • 98
178
m r f@ ill IT i TI
BOX 8
ASK 8-117 or ALL RESPONDENTS
8-117. Were you ever merried or living es married to someone who wss disgnosed as having CErcer during or after the marriage?
YES . . . NO . . .. . . 1 (E -118)
2 (E .122) OK . . . . 8 (E .122) 82
83
RECORD DATA ON FIRST SPOUSE 8ELOW. IF NECESSARY,GO TO CONTINUATION BOOK. RECORD ALL DATA ON SECOND SPOUSE IN CONTINUATION BOOK. 112/
16
a. b. 1ST SI fE/TYPE 2ND SITE/TYPE
8-118. What type of cancer 17-24 was it?
SITE/TYPE SITE/TYPE
25-28 B-119. How old was your apouse AGE: I_I-I AGE: I_I-I when the cancer was diagnoaed? OK. . •• 98 OK. . . • 98
29-32 B-120. In what yeer was the I 1 I 9 I I I I 1 I 9 I I I (SITE/TYPE) diagnosed?
OK •••• 98 OK •••• 98
8-121. Did your spouse have YES . . · 1 any other typea of . (B-118b) YES (B-1 He)
NO . ·
1 2 (B-122) NO 2 (B-1 21)
cancer? OK. · 8 (B-122) OK • 8 (B-1 21) 33-34
35-87
179 I
180
iE !II lUll! 1 !II !I! m ]I m III ]]!I iii
{TIl
B-122. Have any of your closest blood relatives, thst is parents, sisters, brothers or children, ever had any type of cancer?
YES {B-123a} NO 2 {B-12Ba} OK 8 {B-128a} 1-6
17-18
a. b. c. 1ST RELATIVE 2ND RElATIVE 3RD RELATIVE
B-123. Who was the I«lTHER . . 1 MOTHER 1 MOTHER 1 {first/next} FATHER 2 relative who SISTER .
FATHER 2 FATHER 2 3 SISTER 3 SISTER 3
had cancer? 8ROTHER 4 BROTHER 4 BROTHER 4 19-21 CHILD • 5 CHILD . 5 CHILD. 5
22-33 B-124. What type of 1. 1. 1.
cancer did your 1ST SITE/TYPE 1ST SITE/TYPE 1ST SITE/TYPE {RELATIVE} have? 2. 2. 2. 34"'-45
2ND SITE/TYPE 2ND SITE/TYPE 2ND SITE/TYPE
DK 998 DK 998 OK • 998
B-125. How old was 1. I_I-I 1. I 46-51 _I-I 1. I_I-I your {RELATIVE} AGE AGE AGE when the cancer was disgnosed? DK 98 OK 98 OK 98
52-57 2. I_I-I 2. I_I-I 2. I_I-I
AGE AGE AGE
OK . 98 OK • 98 OK 98
:>8-63
B-126. In what year 1. 11191 I I 1. 11191 I I 1. 11191 I I was the cancer YEAR YEAR YEAR diagnosed?
DK 98 OK 98 OK . 98
/.4-69 2. 11191 I I 2. 11191 I I 2. 11191 I I
YEAR YEAR YEAR
DK 98 OK 98 OK 98
B-127. Hsve any other YES 1 {B-123b} YES . 1 {B-123c} YES 1 {B-123d} 10-72 of your closest NO 2 {8-128a} NO . . 2 {B-128a} NO 2 {8-128a} blood relstives DK 8 {B-128a} OK 8 {B-128a} DK 8 (8-128a) had cancer?
13-125
III
/141
Did any of your closest blood relatives, again Which relstives? that is mother, father, brothers, sisters, or (CIRCLE ALL THAT APPLY) children, ever have any of the following:
16 B-128a. Alzheimer's disease or esrly senility? B-128b. YES · 17 1 (B-128b) MOTHER 1 NO ·
18 2 (B-129a) fATHER .
1
· 19 OK 8 (B-129a) SISTER 1 20 BROTHER 1 21 CHILD 1
(B-129a)
B-129a. familial polyposis or Gardner's B-129b. 22 Syndrome?
YES NO
· 23 .
1 (B-129b) MOTHER 1 2 (B-130a) fATHER 1 24
OK 8 (B-130s) SISTER 1 2S
BROTHER 1 26 CHILD 1 27
(B-130s)
28 B-130a. fsmilial hydronephrosis? B-130b.
YES 1 (B-130b) MOTHER 1 29
NO 2 (B-131a) fATHER 1 OK 8 (8-131a) SISTER .
30 1 31
BROTHER 1 32 CHILD 1 33
(B-131a)
34 B-131a. A stroke? B-131b.
YES 1 (8-131b) MOTHER 1 3S RELATIVE HAD SOME fATHER 1 36 THING, NOT SURE IT SISTER 1 37 WAS A STROKE 2 (B-131b) NO . .
BROTHER 1 38 J (SECTION C) CHILD 1 39
OK · 8 (SECTION C)
(SECTION C)
40-49
I 181
I
(This page intentionally left blank)
182
wnm ]flU 11111111111 ITlmF
SECTION C
OCCUPATION AND EXPOSURE
Now I would like some information about the jobs you have had since you were 18 years old. lhat would be since 19__• Include full-time and part-time jobs but only jobs that lasted a yel I' or longer. Count any job change with the same employer as a separate job. Also count the same I:ype of job for different employers separately. let's start with your current or most recent joll and go back in time. (INTERVIEWER: ASK C-1 to C-6 ABOUT ALL JOBS.) (PROBE ALL APPROPRIATE GAPS N TIME BETWEEN JOBS.)
50-51
183 I
184
.i 11IiUi!1IIi Id
C-1.
C-2.
C-3.
C-4.
C-5a.
b.
What is the title of the (most recent/ next) job you held for one year or longer?
What were your main duties on that job?
What kind of business or industry was this? (What did the company or your part of the company do or make?)
In what year did you start that job?
Are you still working at that job?
In what year did that job end?
INTERVIEWER CHECK 1
IS THERE A GAp?
'_0_'_1_1 JOB
YR: 1 1 1 9 1 1 1 (C-5a)
YES 1 tINT. CHK. 2) f>¥l. 2 (C-Sb)
YR: I 1 I 9 I I I
YES 1 (C-6) NO . 2 (INT. CHK. 2)
I~I JOB
YR: 1 1 1 9 1 1 I (C-5b)
YR: I 1 I 9 I I
YES 1 (C-6) NO • 2 (INT. CHK. ;
C-6. What did you do between (YEAR) and (YEAR)? (IF NOT EMPLOYED, RECORD YEARS AND ACTIVITIES. IF EMPLOYED, RECORD IN NEXT JOB.)
YEARS:
ACT IVIT IES:
YEARS:
ACT! VIr IES:
INTERVIEWER CHECK 2
IS START YEAR BEFORE AGE 1B? YES 1 (C-7) NO 2 (C-1)
YES 1 (C-7) NO 2 (C-1)
I
115R/
I~I I~I I~I I~I JOB JOB JOB JOB
16-19
20-23
YR: 11 1 9 1 1 1 YR: 11 1 9 1 1 1 YR: 24-2511 1 9 1 1 1 YR: 11 1 9 1 1 _I
26-28 YR: 1 1 1 9 1 1 1 YR: 11 1 9 1 1 1 YR: 11 1 9 1 1 1 YR: 11 1 9 1 1
YES 1 (C-6) YES 1 (C-6) YES 1 (C-6) YES. 1 (C-6) 29 NO 2 (INT. CHK. 2) NO 2 (INT. CHK. 2) NO 2 (INT. CHK. 2) NO 2 (INT. CHK 2)
YEARS: YEARS: YEARS: YEARS:
ACrIVITIES: ACT! VIT IES: ACrIVlTIES: ACTIVITIES -30-31
YES 1 (C-7) YES 1 (C-7) YES • 1 (C-7) YES. 1 (C· NO 2 (C-1) NO 2 (C-1) NO 2 (C-l) NO 2 (C·
~ ~ I 32
.~
185
1.J!..J2.-1 I.JLL..!..I JOB JOB
C-1. What is the title of the (most recent/ next) job you held for one year or longer?
C-2. What were your main duties on that job?
C-3. What kind of business or industry was this? (What did the company or your part of the company do or make?)
C-4. In what year did you start that job? YR: I 1 I 9 I I I YR: I 1 I 9 I I (C-~a) (C-~b)
C-5b. In what year did that job end?
YR: I 1 I 9 I I I YR: I 1 I 9 I I
INTERVIEWER CHECK 1 YES 1 (C-6) YES 1 (C-6)
IS THERE A GAP? NO 2 (INT. CHK. 2) NO . 2 (INT. CHK. ;
C-6. What did you do between (YEAR) and YEARS: YEARS: (YEAR)? (IF NOT EMPLOYED, RECORD YEARS AND ACTIVITIES. IF EMPLOYED, ACTIVITIES: ACTIVITIES: RECORD IN NEXT JOB.)
INTERVIEWER CHECK 2 YES 1 (C-7) YES 1 (C-7)
IS START YEAR BEFORE AGE 18? NO 2 (C-1) NO 2 (C-1)
186
flSRI
U!_l..2..J 1_1_1_0_1 1_1_1_1_ 1 1_1_1_2 1 JOB JOB JOB JOB
16-19
20-23
YR: 11 1 9 1 1 1 YR: 11 1 9 1 1 1 YR: 11 1 9 1 1 1 YR: 1 1 1 9 1 1 ~24-21
26-28 YR: 1 1 __1 9 1 1 1 YR: 1 1 I 1 9 1 1 1 YR: 11 1 9 1 1 1 YR: 11 1 9 1 1
YES 1 (C-6) YES. 1 (C-6) YES • 1 (C-6) YES. 1 (C-6) 29 NO 2 (INT. CHK. 2) NO 2 (INT. CHK. 2) NO 2 (INT. CHK. 2) NO 2 (INT. CHK . 2)
YEARS: YEARS: YEARS: YEARS:
30-31 ACTlVI TIES: ACTIVITIES: ACTIVI TIES: ACTIVIT IES -
YES 1 (C-7) YES 1 (C-7) YES 1 (C-7) YES. 1 (C . ') 32 NO 2 (C-1) NO 2 (C-1) NO 2 (C-1) NO 2 (C )
187
C-1.
C-2.
C-3.
C-4.
C-S.
C-6.
What i9 the title of the (moat recent/ next) job you held for one year or longer?
What were your main dutie9 on that job?
What kind of bU9ine9s or industry was this? (What did the company or your part of the company do or make?)
In what year did you start that Job?
In what year did that job end?
INTERVIEWER CHECK 1
IS THERE A GAP?
What did you do between (~) and (YEAR)? (If NOT EMPLOYED, RECORD YEARS AND ACT[VITIES. [f EMPLOYED, RECORD IN NEXT JOB.)
I-LU...I JOB
YR: I 1 I 9 I I I
YR: I 1 I 9 I I I
YES 1 (C-6) NO • 2 (INT. CHK. 2)
YEARS:
ACTIVIT [ES:
1..J...J..i-1 JOB
YR: I 1 I 9 I I I
YR: I 1 I 9 I I
YES 1 (C-6) NO. 2 (INT. CHK. "
YEARS:
ACTIVITIES:
INTERVIEWER CHECK 2
IS START YEAR BEfORE AGE 18? YES 1 (C-7) NO 2 (C-1)
YES 1 (C-7) NO 2 (C-1)
188
115R(
,_1_'_5_'
,_1_,_6_, ,_1_'_7_'
,_1_' ~_
JOB JOB JOB JOB
16-19
20-23
YR: , 1 , 9 , , , YR: , 1 , 9 , , , YR: , 1 , 9 , , , YR: ,1 , 9 , 24-25
YR: , 1 , 9 , , I YR: I 1 I 9 I I I YR: I 1 , 9 I I I YR: I 1 , 9 , 26-28
YES 1 (C-6) YES 1 (C-6) YES 1 (C-6) YES • 1 (C-6) 29 NO 2 (INT. CHK. 2) NO 2 (INT. CHK. 2) NO 2 (INT. CHK. 2) NO 2 (INT. C~ K. 2)
YEARS: YEARS: YEARS: YEARS:
ACTlVITIES: ACT IVlT IES: ACTIVITIES: ACTlV IT IE5 - 30-31
YES 1 (C-7) YES 1 (C-7) YES 1 (C-7) YES 1 ( :7) 32 NO 2 (C-1) NO 2 (C-1) NO 2 (C-1) NO 2 (I 1)
----'
189
I 1_1_1_9_1 1.2..L£..1
JOB JOB
C-1. What is the title of the (most recent/ next) job you held for one year or longer?
C-2. What were your main duties on that job?
C-3. What kind of business or industry was this? (What did the company or your part of the company do or make?)
C-4. In what year did you start that job? YR: 11 1 9 1 1 1 YR: 1 1 1 9 1 1
C-5b. In what year did that job end?
YR: 1 1 1 9 1 1 1 YR: 1 1 1 9 1 1 I
INTERVIEWER CHECK 1 YES 1 (C-6) YES 1 (C-6)
IS THERE A GAP? NO • 2 (INT. CHK. 2) NO • 2 (INT. CHK. ,
C-6. What did you do between (YEAR) and YEARS: YEARS: (YEAR)? (IF NOT EMPLOYED, RECORD YEARS AND ACTIVITIES. IF EMPLOYED, ACTIVIT IES: ACTIVIT IES: RECORD IN NEXT JOB.)
INTERVIEWER CHECK 2 YES 1 (C-7) YES 1 (C-7)
IS START YEAR BEFORE AGE 18? NO 2 (C-1l NO 2 (C-1)
eml
1_2_1_1_1 1_2_1_2_1 12...l...L1 I....LL..!.IJOB JOB JOB JOB
16-19
20-23
YR: 1 1 1 9 1 YR: 1 1 1 9 1 YR: 1 1 1 9 1 YR: 1 1 191 J_I 24-2)
26-28 YR: 1 1 1 9 1 YR: 1 1 1 9 1 YR: 1 1 1 9 1 YR: 1 1 191 J_
YES 1 (C-6) YES (C-6) YES (C-6) YES (C-6) 29 NO 2 (INT. CHK. 2) NO 2 (INT. CHK. 2) NO (INT. CHK. 2) NO (!~T. C~K. 2)
YEARS: _____ YEARS: _____ YEARS: ______ YEARS: ___
ACTIVITIES: ____ ACTIVITIES: ____ ACTIVITIES: ____ ACTIV I TIES 3Q-31
Y[S 1 (C-71 YES 1 (C-7) YES 1 (C-71 32 NO 2 (C-1) NO 2 (C-1) NO 2 (C-1)
191
Now, I would like to aak you about some specific jobs. Please tell me about these jobs, even if I;:~J
you held them for less than one year or before you were lB years old.
Oid you ever: Have you already told me about all of these jobs? (IF" YES, ASK "Which jobs were they?" IF" NO, ASK Cl -C5, ENTER JOB #)
C-7a. Work at an incinerator facility? C-7c. 1. # JOB 16-21
YES 1 (C-7c) YES 2. NO 2 (C-Ba) # JOB OK 8 (C-8a) NO 2 (Cl - C5)
C-8a. Work in a leather tanning C-Bc. L plant? , JOB
~2-27 YES 1 (C-Be) YES 2. NO 2 (C-9a) , JOB OK 8 (C-9a) NO 2 (Cl - C5)
C-9a. Work in a dry cleaning C-9b. Was dry cleaning C-9c. establishment? actually done on 1.
the premises? # JOB ~B-34YES 1 (C-9b) YES 1 YES 2.
NO 2 (C-lOa) NO 2 II JOB OK B (C-lOa) OK B NO 2 (Cl - C5)
(C-9c)
C-l0a. Repair or service brakes in C-l0c. cars, buses or trucks? 1. :.5-40
, JOB YES 1 (C-l0c) YES 2. NO 2 (C-l1a) # JOB OK 8 (C-l1a) NO 2 (Cl - C5)
IIIt I
192
[ 11mt
Did you ever: Have you already tll.d me about all of th,,'.e joba? (IF YES, ASI: "Which jobs were till ,y?" IF NO, ASK C1 -C5, ENTER J08 #)
C-11a. Do metal plating? C-11c.1.
# JOB YES (C-11c) YES 2. 41-46NO 2 (C-12a) 1/ lOB OK 8 (C-12a) NO 2 (C1 · C5)
C-12a. Hake or repair electrical trans C-12c. formers or capacitors? 1.
# lOB 47-52 YES (C-12c) YES 2. NO 2 (C-13a) II JOB OK B (C-13a) NO 2 (C1 · C5)
C-13a. Work in a pulp mill, saw mill or C-Dc. planing mill? 1.
# JOB 53-58 YES (C-13c) YES 2.
NO 2 (C-13d) 1/ JOB OK 8 (C-13d) NO 2 (C1 C5)
C-13d. Work in a meat packing or C-13e. Did your job in C-13f. processing plant? volve handling 1.
hides, skins or # JOB 59-65 YES (C-13e) pelts? YES 2.
NO 2 (C-14) YES # JOB OK 8 (C-14) NO 2 NO 2 (C1 · C5)
OK 8 (C-Dr)
193
The ne~t few jobs msy involve the use of herbicides or other pesticides. As you may know, hsrbicides are chemicals that are used to kill tress, buahea, or weeds. Other peeticides include insecticides, which are used to kill insects, fungicides, which are used to kill fungus, and rodenticides, which are uaed to kill rodents. Again, please tell me about these jobs even if you had them for less than one year or before you were 18 years old.
194
?F
BOX C
DID! LIVE ~ BOTH LIVE AND WORK ON rARM?
LIVED •••• 1 (C-20) LIVED/WORKED 2 (C-19)
C-19. Have you already told me "Which jobs were they?"
about all of your jobs on a farm or Ir NO, ASK C-1 - C5. ENTER JOB ,.)
ranch? (Ir YES, ASK
YES. • • • • • • • • ••
NO • • • . • • • • • •.
a. 1 , J(I.
b. , Jel
2 (C1-C5:
74-78
C-20. What crops were ALL THAT APPLY)
grown on eny farm or ranch when you (lived/worked) there? (CIRCLE
CORN ., .. HAY •••.• MILO/SORGHUM SOYBEANS •• WHEAT OTHER (SPECIfY)
79 80 81 82 83 84
85-86
87-88
89-90
91-92
93-94
NONE OK
2 (C-37, ". 43) 8
C-21. Were any herbicides or weed killers ever used on the land or crops?
YES NO OK
1 (C-22a: 2 (C-29) 8 (C-29)
95
195
j !
Did you ever: What was the average number of days per year you:
C-22a. Apply or spray herbicides? C-22b. Applied or sprayed herbicides?
YES 1 (C-22b) 1 TO 5 • NO 2 (C-23a) 6 TO 10 2
DK 8 (C-23a) 11 TO 20 3
21 TO 40 4 '16-97 MORE THAN 40 5
DK ••••• 8
C-23a. Mix or prepare herbicides? C-23b. Mixed or prepared herbicides?
YES 1 (C-23b) 1 TO 5 •
NO 2 (C-24) 6 TO 10 2
DK 8 (C-24) 11 ro 20 3
21 TO 40 4 5'8-99 t-IlRE THAN 40 5
DK ••••• 8
C-24. Work in or near an area where herbicides were used?
100 YES NO 2 DK 8
BOX D
DID R ANSWER YES fO C-22a, C-23a OR C-24?
YES (C-25) NO 2 (C-29)
C-25. What were the names of the herbicides? H l-l02
DK ., • • • • • • • • 998
196
C-26. In what year did you ~ co.a into contact with herbicides?
118-1199
OK. • 98
C-27. In what yesr did you ~ come into contact with herbicides?
120-121 9
OK. • 98
C-28. for how many yesrs in totsl did you come into contact with herbicides?
1_1_1 , YRS 122-123
CONTINUOUS 96 OK •••• 98
1171
C-29. Were ineacticides Or sny other pesticides ever used on the land or crops at any farm Ir ranch when you (lived/worked) there?
YES 1 (I: -30)
NO 2 (1:-37) 16 OK 8 (,:-37)
197
Did you ever: What waa the average numbar of daya per year YOUI
C-JOa. Apply or apray insecticides or other C-JOb. Applied or sprsyed them? pesticidea?
YES (C-3Ob) 1 TO 5 • NO 2 (C-31a) 6 TO 10 2 OK 8 (C-31a) 11 TO 20 3
21 TO 40 • 4 17-18 MORE THAN 40 5 OK ••••• 8
C-31a. Mix or prepare insecticides or other C-31b. Mixed or prepsred them? pesticides?
YES 1 (C-31b) 1 TO 5 • 1 NO 2 (C-32) 6 TO 10 2 OK 8 (C-32) 11 TO 20 3
21 ro40 4 19-20 MORE THAN
. . 40 5
OK. 8
C-32. Work in or near an area where they were used?
21 YES 1 NO 2 OK 8
80X E
DID! ANSWER YES TO C-30a, C-31a OR C-32?
YES (C-33) NO 2 (C-37)
: ~ 2-23
C-33. What were the names of the inaecticides or other pesticides used on the land or crops?
:,~-38
OK • • • • • • • • • • 998
198
C-34. In what year did you first come into contact with insecticides or other pesticides?
39-40 9
OK • 98
C-35. In what year did you last come into contact with them?
41-42 9
OK •• 98
C-36. For how many years in total did you come into contact with them?
'_'_I 43-44 # YRS
CONTINUOUS 96 OK 98
C-37. Were any animals ever raised or kept on any farm or ranch when you (lived/worked) tI'I!re?
YES 11:-38) NO 2 11:-47) 45 OK 8 11:-47)
C-38. What animals were raised or kept there? Were there cattle, chickens, hogs, or any (,I.her animals?
CATTLE 46 CHICKENS 47 HOGS 48 HORSES/MULES 49 SHEEP •.•• 50 TURKEYS ••. 51 OTHER ANIMALS (SPECIFY) 52
53-54
55-56
57-58
OK ••••••••••• 8
C-39. Were any insecticides or other pesticides ever used on any of these animals?
YES 1 (: -40) 59 NO 2 (:-47)
OK 8 (:-47)
199
I
Did you ever: What was the average number of days per year you:
C-40a. Apply or spray insecticides or other C-40b. Applied or sprayed them? pesticides on animals?
YES (C-40b) 1 TO 5 • NO 2 (C-41a) 6 TO 10 2
OK 8 (C-41a) 11 TO 20 3
21 TO 40 4 to-61 MORE THAN 40 5
OK ••••• 8
C-41a. Mix or prepare insecticides or other C-41b. Mixed or prepared them? pesticides?
YES 1 (C-41b) 1 TO 5 • 1
NO 2 (C-42) 6 TO 10 2 OK 8 (C-42) 11 TO 20 3
21 TO 40 4 /·2-63 MORE THAN 40 5 OK ••••• 8
C-42. Work in or near an area where they were l1sed?
YES NO 2 64 OK 8
BOX r
DID R ANSWER YES TO C-40a, C-41a OR C-42?
YES (C-43) NO 2 (C-47)
C-43. What were the names of the insecticides or other pesticides used on animals?
/,7-81
OK 998
........ ,.._._.~__~_______2_00_______________.J.!
C-44. In what year did you ~ come into contact with insecticides or other pesticides USEd on animals?
9 82-83
OK. • 98
C-45. In what yesr did you ~ come into contact with them?
9 84-85
OK. • 98
C-46. for how many yesrs in total did you come into contact with them?
1_1_1 86-87 I YRS
CONTINUOUS 96 OK •.•• 98
C-47. Now, I'd like to ask about some other joba you might have held. Did you ever have I job in right-of-way maintenance for a highway, railroad, or utility?
YES (C-48) NO 2 (C-57) 88 OK 8 (C-57)
C-48. Have you already told me about all of these jobs? (If YES, ASK "Which jobs were nEY?" If NO, ASK C1 - C5. ENTER JOB I.)
9.
YES JOB I 89-93NO 2 (C1-C5) b.
JOB I
C-49. Were herbicides or weed killers ever used in this work?
YES (C-50)
NO 2 (C-57) 94OK 8 (C-57)
r
I
Ir
I I
201
Did you ever: What was the average number of days per year you:
C-50a. Apply or spray them? C-SOb. Applied or sprayed them?
YES 1 (C-50b) 1 TO 5 • NO 2 (C-51a) 6 TO 10 2 OK 8 (C-51 a) 11 TO 20 3
21 TO 40 4 95-96 MORE THAN 40 5 OK ••••• 8
C-51a. Mix or prepare them? C-51b. Mixed or prepared them?
YES 1 (C-51 b) 1 TO S • 1
NO 2 (C-52) 6 TO 10. 2 OK 8 (C-52) 11 TO 20 3
21 TO 40 4 n-98 MORE THAN 40 5 OK ••••• 8
C-52. Work in or near an area where herbicides were used?
99 YES NO 2 OK 8
BOX G
OlD R ANSWER YES TO C-50a, C-51a OR C-52?
YES 1 (C-53) NO 2 (C-57)
C-53. What were the names of the herbicides? 111 )-101
1[1 ~-1l6
OK • • • • • • • • •• 998
202
C-S4. In what year did you ~ come into contaot with harbicidea on (thia Job/theee joba)?
117-1189
OK • 98
C-ss. In what year did you.!!!!. come into contact with herbicidee on (this job/these jobs)?
119-120 9
OK • 98
C-56. for how many yeara in total did you come into contact with herbicides on (this job/thell jobs)?
1_1_1 I VRS 121-122
CONTINUOUS 96 OK 98
11s1
C-57. Did you ever hsve a job in lawn care, landscsping, or grounds maintensnce?
YES 1 (C-58) NO 2 (C-67) 16 DK 8 (C-67)
C-58. Have you alresdy told me sbout all of these jobs? (If YES, ASK "Which jobs were they!' If NO, ASK C1 - C5. ENTER J08 t.)
8.
YES JCE t 17-21 NO 2 (C1-C5) b.
JCE· t
C-59. Were herbicides or weed killers ever used in this work?
YES (C-60) NO 2 (C-67) 22 DK 8 (C-67)
\ 203
I
Did you ever: What waa the average number of daya per year you:
C-60a. Apply or spray them? C-60b. Applied or sprayed them?
YES 1 (C-60b) 1 TO 5 • NO 2 (C-61a) 6 TO 10 2
OK B (C-61 a) 11 TO 20 J D-24 21 TO 40 4
t«lRE THAN 40 5 OK ••••• 8
C-618. Mix or prepare them? C-61b. Mixed or prepared them?
YES 1 (C-61b) 1 TO 5 • 1 NO 2 (C-62) 6 TO 10. 2 OK B (C-62) 11 TO 20 J
21 TO 40 4 :~5-26
MORE THAN 40 5 OK ••••• B
C-62. Work in or near an area where herbicides were used?
YES 27
NO 2
OK 8
BOX H
DID R ANSWER YES fO C-60a, C-618 OR C-62?
YES (C-6J) NO 2 (C-67)
18-29C-6J. What were the names of the herbicides?
30-44 OK •• • • • • • • • • 99B
204
C-'.. In what year did you ~ come into contact with herbicides on (this job/these jobs)? 45-46
9
• 98OK
C-6~. In whst year did you !!!t come into contact with herbicides on (this job/these jobs)?
47-48 9
OK • 98
C-66. For how many years in total did you come into contact with herbicides on (this job/the I! jobs)?
_'_I 49-50 II YRS
CONTINUOUS 96
OK 98
..... 10 •••• ,. ............................................................................................................................. ~ ............ ,. .......................... ..
C-67. Did you ever have a job in logging, forestry or tree farming?
(C-68) YES 51 2 (C-77) NO 8 (C-77) OK
Have you already told me about all of these jobs? (IF YES, ASK "Which jobs were they?"C-68. IF NO, ASK C1 - C~. ENTER JOB #.)
a.
YES JJB # 52-562 (C1-C~) b.NO
J[B #
C-69. Were herbicides or weedkillers ever used in this work?
(C-70)YES 57NO 2 (C-77)
OK B (C-77)
205
Did you ever: What wao the average number of deyo per year you:
C-70a. Apply or opray thorn? C-70b. Applied or oprayed them?
YES 1 (C-70b) 1 TO 5 • 1
NO 2 (C-71a) 6 TO 10 2 OK 8 (C-71a) 11 TO 20 3
21 TO 40 4 58-59 MORE THAN 40 5 DK ••••• 8
C-71a. Mix or prepare them? C-71b. Mixed or prepared them?
YES (C-71b) 1 TO 5 • 1
NO 2 (C-72) 6 TO 10. 2
OK 8 (C-72) 11 TO 20 3 21 TO 40 4
60-61 MORE THAN 40 5 DK ••••• 8
C-72. Work in or near an area where herbicides were used?
YES 1 62 NO 2 DK 8
BOX I
DID R ANSWER YES TO C-70a, C-71a OR C-72?
YES 1 (C-73) NO 2 (C-77)
63-64 C-73. What were the namea of the herbicides?
65-79 OK " • • • • • • • • 998
206
C-74. In what year did you first come into contact with herbicides on (this job/these jobs)'
80-811 1 1 9 1
OK • • 98
C-75. In what year did you last come into contact with herbicides on (this job/these jobs)?
82-839
OK • 98
C-76. For how many years in total did you come into contact with herbicides on (this job/thE,e jobs)?
1_1_1 84-85# YRS
CONTINUOUS 96 OK 98
C-77. Did you ever killers?
have any other jobs in which you came into contact with herbicides or we,,!
YES NO OK
(C-7B) (C-B6)
8 (C-B6) 86
C-7B. Have you already told me about all of these jobs? IF NO, ASK C1 - C5. ENTER JOB ,.)
YES NO
(IF YES, ASK "Which jobs were
(C1-C5)
they:'
a. JCE
b. JOE
,
#
87-91
BOX 1-1
IF [HIS JOB WAS IN THE MILITARY, ASK:
Was this in Vietnam?
YES (C-86) NO 2 (C-79)
207
Did you ever: What was the average number of days per year you:
C-79a. Apply or spray them? C-79b. Applied or sprayed them?
YES (C-79b) 1 TO 5 • NO 2 (C-80a) 6 TO 10 2 OK 8 (C-80a) 11 TO 20 3
21 TO 40 4 92-93 MORE THAN 40 OK • . .
5 8
C-80a. Mix or prepare them? C-80b. Mixed or prepared them?
YES (C-80b) 1 TO 5 • 1 NO 2 (C-81) 6 TO 10. 2 OK 8 (C-81) 11 fO 20 3
21 TO 40 4 '14-95 MORE THAN 40 OK • . .
5 . . 8
C-81. Work in or near an area where herbicides were used?
YES 1 96 NO 2 OK 8
80X J
DID ~ ANSWER YES fO C-79a, C-80a OR C-81?
YES (C-82) NO 2 (C-86)
;]-98C-82. What were the names of the herbicidea?
'19-113
OK ••• • . • • • .• 998
208
C-8J. In What year did you ~ come into contact with herbicidea on (thia job/theae jobs)?
9
OK. • ~8
114-115
C-84. In What year did you laat come into contact with herbicidea on (thia job/these jobs)?
9
OK. • 98
116-117
C-85. for how many years in total did you come into contact with herbicides on (this job/these jobs)?
CONTINUOUS
1_1_1 I YRS
OK ••••
96 98
118-119
I \~.
209
I would like to read to you a list. of mater ials you may have worked with or around on a job. Pleasa tell me if you ~ worked with or around any of the following materials, even if you worked on that job for less than on,
year or before you were 18. FOR EACH YES, ASK b, c, ANO d.
-On a job, did you ever work What were their names? How did you come into Have you already with or around: contact with (it/them)? told me about all
of the jobs you hsd like this? (IF YES, ASK "Whil :11
jobs were they?"
If NO, ASK Cl-CS. ENfER JOB I.)
C-86a. Chemical solvents, such C-86b. C-86c. C-86d.
as acetone, benzene, carbon tetrachloride 1. --_. or toluene? II J( E
16-21 YES 1 (C-86b) YES 1 2. --_. NO 2 (C-87a) OK 98 1 JeE
OK 8 (C-87a) (C-86c) (C-86d) NO 2 (Cl-C~ )
C-87a. Wood preservatives or C-87b. C-87c. C-87d.
wood-treating chemicals? 1 --
1 JO I 22-27
YES 1 (C-87b) YES 1 2.
NO 2 (C-88a) OK • 98 -- /I JO I
OK 8 (C-88a) (C-87c) (C-87d) NO 2 (Cl-C51
C-88a. Insulation or fire C-88b. C-88c. C-B8d.
proofing mater iaIs? 1. -- # JOIi
8-33 YES 1 (B-B8b) YES 1 2. --" NO 2 (B-B9a) OK 98 II JOI OK a (B-89a) (c-a8c) (C-88d) NO 2 (Cl-C5:
C-89a. Nicke 1 compounds or C-89b. C-89c. C-89d. alloys? 1. - # JOE 4-39
YES 1 (C-89b) YES 1 2. NO 2 (C-90a) OK • 98
-/I JOB
OK 8 (C-90a) (C-89c) (C-89d) NO 2 (Cl-C5)
-!
C-90a. Chromium compounds or C-9Db. C-9Dc. C-90d. alloys, such as chromic acid or chromate pig 1. ments?
- # JOB
40-45 YES 1 (C-90b) YES 1 2. NO 2 (C-91a) OK • 98 - II JOB OK a (C-91a) (C-9OC ) (C-90d) NO 2 (Cl-CS)
210
lUi
--
On a job, did you ever work What were their names? How did you come into Have you a 'sady
with or around: contact with (it/them.)? told me ab,,, It all
of the job" you
had like til .s?
(IF YES, A~;I: "Which
jobs were .1 ley?" IF NO, ASK I :1-C5. ENTER JOB .! )
C-91a. Pesticides and fumi C-91b. C-91c. C-91d. gants, other than
herbicides?
II JOB 46-51 YES (C-91b) YES
NO 2 (C-92a) OK • • 98 II JOB
OK 8 (C-92a) (C-91c) (C-91d) NO (C1-C5)
C-92a. Radioact ive C-92b. C-92c. C-92d.
substances?
# JOB 52-57 YES (C-92b) YES NO (C-93a) DK • • 98 n JOB OK B (C-93a) (C-92c) (C-92d) NO (C1-C5)
C-93a. Formaldehyde? C-93c. C-93d.
II JOB 58-63 YES 1 (B-93c) YES
NO 2 (B-94a) n JOB
OK B (B-94a) (C-93d) NO (C1-C5)
C-948. X-rays? C-94c. C-94d.
II JOB 64-69 YES (C-94c) YES .. NO 2 (C-95a) n JOB OK 8 (C-95a) (C-94d) NO (C1-C5)
C-95a. Plywood, fiberboard C-95c. C-95d.
or part ic leboard?
-~ II JOB 70-75
YES (C-95c) YES , . NO 2 (C-96a) /I JOB OK 8 (C-96a) (C-95d) NO 2 (C1-C5)
,,
I ~
'1
211
On a job, did you ever work What were their names? How did you come into Have you already with or around: contact with (it/them)? told me about al
of the jobs you had like this? (IF YES, ASK "WhH h
jobs were they?"
IF NO, ASK C1-C5.
ENfER JOB #.)
C-96a. Wood dust or saw C-96c. C-96d.
dust? 1. #JB 76-81
YES (C-96c) YES 2.
NO 2 (C-97a) IIJB
OK 8 (C-97a) (C-96d) NO 2 (C1-C;)
C-97a. Asbestos? C-97c. C-97d. 1.
# Jill 82-87 YES 1 (C-97c) YES 2.
NO 2 (C-98a) It JIIII
OK 6 (C-96a) (C-97d) NO (C1-C, I
C-98a. Shoe or leather dust? C-98c. C-98d.
1. # Jill 88-93
YES 1 (8-98c) YES 2.
NO 2 (8-99a) 1/ JII
OK a (8-99a) (C-98d) NO 2 (Cl-C' .
C-99a. Vinyl chloride or C-99c. C-99d.
polyvinyl chloride? 1. # JCE 94-99
YES (C-99c) YES 2.
NO (C-l00a) II JU E
OK 8 (C-100a) (C-99d) NO (C1-C5 )
C-l00a. Cutting oils? C-l00c. C-l00d. 1.
/I JOl 00-105 YES (C-l00c) YES 2. NO (C-l0la) /I JO l OK 8 (C-l0la) (C-l00d) NO 2 (C1-C5)
C-l01a. Hexachlorophene? C-l0lc. C-l01d.
1.
YES (C-l0lc) YES 2. ___ ,..,,, ["'_IllNO (SECfION 0) It JOII OK 8 (SECfION 0) (C-l0ld) NO (Cl-C5,
212
II
SECTION D
MILITARY HISTORY /lQJ
0-1. Now I have some questiona about military service. (If!!. MENTIONED MILITARY SERVICE SECTION C, CODE YES. OTHERWISE ASK:) Did you ever serve on active duty in the U.S. Military?
II
YES NO OK
1 (0-3) 2 (0-2) 8 (0-2)
16
0-2. When you were between the ages of 18 and which you think might have prevented you
22 did you have any health or physical problen's from serving in the military?
YES NO OK
(SECTION E, 2 (SECTION E, 8 (SECTION E,
p. p. p.
70) 70) 70)
17
0-3. How many years and months have you served on "X YEARS," ASK "Was that exactly X years?")
active duty in the U.S.
YEARS 1_1_1
Military? (IF ~ ;\YS
18-19
AI'I>
OK MONTHS 1_1_1
9898
20-21
0-4. Were you ever in Vietnam or off the coast of Vietnam when you were in the military?
YES NO OK
1 (O-~)
2 (SECTION E, 8 (SECTION E,
p. p.
70) 70)
22
O-~. Were you atationed in Vietnam or off the coast of Vietnam?
YES NO OK
1 (0-7) 2 (0-6) 8 (0-6)
23
213
0-6. What did you do in Vietnam and when were you there? (RECORD VER8ATIM AND PROBE fOR MONTH ANO YEAR)
24-31
_________________-::::-___________=_ (INTRD, 0-16, P. 61 OK ••••••••••• 98 (INTRD, 0-16, P. 6f
0-7. How many different tours of duty did you serve in Vietnam?
'_'_I 32-33 TOURS
OK ••• ••• 98
34-35
ASK 0-8 - 0-15 fOR EACH fOUR a. b. c. or OUTY fiRST TOUR Of DUTY SECOND TOUR Of DUTY THIRD TOUR Of DUTY
0-8. In what month and year did your (first/next) tour of duty in Vietnam , , , , , -'-'-'-MONTH , YEAR -'-'-'-'I«lNTH , YEAR -'-'-'-, ~6-47
begin? MONTH YEAR OK • • 9898 OK • • 9898 OK • 9898
0-9. What branch of the ARMY 1 ARMY 1 ARMY 1 service were you in? AIR fORCE 2 AIR fORCE 2 AIR fORCE 2
MARINES . 3 MARINES • 3 MARINES • 3
NAVY 4 NAVY 4 NAVY 4 COAST GUARO 5 COAST GUARD 5 COAST GUARD 5 OTHER (SPECIfY) 6 OTHER (SPECIfY) 6 OTHER (SPECIfY) 6 18-53
OK 8 OK B OK • 8
0-10. What was your rank ~
the end of this tour? OK 98 OK 98 OK . 98 54-59
0-11. In what month and year did this tour end? '-'-'-'-' ,;0-71
MONTH , YEAR '-'-'-'-'MONTH , YEAR
OK • 9898 OK 9898 OK 9898 (O-12a) (0-12b) (D-12c)
214
ASK D-B - D-15 FOR EACH TOUR a. b. c. OF DUTY FIRST TOUR OF DUTY SECOND TOUR OF DUTY THIRD TOUR OF Dur
D-12. What was the name of the unit in which you served the longest during that tour of duty? Please give me as much information as you can, in other words, as many organizational levels as you remember. (RECORD VERBATIM)
D-13. What kind of unit was that? Was it an infantry, art Ulery, engineer, intelligence unit, or something else?
72-77 (RECORD VERBATIM)
0-14. Where in Vietnam were you located with this unit? In what military region or corps were you located? And within that region, what were the names of the places or areas near where you served? (RECORD VERBATIM)
D-15. What were your primary duties? (RECORD VERBATIM)
INTERVIEWER CHECK YES 1 (D-16) YES 1 (D-16) YES 1 (D-1, ; I 78-80
ARE ALL TOURS COVERED? NO • 2 (D-Bb) NO 2 (D-Bc) NO 2 (D-B, II
81-125
215
-'-'-'-'--'-'-' At certain times, various chemicals were used in certain parts of Vietnam. For example, "ill· secticides" were sprayed to control insects. "Herbicides" or "defoliants" were used to mak«' leaves drop from bushes and trees or to kill grass or weeds. Military personnel could have come into contact with these chemicals in several different ways.
We would like to learn as much as possible about whether you may have been in an area where chemicals were used. To do this, we need your permission to send your military service nuntl'r and social security number to a special government task force which may be able to get this information from records kept by the militsry. Furnishing such data is voluntary. Would yel please give me these numbers?
D-16. MILITARY SERVICE I ,_,_,_,_,_,_,_,_,_,
REFUSED 999999997 DK 999999998
D-17 • SOCIAL SECURITY I ____,___,_,__
REFUSED 999999997 DK 999999998
BOX K
INTERVIEWER: READ APPROPRIATE PHRASING
IF THE PERSON PROVIDES THE #'s:
You will receive a letter in the mail within the next week with the numbers you have just provided me for verification. Please sign the form making any corrections if necessary and return in the enclosed envelope.
IF THE PERSON WAS UNCERTAIN OF THE D's:
You will receive a letter in the mail within the next week. Please sign the letter, indicat, your military service and social security numbers and return in the enclosed envelope.
IF THE PERSON IS HESITANT:
It is not necessary for you to make up your mind now. I will be sending you a letter on whi:l you can provide the numbers if you decide to do so.
216
r2I1 16-59
0-18. I would now like to ask if you remed>er coming into contact with chemicsls in vsriou I waya while you wsre in Vietnam? Were you ever present when others were spraying chelI Lcsls?
YES (0-19) 60NO 2 (0-13)
OK 8 (0- t5)
0-19. How oftan wers you present when others were sprsying chemicsls? (RECORD VER8ATIM)
OK 998
0-20. Whst were tation or
the chemicals used for, for some other purpose?
that is, were thsy used to kill insects, destroy vegl(CIRCLE ALL THAT APPLY)
s. KILL INSECTS b. DESTROY VEGETATION c. OTHER (SPECIfY) . •
OK ••••••••••• 8
64 65 66
67-68
0-21. What were the names of the specific chemicals that had been sprayed? 69-70
OK ., • • • • • • • • 998
BOX L
REVIEW 0-7. IS RESPONSE "02" OR GREATER?
YES (0-22) NO . 2 (0-23)
0-22. During which of your tours of duty in Vietnam did this happen? (CIRCLE ALL THAT APPLY)
a. b. c. d.
fiRST TOUR SECOND TOUR THIRD TOUR OTHER TOUR (SPECIfY).
86 87 88 89
90-91
217
61-63
0-23. Oid you ever get chemicals on your skin or clothing?
YES 1 (0-2 ~ I NO 2 (0-2111 92 OK 8 (0-2111
0-24. How often did you get chemicals on your skin or clothing? (RECORD VERBATIM)
93-95 OK • • • • • . • • • • 998
0-25. What were the chemicals used for, that is, were they used to kill insects, destroy vegetation or for some other purpose? (CIRCLE ALL THAT APPLY)
a. KILL INSECTS 96 b. DESTROY VEGETATION 97 c. OTHER (SPECIFY) •• 98
99-100 OK •••••••••• , 8
0-26. What were the names of the specific chemicals? 101-102
103-117
OK •.••••••.••998
BOX M
REVIEW 0-7. IS RESPONSE "02" OR GREATER?
YES (0-27)
NO • 2 (0-28)
0-27. Ouring which of your tours of duty in Vietnam did this happen? (CIRCLE ALL THAT APPLY)
B. FIRST TOUR 118 b. SECOND TOUR 119 c. THIRD TOUR 120 d. OTHER TOUR (SPECIFY). 121
122-123 OK ••••••••••• 8
218
tiM
1221
0-28. Oid you ever handle equipment or containers that had been used with chemicals?
YES 1 (['-29) NO 2 ([ -33) 16 OK 8 ([ -33)
0-29. How often did you handle this equipment or containers? (RECORD VERBATIM)
17-19
OK ••••••••• , 998
0-30. Whet were the chemicals used for, that is, were they used to kill insects, destroy "getation or for some other purpoae? (CIRCLE ALL THAT APPLY)
a. KILL INSECrS 20 b. DESTROY VEGETATION 21 c. OTHER (SPECIfY) • • 22
23-24 OK ••••••••••• 8
0-31. What were the names of the specific chemicals that were being used? 25-26
27-41
OK ••• • • • • • • • 998
BO)( N
REVIEW 0-7. IS RESPONSE "02" OR CREMER?
YES 1 (0-32) NO • 2 (D-H)
0-32. Ouring which of your tours of duty in Vietnam did this happen? (CIRCLE ALL THAT APP.')
a. fIRSr TOUR 42 b. SECOND TOUR 43 c. THIRD TOUR 44 d. OTHER TOUR (SPECIfY). 45
46-47
219
I 0-33. Did you ever spray chemicals yourself?
YES (0-34) NO 2 (0-38) 48 OK 8 (0-38)
0-34. How often did you spray chemicals? (RECORO VER8ATIM)
OK • 998
0-3~. What were the chemicals uaed for, that is, were they uaed to kill inaecta, deatroy vegetation or for some other purpoae? (CIRCLE ALL THAT APPLY)
a. KILL INSECTS b. DESTROY VEGETATION c. OTHER (SPECIFY) • •
~. )-56
OK ••••••••••• 8
7-58 0-36. What were the names of the specific chemicals that were sprayed? ~
~ '1-73
OK •• • • • • • • •• 998
BOX 0
REVIEW 0-7. IS RESPONSE "02" OR GREATER?
YES 1 (0-37) NO. 2 (0-38)
0-37. Ouring which of your tours of duty in Vietnam did this happen? (CIRCLE ALL THAT APPLY)
a. FIRST TOUR b. SECOND TOUR c. THIRO TOUR d. OTHER TOUR (SPECIFY).
7~-79
OK •••• • • • • • •• 8
220
0-38. Do you recall ever passing through an area that looked like it had been defoliated?
YES (0-;1)
NO 2 (0-<1 I) 80 OK B (0-•. ')
0-39. How often did you pass through these areas? (RECORD VERBATIM)
81-83
OK . . • • • • • . .• 998
BOX P
REVIEW 0-7. IS RESPONSE "02" OR GREAfER?
YES (0-40) NO • 2 (D-41)
0-40. During which of your tours of duty in Vietnam did you pass through areas that looked like they had been defoliated? (CIRCLE ALL THAT APPLY)
a. 84 FIRST fOUR b. SECOND TOUR 85c. THIRD TOUR 86d. OTHER TOUR (SPECIFY). 87
88-89 OK •••• . • • . • •• 8
0-41. While in Vietnam were you ever exposed to chemicals in any other way?
YES (D-4 ~ ,
NO 2 (BOX I) 90 DK 8 (BOX I)
0-42. In what ways were you exposed? (RECORD VERBATIM)
91-93
DK • • • • • • • • • •• B
I
221
222
0-43. What chemicals were you expossd to? (RECORD VERBATIM)
96-110
OK • • • • • • • • • • • • •• 998
0-44. How often did this happen? (RECORD VERBATIM)
l117,J13
OK • • • • • • • • • • • • •• 998
BOXQ
REVIEW 0-7. IS RESPONSE "02" OR I
GREATER?
YES (0-45) NO • 2 (BOX R)
0-45. During which of your tours of duty in Vietnam did this happen? (CIRCLE ALL THAT APPLY)
L14 s. FIRST TOUR l15 b. SECOND TOUR U6 c. THIRD TOUR .17 d. OTHER TOUR (SPECIFY).
L 3-119
OK ••••••••••• 8
BOX R
REVIEW 0-21, 0-26, 0-31, 0-36, and 0-43. DID R REPORT "AGENT ORANGE"?
YES (SECTION E) NO . 2 (0-46)
D-46. One of the herbicides used in Vietnam was Agent Orange. Do you think you ever came into contact with Agent Orange?
YES 1 (0-47) NO 2 (SECTION n 120 DK 8 (SECTION n
D-47. How did you come in contact with it? (RECORD VERBATIM)
121-123
DK ••••••••••• 8
D-4B. How often did you come in contact with it? (RECORD VERBATIM)
124-126
DK •••••••••••998
BOX S
REVIEW D-7. IS RESPONSE "02" OR GREATER?
YES (0-49) NO • 2 (SECTION E)
D-49. During which of your tours of duty in Vietnam did this happen? (CIRCLE ALL THAT APPL\:
a. FIRST TOUR 127b. SECOND TOUR 128 c. THIRD TOUR 129 d. OTHER TOUR (SPECIFY). 130
131-132 DK • • • • • • • • • •• 8
223
1231
SECTION E
OTHER ACTIVITIES
E-1. Now I have some questiona about activities you may have engaged in ~ of your jobs. In maintsining your lawn or garden did you ever use wsed-killers on a regular basis for more than one year?
YES NO OK
1 2 8
(E-2) (E-5) (E-5)
16
E-2. In what year did you ~ start using weed-killers or herbicides?
9 .7-18
OK •• 98
E-3. For how many years did you use them?
OK
'_'_IYEARS
• ; • 98
; 9-20
E-4. When you were using them, about how many times a year, on the average, did you
'_1_' TIMES
use them?
21-22
224
E-5. As s hobby or other sctivity, have you ever constructed things out of wood on a regulir basis?
YES 1 : :-6)
NO 2 : :-10) 23 OK 8 : :-10)
E-6. What did you make out of wood? (CIRCLE ALL THAT APPLY)
24 a. FURNITURE ••• 25 b. HOUSES ••••• 26 c. OTHER (SPECIFY)
27-28
E-7. In What year did you ~ start working with wood?
, 9 , 29-30 YEAR
OK. • 98
E-8. For how many yesrs did you work with wood?
'_'_I 31-32 YEARS
OK ••• ..• 98
E-9. How often would you say that you worked with wood? Was it:
Daily; At leest once a week; 2
At leaat once a month; or J
Less then once a month? 4 33
OK •••••••••••• 8
225
E-l0. Oid you ever have a hobby or engage in other activities on a regular basis, that involved the use of chemicals, such as developing photographs, refinishing furniture or something else?
YES 1 (E-l1) NO 2 (SECTION n 34 OK 8 (SECTION n
15-36
a. b. c. HOBBY #1 HOBBY #2 HOBBY 13
E-ll. What was the (first/next) hobby or activity that involved the use of
)7-42 chemicsls?
E-12. What chemicals did you <13-51 use in that (hobby/ 1. 1. 1.
activity)? 2. 2. 2.
3. 3. 3. lil-69 OK • 98 OK · 98 OK . 98
10-75 E-13. In what year did you 1112.1_1_I 1112.1_1_I 1112.1_1_I
stsrt that (hobby/ activity) ? OK • 98 OK • 98 OK • 98
E-14. For how many years have you done that? YRS: I_I-I YRS: I_I-I YRS: I I 76-81 _I-
OK • 98 OK • 98 OK 98
E-15. How often would you say that you did that? DAILY 1 DAILY. 1 DAILY. 1 Was it daily, st least l/WEEK 2 1/WEEK 2 1/WEEK 2 once a week, at least l/MONTH 3 l/MONTH 3 l/MONTH 3 once a month, or less LT 1/MONTH 4 LT 1/MONTH 4 LT l/MONTH than once a month? OK 8 OK 8 OK . .
4 8
[-16. Did you ever have any other hobbies or YES 1 (E-l1b) YES 1 (E-11c) YES 1 (E-11d) activities that involved NO 2 (F-1) NO 2 (F-1) NO 2 (F-1) the use of chemicals? OK 8 (F-1) OK 8 (F-1) OK 3 (F-1)
~I
16-65
226
1251
SECTION F
LIFESTYLE
f-1. This last aaction diacuaaaa lifeatyle and peraonal habita. firat I would like to asc you about drinking alcoholic beverages which include liquor, beer or wine. Did you 3ver have an average of one drink or more a week for a year or longer?
YES
NO OK
1
2
8
(f -2)
(F-8)
(F-8)
.16
F-2. How old were you when you started having an average of one or more alcoholic drinks I week?
OK • •
1_1_1 AGE
••• 98
17-18
F-3. 00 you now drink an average of one or more alcoholic beverages a week?
YES
NO OK
1
2
8
J-~)
J-4)
J -~) 19
F-4. How many years ago did you stop drinking regularly?
_1_1 , or YEARS
LESS THEN 1 YEAR
OK 00 98
20-21
F-~. Averaging over the years that you were drinking alcoholic beverage:;. about how many 12-ounce cans or bottles of beer did you usually dr.J.k per week?
1_1_1_1 12 oz. CANS/WEEK
22-24
LESS THAN ONE/WEEK OK ••....•.
OOC 99E
227
F-6. Averaging over the years that you were drinking alcoholic beverages, about how man~ounce glasses of wine did you usually drink T per week?
-'-'-' 25-27 4 OZ. GLASSES/WEEK
LESS THAN ONE/WEEK .000 DK " •..•• 998
F-7. Averaging over the years that you were drinking alcoholic beverages, ~bout how many 1 ~ -ounce shots of hard liquor did you usually drink per week?
1 1/2 -'- 28-30 OZ. SHOTS/WEEK
LESS THAN ONE/WEEK .000 DK • • . • • . • . 998
F-8. We realize the next few questions may be sensitive. Please keep in mind that all information you give me will be kept strictly confidential. During the last five years how many gexual partners have you had?
NONE •• 000 (F-ll)
-'-'-'# PARTNERS
F-9. (Was your partner a woman?/HD~ many of these partners were women?)
-'-'-' : 4-36NUMBER OF WOMEN
DK 998
BOX T
REVIEW F-8 and F-9. ARE THE NUMBERS EQUAL?
YES 1 (F -11)
NO 2 (f-l0)
F-l0. (Was your partner a man?/How many of these partners were men?)
NUMBER -'-'-'17-39
OF MEN DK • • 998
228
following drugs without a physician's prescription:f-11. Have you ever uaed any of the YES NO OK
a. Marijuana or hashish? 2 8 40 41
b. 8arbiturates or downers? 2 8 c. Amphetamines, uppers or
2 8 42speed? • . 43
d. Amyl nitrite or poppers? 2 8 44e. Cocaine? 2 8 45
f. Heroin? 2 8
f-12. Have you ever ussd any drugs thst were injected into your vein or under your skin ,tich wers not prescribed by a physician?
YES 1 If-l})
NO 2 I f-17) 46
OK 8 f -17)
f-1J. In What year did you ~ take drugs by needle?
9 47-48
OK •• • • 98
f-14. In What year did you ~ take drugs this way?
I 1 I 9 49-50
STILL USING 96
OK 98
f-1~. In totsl, would you say you injected yourself or received sn injection of non-prescription
drugs:
More than 100 times? 21 to 100 times? • ~ to 20 times? or • 51Less than ~ times? OK •••••
f-16. Did you sver ehare needles with anyone?
YES 52NO OK II
229
f-17. Now I'd like to 18k you. few queetione ebout your aMOking hiatory. Let'a atert with questione about ciglrettel. Have you Iver aMOked oigarettee regularly, that ie, It leaet hal f I pICk • week for I yllr Dr longer?
YES • NO 01(
1 (F'-18) 2 (F'-24) 8 (F'-24)
53
f-18. Do you ~ smoke cigarettes regularly?
YES NO
(f-19) 2 (f-20)
54
f-19. Averaging over the yelra thlt you e~ked regularly, how .any cigarettee a day did youusually IIIIOke?
1_1_1_1 (f-22) CIGARETTES PER DAY
OK ••• • • • • . • • 998 (f-22)
';5-57
f-20. Averaging over the years that you SMOked regularly, how many cigarettes a day did you usually SMOke?
OK.
1_1_1_1 CIGARETTES PER DAY
998
~'8-60
f-21. How long has it been since you SMOked cigarettes regularly?
1_1_1 , YEARS
LESS fHAN 1 YEAR OK
00 98
:1-62
F-22. About how old were you when you started SMOking cigarettes regularly?
OK •••
1_1_1 AGE
••• 98
:3-64
230
BOX U
REVIEW 0-4. DID ~ SERVE IN VIEfNAM DURING MILITARY?
YES 1 (READ PHRASE) NO 2 (DO NOT READ PHRASE)
F-36. Our last few questions are about your travel outside the U.S. Since you were 18 ytllrs old have you ever lived in or visited any foreign country for at least one continut~~ ~ (other than when you were in Vietnam in the military)?
YES (F-"a) NO 2 (CUI'ilNG)
OK 8 (CUIHNG)
89-90
READ F-37 TO F-40 FOR EACH COUNTRY IDENTIFIED I ;261
What is the (first/ In what year did you For how many months Have you lived i10r
next) country where first live in or did you stsy there? visited any ~ ~~ you lived or visited visit (COUNTRY)? foreign country for for st least ~ne at least one co ,tinu
ous month? ~
F -37a. F -38a. F -39s. F-40a. 1ST COUNTRY I 1 I 9 I I I I_I-I 16-23
, MaS YES 1 ( F-37b) OK 98 OK • • 98 NO 2 ( EOX V)
OK 8 ( EOX V)
-
F-37b. F-J8b. F -39b. F-40b. 2ND COUNTRY I 1 I 9 I I I I_I-I
. , MaS YES 1 ~ 1-37c)
OK • • 98 OK • NO 2 ~ (OX V) 24-31 • 98 OK • 8 I (,OX V)
F-37c. F-38c. F-39c. F-40c. 3RD COUNTRY I 1 I 9 I I I I_I-I
, MaS YES 1 1'-37d) OK 98 OK • 98 NO 2 I
OK • 8 I:~~ ~~ I 32-39
~
233
88
f-29. When you smoked a pipe, how many pipefuls of tobacco did you usually smoke in s week?
1_1_1_1 75-77 I PIPEfULS!WEEK
OK .998
f-JO. Did you ever use snuff on a regular basis; that is, use or dip sn average of one small can of snuff a week for at least one year?
YES 1 (f-31) NO 2 (f-J4) 78 OK 8 (f-J4)
f-31. for how many years altogether hsve you used or dipped snuff?
79-801_1_1 I YEARS
OK ••• 98
F-32. Since you began using snuff, how many smsll or 1 ounce cans of snuff (do/did) you usually use per week, on the average?
1_1_1 81-82 I OF CANS/WEEK
OK •• 98
F-33. When using snuff, (do/did) you ususlly tske it by nose or by mouth?
NOSE MOUTH 2 83 BmH 3 OK 8
F-34. The next two questions ask about your household last year. What was the totsl combined income before taxes of all members of your household last year? Wss it:
Less thsn $5,000? Between $5,000 and $10,000? Between $10,000 snd $15,000? Between $15,000 and $20,000? Between $20,000 and $30,000? Between $30,000 and $40,000? Between $40,000 snd $50,000? $50,000 or more? OK . • •• • •••••••
01 02 03 04 05 06 07 :14-85 08 98
F-35. Whst was the total number of persons in your household lsst year, including yourself?
116-87 1_1_1
# OF PEOPLE
232
1
What is the (first/ In what year did you For how many months Have you lived in or next) country where first live in or did you stay there? visited any ~ you lived or visited visit (~)? foreign country for for at least one at least one continumonth? oua month?
F-37d. F -38d. 4TH COUNTRY , 1 , 9 , , , F-39d. , , -'-
F-40d.
# MOS OK •• • 98 OK .
YES 1 (F-J7e) .10-47 • 98 NO
· DK.
· . 2 (BOX V)
· . 8 (BOX V)
F-J7e. F -38e. F -3ge. F-40e. 5TH COUNTRY , 1 , 9 , , , , , -'-# HOS YES · 1.8-55 1 (CONT. )
OK • • 98 OK • 98 NO 2 (BOX V) OK • 8 (BOX V)
~6-94
80X V
REV lEW F-37a - F-37 j. WAS VIETNAM REPORTED?
YES (F-41) NO 2 (CLOSING)
F-41. What were you doing when you were in Vietnam?
234
WSf;
CLOSING
I would like to thank you for your valuable contribution to the Men'a Health Study. It 1e poee1ble that my euperviaor may need to contact you to clarify aome aapect of the interview.
TIME 95-99,_,-,:1_'-- AM PM
END
235
I SECTION G
EVALUATION REPORT
G-l. What waa the language in which the interview was conducted?
ENGLISH SPANISH CHINESE OTHER (SPECIfY)
1 2 3 4 101
G-2. Waa the respondent's cooperation:
VERY GOOD, GOOD, .• fAIR, OR POOR? ••
2 3
4
L02
G-3. The quality of the interview was:
UNSATISfACTORY, •• QUESTIONABLE, ••• GENERALLY RELIABLE, OR HIGH QUALITY? • • •
1 (G-4) 2 (G-4) 3 (G-5) 4 (G-5) ~.03
G-4. The main reaaon for the unsatisfactory or questionable quality was that the respondent:
WAS ILL OR DISABLED, SPOKE ENGLISH POORLY, WAS EVASIVE OR SUSPICIOUS, WAS BORED OR UNINTERESTED, WAS UPSET OR DEPRESSED BY THE rOPIC, WAS DRUNK OR MENTALLY DISTURBED, •• HAD POOR HEARING OR SPEECH, • • • • • WAS CONfUSED BY fREQUENT INTERRUPTIONS, WAS INSUffICIENTLY KNOWLEDGEABLE, OR SOMETHING ELSE (SPECIfY) •.•••••
01 02
OJ 04 05 06
07 OB 09 10 111~-105
236
"
G-~. Was the reapondent assiated by another person during most of the interview?
YES (G-6) 106 NO (G-7)
G-6. Why was he assisted?
TOO ILL • • • • • • LANGUAGE PROBLEM RESPONDENT REQUEST SOMETHING ELSE (SPECIfY) 107
G-7. Was this an in-person or telephone interview?
TELEPHONE (G-10) IN-PERSON "(G-B) 108
G-B. Why was the respondent interviewed in-person?
TOO ILL • • • . • • LANGUAGE PROBLEM RESPONOENT REQUEST SOMETHING ELSE (SPECIfY) 4 109
G-9. Where was the interview conducted?
R's HOME HOSPITAL 2
SOMETHING ELSE (SPECIFY) 3 110
G-10. Record any other relevant observations, comments or impressions you may have had IlOut this interview..
237
SECTION I
INTRODUCTION
1-1. What is your ralationahip to Mr. (NAME)?
SPOUSE 01 (1-2)
BROTHER 01 (1-3)
SISTER O~ (1-3)
MOTHER O~ 0-3)
FATHER O~ (1-3)
SON •• 05 0-3)
DAUGHTER 01 (1-3)
OTHER MALE RELATIVE (SPECIFY) ____________ 03 0-3)
OTHER FEMALE RELATIVE (SPECIFY) ____________ 0, 0-3)
MALE FRIEND (SPECIFY) ___________ 1 : (1-3)
FEMALE FRIEND (SPECIFY) ___________ 11 (1-3)
1-2. How many years were you married?
'_'_I (A-1)
YEARS LESS THAN ONE • . . • •• 0]
1-3. Howald are you?
_'_I AGE
1-4. During the last five years, on average, how many times a month did you talk with your (RELATlVE)?
TIMES -'-'-'PER MONTH LESS THAN ONE 0011 OK ••••• 99:1
DAILY •.• . .9%
1-5. During the last five years, approximately how many miles apart did you live?
'-'-'-'-'MILES LESS THAN ONE • 0001)
DK • • 99911 SAME HOUSEHOLD • . • 99941
238
APPENDIX H
Selected Cancers Study Military Records Abstraction Form
