Prospective Studies of US Military Forces: The Millennium Cohort Study

Prospective Studies of US Military Forces: The Millennium Cohort Study

MilCo 2010 Follow-up

Prospective Studies of US Military Forces: The Millennium Cohort Study

OMB: 0720-0029

Document [pdf]
Download: pdf | pdf
9738390863
For office use only

PRIVACY ACT STATEMENT: You have rights under the Privacy Act. The following statement describes how that Act applies to
this study:
Authority: Authority to request this information is granted under Title 5, U.S. Code 136, Department of Defense Regulations,
Executive Order 9396, DoD RCS#DD-HA(AR)2106 (expires 01/31/13), and OMB #0720-0029 (expires ??). Personal identifiers will
be used to link survey data with medical and other military records.
Purpose: Medical research information will be collected in a research project titled "Prospective Studies of U.S. Military Forces:
The Millennium Cohort Study." The project objective is to enhance basic medical knowledge and to improve the treatment and
prevention of illnesses that may be related to military service.
Routine Uses: The information provided in this questionnaire will be maintained in data files at the DoD Center for Deployment
Health Research at the Naval Health Research Center and used only for medical research purposes. Use of these data may be
granted to other federal and non-federal medical research agencies as approved by the Naval Health Research Center's
Institutional Review Board. However, your personal identifiers will be protected. By signing the original consent form, you
volunteered to disclose your information as identified above. If you do not agree to this disclosure, your failure will make the
research less useful. The "Blanket Routine Uses" that appears at the beginning of the Department of Defense's compilation of
medical databases also applies to this system.
Anonymity: All responses will be held in confidence by the DoD Center for Deployment Health Research. Information you provide
will be considered only when statistically summarized with the responses of others. Your personal identifiers (name, etc.) will only
be used to link data sets and then the identifiers will be stripped from study data such that medical researchers cannot identify you
individually.
Voluntary Disclosure: Completion of the questionnaire is voluntary. Failure to respond to any of the questions will NOT result in
any penalties except possible lack of representation of your views in the final results and outcomes.
PUBLIC BURDEN STATEMENT: Public reporting burden for this collection of information is estimated at 30 minutes. Comments
on the burden or content of the instrument should be sent to the Millennium Cohort Study team, PO Box 85777, San Diego, CA
92186-5777. Under 5 CFR 1320.5(b), an Agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless the collection displays a valid control number.

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You may also complete this questionnaire online at
www.MillenniumCohort.org

MARKING INSTRUCTIONS
• Use BLACK or BLUE ink.
• Shade circles like this:
• Mistakes must be crossed out with an "X".
• Print in CAPITAL LETTERS and avoid contact with the edge of the box. EXAMPLE:

A B C D E F G H

I

J K L M N O P Q R S T U V W X Y Z

• Answer each question to the best of your ability.
• It will take approximately 30 minutes to complete the questionnaire.
1. What is your current mailing address?
Address Line 1:
Address Line 2
(optional):
City (or FPO/APO):
State/Province/Region
(or AA/AE/AP):

ZIP/Postal Code:

Country:

2. Please provide your daytime phone number:

3. Please provide your email address:

If any of your contact information changes, please log on to www.MillenniumCohort.org
or call our toll-free number at (888) 942-5222 to provide an update.

4. What year were you born?

1

9

M
6. What is today's date?

5. What are the last four digits of your
Social Security number?

M

D D

/

/

Y

Y

2

0

Y

Page 2

Y

6001390863
7. What is your current marital status?
Choose the single best answer.

8. What is the highest level of education that you
have completed?
Choose the single best answer.

Single, never married

9. Which hand do you use
for writing?
Right

Less than high school completion/diploma

Now married

High school degree/GED/or equivalent

Left

Separated

Some college, no degree

Use both equally

Divorced

Associate's degree

Widowed

Bachelor's degree
Master's, doctorate, or professional degree

10. How tall are you?
For example, a person who is 5'8"
tall should write 5 feet 08 inches.
feet

inches

11. What is your current weight?

pounds

12. How much did you weigh a year ago?

pounds

If you are FEMALE, please continue to question 13
If you are MALE, please skip to question 14 on page 4
13. FOR WOMEN ONLY:
a. Have you had at least one menstrual period in the past 12 months?

No

Yes

b. If NO: What is the reason that you have not had a menstrual period in the past 12 months?
Mark all that apply.
Pregnancy and/or breast feeding

Hysterectomy

Contraception or hormone therapy

Other

Menopause

Unknown

please specify

No
c. During the week before your period starts, do you have a serious problem
with your mood - like depression, anxiety, irritability, anger, or mood swings?
d. If YES: Do these problems go away by the end of your period?
e. Are you currently pregnant?
f.

Have you given birth within the last 3 years?

g. Have you ever been diagnosed with gestational diabetes by a glucose tolerance test
during pregnancy?
h. Have you had a miscarriage within the last 3 years?
i.

During the last 3 years, have you tried and been unable to become pregnant?

Page 3

Yes

Does
not apply

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14. In the last 3 years, has your doctor or other health professional told
you that you have any of the following conditions?

If YES, in what
year were you
first diagnosed?

Mark here if you
were hospitalized
for the condition in
the last 3 years

a. Hypertension (high blood pressure)

No

Yes

Hospitalized

b. High cholesterol requiring medication

No

Yes

Hospitalized

c. Coronary heart disease

No

Yes

Hospitalized

d. Heart attack

No

Yes

Hospitalized

e. Angina (chest pain)

No

Yes

Hospitalized

No

Yes

Hospitalized

g. Sinusitis

No

Yes

Hospitalized

h. Chronic bronchitis

No

Yes

Hospitalized

i.

Emphysema

No

Yes

Hospitalized

j.

Asthma

No

Yes

Hospitalized

k. Kidney failure requiring dialysis

No

Yes

Hospitalized

l.

No

Yes

Hospitalized

m. Pancreatitis

No

Yes

Hospitalized

n. Diabetes or sugar diabetes

No

Yes

Hospitalized

o. Gallstones

No

Yes

Hospitalized

p. Kidney stones

No

Yes

Hospitalized

q. Hepatitis B

No

Yes

Hospitalized

r.

No

Yes

Hospitalized

s. Any other hepatitis

No

Yes

Hospitalized

t.

Cirrhosis

No

Yes

Hospitalized

u. Fibromyalgia

No

Yes

Hospitalized

v. Rheumatoid arthritis

No

Yes

Hospitalized

w. Lupus

No

Yes

Hospitalized

f.

Any other heart condition
please specify

Bladder infection

Hepatitis C

Question 14 continued on page 5...
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Question 14 continued from previous page

14. In the last 3 years, has your doctor or other health professional told
you that you have any of the following conditions?

If YES, in what
year were you
first diagnosed?

Mark here if you
were hospitalized
for the condition in
the last 3 years

x. Multiple sclerosis

No

Yes

Hospitalized

y. Crohn's disease

No

Yes

Hospitalized

z. Stomach, duodenal, or peptic ulcer

No

Yes

Hospitalized

aa. Ulcerative colitis or proctitis

No

Yes

Hospitalized

bb. Acid reflux / gastroesophageal reflux disease
requiring medication

No

Yes

Hospitalized

cc. Significant hearing loss

No

Yes

Hospitalized

dd. Significant vision loss even with glasses or contact lenses

No

Yes

Hospitalized

ee. Tinnitus / ringing of the ears

No

Yes

Hospitalized

ff. Migraine headaches

No

Yes

Hospitalized

gg. Stroke

No

Yes

Hospitalized

hh. Neuropathy-caused reduced sensation in hands or feet

No

Yes

Hospitalized

ii. Seizures

No

Yes

Hospitalized

jj. Sleep apnea

No

Yes

Hospitalized

kk. Anemia

No

Yes

Hospitalized

ll. Thyroid condition other than cancer

No

Yes

Hospitalized

No

Yes

Hospitalized

nn. Chronic fatigue syndrome

No

Yes

Hospitalized

oo. Depression

No

Yes

Hospitalized

pp. Schizophrenia or psychosis

No

Yes

Hospitalized

qq. Manic-depressive disorder

No

Yes

Hospitalized

rr. Posttraumatic stress disorder

No

Yes

Hospitalized

ss. Infertility

No

Yes

Hospitalized

No

Yes

Hospitalized

mm. Cancer
please specify

tt. Other
please specify

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15. In the last 3 years, have you had persistent or recurring problems with any of the following?
a. Severe headache

No

Yes

k. Night sweats

No

Yes

b. Diarrhea

No

Yes

l.

No

Yes

c. Rash or skin ulcer

No

Yes

m. Unusual muscle pains

No

Yes

d. Sore throat

No

Yes

n. Shortness of breath

No

Yes

e. Frequent bladder infections

No

Yes

o. Trouble sleeping

No

Yes

f.

No

Yes

p. Unusual fatigue

No

Yes

g. Fever

No

Yes

q. Forgetfulness

No

Yes

h. Sudden unexplained hair loss

No

Yes

r.

No

Yes

i.

Earlobe pain

No

Yes

s. Other

No

Yes

j.

Sleepy all the time

No

Yes

Cough

Chest pain

Confusion

please specify

16. Over the past 3 years, approximately how many days were you hospitalized because of illness or injury?
(exclude hospitalization for pregnancy and childbirth)
None

1 day

2-5 days

6-10 days

11-15 days

16-20 days

21 days or more

17. Over the past 3 years, approximately how many days were you unable to work or perform your usual activities
because of illness or injury? (exclude lost time for pregnancy and childbirth)
None

1 day

2-5 days

6-10 days

11-15 days

16-20 days

18. During the last 4 weeks, how much have you been
bothered by any of the following problems?
Not bothered
a. Stomach pain
b. Back pain
c. Pain in your arms, legs, or joints (knees, hips, etc)
d. Pain or problems during sexual intercourse
e. Headaches
f.

Chest pain

g. Dizziness
h. Fainting spells
i.

Feeling your heart pound or race

j.

Shortness of breath

k. Constipation, loose bowels, or diarrhea
l.

Nausea, gas, or indigestion

m. Ringing in the ears
n. Difficulty with balance
o. Women only: menstrual cramps or other problems with your periods
Page 6

21 days or more

Bothered
a little

Bothered
a lot

5909390869
19. Over the last 2 weeks, how often have you been bothered by any of
the following problems?
Not at all

Several
days

More than
half the
days

Nearly
every day

a. Little interest or pleasure in doing things
b. Feeling down, depressed, or hopeless
c. Trouble falling or staying asleep, or sleeping too much
d. Feeling tired or having little energy
e. Poor appetite or overeating
f.

Feeling bad about yourself - or that you are a failure or have
let yourself or your family down

g. Trouble concentrating on things, such as reading the newspaper
or watching television
h. Moving or speaking so slowly that other people could have noticed,
or the opposite - being so fidgety or restless that you have been
moving around a lot more than usual
If you have been bothered by any of the items listed above on this page,
you may want to seek help from a health professional in your area.

20.

No

Yes

b. Has this ever happened to you before?

No

Yes

c. Do some of these attacks come suddenly out of the blue - that is, in
situations where you don't expect to be nervous or uncomfortable?

No

Yes

d. Do these attacks bother you a lot, or are you worried about having another attack?

No

Yes

a. Were you short of breath?

No

Yes

b. Did your heart race, pound, or skip?

No

Yes

c. Did you have chest pain or pressure?

No

Yes

d. Did you sweat?

No

Yes

e. Did you feel as if you were choking?

No

Yes

f.

No

Yes

g. Did you have nausea or an upset stomach, or the feeling that you were
going to have diarrhea?

No

Yes

h. Did you feel dizzy, unsteady, or faint?

No

Yes

i.

Did you have tingling or numbness in parts of your body?

No

Yes

j.

Did you tremble or shake?

No

Yes

No

Yes

a. In the last 4 weeks, have you had an anxiety attack - suddenly feeling fear or panic?
If you marked NO, please skip to question 22 on page 8

21. Think about your last bad anxiety attack.

Did you have hot flashes or chills?

k. Were you afraid you were dying?

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PAGE STARTS HERE

22. Over the last 4 weeks, how often have you been bothered by any of the
following problems?

Not
at all

More
than half
the days

Several
days

a. Feeling nervous, anxious, on edge, or worrying a lot
about different things
If you marked NOT AT ALL, skip to question 23
b. Feeling restless so that it is hard to sit still
c. Getting tired very easily
d. Muscle tension, aches, or soreness
e. Trouble falling asleep or staying asleep
f.

Trouble concentrating on things, such as reading a book or
watching TV

g. Becoming easily annoyed or irritable
23. On an average day, how many 8-12 oz beverages containing caffeine do you drink (such as coffee, tea, soda)?
None

1-2 per day

3-5 per day

6-10 per day

11 or more per day

24. About how many times each week do you eat from a fast food restaurant (such as hamburgers, tacos, or pizza)?
None

Once a week

2-3 times/week

4-7 times/week

8-14 times/week

25. a. Do you often feel that you can't control what or how much you eat?

15 or more times/week

No

Yes

b. Do you often eat, within any 2 hour period, what most people would regard as
an unusually large amount of food?

No

Yes

c. If you marked YES to either of the above, has this been as often, on
average, as twice a week for the LAST 3 MONTHS?

No

Yes

a. Made yourself vomit?

No

Yes

b. Took more than twice the recommended dose of laxatives?

No

Yes

c. Fasted - not eaten anything at all for at least 24 hours?

No

Yes

d. Exercised for more than an hour specifically to avoid gaining weight after binge eating?

No

Yes

e. If you marked YES to any of these ways of avoiding gaining weight, were any as
often, on average, as twice a week?

No

Yes

26. In the last 3 months, have you done any of the following in order to avoid gaining weight?

27. Have you and a partner ever tried to
get pregnant?
No

Yes

Not applicable

29. a. If you and a partner ever got
pregnant, did you have a
miscarriage?
Does not apply (no pregnancy)

If you marked No or Not applicable,
skip to question 29

28. If YES, have you and a partner ever been
unsuccessful getting pregnant for a year
or more (not including time spent apart,
such as deployment)?
No
Yes

No miscarriage
Yes, 1 miscarriage
Yes, 2 miscarriages
Yes, 3 or more miscarriages
Page 8

b. If YES, list the years of the 3
most recent miscarriages:

6488390862
Not
bothered

30. In the last 4 weeks, how much have you been bothered by
any of the following problems?

Bothered
a little

Bothered
a lot

a. Worrying about your health
b. Your weight or how you look
c. Little or no sexual desire or pleasure during sex
d. Difficulties with husband/wife, partner/lover, or boyfriend/girlfriend
e. The stress of taking care of children, parents, or other family members
f.

Stress at work outside of the home or at school

g. Financial problems or worries
h. Having no one to turn to when you have a problem
i.

Something bad that happened recently

j.

Thinking or dreaming about something terrible that happened to you in
the past - like your house being destroyed, a severe accident, being
hit or assaulted, or being forced into a sexual act

31. In the last year, have you been hit, slapped, kicked, or otherwise physically hurt
by someone, or has anyone forced you to have an unwanted sexual act?

No

Yes

32. Are you currently taking any medicine for anxiety, depression, or stress?

No

Yes

33. Over the past month, how many hours of sleep did you get in an average 24-hour period?
34. Please rate your sleep pattern for the past 2 weeks.

None

Mild

hours

Moderate

Severe

Very
severe

a. Difficulty falling asleep
b. Difficulty staying asleep
c. Problem waking up too early
d. Snoring
35. How satisfied/dissatisfied are you with your current sleep pattern?
Very satisfied

Generally satisfied

Somewhat dissatisfied

Very dissatisfied

36. To what extent do you consider your sleep pattern to interfere with your daily functioning (such as daytime fatigue,
ability to function at work/daily chores, concentration, memory, mood, etc.)?
Not at all interfering

A little

Somewhat

Much

Very much interfering

37. How noticeable to others do you think your sleeping pattern is in terms of impairing the quality of your life?
Not at all noticeable

Barely

Somewhat

Much

Very much noticeable

38. How worried/distressed are you about your current sleep pattern?
Not at all

A little

Somewhat

Much

Very much

39. During the past month, how often have you taken medicine (prescribed or "over the counter") to help you sleep?
Not at all during past month

Less than once a week
Page 9

Once or twice a week

Three or more times a week

0472390869
Not at
all

40. In the past month have you experienced...?

A little
bit

Moderately

Quite
a bit

Extremely

a. Repeated, disturbing memories of stressful
experiences from the past
b. Repeated, disturbing dreams of stressful
experiences from the past
c. Suddenly acting or feeling as if stressful
experiences were happening again
d. Feeling very upset when something happened that
reminds you of stressful experiences from the past
e. Trouble remembering important parts of stressful
experiences from the past
f.

Loss of interest in activities that you used to enjoy

g. Feeling distant or cut off from other people
h. Feeling emotionally numb, or being unable to have
loving feelings for those close to you
i.

Feeling as if your future will somehow be cut short

j.

Trouble falling asleep or staying asleep

k. Feeling irritable or having angry outbursts
l.

Difficulty concentrating

m. Feeling "super-alert" or watchful or on guard
n. Feeling jumpy or easily startled
o. Physical reactions when something reminds you of
stressful experiences from the past
p. Efforts to avoid thinking about your stressful
experiences from the past or avoid having feelings
about them
q. Efforts to avoid activities or situations because they
remind you of stressful experiences from the past

41. In general, would you say your health is: (Please select only one)
Excellent

Very good

Good

Fair

Poor

Fair

Poor

42. How would you describe the condition of your teeth and gums?
Excellent

Very good

Good

43. Choose the single best description of your USUAL daily activities.
You sit during the day and do not walk much.
You stand or walk a lot during the day, but do not carry or lift things often.
You lift or carry light loads, or climb stairs or hills often.
You do heavy work or carry heavy loads often.
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44. In a typical week, how much time do you spend participating in...
(Please mark both your typical "days per week" and "minutes
per day" doing these activities)
# of Days per week
you exercise

On those days,
how many
minutes per day
on average do
you exercise
None

a. STRENGTH TRAINING or work that strengthens your
muscles? (such as lifting/pushing/pulling weights)

AND

OR

b. VIGOROUS exercise or work that causes heavy
sweating or large increases in breathing or heart
rate? (such as running, active sports, marching, biking)

AND

OR

c. MODERATE or LIGHT exercise or work that causes
light sweating or slight increases in breathing or
heart rate? (such as walking, cleaning, slow jogging)

AND

Cannot physically do
None
Cannot physically do

45. On a typical day, how much time do you spend sitting and watching TV or
videos or using a computer?

OR

None
Cannot physically do

hours per day

46. The following questions are about activities you might do during a typical day. Does your health now limit you
in these activities? If so, how much?
No, not limited
Yes, limited
Yes, limited
at all
a little
a lot
a. Vigorous activities, such as running, lifting heavy objects, or
participating in strenuous sports?
b. Moderate activities, such as moving a table, pushing a vacuum
cleaner, bowling, or playing golf?
c. Lifting or carrying groceries?
d. Climbing several flights of stairs?
e. Climbing one flight of stairs?
f. Bending, kneeling, or stooping?
g. Walking more than a mile?
h. Walking several blocks?
i. Walking one block?
j. Bathing or dressing yourself?
47. During the past 4 weeks, have you had any of the following problems with your work or other regular daily
activities as a result of your physical health?
No,
Yes,
Yes,
Yes,
none of
a little of
some of
most of
the time
the time
the time
the time
a. Cut down the amount of time you spent on work or
other activities
b. Accomplished less than you would like
c. Were limited in the kind of work or other activities
d. Had difficulty performing the work or other activities
(for example, it took extra effort)
Page 11

Yes,
all of
the time

4078390865
48. During the past 4 weeks, have you had any of the following problems with your work or other regular daily
activities as a result of any emotional problems (such as feeling depressed or anxious)?
No,
none of
the time

Yes,
a little of
the time

Yes,
some of
the time

Yes,
most of
the time

Yes,
all of
the time

a. Cut down the amount of time you spent on work or
other activities
b. Accomplished less than you would like
c. Didn't do work or other activities as carefully as usual
49. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your
normal social activities with family, friends, neighbors, or groups?
Not at all

Slightly

Moderately

Quite a bit

Extremely

50. During the past 4 weeks, how much bodily pain have you had?
None

Very mild

Mild

Moderate

Severe

Very severe

51. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the
home and housework)?
Not at all

A little bit

Moderately

52. During the past 4 weeks, how much of the time:
(Select the single best answer for each question.)
None
of the
time

A little
of the
time

Quite a bit

Some
of the
time

A good
bit of
the time

Extremely

Most
of the
time

All
of the
time

a. Did you feel full of pep?
b. Have you been a very nervous person?
c. Have you felt so down in the dumps that
nothing could cheer you up?
d. Have you felt calm and peaceful?
e. Did you have a lot of energy?
f.

Have you felt downhearted and blue?

g. Did you feel worn out?
h. Have you been a happy person?
i.

Did you feel tired?

53. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with
your social activities (like visiting with friends, relatives)?
None of the time

A little of the time

Some of the time

Page 12

Most of the time

All of the time

0248390860
54. Please choose the answer that best describes how true or false each of the following statements is for you.
Definitely
true

Mostly
true

Not sure

Mostly
false

Definitely
false

a. I seem to get sick a little easier than other people
b. I am as healthy as anybody I know
c. I expect my health to get worse
d. My health is excellent

55. Compared to 3 years ago, how would you rate your physical health in general now?
Much better

Somewhat better

About the same

Somewhat worse

Much worse

56. Compared to 3 years ago, how would you rate your emotional health or well-being (such as feeling anxious,
depressed, or irritable) now?
Much better

Somewhat better

About the same

Somewhat worse

Much worse

Quite a bit

Extremely

57. In the last 4 weeks, how well have your family or friends supported you?
Not at all

A little bit

Moderately

58. Other than conventional medicine, what other health treatments have you used in the last 12 months?
a. Acupuncture

No

Yes

i.

High dose / megavitamin therapy

No

Yes

b. Biofeedback

No

Yes

j.

Homeopathy

No

Yes

c. Chiropractic care

No

Yes

k. Hypnosis

No

Yes

d. Energy healing

No

Yes

l.

No

Yes

e. Folk remedies

No

Yes

m. Relaxation

No

Yes

f.

No

Yes

n. Spiritual healing

No

Yes

g. Yoga

No

Yes

o. Meditation

No

Yes

h. Movement therapy

No

Yes

p. Breathing techniques

No

Yes

a. Body building supplements (such as amino acids, weight gain products, creatine, etc.)

No

Yes

b. Energy supplements (such as energy drinks, pills, or energy enhancing herbs)

No

Yes

c. Weight loss supplements

No

Yes

No

Yes

No

Yes

Herbal therapy

Massage

59. Have you taken any of the following supplements in the last 12 months?

60. a. Have you ever received the anthrax vaccine?
b. If YES, how many shots of the anthrax vaccine have you received?
61. Have you received the smallpox vaccine after 2001?
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4811390860
62. Indicate the degree to which the following statements are
true in your life...

Not
at
all

To a
To a
To a
To a
To a
very
very
small moderate great
small
great
degree degree degree degree degree

a. I prioritize what is important in life
b. I have an appreciation for the value of my own life
c. I am able to do good things with my life
d. I have an understanding of spiritual matters
e. I have a sense of closeness with others
f.

I have established a path for my life

g. I know that I can handle difficulties
h. I have religious faith
i.

I'm stronger than I thought I was

j.

I have learned a great deal about how wonderful people are

k. I have compassion for others

These next few questions are about drinking alcoholic beverages. Alcoholic beverages include beer, wine, and liquor
(such as whiskey, gin, etc.). For the purpose of this questionnaire:
One drink = one 12-ounce beer, one 4-ounce glass of wine, or one 1.5-ounce shot of liquor
63. In the past year, how often did you typically drink any type of alcoholic beverage?
Never

Rarely

Monthly

Weekly

Daily

If you marked NEVER, skip to question 72 on page 15
64. In the past year, on those days that you drank alcoholic beverages,
on average, how many drinks did you have?

drinks

65. In a typical week, how many drinks of each type of alcoholic beverage do you have?
beer(s)

liquor

wine

66. Last week, how many drinks of alcoholic beverages did you have?
Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

67. In the past year, on how many days did you have 5 or more drinks of any alcoholic beverage?

Sunday

days

68. In the past year, how often did you typically get drunk (intoxicated)?
Never

Monthly or less

2-4 times a month
Page 14

>4 times per month

1054390866

69. FOR MEN ONLY:
In the past year, how often did you typically have 5 or more drinks of alcoholic beverages within a 2-hour period?
Never

Monthly or less

2-4 times a month

>4 times per month

70. FOR WOMEN ONLY:
In the past year, how often did you typically have 4 or more drinks of alcoholic beverages within a 2-hour period?
Never

Monthly or less

2-4 times a month

>4 times per month

71. In the last 12 months, have any of the following happened to you more than once?
a. You drank alcohol even though a doctor suggested that you stop drinking because of a
problem with your health

No

Yes

b. You drank alcohol, were high from alcohol, or hung over while you were working, going to
school, or taking care of children or other responsibilities

No

Yes

c. You missed or were late for work, school, or other activities because you were drinking or
hung over

No

Yes

d. You had a problem getting along with people while you were drinking

No

Yes

e. You drove a car after having several drinks or after drinking too much

No

Yes

72. Have you ever felt any of the following?
a. Felt you needed to cut back on your drinking

No

Yes

b. Felt annoyed at anyone who suggested you cut back on your drinking

No

Yes

c. Felt you needed an "eye-opener" or early morning drink

No

Yes

d. Felt guilty about your drinking

No

Yes

a. Cigarettes

No

Yes

b. Cigars

No

Yes

c. Pipes

No

Yes

d. Smokeless tobacco (chew, dip, snuff)

No

Yes

No

Yes

73. In the past year, have you used any of the following tobacco products?

74. In your lifetime, have you smoked at least 100 cigarettes (5 packs)?

If you marked NO, skip to question 79 on page 16

75. At what age did you start smoking?

years old

76. How many years have or did you smoke an average of at least 3 cigarettes per day
(or one pack per week)?

years

Page 15

2530390866
77. When smoking, how many packs per day did you or do you smoke?

78. Have you ever tried to quit smoking?

Less than half a pack per day

Yes, and succeeded

Half to 1 pack per day

Yes, but not successfully

1 to 2 packs per day

No

More than 2 packs per day
If YES, list
most recent year

79. In the past 3 years, have any of the following life events happened to you?
a. You moved or changed residence more than once

No

Yes

2

0

b. You changed job, assignment, or career path involuntarily (for example,
you lost a job, or you had to take a job you did not like)

No

Yes

2

0

c. You or your partner had an unplanned pregnancy

No

Yes

2

0

d. You were divorced or separated

No

Yes

2

0

e. Suffered major financial problems (such as bankruptcy)

No

Yes

2

0

f.

No

Yes

2

0

g. Experienced sexual harassment

No

Yes

2

0

h. Suffered a violent assault

No

Yes

2

0

i.

Had a family member or loved one who became severely ill

No

Yes

2

0

j.

Had a family member or loved one who died

No

Yes

2

0

No

Yes

2

0

Suffered forced sexual relations or sexual assault

k. Suffered a disabling illness or injury
80. During the past 3 years, have you been PERSONALLY exposed
to any of the following? (do not include TV, video, movies,
computers, or theater)

No

Yes,
1 time

Yes,
more than
1 time

If YES, list
most recent year
of exposure

a. Witnessing a person's death due to war, disaster, or tragic event

2

0

b. Witnessing instances of physical abuse (torture, beating, rape)

2

0

c. Dead and/or decomposing bodies

2

0

d. Maimed soldiers or civilians

2

0

e. Prisoners of war or refugees

2

0

f.

2

0

g. Medical countermeasures for chemical or biological
warfare agent exposure

2

0

h. Alarms necessitating wearing of chemical or biological
warfare protective gear

2

0

Chemical or biological warfare agents

Page 16

2175390861
81. During the past 3 years, were you PERSONALLY
exposed to any of the following?

Don't
know

No

Yes

If YES, list
most recent year
of exposure

a. Occupational hazards requiring protective equipment, such
as respirators or hearing protection

2

0

b. Routine skin contact with paint and/or solvent and/or substances

2

0

c. Depleted uranium (DU)

2

0

d. Microwaves (excluding small microwave ovens)

2

0

e. Pesticides, including creams, sprays, or uniform treatments

2

0

f.

2

0

2

0

Pesticides applied in the environment or around living facilities

g. Any exposure, physical or psychological, during a military
deployment that had a significant impact on your health?
please specify

82. Were you ever injured from any of the following?
No

Yes, while
Yes,
Total # of
NOT deployed while deployed injury events

If YES, list date of
most recent injury
Month
Year

Were you
hospitalized or did
you lose more than
1 day of w ork

a. Training or sports injury

M

M

/

Y

Y

No

Yes

b. Blast / explosion / bullet

M

M

/

Y

Y

No

Yes

c. Motor vehicle accident/crash

M

M

/

Y

Y

No

Yes

If YES, to the crash question above, please answer the following for your most severe accident or crash.
c1. What type of vehicle was involved?

Motorcycle

c2. How many vehicles were involved?

Your vehicle only

c3. What was your role?

Driver

c4. What safety features did you use?

Seat belt

c5. What time and day of the week
did the crash occur?

Day of week:
Time of day:

c6. Which of the following factors (related to Speed
the DRIVER) were involved in the crash? Alcohol

Personal car/truck

Government vehicle

Multiple vehicles

Passenger
Helmet

Both

M
Tu
W
6 A.M. - Midnight
No
No

Neither
Th
F
Sat
Midnight - 6 A.M.

Sun

Yes Fatigue/drowsiness
Yes Distraction (i.e. cell phone use)

No

Yes

No

Yes

c7. Did any of the following contribute to the crash? Bad weather Poor road conditions Combat / enemy fire
Minor injury, no treatment sought
c8. Injury treatment:
Hospitalized
Number of days:
Clinic or office visit only
c9. Total number of work days lost as
c10. Total number of limited work
a result of the crash/accident:
days (do not include lost work days):
83. Did any injury you received in the past 3 years
involve the following?

No

Yes,
while deployed

Yes, while
NOT deployed

If YES, list date of
most recent injury

a. Being dazed, confused, or "seeing stars"

M

M

/

Y

Y

b. Not remembering the injury

M

M

/

Y

Y

c. Losing consciousness (knocked out)

M

M

/

Y

Y

If YES, approximately how long were you unconscious (knocked out) for?
Less than 1 minute
1-4 minutes
5-30 minutes
More than 30 minutes
Page 17

9503390863

Please answer question 84 ONLY if you are ENLISTED (Active Duty, Reserve, or National Guard).
All others please skip to question 85 on page 19
84. Review the list of military occupational categories below. Select the two categories that best match your military
job and fill in the two-digit codes for your primary job code and your secondary job code.
PRIMARY JOB CODE

SECONDARY JOB CODE

ENLISTED MILITARY OCCUPATIONAL CATEGORIES
INFANTRY, GUN CREWS & SEAMANSHIP SPECIALISTS

FUNCTIONAL SUPPORT & ADMINISTRATION

Infantry..................................................................................... 01
Armor or Amphibious............................................................... 02
Combat Engineering................................................................ 03
Artillery/Gunnery, Rockets or Missiles..................................... 04
Air Crew................................................................................... 05
Seamanship............................................................................ 06
Installation Security................................................................. 07

Personnel............................................................................ 50
Administration......................................................................51
Clerical/Personnel............................................................... 52
Data Processing.................................................................. 53
Accounting, Finance or Disbursing...................................... 54
Other Functional Support.................................................... 55
Religious, Morale or Welfare............................................... 56
Information or Education..................................................... 57

ELECTRONIC EQUIPMENT REPAIRERS

ELECTRICAL/MECHANICAL EQUIPMENT REPAIRERS

Radio/Radar.............................................................................10
Fire Control Electric Systems, Non-Missile.............................. 11
Missile Guidance, Control or Check-out.................................. 12
Sonar Equipment..................................................................... 13
Nuclear Weapons Equipment.................................................. 14
ADP Computers....................................................................... 15
Teletype or Cryptographic Equipment..................................... 16
Other Electronic Equipment..................................................... 19

Aircraft or Aircraft Related................................................... 60
Automotive.......................................................................... 61
Wire Communications......................................................... 62
Missile Mechanical or Electrical...........................................63
Armament or Munitions....................................................... 64
Shipboard Propulsion.......................................................... 65
Power Generating Equipment............................................. 66
Precision Equipment............................................................67
Other Mechanical or Electrical Equipment.......................... 69

COMMUNICATIONS & INTELLIGENCE SPECIALISTS
Radio or Radio Code............................................................... 20
Sonar....................................................................................... 21
Radar or Air Traffic Control..................................................... 22
Signal Intel/Electronic Warfare................................................ 23
Intelligence...............................................................................24
Combat Operations Control..................................................... 25
Communications Center Operations........................................ 26

CRAFTWORKERS
Metalworking....................................................................... 70
Construction........................................................................ 71
Utilities................................................................................. 72
Lithography..........................................................................74
Industrial Gas or Fuel Production........................................ 75
Fabric, Leather or Rubber................................................... 76
Other Craftworker................................................................ 79

HEALTH CARE SPECIALISTS
Medical Care............................................................................ 30
Ancillary Medical Support........................................................ 31
Biomedical Sciences or Allied Health...................................... 32
Dental Care..............................................................................33
Medical Administration or Logistics..........................................34

SERVICE & SUPPLY HANDLERS
Food Service....................................................................... 80
Motor Transport................................................................... 81
Material Receipt, Storage or Issue...................................... 82
Law Enforcement................................................................ 83
Personnel Service............................................................... 84
Auxiliary Labor..................................................................... 85
Forward Area Equipment Support....................................... 86
Other Services..................................................................... 87

OTHER TECHNICAL AND ALLIED SPECIALISTS
Photography............................................................................. 40
Mapping, Surveying, Drafting or Illustrating............................. 41
Weather................................................................................... 42
Ordnance Disposal or Diving................................................... 43
Musician................................................................................... 45
Technical Specialist................................................................. 49

OTHER
Patients or Prisoners........................................................... 90
Officer Candidate or Student............................................... 91
Undesignated Occupations................................................. 92
Not Occupationally Qualified............................................... 95

Page 18

8774390862

Please answer question 85 ONLY if you are an OFFICER or WARRANT OFFICER (Active Duty, Reserve, or National
Guard). All others please skip to question 86 on page 20
85. Review the list of military occupational categories below. Select the two categories that best match your military job
and fill in the two-digit codes for your primary job code and your secondary job code.

PRIMARY JOB CODE

SECONDARY JOB CODE

OFFICER or WARRANT OFFICER MILITARY OCCUPATIONAL CATEGORIES
TACTICAL OPERATIONS OFFICERS

GENERAL OFFICERS & EXECUTIVES

Fixed-Wing Fighter or Bomber Pilot................................... 2A
Helicopter Pilot....................................................................2C
Aircraft Crew.......................................................................2D
Ground or Naval Arms........................................................2E
Missiles.............................................................................. 2F
Operations Staff................................................................. 2G
Civilian Pilot........................................................................2H

General or Flag.........................................................................1A
Executive...................................................................................1B

INTELLIGENCE OFFICERS
Intelligence, General......................................................... 3A
Communications Intelligence............................................ 3B
Counter-intelligence........................................................... 3C
ENGINEERING & MAINTENANCE OFFICERS
Construction or Utilities...................................................... 4A
Electrical or Electronic........................................................4B
Communications or Radar................................................. 4C
Aviation Maintenance or Allied........................................... 4D
Ordnance........................................................................... 4E
Missile Maintenance...........................................................4F
Ship Construction or Maintenance..................................... 4G
Ship Machinery...................................................................4H
Safety................................................................................. 4J
Chemical............................................................................ 4K
Automotive or Allied........................................................... 4L
Surveying or Mapping....................................................... 4M
Other.................................................................................. 4N
SCIENTISTS & PROFESSIONALS
Physical Scientist............................................................... 5A
Meteorologist......................................................................5B
Biological Scientist............................................................. 5C
Social Scientist...................................................................5D
Psychologist....................................................................... 5E
Legal.................................................................................. 5F
Chaplain............................................................................. 5G
Social Worker.................................................................... 5H
Mathematician or Statistician............................................. 5J
Educator or Instructor.........................................................5K
Research & Development Coordinator...............................5L
Community Activities Officer.............................................. 5M
Scientist or Professional.....................................................5N

HEALTH CARE OFFICERS
Physician..................................................................................6A
Dentist.......................................................................................6C
Nurse....................................................................................... 6E
Veterinarian...............................................................................6G
Biomedical Sciences or Allied Health........................................6H
Health Service Administration..................................................6I
ADMINISTRATORS
Administrator, General............................................................. 7A
Training Administrator..............................................................7B
Manpower or Personnel............................................................7C
Comptroller or Fiscal................................................................7D
Data Processing.......................................................................7E
Pictorial.................................................................................... 7F
Information............................................................................... 7G
Police....................................................................................... 7H
Inspection.................................................................................7L
Morale & Welfare..................................................................... 7N
SUPPLY, PROCUREMENT & ALLIED OFFICERS
Logistics, General.................................................................... 8A
Supply...................................................................................... 8B
Transportation..........................................................................8C
Procurement or Production...................................................... 8D
Food Service............................................................................8E
Exchange or Commissary........................................................8F
Other........................................................................................ 8G
OTHER
Patient......................................................................................9A
Student.....................................................................................9B
Other........................................................................................ 9E

Page 19

0668390866

Please answer question 86 ONLY if you have a CIVILIAN job.
All others please skip to question 87 on page 22
86. Review the list of civilian occupational categories on this page and the next page. Select the two categories that best
match your civilian job and fill in the three-digit codes for your primary and your secondary job codes.
PRIMARY JOB CODE

SECONDARY JOB CODE

CIVILIAN OCCUPATIONAL CATEGORIES
More categories listed on page 21
ARCHITECTURE & ENGINEERING

EDUCATION, TRAINING & LIBRARY

Architect, Surveyor or Cartographer ...............................171
Engineer.......................................................................... 172
Drafter, Engineering or Mapping Technician................... 173

Postsecondary Teacher................................................. 251
Primary, Secondary or Special Education
School Teacher............................................................. 252
Other Teacher or Instructor............................................253
Librarian, Curator or Archivist........................................ 254
Other Education, Training or Library Occupation...........259

ARTS, DESIGN, MEDIA, ENTERTAINMENT & SPORTS
Art or Design................................................................... 271
Entertainer, Performer, Sports or Related Worker.......... 272
Media Communication Worker........................................273
Media Communication Equipment Worker......................274

FARMING, FISHING & FORESTRY WORKERS
Supervisor, Farming, Fishing or Forestry Worker..........451
Agricultural Worker........................................................ 452
Fishing or Hunting Worker............................................. 453
Forest, Conservation or Logging Worker.......................454
Other Farming, Fishing or Forestry................................459

BUILDING & GROUNDS CLEANING & MAINTENANCE
Supervisor, Building & Grounds, Cleaning &
Maintenance Worker....................................................... 371
Building Cleaning or Pest Control................................... 372
Ground Maintenance.......................................................373

FOOD PREPARATION & SERVING RELATED
Supervisor, Food Preparation or Serving.......................3511
Cook or Food Preparation Worker.................................352
Food and Beverage Worker...........................................353
Other Food Preparation or Serving Related Worker......359

BUSINESS & FINANCIAL OPERATIONS
Business Operations Specialist.......................................131
Financial Specialist..........................................................132

HEALTH CARE

COMMUNITY & SOCIAL SERVICES
Counselor, Social Worker or Other Community
or Social Service Specialist............................................. 211
Religious Worker.............................................................212

Physician........................................................................295
Nursing, Psychiatric or Home Health Aid....................... 311
Occupational or Physical Therapist Assistant or Aid......312
Other Health Care Occupation.......................................319

COMPUTER & MATHEMATICAL

INSTALLATION, REPAIR & MAINTENANCE

Computer Specialist ........................................................151
Mathematical Specialist...................................................152
Mathematical Technician.................................................153

Supervisor of Installation, Maintenance
or Repair Worker........................................................... 491
Electrical or Electric Equipment Mechanic,
Installer or Repairer....................................................... 492
Vehicle or Mobile Equipment Mechanic,
Installer or Repairer....................................................... 493
Other Installation, Maintenance or Repair......................499

CONSTRUCTION & EXTRACTION
Supervisor, Construction or Extraction Worker............... 471
Construction Trades Worker........................................... 472
Helper, Construction Trades........................................... 473
Other Construction or Related Worker............................474
Extraction Worker............................................................475

More categories listed on page 21...

Page 20

6749390862
Question 86 continued, Civilian occupational categories...

CIVILIAN OCCUPATIONAL CATEGORIES
LEGAL

PRODUCTION

Lawyer, Judge or Related Worker................................. 231
Legal Support Worker....................................................232

Life Scientist...................................................................191
Physical Scientist........................................................... 192
Social Scientist or Related Worker................................ 193
Life, Physical or Social Sciences Technician................. 194

Supervisor, Production Worker.....................................511
Assembler, Fabricator...................................................512
Food Processing Worker..............................................513
Metal or Plastic Worker.................................................514
Printing Worker.............................................................515
Textile, Apparel or Furnishing Worker.......................... 516
Woodworker..................................................................517
Plant or Systems Operator............................................518
Other Production Occupation....................................... 519

MANAGEMENT

PROTECTIVE SERVICES

Top Executive................................................................ 111
Advertising, Marketing, Promotions, PR or
Sales Manager...............................................................112
Operations Specialties Manager....................................113
Other Management Occupation.....................................119

First Line Supervisor/Manager, Protective Services.....331
Firefighting or Prevention Worker.................................332
Law Enforcement Worker.............................................333
Other Protective Service Worker..................................339

LIFE, PHYSICAL & SOCIAL SCIENCES

SALES-RELATED

OFFICE & ADMINISTRATIVE SUPPORT

Supervisor, Sales..........................................................411
Retail Sales Worker......................................................412
Sales Representative, Services....................................413
Sales Representative, Wholesale or Manufacturing.....414
Counter or Rental Clerk or Parts Salesperson..............415
Other Sales or Related Worker.....................................419

Supervisor, Office or Administrative Support................. 431
Communications Equipment Operator...........................432
Financial Clerk............................................................... 433
Information or Record Clerk...........................................434
Material Recording, Scheduling, Dispatching
or Distributing Worker.................................................... 435
Secretary or Administrative Assistant............................ 436
Other Office or Administrative Support.......................... 439

TRANSPORTATION & MATERIAL MOVING
Supervisor, Transportation or Material Moving.............531
Motor Vehicle Operator.................................................533
Rail Transportation Worker...........................................534
Water Transportation....................................................535
Other Transportation.....................................................536
Material Moving Worker................................................537

PERSONAL CARE SERVICE
Supervisor, Personal Care or Service............................391
Animal Care or Service.................................................. 392
Entertainment Attendant or Related Worker..................393
Funeral Worker.............................................................. 3941
Personal Appearance.................................................... 395
Transportation, Tourism or Lodging Attendant.............. 396
Other Personal Care or Service Worker........................ 399

Page 21

4196390866
88. What is your annual household income?

87. Which of the following best describes your
employment status? Choose the single best answer.
Full-time (greater than or equal to 30 hours per week)

less than $25,000
$25,000-$49,999

Part-time (less than 30 hours per week)

$50,000-$74,999

Not employed, looking for work

$75,000-$99,999

Not employed, not looking for work

$100,000-$124,999

Not employed, retired

$125,000-$149,999

Not employed, disabled

$150,000 or more

Homemaker
Other

please specify

89. Please indicate your level of agreement
with these statements:

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Strongly
Agree

Agree

a. I have little control over the things that happen to me
b. What happens to me in the future mostly depends on me
c. I can do just about anything I really set my mind to do

Negative

Neither
Somewhat Negative nor Somewhat
Negative
Positive
Positive

Positive

90. What is your overall feeling about your military service?
91. Are you currently serving in the US military?

Yes, Active Duty

Yes, Reserve or National Guard

No

If you marked YES, skip to question 96 on page 23
92. How much did each of the following reasons affect
your decision to leave the military?

Not at
all

a. Dissatisfaction with deployments and/or
frequent moves
b. Military service created hardship for family
c. Dissatisfaction with promotion, pay, or other benefits
d. Dissatisfaction with job or leadership/supervision
e. Desire to continue your education, start a new career,
or change in personal goals
f.

Disability or other medical reasons

g. Difficulty meeting weight standards and/or
fitness standards
h. Incompatibility with the military
i.

Legal problems or problems meeting a
military obligation

j.

Fulfilled term of service or was retirement eligible
Page 22

A little
bit

Moderately

Quite
a bit

Extremely

6540390861

No

93. a. Has the VA determined that you have one or more service connected disabilities?

percent disability

b. If YES, indicate the total percent of your VA service connected disabilities.
None

94. Have you ever received any medical care from VA facilities?

Yes

Some of my care

All of my care

95. Are you currently employed by a US Federal agency or the US Federal government?

No

Yes

96. In the last 3 years, have you received imminent danger pay, hardship duty pay, or combat
zone tax exclusion benefits for deployment?

No

Yes

If you marked NO, skip to question 101 on page 24
97. Use the country and sea codes (01-27) assigned to the locations below to indicate the region(s) where you received
imminent danger pay, hardship duty pay, or combat zone tax exclusion benefits. Please list the most recent first.
Country Codes
01 Afghanistan

02 Bahrain
03 Bosnia or Herzegovina
04 Croatia
05 Iraq
06 Kuwait
07 Kyrgyzstan
08 Macedonia
09 Montenegro
10 Oman

11

Pakistan

Sea Codes

12

Philippines

21 Adriatic Sea

13

Qatar

22 Arabian Sea

14

Saudi Arabia

23 Gulf of Aden

15

Serbia (includes Kosovo)

24 Gulf of Oman

16

Tajikistan

25 Persian Gulf

17

Turkey

26 Red Sea

18

United Arab Emirates

27 Other sea area

19

Uzbekistan

20

Other country

please specify

please specify

Location

Date Arrived

Month

/

Date Departed

Year

Month

/

Year

a.

/

2

0

TO

/

2

0

b.

/

2

0

TO

/

2

0

c.

/

2

0

TO

/

2

0

d.

/

2

0

TO

/

2

0

e.

/

2

0

TO

/

2

0

f.

/

2

0

TO

/

2

0

98. In the last 3 years, have you been to more regions where you received imminent danger pay,
hardship duty pay, or combat zone tax exclusion benefits than fit into the space allowed above?

Page 23

No

Yes

5304390868
99. In the last 3 years, how often have you experienced the following during deployment?
Never

1 time

More than
1 time

List most
recent year
of exposure

a. Feeling that you were in great danger of being killed

2

0

b. Being attacked or ambushed

2

0

c. Receiving small arms fire

2

0

d. Clearing / searching homes or buildings

2

0

e. Having an improvised explosive device (IED)
or booby trap explode near you

2

0

f.

2

0

g. Seeing dead bodies or human remains

2

0

h. Handling or uncovering human remains

2

0

i.

Knowing someone seriously injured or killed

2

0

j.

Seeing Americans who were seriously injured
or killed

2

0

k. Having a member of your unit be seriously
injured or killed

2

0

l.

2

0

m. Being directly responsible for the death of a
non-combatant

2

0

n. Being exposed to smoke from burning trash and/or feces

2

0

Being wounded or injured

Being directly responsible for the death of an
enemy combatant

100. When you were returning from deployment, did you first go to a separate location other than your
home station and complete a structured decompression program?

No

Yes

If YES, please specify location:

101. Do you have any concerns about your health that are not covered in this questionnaire that you would like to share?
(Continue on a separate sheet if necessary.)

Thank you for completing this important questionnaire!
Your responses will help service members and veterans.
More information on the Millennium Cohort Study can be found at
http://www.MillenniumCohort.org
Page 24


File Typeapplication/pdf
File TitleMilCo 2010 Follow-up (39086 - A
AuthorKari.Welch
File Modified2010-03-19
File Created2010-03-19

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