Questionnaire Materials

Anniston Community Health Survey: Follow up and Dioxin Analyses (ACHS-II)

Att3.13_QuestionnaireMaterial

Questionnaire Materials

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Attachment 3.13

Anniston Community Health Survey: Follow up Study and Dioxin Analyses


Questionnaire Materials


Attachment 3.13a. Background Information 2

Attachment 3.13b. Main Questionnaire 7

Attachment 3.13c Interviewer’s Booklet 64






Attachment 3.13

Anniston Community Health Survey: Follow up Study and Dioxin Analyses

Background Information


ACHS-II questions are repeated verbatim from the original ACHS questionnaire (O), modified (M), or deleted (D) for the ACHS-II. New questions (N) are indicated along with their source, as follows:


SEC-TION

TOPIC

STATUS

1

Residential History

N- OMB and DHHS-required primary language standard. See http://aspe.hhs.gov/datacncl/standards/ACA/4302/index.pdf. U.S Department Of Health and Human Services

Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status (effective date Oct 2011).

N – place of birth

M – same as O but restricted to number of times moved since ACHS and location(s) (ACHS)

M – previously calculated and of poor quality; currently simply asks for self report of total number of years living in Anniston, AL (ACHS)

2

Background

D – race and ethnicity (not subject to change)

O – sex, marital status, educational attainment (ACHS from BRFSS)

3

General Health

D – SF-36 questions (licensed) (used in ACHS)

D – 53-item Brief Symptom Inventory (licensed)(used in ACHS)

D – RAND Medical Outcomes Study (MOS) SF-12 (licensed)(used in ACHS)

D – self-reported medication use questions will be replaced with Medications Form (Attachment 3.10)

M – general health status (ACHS from BRFSS )

N – six OMB and DHHS-required disability items to substitute for 101 items from the SF-36, BSI, and MOS SF-12. See http://aspe.hhs.gov/datacncl/standards/ACA/4302/index.pdf. U.S Department Of Health and Human Services

Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status (effective date Oct 2011).


SEC-TION

TOPIC

STATUS

3

Chronic Health Conditions

Participant Medical History:

O – Lifetime ever diabetes was repeated (BRFSS) same as O.

M - Diabetic symptoms assessed since the first survey (ACHS).

O - Lifetime ever hypertension was repeated (ACHS from BRFSS).

M – List of other health conditions similar to O, with reduced number of autoimmune diseases assessed and deletion of infectious diseases. These will be replaced with analytic tests for immune function (ACHS).


Family History of Chronic Health Conditions:

M – same as O but family relation modified to allow more than one member to be specified (ACHS).

4

Physical Activity

(New Section)

N – Physical Activities List, new items developed to assess soil and dust exposures, heavy metals and PCB exposures in the home, outdoor water activities in Alabama (BRFSS).

N – Non-occupational Physical Activity Module will be used to assess adherence to American Diabetic Association guidelines (BRFSS).

M – Past year employment status is moved to this section as a precursor to assess occupational physical activity (modified from BRFSS)

N – Past 12 month hard physical work (1985-1990 NHIS Health Promotion and Disease Prevention Supplement)

N – Past 12-month weight loss or weight gain based on CDC definition of modest (5-10%) weight change or large weight change (>10%) (adapted from CDC guidelines at http://www.cdc.gov/healthyweight/losing_weight/index.html;


CDC References

1DHHS, AIM for a Healthy Weight, page 5. Available online:
http://www.nhlbi.nih.gov/health/public/heart/obesity/aim_hwt.pdf

2Reference for 5%: Blackburn G. (1995). Effect of degree of weight loss on health benefits. Obesity Research 3: 211S-216S. 2

Reference for 10%: NIH, NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Available online:

http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf.


SEC-TION

TOPIC

STATUS

5

Health Behaviors

D – Original exercise and physical activity questions were not structured to estimate adherence to American Diabetic Association physical activity guidelines. New questions moved to Section 4.

D – Original diet questions lacked detail to assess potential chemical exposure pathways. Moved to Section 6.

M – Different smoking and tobacco use items are used to allow calculation of pack-years and to include cigars, pipes, snuff, chewing tobacco (1999-2004 NHANES and 1999 NHIS).

N – Alcoholic beverage intake items based on NIH standard drink definition (http://rethinkingdrinking.niaaa.nih.gov/WhatCountsDrink/WhatsAstandardDrink.asp

6

Diet

(New Section)

N – Past 12-month NCI Percentage Energy from Fat Screener (public domain at http://riskfactor.cancer.gov/diet/screeners/fat).

N – Fish and shellfish intake questions are used to assess relationships between dietary habits with chemical analytical measures (past week, past 12-month). Dietary fish modules are designed for consistency with Alabama Department of Public Health advisories on cooking and cleaning methods. Questions on fish species are developed with the input of the Alabama Department of Conservation and Natural Resources and the Alabama Department of Environmental Management.

N – Locally grown foods, wildlife, and game from the Coosa River Basin. If YES to these items, skip to Local Food Form for time period and food frequency. Questions on fish, game, and wildlife developed with input from Alabama Department of Public Health, Alabama Department of Conservation and Natural Resources, and the Alabama Department of Environmental Management.

The dietary and nutrition modules were very brief at baseline, asked only as ever-never items for major food categories potentially contaminated with PCBs. These were found to be strongly related in baseline statistical analyses to serum PCB levels. Therefore, this module will obtain more detail on dietary factors, timing, place and frequency of exposure.

7

Health Care Access

O – Health insurance status and access to health care (ACHS from BRFSS)

8

Women’s Health History

M – same format as O but restricted to since first survey (ACHS from Tri-State Health Study)


SEC-TION

TOPIC

STATUS

9

Men’s Health History

M – same format as O, but restricted to since first survey; type of birth control questions deleted (ACHS from Tri-State Health Study)

10

Children’s Health History

M – same format as O, but restricted to since first survey (ACHS)

11

Work History

N – Past 12 months business or industry worked at. Past 12-months kind of work done (formatted from American Community Survey). N - Ever worked for Monsanto/Solutia and time periods and type of work there.

M – Same as O but since first survey, ever worked in industries producing chemicals of interest; added manganese and welding (ACHS).

M – Military history same as O but since first survey (ACHS)

M – Annual household income is modified due to poor item response in first survey. Collapsed 8 income categories to 4.

C

Children’s Health Form

M – same as O but restricted to any new children since the first survey.

F

Female Pregnancy Form

M – same as O but restricted to any new pregnancies since the first survey.

L

Local Food Form

N – Additional module, if YES to ever eaten local foods from Section 6. Purpose to assess time period these foods were eaten based on Anniston PCB production history.

M

Male Fathering Form

M – same as O but restricted to any new pregnancies since the first survey.


Published ACHS results noted that more detailed questions are needed on potential exposure pathways, lifestyles, and risk factors than previously assessed. This need is addressed in the increased number of items assessed on dietary patterns, tobacco and alcohol use, exercise, occupational histories related to PCB exposure, residential history, and potential exposure through consumption of locally contaminated foodstuffs.


The original questionnaire included items on history of pregnancy, birth outcomes, and reproductive symptoms. To complete the cohort follow-up, these items will only be asked for occurrences since the first Anniston study. No new health outcomes have been added to the revised questionnaire. The ACHS-II questionnaire will update the adult and child health histories for new self-reported diagnoses since the baseline health conditions were assessed.



Questionnaire Outline



Questionnaire Includes 11 Main Sections for:


  1. Residential History

  2. Background

  3. General Health and Chronic Health Conditions

  4. Physical Activity

  5. Health Behaviors

  6. Diet

  7. Health Care Access

  8. Women’s Health History

  9. Men’s Health History

  10. Children’s Health History

  11. Work History


Includes Supplemental Forms for:


  1. Children’s Health

F) Female Health

L) Local Food

M) Male Health

Attachment 3.13b

Anniston Community Health Survey: Follow up Study and Dioxin Analyses

Main Questionnaire


Shape1

ANNISTON COMMUNITY HEALTH SURVEY II

MAIN QUESTIONNAIRE


STUDY ID:_____ _____ _____ _____ _____

DATE OF INTERVIEW: mm/dd/yyyy

TIME INTERVIEW BEGAN: _____ _____ : _____ _____


a.m.


p.m.


SECTION 1: RESIDENTIAL HISTORY


Thank you for taking part in this interview. Before we begin, I’d like to make sure that our questions will be easy for you to answer . . . .


1-1.

How well do you speak English? Would you say very well, well, not well, or not at all?


01 . . . VERY WELL

02 . . . WELL

03 . . . NOT WELL

04 . . . NOT AT ALL

88 . . . DK

99 . . . REF



The next few questions ask about the places where you have lived, especially since the first Anniston survey.


1-2.

Were you born in Anniston, Alabama?


01 . . . YES . . . . . . . SKIP TO 1-5

02 . . . NO

88 . . . DK

99 . . . REF



1-3.

What city and state or foreign country were you born in?


1-3a. CITY: ______________________________

1-3b. STATE OR FOREIGN COUNTRY: ___________________





1-4.

What year did you first move to Anniston, Alabama?


____ ____ ____ ____

YYYY

8888 . . . . . . . . DK

9999 . . . . . . . . REF



1-5.

Our records show that you took part in the first Anniston survey on [ACHS I - mm/dd/yyyy]. Since that time, how many times have you moved to a different Anniston house or a different city altogether?


____ ____ NUMBER OF MOVES . . . . . . IF 00, SKIP TO 1-7

88 . . . . . . . . DK

99 . . . . . . . . REF




1-6. Please tell me the year you moved, and both the city and the state (or country) you moved to. If you moved to another Anniston address, tell me the name of the street you were living on.


Move No.

Year Moved Out

City and State or Foreign Country

1

1-6a1. PRESENT

1-6a2.

CITY: Anniston

STATE OR FOREIGN COUNTRY: Alabama

(IF ANNISTON) STREET_________________________

2

1-6b1. YYYY

8888 DK

9999 REF

1-6b2.

CITY_________________________________________

STATE OR FOREIGN COUNTRY__________________

(IF ANNISTON) STREET_________________________

3

1-6c1. YYYY

8888 DK

9999 REF

1-6c2.

CITY_________________________________________

STATE OR FOREIGN COUNTRY__________________

(IF ANNISTON) STREET_________________________

4

1-6d1. YYYY

8888 DK

9999 REF

1-6d2.

CITY_________________________________________

STATE OR FOREIGN COUNTRY__________________

(IF ANNISTON) STREET_________________________

5

1-6e1. YYYY

8888 DK

9999 REF

1-6e2.

CITY_________________________________________

STATE OR FOREIGN COUNTRY__________________

(IF ANNISTON) STREET_________________________



1-7.

In your lifetime, what is the total number of years you lived in Anniston, Alabama?


____ ____ ____ TOTAL YEARS IN ANNISTON

000 . . . . . . . . LESS THAN ONE YEAR

888 . . . . . . . . DK

999 . . . . . . . . REF



SECTION 2: BACKGROUND



Next, I’d like to update some of your background information.


2-1.

What is your age?


____ ____ ____ AGE IN YEARS


888 . . . . . . . . . . . DK

999 . . . . . . . . . . . REF



2-2.

INDICATE SEX OF RESPONDENT. ASK ONLY IF NECESSARY.


01 . . . MALE

02 . . . FEMALE

88 . . . DK

99 . . . REF



2-3.

Are you married, divorced, widowed, separated, never married, or a member of an unmarried couple?


01 . . . MARRIED

02 . . . DIVORCED

03 . . . WIDOWED

04 . . . SEPARATED

05 . . . NEVER MARRIED

06 . . . MEMBER OF AN UNMARRIED COUPLE

88 . . . DK

99 . . . REF




2-4.

What is the highest grade or year of school you have completed?


01 . . . NEVER ATTENDED SCHOOL OR ONLY ATTENDED KINDERGARTEN

02 . . . GRADES 1 THROUGH 8 (ELEMENTARY)

03 . . . GRADES 9 THROUGH 11 (SOME HIGH SCHOOL)

04 . . . GRADE 12 OR GED (HIGH SCHOOL GRADUATE)

05 . . . COLLEGE 1 TO 3 YEARS (SOME COLL. OR TECHNICAL SCHOOL)

06 . . . COLLEGE 4 YEARS OR MORE (COLLEGE GRADUATE)

88 . . . DK

99 . . . REF



SECTION 3: GENERAL HEALTH





3-1.

Would you say that in general your health is excellent, very good, good, fair, or poor?


01 . . . EXCELLENT

02 . . . VERY GOOD

03 . . . GOOD

04 . . . FAIR

05 . . . POOR

88 . . . DK

99 . . . REF



3-2.

Are you deaf or do you have serious difficulty hearing?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



3-3.

Are you blind or do you have serious difficulty seeing, even when wearing glasses?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF






3-4.

Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



3-5.

Do you have serious difficulty walking or climbing stairs?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



3-6.

Do you have difficulty dressing or bathing?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



3-7.

Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



This part of the interview will be about health conditions that you might have.



3-8.

Have you ever been told by a doctor, nurse, or other health care professional that you have diabetes?

(IF YES AND IF FEMALE) Was this only when you were pregnant?


(READ ONLY IF NECESSARY) By “other health professional we mean a nurse practitioner, a physician‘s assistant, or some other licensed health professional.





01 . . . YES . . . . . . . . . . . . . . . . . . . . . .

02 . . . YES, BUT FEMALE ONLY TOLD DURING PREGNANCY . . .

03 . . . NO

04 . . . NO, PRE-DIABETES OR BORDERLINE DIABETIC

88 . . . DK

99 . . . REF


How old were you when you were told?

3-8a.

____ ____ ____ years

888 . . . DK

999 . . . REF



Was that Type 1 or Type 2 diabetes?


3-8b.

01 . . . Type 1

02 . . . Type 2

88 . . . DK

99 . . . REF


Shape2

IF 3-8 = 02, 88, 99 --- SKIP TO 3-9





3-8c.

About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your diabetes?


____ ____ NUMBER OF TIMES

88 . . . . . . DK

99 . . . . . . REF



For the next set of questions, I’m going to ask about your diabetes care since the last survey.



3-8d.

Have you been told that you have eye disease or retinopathy?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



3-8e.

(REPEAT IF NECESSARY . . . Since the last survey, . . . .) Have you been told that you have neuropathy or burning, tingling, or pain in the soles of your feet?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF




3-8f.

(REPEAT IF NECESSARY . . . Since the last survey, . . . .) Have you had any sores or irritations on your feet that took more than four weeks to heal?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF




3-8g.

Finally, (REPEAT IF NECESSARY . . . since the last survey, . . . .) have you had an amputation due to diabetes?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



3-9.

Have you ever been told by a doctor, nurse, or other health care professional that you have high blood pressure?

(IF YES AND IF FEMALE) Was this only when you were pregnant?


(READ ONLY IF NECESSARY) By “other health professional we mean a nurse practitioner, a physician‘s assistant, or some other licensed health professional.




01 . . . YES . . . . . . . . . . . . . . . . . . . . . .

02 . . . YES, BUT FEMALE ONLY TOLD DURING PREGNANCY.

03 . . . NO

88 . . . DK

Shape3

IF 3-9 = 02, 88, 99 --- SKIP TO 3-10 TRANSITION

99 . . . REF


How old were you when you were told?

3-9a.

____ ____ ____

years

888 . . . DK

999 . . . REF





3-9b.

About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your high blood pressure?


____ ____ NUMBER OF TIMES

88 . . . . . . DK

99 . . . . . . REF




The next set of questions asks about new health conditions that you may have been told about since the first Anniston Community Health Survey. Here is a card that lists each health condition. [SHOW CARD A].


Our records show that you took part in [ACHS I yyyy]. Since that year, has a doctor told you that you had any of the following . . . . ? If yes, tell me the year when you were first told.






YES

NO

DK

REF

YEAR



3-10

Cancer?

01

02

88

99

3-10b



3-10a

(If yes) What kind? _______________________________________



3-11

Stroke?

01

02

88

99

3-11b



3-12

Liver disease?

01

02

88

99

3-12b



3-13

Kidney disease? Do not include kidney stones, bladder infection or incontinence.

(INTERVIEWER NOTE: Incontinence is not being able to control urine flow.)

01

02

88

99

3-13b



3-14

Heart attack (myocardial infarction)?

01

02

88

99

3-14b



3-15

Congestive heart failure?

01

02

88

99

3-15b



3-16

Coronary heart disease (angina)?

01

02

88

99

3-16b



3-17

High blood cholesterol?

01

02

88

99

3-17b



3-18

Hearing problems?

01

02

88

99

3-18b



3-19

Cataracts?

01

02

88

99

3-19b



3-20

Glaucoma?

01

02

88

99

3-20b



3-21

Parkinson’s Disease?

01

02

88

99

3-21b



3-22

Epilepsy or seizures?

01

02

88

99

3-22b



3-23

Asthma?

01

02

88

99

3-23b



3-24

COPD (Chronic Obstructive Pulmonary Disease), emphysema, or chronic bronchitis?

01

02

88

99

3-24b



3-25

Hyperthyroidism? (overactive)

01

02

88

99

3-25b



3-26

Hypothyroidism? (underactive)

01

02

88

99

3-26b



3-27

Rheumatoid arthritis or osteoarthritis?

01

02

88

99

3-27b



3-27a

(IF YES) What kind? __________________________________________



3-28

Finally, any other autoimmune disease? Here are some examples …. [SHOW CARD B]

01

02

88

99

3-28b


3-28a

(IF YES) What kind? __________________________________________



The next questions ask about some health conditions that your family might have. We are interested in blood relatives like your children, parents, brothers or sisters, grandparents, and aunts or uncles.


First, I will ask if anyone has that condition. If you say yes, I will ask which family member [SHOW CARD C]



3-29.

Has any family member had cancer?


01 . . . YES . . . . . . . . . . . . . . . . . . . . . .

02 . . . NO

88 . . . DK

99 . . . REF



Who was that? And what type of cancer?


3-29a. _______________;

3-29a1. _______________


3-29b. _______________;

3-29b1. _______________


3-29c. _______________;

3-29c1. _______________


3-29d. _______________;

3-29d1. _______________


3-29e. _______________;

3-29e1. _______________



3-30.

Has any family member had heart disease?


01 . . . YES . . . . . . . . . . . . . . . . . . . . . .

02 . . . NO

88 . . . DK

99 . . . REF




Who was that?


3-30a. _______________


3-30b. _______________


3-30c. _______________


3-30d. _______________


3-30e. _______________






3-31.


Has any family member had high blood pressure?


01 . . . YES . . . . . . . . . . . . . . . . . . . . . . .

02 . . . NO

88 . . . DK

99 . . . REF





Who was that?


3-31a. _______________


3-31b. _______________


3-31c. _______________


3-31d. _______________


3-31e. _______________



3-32.

Has any family member had asthma?


01 . . . YES . . . . . . . . . . . . . . . . . . . . . . .

02 . . . NO

88 . . . DK

99 . . . REF



Who was that?


3-32a. _______________


3-32b. _______________


3-32c. _______________


3-32d. _______________


3-32e. _______________






3-33.

Has any family member had thyroid problems?


01 . . . YES . . . . . . . . . . . . . . . . . . . . . . 02 . . . NO

88 . . . DK

99 . . . REF




Who was that?


3-33a. _______________


3-33b. _______________


3-33c. _______________


3-33d. _______________


3-33e. _______________








3-34.

Has any family member had diabetes?


01 . . . YES . . . . . . . . . . . . . . . . . . . . . .

02 . . . NO

88 . . . DK

99 . . . REF



Who was that? And was that Type 1 or Type 2 diabetes?


3-34a. _______________;

3-34a1. _______________


3-34b. _______________;

3-34b1. _______________


3-34c. _______________;

3-34c1. _______________


3-34d. _______________;

3-34d1. _______________


3-34e. _______________;

3-34e1. _______________




3-35.


Has any family member had rheumatoid arthritis or osteoarthritis?


01 . . . YES . . . . . . . . . . . . . . . . . . . . . . 02 . . . NO

88 . . . DK

99 . . . REF





Who was that?

3-35a. _______________


3-35b. _______________


3-35c. _______________


3-35d. _______________


3-35e. _______________




3-36.

Finally has any family member had autoimmune diseases? Here are some examples …. [SHOW CARD D]



01 . . . YES . . . . . . . . . . . . . . . . . . . . . . 02 . . . NO

88 . . . DK

99 . . . REF


Who was that? And what type of autoimmune disease?

3-36a. _______________;

3-36a1. _______________


3-36b. _______________;

3-36b1. _______________


3-36c. _______________;

3-36c1. _______________


3-36d. _______________;

3-36d1. _______________


3-36e. _______________;

3-36e1. _______________




SECTION 4: PHYSICAL ACTIVITY





We are interested in the times you have spent outdoors for recreation or in home maintenance.


Have you ever done any of these types of outdoor activities or hobbies on a regular basis? [SHOW CARD E] For each of these that you tell me “yes,” I will ask if you have done them since you took part in the last Anniston survey.





YES

NO

DK

REF

(IF YES) HAVE YOU DONE THEM SINCE ACHS I?

4-1

Field sports?

01

02

88

99

4-1b

4-2

Gardening?

01

02

88

99

4-2b

4-3

Hiking, jogging, running, or walking?

01

02

88

99

4-3b

4-4

Horseback riding?

01

02

88

99

4-4b

4-5

Hunting game?

01

02

88

99

4-5b

4-4

Yardwork?

01

02

88

99

4-6b

4-7

Any other type of dusty outdoor activity?

01

02

88

99

4-7b

4-7a

(IF YES) What is that? __________________________________________



Have you ever done any of these types of home maintenance activities or hobbies on a regular basis? [SHOW CARD F]. For each of these that you tell me “yes,” I will ask if you have done them since you took part in the first Anniston survey.





YES

NO

DK

REF

(IF YES) HAVE YOU DONE THEM SINCE ACHS I?

4-8

Making lead weights, sinkers, or shot?

01

02

88

99

4-8b

4-9

Lead soldering?

01

02

88

99

4-9b

4-10

Carpentry or home renovation?

01

02

88

99

4-10b

4-11

Painting or papering the house?

01

02

88

99

4-11b

4-12

Window or door caulking?

01

02

88

99

4-12b




4-13.

(IF 4-10b, 4-11b, OR 4-12b = YES) Were these home activities done in a home

or building that was built before 1940, between 1940 and 1959, or between 1960 and 1977? If there is more than one place, tell me about the one that is the oldest. [SHOW CARD G]


01 . . . YES, BEFORE 1940

02 . . . YES, 1940-1959

03 . . . YES, 1960-1977

04 . . . NO, ONLY 1978 OR NEWER

88 . . . DK

99 . . . REF




Have you ever done any of these types of water activities or hobbies [SHOW CARD H] on a regular basis in any Alabama rivers or lakes? [SHOW MAP A]





YES

NO

DK

REF

(IF YES) HAVE YOU DONE THEM SINCE ACHS I?

4-14

Boating?

01

02

88

99

4-14b

4-15

Fishing from river bank or boat?

01

02

88

99

4-15b

4-16

Scuba diving or snorkeling?

01

02

88

99

4-16b

4-17

Stream fishing?

01

02

88

99

4-17b

4-18

Swimming in a pool?

01

02

88

99

4-18b

4-19

Surfing, swimming, or waterskiing in ocean, lake, river?





4-19b

4-20

Any other type of water activity?

01

02

88

99

4-20b

4-20a

(IF YES) What is that? __________________________________________


Shape4

IF 4-14 TO 4-20 = 02, 88, 99 --- SKIP TO 4-22 TRANSITION






4-21.

Have ever you done any of these water activities in Logan Martin Lake, Choccolocco Creek, or Snow Creek? [SHOW MAP B]


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



The next few questions are about exercise, recreation, or physical activities other than your regular job duties, and only in the past month.


Shape5

HOUSEWORK MAY BE INCLUDED AS A PHYSICAL ACTIVITY OR EXERCISE. CODE AS “70 = OTHER” THEN SPECIFY.







4-22.

During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? [IF NECESSARY, SHOW CARD I]


01 . . . YES

02 . . . NO. . . . . . . . . . . . . . . . SKIP TO 4-29

88 . . . DK. . . . . . . . . . . . . . . . SKIP TO 4-29

99 . . . REF. . . . . . . . . . . . . . . . SKIP TO 4-29



4-23.

What type of physical activity or exercise did you spend the most time doing during the past month? [IF NECESSARY, SHOW CARD I]


4-23a.

____ ____ SEE CODE LIST . . . . . . . .IF “70”, SPECIFY: _____________

88 . . . . . . DK

99 . . . . . . REF




4-24.

How many times per week or per month did you take part in this activity during the past month?


1 ____ ____ TIMES PER WEEK

2 ____ ____ TIMES PER MONTH

8 88 . . . . . . DK

9 99 . . . . . . REF




4-25.

And when you took part in this activity, for how many minutes or hours did you usually keep at it?


___ ___:___ ___ HOURS AND MINUTES

88:88 DK

99:99 REF




4-26.

What other type of physical activity gave you the next most exercise during the past month? [IF NECESSARY, SHOW CARD I]

4-26a.

____ ____ SEE CODING LIST . . . . . . . . . . . IF “70”, SPECIFY: ___________

77 . . . . . . NO OTHER ACTIVITY

88 . . . . . . DK

99 . . . . . . REF




4-27.

How many times per week or per month did you take part in this activity during the past month?


1 ____ ____ TIMES PER WEEK

2 ____ ____ TIMES PER MONTH

8 88 . . . . . . DK

9 99 . . . . . . REF



4-28.

And when you took part in this activity, for how many minutes or hours did you usually keep at it?


___ ___:___ ___ HOURS AND MINUTES

88:88 DK

99:99 REF



4-29.

During the past month, how many times per week or per month did you do physical activities or exercises to strengthen your muscles? Do not count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands.


1 ____ ____ TIMES PER WEEK

2 ____ ____ TIMES PER MONTH

8 88 . . . . . . DK

9 99 . . . . . . REF



Some people have jobs that require physical activity, too. I’d like to know if you were working in the past year.


4-30.

Are you currently employed for wages, self-employed, working without pay in a family business or farm, out of work for less than 1 year, out of work for more than one year, a homemaker, a student and not working, retired, or unable to work? [SHOW CARD J]


01 . . . EMPLOYED FOR WAGES

02 . . . SELF-EMPLOYED

03 . . . WORKING WITHOUT PAY IN A FAMILY BUSINESS OR FARM

04 . . . OUT OF WORK FOR LESS THAN 1 YEAR

05 . . . OUT OF WORK FOR MORE THAN 1 YEAR

06 . . . HOMEMAKER

07 . . . STUDENT, NOT WORKING

08 . . . RETIRED

09 . . . UNABLE TO WORK

88 . . DK

99 . . . REF

Shape6

IF 4-30 = 05-99 --- SKIP TO 4-33





4-31.

How much hard physical work is (or was) required on your job in the past 12 months? Would you say a great deal, a moderate amount, a little, or none?


01 . . . GREAT DEAL

02 . . . MODERATE AMOUNT

03 . . . A LITTLE

04 . . . NONE . . . . . . . . . . . . . . . . SKIP TO 4-32

88 . . . DK . . . . . . . . . . . . . . . . . . .SKIP TO 4-32

99 . . . REF. . . . . . . . . . . . . . . . . . SKIP TO 4-32



4-31.

About how many hours per day do (or did) you perform hard physical work on your job?


____ ____ HOURS

88 . . . . . . DK

99 . . . . . . REF



I’d like for you to think about your current weight, and what it was 12 months ago. I will show you a card to help you remember. [SHOW CARD K]


4-32.

Compared to 12 months ago, is your current weight about the same (less than 5 percent change), or have you lost weight or gained weight?


01 . . . ABOUT THE SAME WEIGHT . . . . . . . . . . . . . . . . . .SKIP TO SECTION 5

02 . . . LOST WEIGHT, 5 PERCENT OR MORE

03 . . . GAINED WEIGHT, 5 PERCENT OR MORE . . . . . . .SKIP TO 4-34

88 . . . DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SKIP TO SECTION 5

99 . . . REF. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .SKIP TO SECTION 5



4-33.

A modest amount of weight loss is 5 to 10 percent of your baseline weight. Have you currently lost between 5 to 10 percent, or more than 10 percent of your body weight compared to 12 months ago?


01 . . . LOST BETWEEN 5 TO 10 PERCENT

02 . . . LOST MORE THAN 10 PERCENT

88 . . . DK

99 . . . REF


Shape7

SKIP TO SECTION 5




4-34.

A modest amount of weight gain is 5 to 10 percent of your baseline weight. Have you currently gained between 5 to 10 percent, or more than 10 percent of your body weight compared to 12 months ago?


01 . . . GAINED BETWEEN 5 TO 10 PERCENT

02 . . . GAINED MORE THAN 10 PERCENT

88 . . . DK

99 . . . REF




SECTION 5: HEALTH BEHAVIORS



The next questions ask about cigarette smoking and other tobacco use.


5-1.

Have you smoked at least 100 cigarettes in your entire life?

(5 PACKS = 100 CIGARETTES)


01 . . . YES

02 . . . NO. . . . . . . . . . . . . .SKIP TO 5-8

88 . . . DK. . . . . . . . . . . . . . SKIP TO 5-8

99 . . . REF. . . . . . . . . . . . . SKIP TO 5-8



5-2.

How old were you when you first started to smoke fairly regularly?


____ ____ ____ AGE IN YEARS

777 . . . . . . . . . . . . NEVER SMOKED CIGARETTES REGULARLY

888 . . . . . . . . . . . . DK

999 . . . . . . . . . . . . REF



5-3.

Do you now smoke cigarettes every day, some days, or not at all?


01 . . . EVERY DAY . . . . . . . . . . . SKIP TO 5-5

02 . . . SOME DAYS . . . . . . . . . . .SKIP TO 5-6

03 . . . NOT AT ALL

88 . . . DK

99 . . . REF




5-4. How long has it been since you quit smoking cigarettes?


1 ____ ____ DAYS . . . . . . . . . . . SKIP TO 5-8

2 ____ ____ WEEKS . . . . . . . . . SKIP TO 5-8

3 ____ ____ MONTHS. . . . . . . . SKIP TO 5-8

4 ____ ____ YEARS. . . . . . . . . . SKIP TO 5-8

888 . . . . . . DK

999 . . . . . . REF



5-5. On average, how many cigarettes do you now smoke per day?

(1 PACK = 20 CIGARETTES)

(ENTER “01” IF LESS THAN ONE)

(IF 95 OR MORE PER DAY, ENTER 95)


____ ____ CIGARETTE(S) . . . SKIP TO 5-8

88 . . . . . . . . DK. . . . . . . . . . . . . . SKIP TO 5-8

99 . . . . . . . . REF. . . . . . . . . . . . .SKIP TO 5-8



5-6. On how many of the past 30 days did you smoke a cigarette?

(ENTER “00” FOR NONE)


____ ____ DAY(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-7. On average, when you smoked during the past 30 days, about how many cigarettes did you smoke per day?

(1 PACK = 20 CIGARETTES)

(ENTER “01” IF LESS THAN ONE)

(IF 95 OR MORE PER DAY, ENTER 95)


____ ____ CIGARETTE(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-8.

Have you smoked a pipe at least 20 times in your entire life?


01 . . . YES

02 . . . NO. . . . . . . . . . . . . .SKIP TO 5-13

88 . . . DK. . . . . . . . . . . . . . SKIP TO 5-13

99 . . . REF. . . . . . . . . . . . . SKIP TO 5-13




5-9.

How old were you when you first started to smoke a pipe fairly regularly?


____ ____ ____ AGE IN YEARS

666 . . . . . . . . . . . . NEVER SMOKED A PIPE REGULARLY

888 . . . . . . . . . . . . DK

999 . . . . . . . . . . . . REF



5-10.

Do you now smoke a pipe every day, some days, or not at all?


01 . . . EVERY DAY . . . . . . . . . . . SKIP TO 5-11

02 . . . SOME DAYS . . . . . . . . . . .SKIP TO 5-13

03 . . . NOT AT ALL. . . . . . . . . . . SKIP TO 5-13

88 . . . DK. . . . . . . . . . . . . . . . . . . SKIP TO 5-13

99 . . . REF. . . . . . . . . . . . . . . . . . SKIP TO 5-13



5-11. How many pipefuls of tobacco do you now smoke per day?

(ENTER “01” IF LESS THAN ONE)

(IF 95 OR MORE PER DAY, ENTER 95)


____ ____ PIPEFUL(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-12. For about how many years have you smoked this amount?

(IF LESS THAN ONE YEAR ENTER “01”)


____ ____ YEAR(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-13.

Have you smoked a cigar at least 20 times in your entire life?


01 . . . YES

02 . . . NO. . . . . . . . . . . . . .SKIP TO 5-18

88 . . . DK. . . . . . . . . . . . . . SKIP TO 5-18

99 . . . REF. . . . . . . . . . . . . SKIP TO 5-18




5-14.

How old were you when you first started to smoke a cigar fairly regularly?


____ ____ ____ AGE IN YEARS

666 . . . . . . . . . . . . NEVER SMOKED CIGARS REGULARLY

888 . . . . . . . . . . . . DK

999 . . . . . . . . . . . . REF



5-15.

Do you now smoke a cigar every day, some days, or not at all?


01 . . . EVERY DAY

02 . . . SOME DAYS . . . . . . . . . . .SKIP TO 5-18

03 . . . NOT AT ALL . . . . . . . . . . .SKIP TO 5-18

88 . . . DK . . . . . . . . . . . . . . . . . . .SKIP TO 5-18

99 . . . REF . . . . . . . . . . .. . . . . . . SKIP TO 5-18



5-16. How many cigars do you smoke per day?

(ENTER “01” IF LESS THAN ONE)

(IF 95 OR MORE PER DAY, ENTER 95)


____ ____ CIGAR(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-17. For about how many years have you smoked this amount?

(IF LESS THAN ONE YEAR, ENTER “01”)


____ ____ YEAR(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-18.

Have you used snuff, such as Skoal, Skoal Bandit, or Copenhagen, at least 20 times in your entire life?


01 . . . YES

02 . . . NO. . . . . . . . . . . . . . . . . . . SKIP TO 5-23

88 . . . DK. . . . . . . . . . . . . . . . . . . SKIP TO 5-23

99 . . . REF. . . . . . . . . . . . . . . . . . SKIP TO 5-23




5-19.

How old were you when you first started to use snuff fairly regularly?


____ ____ ____ AGE IN YEARS

666 . . . . . . . . . . . . NEVER USED SNUFF REGULARLY

888 . . . . . . . . . . . . DK

999 . . . . . . . . . . . . REF



5-20.

Do you now use snuff every day, some days, or not at all?


01 . . . EVERY DAY

02 . . . SOME DAYS . . . . . . . . . . .SKIP TO 5-23

03 . . . NOT AT ALL . . . . . . . . . . .SKIP TO 5-23

88 . . . DK . . . . . . . . . . . . . . . . . . .SKIP TO 5-23

99 . . . REF . . . . . . . . . . . . . . . . . .SKIP TO 5-23



5-21. How many “pinches”, “dips”, or “rubs” of snuff do you use per day?

(ENTER “01” IF LESS THAN 1)

(IF 95 OR MORE PER DAY, ENTER 95)


____ ____ PINCH(ES), DIP(S), OR RUB(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-22. For about how many years have you used this amount?

(IF LESS THAN ONE YEAR, ENTER “01”)


____ ____ YEAR(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-23.

Have you used chewing tobacco, such as Redman, Levi Garrett, or Beechnut, at least 20 times in your entire life?


01 . . . YES

02 . . . NO. . . . . . . . . . . . . .SKIP TO 5-28 TRANSITION

88 . . . DK. . . . . . . . . . . . . . SKIP TO 5-28 TRANSITION

99 . . . REF. . . . . . . . . . . . . SKIP TO 5-28 TRANSITION




5-24.

How old were you when you first started to use chewing tobacco fairly regularly?


____ ____ ____ AGE IN YEARS

666 . . . . . . . . . . . . NEVER USED CHEWING TOBACCO REGULARLY

888 . . . . . . . . . . . . DK

999 . . . . . . . . . . . . REF



5-25.

Do you now use chewing tobacco every day, some days, or not at all?


01 . . . EVERY DAY

02 . . . SOME DAYS

03 . . . NOT AT ALL

88 . . . DK

99 . . . REF


Shape8

SKIP TO 5-28 TRANSITION





5-26. How many “plugs”, “wads”, or “chaws” of chewing tobacco do you use per day?

(ENTER “01” IF LESS THAN ONE)

(IF 95 OR MORE PER DAY, ENTER 95)


____ ____ PLUG(S), WAD(S), OR CHAW(S)

88 . . . . . . . . DK

99 . . . . . . . . REF



5-27. For about how many years have you used this amount?

(IF LESS THAN ONE YEAR, ENTER “01”)


____ ____ YEAR(S)

88 . . . . . . . . DK

99 . . . . . . . . REF




The next questions are about alcohol drinks. These include liquor (such as whiskey or gin), beer, wine, wine coolers, and any other type of alcoholic beverage. By a drink, I mean a 12-ounce beer, a 5-ounce glass of wine, or 1-1/2 (one-and-a-half) ounces of liquor. [SHOW CARD L or SHOW DRINK MODELS]


5-28. In your lifetime, have you had at least 12 drinks of beer, wine, or liquor?


01 . . . YES

02 . . . NO . . . . . . . . . . . . . SKIP TO SECTION 8

88 . . . DK . . . . . . . . . . . . . SKIP TO SECTION 8

99 . . . REF. . . . . . . . . . . . . SKIP TO SECTION 8



5-29. Think about a weekend as Friday, Saturday, and Sunday. For a typical week in the past 12 months, what was the usual number of drinks you had on a weekend? (TOTAL FOR ALL THREE WEEKEND DAYS)


____ ____ ____ NUMBER OF DRINKS

888 . . . . . . . . . . . . DK

999 . . . . . . . . . . . . REF



5-30. Think about the weekdays as Monday, Tuesday, Wednesday, and Thursday. For a typical week in the past 12 months, what was the usual number of drinks you had during the weekdays? (TOTAL FOR ALL FOUR WEEKDAYS)


____ ____ ____ NUMBER OF DRINKS

888 . . . . . . . . . . . . DK

999 . . . . . . . . . . . . REF



Shape9

IF SUM OF [7-29 + 5-30 = 000] CONTINUE; ALL ELSE, SKIP TO SECTION 6





5-31. How many years has it been since you drank alcohol drinks?


____ ____ ____ NUMBER OF YEARS

888 . . . . . . . . . . . . DK

999 . . . . . . . . . . . . REF





SECTION 6: DIET



The next set of questions is about the foods you eat.


Think about your eating habits over the past 12 months. About how often did you eat or drink each of the following foods? Remember breakfast, lunch, dinner, snacks, and eating out. For each food, select one choice from this card. [SHOW CARD M]




NEVER

<1 PERMO

1-3 PER MO

1-2 PERWK

3-4 PER WK

5-6 PER WK

1 PER DAY

2 PERDAY

DK

REF

6-1.

Cold cereal

01

02

03

04

05

06

07

08

88

99

6-2.

Skim milk, on cereal or to drink

01

02

03

04

05

06

07

08

88

99

6-3.

Eggs, fried or scrambled in margarine, butter, or oil

01

02

03

04

05

06

07

08

88

99

6-4.

Sausage or bacon, regular-fat

01

02

03

04

05

06

07

08

88

99

6-5.

Margarine or butter on bread, rolls, pancakes

01

02

03

04

05

06

07

08

88

99

6-6.

Orange juice or grapefruit juice

01

02

03

04

05

06

07

08

88

99

6-7.

Fruit (not juices)

01

02

03

04

05

06

07

08

88

99

6-8.

Beef or pork hot dogs, regular-fat

01

02

03

04

05

06

07

08

88

99

6-9.

Cheese or cheese spread, regular-fat

01

02

03

04

05

06

07

08

88

99

6-10.

French fries, home fries, or hash brown potatoes

01

02

03

04

05

06

07

08

88

99

6-11.

Margarine or butter on vegetables, including potatoes

01

02

03

04

05

06

07

08

88

99

6-12.

Mayonnaise, regular-fat

01

02

03

04

05

06

07

08

88

99

6-13.

Salad dressings, regular-fat

01

02

03

04

05

06

07

08

88

99

6-14.

Rice

01

02

03

04

05

06

07

08

88

99

6-15.

Margarine, butter, or oil on rice or pasta

01

02

03

04

05

06

07

08

88

99



6-16. Over the past 12 months, when you prepared foods with margarine or ate margarine, how often did you use a reduced-fat margarine? [SHOW CARD N]


01 . . . DIDN’T USE MARGARINE

02 . . . ALMOST NEVER

03 . . . ABOUT ¼ OF THE TIME

04 . . . ABOUT ½ OF THE TIME

05 . . . ABOUT ¾ OF THE TIME

06 . . . ALMOST ALWAYS OR ALWAYS

88 . . . DK

99 . . . REF



6-17.

Overall, when you think about the foods you ate over the past 12 months, would you say your diet was high, medium, or low in fat?


01 . . . HIGH

02 . . . MEDIUM

03 . . . LOW

88 . . . DK

99 . . . REF



The next questions are about some other foods. Let’s start with fish and shellfish.


6-18.

Have you eaten fish or shellfish in past week?


01 . . . YES . . . . . . . . . . . . . . .

02 . . . NO

88 . . . DK

99 . . . REF




When was the most recent time you ate fish or shellfish?


01 . . . TODAY

02 . . . 1 DAY AGO

03 . . . 2 DAYS AGO

04 . . . 3 DAYS AGO




6-18a.




05 . . . 4-7 DAYS AGO

88 . . . DK

99 . . . REF




And what type of fish or shellfish was this?


6-18b.



SPECIFY: ___________________________

8888 . . . DK

9999 . . . REF




In a typical week in the past 12 months, did you eat . . . . . . . .




YES

NO

DK

REF

6-19.

Fish?

01

02

88

99

6-20.

How about shellfish?

01

02

88

99


Shape10

IF 6-19 & 6-20 = 02, 88, 99 --- SKIP TO 6-66 TRANSITION






6-21. Compared to these models of servings of cooked fish or shellfish, would you say that a typical meal of fish or shellfish that you ate was usually more, about the same, or less? [SHOW FISH SERVING MODELS]


01 . . . MORE

02 . . . ABOUT THE SAME

03 . . . LESS

88 . . . DK

99 . . . REF



In the past 12 months, tell me how the fish you ate was usually cleaned. Did someone ….. [SHOW CARD O]




YES

NO

DK

REF

6-22.

Remove the head?

01

02

88

99

6-23.

Remove the skin?

01

02

88

99

6-24.

Trim the fat along the back?

01

02

88

99

6-25.

Trim the dark meat along length of filet? In the picture it is called the “lateral line.”

01

02

88

99

6-26.

Trim the belly flaps?

01

02

88

99

6-27.

Remove the guts?

01

02

88

99




In the past 12 months, tell me the usual ways the fish you ate was cooked. Was it ….. [SHOW CARD P]





YES

NO

DK

REF

6-28.

Pan fried?

01

02

88

99

6-29.

Deep fried?

01

02

88

99

6-30.

Baked or broiled?

01

02

88

99

6-31.

Boiled or poached?

01

02

88

99

6-32.

A stew or chowder?

01

02

88

99

6-33.

Smoked?

01

02

88

99

6-34.

Grilled?

01

02

88

99

6-35.

Dried?

01

02

88

99

6-36.

Pickled?

01

02

88

99

6-37.

Raw?

01

02

88

99




In the past 12 months, tell me the parts of the fish you usually ate. Did you eat the …..

[SHOW CARD Q]




YES

NO

DK

REF

6-38.

Filet?

01

02

88

99

6-39.

Cheeks?

01

02

88

99

6-40.

Eggs?

01

02

88

99

6-41.

Skin?

01

02

88

99

6-42.

Liver?

01

02

88

99




In the past 12 months, tell me all the places where your fish and shellfish came from. Was it …….? [SHOW CARD R]





YES

NO

DK

REF

6-43.

Bought at a store or market?

01

02

88

99

6-44.

Bought at a restaurant?

01

02

88

99

6-45.

Bought or caught at a farm?

01

02

88

99

6-46.

Wild caught by you or someone else?

01

02

88

99

6-46b.

(IF YES) Was it caught in Alabama?

01

02

88

99




Ranking these places from “1-to-3” with “1” being the “most often” and “3” being “least often,” tell me where you got your fish and shellfish in the past 12 months. Tell me any place you “never” got your fish and shellfish from in the past 12 months. I’ll mark these places with a “4.” [SHOW CARD S]


How about ……

RANK

6-43c.

From a store or market?


6-44c.

From a restaurant?


6-45c.

From a fish farm?


6-46c.

Caught in the wild?



01 . . . MOST OFTEN

02 . . . NOT MOST OR LEAST OFTEN, SOMEWHERE IN BETWEEN

03 . . . LEAST OFTEN

04 . . . NEVER

88 . . . DK

99 . . . REF



The next question is only about fish and shellfish from a store, a market, a restaurant, or a farm. Not including wild caught fish and shellfish, did you eat these types of fish in the past 12 months? [SHOW CARD T]




YES

NO

DK

REF

6-47.

White fish (cod, pollock, whiting, haddock)?

01

02

88

99

6-48.

Catfish?

01

02

88

99

6-49.

Clams?

01

02

88

99

6-50.

Crab?

01

02

88

99

6-51.

Flounder and other flatfish?

01

02

88

99

6-52.

King mackerel?

01

02

88

99

6-53.

Oysters?

01

02

88

99

6-54.

Salmon steaks or filets?

01

02

88

99

6-55.

Salmon, canned?

01

02

88

99

6-56.

Shark?

01

02

88

99

6-57.

Shrimp?

01

02

88

99

6-58.

Swordfish?

01

02

88

99

6-59.

Tilefish?

01

02

88

99

6-60.

Tuna steaks or filets?

01

02

88

99

6-61.

Tuna, canned?

01

02

88

99



The next set of questions is only about wild caught fish from Alabama waters.

Shape11

IF 6-46b = 01 --- SKIP TO 6-63 TRANSITION





6-62.

Have you ever eaten wild caught fish from any Alabama waters?


01 . . . YES

02 . . . NO. . . . . . . . . . . . . .SKIP TO 6-82 TRANSITION

88 . . . DK. . . . . . . . . . . . . . SKIP TO 6-82 TRANSITION

99 . . . REF. . . . . . . . . . . . . SKIP TO 6-82 TRANSITION



Have you ever eaten wild caught fish from the dams, creeks, or lakes along the . . . . [Show Map C]




YES

NO

DK

REF

6-63.

Coosa River?

01

02

88

99

6-64.

Alabama River?

01

02

88

99

6-65.

Mobile River?

01

02

88

99



Have you ever eaten wild caught fish from these sections of the Coosa River …….




YES

NO

DK

REF

6-66.

Weiss Lake? (above Weiss Dam)

[SHOW MAP D]

01

02

88

99

6-67.

H. Neely Henry Lake?

(between Weiss Dam and H. Neely Henry Dam) [SHOW MAP E]

01

02

88

99

6-68.

Logan Martin Lake above Interstate 20?

(between H. Neely Henry Dam and I-20)

[SHOW MAP F]

01

02

88

99

6-69.

Logan Martin Lake below Interstate 20, Choccolocco Creek, or Snow Creek?

(between I-20 and Logan Martin Dam)

[SHOW MAP G]

01

02

88

99

6-70.

Lay Lake?

(between Logan Martin Dam and Lay Dam) [SHOW MAP H]

01

02

88

99



Have you ever eaten these types of wild caught fish from any Alabama creeks, lakes, or rivers? [Show CARDS U-1 AND U-2]




YES

NO

DK

REF

6-71.

Largemouth bass?

01

02

88

99

6-72.

Other bass (spotted, striped, smallmouth, white)?

01

02

88

99

6-73.

Carp?

01

02

88

99

6-74.

Catfish (channel, blue, flathead)?

01

02

88

99

6-75.

Crappie (black or white)?

01

02

88

99

6-76.

Bluegill, other bream, or panfish? (Sunfish)

01

02

88

99

6-77.

Perch (walleye, sauger, yellow perch)?

01

02

88

99

6-78.

Buffalo (largemouth, smallmouth)?

01

02

88

99

6-79.

Suckers (hog, redhorse)?

01

02

88

99

6-80.

Freshwater drum?

01

02

88

99

6-81.

Other fish?

01

02

88

99

6-81a.

(If yes) What kind? _______________________



We are interested in local foods from the Anniston area and from farms or land in the Coosa River Basin. These are foods and food products that are locally grown, harvested, caught, trapped, or hunted.


Have you ever eaten local . . . . . .




YES

NO

DK

REF

6-82.

Chickens?

01

02

88

99

6-83.

Eggs?

01

02

88

99

6-84.

Dairy products like milk or cheese?

01

02

88

99

6-85.

Beef or beef products?

01

02

88

99

6-86.

Pork or pork products?

01

02

88

99



Have you ever eaten wild game like . . . . . .[Show CARD V]




YES

NO

DK

REF

6-87.

Woodcock or dove?

01

02

88

99

6-88.

Quail or wild turkey?

01

02

88

99

6-89.

Duck or goose?

01

02

88

99

6-90.

Deer or other large game?

01

02

88

99

6-91.

Squirrel, rabbit, or other small game?

01

02

88

99



Eating clay is common among many people in the South and throughout the world.




YES

NO

DK

REF

6-92.

Have you ever eaten local clay?

This is clay gathered from Anniston and the Coosa River Basin.

01

02

88

99



Shape12

IF 6-62, AND 6-82 THROUGH 6-92 = 02, 88, 99 --- SKIP TO SECTION 7




Shape13

IF 6-62, OR ANY 6-82 THROUGH 6-92 = 1 --- SKIP TO LOCAL FOODS FORM L






SECTION 7: HEALTH CARE ACCESS



The next few questions are about health care access.


7-1.

Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans?


Some examples of government plans include Medicare for people 65 years and older, Medicaid, Medical Assistance, other types of government-assistance plans for people with low income or disabilities, TRICARE or other military health care, Veterans Administration, or Indian Health Service.


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



7-2.

Do you have one person you think of as your personal doctor or health care provider?

(IF NO) Is there more than one, or is there no person who you think of as your personal doctor or health care provider?


01 . . . YES, ONLY ONE

02 . . . YES, MORE THAN ONE

03 . . . NO

88 . . . DK

99 . . . REF



7-3.

Was there a time during the past 12 months when you needed to see a doctor, but could not because of the cost?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



IF MALE, SKIP TO SECTION 9: MEN’S HEALTH HISTORY





SECTION 8: WOMEN’S HEALTH HISTORY



These next questions ask about women’s health and pregnancy history.


Shape14

IF 2-1 > 52 YEARS --- SKIP TO 8-3




8-1.

Have you been pregnant at any time in the past 12 months?

(IF YES) Are you currently pregnant?


01 . . . YES, IN PAST 12 MONTHS

02 . . . YES, CURRENTLY

02 . . . NO

88 . . . DK

99 . . . REF



8-2.

Have you breastfed at any time in the past 12 months?

(IF YES) Are you currently breastfeeding?


01 . . . YES, IN PAST 12 MONTHS

02 . . . YES, CURRENTLY

02 . . . NO

88 . . . DK

99 . . . REF




8-3.

Are you still having your menstrual cycles? (If currently missing cycles due to pregnancy or breastfeeding, 8-3 = 01)


01 . . . YES . . . . . . . . . . . SKIP TO 8-5

02 . . . NO

88 . . . DK. . . . . . . . . . . SKIP TO 8-5

99 . . . REF. . . . . . . . . . . SKIP TO 8-5



8-4.

(Other than pregnancy or breastfeeding . . . .) What was the reason your menstrual periods stopped? Was it due to …….?





8-4a.






01 . . . Menopause? . . . . . . . . . . . .. . . . .

02 . . . A hysterectomy (removal of womb)? . . . . . . . . . . . . . . . . . . . . .

03 . . . Medical treatment such as chemotherapy, radiation, or hormones?. . . . . . . . . . . . . . . . . . .

88 . . . DK

99 . . . REF

(If 8-4 = 01, 02, or 03) How old were you when you stopped menstruating?


____ ____ ____

YEARS OF AGE

888 . . . . . . . . . . DK

999 . . . . . . . . . . REF




8-5.

What is the total number of times you have been pregnant in your lifetime?


____ ____ NUMBER OF PREGNANCIES

88 . . . . . . . DK

99 . . . . . . . REF


Shape15

IF 8-5 = 00, SKIP TO 8-8





8-6.

What is the total number of months that you breastfed all your children? If you breast fed more than one child, please add up the number of months for each of them into your lifetime.


____ ____ TOTAL NUMBER OF MONTHS

88 . . . . . . . DK

99 . . . . . . . REF





Our records show that you took part in the first Anniston Community Health Survey in [ACHS I yyyy].


8-7.

How many times were you pregnant since then?


____ ____ NUMBER OF PREGNANCIES . .

88 . . . . . . . DK

99 . . . . . . . REF





(If 1 or more times) Were you ever pregnant in the past 12 months?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF





8-7a.

Shape16

IF 8-7 > 00, GO TO FEMALE PREGNANCY FORM F






8-8.

Since the first Anniston survey, have you ever tried to become pregnant but did not even though you wanted to?


01 . . . YES

02 . . . NO . . . . . . . . . . . SKIP TO 8-11 INTRODUCTION

88 . . . DK . . . . . . . . . . . SKIP TO 8-11 INTRODUCTION

99 . . . REF . . . . . . . . . . . SKIP TO 8-11 INTRODUCTION


8-9.

Did you ever see a doctor about the difficulty in becoming pregnant?


01 . . . YES

02 . . . NO . . . . . . . . . . . SKIP TO 8-11 INTRODUCTION

88 . . . DK . . . . . . . . . . . SKIP TO 8-11 INTRODUCTION

99 . . . REF . . . . . . . . . . . SKIP TO 8-11 INTRODUCTION




8-10.

Which of the following reasons caused your difficulty in becoming pregnant? [SHOW CARD W]


01 . . . Not ovulating

02 . . . Blocked tubes

03 . . . Egg not fertilized

04 . . . Egg not implanting

05 . . . Endometriosis

06 . . . Man had fertility problems

or

07 . . . Doctor did not find a reason

88 . . . DK

99 . . . REF



The next questions ask about some medical conditions that affect females. Since the first Anniston survey, has a doctor ever told you that you had developed …. ?





YES

NO

DK

REF

8-11.

Endometriosis?

01

02

88

99

8-12.

Polycystic Ovarian Syndrome?

01

02

88

99

8-13.

Fibroids?

01

02

88

99

8-14.

Pelvic Inflammatory Disease?

01

02

88

99



SKIP TO SECTION 10: CHILDREN’S HEALTH HISTORY





SECTION 9: MEN’S HEALTH HISTORY


These next questions ask about men’s health history, especially changes since the first Anniston Community Health Survey. Our records show that you took part in the first survey in [ACHS I yyyy].



9-1.

How many times did you get a woman pregnant after that date?


____ ____ NUMBER OF PREGNANCIES

88 . . . . . . . DK

99 . . . . . . . REF

Shape17

IF 11-1 = 0, SKIP TO 11-4





9-2.

Since that date, did you smoke cigarettes in the 12 months before fathering any pregnancies?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



9-3.

Since that date, did you smoke during any pregnancies you fathered?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



Shape18

IF 9-1 > 0, GO TO MALE FATHERING FORM M





9-4.

Since the first Anniston survey, did you ever see a doctor about the difficulty in getting a woman pregnant?


01 . . . YES

02 . . . NO . . . . . . . . . . . . . . . SKIP TO SECTION 10 INTRODUCTION

88 . . . DK . . . . . . . . . . . . . . . SKIP TO SECTION 10 INTRODUCTION

99 . . . REF . . . . . . . . . . . . . . . SKIP TO SECTION 10 INTRODUCTION




9-5.

Which of the following reasons caused your difficulty in getting a woman pregnant? [SHOW CARD X]


01 . . . Woman had fertility problems

02 . . . Poor semen or sperm quality

or

03 . . . Doctor did not find a reason

88 . . . DK

99 . . . REF




SECTION 10: CHILDREN’S HEALTH HISTORY


The next series of questions asks about children’s health history. We want to ask about each of your children born alive or adopted since the first Anniston survey. Again, our records show that you took part in the first survey in [ACHS I yyyy], and had |__|__| children.


10-1.

Since that time, how many live-born children did you have?


____ ____ NUMBER OF LIVEBIRTHS

88 . . . . . . . DK

99 . . . . . . . REF



10-2.

Since the first Anniston survey, how many children did you adopt?


____ ____ NUMBER OF ADOPTEES

88 . . . . . . . DK

99 . . . . . . . REF



10-3.

Since the first Anniston survey, you have (SUM OF 10-1 + 10-2) new children.


____ ____ TOTAL NUMBER OF NEW CHILDREN

88 . . . . . . . DK

99 . . . . . . . REF




10-4.

How many children under the age of 19 years are currently living in your household? These may include children you already had during the first Anniston survey.


____ ____ TOTAL NUMBER OF CHILDREN

88 . . . . . . . DK

99 . . . . . . . REF


IF TOTAL NUMBER OF CHILDREN IN HOUSEHOLD = 00

--- SKIP TO SECTION 11

ELSE GO TO CHILDREN’S HEALTH FORM C








SECTION 11: WORK HISTORY


Shape19

IF 4-29 = 05-99 > SKIP TO 11-3






Previously you told me that you have worked at least part of the time in the past 12 months.



11-1.

What kind of business or industry was this? If you worked at more than one job in the past 12 months, please describe the one that you worked the most hours.

(EXAMPLE: HOSPITAL, NEWSPAPER PUBLISHING, MAIL ORDER HOUSE, AUTO ENGINE MANUFACTURING, BANK)


SPECIFY: _______________________

8888 DK

9999 REF



11-2. In the past 12 months, what kind of work did you do?

(EXAMPLE: REGISTERED NURSE, PERSONNEL MANAGER, SUPERVISOR OF ORDER DEPARTMENT, SECRETARY, ACCOUNTANT)


SPECIFY: _______________________

8888 DK

9999 REF




The next questions ask about the places you have worked.


11-3.

Have you ever worked for Monsanto or Solutia?


01 . . . YES

02 . . . NO . . . . . . . . . . . . . . . SKIP TO 11-6

88 . . . DK . . . . . . . . . . . . . . . SKIP TO 11-6

99 . . . REF . . . . . . . . . . . . . . . SKIP TO 11.6



11-4.

Tell me all the time periods you worked for either company.

[SHOW CARD Y]


We are interested in three periods: first, 1971 and before when Monsanto was still producing PCBs; second, between 1972 and 1996, when Monsanto stopped making PCBs; and third, from 1997 to now when Solutia became the owners.


Did you work at any time from . . . ?




YES

NO

DK

REF


11-4a.

1971 and before?

01

02

88

99


11-4b.

1972 to 1996?

01

02

88

99


11-4c.

1997 to now?

01

02

88

99




11-5.

What type of work did you do at either Monsanto or Solutia?

[SHOW CARD Z] Did you ever work in , , ,




YES

NO

DK

REF


11-5a.

Production of PCBs?

01

02

88

99


11-5b.

Production of non-PCB chemicals?

01

02

88

99


11-5c.

Maintenance?

01

02

88

99


11-5d.

Other technical?

01

02

88

99


11-5e.

Administrative?

01

02

88

99


11-5f.

For the company but not at the Anniston site?

01

02

88

99




Since the first Anniston survey or [ACHS I yyyy], have you worked at a job where you might have been exposed to any of the following substances? [SHOW CARD AA]



YES

NO

DK

REF

11-6.

Fertilizers

01

02

88

99

11-7.

Pesticides

01

02

88

99

11-8.

Herbicides

01

02

88

99

11-9.

Solvents

01

02

88

99

11-10.

Electrical Transformers

01

02

88

99

11-11.

Ionizing Radiation

01

02

88

99

11-12.

PCBs

01

02

88

99

11-13.

Heavy metals such as Lead, Boron, Manganese, Mercury, or Cadmium

01

02

88

99

11-14.

Welding Fumes

01

02

88

99


Shape20

IF 11-6, 11-7, AND 11-8 = 02-99 --- SKIP TO 11-16 TRANSITION






11-15.

What type of work did you do when you may have been exposed to fertilizers, pesticides, or herbicides? If you worked in more than one job, tell me about each one.


11-15a. SPECIFY: _______________________

8888 DK

9999 REF


11-15b. SPECIFY: _______________________

8888 DK

9999 REF


11-15c. SPECIFY: _______________________

8888 DK

9999 REF



The next questions are about any military history since the first Anniston survey. Again, our records show that you took part in the first survey in [ACHS I yyyy].


11-16.

Since that time, have you entered the military?


01 . . . YES

02 . . . NO . . . . . . . . . . . . SKIP TO 11-22.

88 . . . DK . . . . . . . . . . . . SKIP TO 11-22.

99 . . . REF . . . . . . . . . . . SKIP TO 11-22.



11-17.

What branch of the service did you join?


01 . . . ARMY

02 . . . NAVY

03 . . . AIR FORCE

04 . . . MARINES

05 . . . COAST GUARD

07 . . . OTHER: 11-17a. SPECIFY _____________________________

88 . . . DK

99 . . . REF



11-18.

What was your start date of military service?


____ ____ / ____ ____ ____ ____ MONTH / YEAR

888888 . . . . . . . . . . . . . . . . . . . . . . DK

999999 . . . . . . . . . . . . . . . . . . . . . . REF



11-19.

What was your end date of military service?


____ ____ / ____ ____ ____ ____ MONTH / YEAR

777777 . . . . . . . . . . . . . . . . . . . . . . CURRENTLY IN SERVICE

888888 . . . . . . . . . . . . . . . . . . . . . . DK

999999 . . . . . . . . . . . . . . . . . . . . . . REF



11-20.

Were you deployed in the Middle East after the first Anniston survey?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF



11-21.

Were you deployed in the Afghanistan after the first Anniston survey?


01 . . . YES

02 . . . NO

88 . . . DK

99 . . . REF




11-22.

Is your annual household income from all sources ….. ? [SHOW CARD AB]


01 . . . LESS THAN $15,000

02 . . . $15,000 - $34,999

03 . . . $35,000 - $49,999

04 . . . $50,000 OR MORE

88 . . . DK

99 . . . REF



END. Thank you for participating in this study. Our research team greatly appreciates your time and cooperation in answering our questions. The information you provided is important. Thank you.



TIME INTERVIEW ENDED: _____ _____ : _____ _____


a.m.


p.m.



DATE OF INTERVIEW: ____ ____ / ____ ____ / ____ ____





SECTION C: CHILDREN’S HEALTH FORM


Shape21

USE PART 1 ONLY FOR NEW CHILDREN SINCE FIRST ANNISTON SURVEY

IF NO NEW CHILDREN, SKIP TO PART 3.







Part 1. The next questions ask about the health history of any new children you had since the first Anniston survey. You just told me that you had |__|__| new children since then. Starting with the youngest, please answer the following questions about each new child.


New Child No.

NC-1. Is this your child or an adopted child?

NC-2. What is the child’s date of birth?

NC-3. What sex is the child?

NC-4. What was the child’s birth weight?

NC-5. Was the child’s birth premature?

NC-6. How many years has the child lived in Anniston?

NC-7. Was the mother in Anniston during her pregnancy?

For New Child 1, ……

NC-1-1.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-1.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-1.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-1.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-1.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-1.

__ __

Y Y

88…DK

99…REF

NC-7-1.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 2, ……

NC-1-2.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-2.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-2.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-2.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-2.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-2.

__ __

Y Y

88…DK

99…REF

NC-7-2.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 3, ……

NC-1-3.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-3.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-3.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-3.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-3.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-3.

__ __

Y Y

88…DK

99…REF

NC-7-3.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 4, ……

NC-1-4.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-4.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-4.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-4.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-4.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-4.

__ __

Y Y

88…DK

99…REF

NC-7-4.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 5, ……

NC-1-5.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-5.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-5.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-5.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-5.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-5.

__ __

Y Y

88…DK

99…REF

NC-7-5.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 6, ……

NC-1-6.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-6.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-6.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-6.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-6.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-6.

__ __

Y Y

88…DK

99…REF

NC-7-6.

01 …YES

02 … NO

88 … DK

99 … REF


SECTION C Part 1: continued


New Child No.

NC-1. Is this your child or an adopted child?

NC-2. What is the child’s date of birth?

NC-3. What sex is the child?

NC-4. What was the child’s birth weight?

NC-5. Was the child’s birth premature?

NC-6. How many years has the child lived in Anniston?

NC-7. Was the mother in Anniston during her pregnancy?

For New Child 7, ……

NC-1-7.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-7.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-7.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-7.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-7.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-7.

__ __

Y Y

88…DK

99…REF

NC-7-7.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 8, ……

NC-1-8.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-8.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-8.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-8.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-8.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-8.

__ __

Y Y

88…DK

99…REF

NC-7-8.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 9, ……

NC-1-9.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-9.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-9.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-9.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-9.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-9.

__ __

Y Y

88…DK

99…REF

NC-7-9.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 10, ……

NC-1-10.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-10.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-10.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-10.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-10.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-10.

__ __

Y Y

88…DK

99…REF

NC-7-10.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 11 ……

NC-1-11.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-11.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-11.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-11.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-11.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-11.

__ __

Y Y

88…DK

99…REF

NC-7-11.

01 …YES

02 … NO

88 … DK

99 … REF

For New Child 12, ……

NC-1-12.

01 … MY CHILD

02 … ADOPTED

88 … DK

99 … REF

NC-2-12.

__/__/______

MM/DD/YYYY

88888888 … DK

99999999 … REF

NC-3-12.

01 … MALE

02 … FEMALE

88 … DK

99 … REF

NC-4-12.

__ __

LB OZ

8888 … DK

9999 … REF

NC-5-12.

01 …YES

02 … NO

88 … DK

99 … REF

NC-6-12.

__ __

Y Y

88…DK

99…REF

NC-7-12.

01 …YES

02 … NO

88 … DK

99 … REF









SECTION C Part 2

Shape22

USE PART 2 ONLY FOR NEW CHILDREN SINCE FIRST ANNISTON SURVEY


FOR EACH CONDITION OR ILLNESS THAT A CHILD HAS, ASK WHICH ONE OF THE CHILDREN HAS IT, AND HOW OLD HE OR SHE WAS WHEN FIRST TOLD.

USE THE SAME NUMBER ASSIGNED IN PART 1 WITH THE YOUNGEST CHILD AS “NC1”. CODE EACH NEW CHILD AS NC1, NC2, NC3, ETC.











PART 2.

In Part 2, we are still asking questions about any new children you had since the first Anniston survey. Has a doctor ever said any of your new children had the following health conditions or illnesses? [SHOW CARD C-1]





YES

NO

DK

REF

WHICH CHILD?

CHILD’S AGE?



C-13.

Cancer?

01

02

88

99

C-13b.

C-13c.



C-13a.

(If yes) What kind? _______________________________________



C-14.

Kidney disease?

01

02

88

99

C-14b.

C-14c.



C-15.

Heart problems?

01

02

88

99

C-15b.

C-15c.



C-16.

Hyperthyroidism? (overactive)

01

02

88

99

C-16b.

C-16c.



C-17.

Hypothyroidism? (underactive)

01

02

88

99

C-17b.

C-17c.



C-18.

Hearing problems?

01

02

88

99

C-18b.

C-18c.



C-19.

Learning disability?

01

02

88

99

C-19b.

C-19c.



C-20.

Attention deficit hyperactivity disorder?

01

02

88

99

C-20b.

C-20c.



C-21.

Asthma?

01

02

88

99

C-21b.

C-21c..



C-22.

Allergies?

01

02

88

99

C-22b.

C-22c.



C-23.

Epilepsy or seizures?

01

02

88

99

C-23b.

C-23c.



C-24.

Diabetes?

01

02

88

99

C-24b.

C-25c.



C-25.

Frequent ear infection?

01

02

88

99

C-25b.

C-25c.



C-26.

Mononucleosis or EBV?

01

02

88

99

C-26b.

C-26c.



C-27.

Juvenile arthritis?

01

02

88

99

C-27b.

C-27c.


C-28

Finally, any other autoimmune disease? Here are some examples …. [SHOW CARD C-2]

01

02

88

99

C-28b.

C-28c.

C-28a.

(If yes) What kind? __________________________________________





SECTION C Part 3:

Shape23

USE PART 3 ONLY FOR CHILDREN FORMERLY REPORTED IN FIRST ANNISTON SURVEY. FOR EACH CONDITION OR ILLNESS THAT A CHILD HAS, ASK WHICH ONE OF THE CHILDREN HAS IT, AND HOW OLD HE OR SHE WAS WHEN FIRST TOLD. IF NO NEW CHILDREN, BEGIN PART 3. NUMBER FORMER CHILDREN FROM YOUNGEST TO OLDEST. CODE EACH FORMER CHILD AS FC1, FC2, FC3, ETC.










PART 3.


In Part 3, we are now asking questions about the children you already had during the first Anniston survey. Has a doctor ever said any of these children had the following health conditions or illnesses? [SHOW CARD C-3]




YES

NO

DK

REF

WHICH CHILD?

CHILD’S AGE?


C-32.

Cancer?

01

02

88

99

C-32b

C-32c


C-32a.

(If yes) What kind? _______________________________________


C-33.

Kidney disease?

01

02

88

99

C-33b

C-33c


C-34.

Heart problems?

01

02

88

99

C-34b

C-34c


C-35.

Hyperthyroidism? (overactive)

01

02

88

99

C-35b

C-35c


C-36.

Hypothyroidism? (underactive)

01

02

88

99

C-36b

C-36c


C-37.

Hearing problems?

01

02

88

99

C-37b

C-37c


C-38.

Learning disability?

01

02

88

99

C-39b

C-39c


C-39.

Attention deficit hyperactivity disorder?

01

02

88

99

C-40b

C-40c


C-40.

Asthma?

01

02

88

99

C-41b

C-41c


C-41.

Allergies?

01

02

88

99

C-42b

C-42c


C-42.

Epilepsy or seizures?

01

02

88

99

C-43b

C-43c


C-43.

Diabetes?

01

02

88

99

C-44b

C-44c


C-43.

Frequent ear infection?

01

02

88

99

C-45b

C-45c


C-44.

Mononucleosis or EBV?

01

02

88

99

C-48b

C-48c


C-44.

Juvenile arthritis?

01

02

88

99

C-49b

C-49c



C-46.

Finally, any other autoimmune disease? Here are some examples …. [SHOW CARD C-4]

01

02

88

99

C-50b

C-50c


C-46a.

(If yes) What kind? __________________________________________



Shape24

CONTINUE TO SECTION 11


SECTION F: FEMALE PREGNANCY FORM (for women with any pregnancies since the first Anniston survey)


The next questions ask about each of your pregnancies since the first Anniston survey. You just told me that you’ve had |__|__| pregnancies since then. Let’s go through each one.


Pregnancy No.

F-1. What year did you become pregnant?

F-2. How old were you?

F-3. What method of birth control were you using 12 months before you became pregnant? [SHOW CARD F-1]

F-4. Did you plan to become pregnant?

F-5. What was the outcome of the pregnancy?

[SHOW CARD F-2]

F-6. Did you smoke cigarettes while you were pregnant?

F-7. Did you drink alcohol while you were pregnant?

F-8. Did you breastfeed this child?

F-8a. (If yes) how many months did you breastfeed?

For Pregnancy 1, ……

F-1-1.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-1.

__ __

Y Y

88…DK

99…REF

F-3-1.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-1.

1 …YES

2 … NO

8 … DK

9 … REF

F-5-1.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-1.

1 …YES

2 … NO

8 … DK

9 … REF

F-7-1.

1 …YES

2 … NO

8 … DK

9 … REF

F-8-1.

1 …YES

2 … NO

8 … DK

9 … REF

F-8a-1.

__ __

M M

88…DK

99…REF

For Pregnancy 2, ……

F-1-2.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-2.

__ __

YY

88…DK

99…REF

F-3-2.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-2.

1 …YES

2 … NO

8 … DK

9 … REF

F-5-2.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-2.

1 …YES

2 … NO

8 … DK

9 … REF

F-7-2.

1 …YES

2 … NO

8 … DK

9 … REF

F-8-2.

1 …YES

2 … NO

8 … DK

9 … REF

F-8a-2.

__ __

M M

88…DK

99…REF

For Pregnancy 3, ……

F-1-3.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-3.

__ __

YY

88…DK

99…REF

F-3-3.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-3.

1 …YES

2 … NO

8 … DK

9 … REF

F-5-3.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-3.

1 …YES

2 … NO

8 … DK

9 … REF

F-7-3.

1 …YES

2 … NO

8 … DK

9 … REF

F-8-3.

1 …YES

2 … NO

8 … DK

9 … REF

F-8a-3.

__ __

M M

88…DK

99…REF


SECTION F: continued


Pregnancy No.

F-1. What year did you become pregnant?

F-2. How old were you?

F-3. What method of birth control were you using 12 months before you became pregnant? [SHOW CARD F-1]

F-4. Did you plan to become pregnant?

F-5. What was the outcome of the pregnancy?

[SHOW CARD F-2]

F-6. Did you smoke cigarettes while you were pregnant?

F-7. Did you drink alcohol while you were pregnant?

F-8. Did you breastfeed this child?

F-8a. (If yes) how many months did you breastfeed?

For Pregnancy 4, ……

F-1-4.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-4.

__ __

YY

88…DK

99…REF

F-3-4.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-4.

01 …YES

02 … NO

88 … DK

99 … REF

F-5-4.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-4.

01 …YES

02 … NO

88 … DK

99 … REF

F-7-4.

01 …YES

02 … NO

88 … DK

99 … REF

F-8-4.

01 …YES

02 … NO

88 … DK

99 … REF

F-8a-4.

__ __

M M

88…DK

99…REF

For Pregnancy 5, ……

F-1-5.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-5.

__ __

YY

88…DK

99…REF

F-3-5.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-5.

01 …YES

02 … NO

88 … DK

99 … REF

F-5-5.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-5.

01 …YES

02 … NO

88 … DK

99 … REF

F-7-5.

01 …YES

02 … NO

88 … DK

99 … REF

F-8-5.

01 …YES

02 … NO

88 … DK

99 … REF

F-8a-5.

__ __

M M

88…DK

99…REF

For Pregnancy 6, ……

F-1-6.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-6.

__ __

YY

88…DK

99…REF

F-3-6.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-6.

01 …YES

02 … NO

88 … DK

99 … REF

F-5-6.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-6.

01 …YES

02 … NO

88 … DK

99 … REF

F-7-6.

01 …YES

02 … NO

88 … DK

99 … REF

F-8-6.

01 …YES

02 … NO

88 … DK

99 … REF

F-8a-6.

__ __

M M

88…DK

99…REF



SECTION F: continued


Pregnancy No.

F-1. What year did you become pregnant?

F-2. How old were you?

F-3. What method of birth control were you using 12 months before you became pregnant? [SHOW CARD F-1]

F-4. Did you plan to become pregnant?

F-5. What was the outcome of the pregnancy?

[SHOW CARD F-2]

F-6. Did you smoke cigarettes while you were pregnant?

F-7. Did you drink alcohol while you were pregnant?

F-8. Did you breastfeed this child?

F-8a. (If yes) how many months did you breastfeed?

For Pregnancy 7, ……

F-1-7.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-7.

__ __

YY

88…DK

99…REF

F-3-7.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-7.

01 …YES

02 … NO

88 … DK

99 … REF

F-5-7.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-7.

01 …YES

02 … NO

88 … DK

99 … REF

F-7-7.

01 …YES

02 … NO

88 … DK

99 … REF

F-8-7.

01 …YES

02 … NO

88 … DK

99 … REF

F-8a-7.

__ __

M M

88…DK

99…REF

For Pregnancy 8, ……

F-1-8.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-8.

__ __

YY

88…DK

99…REF

F-3-8.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-8.

01 …YES

02 … NO

88 … DK

99 … REF

F-5-8.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-8.

01 …YES

02 … NO

88 … DK

99 … REF

F-7-8.

01 …YES

02 … NO

88 … DK

99 … REF

F-8-8.

01 …YES

02 … NO

88 … DK

99 … REF

F-8a-8.

__ __

M M

88…DK

99…REF

For Pregnancy 9, ……

F-1-9.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

F-2-9.

__ __

YY

88…DK

99…REF

F-3-9.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

F-4-9.

01 …YES

02 … NO

88 … DK

99 … REF

F-5-9.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

F-6-9.

01 …YES

02 … NO

88 … DK

99 … REF

F-7-9.

01 …YES

02 … NO

88 … DK

99 … REF

F-8-9.

01 …YES

02 … NO

88 … DK

99 … REF

F-8a-9.

__ __

M M

88…DK

99…REF

Shape25

CONTINUE TO 8-6



SECTION L: LOCAL FOOD FORM


I am going to ask you about local foods you may have eaten in four different times in the past. You may have eaten these local foods during some time periods but not others. Try to remember as best as you can.



  • One time period is 1971 and before when PCBs were still produced here in Anniston.


  • A second time period is from 1972 to 1993. This is the time when PCBs were no longer made but public awareness was low and cleanup of the environment did not start.


  • A third time period is from 1994-2005. This is the time when problems with PCB contamination became public, ADPH issued fish advisories, and PCB litigation occurred.


  • We are also interested in the time period between the first Anniston survey and today. Let’s say from 2006 to now.



For each of the time periods I just described, I would like to know how often you ate each local food. Tell me if you never ate it, ate it regularly, or ate it only part of the time. [SHOW CARD L-1]





SECTION L: LOCAL FOOD FORM


Local Food

L-1. Have you ever eaten [FOOD NAME] from 1971 and earlier?

L-2. From 1971 and earlier, how often did you eat [FOOD NAME]?

L-3. Have you ever eaten [FOOD NAME] from 1972 to 1993?

L-4. From 1972 to 1993, how often did you eat [FOOD NAME]?

L-5. Have you ever eaten [FOOD NAME] from 1994 to 2005?

L-6. From 1994 to 2005, how often did you eat [FOOD NAME]?

L-7. Have you ever eaten [FOOD NAME] from 2006 to now?

L.8. From 2006 to now, how often did you eat [FOOD NAME]?

.

If 6-63 = 02,88,99 > SKIP TO L.1.2


Fish from Coosa River Basin

L-1-1.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-1.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-1.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-1.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-1.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-1.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-1.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-1.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

If 6-82 = 02,88,99 > SKIP TO L.1.3


Local Chicken

L-1-2.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-2.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-2.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-2.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-2.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-2.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-2.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-2.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

If 6-83 = 02,88,99 > SKIP TO L.1.4


Local Eggs

L-1-3.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-3.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-3.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-3.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-3.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-3.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-3.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-3.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF











SECTION L: continued


Local Food

L-1. Have you ever eaten [FOOD NAME] from 1971 and earlier?

L-2. From 1971 and earlier, how often did you eat [FOOD NAME]?

L-3. Have you ever eaten [FOOD NAME] from 1972 to 1993?

L-4. From 1972 to 1993, how often did you eat [FOOD NAME]?

L-5. Have you ever eaten [FOOD NAME] from 1994 to 2005?

L-6. From 1994 to 2005, how often did you eat [FOOD NAME]?

L-7. Have you ever eaten [FOOD NAME] from 2006 to now?

L.8. From 2006 to now, how often did you eat [FOOD NAME]?

.

If 6-84 = 02,88,99 > GO TO L.1.5


Local Dairy,Milk, Cheese

L-1-4.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-4.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-4.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-4.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-4.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-4.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-4.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-4.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

If 6-85 = 02,88,99 > GO TO L.1.6


Local Beef, Beef Products

L-1-5.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-5.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-5.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-5.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-5.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-5.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-5.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-5.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

If 6-86 = 02,88,99 > GO TO L.1.7


Local Pork, Pork Products

L-1-6.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-6.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-6.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-6.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-6.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-6.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-6.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-6.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF



SECTION L: continued


Local Food

L-1. Have you ever eaten [FOOD NAME] from 1971 and earlier?

L-2. From 1971 and earlier, how often did you eat [FOOD NAME]?

L-3. Have you ever eaten [FOOD NAME] from 1972 to 1993?

L-4. From 1972 to 1993, how often did you eat [FOOD NAME]?

L-5. Have you ever eaten [FOOD NAME] from 1994 to 2005?

L-6. From 1994 to 2005, how often did you eat [FOOD NAME]?

L-7. Have you ever eaten [FOOD NAME] from 2006 to now?

L.8. From 2006 to now, how often did you eat [FOOD NAME]?

.

If 6-87 = 02,88,99 > GO TO L.1.8


Woodcock or Dove

L-1-7.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-7.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-7.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-7.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-7.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-7.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-7.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-7.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

If 6-88 = 02,88,99 > GO TO L.1.9


Quail or Wild Turkey

L-1-8.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-8.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-8.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-8.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-8.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-8.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-8.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-8.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

If 6-89 = 02,88,99 > GO TO L.1.10


Duck or Goose

L-1-9.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-9.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-9.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-9.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-9.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-9.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-9.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-9.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF


SECTION L: continued


Local Food

L-1. Have you ever eaten [FOOD NAME] from 1971 and earlier?

L-2. From 1971 and earlier, how often did you eat [FOOD NAME]?

L-3. Have you ever eaten [FOOD NAME] from 1972 to 1993?

L-4. From 1972 to 1993, how often did you eat [FOOD NAME]?

L-5. Have you ever eaten [FOOD NAME] from 1994 to 2005?

L-6. From 1994 to 2005, how often did you eat [FOOD NAME]?

L-7. Have you ever eaten [FOOD NAME] from 2006 to now?

L.8. From 2006 to now, how often did you eat [FOOD NAME]?

.

If 6-90 = 02,88,99 > GO TO L.1.11


Deer or Other Large Game

L-1-10.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-10.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-10.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-10.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-10.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-10.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-10.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-10.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

If 6-91 = 02,88,99 > GO TO L.1.12


Squirrel, Rabbit, or Other Small Game

L-1-11.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-11.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-11.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-11.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-11.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-11.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-11.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-11.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

If 6-92 = 02,88,99 > GO TO SECTION 9


Clay

L-1-12.

01 … YES

02 … NO

88 … DK

99 … REF

L-2-12.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-3-12.

01 … YES

02 … NO

88 … DK

99 … REF

L-4-12.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-5-12.

01 … YES

02 … NO

88 … DK

99 … REF

L-6-12.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

L-7-12.

01 … YES

02 … NO

88 … DK

99 … REF

L-8-12.

01 … LESS THAN ONCE A YEAR

02 … A FEW TIMES PER YEAR

03 … MONTHLY

04 … WEEKLY

05 … DAILY

88 … DK

99 … REF

Shape27 Shape26

GO TO SECTION 7


CONTINUE TO SECTION 12



SECTION M: MALE FATHERING FORM

Shape28

USE IF NUMBER OF PREGNANCIES SINCE FIRST ANNISTON SURVEY

IS GREATER THAN 0







The next questions ask about each of your pregnancies since the first Anniston survey. You just told me that you’ve fathered |__|__| (pregnancy/pregnancies) since then. Let’s go through each one.


Pregnancy No.

M-1. What year did you father a pregnancy?

M-2. How old were you?

M-3. What method of birth control were you using 12 months before your partner became pregnant? (Mark all that apply.) [SHOW CARD M-1]

M-4. Did you plan for your partner to become pregnant?

M-5. What was the outcome of the pregnancy?

[SHOW CARD M-2]

For Pregnancy 1, ……

M-1-1.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

M-2-1.

__ __

Y Y

88…DK

99…REF

M-3-1.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

M-4-1.

01 …YES

02 … NO

88 … DK

99 … REF

M-5-1.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

For Pregnancy 2, ……

M-1-2.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

M-2-2.

__ __

Y Y

88…DK

99…REF

M-3-2.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

M-4-2.

01 …YES

02 … NO

88 … DK

99 … REF

M-5-2.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

For Pregnancy 3, ……

M-1-3.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

M-2-3.

__ __

Y Y

88…DK

99…REF

M-3-3.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

M-4-3.

01 …YES

02 … NO

88 … DK

99 … REF

M-5-3.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF


SECTION M: continued


Pregnancy No.

M-1. What year did you father a pregnancy?

M-2. How old were you?

M-3. What method of birth control were you using 12 months before your partner became pregnant? (Mark all that apply.) [SHOW CARD M-1]

M-4. Did you plan for your partner to become pregnant?

M-5. What was the outcome of the pregnancy?

[SHOW CARD M-2]

For Pregnancy 4, ……

M-1-4.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

M-2-4.

__ __

Y Y

88…DK

99…REF

M-3-4.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

M-4-4.

01 …YES

02 … NO

88 … DK

99 … REF

M-5-4.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

For Pregnancy 5, ……

M-1-5.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

M-2-5.

__ __

Y Y

88…DK

99…REF

M-3-5.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

M-4-5.

01 …YES

02 … NO

88 … DK

99 … REF

M-5-5.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF

For Pregnancy 6, ……

M-1-6.

__ __ __ __

Y Y Y Y

8888…DK

9999…REF

M-2-6.

__ __

Y Y

88…DK

99…REF

M-3-6.

01 … NONE

02 … BC PILL/RING/

IMPLANT/PATCH

03 … CONDOM

04 … DIAPHRAGM

05 … IUD

06 … JELLY/FOAM

07 … NATURAL FAMILY PLANNING

88 … DK

99 … REF

M-4-6.

01 …YES

02 … NO

88 … DK

99 … REF

M-5-6.

01 … ABORTION

02 … ECTOPIC PREGNANCY

03 … MISCARRIAGE

04 … SINGLETON

05 … STILLBIRTH

06 … TWINS

07 … TRIPLETS OR MORE

88 … DK

99 … REF





Shape29

CONTINUE TO 9-4



Attachment 3.13c

Anniston Community Health Survey: Follow up Study and Dioxin Analyses

Interviewer’s Booklet (Supplement to Questionnaire)



Includes response cards as visual aids for:

  1. Questionnaire Sections 1-11

  2. Optional Forms C, F, L, M



Interviewer Instructions:


  1. Flip through the booklet in the order of the interview.

  2. Display the response choices for each item to aid participant recall.

  3. For each item, if participant has difficulty choosing from among response choices, ask probing questions to help increase recall.



SECTION 3. CHRONIC HEALTH CONDITIONS SINCE ACHS



CARD A. HEALTH CONDITIONS


Cancer

Stroke

Liver disease

Kidney disease (not kidney stones, bladder infection or incontinence)

Heart attack (myocardial infarction)

Congestive heart failure

Coronary heart disease (angina)

High blood cholesterol

Hearing problems

Cataracts

Glaucoma

Parkinson’s Disease

Epilepsy or seizures

Asthma

COPD, emphysema, or chronic bronchitis

Hyperthyroidism (overactive)

Hypothyroidism (underactive)

Rheumatoid arthritis or osteoarthritis

Other






Shape30


CARD B. OTHER AUTOIMMUNE DISEASES


Crohn’s Disease

Fibromyalgia

Multiple Sclerosis

Psoriasis

Scleroderma

Systemic Lupus Erythematosis or Lupus

Other


SECTION 3. OTHER AUTOIMMUNE DISEASES





SECTION 3. BLOOD RELATIVES

Shape31


CARD C. BLOOD RELATIVES


Child

Parent

Brother

Sister

Grandmother

Grandfather

Aunt

Uncle

Cousin





















SECTION 3. OTHER AUTOIMMUNE DISEASES

Shape32


CARD D. OTHER AUTOIMMUNE DISEASES


Crohn’s Disease

Fibromyalgia

Multiple Sclerosis

Psoriasis

Scleroderma

Systemic Lupus Erythematosis or Lupus

Other







SECTION 4. OUTDOOR ACTIVITIES



CARD E. OUTDOOR ACTIVITIES


Field sports (football, lacrosse, rugby, soccer, softball, baseball)

Gardening (spading, tilling, weeding, digging, filling)

Hiking, jogging, running, or walking

Horseback riding

Hunting game (deer, elk, quail)

Yardwork (mowing, raking, trimming)

Other




SECTION 4. HOME ACTIVITIES



CARD F. HOME ACTIVITIES


Making lead weights, sinkers, or shot

Lead soldering

Carpentry/home renovation

Window/door caulking

Painting, papering house








SECTION 4. YEAR HOME OR BUILDING BUILT



CARD G. YEAR HOME BUILT


Before 1940

1940-1959

1960-1977

1978 or newer






SECTION 4. WATER ACTIVITIES



CARD H. WATER ACTIVITIES


Boating (canoeing, rowing, kayaking, sailing for pleasure or competition)

Fishing from river bank or boat

Scuba diving/Snorkeling

Stream fishing (e.g. in waders)

Swimming (pool)

Surfing/Swimming/Waterskiing (lake, river)

Other





SECTION 4. WATER ACTIVITIES IN ANY ALABAMA LAKES AND RIVERS


MAP A – ALABAMA LAKES AND RIVERS



SECTION 4. LOGAN MARTIN LAKE, CHOCCOLOCCO CREEK, OR SNOW CREEK


MAP B – LOGAN MARTIN LAKE, CHOCCOLOCCO CREEK, OR SNOW CREEK





SECTION 4. PHYSICAL ACTIVITY OR EXERCISE


CARD I - PHYSICAL ACTIVITIES OR EXERCISE


0 1 Active Gaming Devices (Wii Fit, Dance Dance revolution)

0 2 Aerobics video or class

0 3 Backpacking

0 4 Badminton

0 5 Basketball

0 6 Bicycling machine exercise

0 7 Bicycling

0 8 Boating (Canoeing, rowing, kayaking, sailing for pleasure or camping)

0 9 Bowling

1 0 Boxing

1 1 Calisthenics

1 2 Canoeing/rowing in competition

1 3 Carpentry

1 4 Dancing-ballet, ballroom, Latin, hip hop, etc.

1 5 Elliptical/EFX machine exercise

1 6 Fishing from river bank or boat

1 7 Football (also see Touch Football)

1 8 Frisbee

1 9 Gardening (spading, weeding, digging, filling)

2 0 Golf (with motorized cart)

2 1 Golf (without motorized cart)

2 2 Handball

2 3 Hiking – cross-country

2 4 Hockey

2 5 Horseback riding

2 6 Hunting large game – deer, elk

2 7 Hunting small game – quail

2 8 Inline Skating

2 9 Jogging

3 0 Lacrosse

3 1 Mountain climbing

3 2 Mowing lawn

3 3 Paddleball

3 4 Painting/papering house


3 5 Pilates

3 6 Racquetball

3 7 Raking lawn

3 8 Running

3 9 Rock climbing

4 0 Rope skipping

4 1 Rowing machine exercise

4 2 Rugby

4 3 Scuba diving

4 4 Skateboarding

4 5 Skating – ice or roller

4 6 Sledding, tobogganing

4 7 Snorkeling

4 8 Snow blowing

4 9 Snow shoveling by hand

5 0 Snow skiing

5 1 Snowshoeing

5 2 Soccer

5 3 Softball/Baseball

5 4 Squash

5 5 Stair climbing/Stair master

5 6 Stream fishing (e.g. in waders)

5 7 Surfing

5 8 Swimming

5 9 Swimming in laps

6 0 Table tennis

6 1 Tai Chi

6 2 Tennis

6 3 Touch football (also see Football)

6 4 Volleyball

6 5 Walking

6 6 Waterskiing

6 7 Weight lifting

6 8 Wrestling

6 9 Yoga

7 0 Other______


SECTION 4. WORK STATUS



CARD J. WORK STATUS


Employed for wages

Self-employed

Working without pay in a family business or farm

Out of work for less than 1 year

Out of work for more than 1 year

Homemaker

Student, not working

Retired

Unable to work





SECTION 4. WEIGHT CHANGE


CARD K. WEIGHT CHANGE IN PAST YEAR


GAIN NOW IS . . .

WEIGHT STAYED ABOUT THE SAME

LOSS NOW IS . . .

10% +

LARGE

5-9.9%

MODEST

< 5% GAIN

BETWEEN


AND

< 5% LOSS

BETWEEN

5-9.9%

MODEST

10% +

LARGE

IF WEIGHT 1 YEAR AGO WAS . . . .

AND NOW IS

IF WEIGHT 1 YEAR AGO WAS . . . .

81 or less

82-86

87

90

93

94-98

99 or more

86 or less

87-90

91

95

99

100-103

104 or more

90 or less

91-95

96

100

104

105-109

110 or more

94 or less

95-100

101

105

109

110-115

116 or more

99 or less

100-104

105

110

115

116-120

121 or more

104 or less

105-109

110

115

120

121-125

126 or more

108 or less

109-114

115

120

125

126-131

132 or more

112 or less

113-119

120

125

130

131-138

138 or more

117 or less

118-124

125

130

135

136-142

143 or more

122 or less

123-128

129

135

141

142-147

148 or more

126 or less

127-133

134

140

146

147-153

154 or more

130 or less

131-138

139

145

151

152-159

160 or more

135 or less

136-142

143

150

157

158-164

165 or more

140 or less

141-147

148

155

162

163-169

170 or more

144 or less

145-152

153

160

167

168-175

176 or more

148 or less

149-157

158

165

172

173-181

182 or more

153 or less

154-162

163

170

177

178-186

187 or more

158 or less

159-166

167

175

183

184-191

192 or more

162 or less

163-171

172

180

188

189-197

198 or more

166 or less

167-176

177

185

193

194-203

204 or more

171 or less

172-180

181

190

199

200-208

209 or more

176 or less

177-185

186

195

204

205-213

214 or more

180 or less

181-190

191

200

209

210-219

220 or more

184 or less

185-195

196

205

214

215-225

226 or more

189 or less

190-200

201

210

219

220-230

231 or more

194 or less

195-204

205

215

225

226-235

236 or more

198 or less

199-209

210

220

230

231-241

242 or more

202 or less

203-214

215

225

235

236-247

248 or more

207 or less

208-218

219

230

241

242-252

253 or more

212 or less

213-223

224

235

246

247-257

258 or more

216 or less

217-228

229

240

251

252-264

264 or more

220 or less

221-233

234

245

256

257-269

270 or more

225 or less

226-238

239

250

261

262-274

275 or more

230 or less

230-242

243

255

267

268-279

280 or more

234 or less

235-247

248

260

272

273-285

286 or more

238 or less

239-252

253

265

277

278-291

292 or more

243 or less

244-256

257

270

283

284-296

297 or more

248 or less

249-261

262

275

288

289-301

302 or more

252 or less

253-266

267

280

293

294-307

308 or more

256 or less

257-271

272

285

298

299-313

314 or more

261 or less

262-276

277

290

303

304-318

319 or more

266 or less

267-280

281

295

309

310-323

324 or more

270 or less

271-285

286

300

314

315-329

330 or more

274 or less

275-290

291

305

319

320-335

336 or more

279 or less

280-294

295

310

325

326-340

341 or more

284 or less

285-299

300

315

330

331-345

346 or more

288 or less

289-304

305

320

335

336-351

352 or more

  1. Identify current weight in blue column. Place ruler under the corresponding row of weights.

  2. Show row to participant. Ask for weight one year ago.

  3. Identify if weight loss, same weight, or weight gain from appropriate column heading.

  4. If loss or gain, identify if amount is large or moderate.


SECTION 5. ALCOHOL DRINKS



CARD L. ALCOHOL DRINKS


Source: http://rethinkingdrinking.niaaa.nih.gov/WhatCountsDrink/WhatsAstandardDrink.asp

Alternate: set up alcohol drink models as displayed above with appropriate measures of liquid to demonstrate drink servings.






SECTION 6. DIETARY SCREENER FOOD FREQUENCY



CARD M. HOW OFTEN EATEN


Never

Less than once per month

1 – 3 times per month

1 – 2 times per week

3 – 4 times per week

5 – 6 times per week






SECTION 6. MARGARINE USE



CARD N. MARGARINE USE


Didn’t use margarine

Almost never

About ¼ of the time

About ½ of the time

About ¾ of the time

Almost always or always






SECTION 6. FISH SERVING MODELS



DISPLAY FISH SERVING MODELS


Examples:

Shrimp (4 boiled)

Broiled perch (3-oz)

Pan-fried catfish (3-oz)

Canned tuna (¼ cup)

Poached salmon (3-oz)


Source: http://www.enasco.com/c/fcs/Nasco+Food+Replicas/Meat+%26+Protein/Seafood/





SECTION 6. FISH CLEANING METHODS



CARD O. FISH CLEANING METHODS





Source: http://www.adph.org/tox/assets/gethookedonhealth.pdf

SECTION 6. FISH COOKING METHODS



CARD P. FISH COOKING METHODS


Pan fried

Deep fried

Baked or broiled

Boiled or poached

Stew or chowder

Smoked

Grilled

Dried

Pickled

Raw





SECTION 6. PARTS OF FISH EATEN



CARD Q. FISH PARTS


Filet

Cheeks

Eggs

Skin

Liver





SECTION 6. PLACES FOR FISH



CARD R. PLACES FOR FISH


Bought at a store or market

Bought at a restaurant

Bought or caught at a farm

Wild caught





SECTION 6. RANK WHERE FISH CAME FROM



CARD S. RANK PLACES FOR FISH


Most often

Not most or least often, somewhere in between

Least often

Never















SECTION 6. TYPES OF FISH, BOUGHT OR FARMED



CARD T. TYPES OF FISH, BOUGHT OR FARMED


White fish (cod, pollock, whiting, haddock)

Catfish

Clams

Crab

Flounder and other flatfish

King mackerel

Oysters

Salmon steaks or filets

Salmon, canned

Shark

Shrimp

Swordfish

Tilefish

Tuna steaks or filets

Tuna, canned





SECTION 6. EAT FISH CAUGHT FROM ALABAMA WATERS


MAP C – COOSA, ALABAMA, MOBILE RIVER BASINS




SECTION 6. WEISS LAKE OF COOSA RIVER


MAP D – WEISS LAKE, ABOVE WEISS DAM





















SECTION 6. H. NEELY HENRY LAKE OF COOSA RIVER


MAP E – H. NEELY HENRY LAKE, BETWEEN WEISS DAM AND H. NEELY HENRY DAM




















SECTION 6. LOGAN MARTIN LAKE OF COOSA RIVER


MAP F – LOGAN MARTIN LAKE, BETWEEN H. NEELY HENRY DAM AND INTERSTATE 20














SECTION 6. LOGAN MARTIN LAKE BELOW INTERSTATE 20 OF COOSA RIVER


MAP G – LOGAN MARTIN LAKE, CHOCCOLOCCO CREEK, AND SNOW CREEK, BETWEEN INTERSTATE 20 AND LOGAN MARTIN DAM
















SECTION 6. LAY LAKE OF COOSA RIVER


MAP H – LAY LAKE, BETWEEN LOGAN MARTIN DAM AND LAY DAM


















SECTION 6. WILD CAUGHT FISH



CARD U-1. ALABAMA FISH


LARGEMOUTH BASS

STRIPED BASS

SMALLMOUTH BASS

CARP

CHANNEL CATFISH

FLATHEAD

CRAPPIE (BLACK OR WHITE)

BLUEGILL, BREAM, PANFISH

Image Source: U.S. Fish and Wildlife at http://digitalmedia.fws.gov/; NOAA, Great Lakes Environmental Research Laboratory at http://www.glerl.noaa.gov/pubs/photogallery/Fish/index.html



SECTION 6. WILD CAUGHT FISH



CARD U-2. ALABAMA FISH


WALLEYE (PERCH)

YELLOW PERCH

SAUGER (PERCH)


SMALLMOUTH BUFFALO

BIGMOUTH BUFFALO

REDHORSE (SUCKER)

WHITE SUCKER


FRESHWATER DRUM

Image Source: U.S. Fish and Wildlife at http://digitalmedia.fws.gov/; NOAA, Great Lakes Environmental Research Laboratory at http://www.glerl.noaa.gov/pubs/photogallery/Fish/index.html


SECTION 6. WILD GAME



CARD V. WILD GAME


WOODCOCK

DOVE

QUAIL

WILD TURKEY

DUCK

GOOSE

DEER

WILD HOG

SQUIRREL

RABBIT

Image Source: U.S. Fish and Wildlife at http://digitalmedia.fws.gov/


SECTION 8. FEMALE PREGNANCY PROBLEMS



CARD W. FEMALE PREGNANCY PROBLEMS


Not ovulating

Blocked tubes

Problems with the egg not being fertilized

Problems with the fertilized egg implanting in the womb

Endometriosis

Man had fertility problems

Doctor did not find a reason




SECTION 9. MALE FERTILITY PROBLEMS



CARD X. MALE FERTILITY PROBLEMS


Woman had fertility problems

Problems with semen or sperm quality

Doctor did not find a reason







SECTION 11. TIME PERIOD WORKED AT MONSANTO OR SOLUTIA



CARD Y. TIME PERIOD WORKED


1971 and before

1972-1996

1997 to now




  • 1971 and before - Monsanto produced PCBs


  • 1972 and 1996 - Monsanto stopped making PCBs


  • 1997 to now - Solutia became the facility owners.



SECTION 11. TYPE OF WORK AT MONSANTO OR SOLUTIA



CARD Z. TYPE OF WORK


Production of PCBs

Production of non-PCB chemicals

Maintenance

Other technical

Administrative

For the company but not at the Anniston site




SECTION 11. WORKPLACE CHEMICAL EXPOSURES



CARD AA. WORKPLACE EXPOSURES


Fertilizers

Pesticides

Herbicides

Solvents

Electrical transformers

Ionizing radiation

PCBs

Heavy metals

(lead, boron, manganese, mercury, or cadmium)

Welding fumes




SECTION 11. HOUSEHOLD INCOME



CARD AB. HOUSEHOLD INCOME


Less than $15,000

$15,000 - $34,999

$35,000 - $49,999

$50,000 or more






FORM C – CHILDREN’S HEALTH FORM PART 2 (NEW CHILDREN SINCE ACHS)



CARD C-1. HEALTH CONDITIONS


Cancer

Kidney disease

Heart problems

Hyperthyroidism (overactive)

Hypothyroidism (underactive)

Hearing problems

Learning disability

Attention deficit hyperactivity disorder

Asthma

Allergies

Epilepsy or seizures

Diabetes

Frequent ear infection

Mononucleosis or Epstein-Barr Virus

Juvenile arthritis

Other autoimmune disease




FORM C – CHILDREN’S HEALTH FORM PART 2 (NEW CHILDREN SINCE ACHS)



CARD C-2. OTHER AUTOIMMUNE DISEASE


Celiac Disease

Multiple Sclerosis

Psoriasis

Scleroderma

Systemic Lupus Erythematosis or Lupus

Other





FORM C – CHILDREN’S HEALTH FORM PART 3 (CHILDREN PREVIOUSLY REPORTED IN ACHS)



CARD C-3. HEALTH CONDITIONS


Cancer

Kidney disease

Heart problems

Hyperthyroidism (overactive)

Hypothyroidism (underactive)

Hearing problems

Learning disability

Attention deficit hyperactivity disorder

Asthma

Allergies

Epilepsy or seizures

Diabetes

Frequent ear infection

Mononucleosis or Epstein-Barr Virus

Juvenile arthritis

Other autoimmune disease




FORM C – CHILDREN’S HEALTH FORM PART 3 (CHILDREN PREVIOUSLY REPORTED IN ACHS)



CARD C-4. OTHER AUTOIMMUNE DISEASE


Celiac Disease

Multiple Sclerosis

Psoriasis

Scleroderma

Systemic Lupus Erythematosis or Lupus

Other




FORM F – FEMALE PREGNANCY FORM


CARD F-1. BIRTH CONTROL


None

Birth control pill, ring, implant, patch

Condom

Diaphragm

Intrauterine device (IUD)

Jelly or foam

Natural family planning







FORM F – FEMALE PREGNANCY FORM


CARD F-2. PREGNANCY OUTCOME


Abortion

Ectopic pregnancy

Miscarriage

Singleton

Stillbirth

Twins

Triplets or more






FORM L - LOCAL FOODS FORM



CARD L-1. EATING LOCAL FOODS


TIME PERIODS

HOW OFTEN


1971 and before

1972-1993

1994-2005

2006 to now


Less than once a year

A few times a year

Monthly

Weekly

Daily




  • 1971 and before - PCBs were still produced here in Anniston.


  • 1972 to 1993 - PCBs were no longer made, public awareness was low, and cleanup of the environment did not start.


  • 1994-2005 - problems with PCB contamination became public, the health department issued fish advisories, and PCB litigation occurred.


  • 2006 to now - the time period between the first Anniston survey and today.


FORM M – MALE FATHERING FORM


CARD M-1. BIRTH CONTROL


None

Birth control pill, ring, implant, patch

Condom

Diaphragm

Intrauterine device (IUD)

Jelly or foam

Natural family planning







FORM M – MALE FATHERING FORM


CARD M-2. PREGNANCY OUTCOME


Abortion

Ectopic pregnancy

Miscarriage

Singleton

Stillbirth

Twins

Triplets or more



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleTime Interview Began: _____ _____ : _____ _____
Authorrfoushee
File Modified0000-00-00
File Created2021-01-29

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