Prospective Studies of US Military Forces: The Millennium Cohort Study

Prospective Studies of US Military Forces: The Millennium Cohort Study

Millennium Cohort Follow Up Survey

Prospective Studies of US Military Forces: The Millennium Cohort Study

OMB: 0703-0064

Document [pdf]
Download: pdf | pdf
PRIVACY ACT STATEMENT:
You have rights under the Privacy Act. The following statement describes how that Act applies to this
study:
Authority: Authority to request this information is granted under Title 5, U.S. Code 136, Department of
Defense Regulations, Executive Order 9396, DoD RCS#DD-HA(AR)2106 (expires XX/XX/20XX), and
OMB #0720-0029 (expires XX/XX/20XX). Personal identifiers will be used to link survey data with medical
and other military records.
Purpose: Medical research information will be collected in a research project titled "Prospective Studies
of U.S. Military Forces: The Millennium Cohort Study." The project objective is to enhance basic medical
knowledge and to improve the treatment and prevention of illnesses that may be related to military
service.
Routine Uses: The information provided in this questionnaire will be maintained in data files at the
Deployment Health Research Department at the Naval Health Research Center and used only for medical
research purposes. Use of these data may be granted to other federal and non-federal medical research
agencies as approved by the Naval Health Research Center's Institutional Review Board. However, your
personal identifiers will be protected. By signing the original consent form, you volunteered to disclose
your information as identified above. If you do not agree to this disclosure, your failure will make the
research less useful. The "Blanket Routine Uses" that appears at the beginning of the Department of
Defense's compilation of medical databases also applies to this system.
Anonymity: All responses will be held in confidence by the Deployment Health Research Department.
Information you provide will be considered only when statistically summarized with the responses of
others. Your personal identifiers (name, etc.) will only be used to link data sets and then the identifiers will
be stripped from study data such that medical researchers cannot identify you individually.
Voluntary Disclosure: Completion of the questionnaire is voluntary. Failure to respond to any of the
questions will NOT result in any penalties except possible lack of representation of your views in the final
results and outcomes.
PUBLIC BURDEN STATEMENT: The public reporting burden for this collection of information is estimated
to average 45 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing the burden, to the Department of Defense, Washington
Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark
Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100 (0720-0029) Respondents should be
aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to
comply with a collection of information if it does not display a currently valid OMB control number.

MARKING INSTRUCTIONS
• Use blue or black ink.
• Shade circles like this.
• Include additional comments in the open text field on the last page.

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

Very good

Good

Fair

Poor

2. The following questions are about activities you might do during a typical day. Does your health now limit you
in these activities? If so, how much?
Yes, limited
Yes, limited
No, not
a lot
a little
limited at all
a. Vigorous activities, such as running, lifting heavy objects,
or participating in strenuous sports ............................................................
b. Moderate activities, such as moving a table, pushing a
vacuum cleaner, bowling, or playing golf ...................................................
c. Lifting or carrying groceries .......................................................................
d. Climbing several flights of stairs ................................................................
e. Climbing one flight of stairs ........................................................................
f.

Bending, kneeling, or stooping ...................................................................

g. Walking more than a mile ..........................................................................
h. Walking several blocks ..............................................................................
i.

Walking one block ......................................................................................

j.

Bathing or dressing yourself .......................................................................

3. During the past 4 weeks, have you had any of the following problems with your work or other regular daily
activities as a result of your physical health?
No,
Yes,
Yes,
Yes,
none of a little of some of most of
the time the time
the time the time
a. Cut down the amount of time you spent on work
or other activities ........................................................................

Yes, all
of the
time

b. Accomplished less than you would like ...................................
c. Were limited in the kind of work or other activities ....................
d. Had difficulty performing the work or other
activities (for example, it took extra effort) .................................
4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily
activities as a result of any emotional problems (such as feeling depressed or anxious)?
No,
none of
the time

Yes, a
little of
the time

Yes,
some of
the time

Yes,
most of
the time

Yes, all
of the
time

a. Cut down the amount of time you spent
on work or other activities ...........................................................
b. Accomplished less than you would like ...................................
c. Didn't do work or other activities as carefully as usual .............

page 1

2971411779

5. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your
normal social activities with family, friends, neighbors, or groups?
Not at all

Slightly

Moderately

Quite a bit

Extremely

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

Very mild

Mild

Moderate

Severe

Very severe

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

A little bit

Moderately

Quite a bit

Extremely

8. During the past 4 weeks, how much of the time:
(Select the single best answer for each question)

A little
of the
time

None
of the
time
a. Did you feel full of pep? ...........................................

Some
of the
time

Most
of the
time

A good
bit of the
time

All
of the
time

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

Have you felt downhearted and blue? ....................

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

Did you feel tired? .....................................................

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

A little of the time

Some of the time

Most of the time

All of the time

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

Mostly
true

Not
sure

Mostly
false

Definitely
false

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

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

Somewhat better

About the same

Somewhat worse

Much worse

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

Somewhat better

About the same
page 2

Somewhat worse

Much worse
5487411774

13. What is your current marital status? Choose the single best answer.
Single, never married

Now married

Separated

Divorced

Widowed

14. (If not married) Please choose one of the following to describe your current relationship status:
In a committed relationship

Dating casually

Not seeing anyone

15. (If currently married) Taking things all together, how would you describe your marriage?
Very unhappy 1

2

3

4

5

6

7 Very happy

16. Including yourself, how many people currently reside in your household? (please do not include anyone that does
not live and sleep in your household the majority of the time, such as visiting relatives)
adults (18 and older)
children (17 and younger, please include any biological, adopted, or foster children)
17. What is the highest level of education that you have completed? Choose the single best answer.
Less than high school completion
Associate's degree
High school degree, GED, or equivalent

Bachelor's degree

Some college, no degree

Master's, doctorate, or professional degree

18. Since 2001, have you taken any educational courses?
Skip to question 19

No

Yes, at a military institution

Yes, at an academic institution (non-military)
Yes, at a trade or technical school

a. Did you complete a degree/certificate as a result of these courses?
No, didn't complete all the necessary coursework for a degree/certification
No, coursework still in progress
Yes

Year degree or certification completed ....................................

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

Not employed, retired

Part-time (less than 30 hours per week)

Not employed, disabled

Not employed, looking for work

Homemaker

Not employed, not looking for work

Other

(please specify)

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

feet

inches

21. What is your current weight? ................................................................................................

pounds

22. How much did you weigh a year ago? ..................................................................................

pounds

page 3

3498411774

If Yes, in what
year were you
first diagnosed?

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

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

a. Hypertension (high blood pressure) ...................

No

Yes

Hospitalized

b. High cholesterol requiring medication ................

No

Yes

Hospitalized

c. Coronary heart disease ......................................

No

Yes

Hospitalized

d. Heart attack ........................................................

No

Yes

Hospitalized

e. Angina (chest pain) ............................................

No

Yes

Hospitalized

f.

No

Yes

Hospitalized

g. Sinusitis ...............................................................

No

Yes

Hospitalized

h. Chronic bronchitis ...............................................

No

Yes

Hospitalized

i.

Emphysema ........................................................

No

Yes

Hospitalized

j.

Asthma ................................................................

No

Yes

Hospitalized

k. Kidney failure requiring dialysis ..........................

No

Yes

Hospitalized

l.

Bladder infection .................................................

No

Yes

Hospitalized

m. Pancreatitis .........................................................

No

Yes

Hospitalized

n. Diabetes or sugar diabetes .................................

No

Yes

Hospitalized

o. Gallstones ...........................................................

No

Yes

Hospitalized

p. Kidney stones .....................................................

No

Yes

Hospitalized

q. Hepatitis B ...........................................................

No

Yes

Hospitalized

r.

Hepatitis C ..........................................................

No

Yes

Hospitalized

s. Any other Hepatitis ..............................................

No

Yes

Hospitalized

t.

Cirrhosis ..............................................................

No

Yes

Hospitalized

u. Fibromyalgia .......................................................

No

Yes

Hospitalized

v. Rheumatoid Arthritis ...........................................

No

Yes

Hospitalized

w. Degenerative joint disease .................................

No

Yes

Hospitalized

x. Lupus ..................................................................

No

Yes

Hospitalized

y. Multiple Sclerosis ................................................

No

Yes

Hospitalized

Any other heart condition (please specify)

page 4

5140411770

Question 23 continued from the previous page
If Yes, in what
year were you
first diagnosed?

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

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

Crohn's disease ................................................

No

Yes

Hospitalized

aa. Stomach, duodenal, or peptic ulcer ..................

No

Yes

Hospitalized

bb. Ulcerative colitis or proctitis ..............................

No

Yes

Hospitalized

cc. Acid reflux/ gastroesophageal reflux disease
requiring medication .........................................

No

Yes

Hospitalized

dd. Significant hearing loss ....................................

No

Yes

Hospitalized

ee. Significant vision loss even with glasses or
contact lenses ...................................................

No

Yes

Hospitalized

ff.

Memory loss or memory impairment ................

No

Yes

Hospitalized

gg. Tinnitus/ ringing in the ears ..............................

No

Yes

Hospitalized

hh. Migraine headaches .........................................

No

Yes

Hospitalized

ii. Stroke ...............................................................

No

Yes

Hospitalized

jj. Traumatic brain injury (Do not include injuries
that resulted in only a concussion) ...................

No

Yes

Hospitalized

kk. Neuropathy caused reduced sensation
in the hands or feet ...........................................

No

Yes

Hospitalized

ll.

Seizures ............................................................

No

Yes

Hospitalized

mm. Sleep apnea .....................................................

No

Yes

Hospitalized

nn. Anemia .............................................................

No

Yes

Hospitalized

oo. Thyroid condition other than cancer .................

No

Yes

Hospitalized

pp. Cancer (please specify)

No

Yes

Hospitalized

qq. Chronic fatigue syndrome ................................

No

Yes

Hospitalized

rr.

Depression .......................................................

No

Yes

Hospitalized

ss. Schizophrenia or psychosis ..............................

No

Yes

Hospitalized

tt.

No

Yes

Hospitalized

uu. Posttraumatic stress disorder .........................

No

Yes

Hospitalized

vv. Infertility ............................................................

No

Yes

Hospitalized

ww. Other (please specify)

No

Yes

Hospitalized

Manic depressive disorder ...............................

page 5

8674411775

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

No

Yes

k.

Night sweats ..........................

No

Yes

b. Diarrhea ...................................

No

Yes

l.

Chest pain .............................

No

Yes

c. Rash or skin ulcer ....................

No

Yes

m.

Unusual muscle pains ...........

No

Yes

d. Sore throat ...............................

No

Yes

n.

Shortness of breath ...............

No

Yes

e. Frequent bladder infections ....

No

Yes

o.

Trouble sleeping ....................

No

Yes

f.

Cough ......................................

No

Yes

p.

Unusual fatigue .....................

No

Yes

g. Fever .......................................

No

Yes

q.

Forgetfulness ........................

No

Yes

h. Sudden unexplained hair loss ..

No

Yes

r.

Confusion ..............................

No

Yes

i.

Earlobe pain ............................

No

Yes

s.

Other (please specify) ...........

No

Yes

j.

Sleepy all the time.....................

No

Yes

No

Yes

25. Over the past 3 years, have you had back pain, back aching, or back stiffness almost every day
that lasted for 3 months or more in a row? .....................................................................................

26. Over the past 3 years, approximately how many days were you hospitalized
because of illness or injury? (exclude hospitalization for pregnancy and childbirth) .......................

days

27. Over the past 3 years, approximately how many days were you unable to work or perform your
usual activities because of illness or injury? (exclude lost time for pregnancy and childbirth) ........

days

28. During the last 4 weeks, how much have you been bothered by any of the following problems?
Not
bothered

Bothered
a little

Bothered
a lot

a. Stomach pain ......................................................................................................
b. Back pain ............................................................................................................
c. Pain in your arms, legs, or joints (knees, hips, etc) ............................................
d. Pain or problems during sexual intercourse .......................................................
e. Headaches ..........................................................................................................
f.

Chest pain ...........................................................................................................

g. Dizziness .............................................................................................................
h. Fainting spells .....................................................................................................
i.

Feeling your heart pound or race ........................................................................

j.

Shortness of breath .............................................................................................

k. Constipation, loose bowels, or diarrhea ..............................................................
l.

Nausea, gas, or indigestion ................................................................................

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

page 6

0474411775

29. Over the last 2 weeks, how often have you been bothered by any of the following problems?

Not at all

Several
days

More than
half the days

Nearly
every day

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

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

g. Trouble concentrating on things, such as reading the newspaper
or watching television......................................................................
h. Moving or speaking so slowly that other people could have
noticed, or the opposite - being so fidgety or restless that you
have been moving around a lot more than usual ..........................
i.

If you answered "several days" or more to any item above, how difficult have these problems made it for you
to do your work, take care of things at home, or get along with other people?
Not at all difficult

Somewhat difficult

Very difficult

Extremely difficult

30. a. In the last 4 weeks, have you had an anxiety attack - suddenly feeling fear or panic? ..............

No

Yes

No

Yes

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

No

Yes

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

No

Yes

a. Were you short of breath? ..........................................................................................................

No

Yes

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

No

Yes

c.

Did you have chest pain or pressure? ........................................................................................

No

Yes

d. Did you sweat? ............................................................................................................................

No

Yes

e. Did you feel as if you were choking? ..........................................................................................

No

Yes

f.

Did you have hot flashes or chills? .............................................................................................

No

Yes

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

No

Yes

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

No

Yes

i.

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

No

Yes

j.

Did you tremble or shake? ..........................................................................................................

No

Yes

k. Were you afraid you were dying? ...............................................................................................

No

Yes

If you marked NO, please skip to question 32
b. Has this ever happened to you before? ......................................................................................
c.

31. Think about your last bad anxiety attack.

page 7

7711411776

32. Over the last 4 weeks, how often have you been bothered by any of the following problems?
Several
Not at all
days
a. Feeling nervous, anxious, on edge, or worrying a lot about different things

More than
half the days

If you marked NOT AT ALL, please skip to question 33
b. Feeling restless so that it is hard to sit still ....................................................
c. Getting tired very easily .................................................................................
d. Muscle tension, aches, or soreness .............................................................
e. Trouble falling asleep or staying asleep .........................................................
f.

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

g. Becoming easily annoyed or irritable ..............................................................

33. On an average day, how many 8-12 oz beverages containing caffeine do you drink (such as coffee, tea, soda)?
None

1-2 per day

3-5 per day

6-10 per day

11 or more per day

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

Once a week

2-3 times/week

4-7 times/week

8-14 times/week

15 or more times/week

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

No

Yes

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

No

Yes

No

Yes

c.

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

36. In the last 3 years, have you and a partner tried to get pregnant?
No

Yes

Not applicable
If you marked NO or NOT APPLICABLE, skip to question 38

37. If YES, in the last 3 years, have you and a partner been unsuccessful getting pregnant for a year or more
(not including time spent apart, such as deployment)?
No
Yes
38. In the last 3 years, if you and a partner got pregnant, did you have a miscarriage?
Does not apply (no pregnancy)
No miscarriage
Yes, 1 miscarriage

year

Yes, 2 miscarriages

years

Yes, 3 miscarriages

years

page 8

1559411770

40. FOR WOMEN ONLY:

Yes

Does not
apply

Bothered
a little

Bothered
a lot

No

a. Are you currently pregnant? ..............................................................................................
b. Have you given birth within the last 3 years? ..................................................................
c.

In the last 3 years, have you been diagnosed with gestational diabetes by a
glucose tolerance test during pregnancy? ........................................................................

41. During the last 4 weeks, how much have you been bothered by any of the following problems?
Not
bothered
a. Worrying about your health ....................................................................................
b. Your weight or how you look ..................................................................................
c.

Little of no sexual desire or pleasure during sex ...................................................

d. Difficulties with husband/wife, partner/lover, or boyfriend/girlfriend .......................
e. The stress of taking care of children, parents, or other family members ..............
f.

Stress at work outside of the home or at school .....................................................

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

Something bad that happened recently..................................................................

j.

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

42. Please indicate the degree to which the following statements describe your feelings and behavior.
Not at
all
0

1

2

3

4

5

6

Exactly
so
7
8

a. I often find myself getting angry at people or situations .....
b. When I get angry, I get really mad .....................................
c.

When I get angry, I stay angry ...........................................

d. When I get angry at someone, I want to hit or
clobber the person ..............................................................
e. My anger prevents me from getting along with people
as well as I'd like to .............................................................
43. How often in the past month did you get angry with someone and kick/smash something, get into a
fight or hit someone, or threaten someone with physical violence?
Never

1 time

2 times

3-4 times

5 or more times

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

page 9

No

Yes

1447411776

45. In the last 12 months, did you use prescription-strength pain relievers (including any narcotics or medications such as
Codeine, OxyContin, Percocet)?
Never

Once a month

Few days per month

Few days per week

Daily

46. Over the past month, how many hours of sleep did you get in an average 24-hour period? .................

47. Please rate your sleep pattern for the past 2 weeks.
Mild

None

Moderate

Severe

hours

Very
severe

a. Difficulty falling asleep ................................................................
b. Difficulty staying asleep ..............................................................
c.

Problem waking up too early ......................................................

d. Snoring .......................................................................................

48. How satisfied/dissatisfied are you with your current sleep pattern?
Very satisfied

Generally satisfied

Somewhat dissatisfied

Very dissatisfied

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

A little

Somewhat

Much

Very much interfering

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

Barely

Somewhat

Much

Very much noticeable

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

A little

Somewhat

Much

Very much

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

Less than once a week

Once or twice a week

Three or more times a week

53. Do you consider yourself to be:
Heterosexual or straight

Gay or lesbian

Bisexual

54. People are different in their sexual attraction to other people. Which best describes your feelings? Are you:
Only attracted to females

Mostly attracted to males

Mostly attracted to females

Only attracted to males

Equally attracted to females and males

Not sure

55. Choose the single best description of your USUAL daily activities
You sit during the day and do not walk much
You stand or walk a lot during the day, but do not carry or lift things often
You lift or carry light loads, or climb stairs or hills often
You do heavy work or carry heavy loads often
page 10

1679411773

On those days,
how many
minutes per day
on average do
you exercise

56. In a typical week, how much time do you spend participating in...
(Please mark both your typical "days per week"
# of days per
and "minutes per day" doing these activities)
week you exercise
a. STRENGTH TRAINING or work that strengthens
your muscles? (such as lifting/pushing/pulling weights)
b. VIGOROUS exercise or work that causes heavy
sweating or large increases in breathing or heart
rate? (such as running, active sports, marching,
biking)
c.

AND
days

OR

None
Cannot physically do

OR

None
Cannot physically do

minutes

days
AND
days

57. In the past month have you experienced…?

None
Cannot physically do

minutes
AND

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

OR

minutes

Not at all A little bit
a. Repeated, disturbing memories of stressful
experiences from the past ................................................

Moderately Quite a bit

Extremely

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

Loss of interest in activities that you used to enjoy ..........

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

Feeling as if your future will somehow be cut short ..........

j.

Trouble falling asleep or staying asleep ...........................

k.

Feeling irritable or having angry outbursts ........................

l.

Difficulty concentrating ......................................................

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

Thinking about all items in question 57 a-q above, how difficult have these problems made it for you to
do your work, take care of things at home, or get along with other people?
Not at all difficult

s.

Somewhat difficult

Very difficult

Extremely difficult

Thinking about all items in question 57 a-q above, did these problems cause you to feel distress?
Not at all

A little bit

Moderately

Quite a bit
page 11

Extremely
9560411770

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

hours per day

59. From the following list, indicate if you have used each health practice in the last 12 months.
a. Acupuncture ............................

No

Yes

i.

High dose / megavitamin therapy

No

Yes

b. Biofeedback ............................

No

Yes

j.

Homeopathy ..............................

No

Yes

c. Chiropractic care .....................

No

Yes

k. Hypnosis ...................................

No

Yes

d. Energy healing ........................

No

Yes

l.

Massage ....................................

No

Yes

e. Folk remedies ..........................

No

Yes

m. Relaxation .................................

No

Yes

f.

No

Yes

n. Spiritual healing .........................

No

Yes

g. Yoga .......................................

No

Yes

o. Meditation ..................................

No

Yes

h. Movement therapy ...................

No

Yes

p. Breathing techniques ................

No

Yes

60. If you answered "Yes", to any item in question 59 above, has your level of satisfaction with
conventional medicine led you to seek alternative health practices? ................................................

No

Yes

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

No

Yes

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

No

Yes

c.

Weight loss supplements ............................................................................................................

No

Yes

d. Hormones for muscular strength, enhancement, or performance .............................................

No

Yes

Herbal therapy .........................

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

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

A little bit

Moderately

Quite a bit

Extremely

63. Indicate the degree to which the following statements are
true in your life...
Not
at all

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

a. I prioritize what is important in life ...........................................
b. I have an appreciation for the value of my own life .................
c.

I am able to do good things with my life .................................

d. I have an understanding of spiritual matters ...........................
e. I have a sense of closeness with others .................................
f.

I have established a path for my life .......................................

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

I'm stronger than I thought I was ............................................

j.

I have learned a great deal about how wonderful people are

k.

I have compassion for others .................................................

page 12

4079411770

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

Neither
agree nor
Disagree disagree

Agree

Strongly
agree

a. Posttraumatic stress disorder (PTSD) or posttraumatic stress (PTS) symptoms ....................

No

Yes

b. Depression ....................................................................................................................................

No

Yes

c.

Anxiety ..........................................................................................................................................

No

Yes

d. Substance use ..............................................................................................................................

No

Yes

e. Anger ............................................................................................................................................

No

Yes

f.

Stress ............................................................................................................................................

No

Yes

g. Relationship/family issues ............................................................................................................

No

Yes

Strongly
disagree
a. I have little control over the things that happen to me ...............
b. What happens to me in the future mostly depends on me .......
c.

I can do just about anything I really set my mind to do .............

65. In the last 12 months, did you seek care for any of the following concerns?

66. a. If you answered "Yes" to any of the items in question 65 above, how many times did you seek these services in
the last 12 months?
Once a year

A few times a year

Once a month

Several times a month

Weekly

b. Where did you receive care for these services? (check all that apply)
Military resource/provider

VA resource/provider

Civilian resource/provider

67. In the last 12 months, have you had a physical health concern for which you considered seeking medical care?
No

Yes

skip to question 68

a. (If YES) When you had these physical health concerns, how often did you seek care?
None of the time

A little of the time

Some of the time

Most of the time

All of the time

b. If you did NOT seek care "All of the time", what were the reasons you did NOT seek care?
(check all that apply)
The problem wasn't bad enough to get help

I don’t trust health professionals

I preferred to manage the problem on my own

I don’t think health care treatment would help

Fear of negative effects on military career

Treatment might be uncomfortable or difficult

Concern that others would think negatively of me

Cannot afford treatment/no health insurance

68. a. Have you found it necessary to sleep in a shelter, on the streets, or in another non-residential
setting because of having no other place to stay? (Please only refer to instances during or
after military service time) .............................................................................................................

No

Yes

b. If YES, please indicate the dates of your most recent situation:
m

m

y

/

y

m
to

m

y

y

/
page 13

0760411773

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

Rarely

Monthly

Weekly

Daily

If you marked NEVER, skip to question 79 on page 15

70. In the past year, on those days that you drank alcoholic beverages, on average, how many drinks did you have?
drinks
71. In a typical week, how many drinks of each type of alcoholic beverage do you have? (If NONE, please enter 0)
beer(s)

wine

liquor

72. Last week, how many drinks of alcoholic beverages did you have? (If NONE, please enter 0)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Sunday

73. In the past year, on how many days did you have 5 or more drinks of any
alcoholic beverage? (If NONE, please enter 0) ................................................................................

days

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

Monthly or less

2-4 times a month

>4 times per month

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

Monthly or less

2-4 times a month

>4 times per month

76. FOR WOMEN ONLY:
In the past year, how often did you typically have 4 or more drinks of alcoholic beverages within a 2- hour period?
Never
Monthly or less
2-4 times a month
>4 times per month
77. In the last 12 months, have any of the following happened to you more than once?
a. You drank alcohol even though a doctor suggested that you stop drinking because of a
problem with your health .............................................................................................................

No

Yes

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

No

Yes

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

No

Yes

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

No

Yes

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

No

Yes

c.

page 14

4367411770

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

No

Yes

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

No

Yes

c.

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

No

Yes

d. Felt guilty about your drinking .....................................................................................................

No

Yes

a. Cigarettes ....................................................................................................................................

No

Yes

b. Cigars ..........................................................................................................................................

No

Yes

c.

Pipes ...........................................................................................................................................

No

Yes

d. Smokeless tobacco (chew, dip, snuff) ........................................................................................

No

Yes

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

No

Yes

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

If you marked NO, skip to question 85

81. At what age did you start smoking? .................................................................................................

years old

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

years

83. When smoking, how many packs per day did you or do you smoke?
Less than half a pack a day

Half to 1 pack per day

1 to 2 packs per day

More than 2 packs per day

84. Have you ever tried to quit smoking?
Yes, and succeeded

Yes, but not successfully

No

85. In the past 3 years, have any of the following life events happened to you?

No

Yes

If YES, list
most recent year

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

You or your partner had an unplanned pregnancy ....................................

d. You were divorced or separated ................................................................
e. Suffered major financial problems (such as bankruptcy) ..........................
f.

Suffered forced sexual relations or sexual assault ...................................

g. Experienced sexual harassment ...............................................................
h. Suffered a violent assault ..........................................................................
i.

Had a family member or loved one who became severely ill ....................

j.

Had a family member or loved one who died ............................................

k.

Suffered a disabling illness or injury ...........................................................

page 15

9272411770

86. During the past 3 years, have you been PERSONALLY exposed to any of the following?
(Do not include TV, video, movies, computers, or theater)
Yes,
1 time

No

If YES, list
Yes,
more than most recent year
of exposure
1 time

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

2

0

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

2

0

c.

Dead and/or decomposing bodies ...................................................

2

0

d. Maimed soldiers or civilians .............................................................

2

0

e. Prisoners of war or refugees ............................................................

2

0

f.

Chemical or biological warfare agents .............................................

2

0

g. Medical countermeasures for chemical or biological warfare
agent exposure ................................................................................

2

0

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

2

0

It would be helpful for this study to know about the background experiences that may have happened to some people.

87 a. Before the age of 18, how often did a parent or other adult in your home ever hit, beat, kick, or physically hurt you
in any way?
Never

Once

More than once

Prefer not to answer

b. Before the age of 18, how often did a parent or other adult in your home ever touch your private parts when they
shouldn't have or make you touch their private parts? Or did a parent or other adult that took care of you force
you to have sex?
Never
c.

Once

More than once

Prefer not to answer

Before the age of 18, how often did you get scared or feel really bad because a parent or other adult in your home
called you names, said mean things to you or said that they didn't want you?
Never

Once

More than once

Prefer not to answer

d. When someone is neglected, it means that the grown-ups in their life didn't take care of them the way that they
should. They might not get enough food, take them to the doctor when they are sick, or make sure they have a
safe place to stay. At any time before the age of 18, were you neglected?
Never

Once

More than once

Prefer not to answer

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

No

Don't
know

Yes

If YES, list
most recent year
of exposure

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

2

0

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

2

0

c. Depleted uranium (DU) .........................................................................

2

0

d. Microwaves (excluding small microwave ovens) ................................

2

0

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

2

0

f.

2

0

Pesticides applied in the environment or around living facilities ...........
page 16

0352411770

89. What is your current military status?
Active duty

skip to question 94

Reserve or National Guard

Separated

skip to question 92

Retired

skip to question 90
skip to question 90
m m

y

y

/

90. a. What was your date of separation/retirement from the military: ..........................
b. What was the reason for your separation/retirement from the military?
Planned separation
(end of service term/retirement)

Unplanned administrative separation
(e.g. military downsizing, failure to promote,
failure to meet service standards)

Medical separation

Other
(e.g. pregnancy, parenthood, educational
pursuits)

Disciplinary separation

91. How much did each of the following reasons affect
your decision to leave the military?

Not at
all

A little
bit

Moderately

Quite
a bit

Extremely

a. Dissatisfaction with deployments and/or frequent moves .............
b. Military service created hardship for family ...................................
c.

Dissatisfaction with promotion, pay, or other benefits ..................

d. Dissatisfaction with job ..................................................................
e. Dissatisfaction with leadership/supervision ..................................
f.

Desire to continue your education, start a new career,
or change in personal goals ..........................................................

g. Disability or other medical reasons ...............................................
h. Difficulty meeting weight standards and/or fitness standards ......
i.

Incompatibility with the military ......................................................

j.

Legal problems or problems meeting a military obligation ...........

k. Fulfilled term of service or was retirement eligible ........................

92. Has the VA determined that you have one or more service connected disabilities? ......................
a. If YES, indicate the total percent of your VA service-connected disabilities. ...............

No

Yes

percent disability

93. In the last 3 years, have you received any medical care from Department of Veterans Affairs/Veterans Health
Administration facilities?
None

Very little

Some

Most

All of my care

94. What kind of health coverage or insurance do you currently have? (check all that apply)
No health coverage or insurance

Medicare

School health insurance plan

Medicaid

TRICARE or military health insurance plan

VA health care

Employer health insurance plan

(Department of Veterans Affairs/
Veterans Health Administration)

(self, spouse/partner, parent, or other family member)
page 17

7806411771

95. Have you deployed in the last 3 years? .....................................................

No

skip to question 100

Yes

96. If YES and on a SEA-based deployment, list the specific SEA-based area along with the dates you arrived and
departed from each location. Please list the most recent location first.
Date arrived
Date departed
Please list specific location here
m m
y y
m m
y y

/
/
/
/

a.
b.
c.
d.

/
/
/
/

97. If YES and on a LAND-based deployment, list the specific countries along with the dates you arrived and departed
from each location. Please list the most recent location first.
Date arrived
Date departed
Please list specific location here
m m
y y
m m
y y

/
/
/
/

a.
b.
c.
d.

/
/
/
/

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

1 time

More than
1 time

List most
recent year
of exposure

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

2

0

b. Being attacked or ambushed ..................................................

2

0

c.

Receiving small arms fire ........................................................

2

0

d. Clearing / searching homes or buildings .................................

2

0

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

2

0

f.

Being wounded or injured .......................................................

2

0

g. Seeing dead bodies or human remains ..................................

2

0

h. Handling or uncovering human remains .................................

2

0

i.

Knowing someone seriously injured or killed ..........................

2

0

j.

Seeing Americans who were seriously injured or killed ..........

2

0

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

2

0

2

0

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

2

0

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

2

0

l.

Being directly responsible for the death of an
enemy combatant ....................................................................

page 18

6581411770

99.

Within the last 3 years, were you injured while deployed from any of the following? If you experienced
more than 1 injury during deployment, please provide responses for the most severe injury.
a. Physical training or sports injury while deployed
No

skip to 99b

Yes

a1. Did this injury involve being dazed, confused, "seeing stars," or not remembering the injury?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

a2. Did this injury involve losing consciousness (such as getting knocked out)?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

a3. Were you ever hospitalized or did this injury disrupt your personal and/or work activities
for more than 1 day?
No

Yes

b. Blast/Explosion while deployed
No
Yes
skip to 99c
b1. Did this injury involve being dazed, confused, "seeing stars," or not remembering the injury?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

b2. Did this injury involve losing consciousness (such as getting knocked out)?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

b3. Were you ever hospitalized or did this injury disrupt your personal and/or work activities
for more than 1 day?
No
c.

Yes

Bullet/Shrapnel while deployed
No
Yes
skip to 99d
c1. Did this injury involve being dazed, confused, "seeing stars," or not remembering the injury?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

c2. Did this injury involve losing consciousness (such as getting knocked out)?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

c3. Were you ever hospitalized or did this injury disrupt your personal and/or work activities
for more than 1 day?
No

Yes

d. Motor vehicle accident/crash while deployed
No
Yes
skip to 100
d1. Did this injury involve being dazed, confused, "seeing stars," or not remembering the injury?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

d2. Did this injury involve losing consciousness (such as getting knocked out)?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

d3. Were you ever hospitalized or did this injury disrupt your personal and/or work activities
for more than 1 day?
No

Yes
page 19

9289411778

100.

Within the last 3 years, were you injured while NOT deployed from any of the following? If you
experienced more than 1 injury while not deployed, please provide responses for the most severe injury.
a. Physical training or sports injury while NOT deployed
Yes

No

a1. Did this injury involve being dazed, confused, "seeing stars," or not remembering the injury?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

a2. Did this injury involve losing consciousness (such as getting knocked out)?
No
Yes, 0-30 minutes
Yes, more than 30 minutes
a3. Were you ever hospitalized or did this injury disrupt your personal and/or work activities
for more than 1 day?
No

Yes

b. Blast/Explosion while NOT deployed
Yes

No

b1. Did this injury involve being dazed, confused, "seeing stars," or not remembering the injury?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

b2. Did this injury involve losing consciousness (such as getting knocked out)?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

b3. Were you ever hospitalized or did this injury disrupt your personal and/or work activities
for more than 1 day?
No
c.

Yes

Bullet/Shrapnel while NOT deployed
Yes

No

c1. Did this injury involve being dazed, confused, "seeing stars," or not remembering the injury?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

c2. Did this injury involve losing consciousness (such as getting knocked out)?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

c3. Were you ever hospitalized or did this injury disrupt your personal and/or work activities
for more than 1 day?
No

Yes

d. Motor vehicle accident/crash while NOT deployed
Yes

No

d1. Did this injury involve being dazed, confused, "seeing stars," or not remembering the injury?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

d2. Did this injury involve losing consciousness (such as getting knocked out)?
No

Yes, 0-30 minutes

Yes, more than 30 minutes

d3. Were you ever hospitalized or did this injury disrupt your personal and/or work activities
for more than 1 day?
No

Yes
page 20

1411411777

101.

Within the last 3 years, have you been in a motor vehicle accident / crash while NOT deployed?

No

Yes

If NO, skip to question 102
a. How many motor vehicle accident / crash events in the last 3 years?
1

2

3 or more events

b. List the dates of the 3 most recent motor vehicle accident(s) / crash(s), and indicate which one of these was
the most severe event.
m

c.

m

y

y

/

Most severe event

/

Most severe event

/

Most severe event

For the most SEVERE motor vehicle accident/crash:
c1. What type of vehicle were you in?
Motorcycle

Personal car/truck

Government vehicle

c2. How many vehicles were involved?
Your vehicle only

Multiple vehicles

c3. What was your role?
Driver

Passenger

c4. Which of the following factors (related to the DRIVER) were involved in the motor vehicle accident /
crash?
Speed ............................................................................................................................

No

Yes

Alcohol ...........................................................................................................................

No

Yes

Fatigue/drowsiness .......................................................................................................

No

Yes

Distraction (e.g. cell phone) ..........................................................................................

No

Yes

Strong emotions (e.g. road rage) ..................................................................................

No

Yes

d. What is the total number of work days lost as a result of the motor vehicle accident / crash:

days

e. What treatment did you seek for your injuries from this motor vehicle accident / crash?
No treatment sought

Clinic or office visit only

page 21

Hospitalized: number of days: ....

days

9738411777

102.

What is your annual household income?
less than $25,000

$100,000-$124,999

$25,000-$49,999

$125,000-$149,999

$50,000-$74,999

$150,000 or more

$75,000-$99,999
103.

What is your overall feeling about your military service?
Negative

Somewhat negative

Neither negative nor positive

Somewhat positive

Positive

The statements below are about your relationships with other military personnel.

104.

If you had deployed in the last 3 years, please indicate how much you agree or disagree for each item, based on
your most recent deployment. If you have not deployed in the last 3 years, please indicate how much you
agree or disagree for each item based on your most recent assignment.
Strongly
disagree

Neither
Somewhat agree nor Somewhat Strongly
disagree
agree
agree
disagree

a. I felt a sense of camaraderie between myself and
others in my unit ..........................................................
b. I was impressed by the quality of leadership in my unit
c.

I was supported by the military ....................................

We really appreciate your answers to the questions on the survey. Please continue on to the last few questions on the
next 5 pages about your military occupational categories and contact information.

page 22

9092411770

105. If you are ENLISTED (Active Duty, Reserve, or National Guard), please review the list of military occupational
categories below. Select the two categories that best match your military job and fill in the two-digit codes for your
primary job code and your secondary job code. All others, skip to question 106 on page 24.

PRIMARY JOB CODE

SECONDARY JOB CODE

ENLISTED MILITARY OCCUPATIONAL CATEGORIES
FUNCTIONAL SUPPORT & ADMINISTRATION

INFANTRY, GUN CREWS & SEAMANSHIP SPECIALISTS
Infantry.....................................................................................
Armor or Amphibious...............................................................
Combat Engineering................................................................
Artillery/Gunnery, Rockets or Missiles.....................................
Air Crew...................................................................................
Seamanship............................................................................
Installation Security.................................................................

01
02
03
04
05
06
07

Personnel............................................................................
Administration......................................................................
Clerical/Personnel...............................................................
Data Processing..................................................................
Accounting, Finance or Disbursing......................................
Other Functional Support....................................................
Religious, Morale or Welfare...............................................
Information or Education.....................................................

10
11
12
13
14
15
16
19

ELECTRICAL/MECHANICAL EQUIPMENT REPAIRERS

ELECTRONIC EQUIPMENT REPAIRERS
Radio/Radar.............................................................................
Fire Control Electric Systems, Non-Missile..............................
Missile Guidance, Control or Check-out..................................
Sonar Equipment.....................................................................
Nuclear Weapons Equipment..................................................
ADP Computers.......................................................................
Teletype or Cryptographic Equipment.....................................
Other Electronic Equipment.....................................................
COMMUNICATIONS & INTELLIGENCE SPECIALISTS
Radio or Radio Code...............................................................
Sonar.......................................................................................
Radar or Air Traffic Control.....................................................
Signal Intel/Electronic Warfare................................................
Intelligence...............................................................................
Combat Operations Control.....................................................
Communications Center Operations........................................

20
21
22
23
24
25
26

HEALTH CARE SPECIALISTS
Medical Care............................................................................
Ancillary Medical Support........................................................
Biomedical Sciences or Allied Health......................................
Dental Care..............................................................................
Medical Administration or Logistics..........................................

30
31
32
33
34

OTHER TECHNICAL AND ALLIED SPECIALISTS
Photography.............................................................................
Mapping, Surveying, Drafting or Illustrating.............................
Weather...................................................................................
Ordnance Disposal or Diving...................................................
Musician...................................................................................
Technical Specialist.................................................................

40
41
42
43
45
49

Aircraft or Aircraft Related...................................................
Automotive..........................................................................
Wire Communications.........................................................
Missile Mechanical or Electrical...........................................
Armament or Munitions.......................................................
Shipboard Propulsion..........................................................
Power Generating Equipment.............................................
Precision Equipment............................................................
Other Mechanical or Electrical Equipment..........................

50
51
52
53
54
55
56
57

60
61
62
63
64
65
66
67
69

CRAFTWORKERS
Metalworking.......................................................................
Construction........................................................................
Utilities.................................................................................
Lithography..........................................................................
Industrial Gas or Fuel Production........................................
Fabric, Leather or Rubber...................................................
Other Craftworker................................................................

70
71
72
74
75
76
79

SERVICE & SUPPLY HANDLERS
Food Service.......................................................................
Motor Transport...................................................................
Material Receipt, Storage or Issue......................................
Law Enforcement................................................................
Personnel Service...............................................................
Auxiliary Labor.....................................................................
Forward Area Equipment Support.......................................
Other Services.....................................................................

80
81
82
83
84
85
86
87

OTHER
Patients or Prisoners...........................................................
Officer Candidate or Student...............................................
Undesignated Occupations.................................................
Not Occupationally Qualified...............................................

page 23

1302411776

90
91
92
95

106. If you are an OFFICER or WARRANT OFFICER (Active Duty, Reserve, or National Guard), please review the list of
military occupational categories below. Select the two categories that best match your military job and fill in the
two-digit codes for your primary job code and your secondary job code. All others, skip to question 107
on page 25.

PRIMARY JOB CODE

SECONDARY JOB CODE

OFFICER or WARRANT OFFICER MILITARY OCCUPATIONAL CATEGORIES
TACTICAL OPERATIONS OFFICERS
Fixed-Wing Fighter or Bomber Pilot............................... 2A
Helicopter Pilot............................................................... 2C
Aircraft Crew................................................................... 2D
Ground or Naval Arms.................................................... 2E
Missiles........................................................................... 2F
Operations Staff.............................................................. 2G
Civilian Pilot.................................................................. 2H
INTELLIGENCE OFFICERS
Intelligence, General....................................................... 3A
Communications Intelligence.......................................... 3B
Counter-intelligence........................................................ 3C
ENGINEERING & MAINTENANCE OFFICERS
Construction or Utilities................................................... 4A
Ordnance........................................................................ 4B
Communications or Radar.............................................. 4C
Aviation Maintenance or Allied....................................... 4D
Electrical or Electronic.................................................... 4E
Missile Maintenance....................................................... 4F
Ship Construction or Maintenance.................................. 4G
Ship Machinery............................................................... 4H
Safety............................................................................. 4J
Chemical......................................................................... 4K
Automotive or Allied........................................................ 4L
Surveying or Mapping..................................................... 4M
Other............................................................................... 4N
SCIENTISTS & PROFESSIONALS
Physical Scientist............................................................ 5A
Meteorologist.................................................................. 5B
Biological Scientist.......................................................... 5C
Social Scientist............................................................... 5D
Psychologist................................................................... 5E
Legal............................................................................... 5F
Chaplain......................................................................... 5G
Social Worker................................................................. 5H
Mathematician or Statistician.......................................... 5J
Educator or Instructor..................................................... 5K
Research & Development Coordinator.......................... 5L
Community Activities Officer........................................... 5M
Scientist or Professional................................................. 5N

GENERAL OFFICERS & EXECUTIVES
General or Flag..................................................................... 1A
Executive................................................................................ 1B
HEALTH CARE OFFICERS
Physician..............................................................................
Dentist...................................................................................
Nurse....................................................................................
Veterinarian...........................................................................
Biomedical Sciences or Allied Health.....................................
Health Service Administration................................................

6A
6C
6E
6G
6H
6I

ADMINISTRATORS
Administrator, General...........................................................
Training Administrator............................................................
Manpower or Personnel.........................................................
Comptroller or Fiscal..............................................................
Data Processing.....................................................................
Pictorial...................................................................................
Information.............................................................................
Police......................................................................................
Inspection...............................................................................
Morale & Welfare...................................................................

7A
7B
7C
7D
7E
7F
7G
7H
7L
7N

SUPPLY, PROCUREMENT & ALLIED OFFICERS
Logistics, General...................................................................
Supply....................................................................................
Transportation.......................................................................
Procurement or Production....................................................
Food Service..........................................................................
Exchange or Commissary......................................................
Other......................................................................................

8A
8B
8C
8D
8E
8F
8G

OTHER
Patient................................................................................... 9A
Student.................................................................................. 9B
Other...................................................................................... 9E

page 24

4864411772

107. If you have a CIVILIAN job, please review the list of civilian occupational categories on this page and the next
page. Select the two categories that best match your civilian job and fill in the three-digit codes for your primary
and your secondary job code.

PRIMARY JOB CODE

SECONDARY JOB CODE

CIVILIAN OCCUPATIONAL CATEGORIES
More categories listed on page 26

EDUCATION, TRAINING & LIBRARY
Postsecondary Teacher.................................................
Primary, Secondary or Special Education
School Teacher.............................................................
Other Teacher or Instructor............................................
Librarian, Curator or Archivist........................................
Other Education, Training or Library Occupation...........

ARCHITECTURE & ENGINEERING
Architect, Surveyor or Cartographer ............................... 171
Engineer.......................................................................... 172
Drafter, Engineering or Mapping Technician................... 173
ARTS, DESIGN, MEDIA, ENTERTAINMENT & SPORTS
Art or Design................................................................... 271
Entertainer, Performer, Sports or Related Worker.......... 272
Media Communication Worker........................................ 273
Media Communication Equipment Worker...................... 274
BUILDING & GROUNDS CLEANING & MAINTENANCE
Supervisor, Building & Grounds, Cleaning &
Maintenance Worker....................................................... 371
Building Cleaning or Pest Control................................... 372
Ground Maintenance....................................................... 373
BUSINESS & FINANCIAL OPERATIONS
Business Operations Specialist....................................... 131
Financial Specialist.......................................................... 132
COMMUNITY & SOCIAL SERVICES
Counselor, Social Worker or Other Community
or Social Service Specialist............................................. 211
Religious Worker............................................................. 212
COMPUTER & MATHEMATICAL
Computer Specialist ....................................................... 151
Mathematical Specialist................................................... 152
Mathematical Technician................................................. 153
CONSTRUCTION & EXTRACTION
Supervisor, Construction or Extraction Worker...............
Construction Trades Worker...........................................
Helper, Construction Trades...........................................
Other Construction or Related Worker............................
Extraction Worker............................................................

471
472
473
474
475

251
252
253
254
259

FARMING, FISHING & FORESTRY WORKERS
Supervisor, Farming, Fishing or Forestry Worker..........
Agricultural Worker........................................................
Fishing or Hunting Worker.............................................
Forest, Conservation or Logging Worker.......................
Other Farming, Fishing or Forestry................................

451
452
453
454
459

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

3511
352
353
359

HEALTH CARE
Physician........................................................................
Nursing, Psychiatric or Home Health Aid.......................
Occupational or Physical Therapist Assistant or Aid......
Other Health Care Occupation.......................................

295
311
312
319

INSTALLATION, REPAIR & MAINTENANCE
Supervisor of Installation, Maintenance
or Repair Worker...........................................................
Electrical or Electric Equipment Mechanic,
Installer or Repairer.......................................................
Vehicle or Mobile Equipment Mechanic,
Installer or Repairer.......................................................
Other Installation, Maintenance or Repair.....................

491
492
493
499

More categories listed on page 26...

page 25

4195411779

Question 107 continued, Civilian occupational categories...

CIVILIAN OCCUPATIONAL CATEGORIES
LEGAL
Lawyer, Judge or Related Worker................................. 231
Legal Support Worker.................................................... 232
LIFE, PHYSICAL & SOCIAL SCIENCES
Life Scientist...................................................................
Physical Scientist...........................................................
Social Scientist or Related Worker................................
Life, Physical or Social Sciences Technician.................
MANAGEMENT
Top Executive................................................................
Advertising, Marketing, Promotions, PR or
Sales Manager...............................................................
Operations Specialties Manager....................................
Other Management Occupation.....................................
OFFICE & ADMINISTRATIVE SUPPORT
Supervisor, Office or Administrative Support.................
Communications Equipment Operator...........................
Financial Clerk...............................................................
Information or Record Clerk...........................................
Material Recording, Scheduling, Dispatching
or Distributing Worker....................................................
Secretary or Administrative Assistant............................
Other Office or Administrative Support..........................
PERSONAL CARE SERVICE
Supervisor, Personal Care or Service............................
Animal Care or Service..................................................
Entertainment Attendant or Related Worker..................
Funeral Worker..............................................................
Personal Appearance....................................................
Transportation, Tourism or Lodging Attendant..............
Other Personal Care or Service Worker........................

191
192
193
194

111
112
113
119

431
432
433
434
435
436
439

391
392
393
3941
395
396
399

page 26

PRODUCTION
Supervisor, Production Worker.....................................
Assembler, Fabricator...................................................
Food Processing Worker..............................................
Metal or Plastic Worker.................................................
Printing Worker.............................................................
Textile, Apparel or Furnishing Worker..........................
Woodworker..................................................................
Plant or Systems Operator............................................
Other Production Occupation.......................................

511
512
513
514
515
516
517
518
519

PROTECTIVE SERVICES
First Line Supervisor/Manager, Protective Services.....
Firefighting or Prevention Worker.................................
Law Enforcement Worker.............................................
Other Protective Service Worker..................................

331
332
333
339

SALES-RELATED
Supervisor, Sales..........................................................
Retail Sales Worker......................................................
Sales Representative, Services....................................
Sales Representative, Wholesale or Manufacturing.....
Counter or Rental Clerk or Parts Salesperson..............
Other Sales or Related Worker.....................................

411
412
413
414
415
419

TRANSPORTATION & MATERIAL MOVING
Supervisor, Transportation or Material Moving.............
Motor Vehicle Operator.................................................
Rail Transportation Worker...........................................
Water Transportation....................................................
Other Transportation.....................................................
Material Moving Worker................................................

531
533
534
535
536
537

9683411776

108.

We would like to verify your contact information. Although we obtain address information from DoD sources, we
would like to ensure we have the best information to reach you. What is your current mailing address?
Apt/Suite:

Address Line 1:

City or (FPO/APO):

State/Province/Region
(or AA/AE/AP):

Zip/Postal Code:

Country:

109.

Please provide your phone number(s): (Separate multiple phone numbers with a space)

110.

Please provide your email address(es): (Separate multiple email addresses with a space)

111.

What year were you born? ..............................................................................................................

112.

What are the last four digits of your Social Security Number? .......................................................
m m

d

/

d

y

y

y

/

113.

What is today's date? .............................................................................

114.

A great deal has been learned from this study and as a result we may be asked to consider other
research possibilities. If other related research studies become available, may we contact you
to let you know about them? ............................................................................................................

115.

y

No

Yes

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

Thank you for completing this important questionnaire!

page 27

4711411773


File Typeapplication/pdf
AuthorJennifer.Walstrom
File Modified2014-03-27
File Created2014-03-20

© 2024 OMB.report | Privacy Policy