Form 29 CFR 1910.1043 ( 29 CFR 1910.1043 ( Appendix B-!, Respiratory Questionnaire; Appendix B-II,

Standards Improvement Project-Phase IV

Cotton Dust Standard Appendix B PRA Public Burden Statement

§ 1910.1043 Cotton Dust.

PAPERWORK REDUCTION ACT STATEMENT

Under the cotton dust standard, this medical questionnaire must be administered to all employees who are exposed to cotton dust, and who will therefore be included in their employer's medical surveillance program. (29 CFR 1910.1043(h)(1)(i)). Under the Paperwork Reduction Act, a Federal agency generally cannot conduct or sponsor, and the public is generally not required to respond to, an information collection, unless it is approved by OMB and displays a valid OMB Control Number. Use of this questionnaire is mandatory. The questionnaire assists both physicians and employers to ensure that the physician obtains compliant employee medical documentation. OSHA estimates employer burden for the completion of this collection of information ranges from one hour and five minutes (1.08 hours) to one hour and thirty-five minutes (1.58 hours). This estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and, completing and reviewing the collection of information. The time estimate includes employer time for compliance with the underlying information collection requirements in 29 CFR 1910.1043(h), including employee time for completion of the questionnaire and medical examination and providing information to the physician. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to [email protected] or to OSHA’s Directorate of Standards and Guidance, Department of Labor, Room N-3718, 200 Constitution Ave., NW, Washington, DC 20210; Attn: Paperwork Reduction Act Comment; 1218-0061. (This address is for comments regarding this form only; DO NOT SEND ANY COMPLETED SAMPLE FORM TO THIS OFFICE.)

OMB Approval# 1218-0061; Expires: 00-00-0000

APPENDIX B-I

RESPIRATORY QUESTIONNAIRE

A. IDENTIFICATION DATA

PLANT ______________________

DAY MONTH YEAR

(figures) (last 2 digits)

NAME ____________________ DATE OF INTERVIEW _______________________

(Surname)

______________________________ DATE OF BIRTH ________________________

(First Names)

M F

ADDRESS ____________________ AGE ____ (8, 9) SEX _____________(10)

RACE (11) (Check all that apply)

1. White ___ 4. Hispanic or Latino ___

2. Black or African American ___ 5. American Indian or Alaska Native ___

3. Asian ___ 6. Native Hawaiian or

Other Pacific Islander ___

INTERVIEWER: 1 2 3 4 5 6 7 8 (12)

WORK SHIFT: 1st _____ 2nd _____ 3rd _____ (13)

STANDING HEIGHT __________________________ (14, 15)

WEIGHT _____________________________________ (16, 18)

PRESENT WORK AREA

If working in more than one specified work area, X area where most of the work shift is spent. If "other," but spending 25% of the work shift in one of the specified work areas, classify in that work area. If carding department employee, check area within that department where most of the work shift is spent (if in doubt, check "throughout"). For work areas such as spinning and weaving where many work rooms may be involved, be sure to check to specific work room to which the employee is assigned - if he works in more than one work room within a department classify as 7 (all) for that department.

	Work- room Number	(19) Open	(20) Pick	Area	(21) Card #1	(22) #2	(23) Spin	(24) Wind	(25) Twist
AT RISK (cotton & cotton blend)	1			Cards
	2			Draw
	3			Comb
	4			Thru Out
	5
	6
	7 (all)
Control (synthe-tic & wool)	8
Ex- Worker (cotton)	9

Continued –

	Work- Room Number	(26) Spool	(27) Warp	(28) Slash	(29) Weave	(30) Other
AT RISK (cotton & cotton blend)	1
	2
	3
	4
	5
	6
	7 (all)
Control (synthetic & wool)	8
Ex- Worker (cotton)	9

Use actual wording of each question. Put X in appropriate square after each question. When in doubt record “No”. When no square, circle appropriate answer.

B. COUGH (on getting up)
Do you usually cough first thing in the morning?	___________________________ Yes _______ No _______ (31)
(Count a cough with first smoke or on “first going out of doors.” Exclude clearing throat or a single cough.)

Do you usually cough during the day or at night? (Ignore an occasional cough.)		Yes _______ No _______ (32)
If `Yes' to either question (31-32):
Do you cough like this on most days for as much as three months a year?		Yes _______ No _______ (33)
Do you cough on any particular day of the week?		Yes _______ No _______ (34)
(1) (2) (3) (4) (5) (6) (7) If ‘Yes’: Which day? Mon Tues Wed Thur Fri Sat Sun (35) ­­­­­­­­­­­­­­___________________________________________________________________
C. PHLEGM or alternative word to suit local custom. (on getting up)
Do you usually bring up any phlegm from your chest first thing in the morning? (Count phlegm with the first smoke or on “first going out of doors.” Exclude phlegm from the nose. Count swallowed phlegm.)	Yes _______ No ______ (36)
Do you usually bring up any phlegm from your chest during the day or at night? (Accept twice or more.)	Yes _______ No ______ (37)
If `Yes' to question (36) or (37):
Do you bring up any phlegm like this on most days for as much as three months each year?	Yes _______ No ______ (38)

If `Yes' to question (33) or (38):
(cough) How long have you had this phlegm? (Write in number of years)	(1) ____ 2 years or less (39) (2) ____ More than 2 year-9 years (3) ____ 10-19 years (4) ____ 20+ years
* These words are for subjects who work at night
D. CHEST ILLNESSES
In the past three years, have you had a period of (increased) *cough and phlegm lasting for 3 weeks or more?	(1) ____ No (40) (2) ____ Yes, only one period (3) ____ Yes, two or more periods
*For subjects who usually have phlegm
During the past 3 years have you had any chest illness which has kept you off work, indoors at home or in bed? (For as long as one week, flu?)	Yes _______ No ______ (41)
If `Yes' to (41):
Did you bring up (more) phlegm than usual in any of these illnesses?	Yes _______ No ______ (42)
If `Yes' to (42):
During the past three years have you had:	Only one such illness with increased phlegm? (1) _____ (43) More than one such illness: (2) ______(44) Br. Grade _______

E. TIGHTNESS
Does your chest ever feel tight or your breathing become difficult?			Yes _______ No _______ (45)
Is your chest tight or your breathing difficult on any particular day of the week? (after a week or 10 days from the mill)			Yes _______ No _______ (46)
If `Yes': Which day? (3) (4) (5) (6) (7) (8) Mon. ^ Tues. Wed. Thur. Fri. Sat. Sun. (47) (1) / \ (2) Sometimes Always
If `Yes' Monday: At what time on Monday does your chest feel tight or your breathing difficult?		(1) ___ Before entering the mill (48) (2) ___ After entering the mill
(Ask only if NO to Question (45))
In the past, has your chest ever been tight or your breathing difficult on any particular day of the week?		Yes _______ No _______ (49)
If `Yes': Which day?	(3) (4) (5) (6) (7) (8) Mon. ^ Tues. Wed. Thur. Fri. Sat. Sun. (50) (1) / \ (2) Sometimes Always

F. BREATHLESSNESS
If disabled from walking by any condition other than heart or lung disease put "X" here and leave questions (52-60) unasked.	____________________(51)
Are you ever troubled by shortness of breath, when hurrying on the level or walking up a slight hill?	Yes ______ No ______ (52)
If `No', grade is 1.
If `Yes', proceed to next question.
Do you get short of breath walking with other people at an ordinary pace on the level?	Yes _______ No _______ (53)
If `No', grade is 2.
If `Yes', proceed to next question.
Do you have to stop for breath when walking at your own pace on the level?	Yes _______ No _______ (54)
If `No', grade is 3.
If `Yes', proceed to next question.
Are you short of breath on washing or dressing?	Yes _______ No _______ (55)
If `No', grade is 4. If `Yes' grade is 5.	Dyspnea Grd. __________ (56)
ON MONDAYS
Are you ever troubled by shortness of breath, when hurrying on the level or walking up a slight hill?	Yes _______ No _______ (57)
If `No', grade is 1.
If `Yes', proceed to next question.
Do you get short of breath walking with other people at ordinary pace on the level?	Yes _______ No _______ (58)
If `No', grade is 2.
If `Yes', proceed to next question.
Do you have to stop for breath when walking at your own pace on level ground?	Yes _______ No _______ (59)
If `No', grade is 3.
If `Yes', proceed to next question.
Are you short of breath on washing or dressing?	Yes _______ No _______ (60)
If `No', grade is 4. If `Yes', grade is 5.	B. Grd. _______________ (61)
G. OTHER ILLNESSES AND ALLERGY HISTORY
Do you have a heart condition for which you are under a doctor's care?	Yes _______ No ________ (62)
Have you ever had asthma?	Yes _______ No ________ (63)
If `Yes', did it begin:	(1) _______ Before age 30 (2) _______ After age 30
If `Yes' before 30 did you have asthma before ever going to work in a textile mill?	Yes _______ No ________ (64)
Have you ever had hay fever or other allergies (other than above)?	Yes _______ No ________ (65)
H. TOBACCO SMOKING*
Do you smoke? Record `Yes', if regular smoker up to one month ago (Cigarettes, cigar or pipe)	Yes _______ No _______ (66)

If `No' to (63)
Have you ever smoked? (Cigarettes, cigars, pipe. Record `No' if subject has never smoked as much as one cigarette a day, or 1 oz of tobacco a month, for as long as one year.)							Yes _______ No _______ (67)
If `Yes' to (63) or (64), what have you smoked and for how many years? (Write in specific number of years in the appropriate square)
	(1)	(2)	(3)	(4)	(5)	(6)		(7)	(8)	(9)
Years	<5	5-9	10-14	15-19	20-24	25-29		30-34	35-39	>40
Cigarettes											(68)
Pipe											(69)
Cigars											(70)

If cigarettes, how many packs per day? (Write in number of cigarettes)	(1) ______ Less than 1/2 pack (71) (2) ______ 1/2 pack, but less than 1 pack (3) ______ 1 pack, but less than 1 ½ packs (4) ______ 1 1/2 packs or more
Number of years	__________________________ (72, 73)
If an ex-smoker (cigarettes, cigar or pipe), how long since you stopped? (Write in number of years)	__________________________ (74) (1) ______ 0-1 year (2) ______ 1-4 years (3) ______ 5-9 years (4) ______ 10+ years
* Have you changed your smoking habits since last interview? If yes, specify what changes.

I. OCCUPATIONAL HISTORY**
Have you ever worked in:
A foundry? (As long as one year)					Yes _______ No _______ (75)
Stone or mineral mining, quarry or processing? (As long as one year)					Yes _______ No _______ (76)
Asbestos milling or processing?					Yes _______ No _______ (77)
Other dusts, fumes or smoke? If yes, specify.					Yes _______ No _______ (78)
Type of exposure				__________________________________
Length of exposure				__________________________________
** Ask only on first interview.
At what age did you first go to work in a textile mill? (Write in specific age in appropriate square)
(1)	(2)	(3)	(4)			(5)	(6)
<20	20-24	25-29	30-34			35-39	40+

When you first worked in a textile mill, did you work with:

(1) ______ Cotton or cotton blend (79) (2) ______ Synthetic or wool (80)

APPENDIX B-II

Respiratory Questionnaire for Non-Textile Workers for the

Cotton Industry

__________________________________________________________________

Identification No. Interviewer Code

__________________________________________________________________

Location Date of Interview

__________________________________________________________________

A. IDENTIFICATION

__________________________________________________________________

1. NAME (Last) (First) (Middle Initial)

__________________________________________________________________

2. CURRENT ADDRESS (Number, Street, or Rural Route, City or Town,

County, State, Zip Code)

__________________________________________________________________

3. PHONE NUMBER AREA CODE NO.

( __ __ __ ) ___ ___ ___ - ___ ___ ___ ___

4. BIRTHDATE (Mo., Day, Yr.)

__________________________________________________________________

5. SEX

1. ______ Male 2. ______ Female

6. ETHNIC GROUP OR ANCESTRY (Check all that apply)

1. ____ White

2. ____ Black or African American

3. ____ Asian

4. ____ Hispanic or Latino

5. ____ American Indian or Alaska Native

6. ____ Native Hawaiian or Other Pacific Islander

7. STANDING HEIGHT

__________________ (in)

8. WEIGHT (lbs)

__________________

9. WORK SHIFT

1st ______ 2nd ______ 3rd ______

10. PRESENT WORK AREA

Please indicate primary assigned work area and percent of time spent at that site. If at other locations, please indicate and note percent of time for each.

PRIMARY WORK AREA
SPECIFIC JOB

11. APPROPRIATE INDUSTRY

1. _____ Garnetting

2. _____ Cottonseed Oil Mill

3. _____ Cotton Warehouse

4. _____ Utilization

5. _____ Cotton Classification

6. _____ Cotton Ginning

__________________________________________________________________

B. OCCUPATIONAL HISTORY TABLE

Complete the following table showing the entire work history of the individual from present to initial employment. Sporadic, part-time periods of employment, each of no significant duration, should be grouped if possible.

INDUSTRY AND LOCATION	TENURE OF EMPLOYMENT		SPECIFIC OCCUPATION	AVER-AGE NO. DAYS WORK-ED PER WEEK	HAZARDOUS HEALTH EXPOSURE ASSOCIATED WITH WORK
	FROM (year)	TO (year)			YES	NO	IF YES, DESCR-IBE

C. SYMPTOMS

Use actual wording of each question. Put X in appropriate square after each question. When in doubt record "No.".

COUGH
1. Do you usually cough first thing in the morning? (on getting up)* (Count a cough with first smoke or on "first going out of doors". Exclude clearing throat or a single cough.)	1._____Yes 2._____No
2. Do you usually cough during the day or at night? (Ignore an occasional cough.)	1. ____ Yes 2. ____ No
If YES to either 1 or 2:
3. Do you cough like this on days for as much as three months a year?	1. ____ Yes 2. ____ No 3. ____ NA
4. Do you cough on any particular day of the week?	1. ____ Yes 2. _____ No
If YES:
5. Which day?	Mon. Tue. Wed. Thur. Fri. Sat. Sun. _____
PHLEGM
6. Do you usually bring up any phlegm from your chest first thing in the morning? (on getting up)* (Count phlegm with the first smoke or on "first going out of doors." Exclude phlegm from the nose. Count swallowed phlegm.	1. ____ Yes 2. ____ No
7. Do you usually bring up any phlegm from your chest during the day or at night? (Accept twice or more.)	1. ____ Yes 2. ____ No
If YES to either question 6 or 7:
8. Do you bring up phlegm like this on most days for as much as three months each year?	1. ____ Yes 2. ____ No

If YES to question 3 or 8:
9. How long have you had this phlegm? (cough) (Write in number of years)	(1) ____ 2 years or less (2) ____ More than 2 years - 9 years (3) ____ 10-19 years (4) ____ 20+ years
* These words are for subjects who work at night.
CHEST ILLNESS
10. In the past three years, have you had a period of (increased) cough and phlegm lasting for 3 weeks or more?	(1) ____ No (2) ____ Yes, only one period (3) ____ Yes, two or more periods
For subjects who usually have phlegm:
11. During the past 3 years have you had any chest illness which has kept you off work, indoors at home or in bed? (For as long as one week, flu?)	1. ____ Yes 2. ____ No
If YES to 11:
12. Did you bring up (more) phlegm than usual in any of these illnesses?	1. ____ Yes 2. ____ No
13. Only one such illness with increased phlegm?	1. ____ Yes 2. ____ No
If YES to 12: During the past three years have you had:
14. More than one such illness:	1. ____ Yes 2. ____ No Br. Grade _____________

TIGHTNESS
15. Does your chest ever feel tight or your breathing become difficult?			1. ____ Yes 2. ____ No
16. Is your chest tight or your breathing difficult on any particular day of the week? (after a week or 10 days away from the mill)			1. ____ Yes 2. ____ No
17. If `Yes': Which day?		(3) (4) (5) (6) (7) (8) Mon. ^ Tues. Wed. Thur. Fri. Sat. Sun. (1) / \ (2) Sometimes Always
18. If YES Monday: At what time on Monday does your chest feel tight or your breathing difficult?			_____ Before entering mill _____ After entering mill
(Ask only if NO to Question (15))
19. In the past, has your chest ever been tight or your breathing difficult on any particular day of the week?			1. ____ Yes 2. ____ No
20. If `Yes': Which day?	(3) (4) (5) (6) (7) (8) Mon. ^ Tues. Wed. Thur. Fri. Sat. Sun. (1) / \ (2) Sometimes Always
BREATHLESSNESS
21. If disabled from walking by any condition other than heart or lung disease put "X" in the space and leave questions (22-30) unasked.					________
22. Are you ever troubled by shortness of breath, when hurrying on the level or walking up a slight hill?					1. ____ Yes 2. ____ No
If NO, grade is 1. If YES, proceed to next question.
23. Do you get short of breath walking with other people at an ordinary pace on the level?					1. ____ Yes 2. ____ No
If NO, grade is 2. If YES, proceed to next question.
24. Do you have to stop for breath when walking at your own pace on the level?					1. ____ Yes 2. ____ No
If NO, grade is 3. If YES, proceed to next question.
25. Are you short of breath on washing or dressing?					1. ____ Yes 2. ____ No
If NO, grade is 4, If YES, grade is 5.
26.					Dyspnea Grd. __________________
ON MONDAYS:
27. Are you ever troubled by shortness of breath, when hurrying on the level or walking up a slight hill?					1. ____ Yes 2. ____ No
If NO, grade is 1, If YES, proceed to next question.
28. Do you get short of breath walking with other people at an ordinary pace on the level?					1. ____ Yes 2. ____ No
If NO, grade is 2, If YES, proceed to next question.
29. Do you have to stop for breath when walking at your own pace on the level?					1. ____ Yes 2. ____ No
If NO, grade is 3, If YES, proceed to next question.
30. Are you short of breath on washing or dressing?					1. ____ Yes 2. ____ No
If NO, grade is 4, If YES, grade is 5.
					B. Grd. ___________________
OTHER ILLNESSES AND ALLERGY HISTORY
32. Do you have a heart condition for which you are under a doctor's care?					1. ____ Yes 2. ____ No
33. Have you ever had asthma?					1. ____ Yes 2. ____ No
If yes, did it begin:					(1) Before age 30 ______ (2) After age 30 ______
34. If yes before 30: did you have asthma before ever going to work in a textile mill?					1. ____ Yes 2. ____ No
35. Have you ever had hay fever or other allergies (other than above)?					1. ____ Yes 2. ____ No
TOBACCO SMOKING
36. Do you smoke? Record Yes if regular smoker up to one month ago. (Cigarettes, cigar or pipe)					1. ____ Yes 2. ____ No
If NO to (33).

37. Have you ever smoked? (Cigarettes, cigars, pipe. Record NO if subject has never smoked as much as one cigarette a day, or 1 oz. of tobacco a month, for as long as one year.)						1. ____ Yes 2. ____ No
If YES to (33) or (34); what have you smoked for how many years? (Write in specific number of years in the appropriate square)
	(1)	(2)	(3)	(4)	(5)		(6)	(7)	(8)	(9)
Years	<5	5-9	10-14	15-19	20-24		25-29	30-34	35-39	>40
Cigarettes											(38)
Pipe											(39)
Cigars											(40)

41. If cigarettes, how many packs per day? Write in number of cigarettes	_____________________
	_____ Less than 1/2 pack _____ 1/2 pack, but less than 1 pack _____ 1 pack, but less than 1 1/2 packs _____ 1-1/2 packs or more
42. Number of pack years:	______________
43. If an ex-smoker (Cigarettes, cigar or pipe), how long since you stopped? (Write in number of years.)	______________
	_____ 0-1 year _____ 1-4 years _____ 5-9 years _____ 10+ years

OCCUPATIONAL HISTORY
Have you ever worked in:
44. A foundry? (As long as one year)	1. ____ Yes 2. ____ No
45. Stone or mineral mining, quarrying or processing? (As long as one year)	1. ____ Yes 2. ____ No
46. Asbestos milling or processing? (Ever)	1. ____ Yes 2. ____ No
47. Cotton or cotton blend mill? (For controls only)	1. ____ Yes 2. ____ No
48. Other dusts, fumes or smoke? If yes, specify.	1. ____ Yes 2. ____ No
Type of exposure ______________________ Length of exposure ______________________

____________________________________________________________________

APPENDIX B-III

ABBREVIATED RESPIRATORY QUESTIONNAIRE

A. IDENTIFICATION DATA

PLANT ______________________

DAY MONTH YEAR

(figures) (last 2 digits)

NAME ____________________ DATE OF INTERVIEW ______________________

(Surname)

______________________________ DATE OF BIRTH ______________________

(First Names)

M F

ADDRESS ____________________ AGE ____ (8, 9) SEX ______________(10)

RACE (11) (Check all that apply)

1. White ___ 4. Hispanic or Latino ___

2. Black or African American ___ 5. American Indian or Alaska Native ___

3. Asian ___ 6. Native Hawaiian or

Other Pacific Islander ___

INTERVIEWER: 1 2 3 4 5 6 7 8 (12)

WORK SHIFT: 1st _____ 2nd _____ 3rd _____ (13)

STANDING HEIGHT __________________________ (14, 15)

WEIGHT ___________________________________ (16, 18)

PRESENT WORK AREA

If working in more than one specified work area, X area where most of the work shift is spent. If "other," but spending 25% of the work shift in one of the specified work areas, classify in that work area. If carding department employee, check area within that department where most of the work shift is spent (if in doubt, check "throughout"). For work areas such as spinning and weaving where many work rooms may be involved, be sure to check to specific work room to which the employee is assigned - if he works in more than one work room within a department classify as 7 (all) for that department.

	Work- room Number	(19) Open	(20) Pick	Area	(21) Card #1	(22) #2	(23) Spin	(24) Wind	(25) Twist
AT RISK (cotton & Cotton blend)	1			Cards
	2			Draw
	3			Comb
	4			Thru Out
	5
	6
	7 (all)
Control (synthetic & wool)	8
Ex- Worker (cotton)	9

Continued –

	Work- Room Number	(26) Spool	(27) Warp	(28) Slash	(29) Weave	(30) Other
AT RISK (cotton & cotton blend)	1
	2
	3
	4
	5
	6
	7 (all)
Control (synthetic & wool)	8
Ex- Worker (cotton)	9

Use actual wording of each question. Put X in appropriate square after each question. When in doubt record `No'. When no square, circle appropriate answer.

B. COUGH (on getting up)
Do you usually cough first thing in the morning?		_________________________ Yes _______ No _______ (31)
(Count a cough with first smoke or on “first going out of doors.” Exclude clearing throat or a single cough.)
Do you usually cough during the day or at night? (Ignore an occasional cough.)		Yes _______ No _______ (32)
If `Yes' to either question (31-32):
Do you cough like this on most days for as much as three months a year?		Yes _______ No _______ (33)
Do you cough on any particular day of the week?		Yes _______ No _______ (34)
(1) (2) (3) (4) (5) (6) (7) If ‘Yes’: Which day? Mon Tues Wed Thur Fri Sat Sun (35) ­­­­­­­­­­­­­­___________________________________________________________________
C. PHLEGM or alternative word to suit local custom. (on getting up)
Do you usually bring up any phlegm from your chest first thing in the morning? (Count phlegm with the first smoke or on “first going out of doors.” Exclude phlegm from the nose. Count swallowed phlegm.)			Yes _______ No ______ (36)
Do you usually bring up any phlegm from your chest during the day or at night? (Accept twice or more.)			Yes _______ No ______ (37)
If `Yes' to question (36) or (37):
Do you bring up any phlegm like this on most days for as much as three months each year?			Yes _______ No ______ (38)

If `Yes' to question (33) or (38):
(cough) How long have you had this phlegm? (Write in number of years)			(1) ____ 2 years or less (2) ____ More than 2 years-9 years (3) ____ 10-19 years (4) ____ 20+ years
* These words are for subjects who work at night
D. TIGHTNESS
Does your chest ever feel tight or your breathing become difficult?			Yes _______ No _______ (39)
Is your chest tight or your breathing difficult on any particular day of the week? (after a week or 10 days from the mill)			Yes _______ No _______ (40)
If `Yes': Which day? (3) (4) (5) (6) (7) (8) Mon. ^ Tues. Wed. Thur. Fri. Sat. Sun. (41) (1) / \ (2) Sometimes Always
If `Yes' Monday At what time on Monday does your chest feel tight or your breathing difficult?	(1) ___ Before entering the mill (42) (2) ___ After entering the mill
(Ask only if NO to Question (45))
In the past, has your chest ever been tight or your breathing difficult on any particular day of the week?		Yes _______ No _______ (43)

If `Yes': Which day? (3) (4) (5) (6) (7) (8) Mon. ^ Tues. Wed. Thur. Fri. Sat. Sun. (44) (1) / \ (2) Sometimes Always
E. TOBACCO SMOKING
* Have you changed your smoking habits since last interview? If yes, specify what changes.