Form
Approved OMB
No. 0923-0041
Exp.
Date 01/31/2023
ATSDR
estimates the average public reporting burden for this collection of
information as 32 minutes per response, including the time for
reviewing instructions, searching existing data/information sources,
gathering, and maintaining the data/information needed, and
completing and reviewing the collection of information. An agency
may not conduct or sponsor, and a person is not required to respond
to a collection of information unless it displays a currently valid
OMB Control Number. Send comments regarding this burden estimate or
any other aspect of this collection of information, including
suggestions for reducing this burden to CDC/ATSDR Information
Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta,
Georgia 30333; ATTN: PRA (0923-0041).
Follow-up questions are based on:
ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
FOLLOW-UP QUESTIONS (SEE BELOW) |
9a |
S1_Q10A |
|
Current height (ft) |
APPENDIX E 4.1.1 |
9b |
S1_Q10B |
|
Current height (in) |
APPENDIX E 4.1.1.1 |
10 |
S1_Q11 |
|
Current weight (lb) |
APPENDIX E 4.1.2 |
The following questions are about your height and weight when you were 40 years old.
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.1.1 |
S1_Q12A |
|
What was your height at age 40 years (ft) |
|
|
|
ENTER: |
4.1.1.1 |
S1_Q12B |
|
What was your height at age 40 years (in) |
|
|
|
ENTER: |
4.1.2 |
S1_Q13 |
|
What was your weight at age 40 years (lb) |
|
|
|
ENTER: |
APPENDIX E4
LIFESTYLE INFORMATION
4.2 ALCOHOL AND SMOKING
Follow-up questions are based on:
Q: Have you ever smoked one or more cigarettes per day for 6 months or longer?
Q: Did you ever drink alcoholic beverages such as wine, beer and spirits at least once a month for 6 months or more?
ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
FOLLOW-UP QUESTIONS (SEE BELOW) |
11 |
S4_Q01 |
1 |
Yes to Smoking |
APPENDIX E 4.2.1 – 4.2.4 |
12 |
S4_Q07 |
1 |
Yes to Alcohol beverages |
APPENDIX E 4.2.5 – 4.2.7 |
The following questions are about your smoking and alcohol consumption history.
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.2.1 |
S4_Q02 |
|
If yes, how old were you when you first started smoking one or more cigarettes per day? |
|
|
|
ENTER |
4.2.2 |
S4_Q03 |
|
Are you still a cigarette smoker? |
|
|
1 |
Yes |
|
|
2 |
No |
|
|
|
GO TO: APPENDIX ITEM 4.2.2.1 |
|
|
9 |
Don’t know |
4.2.2.1 |
S4_Q04 |
|
If NO, at what age did you last stop smoking cigarettes |
|
|
|
ENTER: |
4.2.3 |
S4_Q05 |
|
During periods when you smoked, for how many years in total did you smoke cigarettes |
|
|
|
ENTER: |
4.2.4 |
S4_Q06 |
|
During periods when you smoked, how many cigarettes did you usually smoke in a day? One pack contains 20 cigarettes |
|
|
|
ENTER: |
4.2.5 |
S4_Q08 |
|
Are you still drinking alcoholic beverages at least once per month |
|
|
1 |
Yes |
|
|
2 |
No |
4.2.6 |
S4_Q09 |
|
During periods when you were drinking alcoholic beverages, for how many years in total did you drink alcoholic beverages? |
|
|
|
ENTER: |
4.2.7 |
|
|
During periods when you were drinking, how many alcoholic beverages did you usually have in a week OR month? A drink is 12 oz. beer, 4 ounces of wine or a drink containing 1 oz. of liquor. Please select week or month. |
4.2.7.1 |
S4_Q10A |
|
ENTER: (FREQUENCY) |
4.2.7.2 |
S4_Q10B |
1 |
Week |
|
|
2 |
Month |
APPENDIX E4
LIFESTYLE INFORMATION
4.3 PHYSICAL ACTIVITY
Follow-up questions are based on:
Q: Have you ever engaged in vigorous leisure-time physical activity for at least 10 minutes that caused heavy sweating or large increases in breathing or heart rate.
ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
FOLLOW-UP QUESTIONS (SEE BELOW) |
13 |
S5_Q01 |
1 |
Yes |
APPENDIX E 4.3.1 – 4.3.6 |
If yes, please indicate the number of times per week, month, OR year that you engaged in vigorous activity for at least 10 minutes for each age period (up to your current age period).
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.3.1 |
S5_Q02A_01 |
Age group (15-24 years) |
|
|
|
1 |
Yes |
|
|
2 |
No |
|
|
3 |
Age not applicable |
|
S5_Q02A_02 |
Number of times exercised |
|
4.3.1.1 |
|
|
ENTER: FREQUENCY |
4.3.1.2 |
S5_Q02A_03 |
1 |
Week |
|
|
2 |
Month |
|
|
3 |
Year |
4.3.2 |
S5_Q02B_01 |
|
Age group (25-34 years) |
|
|
1 |
Yes |
|
|
2 |
No |
|
|
3 |
Age not applicable |
|
|
|
Number of times exercised |
4.3.2.1 |
S5_Q02B_02 |
|
ENTER: FREQUENCY |
4.3.2.2 |
S5_Q02B_03 |
1 |
Week |
|
|
2 |
Month |
|
|
3 |
Year |
4.3.3 |
S5_Q02C_01 |
|
Age group (35-44 years) |
|
|
1 |
Yes |
|
|
2 |
No |
|
|
3 |
Age not applicable |
|
|
|
Number of times exercised |
4.3.3.1 |
S5_Q02C_02 |
|
ENTER: FREQUENCY |
4.3.3.2 |
S5_Q02C_03 |
1 |
Week |
|
|
2 |
Month |
|
|
3 |
Year |
4.3.4 |
S5_Q02D_01 |
Age group (45-54 years) |
|
|
|
1 |
Yes |
|
|
2 |
No |
|
|
3 |
Age not applicable |
|
|
|
Number of times exercised |
4.3.4.1 |
S5_Q02D_02 |
ENTER: FREQUENCY |
|
4.3.4.2 |
S5_Q02D_03 |
1 |
Week |
|
|
2 |
Month |
|
|
3 |
Year |
4.3.5 |
S5_Q02E_01 |
|
Age group (55-64 years) |
|
|
1 |
Yes |
|
|
2 |
No |
|
|
3 |
Age not applicable |
|
|
|
Number of times exercised |
4.3.5.1 |
S5_Q02E_02 |
|
ENTER: FREQUENCY |
4.3.5.2 |
S5_Q02E_03 |
1 |
Week |
|
|
2 |
Month |
|
|
3 |
Year |
4.3.6 |
S5_Q02F_01 |
|
Age group (65 years and older) |
|
|
1 |
Yes |
|
|
2 |
No |
|
|
3 |
Age not applicable |
|
|
|
Number of times exercised |
4.3.6.1 |
S5_Q02F_02 |
|
ENTER: FREQUENCY |
4.3.6.2 |
S5_Q02F_03 |
1 |
Week |
|
|
2 |
Month |
|
|
3 |
Year |
APPENDIX E4
LIFESTYLE INFORMATION
4.4 CAFFEINATED DRINK CONSUMPTION
Follow-up questions are based on:
Q: Did you ever drink caffeinated beverage? (Check all that apply)
ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
FOLLOW-UP QUESTIONS (SEE BELOW) |
14 |
S13_Q01 |
1 |
Espresso drinks |
APPENDIX ITEM 4.4.1 SERIES |
|
S13_Q02 |
2 |
Regular coffee |
APPENDIX ITEM 4.4.2 SERIES |
|
S13_Q03 |
3 |
Hot or cold tea |
APPENDIX ITEM 4.4.3 SERIES |
|
S13_Q04 |
4 |
Highly caffeinated drinks |
APPENDIX ITEM 4.4.4 SERIES |
|
S13_Q05 |
5 |
Regular soda |
APPENDIX ITEM 4.4.5 SERIES |
The next questions pertain to your usual caffeine habits as an adult. By usual, we mean drinking the beverage at least once a month for six months or more.
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.4.1 |
S13_Q01A |
|
At what age did you first drink (ITEM 30) drinks? |
|
|
|
ENTER: |
4.4.1.1 |
S13_Q01B |
|
Are you still drinking (ITEM 30) drinks? |
|
|
1 |
Yes |
|
|
2 |
No |
|
|
9 |
Don’t know |
4.4.1.2 |
S13_Q01C |
|
At what age did you last drink (ITEM 30) drinks? |
|
|
|
ENTER: |
4.4.1.3 |
S13_Q01D |
|
This is a total of __ __ years. (SYSTEM CALCULATION) |
4.4.1.4 |
S13_Q01E |
|
Years when you did NOT drink (ITEM 30) drinks |
|
|
|
ENTER: |
4.4.1.5 |
S13_Q01F_01 |
How often (per day, week, month or year) did you drink it? |
|
|
|
|
ENTER: FREQUENCY |
4.4.1.5.1 |
S13_Q01F_02 |
1 |
day |
|
|
2 |
week |
|
|
3 |
month |
|
|
4 |
year |
Same questions (APPENDIX ITEM 4.4.1) are asked for the chosen caffeinated drink from Essential Questionnaire ITEM 30.
Regular coffee |
Hot or cold tea |
Highly caffeinated drinks |
Regular soda |
APPENDIX ITEM 4.4.2 |
APPENDIX ITEM 4.4.3 |
APPENDIX ITEM 4.4.4 |
APPENDIX ITEM 4.4.5 |
S13_Q02A |
S13_Q03A |
S13_Q04A |
S13_Q05A |
S13_Q02B |
S13_Q03B |
S13_Q04B |
S13_Q05B |
S13_Q02C |
S13_Q03C |
S13_Q04C |
S13_Q05C |
S13_Q02D |
S13_Q03D |
S13_Q04D |
S13_Q05D |
S13_Q02E |
S13_Q03E |
S13_Q04E |
S13_Q05E |
S13_Q02F_01 |
S13_Q03F_01 |
S13_Q04F_01 |
S13_Q05F_01 |
S13_Q02F_02 |
S13_Q03F_02 |
S13_Q04F_02 |
S13_Q05F_02 |
APPENDIX E4
LIFESTYLE INFORMATION
4.5 TRAUMA/HEAD AND NECK INJURIES
Follow-up questions are based on:
Q: Have you ever had an injury to your head or neck due to the following? (Check all that apply)
ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
FOLLOW-UP QUESTIONS (SEE BELOW) |
16 |
S14_Q01 |
1 |
Childhood injuries |
APPENDIX ITEM 4.5.1 SERIES |
|
S14_Q02 |
2 |
Car accident or moving vehicle |
APPENDIX ITEM 4.5.2 SERIES |
|
S14_Q03 |
3 |
Falling or being hit or playing sports |
APPENDIX ITEM 4.5.3 SERIES |
|
S14_Q04 |
4 |
Fights/Violence/Shaken |
APPENDIX ITEM 4.5.4 SERIES |
|
S14_Q05 |
5 |
Explosion/Blast |
APPENDIX ITEM 4.5.5 SERIES |
The next questions are about injuries to your head and/or neck that that you may have had at anytime in your life. These may have occurred during sporting activities, from falls, violence, car accidents or other accidents. Please include injuries from both childhood and adulthood.
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.5.1 |
S14_Q01A |
|
IF YES, How many head or neck injuries have you had? |
|
|
|
ENTER: |
4.5.1.1 |
S14_Q01B |
|
Age first head or neck injury occurred |
|
|
|
ENTER: |
4.5.1.2
|
S14_Q01C |
|
Did you lose consciousness from this injury? |
|
|
1 |
Yes |
|
|
|
GO TO: APPENDIX ITEM 4.5.1.2.1 |
|
|
2 |
No |
|
|
9 |
Don’t know |
4.5.1.2.1 |
S14_Q01D |
|
How long were you unconscious |
|
|
1 |
Less than 5 minutes |
|
|
2 |
5-59 minutes |
|
|
3 |
1-24 hours |
|
|
4 |
Longer than a day |
|
|
9 |
Don’t know |
4.5.1.3 |
S14_Q01E |
|
Did you go to the emergency room or were you hospitalized for this injury? |
|
|
1 |
Yes |
|
|
2 |
No |
|
|
9 |
Don’t know |
4.5.1.5 |
|
|
From this injury, did you have any of the following? |
|
|
0 |
No |
|
S14_Q01F_01 |
1 |
Skull fracture |
|
S14_Q01F_02 |
2 |
Seizure |
|
S14_Q01F_03 |
3 |
Memory loss/Amnesia |
|
S14_Q01F_04 |
4 |
None of the above |
|
S14_Q01F_05 |
9 |
Don't know |
Same questions (APPENDIX ITEM 4.5.1) are asked for the chosen trauma from Essential Questionnaire ITEM 32
Car accident or moving vehicle |
Falling or being hit or playing sports |
Fights/Violence/Shaken |
Explosion/Blast |
APPENDIX ITEM 4.5.2 |
APPENDIX ITEM 4.5.3 |
APPENDIX ITEM 4.5.4 |
APPENDIX ITEM 4.5.5 |
S14_Q02A |
S14_Q03A |
S14_Q04A |
S14_Q05A |
S14_Q02B |
S14_Q03B |
S14_Q04B |
S14_Q05B |
S14_Q02C |
S14_Q03C |
S14_Q04C |
S14_Q05C |
S14_Q02D |
S14_Q03D |
S14_Q04D |
S14_Q05D |
S14_Q02E |
S14_Q03E |
S14_Q04E |
S14_Q05E |
S14_Q02F_01 |
S14_Q03F_01 |
S14_Q04F_01 |
S14_Q05F_01 |
S14_Q02F_02 |
S14_Q03F_02 |
S14_Q04F_02 |
S14_Q05F_02 |
S14_Q02F_03 |
S14_Q03F_03 |
S14_Q04F_03 |
S14_Q05F_03 |
S14_Q02F_04 |
S14_Q03F_04 |
S14_Q04F_04 |
S14_Q05F_04 |
S14_Q02F_05 |
S14_Q03F_05 |
S14_Q04F_05 |
S14_Q05F_05 |
APPENDIX E4
LIFESTYLE INFORMATION
4.6 ELECTRICAL SHOCKS
Follow-up questions are based on:
Q: Have you ever received any electrical shock that resulted in the following? (Check all that apply)
ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
FOLLOW-UP QUESTIONS (SEE BELOW) |
17 |
S14_Q06 |
1 |
Unconsciousness |
APPENDIX ITEM 4.6.1 SERIES |
|
S14_Q07 |
2 |
Burn |
APPENDIX ITEM 4.6.2 SERIES |
|
S14_Q08 |
3 |
Just the electrical shock |
APPENDIX ITEM 4.6.3 SERIES |
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.6.1 |
S14_Q06A |
|
How many shocks of this type have you received? |
|
|
|
ENTER: |
4.6.1.1 |
S14_Q06B |
|
At what age did you FIRST receive a shock that resulted in unconsciousness? |
|
|
|
ENTER: |
4.6.2 |
S14_Q07A |
|
How many shocks of this type have you received? |
|
|
|
ENTER: |
4.6.2.1 |
S14_Q07B |
|
At what age did you FIRST receive a shock that resulted in a burn? |
|
|
|
ENTER: |
4.6.3 |
S14_Q08A |
|
How many shocks of this type have you received? |
|
|
|
ENTER: |
4.6.3.1 |
S14_Q08B |
|
At what age did you FIRST receive a shock that did not result in unconsciousness or a burn? |
|
|
|
ENTER: |
APPENDIX E4
LIFESTYLE INFORMATION
4.7 PROFESSIONAL SPORTS
NOTE: Organized sports are those that are played within a school or league setting. This does not include casual playing at home or in your community.
Follow-up questions are based on:
Q: Have you participated in organized or professional sports? (Check all that apply)
ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
FOLLOW-UP QUESTIONS (SEE BELOW) |
15 |
S18_Q02 |
1 |
Football |
APPENDIX ITEM 4.7.1/FOOTBALL SURVEY |
|
S18_Q07 |
2 |
Hockey |
APPENDIX ITEM 4.7.2/HOCKEY SURVEY |
|
S18_Q13 |
3 |
Boxing |
APPENDIX ITEM 4.7.3/BOXING SURVEY |
|
S18_Q16 |
4 |
Soccer |
APPENDIX ITEM 4.7.4/SOCCER SURVEY |
|
S18_Q22 |
5 |
Other Sports |
APPENDIX ITEM 4.7.5/ 4.7.6/4.7.7/OTHER SPORT (1-3) SURVEY |
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.7.1 |
S18_Q02A |
|
At what age did you start playing (ITEM 15)? |
|
|
|
ENTER: |
|
S18_Q02B |
|
At what age did you stop playing (ITEM 15)? |
|
|
|
ENTER: |
Same questions were asked about the age for the following selected sports in Essential Questionnaire ITEM 15.
Hockey |
Boxing |
Soccer |
APPENDIX ITEM 4.7.2 |
APPENDIX ITEM 4.7.3 |
APPENDIX ITEM 4.7.4 |
S18_Q07A |
S18_Q13A |
S18_Q16A |
S18_Q07B |
S18_Q13B |
S18_Q16B |
|
|
|
Other sports (1) |
Other sports (2) |
Other sports (3) |
APPENDIX ITEM 4.7.5 |
APPENDIX ITEM 4.7.6 |
APPENDIX ITEM 4.7.7 |
S18_Q22B |
S18_Q29B |
S18_Q36B |
S18_Q22C |
S18_Q29C |
S18_Q36C |
Next, the following survey is to be completed for the selected sport(s).
FOOTBALL
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.7.1.A |
|
|
Did you play FOOTBALL in organized setting as mentioned below? (Check all that apply) |
|
|
0 |
No |
|
S18_Q03 |
1 |
Professionally or semi-professionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.1.A1 – 4.7.1.A3 |
|
S18_Q04 |
2 |
College |
|
|
|
GO TO: APPENDIX ITEM 4.7.1.B1 – 4.7.1.B3 |
|
S18_Q05 |
3 |
High school |
|
|
|
GO TO: APPENDIX ITEM 4.7.1.C1 – 4.7.1.C3 |
|
S18_Q06 |
4 |
Prior to high school |
|
|
|
GO TO: APPENDIX ITEM 4.7.1.D1 – 4.7.1.D3 |
|
|
5 |
Don’t know |
4.7.1.A1 |
S18_Q03A |
|
At what age did you start playing (APPENDIX ITEM 4.7.1.A)? |
|
|
|
ENTER: |
|
S18_Q03B |
|
At what age did you stop playing (APPENDIX ITEM 4.7.1.A)? |
|
|
|
ENTER: |
4.7.1.A2 |
S18_Q03C_01 – 08A |
|
In what league did you play (APPENDIX ITEM 4.7.1.A)? (Check all that apply) |
|
|
|
GO TO: FOOTBALL LEAGUE TABLE |
4.7.1. A3 |
S18_Q03D |
|
What was your primary position while playing (APPENDIX ITEM 4.7.1.A)? |
|
|
0 |
Offense |
|
S18_Q03DI |
|
GO TO: FOOTBALL POSITION TABLE |
|
|
1 |
Defense |
|
S18_Q03DII |
|
GO TO: FOOTBALL POSITION TABLE |
|
|
2 |
Special Teams |
|
S18_Q03DIII |
|
GO TO: FOOTBALL PISITION TABLE |
|
|
3 |
Don't know |
Same questions (APPENDIX ITEM 4.7.1.A1 – 4.7.1.A3) were asked for the selected organized FOOTBALL setting in APPENDIX ITEM 4.7.1.A.
College |
High school |
Prior to high school |
APPENDIX ITEM 4.7.1.B |
APPENDIX ITEM 4.7.1.C |
APPENDIX ITEM 4.7.1.D |
S18_Q04A |
S18_Q05A |
S18_Q06A |
S18_Q04B |
S18_Q05B |
S18_Q06B |
S18_Q04C_01 |
No 4.7.1.A2 LEAGUE questions |
No 4.7.1.A2 LEAGUE questions |
S18_Q04C_02 |
||
S18_Q04C_03 |
||
S18_Q04C_04 |
||
S18_Q04C_05 |
||
S18_Q04C_06 |
||
S18_Q04C_07 |
||
S18_Q04C_08 |
||
S18_Q04D |
S18_Q05C |
S18_Q06C |
S18_Q04DI |
S18_Q05CI |
S18_Q06CI |
S18_Q04DI_01 |
S18_Q05CI_01 |
S18_Q06CI_01 |
S18_Q04DII |
S18_Q05CII |
S18_Q06CII |
S18_Q04DII_01 |
S18_Q04CII_01 |
S18_Q06CII_01 |
S18_Q04DIII |
S18_Q04CIII |
S18_Q06CIII |
S18_Q04DIII_01 |
S18_Q04CIII_01 |
S18_Q06CIII_01 |
FOOTBALL LEAGUE |
|||||
PROFESSIONAL AND SEMI-PROFESSIONAL |
COLLEGE |
HIGH SCHOOL |
PRIOR TO HIGH SCHOOL |
||
VARIABLE CODE |
4.7.1A |
VARIABLE CODE |
4.7.1B |
4.7.1C |
4.7.1D |
S18_Q03C_01 |
NFL |
S18_Q04C_01 |
Division I/FBS |
N/A |
N/A |
S18_Q03C_02 |
AFL |
S18_Q04C_02 |
Division II/FBS |
|
|
S18_Q03C_03 |
CFL |
S18_Q04C_03 |
Division II |
|
|
S18_Q03C_04 |
NFL Europe |
S18_Q04C_04 |
Division III |
|
|
S18_Q03C_05 |
Arena League |
S18_Q04C_05 |
NAIA |
|
|
S18_Q03C_06 |
XFL |
S18_Q04C_06 |
Don’t know |
|
|
S18_Q03C_07 |
Don’t know |
S18_Q04C_07 |
Other |
|
|
S18_Q03C_08 |
Other |
S18_Q04C_08 |
ENTER: |
|
|
S18_Q03C_08A |
ENTER: |
|
|
|
|
FOOTBALL POSITION |
|||
|
OFFENSE POSITION |
DEFENSE POSITION |
SPECIAL TEAM POSITION |
|
S18_Q03DI |
S18_Q03DII |
S18_Q03DIII |
1 |
Tackle |
Defensive tackle |
Punter |
2 |
Guard |
Defensive guard |
Kicker |
3 |
Center |
Nose guard |
Kick returner |
4 |
Tight end |
Note tackle |
Gunner |
5 |
Other offensive lineman |
Other defensive lineman |
Wedge buster |
6 |
Quarterback |
Middle linebacker |
Return blocker |
7 |
Half back |
Strong side linebacker |
Kick coverage |
8 |
Full back |
Weak side linebacker |
FT/PAT Lineman |
9 |
Running back |
Outside linebacker |
Other (ENTER) |
10 |
Slot back |
Other linebacker |
|
11 |
Wide receiver |
Cornerback |
|
12 |
Other (ENTER) |
Safety |
|
13 |
|
Strong safety |
|
14 |
|
Free safety |
|
15 |
|
Other defensive back |
|
16 |
|
Other (ENTER) |
|
99 |
Don’t know |
Don’t know |
Don’t know |
OTHER (ENTER) |
S18_Q03DI_01 |
S18_Q03DII_01 |
S18_Q03DIII_01 |
HOCKEY
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.7.2.A |
|
|
Did you play HOCKEY in organized setting as mentioned below? (Check all that apply) |
|
|
0 |
No |
|
S18_Q08 |
1 |
Professionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.2.A1– 4.7.2.A3 |
|
S18_Q09 |
2 |
Semi-professionally or at junior level |
|
|
|
GO TO: APPENDIX ITEM 4.7.2.B1– 4.7.2.B3 |
|
S18_Q10 |
3 |
College |
|
|
|
GO TO: APPENDIX ITEM 4.7.2.C1– 4.7.2.C3 |
|
S18_Q11 |
4 |
High school |
|
|
|
GO TO: APPENDIX ITEM 4.7.2.D1– 4.7.2.D3 |
|
S18_Q12 |
5 |
Prior to high school |
|
|
|
GO TO: APPENDIX ITEM 4.7.2.E1– 4.7.2.E3 |
|
|
6 |
Don’t know |
4.7.2.A1 |
S18_Q08A |
|
At what age did you start playing (APPENDIX ITEM 4.7.2.A)? |
|
|
|
ENTER: |
|
S18_Q08B |
|
At what age did you stop playing (APPENDIX ITEM 4.7.2.A)? |
|
|
|
ENTER: |
4.7.2.A2 |
|
|
In what league did you play (APPENDIX ITEM 4.7.2.A)? (Check all that apply) |
|
S18_Q08C_01 to S18_Q08C_05 |
|
GOTO: HOCKEY LEAGUE TABLE |
4.7.2.A3 |
S18_Q08D |
|
What was your primary position while playing (APPENDIX ITEM 4.7.2.A) |
|
|
1 |
Left wing |
|
|
2 |
Right wing |
|
|
3 |
Wing |
|
|
4 |
Forward |
|
|
5 |
Center |
|
|
6 |
Lt defensemen |
|
|
7 |
Rt defensemen |
|
|
8 |
Defensemen |
|
|
9 |
Goalie |
|
|
10 |
Other |
|
S18_Q08D_01 |
|
ENTER: |
|
|
99 |
Don’t know |
4.7.2.A4 |
S18_Q08E |
|
Were you ever an enforcer while playing (APPENDIX ITEM 4.7.2.A)? |
|
|
1 |
Yes |
|
|
2 |
No |
|
|
9 |
Don’t know |
Same questions (APPENDIX ITEM 4.7.2.A1 – 4.7.2.A4) were asked for the selected organized setting in APPENDIX ITEM 4.7.2.A.
Semi-professional or junior level |
College |
High school |
Prior to high school |
APPENDIX ITEM 4.7.2.B |
APPENDIX ITEM 4.7.2.C |
APPENDIX ITEM 4.7.2.D |
APPENDIX ITEM 4.7.2.E |
S18_Q09A |
S18_Q10A |
S18_Q11A |
S18_Q12A |
S18_Q09B |
S18_Q10B |
S18_Q11B |
S18_Q12B |
No 4.7.2.A2 LEAGUE questions |
S18_Q10C_01 |
No 4.7.2.A2 LEAGUE questions |
No 4.7.2.A2 LEAGUE questions |
S18_Q10C_02 |
|||
S18_Q10C_03 |
|||
S18_Q10C_04 |
|||
S18_Q10C_05 |
|||
S18_Q10C_06 |
|||
S18_Q10C_07 |
|||
S18_Q09C |
S18_Q10D |
S18_Q11C |
S18_Q12C |
S18_Q09C_01 |
S18_Q10D_01 |
S18_Q11C_01 |
S18_Q12C_01 |
S18_Q09D |
No 4.7.2.A4 question |
No 4.7.2.A4 question |
No 4.7.2.A4 question |
HOCKEY LEAGUE |
||||||
PROFESSIONAL |
SEMI PROFESSIONALLY OR AT JUNIOR LEVEL |
COLLEGE |
HIGH SCHOOL |
PRIOR TO HIGH SCHOOL |
||
VARIABLE CODE |
4.7.2.A |
4.7.2.B |
4 VARIABLE CODE |
4.7.2.C |
4.7.2.D |
4.7.2.E |
S18_Q08C_01 |
NHL |
N/A |
S18_Q10C_01 |
Division I |
N/A |
N/A |
S18_Q08C_02 |
AHL |
|
S18_Q10C_02 |
Division II |
|
|
S18_Q08C_03 |
ECHL |
|
S18_Q10C_03 |
Division III |
|
|
S18_Q08C_04 |
Other |
|
S18_Q10C_04 |
NAIA |
|
|
S18_Q08C_05 |
ENTER: |
|
S18_Q10C_05 |
Don’t know |
|
|
|
|
|
S18_Q10C_06 |
Other |
|
|
|
|
|
S18_Q10C_07 |
ENTER: |
|
|
BOXING
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.7.3.A |
|
|
Did you ever box in organized setting as mentioned below? (Check all that apply) |
|
|
0 |
No |
|
S18_Q14 |
1 |
As Professional |
|
|
|
GO TO: APPENDIX ITEM 4.7.3.A1– 4.7.3.A3 |
|
S18_Q15 |
2 |
As Amateur |
|
|
|
GO TO: APPENDIX ITEM 4.7.3.B1– 4.7.3.B3 |
|
|
6 |
Don’t know |
4.7.3.A1 |
S18_Q14A |
|
How many total bouts of matches did you compete in while boxing in chosen organized setting (APPENDIX ITEM 4.7.3.A)? |
|
|
|
ENTER: |
4.7.2.A2 |
S18_Q14B |
|
In what weight class did you play while boxing in chosen organized setting (APPENDIX ITEM 4.7.3.A)? |
|
|
1 |
Heavyweight |
|
|
2 |
Cruiserweight/junior heavyweight |
|
|
3 |
Light heavyweight |
|
|
4 |
Super middleweight |
|
|
5 |
Middleweight |
|
|
6 |
Super welterweight, junior/light middleweight |
|
|
7 |
Welterweight |
|
|
8 |
Super lightweight or junior/light welterweight |
|
|
9 |
Lightweight |
|
|
10 |
Super featherweight/junior lightweight |
|
|
11 |
Featherweight |
|
|
12 |
Super bantamweight/junior featherweight |
|
|
13 |
Bantamweight |
|
|
14 |
Super flyweight/junior bantamweight |
|
|
15 |
Flyweight |
|
|
16 |
Light flyweight/junior flyweight |
|
|
17 |
Minimumweight/mini flyweight/strawweight |
|
|
18 |
Light minimumweight/Atomweight |
|
|
19 |
Other |
|
S18_Q14B_01 |
|
ENTER: |
|
|
99 |
Don’t know |
Same questions (APPENDIX ITEM 4.7.3.A1 – 4.7.3.A2) were asked for the selected organized setting in APPENDIX ITEM 4.7.3.A.
As an amateur |
APPENDIX ITEM 4.7.3.B |
S18_Q15A |
S18_Q15B |
S18_Q15B_01 |
SOCCER
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.7.4.A |
|
|
Did you play SOCCER in organized setting as mentioned below? (Check all that apply) |
|
|
0 |
No |
|
S18_Q17 |
1 |
Professionally or semiprofessionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.4.A1– 4.7.4.A3 |
|
S18_Q18 |
2 |
College |
|
|
|
GO TO: APPENDIX ITEM 4.7.4.B1– 4.7.4.B3 |
|
S18_Q19 |
3 |
High school |
|
|
|
GO TO: APPENDIX ITEM 4.7.4.C1– 4.7.4.C3 |
|
S18_Q20 |
4 |
Prior to high school |
|
|
|
GO TO: APPENDIX ITEM 4.7.4.D1– 4.7.4.D3 |
|
S18_Q21 |
5 |
Another level |
|
|
|
GO TO: APPENDIX ITEM 4.7.4.E1– 4.7.4.E3 |
|
|
6 |
Don’t know |
4.7.4.A1 |
S18_Q17A |
|
At what age did you start playing (APPENDIX ITEM 4.7.4.A)? |
|
|
|
ENTER: |
|
S18_Q17B |
|
At what age did you stop playing (APPENDIX ITEM 4.7.4A)? |
|
|
|
ENTER: |
4.7.4.A2 |
S18_Q17C |
|
In what league did you play (APPENDIX ITEM 4.7.4.A)? |
|
|
|
GO TO: SOCCER LEAGUE TABLE |
4.7.4.A3 |
S18_Q17D |
|
What was your primary position while playing (APPENDIX ITEM 4.7.4.A) |
|
|
1 |
Defender |
|
|
2 |
Center-back |
|
|
3 |
Sweeper |
|
|
4 |
Full-back/Lt-back/Rt-back |
|
|
5 |
Wingback |
|
|
6 |
Midfielder |
|
|
7 |
Winger/Lt midfield/Rt midfield |
|
|
8 |
Defensive midfielder |
|
|
9 |
Attacking midfielder |
|
|
10 |
Forward |
|
|
11 |
Striker |
|
|
12 |
Goalie |
|
|
13 |
Other |
|
S18_Q17D_01 |
|
ENTER: |
|
|
99 |
Don’t know |
Same questions (APPENDIX ITEM 4.7.4.A1 – 4.7.4.A3) were asked for the chosen organized setting in APPENDIX ITEM 4.7.4.A.
College |
High school |
Prior to high school |
Another level |
APPENDIX ITEM 4.7.4.B |
APPENDIX ITEM 4.7.4.C |
APPENDIX ITEM 4.7.4.D |
APPENDIX ITEM 4.7.4.E |
S18_Q18A |
S18_Q19A |
S18_Q20A |
S18_Q21A |
S18_Q18B |
S18_Q19B |
S18_Q20B |
S18_Q21B |
S18_Q18C |
No 4.7.4.A2 LEAGUE questions |
No 4.7.4.A2 LEAGUE questions |
No 4.7.4.A2 LEAGUE questions |
S18_Q18C_01 |
|||
S18_Q18D |
S18_Q19C |
S18_Q20C |
S18_Q21C |
S18_Q18D_01 |
S18_Q19C_01 |
S18_Q20C_01 |
S18_Q21C_01 |
SOCCER LEAGUE |
||||||
PROFESSIONALLY OR SEMI-PROFESSIONALLY |
COLLEGE |
HIGH SCHOOL |
PRIOR TO HIGH SCHOOL |
ANOTHER LEVEL |
||
VARIABLE CODE |
4.7.4A |
VARIABLE CODE |
4.7.4B |
4.7.4.C |
4.7.4.D |
4.7.4.E |
S18_Q17CI_01 |
North American |
S18_Q18C |
Division I |
N/A |
N/A |
N/A |
S18_Q17CI_02 |
South American |
|
Division II |
|
|
|
S18_Q17CI_03 |
European |
|
Division III |
|
|
|
S18_Q17CI_04 |
Asian/Australian |
|
NAIA |
|
|
|
S18_Q17CI_05 |
African |
|
Other |
|
|
|
S18_Q17CI_06 |
Other |
S18_Q18C_01 |
ENTER: |
|
|
|
|
|
|
Don’t know |
|
|
|
OTHER SPORTS (1)
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.7.5.1 |
S18_Q22A |
|
What was your next, major, organized sport played? GO TO: OTHER ORGANIZED SPORTS TABLE |
|
S18_Q22A_01 |
|
OTHER (ENTER) |
4.7.5.A |
|
|
Did you play this organized sport in organized setting as mentioned below? (Check all that apply) |
|
|
0 |
No |
|
S18_Q23 |
1 |
Professionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.5.A1– 4.7.5.A2 |
|
S18_Q24 |
2 |
Semi-professionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.5.B1– 4.7.5.B2 |
|
S18_Q25 |
3 |
College |
|
|
|
GO TO: APPENDIX ITEM 4.7.5.C1– 4.7.5.C2 |
|
S18_Q26 |
4 |
High school |
|
|
|
GO TO: APPENDIX ITEM 4.7.5.D1– 4.7.5.D2 |
|
S18_Q27 |
5 |
Prior to high school |
|
|
|
GO TO: APPENDIX ITEM 4.7.5.E1– 4.7.5.E2 |
|
S18_Q28 |
6 |
Another level |
|
|
|
GO TO: APPENDIX ITEM 4.7.5.F1– 4.7.5.F2 |
|
|
7 |
Don’t know |
4.7.5.A1 |
S18_Q23A |
|
How many years did you play this organized sport in chosen organized setting (APPENDIX ITEM 4.7.5.1)? |
|
|
|
ENTER: |
4.7.5.A2 |
S18_Q23B |
|
What was your primary position while playing (APPENDIX ITEM 4.7.5.1) |
|
|
|
ENTER: |
|
|
|
|
Same questions (APPENDIX ITEM 4.7.5.A1 – 4.7.5.A2) were asked for the selected organized setting in APPENDIX ITEM 4.7.5.A.
SEMI-PROFESSIONALLY |
COLLEGE |
HIGH SCHOOL |
PIOR TO HIGH SCHOOL |
ANOTHER LEVEL |
APPENDIX ITEM 4.7.5.B |
APPENDIX ITEM 4.7.5.C |
APPENDIX ITEM 4.7.5.D |
APPENDIX ITEM 4.7.5.E |
APPENDIX ITEM 4.7.5.F |
S18_Q24A |
S18_Q25A |
S18_Q26A |
S18_Q27A |
S18_Q28A |
S18_Q24B |
S18_Q25B |
S18_Q26B |
S18_Q27B |
S18_Q28B |
OTHER ORGANIZED SPORTS |
|||||||
1 |
Amateur Wrestling |
16 |
Field Hockey |
31 |
Parachuting |
46 |
Triathlon |
2 |
Auto Racing |
17 |
Flag Football |
32 |
Pentathlon |
47 |
Ultimate Frisbee |
3 |
Bandy |
18 |
Floor Hockey |
33 |
Power Lifting |
48 |
Water Polo |
4 |
Baseball |
19 |
Golf |
34 |
Entertainment Wrestling |
49 |
Water Skiing |
5 |
Basketball |
20 |
Gymnastics |
35 |
Racquetball |
50 |
Other |
6 |
Bodybuilding |
21 |
Horse Jumping |
36 |
Roller Hockey |
|
|
7 |
Bowling |
22 |
Ice Skating |
37 |
Rugby |
|
|
8 |
Bull Riding |
23 |
Inline Skating |
38 |
Skiing |
|
|
9 |
Distance Running |
24 |
Karate |
39 |
Snowboarding |
|
|
10 |
Crew |
25 |
Kickball |
40 |
Softball |
|
|
11 |
Cross County |
26 |
Lacrosse |
41 |
Squash |
|
|
12 |
Cycling |
27 |
Martial Arts |
42 |
Strongman |
|
|
13 |
Decathlon |
28 |
Mixed Martial Arts (MMA) |
43 |
Swimming |
|
|
14 |
Diving |
29 |
Motorcycle Racing |
44 |
Tennis |
|
|
15 |
Equestrian |
30 |
Mountaineering |
45 |
Track and Field |
|
|
OTHER SPORTS (2)
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.7.6 |
S18_Q29 |
|
Did you play any other organized sports? |
|
|
1 |
Yes |
|
|
|
GO TO: APPENDIX ITEM 4.7.6.1 |
|
|
2 |
No |
|
|
3 |
Don’t know |
4.7.6.1 |
S18_Q29A |
|
What was your next, major, organized sport played? GO TO: OTHER ORGANIZED SPORTS TABLE |
|
S18_Q29A_01 |
|
OTHER (ENTER) |
4.7.6.2 |
S18_Q29B |
|
At what age did you start playing (APPENDIX ITEM 4.7.6.1)? |
|
|
|
ENTER: |
|
S18_Q29C |
|
At what age did you stop playing (APPENDIX ITEM 4.7.6.1)? |
|
|
|
ENTER: |
4.7.6.A |
|
|
Did you play this organized sport in organized setting as mentioned below? (Check all that apply) |
|
|
0 |
No |
|
S18_Q30 |
1 |
Professionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.6.A1– 4.7.6.A2 |
|
S18_Q31 |
2 |
Semi-professionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.6.B1– 4.7.6.B2 |
|
S18_Q32 |
3 |
College |
|
|
|
GO TO: APPENDIX ITEM 4.7.6.C1– 4.7.6.C2 |
|
S18_Q33 |
4 |
High school |
|
|
|
GO TO: APPENDIX ITEM 4.7.6.D1– 4.7.6.D2 |
|
S18_Q34 |
5 |
Prior to high school |
|
|
|
GO TO: APPENDIX ITEM 4.7.6.E1– 4.7.6.E2 |
|
S18_Q35 |
6 |
Another level |
|
|
|
GO TO: APPENDIX ITEM 4.7.6.F1– 4.7.6.F2 |
|
|
7 |
Don’t know |
4.7.6.A1 |
S18_Q30A |
|
How many years did you play in the organized sport in chosen organized setting (APPENDIX ITEM 4.7.6.A)? |
|
|
|
ENTER: |
4.7.6.A2 |
S18_Q30B |
|
What was your primary position while playing (APPENDIX ITEM 4.7.6.A) |
|
|
|
ENTER: |
|
|
|
|
Same questions (APPENDIX ITEM 4.7.6.A1 – 4.7.6.A2) were asked for the selected organized setting in APPENDIX ITEM 4.7.6.A.
SEMI-PROFESSIONALLY |
COLLEGE |
HIGH SCHOOL |
PIOR TO HIGH SCHOOL |
ANOTHER LEVEL |
APPENDIX ITEM 4.7.6.B |
APPENDIX ITEM 4.7.6.C |
APPENDIX ITEM 4.7.6.D |
APPENDIX ITEM 4.7.6.E |
APPENDIX ITEM 4.7.6.F |
S18_Q31A |
S18_Q32A |
S18_Q33A |
S18_Q34A |
S18_Q35A |
S18_Q31B |
S18_Q32B |
S18_Q33B |
S18_Q34B |
S18_Q35B |
OTHER SPORTS (3)
APPENDIX ITEM |
VARIABLE CODE |
RESPONSE |
DESCRIPTION |
4.7.7 |
S18_Q36 |
|
Did you play any other organized sports? |
|
|
1 |
Yes |
|
|
|
GO TO: APPENDIX ITEM 4.7.7.1 |
|
|
2 |
No |
|
|
3 |
Don’t know |
4.7.7.1 |
S18_Q36A |
|
What was your next, major, organized sport played? GO TO: OTHER ORGANIZED SPORTS TABLE |
|
S18_Q36A_01 |
|
OTHER (ENTER) |
4.7.7.2 |
S18_Q36B |
|
At what age did you start playing (APPENDIX ITEM 4.7.7.1)? |
|
|
|
ENTER: |
|
S18_Q36C |
|
At what age did you stop playing (APPENDIX ITEM 4.7.7.1)? |
|
|
|
ENTER: |
4.7.7.A |
|
|
Did you play this organized sport in organized setting as mentioned below? (Check all that apply) |
|
|
0 |
No |
|
S18_Q37 |
1 |
Professionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.7.A1– 4.7.7.A2 |
|
S18_Q38 |
2 |
Semi-professionally |
|
|
|
GO TO: APPENDIX ITEM 4.7.7.B1– 4.7.7.B2 |
|
S18_Q39 |
3 |
College |
|
|
|
GO TO: APPENDIX ITEM 4.7.7.C1– 4.7.7.C2 |
|
S18_Q40 |
4 |
High school |
|
|
|
GO TO: APPENDIX ITEM 4.7.7.D1– 4.7.7.D2 |
|
S18_Q41 |
5 |
Prior to high school |
|
|
|
GO TO: APPENDIX ITEM 4.7.7.E1– 4.7.7.E2 |
|
S18_Q42 |
6 |
Another level |
|
|
|
GO TO: APPENDIX ITEM 4.7.7.F1– 4.7.7.F2 |
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7 |
Don’t know |
4.7.7.A1 |
S18_Q37A |
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How many years did you play in the organized sport in chosen organized setting (APPENDIX ITEM 4.7.7.A)? |
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ENTER: |
4.7.7.A2 |
S18_Q37B |
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What was your primary position while playing (APPENDIX ITEM 4.7.7.A) |
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ENTER: |
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Same questions (APPENDIX ITEM 4.7.7.A1 – 4.7.7.A2) were asked for the selected organized setting in APPENDIX ITEM 4.7.7.A.
SEMI-PROFESSIONALLY |
COLLEGE |
HIGH SCHOOL |
PIOR TO HIGH SCHOOL |
ANOTHER LEVEL |
APPENDIX ITEM 4.7.7.B |
APPENDIX ITEM 4.7.7.C |
APPENDIX ITEM 4.7.7.D |
APPENDIX ITEM 4.7.7.E |
APPENDIX ITEM 4.7.7.F |
S18_Q38A |
S18_Q39A |
S18_Q40A |
S18_Q41A |
S18_Q42A |
S18_Q38B |
S18_Q39B |
S18_Q40B |
S18_Q41B |
S18_Q42B |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | NCEH/ATSDR Office of Science |
File Modified | 0000-00-00 |
File Created | 2023-08-29 |