Canadian Health Measures Survey (Cycle 8) - Clinic Questionnaire

Respondent Verification (RVB) - Question identifier:RVB_R15

Name: #{FNAME} #{LNAME}
Sex: [Male/Female]
Date of birth: #{DATEOFBIRTH}
Age: #{AGE}
Preferred language: [English/French]

Here is the first of several forms we will be asking you to complete. Please verify the information above carefully. We will not be able to send the reports in the mail without a valid name.

Respondent Verification (RVB) - Question identifier:RVB_Q15

Is the information above correct?

• 1: Yes
• 2: No

Respondent Verification (RVB) - Question identifier:RVB_Q21

INSTRUCTION: Please make the necessary corrections directly below.
First name

Long Answer Length = 50

Respondent Verification (RVB) - Question identifier:RVB_Q22

INSTRUCTION: Please make the necessary corrections directly below.
Last name

Long Answer Length = 50

Respondent Verification (RVB) - Question identifier:RVB_Q25

INSTRUCTION: Please make the necessary corrections directly below.
Sex at birth

• 1: Male
• 2: Female

Respondent Verification (RVB) - Question identifier:RVB_Q30A

INSTRUCTION: Please make the necessary corrections directly below.
Day of birth

• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10
• 11: 11
• 12: 12
• 13: 13
• 14: 14
• 15: 15
• 16: 16
• 17: 17
• 18: 18
• 19: 19
• 20: 20
• 21: 21
• 22: 22
• 23: 23
• 24: 24
• 25: 25
• 26: 26
• 27: 27
• 28: 28
• 29: 29
• 30: 30
• 31: 31

Respondent Verification (RVB) - Question identifier:RVB_Q30B

INSTRUCTION: Please make the necessary corrections directly below.
Month of birth

• 01: January
• 02: February
• 03: March
• 04: April
• 05: May
• 06: June
• 07: July
• 08: August
• 09: September
• 10: October
• 11: November
• 12: December

Respondent Verification (RVB) - Question identifier:RVB_Q30C

INSTRUCTION: Please make the necessary corrections directly below.
Year of birth

Min = 0; Max = 9999

Respondent Verification (RVB) - Question identifier:RVB_Q31

INSTRUCTION: Please make the necessary corrections directly below.
Age

Min = 0; Max = 99

Respondent Verification (RVB) - Question identifier:RVB_Q35

INSTRUCTION: Please make the necessary corrections directly below.
Preferred language

• 1: English
• 2: French

Respondent Verification (RVB) - Question identifier:RVB_R40

Mailing address:
#{ADDRESSLINE1}
#{ADDRESSLINE2}
#{CITY}, [Alberta/British Columbia/Manitoba/New Brunswick/Newfoundland and Labrador/Northwest Territories/Nova Scotia/Nunavut/Ontario/Prince Edward Island/Quebec/Saskatchewan/Yukon]
#{POSTALCODE}
Phone number 1: #{PHONEHOME}
Phone number 2: #{PHONECELL}
Email address: #{EMAIL}

Please verify the information above carefully.

Respondent Verification (RVB) - Question identifier:RVB_Q40

Is the information above correct?

• 1: Yes
• 2: No

Respondent Verification (RVB) - Question identifier:RVB_Q50

INSTRUCTION: Please make the necessary corrections directly below.
Phone number 1

Long Answer Length = 12

Respondent Verification (RVB) - Question identifier:RVB_Q55

INSTRUCTION: Please make the necessary corrections directly below.
Phone number 2

Long Answer Length = 12

Respondent Verification (RVB) - Question identifier:RVB_Q60

INSTRUCTION: Please make the necessary corrections directly below.
Email address

Long Answer Length = 80

Respondent Verification (RVB) - Question identifier:RVB_R90

During the household interview, you indicated that you were #{AGE} years old; however, you have now stated that you are #{RVB_Q31} years old. As a result, you are not eligible to participate in this survey. We regret the inconvenience, but we cannot proceed with your appointment.

INSTRUCTION: This respondent will not be reimbursed for coming to the MEC.

Respondent Verification (RVB) - Question identifier:RVB_R100

INSTRUCTION:
- Click <Next> to go to the Participant's Personal Information form.
- Print the Participant's Personal Information form.
- Click <More settings> and then uncheck the box <Headers and footers> and adjust the print scale as needed.

Respondent Verification (RVB) - Question identifier:RVB_R105

Name: #{RVB_Q21} #{RVB_Q22}
Mailing address:
#{ADDRESSLINE1}
#{ADDRESSLINE2}
#{NAD_Q07}, #{NAD_Q10.Text}
#{NAD_Q08}
Phone number 1: #{RVB_Q50}
Phone number 2: #{RVB_Q55}
Email address: #{RVB_Q60}
Sex: #{RVB_Q25.Text}
Date of birth: #{DOB_MONTH_E} #{DOB_DAY}, #{DOB_YEAR}
Age: #{RVB_Q31}
Preferred language: #{RVB_Q35.Text}


Signature of participant or parent/guardian:

____________________________________________

Date: #{THISDATE}

FOR OFFICE USE ONLY

Entered by #{MEC_USERNAME}

Verified by:

____________________________________________

Respondent Verification (RVB) - Question identifier:RVB_R110

INSTRUCTION:
- After completing the component, print the Respondent Verification and Urine Collection 1 labels.
- CLINICID + shortname label: Stick the label onto a bracelet. Attach the bracelet around the wrist of the respondent.
- CLINICID + shortname label: Stick it onto the respondent's file folder.
- CLINICID + urine ID label: Stick it onto a urine sample container.

DO NOT give the container to the respondent until the Urine component has been unlocked (after CONSENT).

New Address (NAD) - Question identifier:NAD_Q01

Civic number

Min = 0; Max = 999999

New Address (NAD) - Question identifier:NAD_Q02

Civic number suffix (Example: 1/2, A, B)

Long Answer Length = 3

New Address (NAD) - Question identifier:NAD_Q06

Apartment number

Long Answer Length = 6

New Address (NAD) - Question identifier:NAD_Q03

Street name

Long Answer Length = 50

New Address (NAD) - Question identifier:NAD_Q04

Street type

Long Answer Length = 25

New Address (NAD) - Question identifier:NAD_Q05

Street direction

Long Answer Length = 10

New Address (NAD) - Question identifier:NAD_Q13

Rural address

Long Answer Length = 60

New Address (NAD) - Question identifier:NAD_Q07

City, municipality, town, village, indian reserve

Long Answer Length = 50

New Address (NAD) - Question identifier:NAD_Q10

Province or territory

• 10: Newfoundland and Labrador
• 11: Prince Edward Island
• 12: Nova Scotia
• 13: New Brunswick
• 24: Quebec
• 35: Ontario
• 46: Manitoba
• 47: Saskatchewan
• 48: Alberta
• 59: British Columbia
• 60: Yukon
• 61: Northwest Territories
• 62: Nunavut

New Address (NAD) - Question identifier:NAD_Q08

Postal code

Long Answer Length = 7

Consent (CON) - Question identifier:CON_R01

Before we start, we need to ensure you have reviewed the information in [the Information and Consent Booklet] that was given or sent to you previously.

INSTRUCTION: Show the respondent [the Information and Consent Booklet].

Consent (CON) - Question identifier:CON_Q01

Have you read [the booklet]?

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_R02

Do you have any questions about any of the information in [the booklet], or about today's portion of the survey?

INSTRUCTION: Answer any questions as thoroughly as possible.

Consent (CON) - Question identifier:CON_R03

Here is [the Information and Consent Booklet]. Please take a few minutes to read through it. If you have any questions about the information in [the booklet] or the tests, I can answer them for you.

INSTRUCTION: Allow [the parent or guardian/the respondent] sufficient time to read [the Information and Consent Booklet] (approximately 5 minutes). Answer any questions as thoroughly as possible.

Consent (CON) - Question identifier:CON_R03B

As outlined in [the Information and Consent Booklet], if you agree, some of your blood and urine samples will be stored in the Statistics Canada Biobank for future health research. Genetic research projects require additional consent. If you choose to allow your stored samples to be used for genetic research, we need to ensure you review the information in [the Genetic Consent Document].

Please take a few minutes to read through it. If you have any questions about the information in [the Genetic Consent Document], I can answer them for you.

INSTRUCTION: Allow [the parent or guardian/the respondent] sufficient time to read [the Genetic Consent Document] (approximately 5 minutes). Answer any questions as thoroughly as possible.

Consent (CON) - Question identifier:CON_R04

Based on the information you've received in [the Information and Consent Booklet] and [the Genetic Consent Document], we'll now record the items for which you consent to participate.

We will then print out the Consent form for you to sign.

INSTRUCTION: After recording the items on the next page, print out the form and sign it as the witness.

Consent (CON) - Question identifier:CON_R05

Date (yyyy-mm-dd): #{THISDATE}
Identification number: #{CLINICID}
Name of participant: #{RESPONDENTNAME}
Age: #{CON_AGE}
Sex: [Male/Female]

Consent (CON) - Question identifier:CON_R06

[As the parent or guardian, what are you consenting to for the participant?/As the participant, what are you consenting to?]

Consent (CON) - Question identifier:CON_Q06A

Participating in the physical measure tests.

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_Q06B

Receiving reports of the test results.

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_Q06C

Allowing Statistics Canada to test the participant's biological samples, that may require mandatory reporting of results in the province of residence. I understand that you will contact me, as well as the appropriate provincial authorities, if the results are outside the established reference range and require a follow-up. I have been informed of the [contaminants/diseases and contaminants] requiring mandatory reporting in the province of residence.

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_Q06D

Storage and use of the participant's biological samples for future health studies.

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_Q06E

Allowing the participant's genetic information (DNA) to be used and published as population-level summary statistics for genetic research. Statistics Canada will only publish averaged results for all CHMS participants, NOT individual results.

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_R06A

INSTRUCTION:
- Click <Next> to go the Consent form.
- Print the Consent form.
- Click <More settings> and then uncheck the box <Headers and footers> and adjust the print scale as needed.

Consent (CON) - Question identifier:CON_R07

Date (yyyy-mm-dd): #{THISDATE}
Identification number: #{CLINICID}
Name of participant: #{RESPONDENTNAME}
Age: #{CON_AGE}
Sex: [Male/Female]

I have read and understood the information provided to me for the #{SurveyNameEnglish}. By signing this form, I am choosing to consent ("Yes") or not consent ("No") to the [following for #{FNAME}/following]:
[- Yes to/- No to/EMPTY][Participating in the physical measure tests./EMPTY]
[- Yes to/- No to/EMPTY][Receiving reports of the test results./EMPTY]
[- Yes to/- No to/EMPTY][Allowing Statistics Canada to test the participant's biological samples, that may require mandatory reporting of results in the province of residence. I understand that you will contact me, as well as the appropriate provincial authorities, if the results are outside the established reference range and require a follow-up. I have been informed of the [contaminants/diseases and contaminants] requiring mandatory reporting in the province of residence./EMPTY]
[- Yes to/- No to/EMPTY][Storage and use of the participant's biological samples for future health studies./EMPTY]
[- Yes to/- No to/EMPTY][Allowing the participant's genetic information (DNA) to be used and published as population-level summary statistics for genetic research. Statistics Canada will only publish averaged results for all CHMS participants, NOT individual results./EMPTY]

Consent (CON) - Question identifier:CON_R07A

[As the parent or guardian, I have had sufficient time to decide whether or not to consent to allow #{FNAME} to participate in the measures taken as part of the survey. I understand that even if I have answered "Yes" to some or all of the items on this form, I can withdraw #{FNAME} from any part of the survey or any subsequent studies at any time until #{FNAME} has reached the age of 15. After reaching the age of 15, #{FNAME} can make your own decision regarding participation in future health or genetic studies. However, I understand that neither I nor #{FNAME} can withdraw consent for analyses that require mandatory reporting of results once these have been provided to provincial authorities./As the participant, I have had sufficient time to decide whether or not to consent to participate in the measures taken as part of the survey. I understand that even if I have answered "Yes" to some or all of the items on this form, I can withdraw from any part of this survey or any subsequent studies at any time. However, I understand that I cannot withdraw my consent for analyses that require mandatory reporting of results once these have been provided to provincial authorities.]

PARTICIPANT SIGNATURE SECTION

Name of consenting [parent or guardian (please print)/participant]: [______________________________/#{RESPONDENTNAME}]

Signature of consenting [parent or guardian/participant]: ______________________________

Date: #{DV_NEWDATE}

WITNESS SIGNATURE SECTION

Name of witness: #{MEC_USERNAME}

Signature of witness: ______________________________

Date: #{DV_NEWDATE}

FOR OFFICE USE ONLY

Verified by: ______________________________

Consent (CON) - Question identifier:CON_R08

Your parent or guardian has said you can take part in the tests today. I'm now going to print out a form for you. If you would like to take part in the tests, we need you to write or print your name on this form.

INSTRUCTION: Give the Assent form to the child and check that it has been completed correctly. Sign it as the witness.

Consent (CON) - Question identifier:CON_R08A

INSTRUCTION:
- Click <Next> to go the Assent form.
- Print the Assent form.
- Click <More settings> and then uncheck the box <Headers and footers> and adjust the print scale as needed.

Consent (CON) - Question identifier:CON_R09

Date (yyyy-mm-dd): #{THISDATE}
Identification number: #{CLINICID}
Name of participant: #{RESPONDENTNAME}
Age: #{CON_AGE}
Sex: [Male/Female]

We would like you to take part in some tests today for the #{SurveyNameEnglish}. Your results in these tests would be used with the results from other people across Canada to see how healthy we are as a group. Only you, your parent or guardian and the survey team will know that you are taking part in this survey, as all your results will be coded. If you decide to take part in this survey, here's what's going to happen:

- We'll take measurements like your height, weight, height when sitting and waist circumference.
- We'll check some of your vital signs at rest to see how fast your heart is beating and the blood pressure in your arteries.
- We'll ask you to provide us with a small urine sample and a blood sample. These samples will be used for tests that will happen later, and that can tell us a lot about you and your environment.
- We'll ask you to wear an activity monitor for a few days to better understand how well you sleep and how active you are during the day.

You do not have to do any part of the survey that you do not want to do, and you can decide to stop at any time. If you want to take part in this survey, write or print your name below.

Consent (CON) - Question identifier:CON_R09A

PARTICIPANT SIGNATURE SECTION

Name of participant: #{RESPONDENTNAME}

Signature of participant: ______________________________

Date: #{DV_NEWDATE}

WITNESS SIGNATURE SECTION

Name of witness: #{MEC_USERNAME}

Signature of witness: ______________________________

Date: #{DV_NEWDATE}

FOR OFFICE USE ONLY

Verified by: ______________________________

Consent (CON) - Question identifier:CON_Q09

INSTRUCTION: Record whether the respondent has assented to participating in the physical measure tests.

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_R10

Record the name of the person who signed the Consent form.

INSTRUCTION: Enter the person's first and last name. Only use upper-case characters.

Consent (CON) - Question identifier:CON_Q10

First and last name

Long Answer Length = 80

Consent (CON) - Question identifier:CON_R11

You have indicated on the Consent form that you do not want to receive reports of [your/#{FNAME}'s] test results. However, you have agreed that Statistics Canada can test [your/#{FNAME}'s] biological samples for reportable [contaminants/diseases and contaminants]. I just want you to be aware that, by agreeing to have these tests done, you will receive the results if they are positive.

INSTRUCTION: Answer any questions as thoroughly as possible.

Consent (CON) - Question identifier:CON_R12

Today, at the end of the visit, you will receive [#{FNAME}'s/your] Report of Physical Measurements containing the results that are immediately available.

Through a secure website, we can provide you with [his/her/your] remaining test results as they become available. Online results will be shared faster and provide user-friendliness, convenience, and accessibility.

Otherwise, we can send the final report of [his/her/your] remaining test results through mail in a minimum of 6 to 7 months.

Consent (CON) - Question identifier:CON_Q13

How do you prefer to receive [his/her/your] results?

• 1: By mail, in a minimum of 6 to 7 months
• 2: Via a secure website, as they become available

Consent (CON) - Question identifier:CON_Q14

[His/Her/Your] results can be sent to you either by regular mail or by courier.

Can we send you the final report by regular mail?

INSTRUCTION: If "No" is selected, the final report of test results will be sent by courier.

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_Q15

INSTRUCTION: Is the respondent in a wheelchair?

• 1: Yes
• 2: No

Consent (CON) - Question identifier:CON_Q16

The laboratories that analyse the urine samples require that these samples are provided without the use of a catheter. For this reason, we need to know if you use a catheter.

INSTRUCTION: Record if the respondent is using a catheter.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Subsampling Labels (SSL) - Question identifier:SSL_N50

Press < 1 > to print the sub-sampling labels.

• 1: Print the labels

Subsampling Labels (SSL) - Question identifier:SSL_N55

Stick each label on the appropriate specimen tube.

Press <1> to continue.

• 1: Continue

Urine Collection 1 (UC1) - Question identifier:UC1_Q10

Now, we would like you to provide a urine sample.

INSTRUCTION: Use a black Sharpie to mark ^DT_QC1Q10 on the urine container.

• 9: DK

Urine Collection 1 (UC1) - Question identifier:UC1_Q15

Certain respondents prefer to use a urine collection device that rests under the toilet seat rather than the usual container. Would you like to use a urine collection device?

• 1: Yes
• 2: No

Urine Collection 1 (UC1) - Question identifier:UC1_R20

Please use this container to collect the urine sample.

- Once you are in the washroom, you will need to remove the lid and place it on the shelf, the inside of the lid facing up.
- Do not touch the inside of the container or the inside of the lid.
- Fill the container to above the marked line and put the lid back on tightly.
- Once you are finished, please rinse and dry the exterior of the container. Wash your hands, place the container in the paper bag provided and bring it back to me.

In case you forget any of the collection procedures, there are step by step instructions posted in the washroom.

INSTRUCTION: Demonstrate how to remove the lid using the sample container and ensure the respondent understands what is meant by placing the lid on the shelf "with the inside facing up".

Answer any questions as thoroughly as possible.

Urine Collection 1 (UC1) - Question identifier:UC1_R21

#{DT_UC1R21E}To use the urine collection device:

- You will need to lift the toilet seat and install the collection device.
- Ensure it fits snugly in the front of the toilet with the edges resting over the lip of the bowl.
- Lower the toilet seat.

INSTRUCTION: Show the sample urine collection device to the respondent or parent/guardian and demonstrate which end is the front.

Answer any questions as thoroughly as possible.

Urine Collection 1 (UC1) - Question identifier:UC1_R22

To collect the urine, ensure you are sitting on the toilet seat in such a way that the urine stream is collected in the device.

Try to collect as much urine as possible and avoid touching the inside of the collection device, and do not throw any toilet paper into the collection device.

[Once ^FNAME no longer requires your assistance/Once you are finished]:
- Remove the lid of the container and place it on the shelf in the washroom, the inside of the lid facing up.
- Over the toilet, pour the urine from the collection device into the container using the 'spout'.
- Fill the container to above the marked line and put the lid back on tightly.
- Discard the excess urine in the toilet bowl and discard the collection device in the washroom garbage.
- Please rinse and dry the exterior of the container. Wash your hands, place the container in the paper bag provided and bring it back to me.

INSTRUCTION:
- Show the respondent or parent/guardian the spout used for pouring the urine.
- Demonstrate how to remove the lid and pour the urine using the sample container.
- Ensure the respondent or parent/guardian understands what is meant by placing the lid on the shelf "with the inside facing up".
- Once the instructions are read, don the appropriate PPE and accompany the respondent ot the washroom.
- Thoroughly wipe down the full surface of the toilet bowl with Hydrogen Peroxide wipe.
- Install the collection device on the toilet.

Answer any questions as thoroughly as possible.

Urine Collection 1 (UC1) - Question identifier:UC1_Q40

INSTRUCTION: Record whether the respondent provided a urine sample.

• 1: Yes
• 2: No

Urine Collection 1 (UC1) - Question identifier:UC1_Q43

In order to complete an accurate analysis of the sample provided, we would like to know how long ago you urinated prior to providing this sample.
In order to complete an accurate analysis of the sample provided, we would like to know how long ago you urinated prior to providing this sample.

• 1: Less than 1 hour ago
• 2: 1 hour to less than 2 hours ago
• 3: More than 2 hours ago
• 9: DK

Urine Collection 1 (UC1) - Question identifier:UC1_Q50

In order to complete an accurate analysis of the sample provided, we would like to know how long ago you urinated prior to providing this sample.
INSTRUCTION: Did the respondent provide a urine sample of sufficient volume?

• 1: Yes
• 2: No

Urine Collection 1 (UC1) - Question identifier:UC1_Q55

In order to complete an accurate analysis of the sample provided, we would like to know how long ago you urinated prior to providing this sample.
INSTRUCTION: Did the respondent provide a true urine sample?

• 1: Yes
• 2: No

Urine Collection 1 (UC1) - Question identifier:UC1_R60

We did not obtain enough urine for the lab to run all the desired tests. I will prepare another urine container so that a second sample can be collected before the end of the clinic visit.

INSTRUCTION: Prepare a second urine container and print the label for Urine Collection 2.

Using a Sharpie, write the number 2 on top of the lid.

Provide the paper bag containing the second labelled urine container to the respondent.

Urine Collection 1 (UC1) - Question identifier:UC1_Q70_RND

INSTRUCTION: Why was the component not fully completed?

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand / execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement/sample
• 5: No time
• 6: Equipment problem / technical difficulty
• 7: Temporary suspension

Screening Component Introduction (SCI) - Question identifier:SCI_R1

The following questions are asked to ensure that you are given all the tests for which you are eligible. Please answer to the best of your knowledge, as accurate information about you is important.

Adherence to Guidelines (ATG) - Question identifier:ATG_R10

You may have been asked to follow some pre-testing guidelines prior to your appointment. We will now review those guidelines.

Adherence to Guidelines (ATG) - Question identifier:ATG_Q10

Did you eat or drink anything other than water (e.g., coffee, tea, alcohol, juice or flavoured water) after ^DT_FASTINGCUTOFF_TIMEE up until now?

• 1: Yes
• 2: No

Adherence to Guidelines (ATG) - Question identifier:ATG_Q11

INSTRUCTION: Ask questions to determine what and when the respondent ate or drank. Is the respondent considered fasted?

• 1: Yes
• 2: No

Adherence to Guidelines (ATG) - Question identifier:ATG_Q21

Have you smoked cigarettes or used other tobacco or nicotine products?

• 1: Today, during the past 2 hours
• 2: Today, more than 2 hours ago
• 3: Yesterday
• 4: 3 to 4 days ago
• 5: 5 to 7 days ago
• 6: More than 7 days ago
• 7: Never

Adherence to Guidelines (ATG) - Question identifier:ATG_Q22

Have you consumed any caffeinated products (e.g., coffee, pop, energy drinks, tea or chocolate) during the past 2 hours?

• 1: Yes
• 2: No

Adherence to Guidelines (ATG) - Question identifier:ATG_Q23

Have you consumed any alcohol during the past 6 hours?

• 1: Yes
• 2: No

Adherence to Guidelines (ATG) - Question identifier:ATG_Q24

Have you consumed any cannabis (marijuana) during the past 6 hours?

• 1: Yes
• 2: No

Adherence to Guidelines (ATG) - Question identifier:ATG_Q25

Have you exercised today for at least ten minutes at a time (e.g., running, moderate or vigorous walking, swimming, weight training)?

• 1: Yes
• 2: No

Adherence to Guidelines (ATG) - Question identifier:ATG_Q25A

How long has it been since you last exercised?

• 1: 1 to less than 30 minutes ago
• 2: 30 minutes to less than 1 hour ago
• 3: 1 hour to less than 2 hours ago
• 4: More than 2 hours ago

Physical and Health Conditions (PHC) - Question identifier:PHC_R01

I am now going to ask you about your current health and physical condition.

Physical and Health Conditions (PHC) - Question identifier:PHC_Q41

Do you have any acute conditions, for example a sprained wrist, a concussion, flu or other infection? An acute condition develops suddenly and is short-term.

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q41A

INSTRUCTION: What type(s) of acute condition(s) does the respondent have?

• 1: Bone, joint or muscle problem
• 2: Flu or other infection
• 3: Recovery from a medical procedure
• 4: Other health problem
• 5: Fever

Physical and Health Conditions (PHC) - Question identifier:PHC_Q41B

INSTRUCTION: From which test(s) should the respondent be excluded because of this condition?

Probe to determine the seriousness of the condition.

• 01: Activity monitor
• 08: None

Physical and Health Conditions (PHC) - Question identifier:PHC_Q43

Do you have a chronic condition, for example, arthritis, heart condition, multiple sclerosis, or colostomy bag, that may prevent you from participating in any of the tests today? A chronic condition develops slowly and is long lasting.

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q43A

INSTRUCTION: What type(s) of chronic condition(s) does the respondent have?

• 1: Bone, joint or muscle problem
• 2: Cardiovascular condition
• 3: Respiratory condition
• 4: Physically impaired
• 5: Other health problem

Physical and Health Conditions (PHC) - Question identifier:PHC_Q43B

INSTRUCTION: From which test(s) should the respondent be excluded because of this condition?

Probe to determine the seriousness of the condition.

• 01: Activity monitor
• 08: None

Physical and Health Conditions (PHC) - Question identifier:PHC_Q50

In the past 8 weeks, that is from #{DV_DATE8WEEKSAGO} to yesterday, have you had your blood drawn or have a blood draw scheduled in the next 8 weeks, that is from today until #{DV_DATE8WEEKSFUTURE}?

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q51

Do you have a clotting condition such as haemophilia or von Willebrand disease?

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q52

Have you received chemotherapy in the past four weeks?

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q56

Have you ever felt dizzy or fainted during a blood draw?

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q57A

Have you ever had a mastectomy?

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q57B

On which side?

• 1: Right
• 2: Left
• 3: Both

Women's Health Restrictions (WHR) - Question identifier:WHR_R005

I also need to ask a few questions related specifically to women's health.

Women's Health Restrictions (WHR) - Question identifier:WHR_Q005

Have you ever had a menstrual period?

• 1: Yes
• 2: No

Women's Health Restrictions (WHR) - Question identifier:WHR_Q010

At what age did you have your first menstrual period?

Min = 0; Max = 99

Women's Health Restrictions (WHR) - Question identifier:WHR_Q015

Are you currently pregnant?

• 1: Yes
• 2: No
• 9: DK

Women's Health Restrictions (WHR) - Question identifier:WHR_Q020

In what week are you?

Min = 0; Max = 99

Physical Activity Restrictions (PHR) - Question identifier:PHR_R001

The next questions are used to identify people for whom certain tests might be inappropriate. Please answer each question thinking about the tests that you will be doing today. Remember, we're interested in conditions diagnosed by a health professional.

INSTRUCTION: Show the laminated card with pictures of each test to the respondent.

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q010

Are you currently taking prescribed medications for a cardiovascular disease, for example, high blood pressure, a heart condition or an aneurysm?

• 1: Yes
• 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q015

For which condition(s) are you taking the prescribed medications?

• 01: High blood pressure
• 02: Low blood pressure
• 03: Angina
• 04: Previous heart attack
• 05: Aneurysm
• 06: Arrhythmia
• 07: Other heart condition
• 08: Other medical condition
• 98: RF
• 99: DK

EMLA cream application (EMLA) - Question identifier:EMLA_R01

As part of the tests being done today, we will collect a blood sample. Emla™ cream is a numbing cream of the skin that can be used to help ease the pain and stress of a blood draw. It usually takes between 30-60 minutes for its numbing effect to work.

EMLA cream application (EMLA) - Question identifier:EMLA_Q01

Would you be interested in using the Emla™ cream?

INSTRUCTION: Request a phlebotomist or laboratory staff to apply the Emla™ cream if the respondent consents to use Emla cream™.

• 1: Yes
• 2: No

EMLA cream application (EMLA) - Question identifier:EMLA_Q02

The next question is used to identify people for whom Emla™ cream might be inappropriate. Are you currently taking prescribed medications for a cardiovascular disease, for example, high blood pressure, a heart condition or an aneurysm?

• 1: Yes
• 2: No
• 9: DK

EMLA cream application (EMLA) - Question identifier:EMLA_Q03

Do you have any allergies to local anesthetics such as lidocaine or prilocane?

• 1: Yes
• 2: No
• 9: DK

EMLA cream application (EMLA) - Question identifier:EMLA_Q04

Side effects such as redness, swelling, burning and itching sensations can happen to the skin where the cream is applied. Would you like to continue with the Emla™ cream application?

• 1: Yes
• 2: No

EMLA cream application (EMLA) - Question identifier:EMLA_R05

Instruction:
-Before applying the cream, inspect the respondent's arm to select the appropriate vein for blood collection.
-Apply [1.5g - 2g of Emla cream/1g of Emla cream] onto the skin.
-Place the Tegaderm™ dressing on top of the cream and smooth down the dressing edges carefully to ensure it is secure.

EMLA cream application (EMLA) - Question identifier:EMLA_Q05

Was the Emla™ cream applied?

• 1: Yes
• 2: No

EMLA cream application (EMLA) - Question identifier:EMLA_Q06A

If you are experiencing any discomfort or irritation at the application site, notify our staff immediately.

INSTRUCTION: Record the time (followed by "AM" or "PM") at which the Emla™ cream was applied and laboratory staff ID.
Hour

Min = 0; Max = 99

EMLA cream application (EMLA) - Question identifier:EMLA_Q06B

If you are experiencing any discomfort or irritation at the application site, notify our staff immediately.

INSTRUCTION: Record the time (followed by "AM" or "PM") at which the Emla™ cream was applied and laboratory staff ID.
Minute

Min = 0; Max = 99

EMLA cream application (EMLA) - Question identifier:EMLA_Q06C

If you are experiencing any discomfort or irritation at the application site, notify our staff immediately.

INSTRUCTION: Record the time (followed by "AM" or "PM") at which the Emla™ cream was applied and laboratory staff ID.
a.m. / p.m.

• 1: a.m
• 2: p.m

EMLA cream application (EMLA) - Question identifier:EMLA_Q06D

Record the phlebotomist or laboratory staff ID.

Long Answer Length = 10

Medication use (MEUC) - Question identifier:MEUC_R02

Now I'd like to ask a few questions about your use of prescriptions, over-the-counter medications and other health products, including natural health products.

In order to record this information accurately, I will need to see the bottles and containers. We are interested in any medications that have been prescribed or administered by a health professional such as a doctor or dentist, over-the-counter medications or other health products, including natural health products.

This includes such things as insulin, antibiotics, ^DT_MEUText2E. Over-the-counter medications could include such things as pain killers, antacids, allergy pills, and hydrocortisone creams. Examples of health products include vitamins, minerals, amino acids, probiotics, fish oils and other oils, herbal remedies and homeopathic preparations.

Medication use (MEUC) - Question identifier:MEUC_Q02

In the past month, that is from [THISDATE - 31] to today, have you taken or used any prescribed medications, over-the-counter medications or other health products, including natural health products?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medication use (MEUC) - Question identifier:MEUC_Q04A

INSTRUCTION: Record total number of prescribed medications, over-the-counter medications and other health products, including natural health products taken over the past month.
Number of products

Min = 0; Max = 99

Medication use (MEUC) - Question identifier:MEUC_Q04B

INSTRUCTION: Record total number of prescribed medications, over-the-counter medications and other health products, including natural health products taken over the past month.
OR

• 9: DK

Medication use (MEUC) - Question identifier:MEUC_R05

I will now enter all the products you gave me, starting with prescribed medications. It will take a few minutes. Once all products are entered, there will be a few additional questions for each of them.

Medication use (MEUC) - Question identifier:MEUC_R06

INSTRUCTION: Complete questions for each product listed.

List prescribed medications first, followed by over-the-counter medications and finish with other health products.

If all the information has been entered, then press the Next button.

To make changes to the number of products, please press the Previous button.

Medication use (MEUC) - Question identifier:MEUC_R10

Press the Return to Summary button to return to the Component list summary.

Medication use (MEUC) - Question identifier:MEUC_Q15A

How many other prescription medications, over-the-counter medications or other health products, including natural health products, have you taken or used in the past month?
Enter the number of medications

Min = 0; Max = 99

Medication use (MEUC) - Question identifier:MEUC_Q15B

How many other prescription medications, over-the-counter medications or other health products, including natural health products, have you taken or used in the past month?
OR

• 8: RF
• 9: DK

Medication use (MEUC) - Question identifier:MEUC_Q25

In the past 30 days, have you used any nicotine-containing smoking cessation products?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medication use (MEUC) - Question identifier:MEUC_R30

Now I am going to ask you a few questions about your use of other substances such as performance enhancing or recreational drugs. We ask these questions because these drugs can affect the results of the physical and biological measures that we will be taking today. You can be assured that anything you say will remain confidential and that your answer will not screen you out of any tests.

Medication use (MEUC) - Question identifier:MEUC_Q30

In the past week, have you used any performance enhancing or recreational drugs, excluding cannabis (marijuana), such as steroids or cocaine?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medication use (MEUC) - Question identifier:MEUC_R40

INSTRUCTION: Review the medication(s) listed below and verify the list is complete.
^DT_Medlist

Medication use (MEUC) - Question identifier:MEUC_Q50_RND

INSTRUCTION: Why was the component not fully completed?

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Medication use (NPI) - Question identifier:NPI_R17

INSTRUCTION: Go to MedSearch and enter the product information.

Medication use (NPI) - Question identifier:NPI_Q17

INSTRUCTION: Did you find a match for the product in the MedSearch?

• 1: Yes
• 2: No

Medication use (NPI) - Question identifier:NPI_Q18

INSTRUCTION: Enter the product information from the MedSearch tool.
PIN (product identification number)

Long Answer Length = 8

Medication use (NPI) - Question identifier:NPI_Q19

INSTRUCTION: Enter the product information from the MedSearch tool.
Product name

Long Answer Length = 250

Medication use (NPI) - Question identifier:NPI_Q23

INSTRUCTION: Enter the product information from the MedSearch tool.
Route

Long Answer Length = 40

Medication use (NPI) - Question identifier:NPI_Q22

INSTRUCTION: Enter the product information from the MedSearch tool.
Strength

Long Answer Length = 40

Medication use (NPI) - Question identifier:NPI_Q20

INSTRUCTION: Enter the product information from the MedSearch tool.
Manufacturer

Long Answer Length = 80

Medication use (NPI) - Question identifier:NPI_Q21

INSTRUCTION: Enter the product information from the MedSearch tool.
Form

Long Answer Length = 40

Medication use (NPI) - Question identifier:NPI_Q18A

INSTRUCTION: Enter the product information manually.

Enter all the available information found on the product. If some information is missing leave the field blank.
PIN (product identification number)

Long Answer Length = 8

Medication use (NPI) - Question identifier:NPI_Q19A

INSTRUCTION: Enter the product information manually.

Enter all the available information found on the product. If some information is missing leave the field blank.
Product name

Long Answer Length = 250

Medication use (NPI) - Question identifier:NPI_Q23A

INSTRUCTION: Enter the product information manually.

Enter all the available information found on the product. If some information is missing leave the field blank.
Route

• 00: Select
• 01: Oral
• 02: Sublingual (under tongue)
• 03: Buccal (inside of cheek)
• 04: Dental (teeth or gums)
• 05: By inhalation
• 06: Nasal (nose)
• 07: Ophthalmic (eyeball)
• 08: Otic (ear)
• 09: Topical (applied to skin)
• 10: Transdermal (absorbed through skin)
• 11: By injection
• 12: Rectal
• 13: Vaginal
• 50: Other <insert descriptive text related to the question being asked> — specify:

Medication use (NPI) - Question identifier:NPI_Q22A

INSTRUCTION: Enter the product information manually.

Enter all the available information found on the product. If some information is missing leave the field blank.
Strength

Long Answer Length = 40

Medication use (NPI) - Question identifier:NPI_Q20A

INSTRUCTION: Enter the product information manually.

Enter all the available information found on the product. If some information is missing leave the field blank.
Manufacturer

Long Answer Length = 80

Medication use (NPI) - Question identifier:NPI_Q21A

INSTRUCTION: Enter the product information manually.

Enter all the available information found on the product. If some information is missing leave the field blank.
Form

• 00: Select
• 01: Tablet / pill / capsule
• 02: Lozenge
• 03: Chew / gummy
• 04: Globule
• 05: Drop
• 06: Tincture
• 07: Liquid / solution
• 08: Suspension
• 09: Cream / ointment / gel / lotion
• 10: Packet / sachet
• 11: Powder
• 12: Granule
• 13: Spray / aerosol
• 14: Patch
• 15: Kit
• 16: Suppository

Medication use (NPI) - Question identifier:NPI_Q24

Is this a prescription or non-prescription medication?

• 1: Prescription medication
• 2: Non-prescription medication (Include over-the-counter or other health product.)

Medication use (NPI) - Question identifier:NPI_Q25

When was the last time that you [used/took] this product?

• 1: Today
• 2: Yesterday
• 3: Within the last week
• 4: Within the last month
• 5: More than one month ago
• 8: RF
• 9: DK

Medication use (NPC) - Question identifier:NPC_R05

INSTRUCTION: Verify that you have entered the values at question 9 and 10 correctly before leaving this page.

Medication use (NPC) - Question identifier:NPC_Q10A

On the days that you [used/took] this product, how many times did you usually [use/take] it in a single day?
Times per day

Min = 0; Max = 999

Medication use (NPC) - Question identifier:NPC_Q10B

On the days that you [used/took] this product, how many times did you usually [use/take] it in a single day?
OR

• 8: RF
• 9: DK

Medication use (NPC) - Question identifier:NPC_Q11

How much did you usually [use/take] each time you [used/took] it?
Quantity

Min = 0; Max = 99999.99

Medication use (NPC) - Question identifier:NPC_Q12

How much did you usually [use/take] each time you [used/took] it?
Unit of measure

• 00: Select
• 01: Tablets / pills / capsules
• 02: Lozenges
• 03: Chews / gummies
• 04: Millilitres (ml)
• 05: Milligrams (mg)
• 06: Grams (g)
• 07: Tablespoons (tbsp)
• 08: Teaspoons (tsp)
• 09: Capfuls
• 10: Scoops
• 11: Packets / sachets
• 12: Drops
• 13: Sprays
• 14: Doses
• 15: Vials
• 16: Units

Medication use (NPC) - Question identifier:NPC_Q13

OR

• 8: RF
• 9: DK

Medication use (NPC) - Question identifier:NPC_Q14A

[For how long have you been [using/taking] this or a similar product? ([#{NPI_Q19}/#{NPI_Q19A}/this product]})/For how long did you [use/take] this or a similar product? ([#{NPI_Q19}/#{NPI_Q19A}/this product]})]
Length of time

Min = 0; Max = 999

Medication use (NPC) - Question identifier:NPC_Q14B

[For how long have you been [using/taking] this or a similar product? ([#{NPI_Q19}/#{NPI_Q19A}/this product]})/For how long did you [use/take] this or a similar product? ([#{NPI_Q19}/#{NPI_Q19A}/this product]})]
Reporting period

• 0: Select
• 1: Days
• 2: Weeks
• 3: Months
• 4: Years

Medication use (NPC) - Question identifier:NPC_Q14C

[For how long have you been [using/taking] this or a similar product? ([#{NPI_Q19}/#{NPI_Q19A}/this product]})/For how long did you [use/take] this or a similar product? ([#{NPI_Q19}/#{NPI_Q19A}/this product]})]
OR

• 8: RF
• 9: DK

Medication use (NPC) - Question identifier:NPC_Q15A

In the past month, on how many days did you [use/take] [#{NPI_Q19}/#{NPI_Q19A}/this product]?
Enter number of days

Min = 0; Max = 99

Medication use (NPC) - Question identifier:NPC_Q15B

In the past month, on how many days did you [use/take] [#{NPI_Q19}/#{NPI_Q19A}/this product]?
OR

• 1: Used every day in the past month
• 8: RF
• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q05

Now a few questions about your consumption of shellfish over the past month. Think about all the shellfish you ate, both meals and snacks, at home and away from home. Include fresh, frozen and canned shellfish.

• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q10

Have you eaten any of the following shellfish over the past month, that is, from #{DV_DATELASTMONTH} to today?

• 01: Lobster
• 02: Shrimp
• 03: Mussels
• 04: Scallops
• 05: Oysters
• 06: Squid or calamari
• 07: Clams
• 08: Crab (excluding surimi or imitation crab)
• 10: Any other shellfish
• 11: No shellfish
• 98: RF
• 99: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_R12

What other shellfish did you consume?

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q12A

Enter type of shellfish

Long Answer Length = 80

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q12B

OR

• 8: RF
• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q14A

Over the past month, did you consume any other shellfish?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q14B

What other shellfish did you consume?

Long Answer Length = 80

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q16A

Over the past month, did you consume any other shellfish?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q16B

What other shellfish did you consume?

Long Answer Length = 80

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_R24

Now, think about all salt and freshwater fish you ate, both meals and snacks, at home and away from home. Include fresh, frozen and canned fish of all types, as well as the fish in fish and chips.

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q24

Have you eaten any of the following fish over the past month, that is, from #{DV_DATELASTMONTH} to today?

• 01: Fish sticks
• 02: Tuna in a can or pouch
• 03: Tuna steaks or fillets (fresh or frozen)
• 04: Salmon in a can or pouch
• 05: Salmon - fresh, frozen or smoked
• 06: Smelt
• 07: Shark
• 08: Marlin
• 09: Swordfish
• 10: Halibut
• 11: Rainbow trout
• 12: Atlantic cod
• 13: Mackerel
• 14: Herring
• 15: Sardines
• 16: Sole, flounder or plaice
• 17: Haddock
• 18: Tilapia
• 19: Pollock
• 20: Sablefish or black cod
• 21: Bass
• 22: Char
• 23: Orange roughy
• 24: Escolar
• 25: Any other fish
• 26: No fish
• 98: RF
• 99: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_R26

What other fish did you consume?

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q26A

Enter type of fish

Long Answer Length = 80

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q26B

OR

• 8: RF
• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q28A

In the past month, did YOU1 consume any other fish?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q28B

What other fish did you consume?

Long Answer Length = 80

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q30A

In the past month, did you consume any other fish?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q30B

What other fish did you consume?

INSTRUCTION: Enter one type of fish only.

Long Answer Length = 80

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q32

Over the past month, when you ate tuna in a can or pouch, was it:

• 1: light (e.g., skipjack or yellowfin) tuna?
• 2: white (e.g., albacore) tuna?
• 3: both?
• 8: RF
• 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q40_RND

INSTRUCTION: Why was the component not fully completed?

• 1: Respondent unable to continue for health reasons
• 3: Respondent refuses to continue
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Seaweed Consumption (SEW) - Question identifier:SEW_R05

The next questions are about your consumption of seaweed. Think about any seaweed you either ate in sushi or separately.

Seaweed Consumption (SEW) - Question identifier:SEW_Q05

Have you eaten any seaweed over the past month, that is from #{DV_DATELASTMONTH} to today?

INSTRUCTION: 
- If yes, enter the number of times and select the reporting period
- "Refusal" and "Don't know" are options in the reporting period dropdown.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Seaweed Consumption (SEW) - Question identifier:SEW_Q10A

Over the past month, how many times did you eat seaweed?
Number of times

Min = 0; Max = 99

Seaweed Consumption (SEW) - Question identifier:SEW_Q10B

Over the past month, how many times did you eat seaweed?
Reporting period

• 1: Per month
• 2: Per week
• 3: Per day
• 8: RF
• 9: DK

Recent Consumption (C48) - Question identifier:C48_Q05

During the past 48 hours have you eaten any fish, shellfish or seaweed, as individual items or in mixture with other foods?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Recent Consumption (C48) - Question identifier:C48_Q07

Which of the following items did you eat in the past 48 hours:

• 1: Fish (fresh or saltwater)
• 2: Crustaceans (e.g. lobsters, shrimp, crab, crayfish)
• 3: Mollusks (e.g. mussels, scallops, oysters, clams, squid, octopus, calamari, sea snails, cuttlefish)
• 4: Seaweed (including in the form of sushi)
• 8: RF
• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q01

Now I am going to ask you some questions about behaviors and habits to help us better understand your test results.

• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_R04

INSTRUCTION:
Include decaffeinated tea.
Include iced tea if it was made from hot steeped black, white or green tea (in tea bags or in loose leaf form).
Exclude pre-prepared powdered, bottled or canned iced tea.

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q05A

How often do you drink black, white or green tea? Examples of black tea include Orange Pekoe, Earl Grey and English Breakfast. Please do not exclude herbal teas.
Enter frequency

Min = 0; Max = 999

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q05B

How often do you drink black, white or green tea? Examples of black tea include Orange Pekoe, Earl Grey and English Breakfast. Please do not exclude herbal teas.
Select the reporting period.

• 1: per day
• 2: per week
• 3: per month
• 4: per year

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q05C

How often do you drink black, white or green tea? Examples of black tea include Orange Pekoe, Earl Grey and English Breakfast. Please do not exclude herbal teas.
OR

• 8: RF
• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q06

When you drink black, white or green tea, how much do you usually drink in cups? A cup is equivalent to the size of a measuring cup: 250 mililitres or 8 ounces.

• 1: Less than 1 cup
• 2: 1 to less than 2 cups
• 3: 2 or more cups
• 8: RF
• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q07

When did you last drink black, white or green tea?

• 1: Less than 6 hours ago
• 2: 6 to less than 12 hours ago
• 3: 12 to less than 24 hours ago
• 4: 24 or more hours ago
• 8: RF
• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q08

When did you last receive fluoride treatments at the dentist?

• 1: Less than 3 months ago
• 2: 3 to less than 6 months ago
• 3: 6 to less than 9 months ago
• 4: 9 to less than 12 months ago
• 5: 12 or more months ago
• 6: Never
• 8: RF
• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q09

Do you use fluoride-containing products at home, such as toothpaste, mouthwash, or 24-hour fluoride treatment?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q10

When was the last time you used one of these products?

• 1: Less than 6 hours ago
• 2: 6 to less than 12 hours ago
• 3: 12 to less than 24 hours ago
• 4: 24 or more hours ago
• 8: RF
• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q60_RND

INSTRUCTION: Why was the component not fully completed?

• 1: Respondent unable to continue for health reasons
• 3: Respondent refuses to continue
• 5: No time
• 6: Equipment problem / technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (HWM) - Question identifier:HWM_Q05

Next will be a series of body measurements.

• 9: DK

Height and Weight Measurements (HWM) - Question identifier:HWM_R10

I'm going to start by measuring your child's height. Please remove their shoes and place your child on their back with the top of their head touching the headboard.

INSTRUCTION: Have the parent/guardian support the head in the Frankfort plane and ensure all hair ties or ornaments (e.g., buns, braids, clips) have been removed.

Straighten the child's legs by placing one hand gently but with mild pressure over the knees.

The toes must point directly upward with both soles of the feet flexed perpendicularly against the foot piece.

Height and Weight Measurements (HWM) - Question identifier:HWM_Q10

INSTRUCTION: Record how the data will be captured.

• 1: Infantometer
• 2: Self-report
• 3: Too tall
• 9: DK

Height and Weight Measurements (HWM) - Question identifier:HWM_R10A

INSTRUCTION: Record the recumbent length in centimetres (cm).

Height and Weight Measurements (HWM) - Question identifier:HWM_Q10A

Enter the recumbent length

Min = 0.00; Max = 999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_Q10B

Re-enter the recumbent length

Min = 0.00; Max = 999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_Q10_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (HWM) - Question identifier:HWM_R11

I'm going to start by measuring how tall you are. Please remove your shoes and stand with your feet together, keeping your heels, buttocks, back and head in contact with the measuring device. Look straight ahead and stand as tall as possible.

Now, take a deep breath in and hold it.

INSTRUCTION: Ensure the respondent's head is aligned with the Frankfort plane and all hair ties or ornaments (e.g., buns, braids, clips) have been removed.

Take the measurement while the respondent is holding their breath.

Height and Weight Measurements (HWM) - Question identifier:HWM_Q11

INSTRUCTION: Record how the data will be captured.

• 1: Electronically
• 2: Manually with a portable device
• 3: Self-report
• 4: Electronic data entered manually
• 9: DK

Height and Weight Measurements (HWM) - Question identifier:HWM_R11A

INSTRUCTION: Ensure that the stadiometer is set to millimetres (mm).

Press the "Send" button on the left side of the digital display box or the "Data" button on the SPC (send to PC) device.

Height and Weight Measurements (HWM) - Question identifier:HWM_Q11A

Enter the standing height

Min = 0.00; Max = 9999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_Q11B

Re-enter the standing height

Min = 0.00; Max = 9999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_R11C

INSTRUCTION: Record the standing height in centimetres (cm).

Height and Weight Measurements (HWM) - Question identifier:HWM_Q11C

Enter the standing height

Min = 0.00; Max = 999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_Q11D

Re-enter the standing height

Min = 0.00; Max = 999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_Q11_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (HWM) - Question identifier:HWM_R12

Next, I'd like you to sit on this box so that I can measure how tall you are when you are sitting. Sit with your back and head against the measuring device. Put your hands on your lap and keep your legs still. Look straight ahead and sit up as straight as possible.

Now, take a deep breath in and hold it.

INSTRUCTION: Ensure the respondent's head is in the Frankfort plane.

Ensure the respondent does not contract the gluteal muscles nor push with the legs.

Height and Weight Measurements (HWM) - Question identifier:HWM_Q12

INSTRUCTION: Take the measurement while the respondent is holding their breath.

• 9: DK

Height and Weight Measurements (HWM) - Question identifier:HWM_R12A

INSTRUCTION: Ensure that the stadiometer is set to millimetres (mm).

Press the "Send" button on the left side of the digital display box.

Height and Weight Measurements (HWM) - Question identifier:HWM_Q12A

Enter the sitting height

Min = 0.00; Max = 9999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_Q12B

Re-enter the sitting height

Min = 0.00; Max = 9999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_R12C

INSTRUCTION: Record the sitting height in centimetres (cm).

Height and Weight Measurements (HWM) - Question identifier:HWM_Q12C

Enter the sitting height

Min = 0.00; Max = 999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_Q12D

Re-enter the sitting height

Min = 0.00; Max = 999.99

Height and Weight Measurements (HWM) - Question identifier:HWM_Q12_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (HWM) - Question identifier:HWM_R13

Next, I'm going to measure how much you weigh. Please empty your pockets, remove all heavy accessories and step onto the centre of the scale. Keep your hands at your sides and look straight ahead.

INSTRUCTION: Ensure the respondent has on only minimal clothing (no shoes), has nothing in his/her pockets and has removed all heavy accessories (e.g., a watch, belt, pair of glasses).

Refer to help text for instructions on how to tare.

Height and Weight Measurements (HWM) - Question identifier:HWM_Q13

INSTRUCTION: Record how the data will be captured.

• 1: Electronically
• 2: Manually with a portable device
• 3: Self-report
• 4: Electronic data entered manually
• 9: DK

Height and Weight Measurements (HWM) - Question identifier:HWM_R13A

INSTRUCTION: When the measurement is stable, record the weight in kilograms (kg).

Height and Weight Measurements (HWM) - Question identifier:HWM_Q13A

Enter the weight

Min = 0.0; Max = 999.9

Height and Weight Measurements (HWM) - Question identifier:HWM_Q13B

Re-enter the weight

Min = 0.0; Max = 999.9

Height and Weight Measurements (HWM) - Question identifier:HWM_Q13_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (HWM) - Question identifier:HWM_R14

Now I'm going to measure your waist circumference. Please stand up straight with your arms crossed over the chest in a relaxed manner, and breathe normally. I may need to move your clothing slightly because the measurement has to be taken directly on the skin. In order to ensure I have the correct position, I am going to feel for certain landmarks and make a few small marks on your skin with a washable marker to indicate where to place the tape. When I'm done, I'll remove them with a wipe.

INSTRUCTION: Landmark both sides.

Read the measurement at the right side of the body.

Take the measurement at the end of a normal expiration.

Height and Weight Measurements (HWM) - Question identifier:HWM_R14A

INSTRUCTION: Record the waist circumference in centimetres (cm).

Height and Weight Measurements (HWM) - Question identifier:HWM_Q14A

Enter the waist circumference

Min = 0.0; Max = 999.9

Height and Weight Measurements (HWM) - Question identifier:HWM_Q14B

Re-enter the waist circumference

Min = 0.0; Max = 999.9

Height and Weight Measurements (HWM) - Question identifier:HWM_Q14C

OR

• 9: DK

Height and Weight Measurements (HWM) - Question identifier:HWM_Q14_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (HWM) - Question identifier:HWM_Q16_RND

INSTRUCTION: Record the reason why the measurement could not be taken

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (HWM) - Question identifier:HWM_R20

At the end of the appointment, we may need to repeat the measurements I have just completed. The computer randomly selects people to be re-measured for quality control purposes. #{DT_HWMBABYE}

INSTRUCTION: Use a wipe to wash off all marks on the respondent's skin if necessary.

Height and Weight Measurements (HWM) - Question identifier:HWM_Q60_RND

INSTRUCTION: Why was the component not fully completed?

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Blood Pressure Measurement (BPM) - Question identifier:BPM_R100

INSTRUCTION:
- Verify that the room temperature is 21°C +/- 2°C.
- Measure the respondent's arm circumference and select the appropriate cuff size.

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q100

INSTRUCTION: Record the selected cuff size.

• 1: Small (17-22 cm)
• 2: Medium (22-32 cm)
• 3: Large (32-42 cm)
• 4: Extra Large (42-50 cm)
• 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_R105

Now, I will take your blood pressure and heart rate, using an automated blood pressure cuff. During this test, you will need to sit up straight with your feet flat on the floor, your back against the back rest of the chair, and your [left/right] arm on the table.

When I start the machine, there will be a 5 minute rest period. After that, the cuff will inflate automatically once every minute, applying pressure to your arm. A total of 3 measures will be taken. You should not move or talk during the test. It is important that you stay relaxed to ensure we get good results. Although I will not be present during the test, should you require assistance, I will be just outside the room. Do you have any questions before we begin?

INSTRUCTION:
- Ensure P-SET is at AUTO and MODE is set to AVG.
- Secure the cuff on the respondent's [left/right] arm.
- Ensure respondent is in the correct position (palm down, feet flat, arm and back rested, relaxed).
- Press <Suspend/exit interview>.
- Start the OMRON and stopwatch to return to the room after 9 minutes.
- Press <WINDOWS-L> to lock the computer before leaving the room.

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q105

INSTRUCTION: Take the measurement.

• 8: RF

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q110A

INSTRUCTION: Record the blood pressure measurement.
Record the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q110B

Re-enter the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q111A

Record the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q111B

Re-enter the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q112A

Record the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q112B

Re-enter the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q113

OR

• 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q114

INSTRUCTION: Record the reason why the measurement could not be taken.

• 01: Inflation Error
• 02: Deflation Error
• 03: Overpressure Error
• 04: Insufficient Inflation Error
• 05: Indeterminable Blood Pressure Error
• 06: Low Pulse Level
• 07: Blood Pressure Error
• 08: Pulse Rate Error
• 09: Device Error
• 10: Other

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q120A

INSTRUCTION: Record the blood pressure measurement.
Record the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q120B

Re-enter the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q121A

Record the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q121B

Re-enter the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q122A

Record the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q122B

Re-enter the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q123

OR

• 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q124

INSTRUCTION: Record the reason why the measurement could not be taken.

• 01: Inflation Error
• 02: Deflation Error
• 03: Overpressure Error
• 04: Insufficient Inflation Error
• 05: Indeterminable Blood Pressure Error
• 06: Low Pulse Level
• 07: Blood Pressure Error
• 08: Pulse Rate Error
• 09: Device Error
• 10: Other

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q130A

INSTRUCTION: Record the blood pressure measurement.
Record the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q130B

Re-enter the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q131A

Record the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q131B

Re-enter the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q132A

Record the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q132B

Re-enter the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q133

OR

• 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q134

INSTRUCTION: Record the reason why the measurement could not be taken.

• 01: Inflation Error
• 02: Deflation Error
• 03: Overpressure Error
• 04: Insufficient Inflation Error
• 05: Indeterminable Blood Pressure Error
• 06: Low Pulse Level
• 07: Blood Pressure Error
• 08: Pulse Rate Error
• 09: Device Error
• 10: Other

Blood Pressure Measurement (BPM) - Question identifier:BPM_R160

Measurement 1:
Systolic: BPM_Q110A
Diyastolic: BPM_Q111A
Heart Rate: BPM_Q112A
Error: BPM_Q114

Measurement 2:
Systolic: BPM_Q120A
Diastolic: BPM_Q121A
Heart Rate: BPM_Q122A
Error: BPM_Q124

Measurement 3:
Systolic: BPM_Q130A
Diastolic: BPM_Q131A
Heart Rate: BPM_Q132A
Error: BPM_Q134

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q160

INSTRUCTION: Check the blood pressure and heart rate data.

• 1: Measurements are valid.
• 2: Measurements are not valid.

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q161

Was anyone in the room with the respondent (e.g., HMS, parent or guardian) when the blood pressure measurements were taken?

• 1: Yes
• 2: No

Blood Pressure Measurement (BPM) - Question identifier:BPM_R205

There were too many errors with that set of measurements, so we have to do the test again. I will retake your blood pressure and heart rate. Remember, you should not move or talk during the test, and you need to keep both feet flat on the floor. It's important that you stay relaxed to ensure we get good results.

INSTRUCTION:
- Ensure P-SET is at AUTO and MODE is set to AVG.
- Secure the cuff on the respondent's [left/right] arm.
- Ensure respondent is in the correct position (palm down, feet flat, arm and back rested, relaxed).
- Press <Suspend/Exit interview>.
- Start the OMRON and stopwatch to return to the room after 9 minutes.
- Press <WINDOWS-L> to lock the computer before leaving the room.

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q205

INSTRUCTION: Take the measurement.

• 8: RF
• 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q210A

INSTRUCTION: Record the blood pressure measurement.
Record the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q210B

Re-enter the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q211A

Record the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q211B

Re-enter the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q212A

Record the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q212B

Re-enter the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q213

OR

• 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q214

INSTRUCTION: Record the reason why the measurement could not be taken.

• 01: Inflation Error
• 02: Deflation Error
• 03: Overpressure Error
• 04: Insufficient Inflation Error
• 05: Indeterminable Blood Pressure Error
• 06: Low Pulse Level
• 07: Blood Pressure Error
• 08: Pulse Rate Error
• 09: Device Error
• 10: Other

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q220A

INSTRUCTION: Record the blood pressure measurement.
Record the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q220B

Re-enter the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q221A

Record the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q221B

Re-enter the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q222A

Record the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q222B

Re-enter the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q223

OR

• 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q224

INSTRUCTION: Record the reason why the measurement could not be taken.

• 01: Inflation Error
• 02: Deflation Error
• 03: Overpressure Error
• 04: Insufficient Inflation Error
• 05: Indeterminable Blood Pressure Error
• 06: Low Pulse Level
• 07: Blood Pressure Error
• 08: Pulse Rate Error
• 09: Device Error
• 10: Other

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q230A

INSTRUCTION: Record the blood pressure measurement.
Record the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q230B

Re-enter the systolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q231A

Record the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q231B

Re-enter the diastolic blood pressure measurement.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q232A

Record the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q232B

Re-enter the heart rate.

Min = 0; Max = 999

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q233

OR

• 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q234

INSTRUCTION: Record the reason why the measurement could not be taken.

• 01: Inflation Error
• 02: Deflation Error
• 03: Overpressure Error
• 04: Insufficient Inflation Error
• 05: Indeterminable Blood Pressure Error
• 06: Low Pulse Level
• 07: Blood Pressure Error
• 08: Pulse Rate Error
• 09: Device Error
• 10: Other

Blood Pressure Measurement (BPM) - Question identifier:BPM_R260

Measurement 1:
Systolic: BPM_Q210A
Diyastolic: BPM_Q211A
Heart Rate: BPM_Q212A
Error: BPM_Q214

Measurement 2:
Systolic: BPM_Q220A
Diastolic: BPM_Q221A
Heart Rate: BPM_Q222A
Error: BPM_Q224

Measurement 3:
Systolic: BPM_Q230A
Diastolic: BPM_Q231A
Heart Rate: BPM_Q232A
Error: BPM_Q234

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q260

INSTRUCTION: Check the blood pressure and heart rate data.

• 1: Measurements are valid.
• 2: Measurements are not valid.

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q261

Was anyone in the room with the respondent (e.g., HMS, parent or guardian) when the blood pressure measurements were taken?

• 1: Yes
• 2: No

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q600_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_Q05

Hi, my name is.... Please have a seat on the chair. I need to confirm some information before we begin.

• 9: DK

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_Q10

Could you please confirm #{DT_YOUR1} first and last name?

• 1: First and last name are correct
• 2: First or last name is different

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_Q11

I need to confirm your fasting status. Did you eat or drink anything other than water (e.g., coffee, tea, alcohol, juice or flavoured water) after ^DT_FASTINGCUTOFF_TIMEE up until now?

• 1: Yes
• 2: No

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_Q12

What and when did you last eat or drink?
INSTRUCTION: Ask questions to determine what and when the respondent ate or drank. Is the respondent considered fasted?

• 1: Yes
• 2: No

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_R20

INSTRUCTION: During the screening component, EMLA cream was applied to the respondent at #{EMLA_Q06A}:#{EMLA_Q06B} #{DT_EMLATME}

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_R21

INSTRUCTION: During the screening component, [The respondent has stated they had a mastectomy on the right side. Perform phlebotomy only on #{DT_ARME}./The respondent has stated they had a mastectomy on the left side. Perform phlebotomy only on #{DT_ARME}./The respondent has stated no to have had a mastectomy. Perform phlebotomy on #{DT_ARME}.]

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_R22

INSTRUCTION: During the screening component, the respondent has stated they have felt dizzy or fainted previously during a blood draw. Probe and take the appropriate precautions.

Blood Collection (BDC) - Question identifier:BDC_Q10

I am going to do the blood draw.

• 8: RF

Blood Collection (BDC) - Question identifier:BDC_Q20

INSTRUCTION: Record which of the required tubes of blood were collected.
Include only the collected tubes that apply.

• 10: #{BDC10_DESCRIPTIONE}
• 11: #{BDC11_DESCRIPTIONE}
• 12: #{BDC12_DESCRIPTIONE}
• 13: #{BDC13_DESCRIPTIONE}
• 14: #{BDC14_DESCRIPTIONE}
• 15: #{BDC15_DESCRIPTIONE}
• 16: #{BDC16_DESCRIPTIONE}
• 17: #{BDC17_DESCRIPTIONE}
• 18: #{BDC18_DESCRIPTIONE}
• 19: #{BDC19_DESCRIPTIONE}
• 20: #{BDC20_DESCRIPTIONE}
• 21: #{BDC21_DESCRIPTIONE}
• 22: #{BDC22_DESCRIPTIONE}
• 23: #{BDC23_DESCRIPTIONE}
• 24: #{BDC24_DESCRIPTIONE}
• 26: #{BDC26_DESCRIPTIONE}
• 27: #{BDC27_DESCRIPTIONE}
• 28: #{BDC28_DESCRIPTIONE}
• 29: #{BDC29_DESCRIPTIONE}
• 30: #{BDC30_DESCRIPTIONE}
• 31: #{BDC31_DESCRIPTIONE}
• 32: #{BDC32_DESCRIPTIONE}
• 33: #{BDC33_DESCRIPTIONE}
• 34: #{BDC34_DESCRIPTIONE}
• 35: #{BDC35_DESCRIPTIONE}
• 36: #{BDC36_DESCRIPTIONE}
• 37: #{BDC37_DESCRIPTIONE}
• 38: #{BDC38_DESCRIPTIONE}
• 39: #{BDC39_DESCRIPTIONE}
• 43: #{BDC43_DESCRIPTIONE}
• 44: #{BDC44_DESCRIPTIONE}
• 45: #{BDC45_DESCRIPTIONE}
• 46: #{BDC46_DESCRIPTIONE}
• 50: #{BDC50_DESCRIPTIONE}
• 51: #{BDC51_DESCRIPTIONE}
• 52: #{BDC52_DESCRIPTIONE}
• 60: #{BDC60_DESCRIPTIONE}
• 61: #{BDC61_DESCRIPTIONE}
• 62: #{BDC62_DESCRIPTIONE}
• 63: #{BDC63_DESCRIPTIONE}
• 64: #{BDC64_DESCRIPTIONE}
• 65: #{BDC65_DESCRIPTIONE}
• 66: #{BDC66_DESCRIPTIONE}
• 67: #{BDC67_DESCRIPTIONE}
• 70: #{BDC70_DESCRIPTIONE}
• 71: #{BDC71_DESCRIPTIONE}
• 72: #{BDC72_DESCRIPTIONE}
• 73: #{BDC73_DESCRIPTIONE}
• 74: #{BDC74_DESCRIPTIONE}
• 75: #{BDC75_DESCRIPTIONE}
• 76: #{BDC76_DESCRIPTIONE}
• 77: #{BDC77_DESCRIPTIONE}
• 80: #{BDC80_DESCRIPTIONE}
• 81: #{BDC81_DESCRIPTIONE}
• 82: #{BDC82_DESCRIPTIONE}
• 96: #{BDC96_DESCRIPTIONE}
• 97: None of the required tubes
• 98: RF

Blood Collection (BDC) - Question identifier:BDC_R30

INSTRUCTION: Print collection tube labels in MEC App.
- Suspend/exit interview, print the Phlebotomy tube labels.
- Relaunch the phlebotomy component.
- Label format: CLINICID + tubeID.

Blood Collection (BDC) - Question identifier:BDC_Q40

INSTRUCTION: In the presence of the respondent, stick each label on the appropriate blood collection tube.

• 10: #{BDC10_DESCRIPTIONE}
• 11: #{BDC11_DESCRIPTIONE}
• 12: #{BDC12_DESCRIPTIONE}
• 13: #{BDC13_DESCRIPTIONE}
• 14: #{BDC14_DESCRIPTIONE}
• 15: #{BDC15_DESCRIPTIONE}
• 16: #{BDC16_DESCRIPTIONE}
• 17: #{BDC17_DESCRIPTIONE}
• 18: #{BDC18_DESCRIPTIONE}
• 19: #{BDC19_DESCRIPTIONE}
• 20: #{BDC20_DESCRIPTIONE}
• 21: #{BDC21_DESCRIPTIONE}
• 22: #{BDC22_DESCRIPTIONE}
• 23: #{BDC23_DESCRIPTIONE}
• 24: #{BDC24_DESCRIPTIONE}
• 26: #{BDC26_DESCRIPTIONE}
• 27: #{BDC27_DESCRIPTIONE}
• 28: #{BDC28_DESCRIPTIONE}
• 29: #{BDC29_DESCRIPTIONE}
• 30: #{BDC30_DESCRIPTIONE}
• 31: #{BDC31_DESCRIPTIONE}
• 32: #{BDC32_DESCRIPTIONE}
• 33: #{BDC33_DESCRIPTIONE}
• 34: #{BDC34_DESCRIPTIONE}
• 35: #{BDC35_DESCRIPTIONE}
• 36: #{BDC36_DESCRIPTIONE}
• 37: #{BDC37_DESCRIPTIONE}
• 38: #{BDC38_DESCRIPTIONE}
• 39: #{BDC39_DESCRIPTIONE}
• 43: #{BDC43_DESCRIPTIONE}
• 44: #{BDC44_DESCRIPTIONE}
• 45: #{BDC45_DESCRIPTIONE}
• 46: #{BDC46_DESCRIPTIONE}
• 50: #{BDC50_DESCRIPTIONE}
• 51: #{BDC51_DESCRIPTIONE}
• 52: #{BDC52_DESCRIPTIONE}
• 60: #{BDC60_DESCRIPTIONE}
• 61: #{BDC61_DESCRIPTIONE}
• 62: #{BDC62_DESCRIPTIONE}
• 63: #{BDC63_DESCRIPTIONE}
• 64: #{BDC64_DESCRIPTIONE}
• 65: #{BDC65_DESCRIPTIONE}
• 66: #{BDC66_DESCRIPTIONE}
• 67: #{BDC67_DESCRIPTIONE}
• 70: #{BDC70_DESCRIPTIONE}
• 71: #{BDC71_DESCRIPTIONE}
• 72: #{BDC72_DESCRIPTIONE}
• 73: #{BDC73_DESCRIPTIONE}
• 74: #{BDC74_DESCRIPTIONE}
• 75: #{BDC75_DESCRIPTIONE}
• 76: #{BDC76_DESCRIPTIONE}
• 77: #{BDC77_DESCRIPTIONE}
• 80: #{BDC80_DESCRIPTIONE}
• 81: #{BDC81_DESCRIPTIONE}
• 82: #{BDC82_DESCRIPTIONE}
• 96: #{BDC96_DESCRIPTIONE}

Blood Collection (BDC) - Question identifier:BDC_Q45

INSTRUCTION: Are all the required blood tubes collected to sufficient volumes?

• 1: Yes
• 2: No

Blood Collection (BDC) - Question identifier:BDC_Q50_RND

INSTRUCTION: Why was the component not fully completed?

• 01: Respondent unable to continue for health reasons
• 02: Respondent unable to understand or execute technique
• 03: Respondent or Parent or Guardian refuses to continue
• 04: Unable to take measurement or sample
• 05: No time
• 11: Respondent fainted
• 12: Unable to find vein
• 13: Blood flow stopped
• 20: Other

Blood Collection (BDC) - Question identifier:BDC_Q55

INSTRUCTION: Record whether another staff member assisted with the blood draw.

• 1: Yes
• 2: No

Blood Collection (BDC) - Question identifier:BDC_Q60

INSTRUCTION: Record the ID of the staff member that assisted with the blood draw.

Long Answer Length = 10

Activity Monitor (AM) - Question identifier:AM_Q10

INSTRUCTION: Record whether an activity monitor is available.

• 1: Yes
• 2: No
• 9: DK

Activity Monitor (AM) - Question identifier:AM_R11

It is crucial to obtain information about Canadians' daily activity patterns. As a result, this survey will be measuring your daily activity patterns over a 7 day period. In order to do this, we would like you to wear an activity monitor for the next 7 days.
An activity monitor is a small battery-operated electronic device that is worn on a belt around the waist, on the right hip bone. The monitor records all daily activities as electronic signals. It is pre-programmed to start recording tomorrow morning, there is no activation required and it does not need to be turned on or off.

INSTRUCTION: Hold up the activity monitor (on the belt) for display.

Activity Monitor (AM) - Question identifier:AM_R15

The activity monitor is to be worn for the next 7 days and mailed back after the 7 days are over. Do you have any questions before we proceed?

INSTRUCTION: Answer any questions as thoroughly as possible.

Activity Monitor (AM) - Question identifier:AM_R21

We ask that you start wearing this monitor as soon as you wake up tomorrow morning and that you keep wearing it for 7 full days.

• Place it on your right hip bone with the arrow pointing up and the belt snug.
• You can wear it over or under your clothes.
• It is important that you wear the activity monitor 24/7, you should not remove it for sleeping.
• Since the device is waterproof please wear it all day long without interruption (when showering, swimming, taking a nap, etc.).

Please do not alter your usual physical activity behaviour, since we are interested in your normal activity level.

INSTRUCTION: Assist the respondent in putting the belt on. Check to ensure the belt fits snugly around the waist and that the activity monitor is positioned on the right hip bone with the arrow pointing up.

Write the respondent's initials on the belt if more than one member of the same household will receive a monitor.

Activity Monitor (AM) - Question identifier:AM_Q21

INSTRUCTION: Record whether the respondent took an activity monitor.

• 1: Yes
• 2: No

Activity Monitor (AM) - Question identifier:AM_Q31A

INSTRUCTION: To log in the serial number of the activity monitor, scan the bar code on the monitor.

• 1: 1
• 2: 2
• 3: 3
• 4: ...
• 5: 5000

Activity Monitor (AM) - Question identifier:AM_Q31B

INSTRUCTION: Re-scan the bar code on the activity monitor.

• 1: 1
• 2: 2
• 3: 3
• 4: ...
• 5: 5000

Activity Monitor (AM) - Question identifier:AM_Q32

INSTRUCTION: To log in the waybill number of the postage-paid envelope, scan the bar code on the envelope.

Long Answer Length = 13

Activity Monitor (AM) - Question identifier:AM_R33

On the morning of #{DV_DATEMAILBACK}, please put the activity monitor into this postage-paid envelope and put the envelope into any Canada Post mailbox. Full descriptions of what the activity monitor is, what it measures, how it works, and why it is important are included on the information sheet in the envelope. Should you have any questions or concerns, you will find a toll free number on this sheet.

INSTRUCTION: Give the postage-paid envelope (addressed to Statistics Canada), the monitor and the information sheet to the respondent. Ensure they do not confuse this material with the Home Urine Collection material.

Inform the respondent that he/she will receive a reminder call to ensure he/she has started to wear the monitor and another call to remind him/her to return it.

Activity Monitor (AM) - Question identifier:AM_Q33_RND

INSTRUCTION: Why was the component not fully completed?

• 1: Respondent unable to continue for health reasons
• 3: Respondent refuses to continue
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Urine Collection 2 (UC2) - Question identifier:UC2_Q10

INSTRUCTION: Record whether the respondent provided a second urine sample.
If the respondent provided a second urine sample, bring the urine sample to the lab, regardless of volume.

• 1: Yes
• 2: No

Urine Collection 2 (UC2) - Question identifier:UC2_Q30_RND

INSTRUCTION: Why was the component not fully completed?

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand / execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement/sample
• 5: No time
• 6: Equipment problem / technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q05

You have been randomly selected to repeat the anthropometric component where we take body measurements such as your height and weight. You did nothing wrong when these measurements were taken earlier. We repeat these measurements with about 1 out of every 10 participants as a way to ensure consistency of the results.

Do you have any questions?

• 9: DK

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R10

I'm going to start by measuring your child's height. Please remove their shoes and place your child on their back with the top of their head touching the headboard.

INSTRUCTION: Have the parent/guardian support the head in the Frankfort plane and ensure all hair ties or ornaments (e.g., buns, braids, clips) have been removed.

Straighten the child's legs by placing one hand gently but with mild pressure over the knees.

The toes must point directly upward with both soles of the feet flexed perpendicularly against the foot piece.

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q10

INSTRUCTION: Record how the data will be captured.

• 1: Infantometer
• 2: Self-report
• 3: Too tall
• 9: DK

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R10A

INSTRUCTION: Record the recumbent length in centimetres (cm).

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q10A

Enter the recumbent length

Min = 0.00; Max = 999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q10B

Re-enter the recumbent length

Min = 0.00; Max = 999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q10_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R11

I'm going to start by measuring how tall you are. Please remove your shoes and stand with your feet together, keeping your heels, buttocks, back and head in contact with the measuring device. Look straight ahead and stand as tall as possible.

Now, take a deep breath in and hold it.

INSTRUCTION: Ensure the respondent's head is aligned with the Frankfort plane and all hair ties or ornaments (e.g., buns, braids, clips) have been removed.

Take the measurement while the respondent is holding their breath.

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q11

INSTRUCTION: Record how the data will be captured.

• 1: Electronically
• 2: Manually with a portable device
• 3: Self-report
• 4: Electronic data entered manually
• 9: DK

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R11A

INSTRUCTION: Ensure that the stadiometer is set to millimetres (mm).

Press the "Send" button on the left side of the digital display box or the "Data" button on the SPC (send to PC) device.

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q11A

Enter the standing height

Min = 0.00; Max = 9999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q11B

Re-enter the standing height

Min = 0.00; Max = 9999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R11C

INSTRUCTION: Record the standing height in centimetres (cm).

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q11C

Enter the standing height

Min = 0.00; Max = 999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q11D

Re-enter the standing height

Min = 0.00; Max = 999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q11_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R12

Next, I'd like you to sit on this box so that I can measure how tall you are when you are sitting. Sit with your back and head against the measuring device. Put your hands on your lap and keep your legs still. Look straight ahead and sit up as straight as possible.

Now, take a deep breath in and hold it.

INSTRUCTION: Ensure the respondent's head is in the Frankfort plane.

Ensure the respondent does not contract the gluteal muscles nor push with the legs.

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q12

INSTRUCTION: Take the measurement while the respondent is holding their breath.

• 9: DK

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R12A

INSTRUCTION: Ensure that the stadiometer is set to millimetres (mm).

Press the "Send" button on the left side of the digital display box.

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q12A

Enter the sitting height

Min = 0.00; Max = 9999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q12B

Re-enter the sitting height

Min = 0.00; Max = 9999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R12C

INSTRUCTION: Record the sitting height in centimetres (cm).

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q12C

Enter the sitting height

Min = 0.00; Max = 999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q12D

Re-enter the sitting height

Min = 0.00; Max = 999.99

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q12_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R13

Next, I'm going to measure how much you weigh. Please empty your pockets, remove all heavy accessories and step onto the centre of the scale. Keep your hands at your sides and look straight ahead.

INSTRUCTION: Ensure the respondent has on only minimal clothing (no shoes), has nothing in his/her pockets and has removed all heavy accessories (e.g., a watch, belt, pair of glasses).

Refer to help text for instructions on how to tare.

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q13

INSTRUCTION: Record how the data will be captured.

• 1: Electronically
• 2: Manually with a portable device
• 3: Self-report
• 4: Electronic data entered manually
• 9: DK

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R13A

INSTRUCTION: When the measurement is stable, record the weight in kilograms (kg).

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q13A

Enter the weight

Min = 0.0; Max = 999.9

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q13B

Re-enter the weight

Min = 0.0; Max = 999.9

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q13_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R14

Now I'm going to measure your waist circumference. Please stand up straight with your arms crossed over the chest in a relaxed manner, and breathe normally. I may need to move your clothing slightly because the measurement has to be taken directly on the skin. In order to ensure I have the correct position, I am going to feel for certain landmarks and make a few small marks on your skin with a washable marker to indicate where to place the tape. When I'm done, I'll remove them with a wipe.

INSTRUCTION: Landmark both sides.

Read the measurement at the right side of the body.

Take the measurement at the end of a normal expiration.

Height and Weight Measurements (RHWM) - Question identifier:RHWM_R14A

INSTRUCTION: Record the waist circumference in centimetres (cm).

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q14A

Enter the waist circumference

Min = 0.0; Max = 999.9

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q14B

Re-enter the waist circumference

Min = 0.0; Max = 999.9

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q14C

OR

• 9: DK

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q14_RND

INSTRUCTION: Record the reason why the measurement could not be taken.

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q16_RND

INSTRUCTION: Record the reason why the measurement could not be taken

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Height and Weight Measurements (RHWM) - Question identifier:RHWM_Q60_RND

INSTRUCTION: Why was the component not fully completed?

• 1: Respondent unable to continue for health reasons
• 2: Respondent unable to understand or execute technique
• 3: Respondent refuses to continue
• 4: Unable to take measurement or sample
• 5: No time
• 6: Equipment problem or technical difficulty
• 7: Temporary suspension

Report of Measurements (RM) - Question identifier:RM_R05

Your average blood pressure today was #{SYS_AVG} / #{DIA_AVG} mmHg, which means your blood pressure is #{DT_RM_R05_E}

INSTRUCTION:
- Answer any questions as thoroughly as possible.
- Click <Next> to go the Blood Pressure Test Results Report.
- Print the Blood Pressure Test Results Report.
- Click <More settings> and then uncheck the box <Headers and footers> and adjust the print scale as needed.

[Sign the blood pressure reporting letter and ensure that the exit and Sign-out components are completed as soon as possible.]

Report of Measurements (RM) - Question identifier:RM_R10

Date of appointment: #{THISDATE}
Name: #{RESPONDENTNAME}

Result of blood pressure test: #{SYS_AVG} / #{DIA_AVG} mmHg
[Blood pressure is not measured on 1 to 5 year old children./Your blood pressure today is within the normal range. We suggest you see a doctor within the next two years to have your blood pressure rechecked./Your blood pressure today is within the prehypertension range. We suggest you see a doctor within the next year to have your blood pressure rechecked./Your blood pressure today is indicative of stage 1 hypertension. We suggest you see a doctor within the next month to have your blood pressure rechecked./Your blood pressure today is indicative of stage 2 hypertension. YOU SHOULD SEE A DOCTOR WITHIN THE NEXT WEEK TO HAVE YOUR BLOOD PRESSURE RECHECKED./Your blood pressure today is indicative of stage 2 hypertension. YOU SHOULD SEE A DOCTOR OR GO TO A CLINIC OR HOSPITAL EMERGENCY ROOM TODAY TO HAVE YOUR BLOOD PRESSURE RECHECKED./Your blood pressure today is normal./Your blood pressure today is normal but at the high end of the normal range. We suggest you see a doctor within the next two months to have your blood pressure rechecked./Your blood pressure today is high. YOU SHOULD SEE A DOCTOR WITHIN THE NEXT WEEK TO HAVE YOUR BLOOD PRESSURE RECHECKED./Your blood pressure today is very high. YOU SHOULD SEE A DOCTOR OR GO TO A CLINIC OR HOSPITAL EMERGENCY ROOM TODAY TO HAVE YOUR BLOOD PRESSURE RECHECKED.]}

^DT_BPTEXT2_OUT_E

Report of Measurements (RM) - Question identifier:RM_R15A

To whom it may concern:

#{RESPONDENTNAME} was recently a participant in the Canadian Health Measures Survey (CHMS) conducted by Statistics Canada.

At the CHMS temporary examination centre, a health measures specialist performed blood pressure testing on #{RESPONDENTNAME}. After five minutes of quiet rest in a screening room, three blood pressure measurements were taken at one minute intervals, and the average of the three measurements was calculated.

The CHMS is a national survey that collects information about the general health and health behaviours of Canadians. The survey has two phases: an interview at the household and a visit to the CHMS temporary examination centre. At the centre, fully-trained health professionals take direct measures of health such as blood pressure, height and weight. Blood and urine samples are also collected to test for chronic and infectious diseases, as well as markers of nutrition and environmental contaminants. The information gathered through these measurements will help researchers and policy-makers evaluate the extent of major health concerns such as diabetes, obesity, hypertension and cardiovascular disease.

The tests performed as part of the CHMS are not intended to be used as medical diagnoses. We have recommended that #{RESPONDENTNAME} follow up on any test results with a doctor or other health care professional.

If you have any questions about the CHMS please contact us, toll-free, at 1-888-253-1087, or visit our website at www.statcan.gc.ca/chms.

Sincerely,



CHMS Health Measures Specialist

Report of Measurements (RM) - Question identifier:RM_R95

INSTRUCTION:
- Click <Next> to go the Report of Physical Measurements.
- Print the Report of Physical Measurements.
- Click <More settings> and then uncheck the box <Headers and footers> and adjust the print scale as needed.

Report of Measurements (RM) - Question identifier:RM_R100

Demographic information
Date of appointment: #{THISDATE}
Name of respondent: #{RESPONDENTNAME}
Age: #{CON_AGE}
Sex: #{DT_SEXE}

Report of Measurements (RM) - Question identifier:RM_R110

Blood pressure and heart rate
Blood pressure is a measure of the force of blood against the artery walls. It is stated as systolic pressure and diastolic pressure in millimetres of mercury (e.g., 120/80 mmHg). The results for this test are:

Average systolic blood pressure: #{DT_SBP_OUT_E}
Average diastolic blood pressure: #{DT_DBP_OUT_E}
Resting heart rate: #{DT_RHR_OUT_E}

#{DT_BPTEXT_OUT_E}

#{DT_BPTEXT2_OUT_E}

Report of Measurements (RM) - Question identifier:RM_R115

Blood pressure and heart rate
The blood pressure and heart rate measurements were not taken.

Report of Measurements (RM) - Question identifier:RM_R120

Body composition
Anthropometric measurements
The following body composition measures are used to monitor growth and development. The results for this test are:

Standing height: #{DT_HWMTEXT_OUT_ HCM_ E} #{DT_HWMTEXT_OUT_ HFT_ E} #{DT_HWMTEXT_OUT_RL_E} #{DT_HWMTEXT_OUT_S_E} #{DT_HWMTEXT_OUT_WA_E} #{DT_HWMTEXT_OUT_N_E}
Weight: #{DT_HWMTEXT_OUT_WEKG_E} #{DT_HWMTEXT_OUT_WELB_E}

Derived measures
The body mass index (BMI), a ratio of an individual's weight to height, can be used to assess the risk of developing health problems associated with being underweight or overweight. However, it is recommended to assess health risk by combining BMI and waist circumference values. Individuals with a higher waist circumference are at further elevated risk in each BMI category.

Body Mass Index (BMI): #{DT_BMI_OUT_E}

#{DT_BMITEXT_OUT_E} #{DT_HEALTHRISK_OUT_E}

Report of Measurements (RM) - Question identifier:RM_R125

Body composition
The anthropometric measurements were not taken.

Report of Measurements (RM) - Question identifier:RM_R140

INSTRUCTION:
- Click <Next> to go the Report of Measurements - Secure website access.
- Print the Report of Report of Measurements - Secure website access.
- Click <More settings> and then uncheck the box <Headers and footers> and adjust the print scale as needed.

Report of Measurements (RM) - Question identifier:RM_R145

You have chosen to receive today's measurement results through our secure website.

To access your results when they become available, you will need to:
1 - Visit our secure website at the following address: ^DT_PORTAL_URLE
2 - Enter your unique Secure Access Code.
3 - Follow the steps to create your account.

Your Secure Access Code is: #{DT_PORTAL_SAC}

IMPORTANT: For security purposes, your Secure Access Code will expire after 30 days. Please create your account before it expires. Please keep this code safe and do not share it with anyone.

Exit Consent Questions (ECQ) - Question identifier:ECQ_R01

Before you leave, we have a few administrative steps.

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q01

Statistics Canada may combine information about [you/#{FNAME}] collected during this survey with information from other surveys or from administrative data sources.

The results will be used for statistical purposes only.

• 8: RF

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q02

Having a health number will assist Statistics Canada in linking the survey data to the provincial or territorial health information.

[Do you/Does #{FNAME}/Does #{FNAME}] have a(n) [Newfoundland and Labrador/Prince Edward Island/Nova Scotia/New Brunswick/Quebec/Ontario/Manitoba/Saskatchewan/Alberta/British Columbia/Yukon/Northwest Territories/Nunavut] health number?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q03

For which province or territory is [your/#{FNAME}'s] health number?

• 10: Newfoundland and Labrador
• 11: Prince Edward Island
• 12: Nova Scotia
• 13: New Brunswick
• 24: Quebec
• 35: Ontario
• 46: Manitoba
• 47: Saskatchewan
• 48: Alberta
• 59: British Columbia
• 60: Yukon
• 61: Northwest Territories
• 62: Nunavut
• 88: Does not have a Canadian health number

Exit Consent Questions (ECQ) - Question identifier:ECQ_R04

INSTRUCTION:
-Enter a health number for #{DT_HNPROVE}.
-In #{DT_HNPROVE}, the health number is made up of #{DT_DIGITSE}.
-Do not insert blanks, hyphens or commas between the numbers.
-If applicable, only use upper-case characters.

#{DT_HNSPECE}

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q04

What is #{DT_YOUR1} health number?

Long Answer Length = 12

Exit Consent Questions (ECQ) - Question identifier:ECQ_R05

To avoid duplication of surveys, Statistics Canada has signed agreements to share the data from this survey with Health Canada and the Public Health Agency of Canada.

They have agreed to keep the data confidential and use it only for statistical purposes.

With the exception of the postal code, [your name, telephone number, health number and address/your name, telephone number, and address/#{FNAME}'s name, telephone number, health number and address/#{FNAME}'s name, telephone number, and address] will not be shared.

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q05

Do you agree to share the data with Health Canada and the Public Health Agency of Canada?

• 1: Yes
• 2: No
• 9: DK

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q06

We may want to contact your household in a number of years to ask about your participation in a follow-up to this survey.

Do we have your permission to contact you?

• 1: Yes
• 2: No

Exit Consent Questions (ECQ) - Question identifier:ECQ_R07

In case you move or change telephone number(s), it would be helpful if you could provide the name, telephone number and email address of a relative or friend who could help us to contact you.

I want to emphasize that we will contact this person only if we experience difficulty reaching you and only to obtain your new email address and telephone number.

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q07

Is there someone we can contact if we have difficulty reaching you?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Exit Consent Questions (ECQ) - Question identifier:ECQ_R08

Please provide the name, telephone number(s) and e-mail address of the person we can contact.

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q08A

First name

Long Answer Length = 30

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q08B

Last name

Long Answer Length = 30

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q08C

Telephone number 1

Long Answer Length = 10

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q08D

Telephone number 2

Long Answer Length = 10

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q08E

Email

Long Answer Length = 80

MEC Sign-Out (CSO) - Question identifier:CSO_R11

Thank you for participating in the survey. Here is [#{Fname}'s/your] Report of Physical Measurements containing the results for some of the tests [he/she/you] performed today. I will now review it with you to help you understand your results. Do not hesitate if you have any questions about this report.

INSTRUCTION:
- Provide the respondent with his/her Report of Physical Measurements.
- If a respondent has questions that you are not able to answer, ask the appropriate Specialist to answer any questions about the test results.

MEC Sign-Out (CSO) - Question identifier:CSO_R12

We will send the final report of [#{Fname}'s/your] test results in 6 to 7 months. If you move, please inform us by phoning or e-mailing us.

MEC Sign-Out (CSO) - Question identifier:CSO_Q22

INSTRUCTION: Record whether #{RESPONDENTNAME} is to receive the standard reimbursement of $#{AMOUNT}.

• 1: Yes
• 2: No

MEC Sign-Out (CSO) - Question identifier:CSO_Q23

INSTRUCTION: Record the reimbursement amount (in CAN$).

Min = 0; Max = 999

MEC Sign-Out (CSO) - Question identifier:CSO_Q25

INSTRUCTION: Specify the reason why a reimbursement in excess of $#{AMOUNT} is being disbursed.

Long Answer Length = 80

MEC Sign-Out (CSO) - Question identifier:CSO_R30

INSTRUCTION:
- Click <Next> to go the reimbursement form.
- Print the Reimbursement form.
- Click <More settings> and then uncheck the box <Headers and footers> and adjust the print scale as needed.

MEC Sign-Out (CSO) - Question identifier:CSO_R31

Date (yyyy-mm-dd): #{THISDATE}
Identification number: #{CLINICID}
Name of participant: #{RESPONDENTNAME}
Amount reimbursed: $#{DV_CSO_D23}

I have received the $#{DV_CSO_D23} reimbursement for expenses related to #{DT_CSO30TEXTE} participation in the #{SurveyNameEnglish}.

PARTICIPANT SIGNATURE SECTION

#{DT_NAMERPGE}: #{DT_NAMECSO}

#{DT_SIGNATUREE}: ______________________________

Date: #{DV_NEWDATE}

WITNESS SIGNATURE SECTION

Name of witness: #{MEC_USERNAME}

Signature of witness: ______________________________

Date: #{DV_NEWDATE}

SITE MANAGER SIGNATURE SECTION

Name of site manager: ______________________________

Signature of site manager: ______________________________

Date: ______________________________

FOR OFFICE USE ONLY

Verified by: ______________________________

MEC Sign-Out (CSO) - Question identifier:CSO_R36

I would like to provide you with a reimbursement of the expenses for [#{Fname}'s/your] participation in today's portion of the survey. I need you to sign this form, which indicates that you received the reimbursement.

INSTRUCTION:
-Provide the #{DT_CSO31TEXT2E} with the Reimbursement Form.
-When the #{DT_CSO31TEXT2E} returns the form, check to ensure that all requested information has been filled in and is legible.
-Sign the form as the witness.