Canadian Health Measures Survey (Cycle 5) - Clinic Questionnaire

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For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

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Table of Contents

Selected Case Start Block (SCS)

Selected Case Start Block (SCS) - Question identifier:SCS_N11

Verify all information that appears on the screen. If there is an error in any of this information, inform the coordinator immediately. The coordinator will verify and correct the information as necessary.
Press <1> to continue.

  • 1: Continue

Selected Case Start Block (SCS) - Question identifier:SCS_N12

Display the following information on the screen:

Stand : ^STAND Date : ^CurrentDate Session : essionE Clinic ID : ^CLINICID
Household Contact : ^HouseholdContact
Respondent : ^RespondentName
Age : ^AWC_AGE
Sex : ^GenderE
Language of interview : ^RespLangE
Notes : ^PERMNOTE

Select the operation to be performed.

  • 3: Start Clinic Visit
  • 4: Capture Home Visit

Generating the components list (BTB)

Respondent Verification (RVB)

Respondent Verification (RVB) - Question identifier:RVB_N11

Press <1> to print the Participant's personal information form.

  • 1: Print the form

Respondent Verification (RVB) - Question identifier:RVB_R11

Here is the first of several forms we will be asking you to complete. Please read it carefully and provide the information requested.

Respondent Verification (RVB) - Question identifier:RVB_N12

Press <1> to print the label with the respondent's CLINICID as a bar code identifier.

- Stick the first label onto a bracelet
- Attach the bracelet around the wrist of the respondent.

  • 1: Print the label

Name Spelling Confirmation (NSC)

Name Spelling Confirmation (NSC) - Question identifier:NSC_N11

Record whether ^RespondentName's name is spelled correctly.

  • 1: Yes
  • 2: No

Name Spelling Confirmation (NSC) - Question identifier:NSC_N12

Record whether corrections are to be made to:

  • 1: ...the first name only?
  • 2: ...the last name only?
  • 3: ...both names?

Name Spelling Confirmation (NSC) - Question identifier:NSC_N13

Enter the first name only.

Long Answer Length = 25

Name Spelling Confirmation (NSC) - Question identifier:NSC_N14

Enter the last name only.

Long Answer Length = 25

Sex Confirmation (SXC)

Sex Confirmation (SXC) - Question identifier:SXC_N11

Record whether ^RespondentName's sex is correct.

  • 1: Yes
  • 2: No

Sex Confirmation (SXC) - Question identifier:SXC_N12

Record ^RespondentName's sex.

  • 1: Male
  • 2: Female

Confirmation of Birth Date (DDN)

Confirmation of Birth Date (DDN) - Question identifier:DDN_N1

Record whether ^RespondentName's date of birth is ^MonthOfBirthE ^AWC_DOB, ^AWC_YOB.

  • 1: Yes
  • 2: No

Confirmation of Birth Date (DDN) - Question identifier:DDN_Q3

I would like to confirm that your age is ^CalculatedAge.

  • 1: Yes
  • 2: No, return and correct date of birth
  • 3: No, collect age

Confirmation of Birth Date (DDN) - Question identifier:DDN_N4

Record ^RespondentName's age.

Min = 1; Max = 85

Confirmation of Birth Date (DDN) - Question identifier:DDN_N6

Press <1> to print the labels with the respondent's short name.

- First label: Stick it onto the respondent's file folder.

- Second label: Staple it to the inside of the respondent's file folder.

- Third label: Stick it onto a urine sample container.

- Fourth label: Keep for the second urine container, if needed.

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

  • 1: Print the labels

DDN1 (DDN1)

DDN3 (DDN3)

Language Confirmation (LNG)

Language Confirmation (LNG) - Question identifier:LNG_N11

Record ^DT_RESPONDENTNAME's preferred official language.

  • 1: English
  • 2: French

Respondent Verification Component End (RVC)

Consent (CON)

Consent (CON) - Question identifier:CON_N01

Press <1> to print the Consent form(s).

  • 1: Print the form(s)

Consent (CON) - Question identifier:CON_Q11

Before we start the clinic tests, we need to ensure you have reviewed the Information and Consent Booklet that was given to you during the interview at your home. Did you have a chance to read that booklet?

  • 1: Yes
  • 2: No

Consent (CON) - Question identifier:CON_R12

Do you have any questions about any of the information in the booklet or about the clinic portion of the survey?

Consent (CON) - Question identifier:CON_R13

Here is a copy of 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 clinic tests, I can answer them for you.

Consent (CON) - Question identifier:CON_R14

Here is the Consent form for participation in the clinic portion of the survey. Please read the form carefully and check either the "Yes" or "No" box for each item.

Consent (CON) - Question identifier:CON_R15

I am now going to enter that information into our computer system. I may have some additional questions about your responses.

Consent (CON) - Question identifier:CON_N15

Record whether the parent or guardian has consented to the respondent participating in the physical measure tests.

  • 1: Yes
  • 2: No

Consent (CON) - Question identifier:CON_R16

Your parent or guardian has said you can take part in the tests today. If you would like to participate we need you to write or print your name on this form.

Consent (CON) - Question identifier:CON_N16

Record whether the respondent has [consented/assented] to participating in the physical measure tests.

  • 1: Yes
  • 2: No

Consent (CON) - Question identifier:CON_N18

Record whether [the parent or guardian/the respondent] has consented to having [^RespondentFirstName's/his/her] x-rays taken.

  • 1: Yes
  • 2: No

Consent (CON) - Question identifier:CON_N21

Record whether [the parent or guardian/the respondent] has consented to receiving reports of [^RespondentFirstName's/his/her] test results.

  • 1: Yes
  • 2: No

Consent (CON) - Question identifier:CON_N23

Record whether [the parent or guardian/the respondent] has consented to allowing Statistics Canada to test [^RespondentFirstName's/his/her] blood and urine for [contaminants that might require/diseases and contaminants that might require] mandatory reporting in his/her province of residence, and to contact him/her as well as the appropriate provincial authorities if the results are outside the established reference range and require a follow-up.

  • 1: Yes
  • 2: No

Consent (CON) - Question identifier:CON_R23

You have indicated on the Consent form that you do not want to receive reports of [your/^RespondentFirstName's] test results. However, you have agreed that Statistics Canada can test [your/^RespondentFirstName's] blood and urine 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.

Consent (CON) - Question identifier:CON_N24

Record whether the parent or guardian has consented to storage of the respondent's blood and urine for use in future health studies.

  • 1: Yes
  • 2: No

Consent (CON) - Question identifier:CON_N25

Record whether the respondent has agreed to storage of blood and urine for use in future health studies.

  • 1: Yes
  • 2: No

Consent (CON) - Question identifier:CON_N26

Record whether [the parent or guardian/the respondent] has agreed to storage of DNA for use in future health studies.

  • 1: Yes
  • 2: No

Report (REP)

Report (REP) - Question identifier:REP_R11

Today, at the end of the clinic visit, you will receive [^RespondentFirstName's/your] Report of physical measurements containing the results that are immediately available. We will send the final report of [his/her/your] remaining test results in 6 to 7 months.

Report (REP) - Question identifier:REP_N13

Record the name of the person who signed the Consent form.
Enter the person's first and last name.

Long Answer Length = 80

Report (REP) - Question identifier:REP_Q16

Would you rather receive the results by mail or through a secure website?

  • 1: Mail
  • 2: Secure website

Report (REP) - Question identifier:REP_Q20

We can send you the results by regular mail or by courier. Can we send you the final report by regular mail?

  • 1: Yes
  • 2: No

Report (REP) - Question identifier:REP_R21

We will send you the final report of test results by courier.

Report (REP) - Question identifier:REP_Q21

I would like to confirm your mailing address. Is it:
^MailAddress

  • 1: Yes
  • 2: No

Urgent Condition (URG)

Urgent Condition (URG) - Question identifier:URG_R06

I would like to confirm the telephone numbers we have on file.

Urgent Condition (URG) - Question identifier:URG_Q07

Is ^TelephoneNumber1 correct?

  • 1: Yes
  • 2: No

Urgent Condition (URG) - Question identifier:URG_Q09

Is ^TelephoneNumber2 correct?

  • 1: Yes
  • 2: No

Urgent Condition (URG) - Question identifier:URG_Q10

Is there [a/another] phone number that can be used to reach you?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Urgent Condition (URG) - Question identifier:URG_Q11

Can you provide us with an e-mail address?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Urgent Condition (URG) - Question identifier:URG_N13

Is the respondent in a wheelchair?

  • 1: Yes
  • 2: No

Urgent Condition (URG) - Question identifier:URG_Q14

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.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Consent Component End (COC)

Subsampling Labelsl (SSL)

Subsampling Labelsl (SSL) - Question identifier:SSL_N50

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

  • 1: Print the labels

Subsampling Labelsl (SSL) - Question identifier:SSL_N55

Stick each label on the appropriate specimen tube.

Press <1> to continue.

  • 1: Continue

Sub-Sampling Labels Component End (SLE)

Urine Collection 1 (UC1)

Urine Collection 1 (UC1) - Question identifier:UC1_Q10

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

  • 1: Continue
  • 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.
- Fill the container as full as possible 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.

Urine Collection 1 (UC1) - Question identifier:UC1_R21

^DT_UC1R21ETo 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.

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.

Urine Collection 1 (UC1) - Question identifier:UC1_R23

[Once ^RespondentFirstName 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 as full as possible and put the lid back on tightly.
- 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.

Urine Collection 1 (UC1) - Question identifier:UC1_R30

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

Urine Collection 1 (UC1) - Question identifier:UC1_N40

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.

  • 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_N50

The required urine volume can be found on the urine container label.

Did the respondent provide a urine sample of sufficient volume?

  • 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.

Urine Collection 1 (UC1) - Question identifier:UC1_N70

Why was the component not completed?

  • 03: Respondent refuses to continue
  • 06: No time
  • 10: Unable to provide
  • 20: Other - Specify

Urine Collection 1 Component End (U1E)

Screening Component Introduction (SCI)

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. Some questions may have been asked during the home interview, but we need to ensure that our information is up-to-date. We also need to know if any changes have occurred since the home interview.
It is important to note that some medications and physical conditions may exclude you from certain tests.

Please answer to the best of your knowledge, as accurate information about you is important. [Your parent or guardian may need to help you answer some of these questions/EMPTY].

Adherence to Guidelines (ATG)

Adherence to Guidelines (ATG) - Question identifier:ATG_R11

At the time of the home interview, you were given a set of pre-testing guidelines. We will now review those guidelines.

Adherence to Guidelines (ATG) - Question identifier:ATG_Q11

When did you last eat or drink anything other than water (e.g., coffee, tea, alcohol, juice or flavoured water)?

Min = 1.00; Max = 12.59

Adherence to Guidelines (ATG) - Question identifier:ATG_N11

Confirm the date.

  • 1: Yesterday
  • 2: Today

Adherence to Guidelines (ATG) - Question identifier:ATG_N12

Enter the time (followed by "AM" or "PM") the fasting question (ATG_Q11) was asked to the respondent.

Min = 1.00; Max = 12.59

Adherence to Guidelines (ATG) - Question identifier:ATG_Q21A

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_Q31

Have you consumed any alcohol during the past 6 hours?

  • 1: Yes
  • 2: No

Adherence to Guidelines (ATG) - Question identifier:ATG_N32

Probe to determine when and how much the respondent drank.

Record whether the respondent should be excluded from one or more tests.

  • 1: Yes
  • 2: No

Adherence to Guidelines (ATG) - Question identifier:ATG_N33

From which test(s) should the respondent be excluded?

  • 2: Grip Strength
  • 3: mCAFT
  • 4: Sit and reach
  • 5: Jumping mechanography
  • 6: Quantitative computed tomography
  • 7: Vision

Adherence to Guidelines (ATG) - Question identifier:ATG_Q41

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_Q43

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)

Physical and Health Conditions (PHC) - Question identifier:PHC_R11

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

Physical and Health Conditions (PHC) - Question identifier:PHC_Q31

Have you been diagnosed with exercise-induced asthma or a breathing condition that worsens with exercise such as chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD)?

  • 1: Yes
  • 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q32

During the interview in your home, it was reported that you had asthma. Is this correct?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Physical and Health Conditions (PHC) - Question identifier:PHC_Q32A

During the interview in your home, it was reported that you had chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD). Is this correct?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Physical and Health Conditions (PHC) - Question identifier:PHC_Q36A

Are you currently taking any medications for your breathing condition(s)?

  • 1: Yes
  • 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_Q36B

What type(s) of medication(s) are you taking?

  • 1: Quick relief
  • 2: Controller
  • 3: Both

Physical and Health Conditions (PHC) - Question identifier:PHC_Q37

Do you have your quick relief medication(s) with you?

  • 1: Yes
  • 2: No

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

Do you have any acute conditions, for example a sprained wrist, 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_N41

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
  • 6: Fever

Physical and Health Conditions (PHC) - Question identifier:PHC_N42

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

Probe to determine the seriousness of the condition.

  • 01: Activity monitor
  • 02: Grip strength
  • 03: mCAFT
  • 04: Sit and reach
  • 05: Jumping mechanography
  • 06: Quantitative computed tomography
  • 07: Vision
  • 90: 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_N43

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_N44

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

Probe to determine the seriousness of the condition.

  • 01: Activity monitor
  • 02: Grip strength
  • 03: mCAFT
  • 04: Sit and reach
  • 05: Jumping mechanography
  • 06: Quantitative computed tomography
  • 07: Vision
  • 90: None

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)

Women's Health Restrictions (WHR) - Question identifier:WHR_R001

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 = 8; Max = 79

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 = 1; Max = 45

Women's Health Restrictions (WHR) - Question identifier:WHR_Q025

Is there a possibility that you may be pregnant? By "possibility" I mean being sexually active without the use of contraception.

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR)

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.

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q005

Have you ever been diagnosed with an aneurysm?

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q010

Are you currently taking prescribed medications for a blood pressure or heart condition?

  • 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

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q020

Do you feel pain in your chest when you do physical activity?

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q025

In the past month, have you had chest pain when you were not doing physical activity, for example, at rest or during your daily activities of living?

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q030

In the last 12 months, have you lost your balance because of dizziness or have you lost consciousness?

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q040

Under which condition(s) did this happen?

  • 01: Standing up quickly
  • 02: Getting up from lying down
  • 03: After an injury/accident (e.g., concussion, head injury)
  • 04: During an illness (e.g., inner ear infection)
  • 05: During or after exercise
  • 06: After fasting for a long period of time
  • 07: On hot days
  • 08: At random
  • 09: Other - Specify

Physical Activity Restrictions (PHR) - Question identifier:PHR_N045

From which tests should the respondent be excluded because of this condition?

Probe to determine the seriousness of the condition.

  • 03: mCAFT
  • 05: Jumping Mechanography
  • 90: None

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q050

Do you have a bone or joint problem that could be aggravated by physical activity?

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q055

The problem is with which bone or joint?

  • 01: Head / Jaw
  • 02: Neck
  • 03: Back / Spine (excluding neck)
  • 04: Shoulder
  • 05: Arm / Elbow
  • 06: Wrist
  • 07: Hand / Fingers
  • 08: Hip
  • 09: Leg / Knee
  • 10: Ankle
  • 11: Foot / Toes

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q070

Has a health care professional said that you should not do certain types of physical activity?

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_N075

Probe to determine the type(s) of physical activity that the respondent should not do.

Record whether the respondent should be excluded from one or more tests.

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_N080

From which test(s) should the respondent be excluded?

  • 2: Grip Strength
  • 3: mCAFT
  • 4: Sit and reach
  • 5: Jumping mechanography

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q085

Do you know of any other reason why you should not do physical activity?

  • 1: Yes
  • 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q090

Please specify the reason you should not do physical activity?

  • 01: Bone, joint or muscle problem
  • 02: Cardiovascular condition
  • 03: Recovery from a medical procedure
  • 04: Respiratory condition
  • 05: Physically impaired
  • 06: Pregnancy
  • 07: Other health problem
  • 08: Other - Specify

Physical Activity Restrictions (PHR) - Question identifier:PHR_N095

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

Probe to determine the seriousness of the condition.

  • 02: Grip Strength
  • 03: mCAFT
  • 04: Sit and reach
  • 05: Jumping mechanography
  • 90: None

Bone or Joint Problem (BJP)

Bone or Joint Problem (BJP) - Question identifier:BJP_Q1

What is the condition that affects your ^DT_BONEJOINT1E?

  • 01: Arthritis (osteoarthritis or rheumatoid arthritis)
  • 02: Vertebral disorder (e.g., chronic back or neck pain)
  • 03: Osteoporosis
  • 04: Chronic soft tissue condition (e.g., tendonitis)
  • 05: Chronic joint condition (e.g., bursitis, carpal tunnel syndrome)
  • 06: Acute soft tissue condition (e.g., pulled muscle, sprain, strain)
  • 07: Acute bone condition (e.g., broken bone)
  • 08: Neuromuscular disorder (e.g., multiple sclerosis, cerebral palsy, spinal cord dysfunction, muscular dystrophy, brain injury)
  • 09: Amputation
  • 10: Other - Specify

Bone or Joint Problem (BJP) - Question identifier:BJP_N2

Probe to determine what types of activities can aggravate the respondent's ^DT_BONEJOINT1E problem.

Record whether the respondent should be excluded from one or more tests.

  • 1: Yes
  • 2: No

Bone or Joint Problem (BJP) - Question identifier:BJP_N3

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

Mark all that apply.

  • 2: Grip Strength
  • 3: mCAFT
  • 4: Sit and reach
  • 5: Jumping mechanography

Bone Mineral Density Test Restrictions (BMR)

Bone Mineral Density Test Restrictions (BMR) - Question identifier:BMR_R001

I also need to ask a few bone-health-related questions to ensure that you are eligible for the bone mineral density test.

Bone Mineral Density Test Restrictions (BMR) - Question identifier:BMR_Q005

In the last 12 months, that is from ^Date12MonthsAgoE to today, have you broken, fractured, cracked or chipped your leg below the knee joint, including the ankle?

  • 1: Yes
  • 2: No

Bone Mineral Density Test Restrictions (BMR) - Question identifier:BMR_Q010

Which leg?

  • 1: Right
  • 2: Left
  • 3: Both

Bone Mineral Density Test Restrictions (BMR) - Question identifier:BMR_Q015

Do you have metal in your leg anywhere below the knee, including the ankle? For example, screws, rods, plates, shrapnel or pellets?

  • 1: Yes
  • 2: No

Bone Mineral Density Test Restrictions (BMR) - Question identifier:BMR_Q020

Which leg?

  • 1: Right
  • 2: Left
  • 3: Both

Vision Component Restrictions (VIR)

Vision Component Restrictions (VIR) - Question identifier:VIR_R001

Now, some questions about the health and care of your eyes.

Vision Component Restrictions (VIR) - Question identifier:VIR_Q005

Do you have an eye infection?

  • 1: Yes
  • 2: No

Vision Component Restrictions (VIR) - Question identifier:VIR_Q010

In the past year, that is from ^Date12MonthsAgoE to yesterday, have you received corneal transplant surgery?

  • 1: Yes
  • 2: No

Vision Component Restrictions (VIR) - Question identifier:VIR_Q015

In which eye?

  • 1: Right
  • 2: Left
  • 3: Both

Vision Component Restrictions (VIR) - Question identifier:VIR_Q020

In the past 12 weeks, that is from ^Date12WeeksAgoE to yesterday, have you had any of the following: an eye injury, an injection of medicine into an eye or an eye surgery, including corrective laser eye surgery?

  • 1: Yes
  • 2: No

Vision Component Restrictions (VIR) - Question identifier:VIR_Q025

In which eye?

  • 1: Right
  • 2: Left
  • 3: Both

Vision Component Restrictions (VIR) - Question identifier:VIR_Q030

Do you have an artificial eye?

  • 1: Yes
  • 2: No

Vision Component Restrictions (VIR) - Question identifier:VIR_Q035

In which eye?

  • 1: Right
  • 2: Left
  • 3: Both

Vision Component Restrictions (VIR) - Question identifier:VIR_Q040

Are you blind in either one or both eyes?

  • 1: Yes
  • 2: No

Vision Component Restrictions (VIR) - Question identifier:VIR_Q045

In which eye?

  • 1: Right
  • 2: Left
  • 3: Both

Hair Sample Restriction (HSR)

Hair Sample Restriction (HSR) - Question identifier:HSR_N005

From looking at the respondent, are you able to collect a hair sample?

At the crown of their head, the respondent must have:
- At least 2 cm of hair; and
- At least 100 strands of hair (approximately half the diameter of a pencil eraser), which can be collected from multiple locations on the back of the head, but each location should not be greater than the area of a dime.

  • 1: Yes
  • 2: No
  • 3: Need to assess

Hair Sample Restriction (HSR) - Question identifier:HSR_Q010

I also need to ask you a question about your hair to make sure you are able to participate in the hair sampling test today.

Is the hair at the back of your head your own natural hair?

  • 1: Yes
  • 2: No

Medications and Product Confirmation (MEDC)

Medications and Product Confirmation (MEDC) - Question identifier:MEDC_R100

Now I'd like to confirm your use of prescription and over-the-counter medications and other health products, including natural health products.

Medications and Product Confirmation (MEDC) - Question identifier:MEDC_R411

Now I am going to ask you a question about your use of other substances such as performance enhancing or recreational drugs. We ask this question 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.

Medications and Product Confirmation (MEDC) - Question identifier:MEDC_Q411

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

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medications and Product Confirmation (MEDC) - Question identifier:MEDC_N611

From which test(s) should the respondent be excluded because of medication use?

  • 02: Grip strength
  • 03: mCAFT
  • 05: Jumping mechanography
  • 90: None

Confirm Drug Product (CDP)

Confirm Drug Product (CDP) - Question identifier:CDP_Q1

^DT_QUESTIONE
(The response categories are today, yesterday, within the last week, within the last month or more than one month ago.)

  • 1: Today
  • 2: Yesterday
  • 3: Within the last week
  • 4: Within the last month
  • 5: More than one month ago
  • 6: Never ^DT_TAKE1E the product
  • 8: RF
  • 9: DK

Medication Use for Clinic (MEUC)

Medication Use for Clinic (MEUC) - Question identifier:MEUC_Q02

In the past month, that is, from ^DT_DateLastMonthE to today, have you taken or used any ^DT_OTHER1medications that have been prescribed or administered by a health professional such as a doctor or dentist? This includes such things as insulin, ^DT_MEUText2E.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use for Clinic (MEUC) - Question identifier:MEUC_N11

Do you have another prescription medication to capture?

  • 1: Yes
  • 2: No
  • 8: RF

Medication Use for Clinic (MEUC) - Question identifier:MEUC_Q12

Have you taken or used any other prescription medications in the past month? Please include any prescription creams, injections or patches.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use for Clinic (MEUC) - Question identifier:MEUC_Q15

How many other prescription medications have you taken or used in the past month? Please include any prescription creams, injections or patches.

Min = 0; Max = 95

Medication Use for Clinic (MEUC) - Question identifier:MEUC_Q20

Have you taken or used any [other/EMPTY]over-the-counter medications or other health products, including natural health products in the past month?

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.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use for Clinic (MEUC) - Question identifier:MEUC_Q21

How many [other/EMPTY]over-the-counter medications or other health products have you taken or used in the past month?

Min = 1; Max = 95

Medication Use for Clinic (MEUC) - Question identifier:MEUC_Q22

Have you taken or used any [other/EMPTY]over-the-counter medications or other health products, including natural health products, in the past month, that is, from ^DT_DateLastMonthE to today.

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.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use for Clinic (MEUC) - Question identifier:MEUC_N26

Do you have another over-the-counter medication or health product to capture?

  • 1: Yes
  • 2: No
  • 8: RF

Medication Use for Clinic (MEUC) - Question identifier:MEUC_Q27

Have you taken or used any other over-the-counter medications or health products in the past month? Please include any solutions, powders, creams or pastes.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use for Clinic (MEUC) - Question identifier:MEUC_Q29

How many other over-the-counter medications or health products have you taken or used in the past month? Please include any solutions, powders, creams or pastes.

Min = 0; Max = 95

New Product Information (NPI)

New Product Information (NPI) - Question identifier:NPI_N05

Is a product identification number available for the product (e.g., DIN, DIN-HM, NPN, EN)?

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_N07

Record the product identification number from the bottle, tube or box. Include all leading zeros.

Long Answer Length = 8

New Product Information (NPI) - Question identifier:NPI_N08

Select the correct product.

New Product Information (NPI) - Question identifier:NPI_N11

Is ^NPI_N07 the correct product identification number?

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_N15

Why is a product identification number not available for the product?

  • 1: Container not available
  • 2: No product identification number

New Product Information (NPI) - Question identifier:NPI_Q16

[To search for this product I will need some of the following information:
- Product name: for example, Accutane, Alesse 21 or Ventolin.
- Product form: for example, pill, powder, liquid or cream.
- Manufacturer: for example, Roche, Pfizer or GlaxoSmithKline./To search for this product, I will need some of the following information:
- Product name: for example, Children's Tylenol® Cold and Cough Nighttime.
- Product form: for example, pill, powder, liquid or cream.
- Manufacturer: for example, Bayer, Jamieson or Sisu./EMPTY]

  • 1: Continue

New Product Information (NPI) - Question identifier:NPI_N17

Was an exact product match found?

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_Q17A

Product identification number: ^DV_PIN
Product name: ^DV_PRODUCT_NAME
Form: [NPI_S20/EMPTY/English text of category selected at NPI_Q20]
Strength: ^DT_STRENGTH
Route of administration: ^DT_ROUTEE

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_N17B

Do you want to search for the product again?

  • 1: Yes
  • 2: No

New Product Information (NPI) - Question identifier:NPI_Q18

(What is the name of this product? [For example, Accutane, Alesse 21 or Ventolin./For example, Children's Tylenol® Cold and Cough Nighttime.])

Long Answer Length = 80

New Product Information (NPI) - Question identifier:NPI_Q19

What company information is found on the product container?
[For example, Roche, Pfizer, GlaxoSmithKline./For example, Bayer, Jamieson or Sisu.]

Long Answer Length = 80

New Product Information (NPI) - Question identifier:NPI_Q20

(What is the form of this product? For example, is it a pill, powder, liquid or cream?)

  • 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
  • 50: Other - Specify
  • 98: RF
  • 99: DK

New Product Information (NPI) - Question identifier:NPI_Q21

(What is the strength of this product, for example, 250 mg, 1%, 1000 international units?)

Long Answer Length = 80

New Product Information (NPI) - Question identifier:NPI_Q22

(How is this product administered? For example, is it inhaled, swallowed, dissolved beneath the tongue or applied to the skin?)

  • 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 - Specify
  • 98: RF
  • 99: DK

New Product Information (NPI) - Question identifier:NPI_Q25

When was the last time that you ^DT_Take1E this product?
(The response categories are today, yesterday, within the last week or within the last month.)

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

New Product Information (NPI) - Question identifier:NPI_Q63

[For how long have you been [using/taking] [this or a similar product/this product]? (^DV_PRODUCT_NAME)/For how long did you [use/take] [this or a similar product/this product]? (^DV_PRODUCT_NAME)]

(If you stopped [using/taking] it at some point, only include the most recent period of use.)

Min = 1.0; Max = 500.0

New Product Information (NPI) - Question identifier:NPI_N64

Select the reporting period.

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

New Product Information (NPI) - Question identifier:NPI_Q65

In the past month, on how many days did you [use/take] this product (^DV_PRODUCT_NAME)?

Min = 1; Max = 31

New Product Information - Call Block (NPC)

New Product Information - Call Block (NPC) - Question identifier:NPC_Q10

On the days that you ^DT_TAKE1E this product, how many times did you usually ^DT_TAKE3E it in a single day?

Min = 1; Max = 100

New Product Information - Call Block (NPC) - Question identifier:NPC_Q11

How much did you usually ^DT_TAKE3E each time you ^DT_TAKE1E it? ^DT_NPC_TEXT1E

Min = 00000.01; Max = 99995.00

New Product Information - Call Block (NPC) - Question identifier:NPC_N12

Select the unit of measure.

  • 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
  • 50: Other - Specify
  • 98: RF
  • 99: DK

New Product Information - Call Block (NPC) - Question identifier:NPC_Q14

So you ^DT_TAKE1E ^NPC_Q11 [DT_UNITE] ^NPC_Q10 [time/times] that each day you ^DT_TAKE1E this product (^DV_PRODUCT_NAME). Is that correct?

  • 1: Yes
  • 2: No

Other Reason for Screening Out (ORS)

Other Reason for Screening Out (ORS) - Question identifier:ORS_Q0

Other than what you have already mentioned, are there any other reasons you should not participate in one or more of the physical tests?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Other Reason for Screening Out (ORS) - Question identifier:ORS_N1

Is there any other reason why the respondent should not perform the grip strength test?

  • 1: Yes
  • 2: No

Other Reason for Screening Out (ORS) - Question identifier:ORS_N3

Is there any other reason why the respondent should not perform the modified Canadian Aerobic FitnessTest (mCAFT)?

  • 1: Yes
  • 2: No

Other Reason for Screening Out (ORS) - Question identifier:ORS_N4

Is there any other reason why the respondent should not perform the sit and reach test?

  • 1: Yes
  • 2: No

Other Reason for Screening Out (ORS) - Question identifier:ORS_N9

Is there any other reason why the respondent should not perform the jumping mechanography tests?

  • 1: Yes
  • 2: No

Other Reason for Screening Out (ORS) - Question identifier:ORS_N10

Is there any other reason why the respondent should not perform the quantitative computed tomography test?

  • 1: Yes
  • 2: No

Other Reason for Screening Out (ORS) - Question identifier:ORS_N11

Is there any other reason why the respondent should not perform the vision tests?

  • 1: Yes
  • 2: No

Screening Component End (SCR)

Distance Viewing Confirmation (DVC)

Distance Viewing Confirmation (DVC) - Question identifier:DVC_R001

Now, some questions about eyeglasses and contacts.

Distance Viewing Confirmation (DVC) - Question identifier:DVC_Q010

Do you wear eyeglasses or contacts?

  • 1: Yes
  • 2: No

Distance Viewing Confirmation (DVC) - Question identifier:DVC_Q015

Do you use eyeglasses or contacts for distance viewing? For example, while watching television or [driving/seeing the board at school]?

  • 1: Yes
  • 2: No

Distance Viewing Confirmation (DVC) - Question identifier:DVC_N020

Is the respondent currently wearing glasses?

  • 1: Yes
  • 2: No

Distance Viewing Confirmation (DVC) - Question identifier:DVC_Q025

Are you wearing contacts?

  • 1: Yes
  • 2: No

Distance Viewing Confirmation (DVC) - Question identifier:DVC_Q030

In order to perform all of the vision tests today, you will need to remove your contacts.

  • 1: Yes
  • 2: No

Vision Clinic (VIC)

Vision Clinic (VIC) - Question identifier:VIC_N005

Is the respondent currently wearing glasses?

  • 1: Yes
  • 2: No

Vision Clinic (VIC) - Question identifier:VIC_Q010

Are your glasses for distance viewing?

  • 1: Yes
  • 2: No

Vision Clinic (VIC) - Question identifier:VIC_Q015

Are you wearing contacts?

  • 1: Yes
  • 2: No

Vision Clinic (VIC) - Question identifier:VIC_Q020

Are your contacts for distance viewing?

  • 1: Yes
  • 2: No

Vision Clinic (VIC) - Question identifier:VIC_Q025

Did you bring distance viewing glasses with you today?

  • 1: Yes
  • 2: No

Vision Clinic (VIC) - Question identifier:VIC_Q030

In order to perform all of the vision tests today, you will need to remove your contacts.

  • 1: Yes
  • 2: No

Vision Clinic (VIC) - Question identifier:VIC_Q035

Are the lenses of your distance viewing glasses tinted or do they change colour when exposed to light?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Vision Prescription Clinic (VPRC)

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_Q005

Has your eyeglass or contact prescription changed since the household interview?

  • 1: Yes
  • 2: No

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_Q010

Do you have your [new/current] eyeglass or contact prescription with you today?

  • 1: Yes
  • 2: No

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_Q015

Do you know the power or strength of your eyeglass or contact prescription?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_Q020

I will now record the values from the prescription; this will just take a few minutes. (Is this prescription for your eyeglasses or contacts?)

  • 1: Eyeglasses
  • 2: Contacts
  • 9: DK

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N025

Is the sphere value present for the right eye (for example, OD)?

  • 1: Yes
  • 2: No

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_Q030A

(What is the power or strength of the lens for the right eye?)

Min = -30.00; Max = 30.00

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N030B

Re-enter the sphere value for the right eye (for example, OD).

Min = -30.00; Max = 30.00

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N035

Is the cylinder value present for the right eye (for example, OD)?

  • 1: Yes
  • 2: No

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N040A

Record the cylinder value for the right eye (for example, OD).

Min = -10.00; Max = 10.00

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N040B

Re-enter the cylinder value for the right eye (for example, OD).

Min = -10.00; Max = 10.00

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N045

Is the axis value present for the right eye (for example, OD)?

  • 1: Yes
  • 2: No

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N050A

Record the axis value for the right eye (for example, OD).

Min = 0; Max = 180

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N050B

Re-enter the axis value for the right eye (for example, OD).

Min = 0; Max = 180

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N055

Is the sphere value present for the left eye (for example, OS or OG)?

  • 1: Yes
  • 2: No

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_Q060A

(What is the power or strength of the lens for the left eye?)

Min = -30.00; Max = 30.00

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N060B

Re-enter the sphere value for the left eye (for example, OS or OG).

Min = -30.00; Max = 30.00

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N065

Is the cylinder value present for the left eye (for example, OS or OG)?

  • 1: Yes
  • 2: No

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N070A

Record the cylinder value for the left eye (for example, OS or OG).

Min = -10.00; Max = 10.00

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N070B

Re-enter the cylinder value for the left eye (for example, OS or OG).

Min = -10.00; Max = 10.00

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N075

Is the axis value present for the left eye (for example, OS or OG)?

  • 1: Yes
  • 2: No

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N080A

Record the axis value for the left eye (for example, OS or OG).

Min = 0; Max = 180

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N080B

Re-enter the axis value for the left eye (for example, OS or OG).

Min = 0; Max = 180

Vision Prescription Clinic (VPRC) - Question identifier:VPRC_N110

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 06: No time
  • 20: Other - Specify

Vision Prescription Value (VPV)

Vision Questionnaire Component End (VQC)

Fish and Shellfish Consumption (FSF)

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_R10

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.

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

Have you eaten any of the following shellfish over the past month, that is, from ^DateLastMonthE to today?

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

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q10X

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_Q10Y

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_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 ^DateLastMonthE to today?

  • 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
  • 07: Shark
  • 08: Marlin
  • 09: Swordfish
  • 13: Mackerel
  • 14: Herring
  • 19: Any other fish
  • 20: No fish
  • 98: RF
  • 99: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_Q24X

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_Q24Y

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_Q25

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

  • 1: ...light (flaked or chunk) tuna?
  • 2: ...white (solid) tuna?
  • 3: ...both?
  • 8: RF
  • 9: DK

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_N70

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 06: No time
  • 20: Other - Specify

Detail Fish and Shellfish (DFS)

Detail Fish and Shellfish (DFS) - Question identifier:DFS_Q11

Over the past month, how many times did you eat:

... ^DT_QUESTIONE?

Min = 1; Max = 95

Detail Fish and Shellfish (DFS) - Question identifier:DFS_N11

Select the reporting period.

  • 1: Per month
  • 2: Per week
  • 3: Per day

Fish and Shellfish Consumption Component End (FSE)

Anthropometric Component Introduction (ACI)

Anthropometric Component Introduction (ACI) - Question identifier:ACI_R01

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?

Anthropometric Component Introduction (ACI) - Question identifier:ACI_R02

Next will be a series of body measurements.

Height and Weight Measurements (HWM)

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.

Height and Weight Measurements (HWM) - Question identifier:HWM_N11

Record how the data will be captured.

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

Height and Weight Measurements (HWM) - Question identifier:HWM_N11A

Ensure that the stadiometer is set to millimeters (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.

Min = 846.00; Max = 2070.90

Height and Weight Measurements (HWM) - Question identifier:HWM_N11B

Record the standing height in centimetres.

Min = 19.00; Max = 207.60

Height and Weight Measurements (HWM) - Question identifier:HWM_N11C

Re-enter the standing height in centimetres.

Min = 19.00; Max = 207.60

Height and Weight Measurements (HWM) - Question identifier:HWM_N11D

Re-enter the standing height in millimeters.

Min = 846.00; Max = 2070.90

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, step onto the centre of the scale and face me. Keep your hands at your sides and look straight ahead.

Height and Weight Measurements (HWM) - Question identifier:HWM_N13

Record how the data will be captured.

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

Height and Weight Measurements (HWM) - Question identifier:HWM_N13A

Ensure the scale is set to kilograms (kg).

Press <Print> on the scale.

Press <1> to save the measurement in Blaise.

  • 1: Save the measurement

Height and Weight Measurements (HWM) - Question identifier:HWM_N13AA

Check the data returned from the scale.

  • 1: Press <1> to continue.

Height and Weight Measurements (HWM) - Question identifier:HWM_N13B

When the measurement is stable, record the weight in kilograms.

Min = 0.5; Max = 500.0

Height and Weight Measurements (HWM) - Question identifier:HWM_N13C

Re-enter the weight in kilograms.

Min = 0.5; Max = 500.0

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 hanging loosely at your sides, 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.

Height and Weight Measurements (HWM) - Question identifier:HWM_N14A

Record the waist circumference in centimetres.

Min = 0.1; Max = 305.0

Height and Weight Measurements (HWM) - Question identifier:HWM_N14B

Re-enter the waist circumference in centimetres.

Min = 0.1; Max = 305.0

Height and Weight Measurements (HWM) - Question identifier:HWM_R16

Now, I'll measure your neck circumference. Please stand up straight, with your arms hanging loosely at your sides, and look straight ahead. I will need to touch your neck in order to find the appropriate spot to take the measurement.

Height and Weight Measurements (HWM) - Question identifier:HWM_N16A

Record the neck circumference in centimetres.

Min = 0.1; Max = 150.0

Height and Weight Measurements (HWM) - Question identifier:HWM_N16B

Re-enter the neck circumference in centimetres.

Min = 0.1; Max = 150.0

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. In case you are selected, I will now erase the marks I put on your skin to ensure that they do not influence a possible second set of measurements.

Height and Weight Measurements (HWM) - Question identifier:HWM_N60

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 03: Respondent refuses to continue
  • 06: No time
  • 20: Other - Specify

Anthropometric Component End (ANC)

Blood Pressure Measurement (BPM)

Blood Pressure Measurement (BPM) - Question identifier:BPM_N100

Measure the respondent's arm circumference and select the appropriate cuff size. Record the selected cuff size.

  • 1: Child (13-18 cm)
  • 2: Small adult (18-26 cm)
  • 3: Regular adult (26-34 cm)
  • 4: Large adult (32-43 cm)
  • 5: X-Large adult (41-52 cm)

Blood Pressure Measurement (BPM) - Question identifier:BPM_N101

Record how the first set of data will be captured.

  • 1: Electronically (BpTRU)
  • 3: BpTRU data entered manually
  • 9: DK

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q101A

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.

  • 1: Continue
  • 8: RF

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q102

[The cuff will fill with air and it will squeeze your arm a little. It will do this 6 times. During the test, you cannot talk. You need to sit really still and keep both feet flat on the floor. You should stay relaxed to ensure we get good results. Before we start, I will leave you alone to sit and relax for 5 minutes. I will then come back to start the machine. It is very important that we don't talk until the test is done/The cuff will inflate automatically once every minute, applying pressure to your arm. A total of 6 measures will be taken. I will stay in the room for the first measurement then I will leave the room. Although I will not be present during the test, should you require assistance, I will be just outside the room. You should not move or talk during the test, and you need to keep both feet flat on the floor. It is important that you stay relaxed to ensure we get good results. Before we begin, I will leave you alone to sit and relax for 5 minutes. I will then return to start the machine. I ask that you do not talk when I return to take the first measurement]. Do you have any questions before we begin?

  • 1: Continue

Blood Pressure Measurement (BPM) - Question identifier:BPM_N105

Press <1> to save the measurements in Blaise.

  • 1: Save the measurements

Blood Pressure Measurement (BPM) - Question identifier:BPM_N160

Check the blood pressure and heart rate data.
[Press <Clear> on the BPTru screen./EMPTY]

  • 1: Valid - accept the measurements
  • 2: Not valid - re-do the measurements

Blood Pressure Measurement (BPM) - Question identifier:BPM_N161

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_N201

Record how the second set of data will be captured.

  • 1: Electronically (BpTRU)
  • 3: BpTRU data entered manually

Blood Pressure Measurement (BPM) - Question identifier:BPM_Q201

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.

  • 1: Press <1> to continue.
  • 8: RF

Blood Pressure Measurement (BPM) - Question identifier:BPM_N205

Press <1> to save the measurements in Blaise.

  • 1: Save the measurements

Blood Pressure Measurement (BPM) - Question identifier:BPM_N260

Check the blood pressure and heart rate data.
[Press <Clear> on the BPTru screen./EMPTY]

  • 1: Valid - accept the measurements
  • 2: Not valid - reject the measurements

Blood Pressure Measurement (BPM) - Question identifier:BPM_N261

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_R411

[Your average blood pressure today was ^BPM_D317 / ^BPM_D318 mmHg, which means your blood pressure is indicative of severe hypertension. You should see a doctor or clinic today, or go to a hospital emergency room, to have your blood pressure re-checked.

Because of these results, we will not continue with your clinic visit./EMPTY]

Blood Pressure Measurement (BPM) - Question identifier:BPM_R412

[Your average blood pressure today was ^BPM_D317 / ^BPM_D318 mmHg, this means your blood pressure is very high. You should see a doctor or clinic today, or go to a hospital emergency room, to have your blood pressure re-checked.

Because of these results, we will not continue with your clinic visit./EMPTY]

Blood Pressure Measurement (BPM) - Question identifier:BPM_N600

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Blood Pressure Recording (BPR)

Blood Pressure Recording (BPR) - Question identifier:BPR_N1A

Record the systolic blood pressure measurement.

Min = 30; Max = 300

Blood Pressure Recording (BPR) - Question identifier:BPR_N1B

Re-enter the systolic blood pressure measurement.

Min = 30; Max = 300

Blood Pressure Recording (BPR) - Question identifier:BPR_N2A

Record the diastolic blood pressure measurement.

Min = 30; Max = 200

Blood Pressure Recording (BPR) - Question identifier:BPR_N2B

Re-enter the diastolic blood pressure measurement.

Min = 30; Max = 200

Blood Pressure Recording (BPR) - Question identifier:BPR_N3A

Record the heart rate.

Min = 30; Max = 200

Blood Pressure Recording (BPR) - Question identifier:BPR_N3B

Re-enter the heart rate.

Min = 30; Max = 200

Blood Pressure Recording (BPR) - Question identifier:BPR_N4

Record the reason why the measurement could not be taken.

  • 00: Too few pulses detected
  • 01: Excessive motion artifacts
  • 06: Deflation too fast
  • 08: Low pulse amplitude
  • 20: Indeterminate systolic blood pressure
  • 21: Indeterminate diastolic blood pressure
  • 23: Systolic blood pressure under-range
  • 24: Diastolic blood pressure under-range
  • 25: Systolic blood pressure over-range
  • 26: Diastolic blood pressure over-range
  • 88: Other - Specify

Blood Pressure Measurement Component End (BPC)

Phlebotomy Component Introduction (PHI)

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_R10

Hi, my name is.... Please have a seat on the chair, I need to ask you a few questions before we begin.

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_Q11

I need to confirm your fasting status. When did you last eat or drink anything other than water (e.g., coffee, tea, alcohol, juice or flavoured water)?

The respondent reported last eating or drinking at ^ATG_Q11 ^DT_ATGN11E.

  • 1: Yes
  • 2: No

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_N11

Enter the time (followed by "AM" or "PM") at which the respondent last ate or drank something that does not meet the phlebotomy fasting requirements.

Min = 1.00; Max = 12.59

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_N12A

Confirm the date.

  • 1: Yesterday
  • 2: Today

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_N12B

Enter the time (followed by "AM" or "PM") the fasting question (PHI_Q11 or PHI_N11 ) was asked to the respondent.

Min = 1.00; Max = 12.59

Blood Collection (BDC)

Blood Collection (BDC) - Question identifier:BDC_N10

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.

Press <1> to continue.

  • 1: Continue

Blood Collection (BDC) - Question identifier:BDC_Q21

I am going to do the blood draw.

  • 1: Continue
  • 8: RF

Blood Collection (BDC) - Question identifier:BDC_N24

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

  • 39: None of the required tubes
  • 98: RF

Blood Collection (BDC) - Question identifier:BDC_N35

Press <1> to print the blood collection tube labels.

  • 1: Print the labels

Blood Collection (BDC) - Question identifier:BDC_N42

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

Press <1> to continue.

  • 1: Continue

Blood Collection (BDC) - Question identifier:BDC_N44

Record the reason why all required tubes were not collected.

  • 01: Respondent refused
  • 02: Respondent fainted
  • 03: Unable to find vein
  • 04: Blood flow stopped
  • 05: Physical limitation
  • 06: Other - Specify
  • 07: No time
  • 08: Respondent unable to continue for health reasons

Blood Collection (BDC) - Question identifier:BDC_N51

Record whether another staff member assisted with the blood draw.

  • 1: Yes
  • 2: No

Blood Collection (BDC) - Question identifier:BDC_N52

Record the HMSID of the staff member that assisted with the blood draw.

Min = 1000; Max = 9995

Phlebotomy Component End (PHB)

Saliva Collection Block (SC1)

Saliva Collection Block (SC1) - Question identifier:SC1_Q005

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

  • 1: Continue
  • 8: RF
  • 9: DK

Saliva Collection Block (SC1) - Question identifier:SC1_R015

I will show you the various parts of the saliva collection kit.
- Funnel lid containing a liquid
- Funnel
- Tube marked with a fill line

Saliva Collection Block (SC1) - Question identifier:SC1_Q020

Please use [this tube/these tubes] to collect your saliva sample.
- Do not remove the plastic film from the funnel lid.
- [Have ^RespondentName roll/Roll] your tongue to increase the amount of saliva in your mouth.
- You can also massage your cheeks to increase saliva production.
- [Have ^RespondentName spit/Spit] into the funnel until the amount of saliva (not the bubbles) reaches the fill line indicated on the tube. [Make sure the funnel lid is not closed inadvertently by ^RespondentFirstName when he/she is spitting in the funnel/Make sure the funnel lid is not closed inadvertently when you are spitting in the funnel].
- Once you are finished, hold the tube upright and place it in the rack.

  • 1: Continue
  • 8: RF
  • 9: DK

Saliva Collection Block (SC1) - Question identifier:SC1_N025

Press <1> to print [one saliva collection tube label/two saliva collection tube labels] with the respondent's CLINICID plus the TESTID.

In the presence of the respondent, stick the [label/labels] on the collection [tube/tubes].

  • 1: Print

Saliva Collection Block (SC1) - Question identifier:SC1_N035

Scan the barcode on the saliva collection tube.

Min = 50000000900; Max = 59999999999

Saliva Collection Block (SC1) - Question identifier:SC1_N040

Record whether the respondent provided a saliva sample.

  • 1: Yes
  • 2: No

Saliva Collection Block (SC1) - Question identifier:SC1_N045

The required saliva volume is indicated by the fill line marked on the collection tube.

Did the respondent provide a saliva sample of sufficient volume?

  • 1: Full
  • 2: Partial
  • 3: Insufficient

Saliva Collection Block (SC1) - Question identifier:SC1_N050

Scan the barcode on the second saliva collection tube.

Min = 50000000900; Max = 59999999999

Saliva Collection Block (SC1) - Question identifier:SC1_N055

Record whether the respondent provided a saliva sample.

  • 1: Yes
  • 2: No

Saliva Collection Block (SC1) - Question identifier:SC1_N060

The required saliva volume is indicated by the fill line marked on the collection tube.

Did the respondent provide a saliva sample of sufficient volume?

  • 1: Full
  • 2: Partial
  • 3: Insufficient

Saliva Collection Block (SC1) - Question identifier:SC1_N065

- Close the funnel lid(s) by firmly pushing the lid(s) until you hear a click. The DNA stabilizing liquid will flow into the collection tube.
- Unscrew the funnel from the tube(s) and close the tube(s) tightly with the small cap.
- Shake the capped tube(s) for 5 seconds.

Press <1> to continue.

  • 1: Continue

Saliva Collection Block (SC1) - Question identifier:SC1_R085

We did not obtain [""/enough] saliva. We will try to collect [""/additional] saliva before the end of the clinic visit.

Saliva Collection Block (SC1) - Question identifier:SC1_N090

Please scan the respondent's bracelet.

Min = 50000000; Max = 59999999

Saliva Collection Block (SC1) - Question identifier:SC1_N095

Scan the barcode on the 920 saliva collection tube.

Min = 50000000900; Max = 59999999999

Saliva Collection Block (SC1) - Question identifier:SC1_N100

Scan the barcode on the 921 saliva collection tube.

Min = 50000000900; Max = 59999999999

Saliva Collection Block (SC1) - Question identifier:SC1_N105

[Please add more saliva to this tube./Please provide a saliva sample in this tube./Please provide a saliva sample in the empty tube and please add some extra saliva to the partially filled tube./Please add more saliva to these tubes./Please provide a saliva sample in these tubes.]

Answer any questions as thoroughly as possible.

Press <1> to continue.

  • 1: Continue
  • 8: RF
  • 9: DK

Saliva Collection Block (SC1) - Question identifier:SC1_N110

Scan the barcode on the 920 saliva collection tube.

Min = 50000000900; Max = 59999999999

Saliva Collection Block (SC1) - Question identifier:SC1_N115

Record whether the respondent provided a saliva sample.

  • 1: Yes
  • 2: No

Saliva Collection Block (SC1) - Question identifier:SC1_N120

The required saliva volume is indicated by the fill line marked on the collection tube.

Did the respondent provide a saliva sample of sufficient volume?

  • 1: Full
  • 2: Partial
  • 3: Insufficient

Saliva Collection Block (SC1) - Question identifier:SC1_N125

Scan the barcode on the 921 saliva collection tube.

Min = 50000000900; Max = 59999999999

Saliva Collection Block (SC1) - Question identifier:SC1_N130

Record whether the respondent provided a saliva sample.

  • 1: Yes
  • 2: No

Saliva Collection Block (SC1) - Question identifier:SC1_N135

The required saliva volume is indicated by the fill line marked on the collection tube.

Did the respondent provide a saliva sample of sufficient volume?

  • 1: Full
  • 2: Partial
  • 3: Insufficient

Saliva Collection Block (SC1) - Question identifier:SC1_N140

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Saliva Collection 1 Component End (SCE)

Peripheral Quantitative Computed Tomography Measurement Block (QCT)

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_Q010

We will be doing a test of your [right/left] lower leg to measure your bone mineral density.

  • 1: Press <1> to continue.
  • 9: DK

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_Q015

There are two parts to the test which will take 8 to 10 minutes altogether. There will be a small amount of radiation, but it will be less than you would get if you were having a dental x-ray. Do you have any questions before we begin?

  • 1: Press <1> to continue.
  • 8: RF

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_R020

Please remove your sock and shoe from your [right/left] leg (and roll up your pant leg to above the knee).

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_R025

I need to know the length of your lower leg to complete the test. In order to take the measurement, I will mark a point on your knee and ankle using a washable marker. When I'm done, I'll remove them with a wipe.

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_R030

I need to enter some information into the computer to prepare for the test. This will only take a few minutes.

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N035

Enter the CT number for the respondent's scan series.

Min = 20000; Max = 63000

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_R040

Without holding on to the equipment, I need you to lift your [right/left] leg up and put it through the holder so we can position your leg. Rest your heel in the footrest and make sure you are comfortable.

I am going to adjust the holder so your knee is in the right position and fit the strap around your foot to help you to hold it still.

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N045

Were you able to position the respondent?

  • 1: Yes
  • 2: No

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_Q050

We are ready to start the first part of the test. Please hold completely still and do not talk for about 2-3 minutes. I will let you know when we are finished.

  • 1: Yes
  • 2: No
  • 9: DK

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_Q060

The first part of the test was not successful. We'll have to try it again. Please hold completely still and do not talk for about 2-3 minutes. I will let you know when we are finished.

  • 1: Yes
  • 2: No

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N065

Set the reference line.

  • 1: Press <1> to continue.

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_R070

The first part is finished, but I still need you to keep your leg still and in that position. The next part will be longer, about 6-8 minutes. You need to stay still and not talk until I tell you the test is done.

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N075A

Enter the respondent dose.

Min = 0.00; Max = 10.00

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N075B

Re-enter the respondent dose.

Min = 0.00; Max = 10.00

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N080A

Enter the number of measurement slices completed.

Min = 0; Max = 3

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N080B

Re-enter the number of measurement slices completed.

Min = 0; Max = 3

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N085

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 07: Unable to position respondent in scanner
  • 08: Respondent unable to hold still
  • 20: Other - Specify

Peripheral Quantitative Computed Tomography Measurement Block (QCT) - Question identifier:QCT_N090

Did the respondent refuse the test because of the radiation exposure?

  • 1: Yes
  • 2: No
  • 9: DK

PQCT Component End (QCC)

Visual Acuity Scenario's (VAS)

Visual Acuity Measurement (VAM)

Visual Acuity Measurement (VAM) - Question identifier:VAM_Q005

Now, we will be doing a test to evaluate your ability to see from a certain distance.

  • 1: Press <1> to continue.
  • 9: DK

Visual Acuity Measurement (VAM) - Question identifier:VAM_Q015

In order to perform the following vision test, you will need to wear your distance viewing glasses or contacts. Are you wearing your distance viewing glasses or contacts?

  • 1: Yes
  • 2: No

Visual Acuity Measurement (VAM) - Question identifier:VAM_Q020

I would like you to sit up straight, facing forward with your hands on your lap. For this test, you will be reading the letters that appear on the screen in front of you.

  • 1: Press <1> to continue.
  • 8: RF

Visual Acuity Measurement (VAM) - Question identifier:VAM_N060

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Visual Acuity Recording (VAR)

Visual Acuity Recording (VAR) - Question identifier:VAR_Q005

^DT_INTRO_TEXTEE You will read the first line, slowly, from left to right and then stop. I will let you know when to start reading the next line.

Do not squint when reading the letters.

(Do you have any questions?)

  • 1: Press <1> to continue.
  • 9: DK

Visual Acuity Recording (VAR) - Question identifier:VAR_N010A

Record the level at which the respondent failed to identify all the letters correctly.

Min = 10; Max = 200

Visual Acuity Recording (VAR) - Question identifier:VAR_N010B

Re-enter the level at which the respondent failed to identify all the letters correctly.

Min = 10; Max = 200

Visual Acuity Recording (VAR) - Question identifier:VAR_N015A

How many letters did the respondent correctly identify on level ^VAR_N010A?

Min = 0; Max = 5

Visual Acuity Recording (VAR) - Question identifier:VAR_N015B

Re-enter the number of letters that the respondent correctly identified on the level ^VAR_N010A.

Min = 0; Max = 5

Visual Acuity Component End (VAC)

Visual Field (Frequency Doubling Test) Introduction (FDTI)

Visual Field (Frequency Doubling Test) Introduction (FDTI) - Question identifier:FDTI_R005

Now, we will conduct a visual field test which will examine your scope of vision.

Visual Field (Frequency Doubling Test) Introduction (FDTI) - Question identifier:FDTI_R020

First, I will need to enter some information into our computer system to prepare the test. This will only take a few minutes.

Visual Field (Frequency Doubling Test) Introduction (FDTI) - Question identifier:FDTI_N025

Is the respondent wearing glasses?

  • 1: Yes
  • 2: No

Visual Field (Frequency Doubling Test) Introduction (FDTI) - Question identifier:FDTI_Q035

In order to complete the test, you will need to remove your eyeglasses, because they are tinted or they change colour when they are exposed to light.

  • 1: Yes
  • 2: No
  • 8: RF

Visual Field (Frequency Doubling Test) Introduction (FDTI) - Question identifier:FDTI_Q045

I will be taking the measurement on your ^DT_ FDTI045E. Please hold this response bar with one hand and put your thumb on the button. You will need to click this button whenever you perceive a white flicker, as small or as dim as it may seem. Press the button only once and release it quickly.

Do you have any questions before we begin the test?

  • 1: Press <1> to continue.
  • 8: RF

Visual Field (Frequency Doubling Test) Introduction (FDTI) - Question identifier:FDTI_R065

Please place your head on the forehead pad and your chin on the ^ DT_CHINRESTCOLORE chin rest.

- Sit as still as you can with your feet flat on the floor.
- Adjust your head position until you are able to see all four triangles and the black square in the center of the screen.
- Breathe normally.

I am now going to adjust your position so that I can take a precise measurement.

Visual Field (Frequency Doubling Test) Measurement (FDTM)

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R010

We will begin with a practice test.
- Ensure that you can see all four triangles at the edge of the circle.
- Focus on the black square.
- Press the button when you think you see any sort of white flash.
- You should blink normally during the test.

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R015

Now that you have practiced, we will start the test. You will see a brief flash just before the test begins. Remember to stay focused on the black square.

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N025

Were there two errors or more in the first attempt for the right eye?

  • 1: Yes
  • 2: No

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R035

I will now take the measurement on your left eye. Ensure that you can see all four triangles at the edge of the circle, focus on the black square and stay still.

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N045

Were there two errors or more in the first attempt for the left eye?

  • 1: Yes
  • 2: No

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R070

There were some errors with that set of measurements, so we have to do the test again. I will take a second measurement of [your right eye/your left eye/both your eyes, one at a time].

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R080

(I will now take the measurement of your right eye). Ensure that you can see all four triangles at the edge of the circle, focus on the black square and hold still.

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N090

Were there two errors or more in the second attempt for the right eye?

  • 1: Yes
  • 2: No

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R100

(I will now take the measurement of your left eye). Ensure that you can see all four triangles at the edge of the circle, focus on the black square and hold still.

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N110

Were there two errors or more in the second attempt for the left eye?

  • 1: Yes
  • 2: No

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R130

There were too many errors with that set of measurements, so we have to do the test again. I will take a last measurement of [your right eye/your left eye/both your eyes, one at a time].

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R140

(I will now take the last measurement of your right eye). Ensure that you can see all four triangles at the edge of the circle, focus on the black square and hold still.

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N150

Were there two errors or more in the third attempt for the right eye?

  • 1: Yes
  • 2: No

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_R160

(I will now take the last measurement of your left eye). Ensure that you can see all four triangles at the edge of the circle, focus on the black square and hold still.

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N170

Were there two errors or more in the third attempt for the left eye?

  • 1: Yes
  • 2: No

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N180

Record how many tests were saved for the right eye.

Min = 0; Max = 3

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N190

Record how many tests were saved for the left eye.

Min = 0; Max = 3

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N200

Ensure the test results have been saved in the FDTM software and the respondent's .xml file has been transferred from the software to the clinic server on the F:// drive.

Press <1> to continue.

Visual Field (Frequency Doubling Test) Measurement (FDTM) - Question identifier:FDTM_N210

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Visual Field End (FDTC)

Retinal Photography Measurement (RTP)

Retinal Photography Measurement (RTP) - Question identifier:RTP_R005

For this next test, I will take a picture of the interior surface of your [eyes/right eye/left eye].

Retinal Photography Measurement (RTP) - Question identifier:RTP_R015

First, I need to enter some information into our computer system in order to prepare the test. This will only take a few minutes.

Retinal Photography Measurement (RTP) - Question identifier:RTP_Q025

(In order to take a clear picture, you will need to remove your [contacts/glasses]. You will be able to put your [contacts/glasses] back on once we have completed this measurement.)

  • 1: Yes
  • 2: No
  • 3: The [contacts/glasses] were already removed

Retinal Photography Measurement (RTP) - Question identifier:RTP_Q030

During this test, you need to sit up straight, with your feet flat on the floor. I may need to adjust you so that we can take a proper measurement.

1. Please place your head and chin on the rests and remain as still as you can.
2. Focus on the green dot inside the camera.
3. You should expect a flash of bright light and the photo will be taken automatically.

I will take four to six photographs of your [eyes/right eye/left eye].

Do you have any questions before we begin?

  • 1: Press <1> to continue.
  • 8: RF

Retinal Photography Measurement (RTP) - Question identifier:RTP_N045

Ensure the test results have been saved in the Navis-Ex software and the respondent's files transferred from the software to the clinic server R: drive.

  • 1: Press <1> to continue.

Retinal Photography Measurement (RTP) - Question identifier:RTP_N050

Record the number of images saved for the right eye.

Min = 0; Max = 6

Retinal Photography Measurement (RTP) - Question identifier:RTP_N055

Record the number of images saved for the left eye.

Min = 0; Max = 6

Retinal Photography Measurement (RTP) - Question identifier:RTP_N060

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Retinal Photography - Derived Variables (RPD)

Retinal Photography Component End (RTPC)

Intraocular Pressure Introduction (IOPI)

Intraocular Pressure Introduction (IOPI) - Question identifier:IOPI_N010

The respondent removed their contacts at [DVC_D030 (in HH:MM:SS format)/VIC_D030 (in HH:MM:SS format)].

  • 1: Continue
  • 2: Skip IOP measurement

Intraocular Pressure Introduction (IOPI) - Question identifier:IOPI_R020

This next test measures the fluid pressure inside the eye.

Intraocular Pressure Introduction (IOPI) - Question identifier:IOPI_R035

During this test, there will be three puffs of air administered from this machine to your [left eye/right eye/eyes, one at a time]. I will now do a practice puff of air so you can feel how gentle it is. Please sit up straight, lean against the forehead rest and close both of your eyes.

Intraocular Pressure Introduction (IOPI) - Question identifier:IOPI_Q040

During the test, you will need to:

- sit as still as possible.
- adjust your head position until you are able to see the green dot in the middle of the four red dots.
- focus on the green target without squinting your eye.
- breathe normally.

Do you have any questions before we begin the test?

  • 1: Press <1> to continue.
  • 8: RF

Intraocular Pressure Measurement (IOPM)

Intraocular Pressure Measurement (IOPM) - Question identifier:IOPM_R010

I will now take the measurement of your right eye. I'd like you to blink your eyes a few times and when you are ready, hold both your eyes open. Look at the green light and hold still.

Intraocular Pressure Measurement (IOPM) - Question identifier:IOPM_R030

[I will now take the measurement on your left eye. I'd like you to blink your eyes a few times and when you are ready, hold both your eyes open. Look at the green light and hold still./I will now move the forehead rest to the other side and take the same measurement on your left eye. Once again, readjust until you are able to see the green dot in the middle of the four red dots.]

Intraocular Pressure Measurement (IOPM) - Question identifier:IOPM_Q055

There were too many errors with that set of measurements, so we have to do the test again. I will take a second measurement of [your right eye/your left eye/both your eyes, one at a time].

  • 1: Press <1> to continue.
  • 8: RF

Intraocular Pressure Measurement (IOPM) - Question identifier:IOPM_R065

(I will now take the measurement of your right eye). I'd like you to blink your eyes a few times and when you are ready, hold both your eyes open. Look at the green light and hold still.

Intraocular Pressure Measurement (IOPM) - Question identifier:IOPM_R085

^DT_IOPM85E

Intraocular Pressure Measurement (IOPM) - Question identifier:IOPM_N110

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Intraocular Pressure Capture (IOPD)

Intraocular Pressure Capture (IOPD) - Question identifier:IOPD_N005A

Record the IOPcc for the ^DT_EYEE eye.

Min = 7.0; Max = 60.0

Intraocular Pressure Capture (IOPD) - Question identifier:IOPD_N005B

Re-enter the IOPcc for the ^DT_EYEE eye.

Min = 7.0; Max = 60.0

Intraocular Pressure Capture (IOPD) - Question identifier:IOPD_N010A

Record the IOPg for the ^DT_EYEE eye.

Min = 7.0; Max = 60.0

Intraocular Pressure Capture (IOPD) - Question identifier:IOPD_N010B

Re-enter the IOPg for the ^DT_EYEE eye.

Min = 7.0; Max = 60.0

Intraocular Pressure Capture (IOPD) - Question identifier:IOPD_N015A

Record the score for the ^DT_EYEE eye.

Min = 0.0; Max = 10.0

Intraocular Pressure Capture (IOPD) - Question identifier:IOPD_N015B

Re-enter the score for the ^DT_EYEE eye.

Min = 0.0; Max = 10.0

Intraocular Pressure Capture (IOPD) - Question identifier:IOPD_N020

Record whether a low confidence asterisk (*) was displayed next to the measurements of the ^DT_EYEE eye.

  • 1: Yes
  • 2: No

Intraocular Pressure Capture (IOPD) - Question identifier:IOPD_N025

Record the number of puffs successfully administered to the ^DT_EYEE eye.

  • 1: 1 puff
  • 2: 2 puffs
  • 3: 3 puffs

Intraocular Pressure End (IOPC)

Hair Sample Measure (HSM)

Hair Sample Measure (HSM) - Question identifier:HSM_R005

Metals such as mercury and lead are found in the environment. They may accumulate in hair as it grows, making it possible to measure long term exposure.

In order to measure your exposure to certain metals, I need to take a small hair sample from the back of your head, close to the scalp.

Hair Sample Measure (HSM) - Question identifier:HSM_N005

Press <1> to print 2 labels with the respondent's CLINIC ID.

First label: Stick it to the hair collection sheet.
Second label: Stick it to the plastic bag provided for hair collection.

  • 1: Print the labels

Hair Sample Measure (HSM) - Question identifier:HSM_R010

To ensure that your hair is long and thick enough for me to take a sample, I would like to examine the hair at the back of your head. This will require that I touch your head.

Hair Sample Measure (HSM) - Question identifier:HSM_N015

Does the respondent have enough hair for you to take a hair sample?

  • 1: Yes
  • 2: No

Hair Sample Measure (HSM) - Question identifier:HSM_R020

I will now take a sample of your hair. Please sit still and try not to move.

Hair Sample Measure (HSM) - Question identifier:HSM_N020

Was a hair sample successfully collected?

  • 1: Yes
  • 2: No

Hair Sample Measure (HSM) - Question identifier:HSM_Q025

In the past 12 weeks, (that is, from ^DV_Date12WeeksAgoE to today) have you cosmetically treated your hair in any of the following ways?

  • 1: Coloured
  • 2: Bleached or lightened
  • 3: Permanently waved or curled
  • 4: Permanently straightened or relaxed
  • 5: None of the above

Hair Sample Measure (HSM) - Question identifier:HSM_N030

Record the reason why a hair sample was not successfully collected.

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique/Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem/technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 09: Insufficient amount of hair
  • 20: Other - Specify

Hair Sample Measure (HSM) - Question identifier:HSM_N035

Record the reason why the respondent is not willing to provide a hair sample.

  • 1: Invasive
  • 2: Aesthetics (appearance)
  • 3: Cultural/Religious objections (e.g., turban, hijab)
  • 4: Other - Specify

Hair Sample Component End (HSC)

Jumping Mechanography Introduction (JMI)

Jumping Mechanography Introduction (JMI) - Question identifier:JMI_R001

We will now do two tests to measure your lower body strength. There will be a hopping and a jumping test.

Hopping Force Measurement (HFM)

Hopping Force Measurement (HFM) - Question identifier:HFM_R005

First, I need to enter some information into the computer system in order to prepare the tests. This will only take a few minutes.

Hopping Force Measurement (HFM) - Question identifier:HFM_N010

Initiate the hopping test.
- Select "multiple Two Leg Hopping" (m2LH) from the drop down menu.
- Click on "Start selected test".
- "Zero adjust" the plate.

  • 1: Press <1> to continue.

Hopping Force Measurement (HFM) - Question identifier:HFM_R015

The first test measures the force you generate when hopping. I will demonstrate the test and then give you an opportunity to practice before we begin.

- Stand on the force plate, facing the front, with one foot on each side.
- You will have to hold perfectly still for a few seconds.
- When I tell you to, start hopping as high as you can, just like skipping with a rope.
- As you hop, you must ensure that your heels stay off the force plate and your legs stay straight.
- You will hop 10 times; I will tell you when to stop.
- When you stop, hold perfectly still until I say you can move.

Hopping Force Measurement (HFM) - Question identifier:HFM_Q020

To make sure we get good results, you need to practice before we begin the test.

  • 1: Yes
  • 2: No
  • 8: RF

Hopping Force Measurement (HFM) - Question identifier:HFM_R025

We will now start the hopping test. We will repeat the test a few times to ensure that we get your best effort. Do you have any questions before we begin?

Hopping Force Measurement (HFM) - Question identifier:HFM_N030

Record the number of hopping trials.

Min = 0; Max = 5

Hopping Force Measurement (HFM) - Question identifier:HFM_N035

Why was the hopping force measurement not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Jumping Force Measurement (JFM)

Jumping Force Measurement (JFM) - Question identifier:JFM_N005

Initiate the jumping test.
- Select "single Two Leg Jump" (s2LJ) from the drop down menu.
- Click on "Start selected test".
- "Zero adjust" the plate.

Press <1> to continue.

Jumping Force Measurement (JFM) - Question identifier:JFM_R010

The second test measures the force you generate when jumping. I will demonstrate the test and then give you an opportunity to practice before we begin.

- Stand on the force plate, facing the front, with one foot on each side.
- You will have to hold perfectly still for a few seconds.
- When I tell you to start, bend down and jump as high as you can.
- When you land, hold perfectly still until I say you can move.

Jumping Force Measurement (JFM) - Question identifier:JFM_Q015

To make sure we get good results, you need to practice before we begin the test.

  • 1: Yes
  • 2: No
  • 8: RF

Jumping Force Measurement (JFM) - Question identifier:JFM_R020

We will now start the jumping test. We will repeat the test a few times to ensure that we get your best effort. Do you have any questions before we begin?

Jumping Force Measurement (JFM) - Question identifier:JFM_N025

Record the number of jumping trials.

Min = 0; Max = 5

Jumping Force Measurement (JFM) - Question identifier:JFM_N030

Why was the jumping force measurement not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Jumping Force Measurement (JFM) - Question identifier:JFM_N035

Using the MechanographyDataExport shortcut on the desktop, export all of the hopping and jumping trials to the clinic server.

Press <1> to continue.

Jumping Mechanography Component End (JMC)

MCAFT Measurement (AFT)

MCAFT Measurement (AFT) - Question identifier:AFT_R10

The next test we are going to do is a stepping test to measure your fitness level. The test will require you to step up and down this set of stairs continuously to music for 3 minutes at a time. In total, there are 8, 3-minute stages. You are starting at stage ^AFT_D01. During the test, you will wear a heart rate monitor so that I can watch your heart rate. At the end of each 3 minute stepping stage, you will be asked to stop exercising. You will have to stand still and I will check your heart rate to see if you should do another stage. You will continue going through the stages until your heart rate meets a ceiling value for your age and sex. Your ceiling heart rate is ^AFT_D02. If your heart rate is at or above this number, then I will stop the test. At the end of the test, you will slowly walk around for one and a half minutes. Then, you will sit down and I will take your blood pressure and heart rate twice to make sure that you are recovering well from the test.

MCAFT Measurement (AFT) - Question identifier:AFT_R11

During the test, you need to go up and down the stairs following the beat of the music. The stepping pattern goes like this: "step, step, up, step, step, down". When you are stepping, you should never have both feet on the first step at the same time, and you need to make sure that both feet are placed fully on the top step. ^DT_AFT11TEXTE I will play the music and show you how the test is done. Do you have any questions?

MCAFT Measurement (AFT) - Question identifier:AFT_N11A

Record the heart rate at the end of stage 1.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N11B

Re-enter the heart rate at the end of stage 1.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N12A

Record the heart rate at the end of stage 2.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N12B

Re-enter the heart rate at the end of stage 2.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N13A

Record the heart rate at the end of stage 3.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N13B

Re-enter the heart rate at the end of stage 3.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N14A

Record the heart rate at the end of stage 4.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N14B

Re-enter the heart rate at the end of stage 4.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N15A

Record the heart rate at the end of stage 5.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N15B

Re-enter the heart rate at the end of stage 5.

Min = 30; Max = 200

MCAFT Measurement (AFT) - Question identifier:AFT_N16A

Record the heart rate at the end of stage 6.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N16B

Re-enter the heart rate at the end of stage 6.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N17A

Record the heart rate at the end of stage 7.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N17B

Re-enter the heart rate at the end of stage 7.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N18A

Record the heart rate at the end of stage 8.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_N18B

Re-enter the heart rate at the end of stage 8.

Min = 30; Max = 220

MCAFT Measurement (AFT) - Question identifier:AFT_R23

The test is finished. I would like you to slowly walk around for one and a half minutes. I will then have you sit down so that I can take your blood pressure and heart rate again.

MCAFT Measurement (AFT) - Question identifier:AFT_N24

Record how the data will be captured.

  • 1: Electronically (BpTRU)
  • 3: BpTRU data entered manually

MCAFT Measurement (AFT) - Question identifier:AFT_R30

Now, I will take the first of two post exercise blood pressure and heart rate measurements, using this automated blood pressure cuff. During this test, you will need to sit with your feet flat on the floor, your back against the back rest of the chair, and your ^DT_ARME arm on the table. You should not move or talk during the measurement.

MCAFT Measurement (AFT) - Question identifier:AFT_N31A

Press <1> to save the measurements in Blaise.

  • 1: Save the measurements

MCAFT Measurement (AFT) - Question identifier:AFT_N31B

Check the data returned from the BpTRU.

Press <1> to continue.

MCAFT Measurement (AFT) - Question identifier:AFT_N40A

Press <1> to reset the Health Listener registry and continue.

Press <1> to continue.

MCAFT Measurement (AFT) - Question identifier:AFT_R40

I will now take a second blood pressure and heart rate measurement.

MCAFT Measurement (AFT) - Question identifier:AFT_N40B

Press <1> to save the measurements in Blaise.

  • 1: Save the measurements

MCAFT Measurement (AFT) - Question identifier:AFT_N40C

Check the data returned from the BpTRU.

Press <1> to continue.

MCAFT Measurement (AFT) - Question identifier:AFT_N81

Record the reason why the respondent did not complete the test.

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand or maintain technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

MCAFT Measurement Component End (AFC)

Sit and Reach Component Introduction (SRI)

Sit and Reach Component Introduction (SRI) - Question identifier:SRI_R01

The next test we're going to do is called a sit-and-reach test, which will measure your back and hamstring flexibility. Before we start the test, I'll ask you to remove your shoes and we will do some stretches to loosen your leg muscles.

- Sit on the floor with one leg out straight and the bottom of your other foot tucked into the straight leg.
- Reach forward towards the toe of your straight leg only until you feel a slight stretch in the back of your leg.
- You should not feel pain and you must not bounce.
- Hold the stretch for 20 seconds and then switch to the other leg.
- Perform the stretch twice on each leg, alternating each time.

Sit and Reach Component Introduction (SRI) - Question identifier:SRI_R02

I will demonstrate how the test is done.

- Sit with your legs straight out in front of you, your feet flat against the board, one foot on each side of the wooden block. Keep your legs straight.
- Put your arms straight out in front of you with your hands on top of one another, and your middle fingers aligned.
- Reach forward slowly pushing the sliding marker along the scale with your fingertips as far as possible. Do not bounce.
- Lower your head between your arms and breathe out while reaching forwards to help you reach farther.
- When you have reached as far as you can, you must hold that position for 2 seconds. I will count this aloud for you and tell you when to sit up again.

Sit and Reach Component Introduction (SRI) - Question identifier:SRI_R03

Do you have any questions before we begin?

Sit and Reach Measurement (SRM)

Sit and Reach Measurement (SRM) - Question identifier:SRM_N01A

Record the first sit and reach attempt in centimeters.

Min = 0.0; Max = 75.0

Sit and Reach Measurement (SRM) - Question identifier:SRM_N01B

Re-enter the first sit and reach attempt in centimeters.

Min = 0.0; Max = 75.0

Sit and Reach Measurement (SRM) - Question identifier:SRM_N02A

Record the second sit and reach attempt in centimeters.

Min = 0.0; Max = 75.0

Sit and Reach Measurement (SRM) - Question identifier:SRM_N02B

Re-enter the second sit and reach attempt in centimeters.

Min = 0.0; Max = 75.0

Sit and Reach Measurement (SRM) - Question identifier:SRM_N03

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Sit and Reach Component End (SRC)

Grip Strength Component Introduction (GSI)

Grip Strength Component Introduction (GSI) - Question identifier:GSI_R1

Next I am going to measure your upper body strength with a hand grip dynamometer. You will perform this test twice on each hand, alternating each time. When performing the test, hold your hand away from your body and squeeze the handle as hard as you can, blowing out while you squeeze.

Grip Strength Component Introduction (GSI) - Question identifier:GSI_R2

Hold the handle so that the 2nd joint of your fingers fits comfortably under the handle; we can adjust the size if necessary. Remember, hold your arm straight and away from your body and squeeze the handle as hard as you can, blowing out while you squeeze.

Grip Strength Measurement (GSM)

Grip Strength Measurement (GSM) - Question identifier:GSM_N11A

Record the first grip strength measurement for the right hand to the nearest kilogram (kg).

Min = 1; Max = 100

Grip Strength Measurement (GSM) - Question identifier:GSM_N11B

Re-enter the first grip strength measurement for the right hand to the nearest kilogram (kg).

Min = 1; Max = 100

Grip Strength Measurement (GSM) - Question identifier:GSM_N12A

Record the first grip strength measurement for the left hand to the nearest kilogram (kg).

Min = 1; Max = 100

Grip Strength Measurement (GSM) - Question identifier:GSM_N12B

Re-enter the first grip strength measurement for the left hand to the nearest kilogram (kg).

Min = 1; Max = 100

Grip Strength Measurement (GSM) - Question identifier:GSM_N21A

Record the second grip strength measurement for the right hand to the nearest kilogram (kg).

Min = 1; Max = 100

Grip Strength Measurement (GSM) - Question identifier:GSM_N21B

Re-enter the second grip strength measurement for the right hand to the nearest kilogram (kg).

Min = 1; Max = 100

Grip Strength Measurement (GSM) - Question identifier:GSM_N22A

Record the second grip strength measurement for the left hand to the nearest kilogram (kg).

Min = 1; Max = 100

Grip Strength Measurement (GSM) - Question identifier:GSM_N22B

Re-enter the second grip strength measurement for the left hand to the nearest kilogram (kg).

Min = 1; Max = 100

Grip Strength Measurement (GSM) - Question identifier:GSM_N60

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 03: Respondent refuses to continue
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Grip Strength Component End (GSC)

Activity Monitor (AM)

Activity Monitor (AM) - Question identifier:AM_N11

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.

Activity Monitor (AM) - Question identifier:AM_Q11

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?

  • 1: Continue
  • 8: RF

Activity Monitor (AM) - Question identifier:AM_N12

Record the reason why the respondent is not willing to wear an activity monitor for the next 7 days.

  • 01: Burden
  • 02: Invasive
  • 03: Aesthetics
  • 04: Away during the collection period
  • 05: Anticipating change in normal activity
  • 06: Sick or laid up
  • 07: Worried about losing or damaging the device
  • 08: Other - Specify

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 put on the activity monitor as soon as you wake up in the morning and take it off only when going to bed at night. We do not want to miss a step!
¿ 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.

Activity Monitor (AM) - Question identifier:AM_N21

Record whether the respondent took an activity monitor.

  • 1: Yes
  • 2: No

Activity Monitor (AM) - Question identifier:AM_N22

Record the reason why the respondent did not take an activity monitor.

  • 01: Burden
  • 02: Invasive
  • 03: Aesthetics
  • 04: Away during the collection period
  • 05: Anticipating change in normal activity
  • 06: Sick or laid up
  • 07: Worried about losing or damaging the device
  • 08: Other - Specify

Activity Monitor (AM) - Question identifier:AM_N31A

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

Long Answer Length = 7

Activity Monitor (AM) - Question identifier:AM_N31B

Re-scan the bar code on the activity monitor.

Long Answer Length = 7

Activity Monitor (AM) - Question identifier:AM_N32

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 ^DateMailBackE, 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.

Activity Monitor (AM) - Question identifier:AM_N90

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Activity Monitor Component End (AMC)

Urine Collection- Home (UCH)

Urine Collection- Home (UCH) - Question identifier:UCH_N001

Record whether a home urine sample kit is available.

  • 1: Yes
  • 2: No
  • 9: DK

Urine Collection- Home (UCH) - Question identifier:UCH_R005

We would like to better assess your nutritional intake of sodium, potassium and/or iodine. To do this, we would like to collect ^DT_SAMPQTYE urine sample^DT_MULTIPLEE which you will provide at home.

Urine Collection- Home (UCH) - Question identifier:UCH_R010

^DT_SAMPDRYE should be provided ideally within the next 7 days and mailed back to us the same day. Do you have any questions before I read the detailed instructions?

Urine Collection- Home (UCH) - Question identifier:UCH_R015

In ^DT_INSDRYE postage-paid envelope, you will find:
- A box
- A labelled urine container
- An absorbent sheet
- A plastic bag (including a second absorbent sheet)
- An instruction sheet

Urine Collection- Home (UCH) - Question identifier:UCH_R020

^DT_SELFASTE

^DT_READREPE

Urine Collection- Home (UCH) - Question identifier:UCH_N025

Record whether the respondent accepted a home urine sample kit.

  • 1: Yes
  • 2: No

Urine Collection- Home (UCH) - Question identifier:UCH_N035

Press <1> to print the label.

Stick the label to the urine container.

  • 1: Print the labels

Urine Collection- Home (UCH) - Question identifier:UCH_N040

Please scan the urine container.

Min = 50000000010; Max = 59999999999

Urine Collection- Home (UCH) - Question identifier:UCH_N045

Please scan the second urine container.

Min = 50000000010; Max = 59999999999

Urine Collection- Home (UCH) - Question identifier:UCH_N050

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

Long Answer Length = 13

Urine Collection- Home (UCH) - Question identifier:UCH_N050A

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

Long Answer Length = 13

Urine Collection- Home (UCH) - Question identifier:UCH_R050

Please mail the sample^DT_MULTIPLEE in the provided envelope on ^DateMailBackE. Should you have any questions or concerns, you will find a toll free number at the bottom of the provided instruction sheet.

Urine Collection- Home (UCH) - Question identifier:UCH_N060

Why was the component not fully completed?

  • 01: Respondent unable to continue for health reasons
  • 02: Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
  • 04: Equipment problem / technical difficulty
  • 05: Respondent's mental condition
  • 06: No time
  • 20: Other - Specify

Urine Collection- Home (UCH) - Question identifier:UCH_N065

Record the reason why the respondent is not willing to provide a home urine sample.

  • 1: Burden
  • 2: Invasive
  • 3: Away during collection period
  • 4: Health problem
  • 5: Other - Specify

Urine Collection-Home End (UCE)

Urine Collection 2 (UC2)

Urine Collection 2 (UC2) - Question identifier:UC2_N10

Record whether the respondent provided a second urine sample.

  • 1: Yes
  • 2: No

Urine Collection 2 (UC2) - Question identifier:UC2_N30

Why was the component not completed?

  • 03: Respondent refuses to continue
  • 06: No time
  • 10: Unable to provide
  • 20: Other - Specify

Urine Collection 2 Component End (U2E)

Report of Measurements (RM)

Report of Measurements (RM) - Question identifier:RM_N90

Press <1> to print the Report of physical measurements.

  • 1: Print the report

Blood Pressure Measurement Reporting Variables (BPMR)

Anthropometric Reporting Variables (HWMR)

Grip Strength Measurement Reporting Variables (GSMR)

MCAFT Measurement Reporting Variables (AFTR)

Sit and Reach Measurement Reporting Variables (SRMR)

Visual Acuity measurement reporting variable (VAMR)

Intraocular Pressure Measurement Reporting (IOPR)

Report of Measurements Component End (RMC)

Exit Component Introduction (ECI)

Exit Component Introduction (ECI) - Question identifier:ECI_R01

Before you leave, we have a few administrative questions.

Exit Consent Questions (ECQ)

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q13A

Statistics Canada may combine information about [you/^RespondentFirstName] collected during this survey with information from other surveys or from administrative data sources.

The results will be used for statistical purposes only.

  • 1: Continue
  • 2: Respondent does not want the information combined with other data sources
  • 8: RF
  • 9: DK

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q14

Having a [provincial/territorial] health number will assist Statistics Canada in linking the survey data to the [provincial/territorial] health information.
[Do you/Does ^RespondentFirstName] 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_Q15

For which province or territory is [your/^RespondentFirstName'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
  • 98: RF
  • 99: DK

Exit Consent Questions (ECQ) - Question identifier:ECQ_R21

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

[Your name, address, telephone number and health number/Your name, address and telephone number/^RespondentFirstName's name, address, telephone number and health number/^RespondentFirstName's name, address and telephone number] will not be shared.

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q22

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

Do you agree to share [your/^RespondentFirstName's] information with Health Canada and the Public Health Agency of Canada?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Contact (CONT)

Contact (CONT) - Question identifier:CONT_Q01

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
  • 8: RF

Contact (CONT) - Question identifier:CONT_Q03

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

  • 1: Continue
  • 8: RF

Exit Component End (ECC)

Clinic Sign-Out (CSO)

Clinic Sign-Out (CSO) - Question identifier:CSO_R11A

Thank you for participating in the survey. Here is ^DT_REP11TEXTE Report of physical measurements containing the results for some of the tests [he/she/you] performed today.

Clinic Sign-Out (CSO) - Question identifier:CSO_R11B

Do you have any questions about this report? If you would like, a Health Measures Specialist can spend a few minutes reviewing the test results with you now.

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

We will send the final report of ^DT_REP11TEXTE test results in 6 to 7 months. [If you move, please inform us by phoning or e-mailing us/If you move, please inform us by e-mail or by returning this change of address card]

Clinic Sign-Out (CSO) - Question identifier:CSO_N22

Record whether ^RespondentName is to receive the standard reimbursement of $100.

  • 1: Yes
  • 2: No

Clinic Sign-Out (CSO) - Question identifier:CSO_N23

Record the reimbursement amount.

Min = 0; Max = 300

Clinic Sign-Out (CSO) - Question identifier:CSO_N24

Specify the reason why a reimbursement is being disbursed to a dry-run participant.

Long Answer Length = 80

Clinic Sign-Out (CSO) - Question identifier:CSO_N25

Specify the reason why a reimbursement in excess of $100 is being disbursed.

Long Answer Length = 80

Clinic Sign-Out (CSO) - Question identifier:CSO_N30

Press <1> to print the Reimbursement form.

  • 1: Print the form

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

Before you leave, I would like to provide you with a reimbursement of the expenses for ^DT_REP11TEXTE participation in the clinic portion of the survey. I need you to sign this form, which indicates that you received the reimbursement.

End Clinic Visit Component End (CSC)

Date (DATE)

Date (DATE) - Question identifier:DATE_Q01

^DV_QTEXT_E

Min = 1; Max = 31

Date (DATE) - Question identifier:DATE_Q02

(^DV_QTEXT_E)

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

Date (DATE) - Question identifier:DATE_Q03

(^DV_QTEXT_E)

Min = 0; Max = 9997

North American Telephone (NATP)

North American Telephone (NATP) - Question identifier:NATP_Q01

^DV_QTEXT_E

Min = 0; Max = 995

North American Telephone (NATP) - Question identifier:NATP_Q02

(^DV_QTEXT_E)

Min = 0; Max = 9999995

North American Telephone (NATP) - Question identifier:NATP_Q03

(^DV_QTEXT_E)

Long Answer Length = 6

Overseas Telephone (OSTP)

Overseas Telephone (OSTP) - Question identifier:OSTP_Q01

^DV_QTEXT_E

Long Answer Length = 3

Overseas Telephone (OSTP) - Question identifier:OSTP_Q02

(^DV_QTEXT_E)

Long Answer Length = 4

Overseas Telephone (OSTP) - Question identifier:OSTP_Q03

(^DV_QTEXT_E)

Long Answer Length = 8

New Address (NAD)

New Address (NAD) - Question identifier:NAD_Q01

^DV_QTEXT_E

Long Answer Length = 6

New Address (NAD) - Question identifier:NAD_N01

Do you wish to skip the remaining address fields?

  • 1: Yes
  • 2: No

New Address (NAD) - Question identifier:NAD_Q02

(^DV_QTEXT_E)

Long Answer Length = 3

New Address (NAD) - Question identifier:NAD_Q03

(^DV_QTEXT_E)

Long Answer Length = 50

New Address (NAD) - Question identifier:NAD_Q04

(^DV_QTEXT_E)

Long Answer Length = 20

New Address (NAD) - Question identifier:NAD_Q05

(^DV_QTEXT_E)

Long Answer Length = 2

New Address (NAD) - Question identifier:NAD_Q06

(^DV_QTEXT_E)

Long Answer Length = 6

New Address (NAD) - Question identifier:NAD_Q07

(^DV_QTEXT_E)

Long Answer Length = 35

New Address (NAD) - Question identifier:NAD_Q08

(^DV_QTEXT_E)

Long Answer Length = 6

New Address (NAD) - Question identifier:NAD_Q09

(^DV_QTEXT_E)

  • 1: Yes
  • 2: No

New Address (NAD) - Question identifier:NAD_Q10

(^DV_QTEXT_E)

  • 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
  • 76: [U.S.A./" "]
  • 77: [Outside of Canada and U.S.A./" "]

New Address (NAD) - Question identifier:NAD_Q11

(^DV_QTEXT_E)

  • 01: Alabama
  • 02: Alaska
  • 03: Arizona
  • 04: Arkansas
  • 05: California
  • 06: Colorado
  • 07: Connecticut
  • 08: Delaware
  • 09: District of Columbia
  • 10: Florida
  • 11: Georgia
  • 12: Hawaï
  • 13: Idaho
  • 14: Illinois
  • 15: Indiana
  • 16: Iowa
  • 17: Kansas
  • 18: Kentucky
  • 19: Louisiana
  • 20: Maine
  • 21: Maryland
  • 22: Massachusetts
  • 23: Michigan
  • 24: Minnesota
  • 25: Mississippi
  • 26: Missouri
  • 27: Montana
  • 28: Nebraska
  • 29: Nevada
  • 30: New Hampshire
  • 31: New Jersey
  • 32: New Mexico
  • 33: New York
  • 34: North Carolina
  • 35: North Dakota
  • 36: Ohio
  • 37: Oklahoma
  • 38: Oregon
  • 39: Pennsylvania
  • 40: Rhode Island
  • 41: South Carolina
  • 42: South Dakota
  • 43: Tennessee
  • 44: Texas
  • 45: Utah
  • 46: Vermont
  • 47: Virginia
  • 48: Washington
  • 49: West Virginia
  • 50: Wisconsin
  • 51: Wyoming

New Address (NAD) - Question identifier:NAD_Q12

(^DV_QTEXT_E)

Long Answer Length = 12

New Address (NAD) - Question identifier:NAD_Q13

(^DV_QTEXT_E)

Long Answer Length = 60

Health Number Validation (HN)

Health Number Validation (HN) - Question identifier:HN_Q005

What is [your/his/her] health number?

Long Answer Length = 12

Health Number Validation (HN) - Question identifier:HN_N005B

Re-enter the health number.

Long Answer Length = 12

Electronic Address (EA)

Electronic Address (EA) - Question identifier:EA_Q01

I would like to confirm your e-mail address.
Is it ^EMAILADDRESS?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Electronic Address (EA) - Question identifier:EA_Q02

What is your e-mail address?

Long Answer Length = 80

Electronic Address (EA) - Question identifier:EA_Q03

I would like to confirm the e-mail address.
Is it ^EA_Q02?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Get Contact Name (GCN)

Get Contact Name (GCN) - Question identifier:GCN_Q01

^DV_QTEXT_E

Long Answer Length = 50

Get Contact Name (GCN) - Question identifier:GCN_Q02

(^DV_QTEXT_E)

  • 1: Yes
  • 2: No

Get Contact Name (GCN) - Question identifier:GCN_Q03

(^DV_QTEXT_E)

Long Answer Length = 50

Sub-Sampling Labels (CSSL)

Respondent Verification (CRVB)

Consent (CCON)

Urine Collection 1 (CUC1)

Screening (CSCR)

Vision Questions (CVIC)

Anthropometry (CANC)

Blood Pressure (CBPC)

Phlebotomy (CPHB)

Saliva Collection (CSLC)

Quantitative Computed Tomography (CQCT)

Visual Acuity (CVAC)

Visual Field (CFDT)

Retinal Photography (CRTP)

Intraocular Pressure (CIOP)

Hair Sample (CHSC)

Jumping Mechanography (CJMC)

MCAFT (CAFT)

Sit and Reach (CSRC)

Grip Strength (CGSC)

Fish and Shellfish Consumption (CFSF)

Activity Monitor (CAMC)

Urine Collection - Home (CUCH)

Urine Collection 2 (CUC2)

Report of Measurements (CRMC)

Exit (CECC)

End of Clinic Visit (CCSO)

Bio-Bank Flag (BIO)

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