Canadian Health Measures Survey (Cycle 7) - Clinic Questionnaire

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 : exE
Gender : ^GenderE
Language of interview : ^RespLangE
Notes : ^PERMNOTE

Select the operation to be performed.

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

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 confirm/provide the information on this form. We will not be able to send the reports in the mail without a valid name.

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) - 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

Tap Water Confirmation (TAP) - Question identifier:TAP_Q010

Did you, or another member of your household, provide a tap water sample during the household interview?

• 1: Yes
• 2: No
• 9: DK

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) - 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, record 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_R4A

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

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: Stick it onto a urine sample container.

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

• 1: Print the labels

Confirm Contact Information (CFM) - Question identifier:CFM_N07

Is ^TelephoneNumber1 correct?

• 1: Yes
• 2: No

Confirm Contact Information (CFM) - Question identifier:CFM_N09

Is ^TelephoneNumber2 correct?

• 1: Yes
• 2: No

Confirm Contact Information (CFM) - Question identifier:CFM_N10

Was ^DT_CFM10_TEXTE phone number provided?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Confirm Contact Information (CFM) - Question identifier:CFM_N11

Was an email address provided?

• 1: Yes
• 2: No

Confirm Contact Information (CFM) - Question identifier:CFM_N21

Is
^MailAddress
correct?

• 1: Yes
• 2: No

Confirm Electronic Address (CEA) - Question identifier:CEA_N01

Record whether the email address is correct: ^EMAILADDRESS

• 1: Yes
• 2: No

Confirm Electronic Address (CEA) - Question identifier:CEA_N02

Record respondent's email address.

Ask about upper and lower case, special characters, etc.

Long Answer Length = 80

Language Confirmation (LNG) - Question identifier:LNG_N11

Record ^DT_RESPONDENTNAME's preferred official language.

• 1: English
• 2: French

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, 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 today's 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 tests, I can answer them for you.

Consent (CON) - Question identifier:CON_R14

Here is the Consent form for participation in today's 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] densitometry (DXA) measured.

• 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 [EMPTY/and urine]for [contaminants that might require/diseases and contaminants that might require] mandatory reporting in [his/her/his/her] province of residence, and to contact [the parent or guardian/the respondent] 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 [EMPTY/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, saliva 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, saliva and urine for use in future health studies.

• 1: Yes
• 2: No

Report (REP) - Question identifier:REP_R11

Today, at the end of the 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.

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

Subsampling Labels (SSL) - Question identifier:SSL_N50

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

• 1: Print the labels

Subsampling Labels (SSL) - Question identifier:SSL_N55

Stick each label on the appropriate specimen tube.

Press <1> to continue.

• 1: Continue

Urine Collection 1 (UC1) - Question identifier:UC1_Q10

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

• 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.

COVID Introduction (CVI) - Question identifier:CVI_R005

In order to better understand the relationship between the COVID-19 pandemic and your health, I will be asking questions about access to various health care services, COVID-19 tests and vaccines.

Access to Health Care (AHC) - Question identifier:AHC_R010

The next series of questions will be about your access to health care.

Access to Health Care (AHC) - Question identifier:AHC_Q010

In the past 12 months, which of the following health care services did you need? Include any services that you have received or are waiting to receive.

• 01: Consultation or treatment from a family doctor or nurse practitioner
• 02: Consultation with a specialist medical doctor (e.g. surgeon, allergist, orthopedist, or cardiologist)
• 03: Treatment for or monitoring of a chronic condition (e.g. high blood pressure, heart disease, kidney disease, diabetes)
• 04: Cancer treatment
  (e.g. radiation, chemotherapy)
• 05: Screening or diagnostic testing (excluding COVID-19 testing) (e.g. cancer screening, diagnostic imaging, blood tests)
• 06: Reproductive care or gynaecological services (e.g. prenatal or postnatal, maternity, fertility, treatment of gynaecological concerns or problems, abortion or pregnancy termination services)
• 07: Surgery
  (Include any past or scheduled surgical procedures)
• 08: Mental health or addiction services such as counselling or therapy
• 09: Other health care services
• 98: RF
• 99: DK

Access to Health Care (AHC) - Question identifier:AHC_Q015

During the past 12 months, did you receive all the health care services you needed?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Access to Health Care (AHC) - Question identifier:AHC_Q020

Which service(s) did you not receive?

• 01: Consultation or treatment from a family doctor or nurse practitioner
• 02: Consultation with a specialist medical doctor (e.g. surgeon, allergist, orthopedist, or cardiologist)
• 03: Treatment for or monitoring of a chronic condition (e.g. high blood pressure, heart disease, kidney disease, diabetes)
• 04: Cancer treatment
  (e.g. radiation, chemotherapy)
• 05: Screening or diagnostic testing (excluding COVID-19 testing) (e.g. cancer screening, diagnostic imaging, blood tests)
• 06: Reproductive care or gynaecological services (e.g. prenatal or postnatal, maternity, fertility, treatment of gynaecological concerns or problems, abortion or pregnancy termination services)
• 07: Surgery
  (Include any past or scheduled surgical procedures)
• 08: Mental health or addiction services such as counselling or therapy
• 09: Other health care services
• 98: RF
• 99: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q010

During the past 12 months, did you have any dental appointments cancelled, rescheduled or delayed?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q015

Was the purpose of the appointment(s) for...?

• 1: A regular check-up or cleaning
• 2: Dental work or repairs
• 3: Both
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q020

Did you have any tooth or mouth pain as a result of having the dental work cancelled, rescheduled or delayed?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q025

Due to the tooth or mouth pain, did you seek medical attention by...?

• 1: A doctor or nurse at a hospital emergency room
• 2: A doctor or nurse at a medical facility, such as a family doctor's office
• 3: A dentist
• 4: Another type of medical professional
• 5: No, I did not seek any medical attention
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q030

Was this medical attention provided...?

• 1: In person
• 2: Virtually, either with a video connection or over the phone
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q035

When you received the medical attention for your tooth or mouth pain, were you prescribed any medication to help with pain, treat infections, etc.?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q040

During the past 12 months, did you have to cancel, reschedule, or delay any dental appointments because you tested positive for COVID-19 or had to self-isolate because of COVID-19 (e.g. symptoms, close contact with a positive case, etc.)?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_R045

The following questions are about being tested and vaccinated against COVID-19.

COVID Questionnaire (CVD) - Question identifier:CVD_Q045

Have you ever had a nasal or throat swab to test for COVID-19?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q050

Have you ever had a positive test result?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q055

When did you have a positive test result?

• 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

COVID Questionnaire (CVD) - Question identifier:CVD_Q060

(When did you have a positive test result?)

Min = 0; Max = 9997

COVID Questionnaire (CVD) - Question identifier:CVD_Q065

Have you been vaccinated against COVID-19?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q070

How many doses of the COVID-19 vaccine have you received so far?

• 1: One dose
• 2: Two doses
• 3: More than two doses
• 8: RF
• 9: DK

COVID Questionnaire (CVD) - Question identifier:CVD_Q075

When did you receive the first dose of a COVID-19 vaccine?

• 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

COVID Questionnaire (CVD) - Question identifier:CVD_Q080

(What year did you receive the first dose of the COVID-19 vaccine?)

Min = 0; Max = 9997

COVID Questionnaire (CVD) - Question identifier:CVD_Q085

Which vaccine did you receive?

• 1: Pfizer and BioNTech mRNA vaccine
• 2: Moderna mRNA vaccine
• 3: AstraZeneca Oxford vaccine
• 4: Johnson & Johnson vaccine
• 5: Novavax vaccine
• 6: Other
• 8: RF
• 9: DK

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.

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_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) - 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_Q41

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

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_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
• 04: DXA
• 08: None

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

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

• 1: Yes
• 2: No

Physical and Health Conditions (PHC) - Question identifier:PHC_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
• 04: DXA
• 08: None

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

In the past 8 weeks, that is from ^DT_Date8weeksAgoE to yesterday, have you had your blood drawn or have a blood draw scheduled in the next 8 weeks, that is from today until ^DT_Date8weeksFutureE?

• 1: Yes
• 2: No

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

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

• 1: Yes
• 2: No

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

Have you received chemotherapy in the past four weeks?

• 1: Yes
• 2: No

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

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

• 1: Yes
• 2: No

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

Have you ever had a mastectomy?

• 1: Yes
• 2: No

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

On which side?

• 1: Right
• 2: Left
• 3: Both

Women's Health Restrictions (WHR) - Question identifier:WHR_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 = 7; 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) - Question identifier:PHR_R001

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

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q010

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

• 1: Yes
• 2: No

Physical Activity Restrictions (PHR) - Question identifier:PHR_Q015

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

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

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_Q025

Have you had an X-ray with contrast material such as iodine or barium in the last 2 weeks?

• 1: Yes
• 2: No

Bone Mineral Density Test Restrictions (BMR) - Question identifier:BMR_Q030

Have you had any nuclear medicine studies in the past 2 weeks?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_R005

Next, I need to ask a few questions to make sure you are eligible for the complete oral health examination.

Oral Health Restrictions (OHR) - Question identifier:OHR_Q010

Are you required to take antibiotics (e.g. penicillin) before a dental examination or receiving dental care?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_Q030

Have you ever been diagnosed with bacterial endocarditis by a health professional?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_Q040

In the last 12 months, have you had coronary bypass surgery?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_Q045

Do you have a device that was implanted under the skin of your chest to help regulate your heart beat (e.g. a pacemaker or an implantable cardioverter-defibrillator (ICD))?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_Q050

Have you had your pacemaker or implantable cardioverter-defibrillator (ICD) for less than one year?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_Q055

Do you have any other artificial material in your heart, veins or arteries?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_Q065

Have you ever received an organ transplant?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_Q070

Do you currently have end-stage renal disease or in the last year have you undergone haemodialysis?

• 1: Yes
• 2: No

Oral Health Restrictions (OHR) - Question identifier:OHR_Q075

Are you immunosuppressed or are you on immunosuppression therapy (e.g. chemotherapy)?

• 1: Yes
• 2: No

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

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

Medications and Product Confirmation (MEDC) - Question identifier:MEDC_Q410

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

• 1: Yes
• 2: No
• 8: RF
• 9: DK

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

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

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

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

• 1: Yes
• 2: No
• 8: RF
• 9: DK

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

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

• 08: None

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) - Question identifier:MEUC_Q02

In the past month, that is from ^DT_DateLastMonthE to today, have you taken or used any [other/EMPTY] medications that have been prescribed or administered by a health professional such as a doctor or dentist, over-the-counter medications or other health products, including natural health products?

This includes such things as insulin, antibiotics, ^DT_MEUText2E. Over-the-counter medications could include such things as pain killers, antacids, allergy pills, and hydrocortisone creams. Examples of health products include toothpaste, 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_N11

Do you have another prescription medication, over-the-counter medication or other health products, including natural health products, 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, over-the-counter medications or other health products, including natural health products, in the past month?

Please include any prescription creams, injections or patches. Over-the-counter medications could include such things as pain killers, antacids, allergy pills, and hydrocortisone creams. Examples of health products include toothpaste, 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_Q15

How many other prescription medications, over-the-counter medications or other health products, including natural health products, have you taken or used in the past month? Please include any prescription creams, injections or patches. Over-the-counter medications could include such things as pain killers, antacids, allergy pills, and hydrocortisone creams. Examples of health products include toothpaste, vitamins, minerals, amino acids, probiotics, fish oils and other oils, herbal remedies and homeopathic preparations.

Min = 0; Max = 95

New Product Information (NPI) - Question identifier:NPI_Q16

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

• 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: [NPI_S22/EMPTY/English text of category selected at NPI_Q22]

• 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_Q18A

(What is the Product Identification Number?)

Long Answer Length = 8

New Product Information (NPI) - Question identifier:NPI_Q18B

(What is the name of this product? For example, Accutane, Alesse 21, Ventolin, or 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, 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_Q24

Is this a prescription or non-prescription medication?

• 1: Prescription medication
• 2: Non-prescription medication

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) - 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] each day that you ^DT_TAKE1E this product (^DV_PRODUCT_NAME). Is that correct?

• 1: Yes
• 2: No

Cannabis - Call Block (CAN) - Question identifier:CAN_Q006

Have you ever consumed cannabis (marijuana) (e.g. smoked, vaporized, in food or drink)?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Cannabis - Call Block (CAN) - Question identifier:CAN_Q020

In the past week, have you consumed cannabis (marijuana)?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Cannabis - Call Block (CAN) - Question identifier:CAN_Q025

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

• 1: Yes
• 2: No

Insect repellent (INSR) - Question identifier:INSR_R005

The following questions are about your use of insect repellent. Think about any insect repellent applied on your body.

Insect repellent (INSR) - Question identifier:INSR_Q005

In the past two weeks, that is from ^Date2WeeksAgoE to today, have you used insect repellent, such as bug spray, lotion or moist towelettes? For example, OFF! ®, or Muskol ®.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Insect repellent (INSR) - Question identifier:INSR_Q010

Did any of the products used during that period contain DEET? (For example Muskol ®, OFF! ® or OFF! ® Deep Woods products.)

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Respondent Background Confirmation (SDCV) - Question identifier:SDCV_N005

The racial background reported during the household interview is ^DT_SDCV005TEXTE. Based on this information you should pick^DT_PGTEXT1E the ^DT_RACEADJE race adjustment category^DT_PGTEXT2E.

Record the appropriate race adjustment for the respondent.

• 1: White
• 2: Black
• 3: Hispanic
• 4: Asian
• 5: Other

Respondent Background Confirmation (SDCV) - Question identifier:SDCV_N010

Why was ^SDCV_N005 selected as the race adjustment category?

• 1: Morphology does not match race adjustment category
• 2: No reported racial background during household interview
• 3: Incomplete/incorrect racial background from household interview
• 4: Other - Specify

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_N15

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

• 1: Yes
• 2: No

Other Reason for Screening Out (ORS) - Question identifier:ORS_N20

Is there any other reason why the respondent should not perform the oral health test?

• 1: Yes
• 2: No

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 (excluding 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?

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

Fish and Shellfish Consumption (FSF) - Question identifier:FSF_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 (e.g. skipjack or yellowfin) tuna?
• 2: ...white (e.g. albacore) tuna?
• 3: ...both?
• 8: RF
• 9: DK

Seaweed Consumption (SEW) - Question identifier:SEW_R10

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

Seaweed Consumption (SEW) - Question identifier:SEW_Q10

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

• 1: Yes
• 2: No
• 8: RF
• 9: DK

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

Recent Consumption (C48) - Question identifier:C48_Q05

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

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Recent Consumption (C48) - Question identifier:C48_Q07

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

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

Water Analysis Questions (WAQ) - Question identifier:WAQ_R01

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

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q04

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

Min = 0; Max = 365

Water Analysis Questions (WAQ) - Question identifier:WAQ_N05A

Select the reporting period.

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

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q06

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

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

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q07

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

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

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q08

When did you last receive fluoride treatments at the dentist?

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

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q09

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

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Water Analysis Questions (WAQ) - Question identifier:WAQ_Q10

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

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

Anthropometric Component Introduction (ACI) - Question identifier:ACI_R02

Next will be a series of body measurements.

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

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

Height and Weight Measurements (HWM) - Question identifier:HWM_N10

Record how the data will be captured.

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

Height and Weight Measurements (HWM) - Question identifier:HWM_N10A

Record the recumbent length in centimetres.

Min = 33.00; Max = 100.00

Height and Weight Measurements (HWM) - Question identifier:HWM_N10B

Re-enter the recumbent length in centimetres.

Min = 33.00; Max = 100.00

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 millimetres (mm).

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

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 millimetres.

Min = 846.00; Max = 2070.90

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

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

Now, take a deep breath in and hold it.

Height and Weight Measurements (HWM) - Question identifier:HWM_N12A

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

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

Min = 846.00; Max = 2070.90

Height and Weight Measurements (HWM) - Question identifier:HWM_N12B

Record the sitting height in centimetres.

Min = 73.00; Max = 207.60

Height and Weight Measurements (HWM) - Question identifier:HWM_N12C

Re-enter the sitting height in centimetres.

Min = 73.00; Max = 207.60

Height and Weight Measurements (HWM) - Question identifier:HWM_N12D

Re-enter the sitting height in millimetres.

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 and step onto the centre of the scale. 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_R13A

INSTRUCTION: Check the data returned from the scale.

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

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_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. [EMPTY/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.]

Blood Pressure Measurement (BPM) - Question identifier:BPM_N100

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

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

Blood Pressure Measurement (BPM) - Question identifier:BPM_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

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

• 1: Continue

Blood Pressure Measurement (BPM) - Question identifier:BPM_N160

Check the blood pressure and heart rate data.

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

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_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: Continue
• 8: RF

Blood Pressure Measurement (BPM) - Question identifier:BPM_N260

Check the blood pressure and heart rate data.

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

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 go to a doctor, clinic, or a hospital emergency room to have your blood pressure re-checked today.

Because of these results, we will not continue with your 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 go to a doctor, clinic, or hospital emergency room to have your blood pressure re-checked today.

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

Blood Pressure Recording (BPR) - Question identifier:BPR_N1A

Record the systolic blood pressure measurement.

Min = 0; Max = 299

Blood Pressure Recording (BPR) - Question identifier:BPR_N1B

Re-enter the systolic blood pressure measurement.

Min = 0; Max = 299

Blood Pressure Recording (BPR) - Question identifier:BPR_N2A

Record the diastolic blood pressure measurement.

Min = 30; Max = 299

Blood Pressure Recording (BPR) - Question identifier:BPR_N2B

Re-enter the diastolic blood pressure measurement.

Min = 30; Max = 299

Blood Pressure Recording (BPR) - Question identifier:BPR_N3A

Record the heart rate.

Min = 30; Max = 199

Blood Pressure Recording (BPR) - Question identifier:BPR_N3B

Re-enter the heart rate.

Min = 30; Max = 199

Blood Pressure Recording (BPR) - Question identifier:BPR_N4

Record the reason why the measurement could not be taken.

Select the error.

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

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_R10

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

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_Q10A

Could you please confirm your first and last name?

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

Phlebotomy Component Introduction (PHI) - Question identifier:PHI_Q11

I need to confirm your fasting status. 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) - 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.

• 51: 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_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

Saliva Rinse Block (SAR) - Question identifier:SAR_R005

Now we would like you to rinse your mouth with water before we collect your saliva sample.

Saliva Rinse Block (SAR) - Question identifier:SAR_Q010

Have you had anything to eat, drink, smoke or used any oral hygiene products in the past 10 minutes?

• 1: Yes
• 2: No
• 9: DK

Saliva Rinse Block (SAR) - Question identifier:SAR_R015

I will now provide some water.

The water should be swished vigorously in the mouth for 10 seconds. Do not swallow and do not gargle.

When the timer goes off, the water can be discarded back into the cup provided.

Saliva Rinse Block (SAR) - Question identifier:SAR_N020

After completing the oral rinse, a minimum of 5 minutes must elapse before proceeding to Saliva Collection (SC1). While waiting for the 5 minutes to elapse, another block (for example, Urine Collection Home) can be completed.

There is no maximum time limit beyond the 5 minutes provided the respondent has not had anything to eat or drink (including water) in the time since the rinse is completed.

Press <1> to continue.

• 1: Continue

Saliva Collection Block (SC1) - Question identifier:SC1_Q010

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

• 1: Continue
• 9: DK

Saliva Collection Block (SC1) - Question identifier:SC1_R015

In preparation for collection, you should start to pool saliva in your mouth.

You can also massage your cheeks to increase saliva production.

Saliva Collection Block (SC1) - Question identifier:SC1_Q016

This device will be used to collect the saliva sample.

When I start the timer, please place the absorbent pad in their mouth.

Continuously move the pad around the inside of the mouth, over and under the tongue, along the cheeks, on the roof of the mouth and in the space between the teeth and lips.

It is important they do not chew or suck on the absorbent pad.

This process will take up to three minutes. Do you have any questions before we begin?

• 1: Continue
• 8: RF

Saliva Collection Block (SC1) - Question identifier:SC1_Q020

This device will be used to collect the saliva sample.

When I start the timer, please place the absorbent pad in your mouth. Continuously move the pad around the inside of the mouth, over and under the tongue, along the cheeks, on the roof of the mouth and in the space between the teeth and lips.

It is important not to chew or suck on the absorbent pad. I will periodically ask you to remove the pad so that I can check the amount of saliva collected.

This process will take up to three minutes. Do you have any questions before we begin?

• 1: Continue
• 8: RF

Saliva Collection Block (SC1) - Question identifier:SC1_N025

Once collection is complete, stop the timer and have the respondent remove the device from their mouth.

Place the white absorbent pad end into the plastic compression tube. Ensure the device is held in an upright and vertical position at all times.

Press <1> to continue.

• 1: Continue

Saliva Collection Block (SC1) - Question identifier:SC1_N030A

Record the total length of time, in seconds, of the saliva collection.

Min = 01; Max = 180

Saliva Collection Block (SC1) - Question identifier:SC1_N030B

Re-enter the total length of time, in seconds, of the saliva collection.

Min = 01; Max = 180

Saliva Collection Block (SC1) - Question identifier:SC1_N035

Record whether the child cried during collection of the saliva sample.

Crying is defined as the production of tears (shedding or welling) of any duration and intensity, with or without vocalizations.

• 1: Yes
• 2: No

Saliva Collection Block (SC1) - Question identifier:SC1_N040

Press <1> to print the saliva labels.

In the presence of the respondent, stick the labels on the saliva collection tube and corresponding Eppendorf tube.

• 1: Print

Saliva Collection Block (SC1) - Question identifier:SC1_N045

Scan the barcode on the saliva collection tube.

Min = 70000000900; Max = 79999999999

Saliva Collection Block (SC1) - Question identifier:SC1_N050

Record whether the respondent provided a saliva sample.

• 1: Yes
• 2: No

Saliva Collection Block (SC1) - Question identifier:SC1_N055

The required saliva volume is indicated when the indicator changed from light red to dark red.

Did the respondent provide a saliva sample of sufficient volume (indicator changed from light red to dark red)?

• 1: Yes
• 2: No

DXA Component Introduction (DXAI) - Question identifier:DXAI_R005

[We will be doing some scans of ^RespondentFirstName's body that will tell us about your body composition and how strong your bones are. It will take 15 to 20 minutes. I will explain in more detail as I do the exams. There will be a very small amount of radiation, comparable to what you would get if you were flying from Toronto to Vancouver. Do you have any questions before we begin?/We will be doing some scans of your body that will tell us about your body composition and how strong your bones are. It will take 25 to 30 minutes. I will explain in more detail as I do the exams. There will be a very small amount of radiation, comparable to what you would get if you were flying from Toronto to Vancouver. Do you have any questions before we begin?]

DXA Component Introduction (DXAI) - Question identifier:DXAI_R015

I also need to ask a few bone-health-related questions to ensure that ^DT_DXAI015_TEXTE eligible for the bone mineral density test.

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q025

^DT_DXAI025_TEXTE any implanted metal in the lumbar spine? For example, spinal fusion, artificial discs, cages, screws, rods, plates, shrapnel or pellets?

• 1: Yes
• 2: No

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q030

^DT_DXAI020_TEXTE broken, fractured, cracked or chipped a hip?

• 1: Yes
• 2: No

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q035

Which hip?

• 1: Right
• 2: Left
• 3: Both

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q040

^DT_DXAI025_TEXTE a prosthesis or metal in a hip? For example, hip replacements/arthroplasties, implants, screws, rods, plates, shrapnel or pellets?

• 1: Yes
• 2: No

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q045

Which hip?

• 1: Right
• 2: Left
• 3: Both

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q050

^DT_DXAI020_TEXTE broken, fractured, cracked or chipped the femur or tibia near the knee?

• 1: Yes
• 2: No

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q055

Which leg?

• 1: Right
• 2: Left
• 3: Both

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q060

^DT_DXAI025_TEXTE a prosthesis or metal in the knee? For example, knee replacements/arthroplasties, implants, screws, rods, plates, shrapnel or pellets?

• 1: Yes
• 2: No

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q065

Which leg?

• 1: Right
• 2: Left
• 3: Both

DXA Component Introduction (DXAI) - Question identifier:DXAI_R070

I need to make sure that you are properly dressed for the scans. Please empty your pockets and remove any metal as it will interfere with the scans: glasses, jewelry, (underwire bra), piercings, belts, etc. Please use the restroom now if necessary.

DXA Component Introduction (DXAI) - Question identifier:DXAI_Q075

(Directed to the Proxy/Parent)

Since there is a small amount of radiation, I am required to offer you this radiation protection apron. Would you like to use it?

• 1: Yes
• 2: No

DXA Component Introduction (DXAI) - Question identifier:DXAI_R080

[I will need your cooperation. I'd like you to stay with ^RespondentFirstName and I will give you specific instructions on how to position you for each scan.
In order to ensure that ^RespondentFirstName is in the correct position, I might have to use my hands to locate certain landmarks.
At any time, if ^RespondentFirstName feels any discomfort, please let me know./I will give you specific instructions on how to position yourself for each scan.
In order to ensure that you are in the correct position, I might have to use my hands to locate certain landmarks or ask you to show them to me.
At any time, if you feel any discomfort, please let me know.]

DXA Component Introduction (DXAI) - Question identifier:DXAI_R085

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

DXA Measurement (DXAM) - Question identifier:DXAM_N055

Using the DXADataExport shortcut on the desktop, export all of the test results to the MEC server.

Press <1> to continue.

• 1: Continue

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_R005

This scan will be of the lumbar spine. I need to select the test on the computer. This will only take a few minutes.

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_R010

[Please help ^RespondentFirstName lie flat on your back in the middle of the table, on the center white line. Now bend their knees together and place both legs on top of this block. I ask that you stay on your knees near the table and put your arms over you; one arm across their chest and shoulders and the other arm across their knees to prevent movement. Please watch your head because the mobile arm will move over ^RespondentFirstName. Now I will verify the placement of the laser./Please lie flat on your back in the middle of the table, on the center white line. I am going to gently straighten your legs and shoulders. I will place a pillow under your head. Now bend your knees together and place both legs on top of this block. The mobile arm will move over your head and chest. Please point to your belly button over your clothes with your right index finger. This will allow me to verify the placement of the mobile arm. Thank you, you may now return your right arm to the side of your body.]

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_N010

Were you able to position the respondent?

• 1: Yes
• 2: No

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_R015

[We are ready to start the test. Please hold ^RespondentFirstName completely still during the test, which will only take a few minutes. I will let you know when it will be finished./We are ready to start the test. Please hold completely still and do not talk during the test, which will only take a few minutes. I will let you know when it will be finished.]

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_N015

Was the scan successful?

• 1: Yes
• 2: No

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_R020

The first scan was not successful, we will need to repeat it.

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_N020

Was the second scan successful?

• 1: Yes
• 2: No

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_N025

Click in the window of "TBS" software (automatically popped up at the end of the scan) on "Next" then "Export".

Press <1> to continue.

• 1: Continue

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_N030A

Enter the number of scans completed.

Min = 0; Max = 2

AP Vertebral Lumbar Spine (VLM) - Question identifier:VLM_N030B

Re-enter the number of scans completed.

Min = 0; Max = 2

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_R005

This scan will be of your [right/left] hip. I need to select the test on the computer. This will only take a few minutes.

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_R010

Now extend your legs on the table and put your feet alongside this foot brace.
I will rotate your legs inward slightly and then I will attach your feet to the foot brace using the Velcro straps. You should feel a slight pressure in your hips.
The mobile arm will move and I will verify its placement.

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_N010

Were you able to position the respondent?

• 1: Yes
• 2: No

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_R015

We are ready to start the test. Please hold completely still and do not talk during the test, which will only take a few minutes. I will let you know when it will be finished.

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_N015

Was the scan successful?

• 1: Yes
• 2: No

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_R020

The first scan was not successful, we will need to repeat it.

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_N020

Was the second scan successful?

• 1: Yes
• 2: No

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_N025A

Enter the number of scans completed.

Min = 0; Max = 2

Proximal Femur (Hip) Measurement (PFM) - Question identifier:PFM_N025B

Re-enter the number of scans completed.

Min = 0; Max = 2

Whole Body Measurement (WBM) - Question identifier:WBM_R005

This scan will be of the whole body. I need to select the test on the computer. This will only take a few minutes.

Whole Body Measurement (WBM) - Question identifier:WBM_R010

Extend your legs on the table and I will wrap this Velcro strap loosely around your legs to hold them in place. Then, I will verify your alignment.
Now put your arms alongside your body with your hands turned down, palms facing the table.

[(Directed to the Proxy/Parent), I will now require your assistance.
While on your knees near the table, please put one arm across ^RespondentFirstName's chest and the other arm across their knees to prevent any movement.
During the scan, I will explain how to move your arms to avoid having them in the picture.
Please watch your head because the mobile arm will move over ^RespondentFirstName./EMPTY]

Whole Body Measurement (WBM) - Question identifier:WBM_N010

Were you able to position the respondent?

• 1: Yes
• 2: No

Whole Body Measurement (WBM) - Question identifier:WBM_R015

[We are ready to start the test. Please hold ^RespondentFirstName completely still during the test, which will only take a few minutes. I will let you know when it will be finished./We are ready to start the test. Please hold completely still and do not talk during the test, which will only take a few minutes. I will let you know when it will be finished.]

Whole Body Measurement (WBM) - Question identifier:WBM_N015

Was the scan successful?

• 1: Yes
• 2: No

Whole Body Measurement (WBM) - Question identifier:WBM_R020

The first scan was not successful, we will need to repeat it.

Whole Body Measurement (WBM) - Question identifier:WBM_N020

Was the second scan successful?

• 1: Yes
• 2: No

Whole Body Measurement (WBM) - Question identifier:WBM_N025A

Enter the number of scans completed.

Min = 0; Max = 2

Whole Body Measurement (WBM) - Question identifier:WBM_N025B

Re-enter the number of scans completed.

Min = 0; Max = 2

Oral Health Component Introduction (OHI) - Question identifier:OHI_R005

Now, we will begin the oral health examination.

[Please help ^RespondentFirstName sit comfortably in this chair./Please take this mouthwash, swish it in your mouth and then spit it into the sink. Now, please sit back in this chair and make yourself as comfortable as possible./Please take this water, swish it in your mouth then spit it into the sink. Now, please sit back in this chair and make yourself as comfortable as possible.]

Oral Health Component Introduction (OHI) - Question identifier:OHI_R015

For the oral health examination, the only instruments I will use are this mouth mirror and probe. First, I just want to get a sense of the health of your teeth and mouth.

Oral Health Component Introduction (OHI) - Question identifier:OHI_N020

Record the dentate status of the respondent.

This is to record the natural teeth.

• 1: Dentate - both arches
• 2: Dentate - upper arch only
• 3: Dentate - lower arch only
• 4: Edentulous with one or more implants
• 5: Edentulous

Oral Health Component Introduction (OHI) - Question identifier:OHI_Q025

I will record any artificial teeth in your mouth. Do you have any other artificial teeth that you are not currently wearing?

• 1: No prosthetics
• 2: Fixed bridge
• 3: Implant
• 4: Partial denture - acrylic
• 5: Partial denture - cast chrome
• 6: Full denture

Oral Health Component Introduction (OHI) - Question identifier:OHI_N030

Record the prosthetic status of the lower arch.

• 1: No prosthetics
• 2: Fixed bridge
• 3: Implant
• 4: Partial denture - acrylic
• 5: Partial denture - cast chrome
• 6: Full denture

Oral Health Component Introduction (OHI) - Question identifier:OHI_N035

Record the mucosal status of the respondent.

• 01: No mucosal abnormalities
• 02: Angular cheilitis
• 03: Mucosal white patches
• 04: Denture stomatitis
• 05: Denture induced hyperplasia (epulis)
• 06: Glossitis
• 07: Sinus or fistula
• 08: Aphthous ulcer
• 09: Traumatic or unspecified ulcer
• 10: Other - Specify

Oral Health Component Introduction (OHI) - Question identifier:OHI_N040

Record the type of mucosal white patches.

• 1: Leukoplakia
• 2: Lichen planus
• 3: Candidiasis

Oral Health Component Introduction (OHI) - Question identifier:OHI_N085

Record the condition of each tooth.

• 01: Sound - never decayed or restored
• 02: Sound - crown sealed, never decayed or otherwise restored
• 03: Missing - due to orthodontic treatment
• 04: Missing - due to trauma
• 05: Missing - due to caries or periodontal disease
• 06: Unerupted tooth, congenitally missing or unexposed root
• 07: Decayed severely
• 08: Decayed - pit and fissure caries
• 09: Decayed - smooth surface caries
• 10: Decayed - both smooth surface and pit and fissure caries
• 11: Decayed - smooth surface caries
• 12: Filled with amalgam, no other decay
• 13: Filled with composite resin or composite resin and other material (GIC, inlay, crown), no other decay
• 14: Filled with other material (GIC, inlay, crown), no other decay
• 15: Filled with amalgam and composite resin, no other decay
• 16: Filled with amalgam and other material (GIC, inlay, crown), no other decay
• 17: Filled with amalgam, no other decay, but filling is defective and needs replacement
• 18: Filled with composite resin or composite resin and other material (GIC, inlay, crown), but filling is defective and needs replacement
• 19: Filled with other material (GIC, inlay, crown) but filling is defective and needs replacement
• 20: Filled with amalgam and composite resin but filling is defective and needs replacement
• 21: Filled with amalgam and other material (GIC, inlay, crown) but filling is defective and needs replacement
• 22: Bridge abutment, special crown or veneer
• 23: Implant
• 24: Fractured due to trauma
• 25: Other

Oral Health PUFA (OHU) - Question identifier:OHU_Q005

I will use some gauze to dry off your teeth for the next part of the exam.

Is PUFA present on any of the following teeth?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Oral Health Non-Cavitated Lesion (OHL) - Question identifier:OHL_R005

I will use some gauze to dry off your teeth for the next part of the exam.

Oral Health Non-Cavitated Lesion (OHL) - Question identifier:OHL_N010

Record if there is a presence of a non-cavitated lesion for this tooth.

Dry the tooth thoroughly with gauze.

In order to determine the presence of a non-cavitated lesion the following must be observed:

- A visible change in enamel opacity or discoloration (white or brown) is seen at the entrance to the pit or fissure after drying with gauze.

- A distinct visual change in enamel may be visible when wet, however the lesion must be visible when the enamel is dried with gauze to be recorded.

• 1: Yes
• 2: No

Oral Health Amalgam and Composite Resin (OHA) - Question identifier:OHA_R005

I am now going to count the number of surfaces on your teeth that have silver fillings.

Oral Health Amalgam and Composite Resin (OHA) - Question identifier:OHA_N010A

Count and record the number of tooth surfaces with amalgam (silver) fillings.

When the restoration overlaps a surface by at least 1 mm, count it as an additional amalgam surface. For example, if tooth 36 has an occlusal that extends onto the buccal by at least 1 mm, count as 2 surfaces.

Min = 0; Max = 95

Oral Health Amalgam and Composite Resin (OHA) - Question identifier:OHA_N010B

Re-enter the number of tooth surfaces with amalgam fillings.

Min = 0; Max = 95

Oral Health Amalgam and Composite Resin (OHA) - Question identifier:OHA_R015

I am now going to count the number of surfaces on your teeth that have white fillings.

Oral Health Amalgam and Composite Resin (OHA) - Question identifier:OHA_N020A

Count and record the number of tooth surfaces with composite resin (white fillings).

Min = 0; Max = 165

Oral Health Amalgam and Composite Resin (OHA) - Question identifier:OHA_N020B

Re-enter the number of tooth surfaces with composite resin.

Min = 0; Max = 165

Oral Health Fluorosis (OHF) - Question identifier:OHF_N005

Record the fluorosis score for the most affected pair of teeth for teeth 12, 11, 21 or 22. If the level of fluorosis is not the same on each tooth, record the score of the less affected tooth.

The worst 2 teeth selected could be a central and lateral (11 and 12, or 11 and 22, or 21 and 22, or 21 and 12), 2 centrals or 2 laterals.

Teeth with brackets or bands should be excluded from the assessment. If this results in no teeth being available for assessment, record 7.

• 1: Normal
• 2: Questionable
• 3: Very mild
• 4: Mild
• 5: Moderate
• 6: Severe
• 7: All 4 anterior teeth absent
• 8: RF
• 9: DK

Oral Health Traumatic Injury (OHT) - Question identifier:OHT_Q005

Excluding a dental procedure or tooth decay, have you ever lost or damaged any of your front 8 adult teeth, that is the 4 teeth on the top and the 4 teeth on the bottom?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Oral Health Traumatic Injury (OHT) - Question identifier:OHT_N010

Record the condition of each tooth.

• 01: No evidence of traumatic injury
• 02: Unrestored enamel fracture - does not involve dentin
• 03: Unrestored enamel fracture - involves dentin
• 04: Untreated damage - dark discolouration, swelling, fistula
• 05: Restored fracture - full crown
• 06: Restored fracture - other restoration
• 07: Lingual restoration plus history of root canal treatment
• 08: Other

Oral Health Traumatic Injury (OHT) - Question identifier:OHT_Q030

When did you damage your [tooth/teeth]?

• 1: Less than 3 months ago
• 2: 3 to 6 months ago
• 3: More than 6 months ago
• 8: RF
• 9: DK

Oral Health Traumatic Injury (OHT) - Question identifier:OHT_Q035

How did you damage your [tooth/teeth]?

• 1: Sports or physical activity
• 2: Eating or using teeth as a tool
• 3: Driving or riding in a motor vehicle (e.g. automobile, snowmobile, etc.)
• 4: Involved in a violent incident (e.g. assault, bullying, fighting, etc.)
• 5: Other
• 8: RF
• 9: DK

Oral Health Periodontics (OHP) - Question identifier:OHP_R005

Now I will examine your gums. You may feel a bit of discomfort and it is normal to taste a bit of blood. I will say numbers out loud so the recorder can input them into the computer.

Oral Health Probing and Bleeding Index (OHB) - Question identifier:OHB_N04A

Measure the probing depth of tooth ^DT_OHB_TEXTE in millimetres.

Use a probe to 'walk' around every present tooth and enter one score per tooth.

Round down any fractional millimetres to the lower whole millimetre. If the measurement is less than 0.5 mm record it as 0 mm. If a measurement is more than 9 mm, record it as 9 mm.

Min = 0; Max = 9

Oral Health Probing and Bleeding Index (OHB) - Question identifier:OHB_N04B

Re-enter the probing depth of tooth ^DT_OHB_TEXTE in millimetres.

Min = 0; Max = 9

Oral Health Probing and Bleeding Index (OHB) - Question identifier:OHB_N06

Check bleeding index of tooth ^DT_OHB_TEXTE.

• 1: Bleeding
• 2: No bleeding
• 9: DK

Oral Health Attachment Loss (OHS) - Question identifier:OHS_N02A

Measure the attachment loss of ^DT_OHS_TEXTE in millimetres.

Record the worst score of each sextant (by tooth or pair of teeth).

Round down any fractional millimetres to the lower whole millimetre. If the measurement is less than 0.5 mm record it as 0. If a measurement is more than 12 mm, record it as 12 mm.

Min = 0; Max = 12

Oral Health Attachment Loss (OHS) - Question identifier:OHS_N02B

Re-enter the attachment loss of ^DT_OHS_TEXTE in millimetres.

Min = 0; Max = 12

Oral Health Treatment Needs (OHN) - Question identifier:OHN_R005

We have completed the oral health examination. You may rinse your mouth and wipe your face if necessary.

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N010

Dentist to complete the following:

Record the treatment currently needed by the respondent.

• 01: No treatment needed
• 03: Fillings
• 05: Surgery
• 06: Periodontics
• 08: Endodontics
• 10: Soft tissue
• 11: Other - Specify

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N020

Record whether the respondent needs fillings urgently (within a week).

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N025

Was a serious medical condition that requires immediate attention (within 24 hours) discovered during the oral health examination?

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N030

Record whether the respondent needs surgery urgently (within a week).

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N035

Was a serious medical condition that requires immediate attention (within 24 hours) discovered during the oral health examination?

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N040

Record whether the respondent needs periodontics urgently (within a week).

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N045

Was a serious medical condition that requires immediate attention (within 24 hours) discovered during the oral health examination?

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N050

Record whether the respondent needs endodontics urgently (within a week).

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N055

Was a serious medical condition that requires immediate attention (within 24 hours) discovered during the oral health examination?

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N060

Record whether the respondent needs soft tissue treatment urgently (within a week).

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N065

Was a serious medical condition that requires immediate attention (within 24 hours) discovered during the oral health examination?

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N070

Record whether the respondent needs other ([OHN_S010/EMPTY]) treatment urgently (within a week).

• 1: Yes
• 2: No

Oral Health Treatment Needs (OHN) - Question identifier:OHN_N075

Was a serious medical condition that requires immediate attention (within 24 hours) discovered during the oral health examination?

• 1: Yes
• 2: No

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 wear the activity monitor 24/7, you should not remove it for sleeping.
• Since the device is waterproof please wear it all day long without interruption (when showering, swimming, taking a nap, etc.).

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

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 = 5

Activity Monitor (AM) - Question identifier:AM_N31B

Re-scan the bar code on the activity monitor.

Long Answer Length = 5

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.

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^DT_MULTIPLEE.

Stick the label^DT_MULTIPLEE to the urine container^DT_MULTIPLEE.

• 1: Print the label^DT_MULTIPLEE

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

Please scan the urine container.

Min = 70000000010; Max = 79999999999

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

Please scan the second urine container.

Min = 70000000010; Max = 79999999999

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 = 28

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 = 28

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

Please mail the sample^DT_MULTIPLEE in the provided envelope^DT_MULTIPLEE 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_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 2 (UC2) - Question identifier:UC2_N05

Press <1> to print urine label.

• 1: Continue

Urine Collection 2 (UC2) - Question identifier:UC2_N10

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

• 1: Yes
• 2: No

Replicate Anthropometric Component Introduction (RACI) - Question identifier:RACI_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?

Report of Measurements (RM) - Question identifier:RM_N90

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

• 1: Print the report

Exit Component Introduction (ECI) - Question identifier:ECI_R01

Before you leave, we have a few administrative steps.

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q12A

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.

Do we have your permission to combine this information?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

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 to share the data from this survey with Health Canada and the Public Health Agency of Canada.

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

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

Exit Consent Questions (ECQ) - Question identifier:ECQ_Q22

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

• 1: Yes
• 2: No
• 8: RF
• 9: DK

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, email address and address of a relative or friend who could help us to contact you.

• 1: Continue
• 8: RF

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

An interviewer may contact you in the coming days to collect another tap water sample to assess the concentration of metals in your water. I will now review the report with you to help you understand it. Do not hesitate if you have any questions about this report.

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 $150.

• 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_N25

Specify the reason why a reimbursement in excess of $150 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

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

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) - 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) - 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) - 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) - 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) - Question identifier:EA_Q01

I would like to confirm ^DT_YOUR2 e-mail address.
Is it ^EMAILADDRESS?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Electronic Address (EA) - Question identifier:EA_Q02

What is ^DT_YOUR2 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) - 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

Reason Not Done (RND) - Question identifier:RND_N1

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
• 07: Unable to position respondent in scanner
• 08: Respondent unable to hold still
• 09: Respondent refuses due to radiation
• 10: Unable to provide
• 11: Respondent fainted
• 12: Unable to find vein
• 13: Blood flow stopped
• 14: Physical limitation
• 20: Other - Specify