Item
1. In the last year, have you gained or lost more than 10 pounds?
integer
C0043094 (UMLS CUI [1])
Code List
1. In the last year, have you gained or lost more than 10 pounds?
CL Item
lost more than 10 pounds (1)
CL Item
gained more than 10 pounds (2)
CL Item
both lost and gained more than 10 pounds (3)
Item
2 During the last year, how would you compare your TOTAL average daily intake of food to your intake of food when we saw you last year?
integer
C0559267 (UMLS CUI [1])
Code List
2 During the last year, how would you compare your TOTAL average daily intake of food to your intake of food when we saw you last year?
CL Item
Eat a lot more (1)
CL Item
Eat a little more (2)
CL Item
Eat about the same (3)
CL Item
Eat a little less (4)
CL Item
Eat a lot less (5)
Item
A. If you answered EAT A LOT MORE or EAT A LITTLE MORE, the main reason why is:
integer
C0559267 (UMLS CUI [1,1])
C0205217 (UMLS CUI [1,2])
Code List
A. If you answered EAT A LOT MORE or EAT A LITTLE MORE, the main reason why is:
CL Item
A doctor recommended that I eat more (1)
CL Item
I am taking medicine that increases my appetite (2)
CL Item
My physical activity has increased (3)
CL Item
I am more able to shop or prepare food than before (4)
CL Item
A medical or dental problem has improved (5)
CL Item
My appetite has increased for other reasons (6)
Item
B. If you answered EAT A LOT LESS or EAT A LITTLE LESS, the main reason why is:
integer
C0559267 (UMLS CUI [1,1])
C0205216 (UMLS CUI [1,2])
Code List
B. If you answered EAT A LOT LESS or EAT A LITTLE LESS, the main reason why is:
CL Item
A doctor recommended that I eat less (1)
CL Item
I am taking medicine that decreases my appetite (2)
CL Item
My physical activity has decreased (3)
CL Item
I am less able to shop or prepare food than before (4)
CL Item
A medical or dental problem interferes with eating (5)
CL Item
My appetite has decreased for other reasons (6)
food intake other reason
Item
If OTHER REASONS, please specify:
text
C0559267 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
Item
3 Are you following a special diet?
integer
C3164710 (UMLS CUI [1])
Code List
3 Are you following a special diet?
Item
A. What is the purpose of the diet? To lose weight
integer
C0012167 (UMLS CUI [1])
Code List
A. What is the purpose of the diet? To lose weight
Item
A. What is the purpose of the diet? To gain weight
integer
C0043094 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? To gain weight
Item
A. What is the purpose of the diet? For diabetes
integer
C0011849 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For diabetes
Item
A. What is the purpose of the diet? For kidney failure
integer
C0035078 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For kidney failure
Item
A. What is the purpose of the diet? For ulcers
integer
C0041582 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For ulcers
Item
A. What is the purpose of the diet? For diverticulitits
integer
C0156163 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For diverticulitits
Item
A. What is the purpose of the diet? For allergies
integer
C0020517 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For allergies
Item
A. What is the purpose of the diet? For heart trouble
integer
C0018799 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For heart trouble
Item
A. What is the purpose of the diet? For high blood pressure
integer
C0020538 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For high blood pressure
Item
A. What is the purpose of the diet? For other reason
integer
C3840932 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For other reason
diet for other reasons
Item
Other:
text
C3840932 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Item
B. What kind of diet is it? Low calorie
integer
C2930544 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low calorie
Item
B. What kind of diet is it? High calorie
integer
C0301590 (UMLS CUI [1])
Code List
B. What kind of diet is it? High calorie
Item
B. What kind of diet is it? High protein
integer
C0425403 (UMLS CUI [1])
Code List
B. What kind of diet is it? High protein
Item
B. What kind of diet is it? Low fat
integer
C0242970 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low fat
Item
B. What kind of diet is it? High fat
integer
C0521974 (UMLS CUI [1])
Code List
B. What kind of diet is it? High fat
Item
B. What kind of diet is it? Low carbohydrate
integer
C0259836 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low carbohydrate
Item
B. What kind of diet is it? High carbohydrate
integer
C0259835 (UMLS CUI [1])
Code List
B. What kind of diet is it? High carbohydrate
Item
B. What kind of diet is it? Low sugar
integer
C0452316 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low sugar
Item
B. What kind of diet is it? Low salt
integer
C0012169 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low salt
Item
B. What kind of diet is it? Low cholesterol
integer
C2243019 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low cholesterol
Item
B. What kind of diet is it? Low fiber
integer
C0344356 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low fiber
Item
B. What kind of diet is it? High fiber
integer
C0301568 (UMLS CUI [1])
Code List
B. What kind of diet is it? High fiber
Item
B. What kind of diet is it? Bland diet
integer
C0301572 (UMLS CUI [1])
Code List
B. What kind of diet is it? Bland diet
Item
B. What kind of diet is it? Other diet
integer
C0012155 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Code List
B. What kind of diet is it? Other diet
other diet specify
Item
Other:
text
C0012155 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
diet duration
Item
C. About how long have you been following this diet? YEARS
integer
C0012155 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
diet duration
Item
C. About how long have you been following this diet? MONTHS
integer
C0012155 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Item
D. Was this diet recommended by your physician?
integer
C0012155 (UMLS CUI [1,1])
C0583555 (UMLS CUI [1,2])
Code List
D. Was this diet recommended by your physician?
CL Item
lost more than 10 pounds (1)
CL Item
gained more than 10 pounds (2)
CL Item
both lost and gained more than 10 pounds (3)
Item
4 Have you gone off a special diet since we saw you last year?
integer
C0012155 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
Code List
4 Have you gone off a special diet since we saw you last year?
Item
A. What is the purpose of the diet? To lose weight
integer
C0012167 (UMLS CUI [1])
Code List
A. What is the purpose of the diet? To lose weight
Item
A. What is the purpose of the diet? To gain weight
integer
C0043094 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? To gain weight
Item
A. What is the purpose of the diet? For diabetes
integer
C0011849 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For diabetes
Item
A. What is the purpose of the diet? For kidney failure
integer
C0035078 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For kidney failure
Item
A. What is the purpose of the diet? For ulcers
integer
C0041582 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For ulcers
Item
A. What is the purpose of the diet? For diverticulitits
integer
C0156163 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For diverticulitits
Item
A. What is the purpose of the diet? For allergies
integer
C0020517 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For allergies
Item
A. What is the purpose of the diet? For heart trouble
integer
C0018799 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For heart trouble
Item
A. What is the purpose of the diet? For high blood pressure
integer
C0020538 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For high blood pressure
Item
A. What is the purpose of the diet? For other reason
integer
C3840932 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Code List
A. What is the purpose of the diet? For other reason
diet for other reasons
Item
Other:
text
C3840932 (UMLS CUI [1,1])
C3164710 (UMLS CUI [1,2])
Item
B. What kind of diet is it? Low sugar
integer
C0452316 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low sugar
Item
B. What kind of diet is it? Low salt
integer
C0012169 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low salt
Item
B. What kind of diet is it? Low cholesterol
integer
C2243019 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low cholesterol
Item
B. What kind of diet is it? Low fiber
integer
C0344356 (UMLS CUI [1])
Code List
B. What kind of diet is it? Low fiber
Item
B. What kind of diet is it? High fiber
integer
C0301568 (UMLS CUI [1])
Code List
B. What kind of diet is it? High fiber
Item
B. What kind of diet is it? Bland diet
integer
C0301572 (UMLS CUI [1])
Code List
B. What kind of diet is it? Bland diet
Item
B. What kind of diet is it? Other diet
integer
C0012155 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Code List
B. What kind of diet is it? Other diet
other diet specify
Item
Other:
text
C0012155 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
diet duration
Item
C. About how long have you been following this diet? YEARS
integer
C0012155 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
diet duration
Item
C. About how long have you been following this diet? MONTHS
integer
C0012155 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Item
D. Was this diet recommended by your physician?
integer
C0012155 (UMLS CUI [1,1])
C0583555 (UMLS CUI [1,2])
Code List
D. Was this diet recommended by your physician?
Item
5 Have you smoked more than 100 cigarettes or 5 packs of cigarettes in your lifetime?
integer
C3172644 (UMLS CUI [1])
Code List
5 Have you smoked more than 100 cigarettes or 5 packs of cigarettes in your lifetime?
Item
6 Have you smoked cigarettes during the last 30 days?
integer
C0543414 (UMLS CUI [1,1])
C3845590 (UMLS CUI [1,2])
Code List
6 Have you smoked cigarettes during the last 30 days?
Item
7 Does anyone living with you smoke cigarettes regularly?
integer
C0543414 (UMLS CUI [1,1])
C0020052 (UMLS CUI [1,2])
Code List
7 Does anyone living with you smoke cigarettes regularly?
Item
8 Have you ever lived for at least one year in the same household with someone (including a parent or spouse) who smoked cigarettes regularly?
integer
C0543414 (UMLS CUI [1,1])
C0020052 (UMLS CUI [1,2])
Code List
8 Have you ever lived for at least one year in the same household with someone (including a parent or spouse) who smoked cigarettes regularly?
years smoker in household
Item
A. For how many years in total have you lived with someone who smoked cigarettes regularly?
integer
C0543414 (UMLS CUI [1,1])
C0020052 (UMLS CUI [1,2])
C0439234 (UMLS CUI [1,3])
years heavy smoker in household
Item
B. For how many years was that person a heavy smoker, that is, smoked more than 1 pack of cigarettes a day?
integer
C0857118 (UMLS CUI [1,1])
C0020052 (UMLS CUI [1,2])
C0439234 (UMLS CUI [1,3])
Item
9 Can you see well enough (with glasses if needed) to drive?
integer
C0042789 (UMLS CUI [1])
Code List
9 Can you see well enough (with glasses if needed) to drive?
Item
10 Can you see well enough (with glasses if needed) to watch TV?
integer
C0042789 (UMLS CUI [1])
Code List
10 Can you see well enough (with glasses if needed) to watch TV?
Item
11 Can you see well enough (with glasses if needed) to recognize someone across the room?
integer
C0042789 (UMLS CUI [1])
Code List
11 Can you see well enough (with glasses if needed) to recognize someone across the room?
sight reading newspaper
Item
12 Can you see well enough (with glasses if needed) to read the newspaper?
text
C0042789 (UMLS CUI [1,1])
C0034754 (UMLS CUI [1,2])
Item
13 Can you hear well enough (with a hearing aid if necessary) to use the telephone?
integer
C0018767 (UMLS CUI [1,1])
C0039457 (UMLS CUI [1,2])
Code List
13 Can you hear well enough (with a hearing aid if necessary) to use the telephone?
Item
14 Can you hear well enough (with a hearing aid if necessary) to listen to a radio?
integer
C0018767 (UMLS CUI [1])
Code List
14 Can you hear well enough (with a hearing aid if necessary) to listen to a radio?
Item
15 Can you hear well enough (with a hearing aid if necessary) to carry on a conversation in a crowded room?
integer
C0018767 (UMLS CUI [1,1])
C0871703 (UMLS CUI [1,2])
Code List
15 Can you hear well enough (with a hearing aid if necessary) to carry on a conversation in a crowded room?
miles walked
Item
16 Think about the walking you do outside your home. During the last week, about how many city blocks or miles did you walk?
integer
C0080331 (UMLS CUI [1,1])
C0331865 (UMLS CUI [1,2])
Item
Blocks or miles
integer
C0429886 (UMLS CUI [1])
Code List
Blocks or miles
Item
17 When you walk outside your home, what is your usual pace?
text
C1821542 (UMLS CUI [1])
Code List
17 When you walk outside your home, what is your usual pace?
CL Item
No walking at all (No walking at all)
CL Item
Casual strolling (0 to 2 miles per hour) (Casual strolling (0 to 2 miles per hour))
CL Item
Average or normal (2 to 3 miles per hour) (Average or normal (2 to 3 miles per hour))
CL Item
Fairly briskly (3 to 4 miles per hour) (Fairly briskly (3 to 4 miles per hour))
CL Item
Brisk or striding (greater than 4 MPH) (Brisk or striding (greater than 4 MPH))
CL Item
Don't know (Don't know)
Item
18 How would you describe your level of physical activity since we saw you last year?
text
C0026606 (UMLS CUI [1])
Code List
18 How would you describe your level of physical activity since we saw you last year?
CL Item
A lot less active (A lot less active)
CL Item
A little less active (A little less active)
CL Item
About as active (About as active)
CL Item
A little more active (A little more active)
CL Item
A lot more active (A lot more active)
CL Item
Don't know (Don't know)
Item
19 Are you currently taking Premarin for hot flashes or other symptoms of menopause?
integer
C0699710 (UMLS CUI [1,1])
C0847860 (UMLS CUI [1,2])
Code List
19 Are you currently taking Premarin for hot flashes or other symptoms of menopause?
Item
20 Are you currently taking any estrogens or female hormones other than Premarin for hot flashes or other symptoms of menopause?
integer
C0014939 (UMLS CUI [1,1])
C0847860 (UMLS CUI [1,2])
Code List
20 Are you currently taking any estrogens or female hormones other than Premarin for hot flashes or other symptoms of menopause?