Form 2 - Eligibility Screening
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- Jennifer Powell
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1 ID WHI Common ID Col#1 F2DAYS F2 Days since randomization Col#2 N Missing Min Max Mean Std Dev F2CONT Contact type Col#3 The method used to collect the data. 1 Phone 65, Mail 55, Visit 40, Other 1, AREA3Y Living in area for next 3 years Col#4 Do you think you will be living in this area for the next three years? 0 No Yes 161, Missing OTHSTDY In other research study Col#5 Are you now in any other research study? 0 No 157, Yes 4, Missing EXSTDY Excluded study Col#6 Is study on CC list of excluding studies? 0 No 4, Yes Missing 157, Sub-question of F2 V3 Q9 "In any other study". BRCA_F2 Breast cancer ever Col#7 Did a doctor ever say that you had breast cancer? 0 No 156, Yes 5, Missing COLON_F2 Colorectal cancer ever Col#8 Did a doctor ever say that you had colon, rectum, bowel or intestinal cancer? Page 1 of 14
2 0 No 160, Yes Missing COLON10Y Colorectal cancer last 10 years Col#9 Were you told that you had this cancer in the last 10 years? 0 No Yes Missing 160, Sub-question of F2 V3 Q11 "Cancer-colon,rectum". ENDO_F2 Endometrial cancer ever Col#10 Did a doctor ever say that you had endometrial cancer (cancer of the lining of the uterus or womb)? 0 No 159, Yes 2, Missing ENDO10Y Endometrial cancer last 10 years Col#11 Were you told that you had this cancer in the last 10 years? 0 No 1, Yes Missing 159, Sub-question of F2 V3 Q12 "Cancer-endometrial". SKIN_F2 Skin cancer ever Col#12 Did a doctor ever say that you had skin cancer? 0 No 144, Yes 17, Missing MELAN_F2 Melanoma cancer ever Col#13 Was the skin cancer a melanoma? 0 No 159, Yes 1, Missing Page 2 of 14
3 MELAN10Y Melanoma cancer last 10 years Col#14 Were you told that you had this melanoma in the last 10 years? 0 No 1, Yes Missing 159, Sub-question of F2 V3 Q13 "Cancer-skin". Sub-question of F2 V3 Q13.1 "Cancer-melanoma". OTHCA10Y Any other cancer than listed last 10 yrs Col#15 In the past 10 years, did a doctor ever say that you had any other cancers? 0 No 156, Yes 1, Missing 4, RACE Racial or ethnic group Col#16 How would you describe your racial or ethnic group? If you are of mixed blood, which group do you identify with most? 1 American Indian or Alaskan Native Asian or Pacific Islander 4, Black or African-American 14, Hispanic/Latino 6, White (not of Hispanic origin) 133, Other 1, Missing HEARSTDY Reason for contacting study Col#17 How did you hear about the study? (Mark one. If you heard in more than one way, mark the one that made you decide to contact us.) 1 Mailed letter 83, Brochure 16, T.V. 5, Radio 1, Newspaper or Magazine 24, Meeting 1, Friend or Relative 15, Other 10, Missing 1, Page 3 of 14
4 HORM Female hormones ever Col#18 Did you ever use any female hormones like estrogen (Premarin) or progesterone (Provera)?These might be pills, skin patches, implants, creams, suppositories, shots, or birth control pills. (This does not include birth control pills you used before you were 50.) 0 No 52, Yes 104, Missing 4, HORMNW Female hormones now Col#19 Are you using female hormones now? 0 No 36, Yes 68, Missing 57, Sub-question of F2 V3 Q17 "Female hormones ever". HORM3M Female hormones last 3 months Col#20 Have you used female hormones in the last 3 months? 0 No 33, Yes 1, Missing 126, Sub-question of F2 V3 Q17 "Female hormones ever". Sub-question of F2 V3 Q17.1 "Female hormones now". OSTEOBK Osteoporosis-related fracture ever Col#21 Have you ever had an osteoporosis-related fracture or broken bone? (Osteoporosis is a condition where bones become brittle and weak as a woman ages.) 0 No 100, Yes 2, Missing 58, Sub-question of F2 V3 Q17 "Female hormones ever". Page 4 of 14
5 HORMBK Hormones to treat osteoporosis fracture Col#22 Did a doctor give you hormones to treat the fracture or broken bone? 0 No 2, Yes Missing 159, Sub-question of F2 V3 Q17 "Female hormones ever". Sub-question of F2 V3 Q17.3 "Osteoporosis-related fracture". HYST Hysterectomy ever Col#23 Did you ever have a hysterectomy? (This is an operation to take out your uterus or womb.) 0 No 94, Yes 67, Missing HYST3M Hysterectomy last 3 months Col#24 Was your hysterectomy within the last 3 months? 0 No 66, Yes Missing 94, Sub-question of F2 V3 Q18 "Ever had a hysterectomy". HYSTAGE Age at hysterectomy Col#25 How old were you when you had your hysterectomy? 1 Less than 30 3, , , , , , , or older 3, Missing 94, Sub-question of F2 V3 Q18 "Ever had a hysterectomy". Page 5 of 14
6 MENSELST Last time had any menstrual bleeding Col#26 When was the last time you had any menstrual bleeding or spotting? (Your best guess.) 1 Still having menstrual bleeding 7, Within last 6 months 3, to 12 months ago 2, Over 12 months ago 145, Missing 2, MEALOUT 10 or more meals prepared away from home Col#27 How many of your meals are prepared away from your home each week, that is, meals that you eat in a restaurant, or as "take-out", or at friends' or relatives' houses? 1 Less than 10 meals each week 156, or more meals each week 5, Missing MALDIET Special malabsorption diet Col#28 Are you following a special diet prescribed by a doctor for malabsorption, celiac sprue (sometimes this is called a gluten-free diet), ulcerative colitis, or Crohn's disease? (We know that these may be unfamiliar words. If you have not been told to follow one of these diets, mark No.) 0 No 156, Yes Missing 4, LFDIETF2 Special low-fiber diet Col#29 Are you following a special low-fiber or low-residue diet (low in fruits, vegetables, and grains) that was prescribed for you by your doctor? 0 No 156, Yes Missing 4, DIAB Diabetes ever Col#30 Did a doctor ever say that you had sugar diabetes or high blood sugar when you were not pregnant? 0 No 152, Yes 9, Missing Page 6 of 14
7 DIABAGE Age first told had diabetes Col#31 How old were you when you were first told you had sugar diabetes? (Don't include diabetes you had only when pregnant.) 1 Less than , , , or older Missing 152, Sub-question of F2 V3 Q23 "Sugar diabetes". DIABCOMA Hospitalized for a diabetic coma Col#32 Were you ever hospitalized for a diabetic coma? 0 No 9, Yes Missing 152, Sub-question of F2 V3 Q23 "Sugar diabetes". DBDIETF2 Special diet for diabetes Col#33 Did a doctor ever tell you to keep a special diet for your diabetes? 0 No 2, Yes 7, Missing 152, Sub-question of F2 V3 Q23 "Sugar diabetes". INSULIN Insulin shots ever Col#34 Did you ever take insulin shots? 0 No 6, Yes 2, Missing 152, Sub-question of F2 V3 Q23 "Sugar diabetes". Page 7 of 14
8 INSULINW Insulin shots now Col#35 Are you using insulin now? 0 No Yes 2, Missing 159, Sub-question of F2 V3 Q23 "Sugar diabetes". Sub-question of F2 V3 Q23.4 "Ever taken insulin". DIABPILL Pills for diabetes ever Col#36 Did you ever take pills for your diabetes to lower your blood sugar? 0 No 2, Yes 6, Missing 152, Sub-question of F2 V3 Q23 "Sugar diabetes". DIABNW Diabetes now Col#37 Do you have sugar diabetes or high blood sugar now? 0 No 2, Yes 7, Missing 152, Sub-question of F2 V3 Q23 "Sugar diabetes". DVT DVT ever Col#38 Did a doctor ever say that you had a blood clot in your legs? This is sometimes called deep vein thrombosis or DVT. This does not include varicose veins or phlebitis. 0 No 156, Yes 5, Missing DVT6M DVT last 6 months Col#39 Did you have a blood clot in your leg in the last 6 months? 0 No 5, Yes Missing 156, Sub-question of F2 V3 Q24 "Blood clot in legs". Page 8 of 14
9 DVTACC1M DVT 1 month after accident Col#40 Did this blood clot occur within one month after a serious accident, fracture, injury, or operation? 0 No 2, Yes 2, Missing 156, Sub-question of F2 V3 Q24 "Blood clot in legs". PE Pulmonary embolism ever Col#41 Did a doctor ever say that you had a blood clot in your lung? This is sometimes called a pulmonary embolus or PE. 0 No 160, Yes 1, Missing PE6M Pulmonary embolism last 6 months Col#42 Did you have a blood clot in your lung in the last 6 months? 0 No 1, Yes Missing 160, Sub-question of F2 V3 Q25 "Blood clot in lung". PEACC1M Pulmonary embolism 1 mo after accident Col#43 Did this blood clot occur within one month after a serious accident, fracture, injury, or operation? 0 No Yes Missing 160, Sub-question of F2 V3 Q25 "Blood clot in lung". STROKE Stroke ever Col#44 Did a doctor ever say that you had a stroke? 0 No 159, Yes 2, Missing Page 9 of 14
10 STROKE6M Stroke last 6 months Col#45 Did you have a stroke in the last 6 months? 0 No 2, Yes Missing 159, Sub-question of F2 V3 Q26 "Stroke ever". TIA TIA ever Col#46 Did a doctor ever say that you had a small stroke that lasted less than 24 hours? This is sometimes called a transient ischemic attack or TIA. 0 No 158, Yes 3, Missing TIA6M TIA last 6 months Col#47 Did you have a TIA in the last 6 months? 0 No 3, Yes Missing 158, Sub-question of F2 V3 Q27 "Small stroke ever". MI MI ever Col#48 Did a doctor ever say that you had a heart attack? This is sometimes called a coronary, myocardial infarction, or MI. 0 No 158, Yes 3, Missing MIAGE Age first had MI Col#49 How old were you when you had your first heart attack? (Your best guess.) 1 Less than , , or older Missing 158, Sub-question of F2 V3 Q28 "Heart attack ever". Page 10 of 14
11 MI6M MI last 6 months Col#50 Did you have a heart attack in the last 6 months? 0 No 3, Yes Missing 158, Sub-question of F2 V3 Q28 "Heart attack ever". SCANEMIA Sickle cell anemia ever Col#51 Did a doctor ever say that you had any of the following health problems? (Please mark No or Yes for each problem listed.) Sickle cell anemia? 0 No 161, Yes Missing CHF_F2 Heart failure ever Col#52 Did a doctor ever say that you had any of the following health problems? (Please mark No or Yes for each problem listed.) Heart failure? 0 No 160, Yes 1, Missing LIVERDIS Liver disease ever Col#53 Did a doctor ever say that you had any of the following health problems? (Please mark No or Yes for each problem listed.) Liver disease (chronic active hepatitis, cirrhosis, or yellow jaundice)? 0 No 157, Yes 3, Missing BLDPROB Bleeding problem ever Col#54 Did a doctor ever say that you had any of the following health problems? (Please mark No or Yes for each problem listed.) Bleeding problem? 0 No 157, Yes 4, Missing L15LBS6M Lost 15 lbs in the last 6 mo w/o trying Col#55 Have you lost 15 or more pounds in the last 6 months without trying? 0 No 161, Yes Missing DIALYSIS Kidney dialysis for kidney failure Col#56 Page 11 of 14
12 Are you on kidney dialysis or a kidney machine for kidney or renal failure? 0 No 161, Yes Missing OTHCHRON Other long-term illness Col#57 Do you have any other long-term or chronic illness? 0 No 111, Yes 49, Missing HARDSTDY Problems make it hard to participate Col#58 Are there any reasons, like serious emotional problems, mental illness, or too much stress, that would make it hard for you to be in a research study? 0 No 149, Yes Missing 12, COMECC Able to come to clinic Col#59 Will you be able to come to our clinic? 0 No Yes 161, Missing HELPCC Kind of help needed to come to clinic Col#60 What kind of help would you need to come to our clinic? 1 Transportation Child care Adult care Other Missing 161, Sub-question of F2 V3 Q34 "Able to get to clinic". INTDM Interested in DM part of study Col#61 Do you think you might be interested in the Dietary Change part of the study? 0 No 23, Yes 103, Don't know 31, Missing 3, Page 12 of 14
13 AVAILDM Available for regular dietary meetings Col#62 If you join the dietary part of the study, you will be placed in a dietary change or usual diet group. You may be attending regular group meetings. Will you be available for regular meetings for the next year? 0 No 3, Yes 122, Missing 35, Sub-question of F2 V3 Q35 "Interested in diet". INTHRT Interested in HRT part of study Col#63 Do you think you might be interested in the Hormone Replacement part of the study? 0 No 76, Yes 34, Don't know 46, Missing 3, AVAILHRT Consider taking only HRT from CC Col#64 If you join the hormone part of the study, you may be placed into the hormone or no-hormone (placebo) group. Would you consider taking only the hormone pills given to you by Clinical Center staff if you join the hormone part of the study? 0 No 2, Yes 36, Don't know 36, Missing 85, Sub-question of F2 V3 Q36 "Interested in HRT". TALKDOC Interested in talking to Dr. about HRT Col#65 If you are currently on hormones, are you interested in talking to your doctor about the Hormone Replacement part of the study? 0 No 5, Yes 20, Not on hormones 33, Don't know 9, Missing 92, Sub-question of F2 V3 Q36 "Interested in HRT". Page 13 of 14
14 HRTINFDR Send HRT info to Doctor Col#66 Would you like us to send information about the Hormone Replacement part of the study to your doctor? 0 No 30, Yes 33, Missing 97, Sub-question of F2 V3 Q36 "Interested in HRT". HELPFILL Need someone to help fill out forms Col#67 Will you need someone to help you fill out forms if you join this study? 0 No 142, Yes 2, Missing 16, HORMSTAT HRT use ever Col#68 Computed from Form 2, questions 17 and Combines questions 17 and 17.1 into a three category HRT use variable (never, past, current). 0 Never used hormones 52, Past hormone user 36, Current hormone user 68, Missing 4, AGEHYST Hysterectomy age group Col#69 Computed from Form 2, questions 18 and Collapses age at hysterectomy categories from question 18.2 into four groups. Set to missing if no hysterectomy, or age at hysterectomy is missing. 1 < 40 22, , , , Missing 94, DIABTRT Diabetes treated (pills or shots) Col#70 Computed from Form 2, question 23, 23.4 and Indicator for whether the participant has ever been treated for diabetes with pills or shots. 0 No 154, Yes 7, Missing Page 14 of 14
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