ONS/REC: 1 = WITHIN LAST 2 WEEKS 2 = 2 WEEKS TO < 1 MONTH 3 = 1 MONTH TO < 6 MONTHS 4 = 6 MONTHS TO < 1 YEAR 5 = 1 YEAR OR LONGER
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- Garry Phelps
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1 ONS/REC: 1 = WITHIN LAST 2 WEEKS 2 = 2 WEEKS TO < 1 MONTH 3 = 1 MONTH TO < 6 MONTHS 4 = 6 MONTHS TO < 1 YEAR 5 = 1 YEAR OR LONGER CARD_ONS.WPD: 05/01/2001
2 CARD A LIFE EVENTS Record these events on the comorbidity timeline. Before we get started, I want to ask you some real quick questions about some special or important things that may have happened in your life. 1. Have you ever moved from one house or apartment to another? 2. Have you ever changed schools? 3. Have you ever had a favorite teacher? 4. Have you had any special family vacations? 5. Have you ever gone away to camp? 6. Have you ever had a pet? 7. Have you had any other (special or unique) experiences that stand out in your mind (that were very important to you)? OK. Now we can start the interview questions. CARD_A.WPD: 05/01/2001
3 CARD A-1 CODE Native American/American Indian Asian Pacific Islander African-American/Black, not of Hispanic origin African-American/Black, of Hispanic origin Caucasian/White, not of Hispanic origin Caucasian/White, of Hispanic origin Other CARD_A1.WPD: 05/01/2001
4 CARD F ALCOHOL EQUIVALENTS BEER/LITE BEER 1 12-oz. bottle/can of beer... 1 DRINK 1 case of beer DRINKS 1 40-oz. bottle of beer DRINKS WINE (INCLUDES CHAMPAGNE) 1 glass of wine (5-6 oz.)... 1 DRINK 1 bottle of wine (750 ml)... 6 DRINKS 1 liter of wine... 6 DRINKS 1 "wine cooler" (12 oz.)... 1 DRINK HARD LIQUOR 1 highball, or shot glass... 1 DRINK 1/2 pint of liquor... 6 DRINKS 1 pint of liquor DRINKS 1 fith of liquor DRINKS 1 quart of liquor DRINKS 1 liter of liquor DRINKS 1 gallon DRINKS OTHER 1 12-oz. bottle of malt liquor... 1 DRINK 1 pint of fortified wine (e.g., Mad Dog)... 6 DRINKS 1 fith of fortified wine (e.g., Mad Dog)... 8 DRINKS 1 DRINK = APPROXIMATELY 9 GM ABSOLUTE ALCOHOL CARD_F.WPD: 05/01/2001
5 CARD F1 FREQUENCY CODES Daily times/week times/week times/month times/month Once every 2-4 months times ever Never CARD_F1.WPD: 05/01/2001
6 BARBITURATES SEDATIVES SLEEPING PILLS SECONAL VALIUM LIBRIUM TRANQUILIZERS QUAALUDES XANAX COCAINE CRACK COCA LEAVES AMPHETAMINES SPEED STIMULANTS WHITE CROSSES BLACK BEAUTIES CRANK CRYSTAL METH CARD H OPIATES HEROIN CODEINE DEMEROL MORPHINE PERCODAN METHADONE DARVON OPIUM DILAUDID PRESCRIPTION PAIN KILLERS HALLUCINOGENS PSYCHEDELICS LSD (Acid) MESCALINE PEYOTE PSILOCYBIN (Mushrooms) DMT PCP (Angel Dust) INHALANTS GLUE TOLUENE GASOLINE PAINT PAINT THINNERS OTHER KHAT BETEL NUT NITROUS OXIDE AMYL NITRITE ECSTASY CARD_H.WPD: 05/01/2001
7 COCAINE CRACK COCA LEAVES AMPHETAMINES SPEED STIMULANTS WHITE CROSSES BLACK BEAUTIES CRANK CRYSTAL METH CARD J-1 OPIATES HEROIN CODEINE DEMEROL MORPHINE PERCODAN METHADONE DARVON OPIUM DILAUDID PRESCRIPTION PAIN KILLERS BARBITURATES SEDATIVES SLEEPING PILLS SECONAL VALIUM LIBRIUM TRANQUILIZERS QUAALUDES XANAX MARIJUANA HASHISH HALLUCINOGENS PSYCHEDELICS LSD (Acid) MESCALINE PEYOTE PSILOCYBIN (Mushrooms) DMT PCP (Angel Dust) CARD_J1.WPD: 05/01/2001
8 CARD J-2 Cimetidine (Tagamet) Clonidine Dexedrine Ephedrine Guaifenesin (cough medicines, expectorants, Robitussin, Sinutab, Sudafed, Triaminic) Phenylpropanolamine (Diet pills, Dexatrim, Acutrim, children's cold tablets) Propanolol (blood pressure medication) Ritalin (Methylphenidate) Steroids (Dexamethasone, Prednisone) CARD_J2.WPD: 05/01/2001
9 CARD L Sedatives Barbiturates Sleeping Pills Valium Librium Tranquilizers Quaaludes Xanax Stimulants Cocaine Crack Coca Leaves Amphetamines Speed White Crosses Black Beauties Crank Dexedrine Ephedrine Phenylpropanolamine (Diet pills, Dexatrim, Acutrim, children's cold tablets) Ritalin Steroids (Dexamethasone, Prednisone) Marijuana CARD_L.WPD: 05/01/2001
10 CARD_S.WPD: 05/01/2001 CARD S WEIGHT CHART GIRLS BOYS Height Age (years) Height Age (years) '4" 36 3'4" 36 3'5" 37 3'5" '6" 39 3'6" '7" '7" '8" '8" '9" '9" ' '10" '11" '11" ' ' '1" '1" '2" '2" '3" '3" '4" '4" '5" '5" '6" '6" '7" '7" '8" '8" '9" '9" '10" '10" '11" '11" ' ' '1" '1" '2" '2" '3" '3" '4" '4" '5" '5" '6" '6" '7" '7" '8" '8" '9" '9" ' '10" '11" '11" ' 6' '1" 6'1" '2" Adapted from K-SADS-E (H. Orvaschel and J. Puig-Antich, February, 1987). 6'3" 6'4"
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