Form:	NOD Baseline Participant Questionnaire v5.0

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 423)
1832	Participant initials: (Go To: 423)
* 423	EDRN Protocol ID (Go To: 422)
* 422	EDRN Site ID (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 1219)
* 1219	Date of contact (MM/DD/YYYY): (Go To: 4223)
* 4223	Weight (value): (Go To: 4224)
* 4224	Weight (unit): (Go To: 4221)
	Permissible Values (value): kg (kilograms) (1) (Go To: 4783)
	lbs (pounds) (2) (Go To: 4783)
	Unknown (99)
* 4783	Weight measurement method (Go To: 4221)
	Permissible Values (value): On a scale, in real time (1)
	Medical records (2)
	Patient recall (3)
	Unknown (99)
* 4221	Height (value): (Go To: 4222)
* 4222	Height (unit): (Go To: 4933)
	Permissible Values (value): cm (centimeters) (1) (Go To: 4784)
	inches (2) (Go To: 4784)
	Unknown (99)
* 4784	Height measurement method (Go To: 4933)
	Permissible Values (value): Stadiometer (1)
	Medical records (2)
	Patient recall (3)
	Unknown (99)
* 4933	Weight (value), second instance (Go To: 4934)
* 4934	Weight (unit), 2nd instance (Go To: 5023)
	Permissible Values (value): kg (kilograms) (1)
	lbs (pounds) (2)
	Unknown (99)
* 5023	Weight (value), third instance (Go To: 5022)
* 5022	Weight (unit), 3rd instance (Go To: 1322)
	Permissible Values (value): kg (kilograms) (1)
	lbs (pounds) (2)
	Unknown (99)
* 1322	Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 1315)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 1315	Race (What is your race? Check all that apply.) (Go To: 1600)
	Permissible Values (value): White (1)
	Black or African-American (2)
	American Indian or Alaska Native (3)
	Asian (4)
	Native Hawaiian or other Pacific Islander (7)
	Prefer not to answer (89)
	Other, specify: (97) (Go To: 1294)
	Unknown (99)
* 1294	Race (Other, specify) (Go To: 1600)
* 1600	Ashkenazi (Eastern European) Jewish decent: (Is your biological mother or father of Ashkenazi (Eastern European) Jewish decent?) (Go To: 5661)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 5661	Do you think of yourself as: (Go To: 5662)
	Permissible Values (value): Male (1)
	Female (2)
	Prefer not to answer (89)
	Other (95)
	Unknown (99)
* 5662	What was your sex assigned at birth? (Go To: 2979)
	Permissible Values (value): Male (1)
	Female (2)
	Prefer not to answer (89)
	Other (95)
	Unknown (99)
* 2979	History of pancreatitis? (Pancreatitis is an inflammation of the pancreas. It can be short-term or long-term) (Go To: 3251)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 3251	Gallstones and/or sludge present? (Go To: 1623)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 1623	Do you have stomach ulcers, or peptic ulcer disease? (Go To: 1307)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 1307	Ever had cancer [other than basal/squamous cell skin cancer] confirmed by a doctor? (Have you ever had cancer [other than basal/squamous cell skin cancer] confirmed by a doctor?) (Go To: 2275)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1341)
	Prefer not to answer (89)
	Unknown (99)
* 1341	Cancer type/location (Go To: 2275)
	Permissible Values (value): Bladder (1)
	Bone (2)
	Brain (3)
	Breast (4)
	Cervix (5)
	Colon (6)
	Esophagus (7)
	Head & neck (mouth, nose, and throat) (8)
	Kidney (9)
	Liver (10)
	Leukemia (11)
	Lung (12)
	Lymphoma, including Hodgkins (13)
	Ovary (14)
	Pancreas (15)
	Prostate (16)
	Rectum (17)
	Skin (melanoma, no basal or squamous) (18)
	Stomach (19)
	Thyroid (20)
	Uterus (21)
	Endometrium (22)
	Testis (24)
	Vagina (26)
	Gall bladder (40)
	Mesothelioma (42)
	Multiple myeloma (44)
	Prefer not to answer (89)
	Other (95)
	Unknown (99)
* 2275	Chemotherapy used? (Go To: 2477)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 2477	Radiation therapy used? (Go To: 4794)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 4792)
	Prefer not to answer (89)
	Unknown (99)
* 4792	Condition(s) that were treated (Check all that apply) (Go To: 4793)
	Permissible Values (value): Acne (1)
	Thyroid (2)
	Cancer (3)
	Other (95)
	Prefer not to answer (89)
	Unknown (99)
* 4793	Body area(s) that were treated (check all that apply) (Go To: 4794)
	Permissible Values (value): Head (1)
	Neck (2)
	Chest (3)
	Upper back/spine (4)
	Abdomen (5)
	Groin (6)
	Arms (7)
	Legs (8)
	Lower back/pelvis (9)
	Prefer not to answer (89)
	Unknown (99)
* 4794	Allergies (Check all that apply): (Go To: 3165)
	Permissible Values (value): Seasonal (pollen, mold, etc.) (1)
	Environmental (cats, dogs, dust, etc.) (2)
	Foods (eggs, milk, peanuts, etc.) (3)
	Medications (aspirin, antibiotics, etc.) (4)
	No known allergies (5)
	Prefer not to answer (89)
	Unknown (99)
3165	Has a doctor diagnosed you with yellow jaundice? (Yellow jaundice, in which the skin/eyes turn a yellowish color, is a symptom of liver problems.) (Go To: 4795)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 4795	Has the participant experienced any of the following symptoms? (Check all that apply) (Go To: 5658)
	Permissible Values (value): None (0)
	Nausea (1)
	Vomiting (2)
	Indigestion (5)
	Heart burn (6)
	Prefer not to answer (89)
	Unknown (99)
* 5658	Experience back pain? (Go To: 5659)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 5026)
	Prefer not to answer (89)
	Unknown (99)
* 5026	Severity of back pain (Go To: 5659)
	Permissible Values (value): No pain (0)
	Mild pain (does not require narcotics) (1)
	Severe pain (requires narcotics) (2)
	Prefer not to answer (89)
	Unknown (99)
* 5659	Experience abdominal pain? (Go To: 4796)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 5025)
	Prefer not to answer (89)
	Unknown (99)
* 5025	Severity of abdominal pain (Go To: 4796)
	Permissible Values (value): No pain (0)
	Mild pain (does not require narcotics) (1)
	Severe pain (requires narcotics) (2)
	Prefer not to answer (89)
	Unknown (99)
* 4796	How often do you have a drink containing alcohol? (Go To: 1300)
	Permissible Values (value): Never (1)
	Monthly or less (2) (Go To: 4797)
	2-4 times a month (3) (Go To: 4797)
	2-3 times a week (4) (Go To: 4797)
	4 or more times a week (5) (Go To: 4797)
	Prefer not to answer (89)
	Unknown (99)
* 4797	On the days that you do drink, how many drinks do you have on average? (Go To: 1300)
	Permissible Values (value): 1-2 (1)
	3-4 (2)
	5-6 (3)
	7-8 (4)
	9-10 (5)
	>10 (6)
	Prefer not to answer (89)
	Unknown (99)
* 1300	Ever smoke cigarettes regularly, at least one a day for a year or more? (Did you ever smoke cigarettes regularly, at least one a day for a year or more?) (Go To: 4798)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1299)
	Prefer not to answer (89)
	Unknown (99)
* 1299	Currently smoke at least one cigarette a day? (Do you currently smoke cigarettes regularly, at least one a day?) (Go To: 1297)
	Permissible Values (value): No (0) (Go To: 1298)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 1298	Age quit smoking cigarettes? (How old were you when you permanently quit smoking cigarettes?) (Go To: 1297)
* 1297	Age first began smoking cigarettes regularly, at least one a day? (How old were you when you began smoking cigarettes regularly, at least one a day?) (Go To: 1325)
* 1325	Average number of cigarettes smoked per day? (During the time you have smoked, on average, how many cigarettes did you smoke per day?) (Go To: 1301)
* 1301	Total number of years smoked? (How many years total have you smoked?) (Go To: 1715)
* 1715	Total number of pack years smoked. (Go To: 4798)
* 4798	Have you ever lived with someone who smoked regularly? (Go To: 5027)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 5027	My appetite is (Go To: 5028)
	Permissible Values (value): Very poor (1)
	Poor (2)
	Average (3)
	Good (4)
	Very good (5)
	Prefer not to answer (89)
	Unknown (99)
* 5028	When I eat (Go To: 5029)
	Permissible Values (value): I feel full after eating only a few mouthfuls (1)
	I feel full after eating about a third of a meal (2)
	I feel full after eating over half a meal (3)
	I feel full after eating most of the meal (4)
	I hardly ever feel full (5)
	Prefer not to answer (89)
	Unknown (99)
* 5029	Food tastes (Go To: 5030)
	Permissible Values (value): Very bad (1)
	Bad (2)
	Average (3)
	Good (4)
	Very good (5)
	Prefer not to answer (89)
	Unknown (99)
* 5030	Normally I eat (Go To: 4799)
	Permissible Values (value): Less than one meal a day (1)
	One meal a day (2)
	Two meals a day (3)
	Three meals a day (4)
	More than three meals a day (5)
	Prefer not to answer (89)
	Unknown (99)
* 4799	Rate the level of your lack of appetite (Go To: 4801)
	Permissible Values (value): I dont have a lack of appetite (1)
	Very mild (can usually be ignored) (2) (Go To: 4800)
	Mild (can be ignored if I don’t think about it) (3) (Go To: 4800)
	Moderate (cannot be ignored, but does not affect your lifestyle) (4) (Go To: 4800)
	Severe (affects your life) (5) (Go To: 4800)
	Very severe (markedly affects your life) (6) (Go To: 4800)
	Prefer not to answer (89)
	Unknown (99)
* 4800	Have you experienced a lack of appetite? (Go To: 4801)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 4801	How would you compare your appetite (desire to eat) now to what it was 12 months ago? (Go To: 4802)
	Permissible Values (value): The same (1)
	Increased (2)
	Slightly reduced (about 75% of normal) (3)
	Moderately reduced (about 50% of normal) (4)
	Markedly reduced (about 25% of normal or less) (5)
	Prefer not to answer (89)
	Unknown (99)
* 4802	Have you experienced fatigue, breathlessness, and/or chest pain? (Go To: 4806)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 4803)
	Prefer not to answer (89)
	Unknown (99)
* 4803	Which of the following describes your ability to carry out your usual activities? (Go To: 4806)
	Permissible Values (value): I am able to carry out my usual activities. (1)
	I can carry out my usual activities with effort. (2)
	I am unable to carry out my usual activities. (3)
	Prefer not to answer (89)
	Unknown (99)
* 4806	Hours per week spent on low intensity cardiovascular activities (i.e. walking, shopping, leisure and etc.) (Go To: 4807)
* 4807	Hours per week spent on high intensity cardiovascular activities (i.e. cycling, running and etc.) (Go To: 1045)
* 1045	Performance status (Which of the following options would you say describes your current performance status?) (Go To: 4804)
	Permissible Values (value): Fully active, able to carry on all pre-disease performance without restriction (0)
	Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work (1)
	Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours (2)
	Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours (3)
	Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair (4)
	Prefer not to answer (89)
	Unknown (99)
* 4804	What kind of job have you held for the longest period of time? (Go To: 4805)
	Permissible Values (value): Manufacturing (1)
	Chemical (2)
	Construction (3)
	Truck Driver (4)
	Agriculture (5)
	Sandblasting (6)
	Non-Specific Office Job (7)
	Mining (8)
	Marketing (10)
	Health Care Worker (11)
	Education (12)
	Airline Industry (13)
	Welding (9)
	Other (95)
	Not applicable (98) (Go To: 3269)
	Prefer not to answer (89)
	Unknown (99) (Go To: 3269)
* 4805	How many years total did you work at that job? (Go To: 4808)
	Permissible Values (value): 6 months-1 year (1)
	2-4 years (2)
	5-10 years (3)
	>10 years (4)
	Not applicable (98)
	Prefer not to answer (89)
	Unknown (99)
* 4808	What kind of tools or equipment did you work with? (Check all that apply) (Go To: 4809)
	Permissible Values (value): Electronic Devices (1)
	Electronic/Power Generation (2)
	Material Handling (3)
	Plant/Refinery Equipment (4)
	Heavy Equipment/Vehicle Operation (5)
	Chemicals (6)
	Other (95)
	Not applicable (98)
	Prefer not to answer (89)
	Unknown (99)
* 4809	Where did you spend most of your time while working on that job? (Go To: 3269)
	Permissible Values (value): Inside Office (1)
	Inside Warehouse (2)
	Inside Vehicle (3)
	Outside in open area (4)
	Construction Site (5)
	Outside at chemical plant/ refinery (6)
	Other (95)
	Not applicable (98)
	Prefer not to answer (89)
	Unknown (99)
* 3269	Have you ever had genetic testing? (Go To: 4810)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 4811)
	Prefer not to answer (89)
	Unknown (99)
* 4811	Genetic and/or hereditary condition(s) (Check all that apply): (Go To: 4810)
	Permissible Values (value): Hereditary pancreatitis (1)
	BRCA 1/2 related breast and/or ovarian cancer (2)
	FAMMM (familial atypical multiple mole/ melanoma) Syndrome (3)
	Lynch syndrome (HNPCC) (4)
	Peutz-Jeghers syndrome (5)
	ATM gene mutation (6)
	Cystic Fibrosis (7)
	Prefer not to answer (89)
	Other, specify: (97) (Go To: 4829)
	Unknown (99)
* 4829	Genetic and/or hereditary condition(s). Other, specify (Go To: 4810)
* 4810	Are you adopted? (Go To: 3144)
	Permissible Values (value): No (0)
	Yes, with access to family health history (1)
	Yes, with no access to family health history (3) (Go To: 1097)
	Prefer not to answer (89)
	Unknown (99)
* 3144	Number of loops: (Go To: 3200)
	Permissible Values (value): 1 (1)
	2 (2)
	3 (3)
	4 (4)
	5 (5)
	6 (6)
	7 (7)
	8 (8)
	9 (9)
	10 (10)
	11 (11)
	12 (12)
	13 (13)
	14 (14)
	15 (15)
	16 (16)
	17 (17)
	18 (18)
	19 (19)
	20 (20)
	21 (21)
	22 (22)
	23 (23)
	24 (24)
	25 (25)
	26 (26)
	27 (27)
	28 (28)
	29 (29)
	30 (30)
	31 (31)
	32 (32)
	33 (33)
	34 (34)
	35 (35)
	36 (36)
	37 (37)
	38 (38)
	40 (40)
* 3200	Line number or identifier (system-generated): (Go To: 3199)
* 3199	Relative type (for medical condition): (Go To: 4815)
	Permissible Values (value): Brother (1)
	Sister (2)
	Son (3)
	Daughter (4)
	Father (5)
	Mother (6)
* 4815	Relative vital status (Go To: 4816)
	Permissible Values (value): Alive (0)
	Deceased (1)
	Prefer not to answer (89)
	Unknown (99)
* 4816	Relative cigarette smoking (Go To: 4817)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 4817	Relative diabetes (Go To: 4818)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 4818	Relative pancreatitis (Go To: 4819)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 4819	Relative pancreatic cancer (Go To: 1349)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 1349	Have any of the participant´s living and deceased first degree blood relatives been diagnosed with cancer [other than basal/squamous cell skin cancer]? (Have any of your living and deceased first degree blood relatives (biological parents, siblings, children) been diagnosed with cancer [other than basal/squamous cell skin cancer]? [Not including half-siblings, step-siblings, step-parents, or step-children]. (Go To: 4813)
	Permissible Values (value): No (0)
	Yes (1)
	Prefer not to answer (89)
	Unknown (99)
* 4813	Family member genetic and/or hereditary condition(s) (check all that apply): (Go To: 3158)
	Permissible Values (value): No (0)
	Hereditary pancreatitis (1)
	BRCA 1/2 related breast and/or ovarian cancer (2)
	FAMMM (familial atypical multiple mole/ melanoma) Syndrome (3)
	Lynch syndrome (HNPCC) (4)
	Peutz-Jeghers syndrome (5)
	ATM gene mutation (6)
	Cystic Fibrosis (7)
	Other, specify: (97) (Go To: 4814)
	Prefer not to answer (89)
	Unknown (99)
* 4814	Family member genetic and/or hereditary condition(s) Other, specify (Go To: 3158)
3158	Loop-specific comments: (Go To: 1097)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)