| CDE ID | CDE Description | | * 421 | EDRN Participant ID (Go To: 773) |
| * 773 | Visit code (Go To: 422) |
| | | Permissible Values (value): | BLN1 (1) |
|
| | |
| | |
| | |
| * 422 | EDRN Site ID (Go To: 423) |
| * 423 | EDRN Protocol ID (Go To: 929) |
| * 929 | EDRN Staff ID of the person who collected the data: (Go To: 807) |
| * 807 | Date of baseline visit: (Go To: 799) |
| 799 | Height [in inches] (What is your total current height in inches?) (Go To: 440) |
| 440 | Weight [in pounds] (What is your current weight [in pounds]? (Go To: 435) |
| 435 | Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 436) |
| | | Permissible Values (value): | No (0) |
|
| | |
| | |
| 436 | Race (What is your race? Check all that apply.) (Go To: 434) |
| | | Permissible Values (value): | White (1) |
|
| | | | Black or African-American (2) |
|
| | | | American Indian or Alaska Native (3) |
|
| | |
| | | | Native Hawaiian or other Pacific Islander (7) |
|
| | | | Other, specify: (97) (Go To: 793) |
|
| | |
| 793 | Race (Other,specify) (Go To: 434) |
| 434 | Gender (What is your gender?) (Go To: 819) |
| | | Permissible Values (value): | Male (1) |
|
| | |
| 459 | Have menstrual periods stopped due to natural menopause, hysterectomy, the removal of both ovaries, or radiation or chemotherapy treatment? (Have your menstrual periods stopped due to natural menopause, hysterectomy, the removal of both ovaries, or radiation or chemotherapy treatment?) (Go To: 458) |
| | | Permissible Values (value): | No (0) |
|
| | |
| | |
| 460 | Age when menstrual periods stopped (How old were you when your menstrual periods stopped?) (Go To: 458) |
| 458 | Age of first menstrual period? (How old were you when you first started having menstrual periods?) (Go To: 819) |
| 819 | Number of living and deceased blood-related daughters: (How many living and deceased blood-related daughters do you have? [Not including adopted, foster, or step-daughters] (Go To: 818) |
| 818 | Number of living and deceased blood-related sons: (How many living and deceased blood-related sons do you have? [Not including adopted, foster, or step-sons] (Go To: 820) |
| 820 | Number of living and deceased first-degree blood brothers: (How many living and deceased blood-related brothers do you have? [Not including adopted, foster, half-brothers or step-brothers] (Go To: 821) |
| 821 | Number of living and deceased first-degree blood sisters: (How many living and deceased blood-related sisters do you have? [Not including adopted, foster, half-sisters or step-sisters] (Go To: 1085) |
| * 1085 | 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: 783) |
| | | Permissible Values (value): | No (0) |
|
| | |
| | |
| * 1084 | How many of the participant´s living and deceased first degree blood relatives have been diagnosed with cancer [other than basal/squamous cell skin cancer]? (How many of your living and deceased first degree blood relatives (biological parents, siblings, children) have been diagnosed with cancer [other than basal/squamous cell skin cancer]? [Not including half-siblings, step-siblings, step-parents, or step-children].) (Go To: 1200) |
| * 1200 | Relative type (mother, brother, etc) (Go To: 850) |
| | | Permissible Values (value): | Brother (1) |
|
| | |
| | |
| | |
| | |
| | |
| | |
| * 850 | First primary cancer: (Go To: 798) |
| | | Permissible Values (value): | Bladder (1) |
|
| | |
| | |
| | |
| | |
| | |
| | |
| | | | Head & neck (mouth, nose, and throat) (8) |
|
| | |
| | |
| | |
| | |
| | | | Lymphoma, including Hodgkins (13) |
|
| | |
| | |
| | |
| | |
| | | | Skin (melanoma, no basal or squamous) (18) |
|
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| * 798 | Age at which family member's first cancer was diagnosed: (Go To: 851) |
| * 851 | Subsequent primary cancer(s): (Go To: 783) |
| | | Permissible Values (value): | Bladder (1) |
|
| | |
| | |
| | |
| | |
| | |
| | |
| | | | Head & neck (mouth, nose, and throat) (8) |
|
| | |
| | |
| | |
| | |
| | | | Lymphoma, including Hodgkins (13) |
|
| | |
| | |
| | |
| | |
| | | | Skin (melanoma, no basal or squamous) (18) |
|
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| 783 | On average, how many glasses of wine do you drink? Count a four-ounce glass of wine as one drink. (Go To: 784) |
| | | Permissible Values (value): | None (4) |
|
| | |
| | |
| | |
| | |
| | |
| 784 | On average, how many glasses/cans of beer do you drink? Count a twelve-ounce can as one beer. (Go To: 782) |
| | | Permissible Values (value): | None (4) |
|
| | |
| | |
| | |
| | |
| | |
| 782 | On average, how many shots of hard liquor or mixed drinks do you drink? Count one shot (1 1/2 ounces) or one mixed drink as one drink. (Go To: 930) |
| | | Permissible Values (value): | None (4) |
|
| | |
| | |
| | |
| | |
| | |
| 930 | Has participant ever been exposed to agent orange? (Have you ever been exposed to agent orange?) (Go To: End of Form) |
| | | Permissible Values (value): | No (0) |
|
| | |
| | |