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NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Demographics and Health Form

246 Shared Subjects

N/A
Clinical Assessments
Demographics
02/10/2020
pax_demographics_form01
02/11/2020
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR*
src_subject_id String 20 Required Subject ID how it's defined in lab/project
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY
sex String 20 Required Sex of subject at birth
M;F; O; NR
M = Male; F = Female; O=Other; NR = Not reported demo_3, gender
country_origin String 100 Recommended Country of Origin demo_1
fspgod String 70 Recommended Subject's gender OTHER describe demo_4
ques_gendernotes String 255 Recommended Gender -Notes demo_4_6_text
ethnic_group String 255 Recommended Ethnic group demo_5
fsprg String 150 Recommended In your own words, to which race(s) or racial group(s) do you belong? demo_5_8_text
bkgrnd_education String 1,020 Recommended Subject's education (school and preschool) demo_6
sexual_or_descrip String 100 Recommended What is your sexual orientation? demo_8
sexual_orientation_descrip String 50 Recommended What is your sexual orientation? demo_8_6_text
resp_relstatus_other String 300 Recommended If not already listed, what is your relationship status? 777=Not applicable demo_9, demo_9_10_text
demo_10 Integer Recommended Do you have any siblings (biological, adopted, or step)? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable
demo_10a String 40 Recommended How many siblings do you have in total?
fhs_sibling1_age Integer Recommended Sibling #1: age (or age at death) demo_10b#1_1
fhs_sibling2_age Integer Recommended Sibling #2: age (or age at death) demo_10b#1_2
fhs_sibling3_age Integer Recommended Sibling #3: age (or age at death) demo_10b#1_3
fhs_sibling4_age Integer Recommended Sibling #4: age (or age at death) demo_10b#1_4
fhs_sibling5_age Integer Recommended Sibling #5: age (or age at death) demo_10b#1_5
demo_10b_1_6 Integer Recommended Age in years of Sibling 6 1::100;888 888 = non applicable demo_10b#1_6
demo_10b_1_7 Integer Recommended Age in years of Sibling 7 1::100;888 888 = non applicable demo_10b#1_7
demo_10b_1_8 Integer Recommended Age in years of Sibling 8 1::100;888 888 = non applicable demo_10b#1_8
demo_10b_2_1 Integer Recommended Relation (e.g. biological/adopted/step brother or sister) of sibling 1 1::10;888 1 = Biological Brother ; 2 = Biological Sister ; 3 = Adopted Brother ; 4 = Adopted Sister ; 5 = Step Brother ; 6 = Step Sister ; 7 = Half Brother ; 8 = Half Sister ; 9 = Other; 10 = Adopted siblings ; 888 = non applicable demo_10b#2_1
demo_10b_2_2 Integer Recommended Relation (e.g. biological/adopted/step brother or sister) of sibling 2 1::10;888 1 = Biological Brother ; 2 = Biological Sister ; 3 = Adopted Brother ; 4 = Adopted Sister ; 5 = Step Brother ; 6 = Step Sister ; 7 = Half Brother ; 8 = Half Sister ; 9 = Other; 10 = Adopted siblings ; 888 = non applicable demo_10b#2_2
demo_10b_2_3 Integer Recommended Relation (e.g. biological/adopted/step brother or sister) of sibling 3 1::10;888 1 = Biological Brother ; 2 = Biological Sister ; 3 = Adopted Brother ; 4 = Adopted Sister ; 5 = Step Brother ; 6 = Step Sister ; 7 = Half Brother ; 8 = Half Sister ; 9 = Other; 10 = Adopted siblings ; 888 = non applicable demo_10b#2_3
demo_10b_2_4 Integer Recommended Relation (e.g. biological/adopted/step brother or sister) of sibling 4 1::10;888 1 = Biological Brother ; 2 = Biological Sister ; 3 = Adopted Brother ; 4 = Adopted Sister ; 5 = Step Brother ; 6 = Step Sister ; 7 = Half Brother ; 8 = Half Sister ; 9 = Other; 10 = Adopted siblings ; 888 = non applicable demo_10b#2_4
demo_10b_2_5 Integer Recommended Relation (e.g. biological/adopted/step brother or sister) of sibling 5 1::10;888 1 = Biological Brother ; 2 = Biological Sister ; 3 = Adopted Brother ; 4 = Adopted Sister ; 5 = Step Brother ; 6 = Step Sister ; 7 = Half Brother ; 8 = Half Sister ; 9 = Other; 10 = Adopted siblings ; 888 = non applicable demo_10b#2_5
demo_10b_2_6 Integer Recommended Relation (e.g. biological/adopted/step brother or sister) of sibling 6 1::10;888 1 = Biological Brother ; 2 = Biological Sister ; 3 = Adopted Brother ; 4 = Adopted Sister ; 5 = Step Brother ; 6 = Step Sister ; 7 = Half Brother ; 8 = Half Sister ; 9 = Other; 10 = Adopted siblings ; 888 = non applicable demo_10b#2_6
demo_10b_2_7 Integer Recommended Relation (e.g. biological/adopted/step brother or sister) of sibling 7 1::10;888 1 = Biological Brother ; 2 = Biological Sister ; 3 = Adopted Brother ; 4 = Adopted Sister ; 5 = Step Brother ; 6 = Step Sister ; 7 = Half Brother ; 8 = Half Sister ; 9 = Other; 10 = Adopted siblings ; 888 = non applicable demo_10b#2_7
demo_10b_2_8 Integer Recommended Relation (e.g. biological/adopted/step brother or sister) of sibling 8 1::10;888 1 = Biological Brother ; 2 = Biological Sister ; 3 = Adopted Brother ; 4 = Adopted Sister ; 5 = Step Brother ; 6 = Step Sister ; 7 = Half Brother ; 8 = Half Sister ; 9 = Other; 10 = Adopted siblings ; 888 = non applicable demo_10b#2_8
have_children Integer Recommended Do you have children? 0;1 0 = No; 1 = Yes demo_11
numchild Integer Recommended number of children demo_11a
area5_explain String 360 Recommended Church, religion or spiritual orientation? Explain briefly demo_12
demoginfo15 String 50 Recommended Which religion do you currently practice? demo_12_12_text
demo__13 Integer Recommended How frequently do you attend religious community meetings (e.g., services, prayer meetings)? 1::5 1 = One or more times per week ; 2 = One or more times per month ; 3 = One or more times per year ; 4 = Less than once per year ; 5 = N/A - I do not attend religious community meetings demo_13
demo__14 Integer Recommended How religious and/or spiritual would you say you are?
1::6
1 = Very Religious/Spiritual ; 2 = Somewhat Religious/Spiritual ; 3 = Slightly Religious/Spiritual ; 4 = Not at All Religious/Spiritual ; 5 = Unsure ; 6 = Prefer Not to Answer demo_14
duf10_c Integer Recommended Do you exercise regularly? 0::2 0= No; 1= Yes; 2= Prefer not to answer demo_15
demo_15a String 30 Recommended Why do you exercise? (mark all that apply) 1 = Stress relief ; 2 = Health reasons ; 3 = Increase muscle mass ; 4 = Weight loss ; 5 = Preparing for a strength competition ; 6 = Preparing for an aerobic competition ; 7 = Physician directed ; 8 = Fun ; 9 = Other (please specify)
demo_15a_9_text String 80 Recommended Please specify other reason to exercise
demo__16 Integer Recommended Over the last two months, what was the average number of times you exercised or played sports for at least 30 minutes at at time? 1::9 1 = Never ; 2 = Less than 1 time per week ; 3 = 1 time per week ; 4 = 2 times per week ; 5 = 3 times per week ; 6 = 4 times per week ; 7 = 5 times per week ; 8 = 6 times per week ; 9 = 7 times or more per week demo_16
demo_17 Integer Recommended Over the last two months, how many times per week did you run or jog? 1::9 1 = Never ; 2 = Less than 1 time per week ; 3 = 1 time per week ; 4 = 2 times per week ; 5 = 3 times per week ; 6 = 4 times per week ; 7 = 5 times per week ; 8 = 6 times per week ; 9 = 7 times or more per week
demo__18 Integer Recommended Over the last two months, how many times per week did you lift weights or participate in other forms of strength conditioning exercise? 1::9 1 = Never ; 2 = Less than 1 time per week ; 3 = 1 time per week ; 4 = 2 times per week ; 5 = 3 times per week ; 6 = 4 times per week ; 7 = 5 times per week ; 8 = 6 times per week ; 9 = 7 times or more per week demo_18
demo__19 Integer Recommended How much do you think you exercise, relative to other people your age? 1::5 1 = A lot less ; 2 = A little less ; 3 = Average ; 4 = A little more ; 5 = A lot more demo_19
demo__20 Integer Recommended How fit do you think you are, relative to other people your age? 1::5 1 = A lot less ; 2 = A little less ; 3 = Average ; 4 = A little more ; 5 = A lot more demo_20
demo__21 Integer Recommended Which of the following are you currently trying to do about your weight? 1::3 1 = Trying to LOSE weight ; 2 = Trying to GAIN weight ; 3 = Maintain weight demo_21
demo__22 String 35 Recommended Which best describes your diet? (mark all that apply) 1 = Weight loss ; 2 = Vegetarian/Vegan ; 3 = Low salt/sodium ; 4 = Weight gain ; 5 = Cholesterol lowering ; 6 = High protein ; 7 = Low fat ; 8 = High carbohydrate ; 9 = Low carbohydrate ; 10 = No special diet ; 11 = Other (please specify) demo_22
prom_diet_other String 100 Recommended If you follow a diet other than those indicated above, please specify: demo_22_11_text
demo_23 Integer Recommended How do you consider your overall eating habits compared to others your same age? 1::4 1 = Poor ; 2 = Fair ; 3 = Good ; 4 = Excellent
demo_24 Integer Recommended On average, how many hours of sleep do you get in a 24-hour time period? 1::9 1 = 0 (less than 1 hour) ; 2 = 1 ; 3 = 2 ; 4 = 3 ; 5 = 4 ; 6 = 5 ; 7 = 6 ; 8 = 7 ; 9 = 8 or more hours
ksads_50 Integer Recommended Tobacco/Nicotine Use (ever smoked) 0;1;998;999 0= No dx; 1=Yes dx; 998=N/A; 999=Missing demo_25
smoke Integer Recommended Have you smoked at least 100 cigarettes (5 packs) in entire life 0;1 0=No; 1=Yes demo_25a
suq13c2 Float Recommended How old were you when you started using chewing tobacco on a pretty regular basis? demo_25b
demo_26 Integer Recommended Do you CURRENTLY use tobacco or nicotine products (cigarettes, e-cigarettes, pipes, cigars, smokeless tobacco chew, dipping, pinching)? 0;1 1 = Yes ; 0 = No
psqb20d String 1,000 Recommended Which tobacco products and how often demo_26a
esq3_1 String 200 Recommended If used other tobacco/nicotine products in past 24 hours: What kind and how much? demo_26a_5_text
demo_26b Integer Recommended When using these tobacco products (currently using), how often do you use them? 1::4 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly
demo_26c Integer Recommended How many tobacco products do you currently smoke or how often do you use these products on a typical day? 1::5 1 = 1 or 2 ; 2 = 3 or 4 ; 3 = 5 or 6 ; 4 = 7 to 9 ; 5 = 10 or more
demo_27_1 Integer Recommended Has anyone in your family ever received psychiatric treatment or been hospitalized for psychiatric reasons? 0::2;888 0 = No ; 1 = Yes ; 2 = Not Sure ; 888 = non applicable demo_27.1
demo_27_2 Integer Recommended Has anyone in your family received psychiatric treatment or been hospitalized for psychiatric reasons in the past 18 months? 0::2;888 0 = No ; 1 = Yes ; 2 = Not Sure ; 888 = non applicable demo_27.2
demo_27_3 Integer Recommended Has anyone in your family received psychiatric treatment or been hospitalized for psychiatric reasons in the past 6 months? 0::2;888 0 = No ; 1 = Yes ; 2 = Not Sure ; 888 = non applicable demo_27.3
additioninfo String 500 Recommended Additional family psychiatric information (if necessary): demo_27a
demo_28_1 Integer Recommended Does anyone in your family have a history of mental illness or alcohol/drug abuse? 0::2;888 0 = No ; 1 = Yes ; 2 = Not Sure ; 888 = non applicable demo_28.1
demo_28_2 Integer Recommended Has anyone in your family been diagnosed with a mental illness or alcohol/drug abuse in the past 18 months? 0::2;888 0 = No ; 1 = Yes ; 2 = Not Sure ; 888 = non applicable demo_28.2
demo_28_3 Integer Recommended Has anyone in your family been diagnosed with a mental illness or alcohol/drug abuse in the past 6 months? 0::2;888 0 = No ; 1 = Yes ; 2 = Not Sure ; 888 = non applicable demo_28.3
mentalhealth28 String 255 Recommended Describe other mental illnesses family members suffer from demo_28a
demo_29_1 Integer Recommended Has any member of your family ever made a suicide attempt? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_29.1
demo_29_2 Integer Recommended Has any member of your family made a suicide attempt in the past 18 months? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_29.2
demo_29_3 Integer Recommended Has any member of your family made a suicide attempt in the past 6 months? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_29.3
mentalhealth29 String 100 Recommended Who in family has attempted suicide? demo_29_1_text
demo_30_1 Integer Recommended Has any member of your family died from suicide? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_30.1
demo_30_2 Integer Recommended Has any member of your family died from suicide in the past 18 months? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_30.2
demo_30_3 Integer Recommended Has any member of your family died from suicide in the past 6 months? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_30.3
demo_30_1_text String 80 Recommended How is this person who died from suicide related to you?
demo_31 Integer Recommended Has anyone you know made a suicide attempt in the last 6 months? 0;1 1 = Yes ; 0 = No
demo_31_1_text String 80 Recommended What is your relationship to this person who made a suicide attempt in the last 6 months?
demo_32 Integer Recommended Are you CURRENTLY receiving mental health treatment or counseling? 0;1 0 = No ; 1 = Yes
demo_32a_1 String 15 Recommended Please mark the format and frequency of therapy you are currently utilizing (mark all that apply): Individual Therapy 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
demo_32a_2 Integer Recommended Please mark the format and frequency of therapy you are currently utilizing (mark all that apply): Group Therapy 1::5 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
demo_32a_3 Integer Recommended Please mark the format and frequency of therapy you are currently utilizing (mark all that apply): Couples of Family Therapy 1::5 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
demo_32a_4 Integer Recommended Please mark the format and frequency of therapy you are currently utilizing (mark all that apply): Intensive Outpatient Treatment/Partial Hospitalization Program 1::5 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
demo_32a_5 Integer Recommended Please mark the format and frequency of therapy you are currently utilizing (mark all that apply): Other Therapy (please specify): 1::5 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
other_tx String 100 Recommended Specify other specific therapy demo_32a_5_text
mht Integer Recommended Have you received any mental health treatment? 0;1;2;888 0= No; 1= Yes; 2 = Not Sure; 888 = non applicable demo_33.1
demo_33_2 Integer Recommended Have you received ANY mental health treatment or counseling in the past 18 months? 0::2;888 0 = No ; 1 = Yes ; 2 = Not Sure ; 888 = non applicable demo_33.2
demo_33_3 Integer Recommended Have you received ANY mental health treatment or counseling in the past 6 months? 0::2;888 0 = No ; 1 = Yes ; 2 = Not Sure ; 888 = non applicable demo_33.3
demo_33a_1 String 15 Recommended Please mark the format and frequency of therapy you have previously received (mark all that apply): Individual Therapy 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
demo_33a_2 Integer Recommended Please mark the format and frequency of therapy you have previously received (mark all that apply): Group Therapy 1::5 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
demo_33a_3 Integer Recommended Please mark the format and frequency of therapy you have previously received (mark all that apply): Couples or Family Therapy 1::5 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
demo_33a_4 Integer Recommended Please mark the format and frequency of therapy you have previously received (mark all that apply): Intensive Outpatient Treatment/Partial Hospitalization Program 1::5 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
demo_33a_5 Integer Recommended Please mark the format and frequency of therapy you have previously received (mark all that apply): Other Therapy (please specify): 1::5 1 = Two or More Times a Week ; 2 = Once a Week ; 3 = Bi-Weekly ; 4 = Once a Month ; 5 = Less Than Once a Month
othertherapy1_name String 200 Recommended Other Therapy1: If a therapy other than one listed was provided to participant, provide the name and description of the therapy demo_33a_5_text
demo_34_1 Integer Recommended Have you ever thought about receiving mental health treatment or counseling but did not? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_34.1
demo_34_2 Integer Recommended Have you thought about receiving mental health treatment or counseling in the past 18 months but did not? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_34.2
demo_34_3 Integer Recommended Have you thought about receiving mental health treatment or counseling in the past 6 months but did not? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_34.3
demo_34a String 35 Recommended What keeps you from getting involved in therapy? (mark all that apply) 1 = I don't trust mental health professionals ; 2 = I don't know where to get help ; 3 = I don't have adequate transportation ; 4 = It is difficult to schedule an appointment ; 5 = There would be difficulty finding time for treatment ; 6 = Mental health care costs too much money ; 7 = It would be too embarrassing ; 8 = I would be seen as weak ; 9 = Mental health care doesn't work ; 10 = Other, please specify
mhh4_ynot14 String 255 Recommended Why aren't you getting mental health treatment? Other (please specify) demo34a_10_text
hq_psymed Integer Recommended Are you currently taking any medication for a psychiatric or neurology problem (such as an antidepressant, an anti-anxiety medication, a mood stabilizer, an antipsychotic or an anticonvulsant? (See back of this sheet for names of medications). 0;1 0=No; 1=Yes demo_35
medname_mta String 200 Recommended What is the psychiatric medication name? demo_35a
demo_35b String 120 Recommended At what age did you begin taking your currently used psychiatric medication? For multiple medications, please specify the age for each medication.
demo_35c String 20 Recommended Who is your current prescriber for psychiatric medication? (mark all that apply) 1 = General Practitioner - University Health Center ; 2 = Psychiatrist - University Health Center ; 3 = General Practitioner - Outside the University ; 4 = Psychiatrist - Outside the University ; 5 = Other, Please specify ; 6 = Unsure
demo_35c_5_text String 40 Recommended Please specify other prescriber for psychiatric medication
demo_36_1 Integer Recommended Have you EVER taken any psychiatric medications? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_36.1
demo_36_2 Integer Recommended Have you taken any psychiatric medications in the past 18 months? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_36.2
demo_36_3 Integer Recommended Have you taken any psychiatric medications in the past 6 months? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_36.3
hx_psymeds_spec String 300 Recommended Please describe your history of taking psychiatric medication. demo_36a
ifyes_old_rx String 110 Recommended If you have EVER taken psychiatric medications, then how old were you? demo_36b
demo_36c String 20 Recommended Who was the prescriber for your previous psychiatric medication? (mark all that apply) 1 = General Practitioner - University Health Center ; 2 = Psychiatrist - University Health Center ; 3 = General Practitioner - Outside the University ; 4 = Psychiatrist - Outside the University ; 5 = Other, Please specify ; 6 = Unsure
demo_36c_5_text String 40 Recommended Please specify prescriber for your previous psychiatric medication
pgr_othmed Integer Recommended Taken other medications 0;1 1=yes; 0=no demo_37
cortisol35 String 200 Recommended Please describe other therapies, medications, dosage, and frequency of usage demo_37a
demo_38 Integer Recommended Do you currently or have you in the past 6 months, taken any dietary supplements (e.g. vitamins, pre-workout, performance enhancers, weight loss pills, caffeine pills, protein powder, etc.). 0;1 1 = Yes ; 0 = No
currmed_supplement String 255 Recommended Supplements (Herbal, Vitamin, etc.) (Supplement, Dose, Frequency, Reason) demo_38a
demo_39_1 Integer Recommended In the last 12 months, have you been on birth control pills or any other hormonal therapy? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_39.1
demo_39_2 Integer Recommended In the last 6 months, have you been on birth control pills or any other hormonal therapy? 0;1;888 1 = Yes ; 0 = No ; 888 = non applicable demo_39.2
cortisol17 String 200 Recommended Please describe hormonal contraceptives used demo_39a
demo_39b String 60 Recommended At what age did you begin birth control or any other hormonal therapy?
demo_40_1_1 Integer Recommended Caffeine use: How Often - Brewed Coffee (hot or cold) (1 drink = 8 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_40#1_1
demo_40_1_2 Integer Recommended Caffeine use: How Often - Cappuccino (1 drink = 8 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_40#1_2
demo_40_1_3 Integer Recommended Caffeine use: How Often - Frozen blended coffee drink (1 drink = 8 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_40#1_3
demo_40_1_4 Integer Recommended Caffeine use: How Often - Hot brewed Tea (1 drink = 8 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_40#1_4
demo_40_1_5 Integer Recommended Caffeine use: How Often - Iced Tea (1 drink = 8 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_40#1_5
demo_40_1_6 Integer Recommended Caffeine use: How Often - Espresso (report number of shots) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_40#1_6
demo_40_1_6a Integer Recommended Caffeine use: Espresso: number of shots demo_40#1_6a
demo_40_2_1 Integer Recommended Caffeine use: Number of Cups/Bottles - Brewed Coffee (hot or cold) (1 drink = 8 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_40#2_1
demo_40_2_2 Integer Recommended Caffeine use: Number of Cups/Bottles - Cappuccino (1 drink = 8 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_40#2_2
demo_40_2_3 Integer Recommended Caffeine use: Number of Cups/Bottles - Frozen blended coffee drink (1 drink = 8 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_40#2_3
demo_40_2_4 Integer Recommended Caffeine use: Number of Cups/Bottles - Hot brewed Tea (1 drink = 8 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_40#2_4
demo_40_2_5 Integer Recommended Caffeine use: Number of Cups/Bottles - Iced Tea (1 drink = 8 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_40#2_5
demo_40_2_6 Integer Recommended Caffeine use: Number of Cups/Bottles - Espresso (report number of shots) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_40#2_6
demo_41_1_1 Integer Recommended Caffeine use: How Often - Cola-Type (1 can = 12 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_41#1_1
demo_41_1_2 Integer Recommended Caffeine use: How Often - Coke Blak (coffee flavored cola) (1 can = 12 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_41#1_2
demo_41_1_3 Integer Recommended Caffeine use: How Often - Pepsi MAX (1 can = 12 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_41#1_3
demo_41_1_4 Integer Recommended Caffeine use: How Often - Pepper-Type (Dr. Pepper, Mr. PIBB, etc.) (1 can = 12 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_41#1_4
demo_41_1_5 Integer Recommended Caffeine use: How Often - Mountain Dew/Mellow Yellow (1 can = 12 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_41#1_5
demo_41_1_6 Integer Recommended Caffeine use: How Often - Vault Soda (1 can = 12 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_41#1_6
demo_41_1_7 Integer Recommended Caffeine use: How Often - Sunkist (just this brand) (1 can = 12 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_41#1_7
demo_41_1_8 Integer Recommended Caffeine use: How Often - Barq's Root Beer (regular only/just this brand) (1 can = 12 oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_41#1_8
demo_41_2_1 Integer Recommended Caffeine use: Number of Cups/Bottles - Cola-Type (1 can = 12 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_41#2_1
demo_41_2_2 Integer Recommended Caffeine use: Number of Cups/Bottles - Coke Blak (coffee flavored cola) (1 can = 12 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_41#2_2
demo_41_2_3 Integer Recommended Caffeine use: Number of Cups/Bottles - Pepsi MAX (1 can = 12 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_41#2_3
demo_41_2_4 Integer Recommended Caffeine use: Number of Cups/Bottles - Pepper-Type (Dr. Pepper, Mr. PIBB, etc.) (1 can = 12 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_41#2_4
demo_41_2_5 Integer Recommended Caffeine use: Number of Cups/Bottles - Mountain Dew/Mellow Yellow (1 can = 12 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_41#2_5
demo_41_2_6 Integer Recommended Caffeine use: Number of Cups/Bottles - Vault Soda (1 can = 12 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_41#2_6
demo_41_2_7 Integer Recommended Caffeine use: Number of Cups/Bottles - Sunkist (just this brand) (1 can = 12 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_41#2_7
demo_41_2_8 Integer Recommended Caffeine use: Number of Cups/Bottles - Barq's Root Beer (regular only/just this brand) (1 can = 12 oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_41#2_8
demo_42_1_1 Integer Recommended Caffeine use: How Often - 5-Hr Energy Shot (2.5 fl oz) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_1
demo_42_1_2 Integer Recommended Caffeine use: How Often - AMP Energy Drink (16 fl oz can) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_2
demo_42_1_3 Integer Recommended Caffeine use: How Often - Full Throttle (16 fl oz can) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_3
demo_42_1_4 Integer Recommended Caffeine use: How Often - Glaceau Vitaminwater Energy (20 fl oz bottle) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_4
demo_42_1_5 Integer Recommended Caffeine use: How Often - Monster Energy Drink (16 fl oz can) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_5
demo_42_1_6 Integer Recommended Caffeine use: How Often - Red Bull Energy Drink (8.3 fl oz can) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_6
demo_42_1_7 Integer Recommended Caffeine use: How Often - Rip it Energy Drink (8.5 fl oz can) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_7
demo_42_1_8 Integer Recommended Caffeine use: How Often - Rock Star Energy Drink (16 fl oz can) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_8
demo_42_1_9 Integer Recommended Caffeine use: How Often - SoBe adrenaline sport drink (16 fl oz can) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_9
demo_42_1_10 Integer Recommended Caffeine use: How Often - SoBe Energy Citrus (16 fl oz can) 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_10
demo_42_1_11 Integer Recommended Caffeine use: How Often - Other caffeinated energy drink 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_42#1_11
demo_42_1_11_text String 40 Recommended Caffeine use: Please specify other caffeinated energy drink (reporting by frequency) demo_42#1_11_text
demo_42_2_1 Integer Recommended Caffeine use: Number of Cups/Bottles - 5-Hr Energy Shot (2.5 fl oz) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_1
demo_42_2_2 Integer Recommended Caffeine use: Number of Cups/Bottles - AMP Energy Drink (16 fl oz can) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_2
demo_42_2_3 Integer Recommended Caffeine use: Number of Cups/Bottles - Full Throttle (16 fl oz can) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_3
demo_42_2_4 Integer Recommended Caffeine use: Number of Cups/Bottles - Glaceau Vitaminwater Energy (20 fl oz bottle) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_4
demo_42_2_5 Integer Recommended Caffeine use: Number of Cups/Bottles - Monster Energy Drink (16 fl oz can) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_5
demo_42_2_6 Integer Recommended Caffeine use: Number of Cups/Bottles - Red Bull Energy Drink (8.3 fl oz can) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_6
demo_42_2_7 Integer Recommended Caffeine use: Number of Cups/Bottles - Rip it Energy Drink (8.5 fl oz can) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_7
demo_42_2_8 Integer Recommended Caffeine use: Number of Cups/Bottles - Rock Star Energy Drink (16 fl oz can) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_8
demo_42_2_9 Integer Recommended Caffeine use: Number of Cups/Bottles - SoBe adrenaline sport drink (16 fl oz can) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_9
demo_42_2_10 Integer Recommended Caffeine use: Number of Cups/Bottles - SoBe Energy Citrus (16 fl oz can) 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_10
demo_42_2_11 Integer Recommended Caffeine use: Number of Cups/Bottles - Other 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_42#2_11
demo_42_2_11_text String 40 Recommended Caffeine use: Please specify other caffeinated energy drink (reporting by number, if different from that reported by frequency) demo_42#2_11_text
demo_43_1_1 Integer Recommended Caffeine use: How Often - Jolt gum 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_43#1_1
demo_43_1_2 Integer Recommended Caffeine use: How Often - Stay Alert gum 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_43#1_2
demo_43_1_3 Integer Recommended Caffeine use: How Often - Vivarin/NoDoz Maximum 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_43#1_3
demo_43_1_4 Integer Recommended Caffeine use: How Often - NoDoz regular/Generic Caffeine pills 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_43#1_4
demo_43_1_5 Integer Recommended Caffeine use: How Often - Dexatrim or other weight control aids 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_43#1_5
demo_43_1_6 Integer Recommended Caffeine use: How Often - Bayer Headache Relief/Excedrin pills 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_43#1_6
demo_43_1_7 Integer Recommended Caffeine use: How Often - Other 1::5 1 = Daily ; 2 = Weekly ; 3 = Monthly ; 4 = Yearly ; 5 = Never demo_43#1_7
demo_43_1_7_text String 40 Recommended Caffeine use: Please specify: other caffeinated candy/gum/supplement (reported by frequency) demo_43#1_7_text
demo_43_2_1 Integer Recommended Caffeine use: Number of Doses - Jolt gum 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_43#2_1
demo_43_2_2 Integer Recommended Caffeine use: Number of Doses - Stay Alert gum 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_43#2_2
demo_43_2_3 Integer Recommended Caffeine use: Number of Doses - Vivarin/NoDoz Maximum 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_43#2_3
demo_43_2_4 Integer Recommended Caffeine use: Number of Doses - NoDoz regular/Generic Caffeine pills 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_43#2_4
demo_43_2_5 Integer Recommended Caffeine use: Number of Doses - Dexatrim or other weight control aids 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_43#2_5
demo_43_2_6 Integer Recommended Caffeine use: Number of Doses - Bayer Headache Relief/Excedrin pills 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_43#2_6
demo_43_2_7 Integer Recommended Caffeine use: Number of Doses - Other 1::6 1 = 0 None ; 2 = 1-2 ; 3 = 3-4 ; 4 = 5-6 ; 5 = 7-9 ; 6 = 10 or more demo_43#2_7
demo_43_2_7_text String 40 Recommended Caffeine use: Please specify: other caffeinated candy/gum/supplement (reported by number, if different from that reported by frequency) demo_43#2_7_text
version_form String 121 Recommended Form used/assessment name
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

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