skip top navigation
National Cancer Institute   U.S. National Institutes of Healthwww.cancer.gov
Finland
Finland
ATBC Study

Questionnaires and Forms

Baseline Risk Factor Questionnaires
Dietary History
Follow-Up Questionnaires
Other Forms

To view the PDF files on this site, you will need Adobe Acrobat Reader.

Baseline Risk Factor Questionnaires

Baseline Form 1
    1. Name, Address, Personal Identifiers, Phone Number
    2. Residence
    3. Marital Status
    4. Education
    5. Vocational Training
    6. Occupation
    7. Medical History
    8. Dental Health
    9. Physical Activity
    10. Smoking History
    11. Drug and Vitamin Use
Baseline Form 2
    1. Height, Weight, Blood Pressure, Heart Rate, Visual Acuity
    2. Medical Symptoms (dyspnea, chest pain, claudication, cough, phlegm)
    3. Number of Cigarettes Smoked
    4. Administrative information (checklist of exclusion criteria, indication of fasting, indication of blood sample taken, indication of chest x-ray taken)
Baseline Form 3
    1. Administrative information (difficulty in coming to visit, return dietary history form, return picture book, return toenail sample, estimate of greyness of hair, capsules ID number, indication of extra blood, indication of fasting hours)

Return to top

Dietary History

Food Frequency Questionnaire (long form) - All food and nutrient data are based on this questionnaire
Food Frequency Questionnaire (short form) - Used mainly for methods work
Picture Booklet (PDF) (5 MB)

Return to top

Follow-up Questionnaires

Follow-up Form A
    1. Illnesses
    2. Physician contact
    3. Symptoms
    4. Bedridden
    5. Smoked
    6. Vitamin/mineral use past 2 weeks
    7. Changes in prescription drugs
Follow-up Form B
    1. Difficulty in coming to visit
    2. Symptoms participants suspects due to capsules
    3. Cancer diagnosis
    4. Capsule compliance
    5. Chest x-ray
Follow-up Form C
    1. Weight, Blood Pressure, Heart Rate, Visual Acuity
    2. Medical Symptoms (dyspnea, chest pain, claudication, cough, phlegm)
    3. Estimate of hair greyness
    4. Difficulty in coming to visit
    5. Symptoms participant suspects due to capsules
    6. Cancer
    7. Capsule compliance information
    8. Chest x-ray
Follow-up Form E
    1. Hair color
    2. Eye color
    3. Tanning ability of skin
    4. Trips to south
    5. Time outdoors
    6. Work history
    7. Physical activity at work
    8. Physical activity at leisure
    9. Weight at age 25
    10. Medical diagnoses told by physician
    11. Medical procedures
    12. Pain medication
    13. Parent history of diseases
    14. Number of siblings
    15. Sibling history of diseases
    16. Use of smoke sauna
    17. Years smoked regularly (filter/non-filter)
    18. Any radon measurement in residence

Return to top

Other Forms

Physician Hospital Care
Drop-Out
Non-Attendance
Chest X-Ray
Blood Sample
Case-Control
Name & Address Change
Cancer End-Point
Cancer Diagnosis

Return to top
 
National Cancer Institute Department of Health and Human Services National Institutes of Health USA.gov