Table 1.
Questionnaires Mailed to Chicago Heart Association Detection Project in Industry Participants for the Follow-up Examination, Chicago Healthy Aging Study, 2007–2010
| Questionnaire | Estimated Time Needed for Completion, minutes | Description |
|---|---|---|
| SF-36 | 15 | 36-item questionnaire that assesses 8 health domains: physical functioning, role limitations due to physical health problems, bodily pain, general health, vitality (energy/fatigue), social functioning, role limitations due to emotional problems, and mental health (psychological distress and psychological well-being) |
| ADL and IADL | 5 | ADL: 6 basic functions—bathing, dressing, toileting, transfer, continence, and feeding. IADL: homemaking skills necessary for independent living, including housework, meal preparation, taking medications, managing money, shopping, and telephone use |
| NIH Dietary History Questionnaire | 60 | Food frequency questionnaire assessing frequency of consumption of 124 common food items during the previous year; includes questions on both portion size and dietary supplements |
| Medical history | 10 | Questions on current and previous medical problems and treatments, hospitalizations, and outpatient visits, including occurrence and treatment of cardiovascular disease (angina, congestive heart failure, prior myocardial infarction, coronary occlusion, coronary thrombosis, stroke, transient ischemic attack), hypertension, hypercholesterolemia, diabetes mellitus, cancer (type and location), chronic lung disease, arthritis, hearing and visual impairments, other medical problems, and operations |
| Personal history | 10 | Questions on lifestyle risk factors, including current and past smoking status, coffee and alcohol consumption, and level of physical activity and exercise |
| Pittsburgh Sleep Quality Indexa | 21-item questionnaire on individual sleep habits (bedtime, morning rising time, sleep-onset latency, and night sleep duration), insomnia, and use of hypnotic medications over a 1-month time interval | |
| Epworth Sleepiness Scalea | Questions on the likelihood of dozing off or falling asleep in 8 different sedentary situations | |
| Berlin Questionnairea | Questions on snoring, daytime sleepiness or fatigue, and presence of obesity or hypertension |
Abbreviations: ADL, Activities of Daily Living; IADL, Instrumental Activities of Daily Living; NIH, National Institutes of Health; SF-36, 36-item Short Form Health Survey.
a Additional questionnaire mailed to all participants as part of an ancillary study on sleep.