the Scottish
survey1998
VOLUME 2
A SURVEY CARRIED OUT ON BEHALF OF THE SCOTTISH EXECUTIVE HEALTH DEPARTMENT
EDITED BY ANDREW SHAW, ANNE MCMUNN AND JULIA FIELD
JOINT HEALTH SURVEYS UNIT, AT THE NATIONAL CENTRE FOR SOCIAL RESEARCH AND DEPARTMENT OF EPIDEMIOLOGY & PUBLIC HEALTH, UCL
NOVEMBER 2000 © Crown copyright 2000 First published 2000 Not to be sold separately
ISBN 1 84268 085 4
ii CONTENTS
VOLUME 2: TECHNICAL REPORT
15 METHODOLOGY AND RESPONSE...... 1 Kavita Deepchand, Johanna Laiho 15.1 Introduction...... 2 15.2 Survey design and fieldwork procedures...... 2 15.3 Interviewing and measuring children ...... 3 15.4 Survey coverage...... 4 15.5 Ethical clearance...... 5 15.6 Sample selection ...... 6 15.7 Survey response ...... 9 15.8 Weighting...... 10 15.9 Comparison of the responding sample with the general population...... 14 15.10 The accuracy of the survey results ...... 14 15.11 Social class variables ...... 15 Tables ...... 17
16 QUALITY CONTROL OF BLOOD AND SALIVA ANALYTES ...... 35 Marion Brookes and Anne McMunn with John Sprunt, Paul Finglas and Ian Gibb 16.1 Introduction and key conclusions ...... 35 16.2 Samples collected ...... 35 16.3 Change of analysing laboratories ...... 36 16.4 Methodology...... 36 16.5 Quality control ...... 39 Tables ...... 45
APPENDICES A Fieldwork documents...... 77 B Measurement protocols...... 183 C Health Board areas...... 217 D Glossary ...... 219
iii iv 15 METHODOLOGY AND RESPONSE 15
Kavita Deepchand, Johanna Laiho
SUMMARY
77% (9093) of the eligible sample of households (people in private households aged 2 – 74) completed at least one individual interview. 76% (9047) of eligible adults and 75% (3892) of eligible children completed an individual interview. 82% (7455) of interviewed adults (3287 men and 4168 women) and 83% (3211) of children (1625 boys and 1586 girls) were visited by a nurse. 68% (6178) of the eligible sample of adults gave a blood sample (with a further 3% who agreed to give a blood sample but from whom one could not be obtained). 46% (466) of the eligible sample of children (aged 11 – 15) gave a blood sample. Blood samples were more likely to be obtained from men than women (of those visited by a nurse, blood samples were obtained from 85% of men and 81% of women). For adults, response rates at most stages were lowest amongst the youngest age group (16 – 24).
1 15.1 INTRODUCTION The objective of the Scottish Health Survey was to provide data about the health of the population aged 2 to 74 living in private households in Scotland. This volume of the report describes the technical aspects of the survey. Chapter 15 deals with the methodological issues including sampling, weighting and standard error estimations. It also describes the survey’s coverage, fieldwork procedures and response rates. Chapter 16 deals with the blood analytes: laboratories used, procedures and quality.
15.2 SURVEY DESIGN AND FIELDWORK PROCEDURES This section outlines the timing of the survey, the fieldwork procedures and the coverage of the survey.
Interviewing began in April 1998, and was carried out over a 13 month period. The random sample of addresses was selected from 312 postcode sectors, and in each month of the first twelve months, addresses in 26 sectors were issued to interviewers. Further details of the sample design are given in Section 15.6.
An advance letter was posted to each sampled address at the beginning of the relevant fieldwork month. This informed residents that their household had been selected for inclusion in the survey. Every address was then visited by an interviewer. One adult from each household provided basic information about the members of the household. The interviewer then randomly selected, for the main interview, one resident adult aged between 16 and 74 years old and a maximum of two resident children aged between 2 and 15. If there were no residents within the relevant age range at the address, no interview was attempted.
The sample was designed to ensure that every household within a region was given an equal chance of selection. This was done by taking into account the Multiple Occupancy Indicator (MOI) at the sample selection stage. However, we still needed to implement a strategy for dealing with addresses where the MOI equals 1, but which actually contain more than one household. Where the actual number of households was three or less, all household units were included in the sample. Where the number of households was greater than three, three household units were randomly selected by the interviewer using specially- designed random number tables attached to each Address Record Form and a corrective weight applied at the analysis stage. The Address Record Form is a document which provides interviewers with the sample addresses and selection instructions, onto which they write details of calls to the address and record their selection procedures.
Unlike the 1995 survey where nurses used a paper questionnaire, both interviewers and nurses for the 1998 Survey used Computer-Assisted Personal Interviewing (CAPI). This entails informants’ responses being entered directly into a laptop computer. A description of the content of the individual and nurse interviews is given in Section 15.4.
Interviewers also took height and weight measurements of all those interviewed. At the end of the interviewer-administered interview, informants were asked if they would be willing to take part in the next stage of the survey - the nurse visit. For those who agreed, an appointment was made for the nurse to visit within a few days of the interview. The nurse interview entailed collecting the names of any prescribed medicines and taking further anthropometric measurements (waist, hip, mid-upper arm circumference and demi-span) and small saliva and blood samples. Nurses also took blood pressure measurements and administered a lung function test.
Each test tube (containing either blood or saliva) was clearly labelled with the informant’s serial number and date of birth. Tubes for each informant were packed separately from
2 those of other members of the household. The tubes were put in a larger plastic container and placed inside a pre-paid box and sent to the Royal Victoria Infirmary in Newcastle. A small sub-sample of blood samples was sent to the Institute of Food Research in Norwich. Further details of the blood analysis may be found in Chapter 16.
In addition to the advance letter, informants were given two further leaflets: one by the interviewer that described the purpose of the survey and one by the nurse that explained the measurements taken during the nurse visit. Copies of these are contained in Appendix A.
Every informant was given a Measurement Record Card in which interviewers and nurses entered the informant’s height and weight; waist and hip or arm circumference, or demi-span (as appropriate); blood pressure and lung function values. With their agreement, informants were also later sent the results of their blood sample analyses and, with their written consent, informants’ blood pressure, lung function and blood sample analyses were also sent to their GP. Nurses were issued with a set of guidelines to follow when commenting on informants’ blood pressure readings (see Appendix B for details). The nurse was instructed to contact the Survey Doctor as soon as feasible whenever an adult informant had severely raised blood pressure. They were instructed not to comment on a child’s reading. Where permission had been given for results to be sent to an informant’s GP, the Survey Doctor contacted the GP if any blood pressure or blood sample results were abnormal.
All interviewers were fully briefed in person on the administration of the survey, and were given training in measuring height and weight (including a practice session).
All nurses were professionally qualified and proficient in taking blood before joining the Health Survey team. They attended a two-day training session at which they received equipment training and were briefed on the specific requirements of the survey with respect to taking blood pressure, lung function, making anthropometric measurements and taking saliva and blood samples.
Full sets of written instructions, covering both survey procedures and measurement protocols were provided for both interviewers and nurses (Appendix B contains a copy of the measurement protocols).
All nurses and new interviewers were supervised during the early stages of their work to ensure that interviews and protocols were being correctly administered. Routine supervision of the work of both interviewers and nurses was carried out thereafter.
15.3 INTERVIEWING AND MEASURING CHILDREN Children aged 13–15 were interviewed directly by interviewers, permission having first been obtained from the child’s parent or guardian. Interviewers were instructed to ensure that the child’s parent or guardian was present in the home throughout the interview. Information about younger children was collected from a parent. Younger children were present while their parent answered questions about their health. This was partly because the interviewer had to measure their height and weight and, in the case of those aged 8 and over, to ask the child to complete a short self-completion booklet during the interview. It also ensured that the child could contribute information.
Verbal agreement from the child’s parent, or someone with legal parental responsibility for that child, for a nurse to carry out any measurements on a child aged 2–15 had to be obtained before the measurement was taken. In the case of the blood sample, written consent was obtained from the 11-15 year old and counter-signed by their parent/legal guardian. This person had to be present during the nurse visit. Written consent to send information to a child’s GP was obtained from the parent.
3 15.4 SURVEY COVERAGE 15.4.1 Questionnaire content As in the 1995 Scottish Health Survey, the 1998 survey’s main focus was cardiovascular disease (CVD) and related risk factors. The questions on CVD were based on those adopted in the 1995 survey. In general, where topics were repeated from 1995, the same questions were used, though a number of subtle revisions and enhancements were made. Figure 15.1 shows a comparison of the survey modules covered in the 1995 and 1998 Scottish Health Surveys.
Figure 15.1 Content of the 1998 and 1995 Scottish Health Surveys
Household level data collected in both surveys: Household size and composition Car and telephone ownership Accommodation tenure and number of bedrooms, smoke detectors State benefits Household cooking and heating appliances Type of dwelling and area
Individual level data 1998 1995 (16-64) Interviewer visit General health, longstanding illness, acute sickness ✔ (2 –74) ✔ Respiratory problems, including use of medication/health services ✔ (2 –74) ✔ Asthma ✔ (2 –74) ✗ Incontinence a ✔ (8 –74) ✗ Symptoms of the chest ✔ (2 –74) ✔ Cardiovascular problems ✔ (16 -74) ✔ Physical Activity – adults ✔ (16 – 74) ✔ - children ✔ (2 – 15) ✗ Eating Habits ✔ (2 –74) ✔ GHQ 12 a ✔ (16 – 74) ✔ Accidents ✔ (2 – 74) ✔ Smoking and drinking b,e ✔ (8 –74) ✔ Dental health ✔ (2 74) ✔ Contraception & HRT (women only) b ✔ (16 – 74) ✔ Height/weight ✔ (2 – 74) ✔ Economic status/occupation c ✔ (16 – 74) ✔ Educational attainment ✔ (2 – 74) ✔ Parental history ✔ (2 – 74) ✔
Nurse visit Prescribed drugs and vitamin supplements ✔ (2 – 74) ✔ Food poisoning ✔ (2 – 74) ✔ Upper arm circumference ✔ (2 – 74) ✗ Demi-span ✔ (65 – 74) ✗ Blood pressure ✔ (5 – 74) ✔ Lung function ✔ (7 – 74) ✔ Blood sample –haemoglobin and ferritin, plasma fibrinogen, total and HDL cholesterol, C-reactive protein, gamma gt, cotinine (and lead in children) ✔ (11 – 74) ✔ Blood sample – vitamins A, C and E, and carotenoids d ✔ (11 – 74) ✔
a These modules were administered by self-completion. b This module was administered by self-completion for those aged 16-17 and some aged 18-19. c Information collected from respondent and Chief Income Earner (if not the same) d Taken in a sub-sample of sampling points (60 points) e Different questions depending on age
4 Copies of all survey data collection documents are included in Appendix A. Measurement and saliva and blood sample collection protocols are given in Appendix B.
Self-completion booklets Informants age 8 and over were asked to complete a self-completion booklet during the interview. There were four booklets – one for adults aged 18–74, one for young adults aged 16–17, one for children aged 13–15 and one for those aged 8–12. The information obtained was as follows:
Adults’ booklet: GHQ12, CAGE questions on drinking experiences, incontinence, contraceptive pill and HRT use.
Young adults’ booklet: smoking, drinking (including CAGE), GHQ12, incontinence and contraceptive pill use.
Children aged 13–15: smoking, drinking, GHQ12 and incontinence Children aged 8–12: smoking and drinking
15.5 ETHICAL CLEARANCE Approval was sought and obtained from the Research Ethics Committees for all Area Health Boards in Scotland before fieldwork started.
15.6 SAMPLE SELECTION 15.6.1 Sample coverage The Scottish Health Survey 1998 sample covers the private household population aged 2-74 living throughout Scotland. In the 1995 survey information was gathered from people aged 16-64. The inclusion of older people and children in the 1998 survey was decided in order to extend the understanding of the health conditions of the general population in Scotland.
In order to control for any seasonal differences in health, lifestyle, and accidents, the survey fieldwork was distributed evenly over the calendar year.
The sample was also designed to ensure that the sample size was sufficiently large within regions for the purpose of regional analysis (see 15.6.4). The regional analysis was conducted at the same level as in the previous Health Survey, where the Health Boards were aggregated into the following “health regions”:
Highland & Islands Grampian & Tayside Lothian & Fife Borders, Dumfries & Galloway Greater Glasgow Lanark, Ayrshire & Arran Argyll, Clyde & Forth Valley.
The survey covered all the areas of Scotland where fieldwork could feasibly be carried out. About 90 inhabited islands with very small populations were excluded from the sampling frame. The islands included in the sampling frame were:
Highland and Islands: Skye, Lewis, Harris, Orkney (mainland only) and Shetland (mainland only)
5 Ayrshire & Arran: Arran Argyll & Clyde: Bute, Islay and Mull.
15.6.4 Sample design and selection The sample was selected using a multi-stage clustered design. Geographical areas, which in most instances were postcode sectors, were selected at the first stage. Within each selected area, a random sample of addresses was selected, and at each address up to 3 households were selected (though at the vast majority only one household was included in the survey). Households with no residents within the age range 2–74 were screened out. At all other addresses one adult within the age range 16-74 was selected and up to two children aged 2 – 15. Each of these stages is described in turn below.
Selection of areas (sectors) The geographical areas selected for the Health Survey were, in most instances, postcode sectors. However, before selection, the following amendments were made to the sampling frame:
• Postcode sectors that spanned ‘Health Region’ boundaries were divided into regional sub-sectors; • To avoid near neighbours being selected for the survey, any postcode sectors in the Highland, Borders, Dumfries and Galloway, Argyll, or Clyde and Forth Valley with fewer than 250 PAF addresses were combined with an adjacent sector within the same health region; in the other health regions sectors with fewer than 500 addresses were combined with an adjacent sector; • To avoid any excessively large geographical areas being selected, sectors greater than 500sqkm in size were split into two or more sub-sectors, the split being done in such a way as would ensure the sub-sectors had greater than 250 addresses. • Ignoring the postcode geography, Mainland Orkney and Mainland Shetland were divided into two geographical areas with roughly the same number of addresses. Lewis and Harris were split into three areas with roughly the same number of addresses.
This process converted the sampling frame from one based on postcode sectors to one based on sectors, sub-sectors and combined sectors. Although obviously not strictly accurate, in what follows we refer to sub-sectors and combined sectors simply as ‘sectors’.
For the survey 312 ‘sectors’ were selected from a total of 935. The selection of sectors was carried out separately within each health region the following numbers being selected.
Highland and Islands 31 Grampian and Tayside 50 Lothian and Fife 61 Borders, Dumfries and Galloway 31 Greater Glasgow 50 Lanark, Ayrshire and Arran 51 Argyll and Clyde and Forth Valley 38
6 In each region ‘sectors’ were in general selected with probability proportional to size, where size is the number of Postcode Address File (PAF) addresses1. The exceptions to this rule were: • The seven areas covering the mainlands of Orkney, Shetland and Lewis and Harris (see above) were all selected with certainty; • Any very large sectors for which probability proportional to size was calculated to be greater than 1 were selected with certainty.
Before selection the sectors within each health region were sorted by the Carstairs deprivation index2. The sectors were then selected systematically, so the final sample is implicitly stratified by the index.
Once selected, the 312 sectors were systematically allocated to calendar months, giving 26 sectors per month and 78 sectors per quarter.
Selection of addresses within sectors Within each selected sector 46 addresses were selected systematically from the Postcode Address File (PAF), to give a total issued sample of 14,352 addresses. The PAF was sorted by postcode before selection so the selected sample per sector can be assumed stratified by area.
As fieldwork progressed it became evident that the issued sample would not yield the required number of interviews. Therefore, a ‘top-up’ sample was selected, comprising an additional 12 addresses within each of the 78 sectors allocated to the final quarter of fieldwork. This boosted the total issued sample size by 936 to 15,288.
The PAF used for the survey was expanded by the Multiple Occupancy Indicator (MOI).
Selection of households and individuals The selection of households at addresses and individuals within households was carried out by the survey interviewers.
As noted in the previous section, the MOI on PAF is a reasonable indicator of the number of dwelling units at an address and, apart from vacancies and dwellings with multiple households, approximates to the number of households at an address. If the MOI was a perfect indicator of household number then selecting one household at each address would mean that, within a sector, all households had an equal probability of selection for the survey. However, in practice, there is often a difference between the MOI and the number of households and in order to minimise variation in the probabilities of selection interviewers were given instructions on the selection of households at addresses. • If the Multiple Occupancy Indicator (MOI) in the PAF was greater than one, interviewers were instructed to randomly select only one per address following a special instructed procedure and using computer-generated selection digits. • If the value of the MOI was one, but there were two or three households resident at the address, the interviewer was instructed to include all of these in the sample. In case of four or more households resident at the address (and MOI equals 1), three households were randomly selected.
Following these procedures, a total of 44 additional households were selected for the survey.
In instances where no households were resident at an address the address was screened out. These included PAF addresses covering buildings not yet built or not ready for occupation, demolished or derelict buildings, vacant buildings, and businesses or institutions.
7 Having selected the household, interviewers enumerated the individuals resident within the household. Households with no persons within the age-range 2-74 were excluded. For the rest one adult within the age-range 16-74 was selected at random, and up to two children aged 2-15.
15.6.5 Errors in Multiple Occupancy Indicator values In the course of preparing this chapter, it was established that the MOI values supplied with the initial sample of 14,352 addresses were not wholly accurate. We understand, though this was not known to us at the time of sample selection, that the supplied MOI values were derived by matching addresses after selecting the sample addresses from the expanded PAF. That is, MOI values were calculated after sample selection rather than being drawn directly from the original PAF. A flaw in the matching process resulted in some addresses having inflated values of the MOI, these generally being cases where the true MOI value was one.
Values of the MOI are used in calculating the ‘weight’ given to each informant in the sample (see Section 15.8). It was essential, therefore, to investigate these errors and establish correct MOI values. Our scrutiny stretched back to the original selection of the sample through to the values of all variables used in weighting.
Firstly, it was confirmed that these errors affected neither the sampling of addresses nor the data collected for each selected informant. That is, the survey itself had been implemented as designed; the problems lay with descriptive information about the sample which is essential for correct weighting thereof.
Secondly, it proved to be possible to re-calculate MOI values using the same version of PAF as applied at the time of selection and it was established these new values were highly reliable. The outcome was that MOI values were revised downwards for 1379 addresses, resulting in MOI values equal to one for all except 59 of these cases. The original MOI values for 12,973 addresses were confirmed to have been correct. (The selection of the additional 936 addresses to boost the sample was not subject to this error.)
Interviewers were required always to establish the number of households at each address, regardless of the MOI. However, they were supplied with MOI values and at addresses with more than one household unit, the number selected for the survey was determined by whether or not the MOI was equal to one. Therefore, errors in MOI values were a potential source of confusion for interviewers, as well as affecting the number of households selected at a very small number of addresses.
Researchers reviewed the Address Record Form for every productive address with an original MOI value greater than one. A very high standard of household selection was observed. However, variations were found in practices for recording selection information, including the number of households. Therefore, to ensure consistency, researchers determined the values for number of households used in weighting.
Finally, the use of incorrect MOI values did make possible the selection of an incorrect number of households at one address. This happened in the rare circumstances that the correct MOI was equal to one but nevertheless the interviewer found that more than one household was living at the address. There were 8 such addresses at which only one of the households was selected for interview, in accordance with the interviewers’ instructions, though 2 or 3 households would have been selected had the correct MOI been in use. (This does not bias results, since weighting reflects the actual number of households selected.) 15.7 SURVEY RESPONSE Bearing in mind that the sample design aimed to interview one adult (aged 16 to 74) and up
8 to two children (aged 2 to 15) per household, this section reports on eligibility and co- operation rates It includes, firstly, eligibility rates and numbers of eligible households and individuals. It then covers response rates at household and individual levels for various stages of the survey – interview, nurse visit, anthropometry and other physical measurements.
Household response Figure 15.2 shows the household response. The row labelled ‘Total eligible households’ shows the number of private residential households at these addresses allowing for the occasional selection of up to three households.
Households described as ‘co-operating’ are those where at least one eligible person was interviewed at Stage 1. 77% of eligible households took part in the 1998 survey.
Figure 15.2 Summary of household response
Issued addresses 15332 100% Out of scope: 1739 11% - insufficient address details 104 - not yet built/derelict/demolished 230 - empty 828 - business/industrial address 286 - institution 25 - other deadwood/information refused 266
Residential addresses 13549 88% Households selected (estimated) 13606 89% Households ineligible (estimated) 1770 12% TOTAL ELIGIBLE HOUSEHOLDS (estimated) 11836 77%
Participating households (at least 1 interview) 9093 77% of total eligible households
15.7.3 Individual response There were 12939 individual interviews (9047 with adults and 3892 with children). 7455 adults and 3211 children saw a nurse and 6178 adults and 466 children gave a blood sample.
The numerator of the response rate – the number of productive outcomes – is known (though there are a variety of different outcomes). The denominator – the total number of adults in the sampled households is not known because the number in non-co-operating households is unknown. The total is therefore estimated. To do this, the assumption was made that non-co-operating households include the same average number of adults as co-operating households. This assumption gives an estimated total of 11836 adults and 5059 children (the ‘set sample’).
9 Using this estimate as a denominator, the response rates for adults at various stages are given in the table below. (Note that not all informants were asked to provide every measurement and that not all measurements and samples resulted in analysable data). Figures are also estimated on the basis that the eligible proportion among non-participants was the same as that among those who did take part.
Figure 15.3 Response rates for adults for various measurements
Achieved %
Interviewed 9047 76 Height measured 8549 73 Weight measured 8230 71 Saw a nurse 7455 63 Waist-Hip measured 7326 63 Blood Pressure measured 7342 62 Gave a saliva sample 7269 61 Agreed to give blood 6426 57 Gave a blood sample 6178 55
Interviews were carried out with 3892 children (in the case of those aged 2-12 the information was obtained from a parent). Nurse visits were conducted with 83% (3211) of interviewed children. Blood samples were not taken from under 15 year olds until the fourth month of fieldwork (July) therefore the number of eligible children was limited to nine months. In that time 1006 children were eligible for a blood sample. 46% (466) of these children gave a blood sample. Tables 15.1 – 15.4
15.8 WEIGHTING The Weighting procedure The sample of individuals selected for the Scottish Health Survey did not have equal chances of selection. This is due to the following aspects of the sample design: 1.certain regions were over-sampled, 2.some postcode sectors were selected with certainty, 3.only one person aged 16-74 was selected within a household, 4.maximum two children aged 2-15 were selected within a household, 5.the selection probability depended also on the Multiple Occupancy Indicator (MOI)3, which on visiting the address, was found not to match the number of resident households.
Details of all of these factors are included in Section 15.6.
To obtain population estimates from the survey the data has, at a minimum, to be weighted by the inverse of the probability of selection. But in addition, to make the 1998 survey comparable with the 1995 survey and to give a balance across survey months, it was thought desirable to down-weight the boosted final quarter. And finally, it was apparent that response rates differ by region, age, and sex, so additional weighting to adjust for the
10 perceived non-response bias was also considered desirable. The weight applied to the data has consequently three components: - The inverse of the probability of selection; multiplied by - A factor to down-weight the data from the final quarter; multiplied by - A factor to adjust for differential response rates by region, age and sex.
The probability of selection The probability of selection is itself calculated as the product of four separate probabilities: the probability of selection of the sector; the probability of selection of the address within the sector; the probability of selection of the household at the address; and the probability of selection of the individual within the household.
Taking each of these in turn:
The probability of selection for the sector is calculated as equal to 1 for the mainlands of Orkney, Shetland, Harris and Lewis, and equal to
number of addresses in sector Minimum 1, number of sectors selected within the region x ()total addresses in region
The probability of selection of the address within a sector is calculated as number of addresses selected from the sector x MOI number of addresses in the sector
The probability of selection of the household at the address is calculated as number of households selected at the address number of households at the address
If the MOI was always equal to the number of households at the address this probability multiplied by the MOI of the previous probability would always be equal to one. In practice the MOI was not always an accurate predictor of the number of households. To avoid excessive variation in the final weights (which would make estimates unstable) the probability of selection of the household at the address was constrained to fall within the 13, 1 range ( 3MOI MOI ) .In other words, if the probability was calculatedless than as 3MOI
1 3 3 it was set to 3MOI , and if it was calculated as more than MOI it was set toMOI .
Finally, the probability of selection of the individual within the household was calculated as
1 for adults, and number of adults aged 16-74 at address number of children aged 2-15 selected at address for children. number of children aged 2-15 at address
11 Down-weighting the final quarter As described in Section 15.6.4, initially 46 addresses were selected per sector but later an additional 12 addresses were selected from each of the 78 sectors allocated to the last quarter of fieldwork. Since the impact of this is to unbalance the seasonal distribution of the survey, this was adjusted for by multiplying the inverse probability weights of those in the final quarter by a factor equal to 46/58.
Non-response adjustment Perceived non-response bias by region, age and sex was adjusted for using post-stratification to the mid-1998 population estimates for Scotland. The post-stratification was done in two stages: at the first stage respondents were divided into regions. The inverse probability weights (with the final quarter adjustment) for all respondents within a region were then multiplied by a uniform factor to bring the survey distribution by region into line with the population distribution. This factor was largest for regions with the lowest response rates.
Figure 15.4 Weighting for differences in response by region
Mid-1998 Sample after population selection Additional Region estimates, % weights Weight
Highland and Islands 5.4 5.6 0.98 Grampian and Tayside 17.9 18.6 0.96 Lothian and Fife 21.9 23.3 0.94 Borders and Dumfries and Galloway 5.0 4.8 1.03 Greater Glasgow 17.8 12.9 1.38 Lanark and Ayrshire and Arran 18.3 21.0 0.87 Argyll and Clyde and Forth Valley 13.7 13.8 0.99
At the second stage respondents were divided by sex and age-group but not by region (the age-groups being single years of age for those aged 2-15, then 16-19, 20-24, 25-29, etc). Within each of these sex-age groups a further uniform factor was applied to the weights to bring the survey distribution by age and sex into line with the population distribution. This factor was largest for the sex/age groups with the lowest response rates.
Figure 15.5 Weighting to population age and sex distribution, adults
Age Mid-1998 population Sample after estimates, % weights 1 - 3 Weight 4 Men 16 - 19 3.7 3.2 1.14 20 - 24 4.5 3.1 1.47 25 - 29 5.3 3.7 1.42 30 - 34 5.7 4.5 1.28 35 - 39 5.5 4.9 1.14 40 - 44 4.9 4.4 1.09 45 - 49 4.5 4.5 1.00 50 - 54 4.4 4.1 1.07 55 - 59 3.6 4.0 0.91 60 - 64 3.3 3.5 0.95 65 - 69 3.0 3.3 0.90 70 - 74 2.4 2.6 0.93
12 Women 16 - 19 3.5 3.3 1.08 20 - 24 4.3 3.8 1.14 25 - 29 5.1 4.1 1.24 30 - 34 5.7 5.4 1.06 35 - 39 5.6 5.8 0.95 40 - 44 4.9 6.1 0.82 45 - 49 4.6 5.3 0.88 50 - 54 4.6 5.4 0.84 55 - 59 3.9 4.0 0.97 60 - 64 3.7 4.1 0.91 65 - 69 3.6 4.0 0.90 70 - 74 3.2 3.1 1.04
Figure 15.6 Weighting to population age and sex distribution, children
Age Mid-1998 population Sample after estimates, % weights 1 - 3 Weight 4 Boys 2 3.4 3.2 1.05 3 3.5 3.5 1.00 4 3.6 3.1 1.17 5 3.7 3.6 1.02 6 3.8 3.9 0.98 7 3.8 3.7 1.02 8 3.6 4.0 0.90 9 3.7 3.9 0.93 10 3.8 3.9 0.98 11 3.7 3.8 0.98 12 3.8 4.4 0.86 13 3.7 3.7 0.97 14 3.6 3.2 1.12 15 3.6 3.3 1.09
Girls 2 3.2 3.4 0.94 3 3.3 2.8 1.18 4 3.4 3.3 1.04 5 3.5 3.5 1.01 6 3.7 3.7 0.99 7 3.6 3.4 1.05 8 3.5 4.1 0.85 9 3.5 3.1 1.12 10 3.6 4.2 0.85 11 3.6 4.0 0.88 12 3.6 3.1 1.16 13 3.5 3.7 0.95 14 3.4 2.9 1.17 15 3.5 3.5 1.00
Dividing the non-response weighting into two stages in this way means that the final survey weights will be less variable than would be the case if non-response by age and sex had been adjusted for in each region separately. However, the two-stage method employed does
13 include an implicit assumption that the relative response rates by age and sex are the same for all regions.
Scaling of the final weights The final weights calculated as described above (i.e. the inverse of the probability of selection multiplied by the non-response factors) give grossed estimates for the total household population of Scotland aged 2-74. For the survey report the weights have been scaled down so that the weighted sample size for adults is close to the unweighted base. This is a purely cosmetic change and it does not change any of the reported survey estimates. Children’s weights are scaled identically, so that (where the data permits) analyses combining adults and children can be undertaken. This scaling produces a weighted sample size for children which is much lower than the unweighted base, largely as a consequence of interviewing up to two children but never more than one adult.
15.9 COMPARISON OF THE RESPONDING SAMPLE WITH THE GENERAL POPULATION As with all multi-stage surveys, problems of non-response bias are compounded because of the potential for informants to drop out at each stage. This section compares the achieved sample at three survey stages (interview, nurse visit and blood sample obtained) with the general population in terms of age and sex. The population data used is taken from the mid- 1998 population estimates.
As described above, the achieved sample at the first (interview) stage was weighted to match the age and sex distribution of the mid-1998 population estimates for Scotland. There were slightly higher response rates for men agreeing to the nurse visit and to providing a blood sample which means that men were slightly over-represented at these two stages. There was a lower response among young women giving blood which resulted in their under-representation for this part of the Health Survey. These findings matched those found in the 1995 survey. Tables 15.5 – 15.10
15.10 THE ACCURACY OF THE SURVEY RESULTS The Health Survey data produces a set of health related survey estimates for different subgroups in order to analyse the health of the people living in Scotland. Each survey estimate has an associated error, which is the difference of the survey estimate from the related population parameter.
The total error, that is, the mean squared error, is the sum of all variable errors and the square of bias.
Sampling errors are random and can be, in principle, estimated from the survey data. Random sampling error arises from the variation around the sample estimates and the true population values. If the survey were to be repeated with the same survey design and under the same conditions, due to the random effect the dataset would produce different results around the true population values and the variable sampling errors would vary.
In contrast, biases are constant errors, and cannot be measured from the survey data itself. Biases can arise at any stage of implementing the survey design, for example in sampling design, choice of sampling frame, non-response or achieving only partial information from some people.
Generally, random errors are reduced when the sample size is increased, but the change in the sample size does not usually affect the bias. Thus as sample size increases bias becomes
14 the dominant component of the survey error. Therefore the importance of controlling for bias increases with big sample sizes.
Tables 15.11-15.23 contain a number of key variables of the health survey. For each the estimated proportion/mean, the size of the base, standard error, 95% confidence interval and the design effect (or deft) is reported. The square root of variance, that is the measure of standard error, is used to describe the magnitude of how the values differ across units in the dataset. On the other hand the deft values compare the variance under the complex survey design actually used to what would have obtained using simple random sampling.
The standard errors and design factors shown in Tables 15.11-15.23 are based on the true standard errors, taking into account the stratified sampling design of the Scottish Health Surveys. Standard errors were calculated using the package STATA. This uses linearization based variance estimators for non-linear functions like sample ratios. Calculations are based on a first-order Taylor expansion method, and the estimates were calculated both for means and for population proportion estimates4.
The calculations are shown only for adults by sex. When it comes to children aged 2-15, the group is so heterogeneous that overall estimates would be meaningless in terms of accuracy or interpretation of the results. Tables 15.11 – 15.23
15.11 SOCIAL CLASS VARIABLES Social Class was based on the Registrar General’s Standard Occupational Classification. Derived variables for social class were defined on two bases: the first was based on the social class of the (adult) informant’s own current or last occupation; the second was base on the current or last occupation of the chief income earner within the informant’s household.
For the informant’s own social class, details of current or last occupation were recorded for 8435 informants, which is 93% of the total achieved sample of adults. Of the rest, 494 said they had never had a job (5%), and for the remaining 118 informants insufficient details were provided to assign a social class (1%).
The questionnaire asked all adult informants whether they regarded themselves as the Chief Income Earner (CIE) in the household. In cases where the informant was not the CIE, they answered a series of employment questions by proxy so that social class of the chief income earner could be determined. 32% of adult informants (2926) said they were not the chief income earner. From these, a social class category was ascertained for 2801 (96%). Of the remaining 125 the informant reported that 19 (1%) had never had a job. The remaining 106 (3%) had insufficient information in order to assign a social class category.
For the social classification for the chief income earner (informant or other household member), details of current or last occupation were recorded for 8717 informants (96% of the total sample). 330 households did not have a social classification for the CIE. There was insufficient information to classify the occupations of 17 chief income earners (less than 1%), while the remainder of chief income earners had never had a job (213 cases, which is 2% of the adult sample).
Children were assigned the social class classification of the Chief Income Earner in the household.
15 References and notes
1 A version of PAF expended by the MOI was used as the sampling frame for the Health Survey (see section on the selection of addresses within sectors). The ‘size’ of sectors was calculated from this expanded list.
2 Carstairs index is derived by combining variables taken from small area Census data and is described as a measure which reflects access to those material resources which provide access to ‘those goods and resources and amenities and of a physical environment which are customary in society’ (Carstairs and Morris, 1991). The scores used in the sampling stage are calculated from the 1991 Census data using the variables for overcrowding, male unemployment rate, low social class and the proportion of all persons in private households which do not own a car. Further details on constructing the scores in: Carstairs Scores for Scottish Postcode Sectors From the 1991 Census, Public Health Research Unit, University of Glasgow.
3 That is, the true MOI value as applied in the sample selection, rather than the erroneous values supplied with some addresses.
4 The linearization method used for calculating the true standard errors and defts for means and population proportion estimates is described in detail in Stata Reference Manual. Release 6.0. Volume 4. College Station, TX: Stata Corporation.
16 Chapter 15 LIST OF TABLES
Table 15.1 Response to nurse visit, by region Table 15.2 Response to blood sample, by region Table 15.3 Response to survey stages, by age and sex: adults Table 15.4 Summary of children’s individual response to the survey, by sex Table 15.5 Sex and age distribution of responding sample compared with mid-1998 population estimates for adults Table 15.6 Sex and age distribution of responding sample compared with mid-1998 population estimates for children Table 15.7 Sex and age distribution (weighted) of responding sample compared with mid-1998 population estimates for adults Table 15.8 Sex & age distribution (weighted) of responding sample compared with mid-1998 population estimates Table 15.9 Age distribution (weighted) of responding sample compared with mid-1998 population estimates, by sex Table 15.10 Age distribution (weighted) of responding sample compared with mid-1998 population estimates, by region and sex Table 15.11 True standard errors and 95% confidence intervals for CVD variables Table 15.12 True standard errors and 95% confidence intervals for respiratory symptoms and doctor-diagnosed asthma Table 15.13 True standard errors and 95% confidence intervals for lung function variables Table 15.14 True standard errors and 95% confidence intervals for accident variables Table 15.15 True standard errors and 95% confidence intervals for alcohol consumption variables Table 15.16 True standard errors and 95% confidence intervals for cigarette smoking variables Table 15.17 True standard errors and 95% confidence intervals for anthropometric measurement variables Table 15.18 True standard errors and 95% confidence intervals for body mass index (BMI) within region Table 15.19 True standard errors and 95% confidence intervals for blood pressure measurement variables Table 15.20 True standard errors and 95% confidence intervals for blood pressure measurement variables within region Table 15.21 True standard errors and 95% confidence intervals for saliva and blood analyte variables Table 15.22 True standard errors and 95% confidence intervals for physical activity Table 15.23 True standard errors and 95% confidence intervals for general health variables
17 Table 15.1 Response to nurse visit, by region
1998
Region Total
Forth Borders, Lanarkshire, Valley, Highland Grampian Lothian Dumfries Greater Ayrshire Argyll & & Islands & Tayside & Fife & Galloway Glasgow & Arran Clyde
n% n% n% n% n% n% n% n% Interviewed at first stage - adults 902 100 1451 100 1836 100 826 100 1294 100 1615 100 1123 100 9047 100 - children 424 100 599 100 762 100 336 100 569 100 724 100 478 100 3892 100
Did not agree to nurse visit - adults 31 3 115 8 113 6 84 10 78 6 107 7555583 6 - children 11 3 36 6 41 5 20 6 29 5 49 7153201 5
Agreed to nurse visit - adults 871 97 1336 92 1723 94 742 90 1216 94 1508 93 1068 95 8464 94 - children 413 97 563 94 721 95 316 94 540 95 675 93 463 97 3691 95
Responder to nurse visit - adults (16-74) 781 87 1212 84 1502 82 688 83 1029 80 1306 81 937 83 7455 88 - children (2-15) 363 86 515 86 626 82 291 87 443 78 586 81 387 81 3211 87 - adults (65-74) 133 203 234 129 189 189 143 1220 - children (4-15) 313 426 525 261 378 487 336 2726 - children (5-15) 298 392 478 248 352 442 309 2519 - children (7-15) 258 320 384 201 292 359 245 2059 - children (11-15) 156 175 232 106 165 195 131 1160
Measurements obtained: waist/hip measurement - adults (16-74) 762 98 1190 98 1476 98 684 99 1007 98 1280 98 922 98 7321 98 demi-span - adults (65-74) 132 99 201 99 229 98 129 100 184 97 180 95 142 99 1197 98 mid upper arm circumference - children (2-15) 355 98 504 98 608 97 287 99 432 98 569 97 381 98 3136 98 blood pressure measurement - adults (16-74) 759 97 1195 99 1479 98 681 99 1013 98 1290 99 925 99 7342 98 - children (5-15) 291 98 389 99 461 96 245 99 338 96 430 97 301 97 2455 97 lung function measurement - adults (16-74) 722 92 1175 97 1443 97 661 98 979 97 1241 96 868 94 7089 96 - children (7-15) 241 93 310 97 368 96 198 99 280 96 344 96 231 94 1972 96 saliva sample obtained - adults (16-74) 764 98 1190 98 1470 98 680 99 996 97 1251 96 918 98 7269 98 - children (4-15) 305 97 405 95 495 94 254 97 358 95 456 94 316 94 2589 95 blood sample - adults (16-74) - adults (16-74) 630 81 1041 86 1245 83 590 86 835 81 1072 82 765 82 6178 83 - children (11-15) 71 46 59 34 86 37 49 46 61 37 95 49 45 34 466 40
18 Table 15.2 Response to blood sample, by region
1998
Region Total
Forth Borders, Lanarkshire, Valley, Highland Grampian Lothian Dumfries Greater Ayrshire Argyll & & Islands & Tayside & Fife & Galloway Glasgow & Arran Clyde
n% n% n% n% n% n% n% n% Adults (16-74) Responder to nurse visit 781 100 1212 100 1502 100 688 100 1029 100 1306 100 937 100 7455 100
Reason for no blood sample: - ineligible 49 6 55 5 81 5 31 5 73 7 69 5 51 5 409 5 - attempted, not obtained 24 3 35 3 51 3 22 3 47 5 27 2 42 4 248 3 - refused 78 10 81 7 125 8 45 7 74 7 138 11 79 8 620 8
Blood sample taken 630 81 1041 86 1245 83 590 86 835 81 1072 82 765 82 6178 83
Children (11-15) Responder to nurse visit 156 100 175 100 232 100 106 100 165 100 195 100 131 100 1160 100
Reason for no blood sample: - parent refused/ not applicable 70 45 101 58 131 56 42 40 89 54 85 44 71 54 679 59 - attempted, not obtained 7 4 7 4 7 3 7 774747571 - refused 8 5 8 5 8 3 8 885848681
Blood sample taken 71 46 59 34 86 37 49 46 61 37 95 49 45 34 466 40
19 Table 15.3 Response to survey stages, by age and sex: adults
1998
Age Total
16-24 25-34 35-44 45-54 55-64 65-74
n% n% n% n% n% n% n% Men Completed interviews 399 100 764 100 828 100 694 100 683 100 573 100 3941 100
Responder to nurse visit 309 77 602 79 687 83 594 86 596 87 499 87 3287 83
Responded to: - height measurement 379 95 734 96 792 96 661 95 643 94 523 91 3732 95 - weight measurement 375 94 711 93 771 93 651 94 631 92 507 88 3646 93 - waist-hip measurement 308 77 598 78 685 83 589 85 589 86 493 86 3262 83 - blood pressure measurement 308 77 600 79 685 83 589 85 594 87 493 86 3269 83 - lung function measurement 300 75 577 76 668 81 576 83 560 82 469 82 3150 80 - saliva sample measurement 308 77 597 78 681 82 585 84 590 86 490 86 3251 82 - blood sample obtained 244 61 504 66 610 74 516 74 516 76 414 72 2804 71 - blood sample attempted, not obtained 5 1 8 1 13 2 18 3 20 3 22 4 86 2
Women Completed interviews 528 100 974 100 1008 100 896 100 809 100 891 100 5106 100
Responder to nurse visit 409 77 793 81 821 81 762 85 662 82 721 81 4168 82
Responded to: - height measurement 510 97 937 96 970 96 845 94 752 93 803 90 4817 94 - weight measurement 472 89 871 89 925 92 813 91 727 90 776 87 4584 90 - waist-hip measurement 390 74 750 77 806 80 750 84 657 81 706 79 4059 79 - blood pressure measurement 390 74 756 78 807 80 757 84 659 81 693 78 4073 80 - lung function measurement 383 73 742 76 780 77 724 81 627 78 683 77 3939 77 - saliva sample measurement 388 73 745 76 799 79 746 83 647 80 693 78 4018 79 - blood sample obtained 281 53 614 63 683 68 662 74 555 69 579 65 3374 66 - blood sample attempted, not obtained 14 3 28 3 37 4 21 2 29 4 33 4 162 3
All adults Completed interviews 927 100 1738 100 1836 100 1590 100 1492 100 1464 100 9047 100
Responder to nurse visit 718 77 1395 80 1508 82 1356 85 1258 84 1220 83 7455 82
Responded to: - height measurement 889 96 1671 96 1762 96 1506 95 1395 93 1326 91 8549 94 - weight measurement 847 91 1582 91 1696 92 1464 92 1358 91 1283 88 8230 91 - waist-hip measurement 699 75 1348 76 1491 81 1339 84 1246 84 1199 82 7321 81 - blood pressure measurement 699 75 1360 78 1495 81 1353 85 1256 84 1214 83 7377 82 - lung function measurement 683 74 1319 76 1448 79 1300 82 1187 80 1152 79 7089 78 - saliva sample measurement 696 75 1342 77 1480 81 1331 84 1237 83 1183 81 7269 80 - blood sample obtained 525 57 1118 64 1293 70 1178 74 1071 72 993 68 6178 68 - blood sample attempted, not obtained 19 2 36 2 50 3 39 2 49 3 55 4 248 3
20 Table 15.4 Summary of children’s individual response to the survey, by sex
1998
Responding sample Sex Total
Boys Girls
n% n% n%
Completed interview 1987 100 1905 100 3892 100
Responder to nurse visit 1625 82 1586 83 3211 83
Responded to: - height measurement 1857 93 1772 93 3629 93 - weight measurement 1819 92 1728 91 3547 91 - MUAC measurement 1582 80 1554 82 3136 81 - blood pressure measurementa 1242 80 1213 81 2455 80 - saliva obtainedb 1299 77 1290 79 2589 78 - lung function measuredc 989 78 983 80 1972 79 - blood sample obtainedd 260 36 206 30 466 33
Bases (unweighted): Children interviewed aged 5-15 1561 1496 3057 Children interviewed aged 4-15 1679 1637 3316 Children interviewed aged 7-15 1272 1230 2502 Children interviewed aged 11-15 717 690 1407
a Bases on interviewed children aged 5-15 b Based on interviewed children aged 4-15 c Based on interviewed children aged 7-15 d Based on interviewed children aged 11-15. The percentages in this table are based on all 11-15 year olds. However blood samples were not taken in the first 3 months of fieldwork therefore the real bases are much lower.
Table 15.5 Sex and age distribution of responding sample compared with mid- 1998 population estimates for adults
1998
Responding sample Mid-1998 Responder to Responder to population interview interview estimates (unweighted) (weighted)
%%% All men 49 44 49 16 – 24 8 4 8 25 – 34 11 8 11 35 – 44 10 9 10 45 – 54 9 8 9 55 – 64 6 8 7 65 – 74 5 6 5
All women 51 56 51 16 – 24 8 6 8 25 – 34 10 11 11 35 – 44 10 11 10 45 – 54 10 10 9 55 – 64 7 9 7 65 – 74 7 10 7
All 16 – 24 15 10 15 25 – 34 21 19 21 35 – 44 20 20 20 45 – 54 19 18 18 55 – 64 13 16 14 65 – 74 12 16 12
21 Table 15.6 Sex and age distribution of responding sample compared with mid- 1998 population estimates for children
1998
Responding sample Mid-1998 Responder to Responder to population interview interview estimates (unweighted) (weighted)
%%% All boys 51 51 51 2 – 3 7 8 7 4 – 5 7 7 7 6 – 7 8 7 8 8 – 9 7 7 7 10 – 11 8 7 8 12 – 13 7 8 7 14 – 15 7 7 7
All girls 49 49 49 2 – 3 7 7 7 4 – 5 7 7 7 6 – 7 7 7 7 8 – 9 7 7 7 10 – 11 7 8 7 12 – 13 7 7 7 14 – 15 7 7 7
All 2 – 3 13 15 13 4 – 5 14 14 14 6 – 7 15 14 15 8 – 9 14 14 14 10 – 11 15 15 15 12 – 13 15 15 15 14 – 15 14 14 14
22 Table 15.7 Sex and age distribution (weighted) of responding sample compared with mid-1998 population estimates for adults
1998
Responding sample Age Total
16-24 25-34 35-44 45-54 55-64 65-74
%
At interview Men 8 11 10 9 7 5 49 Women 8 11 10 9 7 7 51
Bases (weighted) 1385 1896 1817 1578 1269 1055 9000
At nurse visit Men 8 10 10 9 7 6 50 Women 7 10 10 9 7 6 50
Bases (weighted) 1093 1515 1497 1354 1067 886 7412
Providing blood sample Men 7 10 11 10 8 6 51 Women 6 10 10 10 7 6 49
Bases (weighted) 823 1216 1290 1185 917 715 6146
Mid-1998 population estimates Men 8 11 10 9 6 5 49 Women 8 10 10 10 7 7 51
Bases a 580 793 760 718 472 442 3764 a Base figures shown in thousands
Table 15.8 Sex and age distribution (weighted) of responding sample compared with mid-1998 population estimates, for children
1998
Responding sample Age Total
2-3 4-5 6-7 8-9 10-11 12-13 14-15
%
At interview Boys 7 7 8 7 8 7 7 51 Girls 7 7 7 7 7 7 7 49
Bases (weighted) 285 304 318 306 315 312 301 2141
At nurse visit Boys 7 7 8 7 7 7 7 51 Girls 7 7 8 7 8 7 7 49
Bases (weighted) 237 245 267 242 264 251 248 1754
Providing blood sample b Boys - - - - 11 21 24 56 Girls - - - - 7 19 18 44
Bases (weighted) - - - - 44 98 105 247
Mid-1998 population estimates Boys 7 7 8 7 8 7 7 51 Girls 7 7 7 7 7 7 7 49
Bases a 119 128 133 128 132 130 126 896 a Base figures shown in thousands b Children aged 2-10 were ineligible to give a blood sample. 23 Table 15.9 Age distribution (weighted) of responding sample compared with mid-1998 population estimates, by sex
1998
Age At interview At nurse visit Providing blood Mid-1998 sample population estimates a
%%%% Men 16 – 24 16 15 14 16 25 – 34 22 20 20 22 35 – 44 20 20 21 20 45 – 54 18 18 19 19 55 – 64 14 15 15 12 65 – 74 11 11 11 11
Bases (weighted) 4423 3675 3132 1848
Women 16 – 24 15 14 13 15 25 – 34 21 21 20 21 35 – 44 20 20 21 20 45 – 54 18 18 20 19 55 – 64 14 14 15 13 65 – 74 12 13 13 13
Bases (weighted) 4577 3737 3014 1915
Boys 2 – 3 13 14 - 13 4 – 5 14 14 - 14 6 – 7 15 15 - 15 8 – 9 14 14 - 14 10 – 11 15 15 20 15 12 – 13 15 14 37 14 14 – 15 14 14 43 14
Bases (weighted) 1096 888 139 459
Girls 2 – 3 13 14 - 13 4 – 5 14 14 - 14 6 – 7 15 15 - 15 8 – 9 14 14 - 14 10 – 11 15 16 15 15 12 – 13 15 15 44 15 14 – 15 14 14 42 14
Bases (weighted) 1045 866 108 438 a Base figures shown in thousands
24 Table 15.10 Age distribution (weighted) of responding sample compared with mid-1998 population estimates, by region and sex
1998
Age At interview At nurse visit Providing blood Mid-1998 sample population estimate
%%%%
Highland and Islands Men 16 – 24 14 12 11 14 25 – 34 21 21 20 18 35 – 44 22 21 22 21 45 – 54 20 21 23 20 55 – 64 14 15 15 15 65 – 74 10 10 9 11 Base (weighted) 237 207 171 101
Women 16 – 24 16 15 13 12 25 – 34 20 21 18 19 35 – 44 19 18 20 20 45 – 54 17 18 19 19 55 – 64 13 13 15 16 65 – 74 14 15 15 13 Base (weighted) 245 206 160 101
Grampian & Tayside Men 16 – 24 16 16 15 16 25 – 34 22 22 21 21 35 – 44 21 20 20 21 45 – 54 16 16 17 18 55 – 64 13 14 15 14 65 – 74 12 12 12 11 Base (weighted) 818 684 604 333
Women 16 – 24 16 15 13 15 25 – 34 20 22 21 20 35 – 44 20 21 22 20 45 – 54 16 17 17 18 55 – 64 14 13 14 14 65 – 74 13 13 13 13 Base (weighted) 813 668 561 337
Lothian & Fife Men 16 – 24 15 15 14 17 25 – 34 25 23 21 23 35 – 44 21 22 22 20 45 – 54 17 18 18 17 55 – 64 13 14 14 13 65 – 74 9 10 10 10 Base (weighted) 997 819 709 410
Women 16 – 24 17 18 16 15 25 – 34 22 20 19 22 35 – 44 17 17 17 20 45 – 54 17 18 20 17 55 – 64 15 16 17 14 65 – 74 12 13 13 12 Base (weighted) 1002 825 652 423
Continued ...
25 Table 15.10 – continued
1998 Borders, Dumfries & Galloway Men 16 – 24 14 14 13 13 25 – 34 20 18 18 18 35 – 44 23 24 26 20 45 – 54 19 19 18 19 55 – 64 12 12 13 16 65 – 74 12 13 12 14 Base (weighted) 210 181 157 90
Women 16 – 24 9 9 8 12 25 – 34 17 16 15 18 35 – 44 20 21 20 20 45 – 54 21 21 23 19 55 – 64 17 18 19 17 65 – 74 17 15 15 15 Base (weighted) 229 189 162 93
Greater Glasgow Men 16 – 24 16 15 14 17 25 – 34 21 20 19 24 35 – 44 21 19 21 21 45 – 54 20 21 22 16 55 – 64 12 13 13 13 65 – 74 12 12 11 10 Base (weighted) 742 612 506 326
Women 16 – 24 16 14 14 16 25 – 34 20 20 19 22 35 – 44 23 23 23 20 45 – 54 17 18 19 15 55 – 64 11 11 11 14 65 – 74 13 14 14 13 Base (weighted) 826 644 509 346
Lanarkshire, Ayrshire & Arran Men 16 – 24 20 19 17 16 25 – 34 19 18 17 21 35 – 44 20 20 22 20 45 – 54 17 18 18 18 55 – 64 15 15 15 14 65 – 74 9 10 11 11 Base (weighted) 822 670 554 336
Women 16 – 24 13 13 10 15 25 – 34 21 21 21 20 35 – 44 20 19 20 20 45 – 54 19 20 22 18 55 – 64 16 16 15 15 65 – 74 12 11 11 13 Base (weighted) 830 676 544 352
Continued ...
26 Table 15.10 – continued
1998 Forth Valley, Argyll & Clyde Men 16 – 24 14 11 11 16 25 – 34 21 20 21 21 35 – 44 19 19 20 21 45 – 54 18 20 19 18 55 – 64 18 19 19 14 65 – 74 11 12 11 11 Base (weighted) 596 501 433 252
Women 16 – 24 12 12 11 14 25 – 34 22 22 22 20 35 – 44 21 22 23 20 45 – 54 18 18 20 18 55 – 64 16 15 16 15 65 – 74 12 11 10 13 Base (weighted) 633 527 423 263
27 Table 15.11 True standard errors and 95% confidence intervals for CVD variables
1998
CVD conditions % (p) Sample True 95% confidence Deft size (unweighted) standard interval error Men Ever had angina 5.2 3938 0.34 4.6 - 5.9 0.95 Ever had heart attack 4.2 3938 0.32 3.5 - 4.8 1.00 Ever had heart murmur 2.5 3936 0.26 2.0 - 3.0 1.04 Ever had abnormal heart rhythm 5.5 3937 0.39 4.7 - 6.2 1.06 Ever had other heart trouble 1.7 3940 0.22 1.3 - 2.1 1.07 Ever had stroke 1.3 3938 0.17 1.0 - 1.6 0.91 Ever had diabetes 2.9 3939 0.27 2.3 - 3.4 1.03
Women Ever had angina 4.3 5099 0.32 3.7 - 4.9 1.13 Ever had heart attack 1.9 5102 0.21 1.5 - 2.3 1.10 Ever had heart murmur 3.8 5104 0.30 3.2 - 4.3 1.11 Ever had abnormal heart rhythm 6.2 5101 0.39 5.4 - 6.9 1.15 Ever had other heart trouble 0.9 5106 0.16 0.5 - 1.2 1.20 Ever had stroke 1.2 5102 0.15 0.9 - 1.5 0.96 Ever had diabetes 2.3 5104 0.21 1.9 - 2.7 1.01
Men Had cardiovascular condition 23.6 3935 0.77 22.1 - 25.1 1.14 Had IHD (angina or heart attack) 6.4 3940 0.37 5.7 - 7.2 0.95 Had CVD (angina, heart attack or stroke) 7.2 3940 0.40 6.4 - 8.0 0.96
Women Had cardiovascular condition 23.5 5090 0.70 22.1 - 24.9 1.17 Had IHD (angina or heart attack) 4.6 5103 0.32 3.9 - 5.2 1.11 Had CVD (angina, heart attack or stroke) 5.3 5103 0.34 4.6 - 6.0 1.09
Table 15.12 True standard errors and 95% confidence intervals for respiratory symptoms and doctor-diagnosed asthma
1998
Respiratory symptoms % (p) Sample True 95% confidence Deft size (unweighted) standard interval error Men Ever had wheezing or whistling in the 25.1 3938 0.88 23.4 - 26.8 1.27 chest Had wheezing or whistling in the last 12 63.5 999 1.72 60.1 - 66.8 1.13 months Doctor-diagnosed asthma 10.7 3940 0.58 9.6 - 11.8 1.18
Women Ever had wheezing or whistling in the 24.2 5104 0.78 22.7 - 25.7 1.30 chest Had wheezing or whistling in the last 12 63.2 1273 1.59 60.1 - 66.3 1.18 months Doctor-diagnosed asthma 12.2 5104 0.51 11.2 - 13.2 1.10
28 Table 15.13 True standard errors and 95% confidence intervals for lung function variables
1998
Lung function Mean Sample True 95% confidence Deft size (unweighted) standard interval error Men FEV 3.8 3115 0.02 3.7 - 3.8 1.20 FVC 4.7 3115 0.02 4.6 - 4.7 1.28 Peak flow 551.9 3115 3.25 545.5 - 558.3 1.31
Women FEV 2.7 3875 0.01 2.7 - 2.7 1.14 FVC 3.3 3875 0.02 3.2 - 3.3 1.20 Peak flow 373.8 3875 2.29 369.3 - 378.3 1.30
Table 15.14 True standard errors and 95% confidence intervals for accident variables
1998
Accidents Mean/% Sample True 95% confidence Deft size (unweighted) standard interval error Men Percentage having at least one accident in 17.2 3941 0.75 15.7 - 18.7 1.25 previous 12 months Annual accident rate per 100 persons 21.3 3941 1.03 19.3 - 23.3 1.28 Annual work-based accident rate per 100 7.5 3941 0.68 6.2 - 8.8 1.35 persons in work Annual non-work accident rate per 100 13.8 3941 0.82 12.2 - 15.4 1.25 persons
Women Percentage having at least one accident in 11.5 5106 0.55 10.4 - 12.5 1.23 previous 12 months Annual accident rate per 100 persons 13.5 5106 0.70 12.1 - 14.8 1.11 Annual work-based accident rate per 100 1.7 5106 0.27 1.2 - 2.2 1.17 persons in work Annual non-work accident rate per 100 11.8 5106 0.67 10.5 - 13.1 1.12 persons
Table 15.15 True standard errors and 95% confidence intervals for alcohol consumption variables
1998
Number of alcohol units consumed per Mean/% Sample True 95% confidence Deft week size (unweighted) standard interval error Men Mean number of alcohol units usually 19.2 3901 0.47 18.3 - 20.1 1.22 consumed per week Drink more than 21 units a week (%) 32.6 3898 0.88 30.9 - 34.3 1.17
Women Mean number of alcohol units usually 6.7 5062 0.17 6.3 - 7.0 1.17 consumed per week Drink more than 14 units a week (%) 14.2 5061 0.61 13.0 - 15.4 1.24
29 Table 15.16 True standard errors and 95% confidence intervals for cigarette smoking variables
1998
Cigarette smoking Mean/% Sample True 95% confidence Deft size (unweighted) standard interval error Men Mean number of cigarettes smoked per 17.6 1362 0.34 16.9 - 18.3 1.20 smoker per day (current smokers) Per capita mean number of cigarettes per 6.0 3923 0.21 5.6 - 6.4 1.30 day
Women Mean number of cigarettes smoked per 15.2 1736 0.23 14.7 - 15.6 1.07 smoker per day (current smokers) Per capita mean number of cigarettes per 4.8 5076 0.16 4.5 - 5.1 1.24 day
Cigarette smoking status Men Used to smoke cigarettes regularly (%) 22.0 3928 0.74 20.5 - 23.4 1.11 Current cigarette smoker (%) 34.1 3928 0.95 32.3 - 36.0 1.25 Never smoked cigarettes/used to smoke 43.9 3928 0.97 42.0 - 45.8 1.22 cigarettes occasionally (%)
Women Used to smoke cigarettes regularly (%) 17.6 5083 0.58 16.4 - 18.7 1.09 Current cigarette smoker (%) 32.4 5083 0.84 30.7 - 34.0 1.29 Never smoked cigarettes/used to smoke 50.0 5083 0.86 48.3 - 51.7 1.23 cigarettes occasionally (%)
Table 15.17 True standard errors and 95% confidence intervals for anthropometric measurement variables
1998
Anthropometric measurement Mean/% Sample True 95% confidence Deft size (unweighted) standard interval error Height Men Mean height (cm) 174.8 3707 0.14 174.6 - 175.1 1.24 Women Mean height (cm) 161.1 4796 0.11 160.8 - 161.3 1.17
Weight Men Mean weight (kg) 81.1 3637 0.27 80.6 - 81.7 1.21 Women Mean weight (kg) 68.6 4573 0.25 68.1 - 69.1 1.13
Body mass index Men Mean body mass index (kg/m2) 26.5 3609 0.08 26.4 - 26.7 1.20 Women Mean body mass index (kg/m2) 26.5 4543 0.10 26.3 - 26.7 1.16
Men 20 kg/m2 or less (%) 4.5 3609 0.39 3.8 - 5.3 1.13 Over 20 - 25 kg/m2 (%) 33.3 3609 0.90 31.6 - 35.1 1.14 Over 25 - 30 kg/m2 (%) 42.6 3609 0.92 40.8 - 44.4 1.12 Over 30 kg/m2 (%) 19.6 3609 0.73 18.1 - 21.0 1.11
Women 20 kg/m2 or less (%) 6.4 4543 0.44 5.5 - 7.2 1.20 Over 20 - 25 kg/m2 (%) 39.4 4543 0.85 37.8 - 41.1 1.18 Over 25 - 30 kg/m2 (%) 32.1 4543 0.75 30.7 - 33.6 1.08 Over 30 kg/m2 (%) 22.1 4543 0.73 20.7 - 23.5 1.18
Waist and hip Men Mean waist (cm) 92.4 3250 0.24 91.9 - 92.9 1.24 Mean hip (cm) 102.0 3252 0.17 101.7 - 102.3 1.28 Mean waist/hip ratio 0.9 3248 0.00 0.9 - 0.9 1.20 Women Mean waist (cm) 81.8 4039 0.25 81.3 - 82.3 1.21 Mean hip (cm) 102.2 4041 0.20 101.8 - 102.6 1.14 Mean waist/hip ratio 0.8 4035 0.00 0.8 - 0.8 1.23
30 Table 15.18 True standard errors and 95% confidence intervals for body mass index (BMI) within region
1998
Mean/% Sample True 95% confidence Deft size (unweighted) standard interval error Body mass index Men Highland & Islands 26.8 378 0.20 26.4 - 27.2 0.67 Grampian & Tayside 26.5 593 0.15 26.2 - 26.8 1.05 Lothian & Fife 26.6 767 0.18 26.2 - 26.9 1.24 Borders, Dumfries & Galloway 26.2 320 0.25 25.7 - 26.7 0.89 Greater Glasgow 26.2 472 0.26 25.7 - 26.7 1.35 Lanarkshire, Ayrshire & Arran 26.7 623 0.20 26.3 - 27.1 1.21 Forth Valley, Argyll & Clyde 26.7 456 0.23 26.2 - 27.1 1.27
Women Highland & Islands 26.4 452 0.26 25.8 - 26.9 0.82 Grampian & Tayside 26.7 727 0.24 26.3 - 27.2 1.15 Lothian & Fife 26.2 951 0.22 25.8 - 26.7 1.30 Borders, Dumfries & Galloway 27.0 436 0.28 26.4 - 27.5 0.75 Greater Glasgow 26.1 631 0.26 25.6 - 26.6 1.31 Lanarkshire, Ayrshire & Arran 26.8 781 0.21 26.4 - 27.2 1.07 Forth Valley, Argyll & Clyde 26.5 565 0.24 26.1 - 27.0 1.06
% Obese (BMI over 30) Men Highland & Islands 22.2 378 1.96 18.3 - 26.0 0.92 Grampian & Tayside 18.2 593 1.51 15.3 - 21.2 0.95 Lothian & Fife 19.6 767 1.53 16.6 - 22.6 1.07 Borders, Dumfries & Galloway 17.3 320 2.26 12.9 - 21.7 1.07 Greater Glasgow 19.4 472 2.24 15.0 - 23.8 1.23 Lanarkshire, Ayrshire & Arran 21.2 623 1.81 17.6 - 24.7 1.10 Forth Valley, Argyll & Clyde 19.3 456 1.91 15.5 - 23.0 1.03
Women Highland & Islands 22.0 452 2.09 17.9 - 26.1 1.07 Grampian & Tayside 22.8 727 1.80 19.3 - 26.4 1.16 Lothian & Fife 21.1 951 1.68 17.8 - 24.4 1.27 Borders, Dumfries & Galloway 22.0 436 2.31 17.5 - 26.5 1.16 Greater Glasgow 20.0 631 1.96 16.1 - 23.8 1.23 Lanarkshire, Ayrshire & Arran 24.6 781 1.53 21.6 - 27.6 0.99 Forth Valley, Argyll & Clyde 22.3 565 1.75 18.9 - 25.7 1.00
Table 15.19 True standard errors and 95% confidence intervals for blood pressure measurement variables
1998
Blood pressure measurement Mean/% Sample True 95% confidence Deft size (unweighted) standard interval error Men Mean systolic blood pressure 132.4 3031 0.32 131.8 - 133.0 1.16 Mean diastolic blood pressure 73.5 3031 0.25 73.0 - 74.0 1.18 % with high blood pressurea 27.8 3018 0.89 26.1 - 29.6 1.10
Women Mean systolic blood pressure 127.4 3729 0.37 126.7 - 128.1 1.11 Mean diastolic blood pressure 69.5 3729 0.22 69.1 - 69.9 1.12 % with high blood pressure1 22.3 3707 0.76 20.8 - 23.8 1.10 a The definition of high blood pressure i.e. hypertension for SBP and DBP thresholds is 140/90 mmHg
31 Table 15.20 True standard errors and 95% confidence intervals for blood pressure measurement variables within region
1998
Characteristic Mean/% Sample True 95% confidence Deft size (unweighted) standard interval error % with high blood pressure Men Highland & Islands 31.1 328 2.65 25.9 - 36.3 1.03 Grampian & Tayside 23.8 504 1.98 19.9 - 27.6 1.04 Lothian & Fife 28.3 630 1.97 24.5 - 32.2 1.10 Borders, Dumfries & Galloway 31.2 281 2.78 25.8 - 36.7 1.00 Greater Glasgow 27.8 400 2.38 23.1 - 32.4 1.06 Lanarkshire, Ayrshire & Arran 26.3 496 2.18 22.0 - 30.6 1.10 Forth Valley, Argyll & Clyde 32.0 379 2.60 26.9 - 37.1 1.08
Women Highland & Islands 27.7 372 2.67 22.5 - 33.0 1.15 Grampian & Tayside 20.4 627 1.67 17.2 - 23.7 1.03 Lothian & Fife 20.9 754 1.47 18.1 - 23.8 0.99 Borders, Dumfries & Galloway 28.9 352 2.25 24.5 - 33.3 0.93 Greater Glasgow 20.7 498 2.31 16.2 - 25.3 1.27 Lanarkshire, Ayrshire & Arran 27.1 628 2.01 23.1 - 31.0 1.13 Forth Valley, Argyll & Clyde 18.6 476 1.77 15.1 - 22.1 0.99 a The definition of high blood pressure i.e. hypertension for SBP and DBP thresholds is 140/90 mmHg
Table 15.21 True standard errors and 95% confidence intervals for saliva and blood analyte variables
1998
Mean/% Sample True 95% confidence Deft size (unweighted) standard interval error Cotinine Men 0<15 (ng/ml) (%) 63.3 2757 1.14 61.1 - 65.6 1.41 15+ (ng/ml) (%) 36.7 2757 1.14 34.4 - 38.9 1.25 Women 0<15 (ng/ml) (%) 69.9 3181 1.01 67.9 - 71.9 1.24 15+ (ng/ml) (%) 30.1 3181 1.01 28.1 - 32.1 1.24
Total cholesterol Men Mean total cholesterol (mmol/l) 5.4 2686 0.03 5.3 - 5.4 1.25 Women Mean total cholesterol (mmol/l) 5.4 3238 0.02 5.4 - 5.5 1.06
HDL – cholesterol Men Mean HDL – cholesterol (mmol/l) 1.3 2668 0.01 1.3 - 1.3 1.29 Women Mean HDL – cholesterol (mmol/l) 1.6 3223 0.01 1.5 - 1.6 1.19
Ferritin Men Mean ferritin (ng/ml) 118.3 2721 2.15 114.1 - 122.5 1.13 Women Mean ferritin (ng/ml) 50.7 3233 1.11 48.5 - 52.8 1.06
Haemoglobin Men Mean haemoglobin (g/dl) 15.0 2742 0.02 15.0 - 15.0 1.25 Women Mean haemoglobin (g/dl) 13.3 3268 0.02 13.3 - 13.3 1.11
Fibrinogen Men Mean fibrinogen (g/l) 2.6 2480 0.02 2.6 - 2.6 1.22 Women Mean fibrinogen (g/l) 2.8 2980 0.02 2.8 - 2.8 1.14
C – reactive protein Men Mean C–reactive protein (mg/l) 2.9 2720 0.14 2.6 - 3.2 1.15 Women Mean C–reactive protein (mg/l) 3.7 3268 0.19 3.4 - 4.1 1.16
32 Table 15.22 True standard errors and 95% confidence intervals for physical activity
1998 Summary physical activity level % (p) Sample True 95% confidence Deft size (unweighted) standard interval error Men Group 1 – Low 33.2 3934 0.86 31.5 - 34.9 1.14 Group 2 – Medium 28.6 3934 0.86 26.9 - 30.3 1.20 Group 3 – High 38.2 3934 0.88 36.4 - 39.9 1.14
Women Group 1 – Low 37.7 5100 0.83 36.1 - 39.3 1.22 Group 2 – Medium 35.3 5100 0.82 33.7 - 36.9 1.22 Group 3 – High 27.0 5100 0.80 25.4 - 28.5 1.29
Table 15.23 True standard errors and 95% confidence intervals for general health variables
1998
Base Characteristic %(p) Sample True 95% confidence Deft size (unweighted) standard interval error Longstanding illness/acute sickness Men Longstanding illness/disability 39.9 3941 0.94 38.0 - 41.7 1.21 Limiting longstanding illness 22.5 3941 0.73 21.1 - 23.9 1.10 Self-reported acute sickness 13.0 3940 0.63 11.7 - 14.2 1.19
Women Longstanding illness/disability 40.4 5106 0.88 38.7 - 42.1 1.28 Limiting longstanding illness 24.7 5106 0.76 23.2 - 26.1 1.27 Self-reported acute sickness 17.8 5105 0.65 16.6 - 19.1 1.21
Self-reported general health Men Very good/Good 76.8 3941 0.79 75.3 - 78.4 1.18 Fair 17.5 3941 0.70 16.1 - 18.9 1.15 Bad/Very bad 5.7 3941 0.40 4.9 - 6.5 1.09
Women Very good/Good 77.4 5106 0.74 75.9 - 78.8 1.26 Fair 17.1 5106 0.65 15.9 - 18.4 1.23 Bad/Very bad 5.5 5106 0.37 4.8 - 6.2 1.17
GHQ12 score Men 0 62.5 3879 0.87 60.7 - 64.2 1.12 1-3 24.9 3879 0.77 23.4 - 26.4 1.11 4 or more 12.6 3879 0.57 11.5 - 13.7 1.07
Women 0 55.1 5043 0.85 53.4 - 56.8 1.21 1-3 26.7 5043 0.72 25.3 - 28.1 1.16 4 or more 18.2 5043 0.65 16.9 - 19.5 1.20
33 34 16 QUALITY CONTROL OF BLOOD AND SALIVA ANALYTES 16 Marion Brookes and Anne McMunn with John Sprunt, Paul Finglas and Ian Gibb 16.1 INTRODUCTION AND KEY CONCLUSIONS This chapter describes the assay of analytes, quality control and quality assessment that were carried out during the survey period. Details of procedures used in the collection, processing and transportation of the specimens are described in Appendix B.
The overall conclusion for the data provided in this chapter is that methods and equipment used for the measurement of blood and saliva analytes produced internal quality control (IQC) and external quality assessment (EQA) results within expected limits. The results of the analyses for each of the main blood analytes and saliva cotinine levels were acceptable for the 1998 Scottish Health Survey. In addition, IQC for the vitamin and carotenoid analyses showed consistent concentration values throughout the course of the project. Also, the EQA NIST Round Robin results for vitamin and carotenoid analysis in the three analysis periods in 1998 showed good agreement between the measured component concentrations and the NIST standard values. It can, therefore, be concluded that results of the analyses for vitamins C, A, E and carotenoids are all acceptable for the 1998 Scottish Health Survey.
16.2 SAMPLES COLLECTED In the first quarter of the survey year only adults aged 16-74 were eligible for providing a blood sample. In the remaining data collection period (after receipt of ethical approval to use a topical anaesthetic), eligibility was further extended to children aged 11-15. Following written consent from eligible informants, three blood samples were collected and despatched to the Department of Clinical Biochemistry at the Royal Victoria Infirmary (RVI) in Newcastle-upon-Tyne. The three tubes for adults were one 6ml plain tube, a 4ml EDTA tube and a 4.5ml citrate tube. For children the three tubes were a 6ml plain and two 2ml EDTA tubes. An additional 6ml plain tube was also taken for a sub-group of adult informants for analysis of vitamins A, C, E and carotenoids. A saliva sample was also collected from informants aged 4-74.
Samples collected in the 6ml plain tube (no anticoagulant) for serum This provided the sample for total cholesterol, high density lipid (HDL)-cholesterol, gamma glutamyl transpeptidase (gamma gt) and C-reactive protein (CRP), for informants aged 16- 74, ferritin for those aged 11-74 and total immunoglobulin E (IgE) and house dust mite specific IgE for informants aged 11-15. Where written consent was given by the informant, a minimum of 0.5ml of the remaining serum was stored in a freezer at minus 70°C ± 5°C for possible future analysis.
Samples collected in the 4ml ethylene diamine tetra-acetic acid (EDTA) tube This provided the sample for haemoglobin for informants aged 16-74. If written consent was given by the informant, approximately 1ml of whole blood was stored in a freezer at minus 20°C ± 5°C for possible future analysis.
35 Samples collected in the 4.5ml citrate tube This provided the sample for fibrinogen for informants aged 16-74.
Samples collected in the two 2ml EDTA tubes One tube provided the sample for haemoglobin analysis for informants aged 11-15 whilst the other tube provided the sample for blood lead analysis for informants aged 11-15.
Additional 6ml plain (no anticoagulant) tube This provided the sample for analysis of vitamins A, C and E, and carotenoids for a sub-group of 776 informants aged 16-74.
Saliva tube A dental roll saturated with informants’ saliva was placed in a tube in order to be analysed for cotinine (a derivative of nicotine that shows recent exposure to tobacco smoke) analysis for informants aged 4 - 74.
16.3 CHANGE OF ANALYSING LABORATORIES For the analysis of the main (non-vitamin) blood analytes, The 1998 Scottish Health Survey used the same laboratory as the 1998 Health Survey for England, the Royal Victoria Infirmary (RVI) in Newcastle upon Tyne. This was a change from the 1995 Scottish Health Survey and previous Health Surveys for England (1994 to 1997) in which the West Middlesex University Hospital (WMUH) was used for blood analysis. WMUH was taken over by SmithKline Beecham Clinical Laboratories (SKBC) in 1997. A resulting increase in costs associated with using this laboratory necessitated a change of laboratory for the 1998 surveys. A cross-over study comparing differences between the two laboratories study was considered and deemed unhelpful as most of the analytical techniques had changed between 1995 and 1998, making comparison between the two laboratories problematic.
The Diet Health and Consumer Science Division at the Institute of Food Research in Norwich acted as the vitamin assay laboratory for the 1998 Scottish Health Survey. This was also a change from the laboratory used for vitamin analysis for the 1995 Scottish Health Survey. Similar High Performance Liquid Chromotography (HPLC) methods were employed. However, differences in handling between the two survey years (fewer problems with sample transport in the 1998 Scottish Health Survey reducing the risk of degradation during shipment, lower storage temperatures and shorter storage times, as well as stricter criteria for sample exclusion) has meant that comparison of data for the two years is not possible.
As in 1995, cotinine analysis for the 1998 Scottish Health Survey was conducted by the Nicotine Laboratory at New Cross Hospital. However, in 1998 cotinine was analysed using a saliva sample while in 1995 a blood serum sample was used for cotinine analysis. 1995 and 1998 cotinine levels are not compared in this report.
16.4 METHODOLOGY The Department of Clinical Biochemistry at the RVI acted as the co-ordinating department for transport of samples to a variety of individual departments within the RVI undertaking analysis for the 1998 Scottish Health Survey as well as alternative laboratories in the case of saliva and vitamin samples. All analyses were carried out according to Standard Operating Procedures by State Registered Medical Laboratory Scientific Officers (MLSOs) under the supervision of the Senior MLSO. All results were routinely checked by the duty Biochemist and highly abnormal results were immediately faxed to the Survey Doctor in
36 Aberdeen. Where prior consent was obtained, the Survey Doctor notified and advised the informant and their General Practitioner as appropriate.
A schedule of Planned Preventative Maintenance was used for each item of analytical equipment. These plans were carried out jointly by the manufacturers and the laboratories. Records were kept of when maintenance was due and carried out.
Table 16.1 shows reference ranges used by the various laboratories for each of the analytes measured in the 1998 Scottish Health Survey. Values within these reference ranges were considered to be clinically ‘normal’ while those outside were treated as clinically ‘abnormal’ (either too high or too low). Table 16.1
Total cholesterol Measurement of total cholesterol was carried out using the DAX Cholesterol Oxidase assay method, calibrated to Centre for Disease Control (CDC) guidelines, by the Biochemistry Department at RVI. The same method was used by both laboratories in 1995 (at WMUH) and in 1998 (at RVI), although the equipment used was different. As both labs perform within acceptable ranges in EQA schemes, comparisons between the two years have been made in the 1998 Scottish Health Survey report. Some caution should be applied in interpreting this comparison, however.
HDL-cholesterol HDL-cholesterol was measured using the DAX Cholesterol Oxidase assay method calibrated to CDC after PTA precipitation by the Biochemistry Department at RVI.
Gamma glutamyl transpeptidase (gamma gt) Analysis of gamma gt was carried out using the DAX Nitoanilide (37°C) assay method by the Biochemistry Department at RVI.
C-reactive Protein (CRP) CRP was analysed using the N Latex CRP mono Immunoassay on the Behring Nephelometer II Analyzer by the Biochemistry Department at RVI. Samples were not analysed for C-reactive protein in 1995.
Ferritin Measurement of ferritin was carried out using the Abbott Microparticle Enzyme Immunoassay (MEIA) /IMX ferritin assay method by the Haematology Department at RVI. In 1995 WMUH used the Boehringer Enzymun method instead. Results from a comparison study of the two different analytical methods carried out at the WMUH (where the Abbott Microparticle Enzyme Immunoassay (MEIA) /IMX ferritin assay method was used from 1996) were presented in the 1996 Health Survey for England report.1 Given the wide inter- laboratory variability of immunoassays and the difference in analytical methods the ferritin data in the 1998 report are not comparable with those in 1995.
Haemoglobin Haemoglobin analysis was carried out by the Haematology Department. The majority of samples were analysed on the first of two Coulter Electronics Ltd Model STKS analysers (designated as STKSA). Occasional analysis was carried out using the second analyser (designated as STKSB). Both analysers had two tests and two blank spectrophotometric readings taken at 525 ± 30nm in an Isoton III dilution. The methods used for haemoglobin analysis have not changed; therefore, the 1998 results from RVI are comparable to results in 1995 from WMUH.
37 Fibrinogen Fibrinogen was measured using the Organon Teknika MDA 180 analyser and a modification of the Clauss thrombin clotting method by the Department of Haematology. In the 1995 Scottish Health Survey WMUH used the nephelometric method (clot turbidity) for fibrinogen analysis. This change in methods means that 1998 fibrinogen results are not comparable with those from 1995.
Blood Lead Analysis of blood lead was carried out using the Phillips Atomic Absorption Spectrophotometer with Graphite Furnance for electrothermal atomisation (giving reliable results in the range of 0- 20 µg/dL) by the Environmental & Occupational Medicine Department at RVI.
Total IgE and house dust mite specific IgE Total and house dust mite specific IgE was analysed using the Pharmacia CAP system immunoassay method on the Pharmacia Autocap analyser at the accredited Regional Department of Immunology at RVI.
Vitamin samples — storage and transportation In a sub-sample of over 776 informants,2 an extra 6ml plain plastic tube of blood was taken to be analysed for vitamins A, C, E and carotenoids. After venepuncture, the tube was put in a plastic bag, placed inside a jiffy bag, kept in a cool box to avoid exposure to heat and light, and delivered within five hours to one of nine local laboratories in Scotland for immediate processing. Samples were centrifuged and two tubes of serum samples were prepared at the local laboratories: Tube A, a 0.5ml serum sample was immediately stabilised with 1ml meta- phosphoric acid (10% V/V) for vitamin C analysis; Tube B, approximately 2ml serum, was stored for analysis of vitamins A, E and carotenoids. Throughout this inital processing, samples were kept at 4°C and protected from sunlight. Both tubes were then stored at -40°C or below in dry ice, before being transferred on a regular basis to the Diet Health and Consumer Science Division at the Institute of Food Research (IFR) in Norwich for analysis. Once at the IFR, samples were stored at -196 °C in liquid nitrogen until analysed.
Vitamin samples — assay methods Vitamin C in metaphosphoric acid extracts of serum was measured by High Performance Liquid Chromatography (HPLC) with electrochemical detection. Sets of fresh working ascorbic acid standards, stored on ice, in the normal physiological concentration range were used to give a calibration curve for electrode response on each day of analysis. Output was to the Chrom Perfect chromatographic data handling system. Serum vitamins A, E and carotenoids were analysed by high pressure liquid chromatography (HPLC), with a variable wavelength UV/Vis multichannel photodetector for vitamins A and E and a fixed wavelength absorbance detector for carotenoids. Stock solutions of analytes were diluted to give an absorbance reading of approximately 0.5AU, the exact absorbance measured by a scanning spectrophotometer connected to a data handling system. Precise concentrations were calculated. Working standards were prepared from these stock solutions and injected every analysis day to ensure consistency of instrument response. Output from the detectors was directed to the Chrom Perfect chromatographic data handling system.
Cotinine Measurement of saliva cotinine was carried out using a Hewlett Packard hp5890 gas chromatograph machine, with a rapid-liquid chromatography technique by the Nicotine Laboratory at New Cross Hospital. Saliva samples received at RVI are checked for correct identification, assigned a laboratory accession number and stored at 4°C before being despatched weekly in polythene bags (20 samples per bag) by Red Star courier for overnight delivery to New Cross.
38 16.5 QUALITY CONTROL 16.5.1 Internal Quality Control (IQC) The purpose of IQC is to ensure reliability of an analytical run. IQC also helps to identify, and prevent the release of, any errors in an analytical run. IQC is also used to monitor trends over time.
For each analyte or group of analytes, the laboratory obtains a supply of quality control materials, usually at more than one concentration of analyte. A target (mean) value is assigned for each analyte. These target values are obtained from replicate measurements (over several runs) in conjunction with target values provided from manufacturers of IQC materials, if available. The standard deviation (S.D.) and the coefficient of variation (C.V.) are measures of imprecision and are presented below. Samples are re-analysed if the S.D. or C.V are unacceptably high.
Standard deviation (S.D.) is calculated as
Coefficient of variation (C.V.) is calculated as standard deviation/mean x 100%
Tables for this chapter include summaries of IQC data expressed as means, standard deviations (S.D.) and coefficients of variation (C.V.).
Total cholesterol Low, Medium and High control materials are assayed with every 50 samples. Table 16.2 shows the monthly internal quality control results for total cholesterol. Table 16.2
HDL-cholesterol A control is precipitated with each batch prior to assay on the DAX where control materials are assayed with every 50 samples. Table 16.3 shows the monthly internal quality control results for HDL-cholesterol. Note that acceptable coefficients of variation are higher for HDL-cholesterol than for total cholesterol. Table 16.3
Gamma gt Low, Medium and High control materials are assayed with every 50 samples. Table 16.4 shows the monthly internal quality control results for gamma glutamyl transpeptidase. Table 16.4
C-reactive protein Table 16.5 shows the monthly internal quality control results for four levels of C-reactive protein. Table 16.5
Ferritin IMX Ferritin calibrator and Low, Medium and High controls are included in each assay run of 21 samples and are calibrated against reagent and reaction cell batches. Table 16.6 shows the monthly internal quality control results for ferritin. Table 16.6
Haemoglobin The analyser is calibrated using material provided by the manufacturer (Coulter). Indices are checked at least daily using Coulter controls at three levels. In-house preparations, normal level, abnormal level I (ABNI) and abnormal level II (ABNII) are used to monitor
39 within batch and between batch variation during the day. Reproducibility is assessed by 15 random samples being tested on 6 different occasions over a 6 hour period. Table 16.7 shows the monthly internal quality control results for haemoglobin with two or three levels of haemoglobin tested each month. Table 16.7
Fibrinogen Control plasmas are assayed at regular intervals and instrument function tests are monitored continuously for fibrinogen with the control interval specified as every 4 hours or 100 specimens. Significant deviations from specified limits are flagged and must be acknowledged by the operator. Table 16.8 shows the monthly internal quality control results for two fibrinogen levels. Note that coefficient of variation values tend to be higher for fibrinogen than for many of the other analytes presented here. Table 16.8
Total IgE and house dust mite specific IgE One internal control serum is included per run for Total IgE. One internal control serum positive for two allergens, House Dust Mite and Timothy Grass, is included per run for the Specific IgE. The IQC is reported as a score 0=negative to 6=strongly positive, deduced from unit ‘bands’ where a to b units score 1; b to c units score 2 etc. Units are not routinely reported for these analytes. Tables 16.9 and 16.10 show the monthly internal quality control results for total IgE and house dust mite specific IgE. Tables 16.9, 16.10
Blood Lead An internal QC sample was run after every five samples and the initial external QC sample was reanalysed at the end of each batch (the intra-assay measurement). Table 16.11 shows the monthly internal quality control results for blood lead measured in µg/dL. Table 16.11
Vitamin C In the first analysis period (April 1998 – July 1998) recovery tests yielded 105.0% and 98.5% recovery of added ascorbic acid. The between-batch coefficient of variation ranged from 8.7% to 15.3%. In the second analysis period (August 1998 – October 1998) the average between-batch coefficient of variation, CVB, was 18.2%. Spiking 10 µg/ml of vitamin C into control samples gave mean recovery of 105.5% with SD of 13.4%. In the third analysis period (November 1998 – January 1999) the average between-batch coefficient of variation, CVB, was 17.5 %. Spiking 10 µg/ml of vitamin C into control samples gave mean recovery of 102.7% with SD of 15.0%. In the fourth analysis period
(February 1999 – April 1999) the average between-batch coefficient of variation, CVB, was 8.3%. Spiking 10 µg/ml of vitamin C into control samples gave mean recovery of 106.8% with SD of 13.0%. In the fifth analysis period (May 1999 – July 1999) the average between- batch coefficient of variation, CVB, was 5.7%. Spiking 10 µg/ml of vitamin C into control samples gave mean recovery of 101.8% with SD of 5.6%. These levels of variation are considered acceptable for the determination of this vitamin in plasma. These IQC results for vitamin C are shown in table 16.12. Table 16.12
Vitamins A, E and carotenoids Throughout the study a stock IQC sample was included with every extracted batch of plasma samples from the local laboratories. Instrument response consistency was ensured by injecting a standard fat-soluble vitamin and carotenoid mixture every day of analysis. For the first analysis period (April 1998 – July 1998) the average CVB for vitamins A & E and carotenoids was 9.1% (range = 4 - 21%) an acceptable level of variation for these vitamins in plasma. In the second analysis period (August 1998 – October 1998) the average CVB for vitamins A & E and carotenoids was 7.2% (range = 4 - 17%). In the third analysis period
40 (November 1998 – January 1999) the average CVB for vitamins A & E and carotenoids was 7.4% (range = 4 - 15%). In the fourth analysis period (February 1999 – April 1999) the
average CVB for vitamins A & E and carotenoids, with the exception of cis-ß carotene, was
8.2% (range = 2 - 15%). The CVB value of 31.6% for cis-ß carotene for this series of IQC results is higher than previous analysis periods (12-17%). This is explained by this being the lowest concentration component shown and subsequently more subject to systematic
variations and noise. In the fifth analysis period (May 1999 – July 1999) the average CVB for vitamins A & E and carotenoids was 5.7% (range = 3 – 12.5%). These results for carotenoid concentrations in this quarter are not directly comparable to previous quarters because a new batch of IQC plasma had been used. The internal quality control results for vitamins A, E and carotenoids are shown in Table 16.13. Table 16.13
Cotinine The Medical Toxicology Unit at New Cross participates in inter-laboratory split analyses to ensure comparable results. A summary of these monthly results for five levels of cotinine are presented in Table 16.14. Table 16.14
16.5.2 External quality assessment (EQA) EQA helps to safeguard accuracy of analytical methods and permits comparison of results between laboratories measuring the same analyte. An EQA scheme for an analyte or group of analytes distributes aliquots of the same samples to participating laboratories, who are blind to the concentration of the analytes. The usual practice is to participate in a scheme for a full year during which samples are distributed at regular frequency (monthly or bimonthly, for example); the number of samples in each distribution and the frequency differ between schemes. The samples contain varying concentrations of analytes. The same samples may or may not be distributed more than once. Samples are assayed shortly after they arrive at the laboratory. Depending on the frequency of distribution there may be weeks or months in which no EQA samples are analysed. Results are returned to the scheme organisers, who issue a laboratory specific report giving at least the following data:
• mean values, usually for all methods and for method groups;
• a measure of the between-laboratory precision;
• the bias of the results obtained by that laboratory.
EQA is a retrospective process of assessment of performance, particularly of inaccuracy or bias with respect to mean values; unlike IQC, it does not provide control of release of results at the time of analysis.
The United Kingdom National External Quality Assessment Schemes (UKNEQAS) is a network of EQA schemes run by UK clinical laboratories. The Welsh External Quality Assessment Schemes (WEQAS), the Coulter Interlaboratory QA programme, National External Quality Assessment Scheme for Haematology, the Cambridge External Quality Assessment Schemes and the Central Quality Assessment Schemes (QAS) are all schemes that the laboratories participate in on a routine basis.
Each of the figures presented in Tables 16.15 - 16.27 corresponds with an individual EQA sample.
Total cholesterol The Clinical Biochemistry Department at RVI participates in the UKNEQAS for total cholesterol. Table 16.15 shows the monthly EQA results for total cholesterol. The target and achieved values are shown. Table 16.15
41 HDL-cholesterol The Clinical Biochemistry laboratory participates in the WEQAS for HDL-cholesterol. Table 16.16 shows the monthly EQA results for HDL-cholesterol. The target and achieved values are shown. Table 16.16
Gamma gt The Clinical Biochemistry laboratory participates in UKNEQAS for gamma gt. Table 16.17 shows the monthly EQA results for gamma glutamyl transpeptidase. The target and achieved values are shown. Table 16.17
C-reactive protein The Clinical Biochemistry laboratory participates in UKNEQAS for C-reactive protein. Table 16.18 shows the monthly EQA results for C-reactive protein. The target and achieved values are shown. Table 16.18
Ferritin The Haematology laboratory receives two ferritin samples each month as participants in the UKNEQAS for ferritin. Table 16.19 shows the external quality assessment results for ferritin for each month. The target and achieved values are shown. Table 16.19
Haemoglobin The Haematology laboratory participates in three different EQA schemes for haemoglobin. For the Coulter Interlaboratory QA Program results from ‘normal’ level material are submitted monthly to Coulter who produce reports to its 890 participants. UKNEQAS supply 2 samples monthly to a group of 235 participants and the Cambridge EQAS supply a weekly sample to its 72 participants. Table 16.20 shows the monthly UKNEQAS results for haemoglobin. Table 16.20
Fibrinogen The Haematology laboratory participates in the UKNEQAS and the Central QAS for fibrinogen. The UKNEQAS includes 4 surveys per year while the Central QAS runs fortnightly, roughly. Table 16.21 shows the UKNEQAS results for fibrinogen while Table 16.22 shows the Central QAS results. Tables 16.21, 16.22
Total IgE and house dust mite specific IgE The Immunology laboratory participates in the UKNEQAS for both total and house dust mite specific (HDM) IgE. The EQA scheme for total IgE distributes samples 8 times each year (roughly every six weeks). Therefore there are no EQA results for some calendar months. Table 16.20 shows the EQA results for total IgE. Table 16.23
The UKNEQAS for specific IgE types was set up to allow laboratories to screen a number of different allergens. For allergen specific IgE, a graded performance criteria based on Overall Misclassification Index Scores (OMIS) is set by the scheme organisers and committee based on the amount of variation between the target and achieved sample results. The grades are OMIS=0 being Ideal, OMIS 1-2 being Acceptable and OMIS >2 being Poor. The OMIS grades for the reported EQA results for HDM IgE were reported twice during the Health Survey data collection period and both were 0 – Ideal. Target and achieved mean results are shown in Table 16.24. Table 16.24
Blood Lead The Environmental & Occupational Medicine laboratory also participates in the UKNEQAS. A UKNEQAS sample, for which the consensus mean has been established and
42 reported, is included as a first determination followed by an in house prepared internal QC sample. Table 16.25 shows the EQA results for lead reported as µmol/L as required by UKNEQAS. To convert to µg/dL divide the µmol/L value by 0.048. For example an informant with a blood lead of 1.2 µmol/L can also be said to have a blood lead of 25 µg/dL. Table 16.25
Vitamin C The assay laboratory participated in the US National Institute for Standards in Technology (NIST) programme for vitamin C once during the year of Scottish Health Survey data collection as this was the only vitamin C Round Robin offered by NIST during the year (Round Robin XII – RR12). This external quality assessment scheme is less well- established and has fewer participants than that for fat soluble vitamins. The concentration of ascorbic acid was measured for a standard solution and two unknown serum samples (level I and level II). The NIST EQA report indicated that the assay laboratory result was within 2 standard deviations of the mean concentration for the Level I unknown sample and within 1 standard deviations for the Level II unknown sample. NIST results in previously published fat-soluble vitamin Round Robins rated these divisions as, respectively, Acceptable and Exceptional. Results of external quality assessment for vitamin C are shown in Table 16.26. Table 16.26
Vitamins A, E and carotenoids The Institute of Food Research joined the US National Institute of Standards and Technology (NIST) Micronutrient Measurement Quality Assurance Programme for 1998/9 and submitted results for Round Robins XLII (RR42, 28th May 1998), XLIII (RR43, 28th August 1998) and XLIV (RR44, 23rd November 1998). Four serum samples from an aged (10 years) serum pool were distributed to laboratories, some of whom experienced interferences due to plasticizers extracted from the plasma storage bags in the chromatographic region for retinol and/or tocopherol.
In the first analysis period (April 1998 – July 1998) (RR XLII) IFR performance was rated exceptional (±1 standard deviation) for retinol (0-5%), acceptable (± 2 SD) for α-tocopherol (6-10%) and trans-ß-carotene. Total- and ß-carotene (11-20%) were rated as marginal ( > 2 SD of the assigned value). Preliminary results for the second NIST round robin indicated that IFR results for all data were close to the historical median indicating the dilution difficulties experienced in the NIST first round robin had been overcome. In the second analysis period (August 1998 – October 1998) (RR XLIII) IFR performance improved from marginal ( >2 SD) to acceptable (± 2 SD) for total ß-carotene. Retinol and a-tocopherol were rated acceptable (± 2 SD) and trans-ß-carotene rated as exceptional (± 1 SD). In the third analysis period (November 1998 – January 1999) (RR XLIV) a greater range of components were measured in the round robin than in previous rounds. IFR performance was rated acceptable (± 2 SD) for total-ß-carotene, retinol and α-tocopherol. ß- cryptoxanthin was rated as exceptional (± 1 SD). IFR Trans-ß-carotene values for three of the four sera samples show only minor differences to the NIST assigned values (NAV) only <=7%. For the fourth sample the difference was around 24% leading to the overall marginal rating (>2 SD). There were no EQA NIST round robin results for vitamins A, E and carotenoids for the fourth analysis period (February 1999 – April 1999) or fifth analysis period (May 1999 – July 1999). The external quality assessment results for vitamins A, E and carotenoids are shown in Table 16.27. Table 16.27
Cotinine There was no external quality control scheme available in 1998 to analyse cotinine but, as stated in section 16.3.1, the Medical Toxicology Unit does participate in inter-laboratory split analyses to ensure comparable results.
43 References and notes
1 Prescott-Clarke P, Primatesta P (eds) Health Survey for England 1996, The Stationery Office, London 1997.
2 See Section 14.2.1, Chapter 14, Volume One for details regarding the representativeness of this sub-sample of informants
44 CHAPTER 16 - LIST OF TABLES
Table 16.1 Reference intervals for analytes Table 16.2 Internal quality control results for total cholesterol Table 16.3 Internal quality control results for HDL-cholesterol Table 16.4 Internal quality control results for Gamma-gt Table 16.5 Internal quality control results for C-reative Protein (CRP) Table 16.6 Internal quality control results for ferritin Table 16.7 Internal quality control results for haemoglobin Table 16.8 Internal quality control results for fibrinogen Table 16.9 Internal quality control results for Total IgE Table 16.10 Internal quality control results for HDM specific IgE Table 16.11 Internal quality control results for blood lead Table 16.12 Internal quality control for vitamin C Table 16.13 Internal quality control for vitamins A, E and carotenoids Table 16.14 Internal quality control results for cotinine Table 16.15 External quality assessment results for total cholesterol Table 16.16 External quality assessment results for HDL-cholesterol Table 16.17 External quality assessment results for Gamma-gt Table 16.18 External quality assessment results for C-reative Protein (CRP) Table 16.19 External quality assessment results for ferritin Table 16.20 External quality assessment results for haemoglobin Table 16.21 External quality assessment results (UKNEQAS) for fibrinogen Table 16.22 External quality assessment results (Central QAS) for fibrinogen Table 16.23 External quality assessment results Total IgE Table 16.24 External quality assessment results for HDM specific IgE Table 16.25 External quality assessment results for blood lead Table 16.26 External quality control (Round Robin 12) for vitamin C – fourth analysis period (February -- April 1999) Table 16.27 External quality control (Round Robin 42) for vitamins A, E and carotenoid
45 Table 16.1 Reference intervals for analytes 1998
Analyte Reference Units interval
Total cholesterol Men 3.5-6.4 mmol/l Women 3.5-6.4 mmol/l
HDL-cholesterol Men 1.0-1.5 mmol/l Women 1.2-1.8 mmol/l
Gamma-gt Men 7 - 42 iu/l Women 6 - 22 iu/l
C-reactive protein Men 0-12 mg/l Women 0-12 mg/l
Ferritin Men 25-400 ng/ml Women (Pre-menopausal <50) 6-85 ng/ml Women (Post-menopausal >=50) 20-200 ng/ml
Haemoglobin Men 13.2-16.9 g/dl Women 11.5-16.5 g/dl
Fibrinogen Men 1.46-3.80 g/l Women 1.46-3.80 g/l
Total IgE Men <100 kU/l Women <100 kU/l
House dust mite specific IgE Men <0.4 kU/l Women <0.4 kU/l
Blood lead Men <10 µg/dL Women <10 µg/dL
46 Table 16.2 Internal quality control results for total cholesterol
1998
Date Level (mmol/l) Acceptable S.D.(mmol/l) C.V. (%) Target/Achieved Range Achieved Achieved April, 1998 3.2/3.2 3.1-3.3 0.04 1.2 4.9/4.9 4.8-5.0 0.05 0.9 6.8/6.8 6.7-7.0 0.06 1.0
May 3.2/3.2 3.1-3.3 0.05 1.5 4.9/4.9 4.8-5.0 0.07 1.4 6.8/6.8 6.7-7.0 0.26 1.3
June 3.2/3.2 3.1-3.3 0.05 1.5 4.9/4.9 4.8-5.0 0.07 1.4 6.8/6.8 6.7-7.0 0.09 1.4
July 2.9/2.9 2.8-3.0 0.05 1.8 4.6/4.7 4.5-4.7 0.04 1.0 6.4/6.4 6.2-6.5 0.06 1.0
August 2.9/2.9 2.8-3.0 0.06 2.1 4.6/4.6 4.5-4.7 0.07 1.4 6.4/6.3 6.2-6.5 0.07 1.1
September 2.9/2.9 2.8-3.0 0.03 0.9 4.6/4.6 4.5-4.7 0.04 0.9 6.4/6.3 6.2-6.5 0.05 0.9
October 2.9/2.9 2.8-3.0 0.04 1.5 4.6/4.7 4.5-4.7 0.06 1.3 6.4/6.4 6.2-6.5 0.08 1.3
November 2.9/2.9 2.8-3.0 0.04 1.1 4.6/4.6 4.5-4.7 0.10 2.1 6.4/6.3 6.2-6.5 0.08 1.2
December 2.9/2.9 2.8-3.0 0.05 1.7 4.6/4.7 4.5-4.7 0.06 1.0 6.4/6.4 6.2-6.5 0.08 1.0
January, 1999 2.9/2.9 2.8-3.0 0.05 1.6 4.6/4.7 4.5-4.7 0.06 1.4 6.4/6.4 6.2-6.5 0.08 1.3
February 2.9/2.9 2.8-3.0 0.05 1.6 4.6/4.6 4.5-4.7 0.19 4.2 6.4/6.3 6.2-6.5 0.09 1.4
March 2.9/2.9 2.8-3.0 0.07 2.3 4.6/4.6 4.5-4.7 0.11 2.4 6.4/6.3 6.2-6.5 0.10 1.5
April 2.9/2.9 2.8-3.0 0.04 1.5 4.6/4.7 4.5-4.7 0.06 1.4 7.3/7.3 7.1-7.5 0.10 1.4
47 Table 16.3 Internal quality control results for HDL-cholesterol
1998
Date Level (mmol/l) Acceptable S.D.(mmol/l) C.V. (%) Target/Achieved Range Achieved Achieved April, 1998 2.1/2.0 1.8-2.4 0.18 9.1
May 1.8/1.8 1.6-2.0 0.08 4.4
June 1.8/1.8 1.6-2.0 0.10 5.4
July 1.8/1.8 1.6-2.0 0.13 7.2
August 1.8/1.8 1.6-2.0 0.11 6.2
September 1.8/1.9 1.6-2.0 0.08 4.5
October 1.8/1.8 1.6-2.0 0.09 5.0
November 1.8/1.8 1.6-2.0 0.06 3.5
December 1.8/1.8 1.6-2.0 0.11 6.5
January, 1999 1.8/1.8 1.6-2.0 0.09 4.7
February 1.8/1.9 1.6-2.0 0.12 6.7
March 1.8/1.8 1.6-2.0 0.14 7.8
April 1.8/1.8 1.6-2.0 0.15 8.0
48 Table 16.4 Internal quality control results for Gamma gt
1998
Date Level (U/L) Acceptable S.D.(U/L) C.V. (%) Target/Achieved Range Achieved Achieved April, 1998 17.0/16.5 15-18 0.6 3.6 56.0/56.4 54-59 1.0 1.7 106.0/105.6 102-110 1.6 1.6
May 17.0/16.5 15-18 0.6 3.8 56.0/56.5 54-59 1.2 2.1 106.0/106.9 102-110 2.4 2.2
June 17.0/16.3 15-18 0.7 4.2 56.0/55.3 54-59 1.3 2.3 106.0/104.5 102-110 2.6 2.5
July 17.0/16.4 15-18 0.6 4.0 56.0/55.0 54-59 1.0 1.8 106.0/103.5 102-110 1.4 1.3
August 15.0/15.2 14-17 0.6 4.0 55.0/54.1 53-57 1.0 3.1 89.0/89.0 87-92 1.2 1.4
September 15.0/15.2 14-17 0.7 4.5 55.0/54.7 53-57 0.9 1.7 89.0/89.4 87-92 1.2 1.3
October 15.0/15.3 14-17 0.7 4.8 55.0/55.2 53-57 1.1 2.0 89.0/90.4 87-92 1.1 1.2
November 15.0/15.4 14-17 0.6 4.0 55.0/55.5 53-57 0.9 1.6 89.0/90.2 87-92 1.0 1.2
December 15.0/15.5 14-17 0.7 4.6 55.0/55.4 53-57 0.9 2.8 89.0/90.0 87-92 1.1 1.2
January, 1999 15.0/15.8 14-17 0.7 4.2 55.0/56.1 53-57 0.9 1.5 89.0/91.0 87-92 1.0 1.1
February 15.0/15.4 14-17 0.6 3.9 55.0/55.3 53-57 1.0 1.9 89.0/90.3 87-92 1.0 1.2
March 15.0/15.5 14-17 0.7 4.5 55.0/55.83 53-57 0.9 1.7 89.0/90.2 87-92 1.0 1.1
April 15.0/15.7 14-17 0.6 4.1 55.0/56.2 53-57 1.0 1.8 131.0/131.9 128-134 1.8 1.4
49 Table 16.5 Internal quality control results for C-reactive protein (CRP)
1998
Date Level (mg/l) Acceptable S.D. (mg/l) C.V. (%) Target/Achieved Range Achieved Achieved April, 1998 1.7/1.7 1.6-1.9 0.06 3.7 16.8/16.8 15.6-18.1 0.64 3.8 40.4/40.2 37.9-41.6 1.32 3.3 91.0/90.4 83.3-98.7 3.38 3.7
May 1.7/1.8 1.6-1.9 0.07 4.2 15.8/15.7 14.4-17.1 0.65 4.1 27.1/27.2 25.0-29.2 1.05 3.9 37.6/37.7 35.4-39.8 1.16 3.1
June 1.7/1.8 1.6-1.9 0.09 5.2 15.8/15.9 14.4-17.1 0.61 3.8 27.1/27.6 25.0-29.2 1.00 3.6 37.6/38.3 35.4-39.8 1.07 2.8
July 1.70/1.8 1.6-1.9 0.09 5.1 15.80/15.7 14.4-17.1 0.45 2.9 27.10/27.4 25.0-29.2 0.62 2.3 37.60/38.3 35.4-39.8 1.02 2.7
August 1.70/1.8 1.6-1.9 0.09 5.1 15.8/15.9 14.4-17.1 0.43 2.7 27.1/27.9 25.0-29.2 0.65 2.3 37.6/39.2 35.4-39.8 1.11 2.8
September 1.7/1.7 1.6-1.9 0.08 4.7 15.8/15.6 14.4-17.1 0.59 3.8 27.1/27.8 25.0-29.2 0.87 2.6 37.6/39.2 35.4-39.8 1.06 2.7
October 1.7/1.7 1.6-1.9 0.07 3.9 15.8/15.3 14.4-17.1 0.44 2.8 27.1/27.6 25.0-29.2 0.69 2.5 37.6/38.8 35.4-39.8 1.15 3.0
November 1.7/1.7 1.6-1.9 0.08 4.8 15.8/15.3 14.4-17.1 0.57 3.7 27.1/27.6 25.0-29.2 0.83 3.0 37.6/38.7 35.4-39.8 1.10 2.8
December 1.7/1.7 1.6-1.9 0.08 4.8 15.8/15.5 14.4-17.1 0.64 4.2 27.1/27.4 25.0-29.2 1.06 3.9 37.6/38.4 35.4-39.8 1.31 3.4
January, 1999 1.5/1.5 1.3-1.6 0.08 5.6 15.8/15.0 14.4-17.1 0.71 4.8 27.1/26.6 25.0-29.2 1.02 3.8 37.6/37.5 35.4-39.8 1.32 3.5
February 1.5/1.5 1.3-1.6 0.07 4.4 15.8/15.9 14.4-17.1 0.52 3.3 27.1/27.6 25.0-29.2 0.83 3.0 37.6/38.1 35.4-39.8 1.21 3.2
March 1.5/1.6 1.3-1.6 0.06 3.7 15.8/16.2 14.4-17.1 0.64 4.0 27.1/27.8 25.0-29.2 0.96 3.5 37.6/38.1 35.4-39.8 1.11 2.9
April 1.5/1.5 1.3-1.6 0.07 4.9 15.8/16.3 14.4-17.1 0.73 4.5 27.1/27.6 25.0-29.2 1.04 3.8 37.6/37.6 35.4-39.8 2.11 5.6
50 Table 16.6 Internal quality control results for ferritin
1998
Date Level (ng/ml) Acceptable S.D.(ng/ml) C.V. (%) Target/Achieved Range Achieved Achieved April, 1998 Low 20.0/20.4 17.4-22.6 1.40 6.9 Medium 150.0/149.8 130.0-170.0 4.67 3.1 High 400.0/419.7 348.0-452.0 19.87 4.7
May Low 20.0/20.3 17.4-22.6 1.20 5.9 Medium 150.0/153.1 130.0-170.0 6.30 4.1 High 400.0/411.7 348.0-452.0 21.77 5.3
June Low 20.0/20.2 17.4-22.6 0.96 4.7 Medium 150.0/153.5 130.0-170.0 6.30 4.1 High 400.0/412.1 348.0-452.0 15.33 3.7
July Low 20.0/20.1 17.4-22.6 0.92 4.6 Medium 150.0/150.5 130.0-170.0 7.12 4.7 High 400.0/428.8 348.0-452.0 29.69 6.9
August Low 20.0/20.4 17.4-22.6 1.24 6.1 Medium 150.0/151.2 130.0-170.0 5.41 3.6 High 400.0/417.1 348.0-452.0 21.43 5.1
September Low 20.0/20.6 17.4-22.6 1.04 5.1 Medium 150.0/154.3 130.0-170.0 6.91 4.5 High 400.0/422.5 348.0-452.0 20.17 4.8
October Low 20.0/20.4 17.4-22.6 2.15 10.5 Medium 150.0/159.5 130.0-170.0 6.09 3.8 High 400.0/412.1 348.0-452.0 19.99 4.9
December Low 20.0/19.9 17.4-22.6 1.60 8.1 Medium 150.0/150.6 130.0-170.0 7.80 5.2 High 400.0/385.4 348.0-452.0 25.74 6.7
January, 1999 Low 20.0/19.8 17.4-22.6 1.02 5.2 Medium 150.0/153.0 130.0-170.0 6.07 4.0 High 400.0/396.1 348.0-452.0 23.55 6.0
February Low 20.0/20.6 17.4-22.6 1.54 7.5 Medium 150.0/152.7 130.0-170.0 6.74 4.4 High 400.0/398.3 348.0-452.0 26.70 6.7
March Low 20.0/20.8 17.4-22.6 0.92 4.4 Medium 150.0/157.5 130.0-170.0 6.49 4.1 High 400.0/423.1 348.0-452.0 27.53 6.5
April Low 20.0/20.5 17.4-22.6 0.88 4.3 Medium 150.0/157.9 130.0-170.0 4.24 2.7 High 400.0/423.5 348.0-452.0 28.03 6.6
51 Table 16.7 Internal quality control results for haemoglobin
1998
Date Level (g/dl) Acceptable S.D.( g/dl) C.V. (%) Target/Achieved Range Achieved Achieved April, 1998 5.2a/5.3 4.9-5.5 0.00 0.0 12.5b/12.8 12.1-12.9 0.00 0.0 16.5c/16.7 15.9-17.1 0.07 0.4 16.7d/16.6 16.3-17.1 0.20 1.2
5.2a/5.3 4.9-5.5 0.13 2.5 12.9b/13.1 12.5-13.3 0.13 1.0 16.4c/16.6 15.8-17.0 0.17 1.0 16.3d/16.0 15.7-16.9 0.23 1.4
May 5.2a/5.4 4.9-5.5 na Na 12.9b/13.1 12.5-13.3 0.00 0.0 16.4c/16.4 15.8-17.0 0.09 0.6 16.3d/16.0 15.7-16.9 0.29 1.8
5.1a/5.2 4.8-5.4 0.09 1.8 12.8b/13.0 12.4-13.2 0.10 0.8 16.3c/16.4 15.7-16.9 0.20 1.2
5.2a/5.1 4.9-5.5 0.06 1.1 12.9b/12.7 12.5-13.3 0.21 1.6
June 5.2a/5.0 4.9-5.5 0.18 3.7 12.9b/12.8 12.5-13.3 0.22 1.7 16.3c/16.3 15.7-16.9 0.24 1.5 16.3d/16.3 15.7-16.9 0.22 1.3
5.1a/5.0 4.8-5.4 0.19 3.8 12.4b/12.6 12.0-12.8 0.14 1.1 16.2c/16.3 15.6-16.8 0.24 1.5 16.2d/16.1 15.6-16.8 0.33 2.1
July 5.1a/5.0 4.8-5.4 0.14 2.7 12.4b/12.5 12.0-12.8 0.17 1.3 16.2c/16.5 15.6-16.8 0.21 1.2 16.2d/16.0 15.6-16.8 0.30 1.9
16.1c/16.1 15.5-16.7 0.17 1.1 16.1d/16.1 15.5-16.7 0.15 0.9
August 5.1a/5.0 4.8-5.4 0.09 1.8 12.4b/12.6 12.0-12.8 0.13 1.0 16.1c/16.2 15.5-16.7 0.17 1.0 16.1d/15.9 15.5-16.7 0.24 1.5
5.2a/5.2 4.9-5.5 0.08 1.5 12.8b/13.0 12.4-13.2 0.13 1.0 16.2c/16.4 15.6-16.8 0.18 1.1 16.2d/16.1 15.6-16.8 0.17 1.0
September 5.2a/5.2 4.9-5.5 0.10 1.8 12.8b/12.5 12.4-13.2 0.57 4.5 16.2c/16.3 15.6-16.8 0.29 1.8 16.2d/16.4 15.6-16.8 0.18 1.1
5.1a/5.1 4.8-5.4 0.07 1.3 12.6b/12.6 12.2-13.0 0.12 1.0 16.3c/16.3 15.7-16.9 0.20 1.2 16.3d/16.2 15.7-16.9 0.33 2.1 a Coulter Analyser STKSA, using abnormal control II b Coulter Analyser STKSA, using abnormal control I c Coulter Analyser STKSA, using normal control d Coulter Analyser STKSB, using normal control Continued ...
52 Table 16.7 – continued
1998
Date Level (g/dl) Acceptable S.D.( g/dl) C.V. (%) Target/Achieved Range Achieved Achieved October, 1998 5.1a/5.1 4.8-5.4 0.16 3.3 12.6b/12.6 12.2-13.0 0.18 1.4 16.3c/16.3 15.7-16.9 0.25 1.5 16.3d/16.1 15.7-16.9 0.14 0.9
November 5.0a/4.9 4.7-5.3 0.14 2.8 12.7b/12.6 12.3-13.1 0.22 1.7 16.3c/15.9 15.7-16.9 0.34 2.1 16.3d16.1 15.7-16.9 0.23 1.4
December 5.0a/5.0 4.7-5.3 0.09 1.9 12.7b/12.8 12.3-13.1 0.28 2.2 16.3c/16.1 15.7-16.9 0.39 2.4 16.3d/16.2 15.7-16.9 0.25 1.6
5.1a/5.0 4.8-5.4 0.11 2.2 12.8b/12.8 12.4-13.2 0.16 1.2 16.4c/16.4 15.8-17.0 0.15 0.9 16.5d/16.3 15.9-17.1 0.08 0.5
January, 1999 5.1a/5.2 4.8-5.4 0.12 2.3 12.8b/12.8 12.4-13.2 0.10 0.8 16.4c/16.4 15.8-17.0 0.38 2.3 16.5d/16.3 15.9-17.1 0.14 0.9
12.7b/12.7 12.3-13.1 0.06 0.5 16.3c/16.4 15.7-16.9 0.19 1.2 16.2d/16.3 15.6-16.8 0.16 1.0
February 5.0a/5.2 4.7-5.3 0.13 2.5 12.8b/12.7 12.4-13.2 0.09 0.7 16.4c/16.3 15.8-17.0 0.15 0.9 16.4d/16.2 15.8-17.0 0.15 0.9
5.0a/5.2 4.7-5.3 0.08 1.5 12.8b/12.8 12.4-13.2 0.18 1.4 16.4c/16.2 15.8-17.0 0.32 2.0 16.4d/16.3 15.8-17.0 0.13 0.8
March 5.0a/5.1 4.7-5.3 0.16 3.1 12.8b/12.8 12.4-13.2 0.20 1.6 16.4c/16.5 15.8-17.0 0.14 0.9 16.4d/16.4 15.8-17.0 0.16 1.0
5.2a/5.3 4.9-5.5 0.16 3.0 12.6b/12.8 12.2-13.0 0.13 1.0 16.5c/16.6 15.9-17.1 0.22 1.3 16.3d/16.3 15.7-16.9 na na
April 5.2a/5.3 4.9-5.5 0.09 1.6 12.6b/12.8 12.2-13.0 0.06 0.5 16.5c/16.7 15.9-17.1 0.15 0.9 16.3d/16.3 15.7-16.9 0.21 1.3
5.0a/5.1 4.7-5.3 0.12 2.4 12.9b/13.0 12.5-13.3 0.13 1.0 16.4c/16.4 15.8-17.0 0.27 1.6 16.5d/16.4 15.9-17.1 0.21 1.3 a Coulter Analyser STKSA, using abnormal control II b Coulter Analyser STKSA, using abnormal control I c Coulter Analyser STKSA, using normal control d Coulter Analyser STKSB, using normal control na Not appropriate because only one sample
53 Table 16.8 Internal quality control results for fibrinogen
1998
Date Level (g/l) Acceptable S.D.( g/l) C.V. (%) Target/Achieved Range Achieved Achieved April, 1998 Low 1.30/1.26 1.10-1.50 0.10 8.2 High 2.70/2.71 2.26-2.92 0.19 6.9
May Low 1.30/1.20 1.10-1.50 0.10 8.6 High 2.70/2.48 2.26-2.92 0.16 6.6
June Low 1.30/1.28 1.10-1.50 0.11 8.3 High 2.70/2.67 2.26-2.92 0.17 6.5
July Low 1.30/1.21 1.10-1.50 0.10 8.1 High 2.70/2.61 2.26-2.92 0.16 6.2
August Low 1.30/1.25 1.10-1.50 0.10 8.2 High 2.70/2.72 2.26-2.92 0.16 6.1
September Low 1.30/1.26 1.10-1.50 0.14 11.0 High 2.70/2.69 2.26-2.92 0.21 7.9
October Low 1.30/1.28 1.10-1.50 0.12 9.5 High 2.60/2.48 2.34-2.86 0.15 6.2
November Low 1.30/1.27 1.10-1.50 0.13 10.1 High 2.60/2.58 2.34-2.86 0.17 6.6
December Low 1.30/1.20 1.10-1.50 0.12 10.2 High 2.60/2.49 2.34-2.86 0.20 7.9
January, 1999 Low 1.30/1.33 1.10-1.50 0.11 8.2 High 2.60/2.66 2.34-2.86 0.21 8.1
February Low 1.30/1.28 1.10-1.50 0.12 9.4 High 2.60/2.63 2.34-2.86 0.20 7.5
March Low 1.30/1.32 1.10-1.50 0.10 7.6 High 2.60/2.78 2.34-2.86 0.22 7.8
April Low 1.30/1.21 1.10-1.50 0.09 7.7 High 2.60/2.42 2.34-2.86 0.12 5.0
54 Table 16.9 Internal quality control results for Total IgE
1998
Date Level (kU/l) Acceptable Target/Achieved Range July, 1998a 180/180 148-211 180/173 148-211 180/168 148-211 180/152 148-211
August 180/171 148-211 180/169 148-211 180/164 148-211 180/154 148-211
September 180/168 148-211 180/187 148-211
October 180/178 148-211 180/168 148-211 180/169 148-211 180/187 148-211
November 180/191 148-211 180/184 148-211 180/156 148-211 180/169 148-211
December 180/165 148-211 180/179 148-211 180/166 148-211 180/161 148-211 180/166 148-211 180/174 148-211
January, 1999 180/172 148-211 180/186 148-211 180/181 148-211 180/170 148-211
February 180/177 148-211 180/169 148-211 180/197 148-211 180/199 148-211 180/180 148-211 180/185 148-211
March 180/188 148-211 180/173 148-211 180/180 148-211 180/191 148-211 180/186 148-211
April 180/184 148-211 180/174 148-211 180/177 148-211 180/179 148-211 a IgE was only measured in children and the Health Survey did not begin collecting blood from children until July 1998. Therefore, quality control results for this analyte begin in July rather than April.
55 Table 16.10 Internal quality control results for HDM specific IgE
1998 Measured units Date Scorea Augustb 29.2 4 23.2 4
September 29.9 4 34.5 4
October 30.2 4 25.2 4 28.5 4 32.4 4 29.5 4 31.0 4 31.1 4 24.3 4 30.1 4
November 32.2 4 34.5 4 28.7 4 29.1 4 26.3 4
December 31.8 4 33.2 4 31.6 4
January, 1999 30.4 4 26.8 4 30.2 4 27.3 4 28.7 4 26.1 4
February 30.9 4 35.7 4 25.2 4 28.9 4 31.9 4 28.7 4 29.7 4
March 25.9 4 31.2 4 28.4 4 32.8 4 26.4 4
April 27.3 4 29.9 4 31.1 4 27.8 4 28.5 4 23.8 4 26.7 4
May 29.0 4 30.0 4 a Scores derived from unit ‘bands’ eg a-b units score 1, b-c units score 2 etc. Positivity expressed in terms of score 0=negative and 6=strongly positive. A score of 4 equates to a positive result. b IgE was only measured in children and the Health Survey did not begin collecting blood from children until July 1998. Therefore, quality control results for this analyte begin in July rather than April.
56 Table 16.11 Internal quality control results for blood lead
1998
Date Level (µg/dL) S.D. (µg/dL) S.D. (µg/dL) Target/Achieved Achieved Intra assay August, 1998a 5.0/4.8 0.14 0.0 5.0/4.8 0.21 0.1 5.0/4.7 0.29 0.1
September 5.0/5.0 0.18 0.0 5.0/4.7 0.23 0.0 5.0/4.8 0.17 0.0 5.0/4.7 0.21 0.3 5.0/5.2 0.17 0.3
October 5.0/5.3 0.21 0.3 5.0/5.3 0.07 0.1 5.0/4.9 0.21 0.4 5.0/5.3 0.21 0.1
November 5.0/4.8 0.17 0.1 5.0/4.9 0.22 0.0 5.0/4.8 0.21 0.4 5.0/5.4 0.36 0.4
December 5.0/5.3 0.21 0.1 5.0/5.1 0.07 0.1 5.0/5.1 0.28 0.1
January, 1999 5.0/5.1 0.30 0.1 5.0/4.8 0.12 0.0 5.0/5.2 0.00 0.1 5.0/4.7 0.14 0.1 5.0/4.8 0.07 0.1 5.0/5.0 0.38 0.2 5.0/5.1 0.14 0.0
February 5.0/5.2 0.24 0.0 5.0/5.1 0.07 0.0 5.0/5.1 0.21 0.3 5.0/4.7 0.10 0.3 5.0/5.2 0.22
March 10.8/10.7 0.29 0.15 10.8/10.5 0.25 0.02 10.8/10.7 0.36 0.08
April 10.8/10.9 0.19 0.31 10.8/10.3 0.14 0.01 10.8/10.7 0.40 0.04 10.8/10.7 0.15 0.26 a Lead was only measured in children and the Health Survey did not begin collecting blood from children until July 1998. Therefore, quality control results for this analyte begin in July rather than April.
57 Table 16.12 Internal quality control for vitamin C
1998
Date Mean (umol) S.D. Achieved C.V. (umol) Achieved (%) First analysis period (April – July 1998)
IQC samples (n=3) 56.3 4.92 8.7
Recovery (%) 105.0 10.30 9.9
IQC samples (n=14) 55.4 8.47 15.3
Recovery (%) 98.5 15.11 15.3
Second analysis period (August – October 1998)
IQC samples (n=22) 50.1 9.13 18.2
Recovery (%) 105.5 13.42 12.7
Third analysis period (November 1998 – January 1999)
IQC samples (n=25) 50.0 8.77 17.5
Recovery (%) 102.7 14.95 14.6
Fourth analysis period (February – April 1999)
IQC samples (n=32) 48.2 4.00 8.3
Recovery (%) 106.8 13.02 12.2
Fifth analysis period (May – June 1999)
IQC samples (n=26) 47.1 2.66 5.7
Recovery (%) 101.8 5.65 5.6
58 Table 16.13 Internal quality control for vitamins A, E and carotenoids
1998
Date/Analyte Mean (umol) S.D. Achieved C.V. (umol) Achieved (%) First analysis period (April – July 1998) IQC samples (n=3)
Lutein 0.20 0.01 6.8 Zeaxanthin 0.10 - - Beta-Crptoxan 0.45 0.05 10.2 Trans-Lycopene 0.26 0.04 14.0 Cis-Lycopene 0.21 0.02 9.3 Total-Lycopene 0.47 0.03 6.1 Alpha-Carotene 0.24 0.02 7.6 Trans-beta-Carotene 0.47 0.07 15.3 Cis-beta-Carotene 0.03 0.00 7.8 Total-beta-Carotene 0.50 0.07 14.7 Retinol 2.57 0.18 7.1 Alpha-Tocopherol 26.97 - -
IQC samples (n=4)
Lutein 0.19 0.02 10.7 Zeaxanthin 0.03 0.00 21.1 Beta-Crptoxan 0.39 0.05 11.8 Trans-Lycopene 0.47 0.07 15.4 Cis-Lycopene 0.34 0.02 4.9 Total-Lycopene 0.81 0.08 9.9 Alpha-Carotene 0.14 0.01 5.1 Trans-beta-Carotene 0.46 0.03 6.3 Cis-beta-Carotene 0.02 0.00 15.9 Total-beta-Carotene 0.48 0.03 15.1 Retinol 2.37 0.24 10.0 Alpha-Tocopherol 33.56 3.10 9.2
IQC samples (n=11)
Lutein 0.24 0.01 4.1 Zeaxanthin 0.04 0.00 7.0 Beta-Crptoxan 0.29 0.01 3.9 Trans-Lycopene 0.38 0.02 5.8 Cis-Lycopene 0.32 0.02 5.8 Total-Lycopene 0.70 0.04 5.7 Alpha-Carotene 0.10 0.01 7.5 Trans-beta-Carotene 0.55 0.04 6.9 Cis-beta-Carotene 0.02 0.00 11.9 Total-beta-Carotene 0.57 0.04 6.8 Retinol 2.23 0.10 4.3 Alpha-Tocopherol 29.93 1.56 5.2
Second analysis period (August – October 1998) IQC samples (n=14)
Lutein 0.23 0.01 4.7 Zeaxanthin 0.04 0.00 7.7 Beta-Crptoxan 0.30 0.01 3.7 Trans-Lycopene 0.38 0.02 5.2 Cis-Lycopene 0.31 0.02 7.3 Total-Lycopene 0.69 0.04 5.5 Alpha-Carotene 0.10 0.02 16.8 Trans-beta-Carotene 0.54 0.03 6.3 Cis-beta-Carotene 0.02 0.00 13.0 Total-beta-Carotene 0.57 0.03 6.0 Retinol 2.21 0.10 4.5 Alpha-Tocopherol 29.56 1.61 5.5 Continued …
59 Table 16.13 - continued
1998
Date/Analyte Mean (umol) S.D. Achieved C.V. (umol) Achieved (%) Third analysis period (November 1998 – January 1999) IQC samples (n=23)
Lutein 0.22 0.02 8.2 Beta-Crptoxan 0.32 0.01 4.2 Trans-Lycopene 0.40 0.02 5.5 Cis-Lycopene 0.32 0.02 7.4 Total-Lycopene 0.72 0.04 6.0 Alpha-Carotene 0.14 0.02 12.8 Trans-beta-Carotene 0.64 0.03 4.3 Cis-beta-Carotene 0.05 0.01 15.4 Total-beta-Carotene 0.68 0.03 4.6 Retinol 2.36 0.11 4.5 Alpha-Tocopherol 28.44 2.25 7.9
Fourth analysis period (February – April 1999) IQC samples (n=22)
Lutein 0.25 0.04 14.8 Beta-Crptoxan 0.31 0.01 4.6 Trans-Lycopene 0.37 0.03 8.4 Cis-Lycopene 0.29 0.04 12.3 Total-Lycopene 0.66 0.06 9.3 Alpha-Carotene 0.12 0.01 11.9 Trans-beta-Carotene 0.61 0.05 8.1 Cis-beta-Carotene 0.07 0.02 31.6 Total-beta-Carotene 0.68 0.03 4.7 Retinol 2.42 0.06 2.4 Alpha-Tocopherol 29.11 1.46 5.0
Fifth analysis period (May – June 1999)a IQC samples (n=18)
Lutein 0.25 0.01 4.2 Beta-Crptoxan 0.58 0.02 3.4 Trans-Lycopene 0.46 0.03 5.6 Cis-Lycopene 0.42 0.02 5.8 Total-Lycopene 0.88 0.06 6.5 Alpha-Carotene 0.24 0.02 8.7 Trans-beta-Carotene 0.79 0.04 4.5 Cis-beta-Carotene 0.05 0.01 12.5 Total-beta-Carotene 0.84 0.04 4.4 Retinol 2.73 0.08 3.0 Alpha-Tocopherol 38.77 1.37 3.5 a A new batch of IQC plasma was used in this analysis period, the values shown for carotenoid concentrations are not directly comparable with those of previous analysis periods.
60 Table 16.14 Internal quality control results for cotinine
1998
Date Target/Achieved S.D. Achieved C.V. (ng/ml) (ng/ml) Achieved (%) June, 1998 1.00/1.04 0.14 13.2 5.00/5.12 0.25 4.9 100.00/100.80 3.25 3.2 600.00/598.71 8.92 1.5
July 1.00/0.97 0.12 12.4 5.00/4.97 0.27 5.5 100.00/99.53 2.94 3.0 400.00/400.37 9.99 2.5 600.00/600.97 9.96 1.7
August 1.00/1.02 0.12 12.3 5.00/5.05 0.36 7.1 20.00/19.82 0.99 5.0 100.00/98.63 3.37 3.4 400.00/399.51 13.09 3.3 600.00/599.86 21.68 3.6
September 1.00/0.97 0.12 12.4 5.00/4.99 0.25 5.0 20.00/20.00 0.78 3.9 100.00/99.14 2.50 2.5 400.00/402.47 7.93 2.0 600.00/597.74 8.45 1.4
October 1.00/0.96 0.12 12.6 5.00/4.89 0.24 4.9 20.00/19.65 1.08 5.5 100.00/98.20 2.73 2.8 400.00/399.39 7.87 2.0 600.00/597.65 8.18 1.4
November 1.00/0.95 0.10 10.5 5.00/4.95 0.22 4.5 20.00/20.12 0.52 2.6 100.00/100.37 1.91 1.9 400.00/402.95 7.48 1.9 600.00/600.62 5.78 1.0
December 1.00/0.97 0.13 13.4 5.00/4.99 0.21 4.1 20.00/20.54 0.88 4.3 100.00/99.05 2.93 3.0 400.00/398.84 9.75 2.5 600.00/595.44 10.54 1.8
January, 1999 1.00/0.97 0.10 10.2 5.00/5.04 0.23 4.7 20.00/20.06 0.86 4.3 100.00/99.05 2.76 2.8 400.00/401.84 7.16 1.8 600.00/594.24 21.60 3.6
February 1.00/0.96 0.12 12.4 5.00/4.97 0.27 5.5 20.00/19.93 0.77 3.8 100.00/98.43 2.99 3.0 400.00/402.25 10.91 2.7 600.00/596.80 10.10 1.7 Continued ...
61 Table 16.14 - continued
1998
Date Target/Achieved S.D. Achieved C.V. (ng/ml) (ng/ml) Achieved (%) March, 1999 1.00/0.96 0.12 12.4 5.00/4.97 0.26 5.3 20.00/20.15 0.81 4.0 100.00/98.85 2.83 2.9 400.00/401.43 10.26 2.6 600.00/594.36 13.83 2.3
April 1.00/0.96 0.12 12.1 5.00/4.96 0.24 4.9 20.00/19.79 0.68 3.5 100.00/98.38 2.28 2.3 400.00/402.41 5.94 1.5 600.00/595.64 7.64 1.3
May 1.00/1.00 0.14 14.5 5.00/5.08 0.26 5.0 20.00/20.95 0.62 3.0 100.00/100.68 1.93 1.9 400.00/409.68 9.46 2.3 600.00/600.56 13.67 2.3
62 Table 16.15 External quality assessment results for total cholesterol
1998
Date Target value a Assayed value (mmol/l) (mmol/l) April, 1998 3.0 2.9
May 3.0 2.9 3.1 3.1
June 2.8 2.8 3.9 3.9
July 4.0 3.8 1.8 2.1
August 3.7 3.6 3.8 3.8
September 5.0 4.8 3.6 3.5
October 2.8 2.7 3.9 3.9
November 2.1 2.1 3.7 3.6 3.0 3.0
December 2.2 2.2
January, 1999 4.0 3.9 4.0 3.7
February 2.1 2.1 3.0 3.0
March 4.0 4.0 3.3 3.3
April 3.6 3.7 3.6 3.6 a Method trimmed mean.
63 Table 16.16 External quality assessment results for HDL- cholesterol
1998
Date Target value a Assayed value (mmol/l) (mmol/l) April, 1998 1.3 1.3 1.3 1.3 1.4 1.4 1.4 1.4 1.4 1.4
May 1.4 1.4 1.2 1.3 1.4 1.4 1.3 1.3 1.4 1.4
June 1.4 1.5 1.2 1.3 1.3 1.4 1.6 1.6
July 1.4 1.6 1.2 1.3 1.2 1.4 1.4 1.5
August 1.6 1.6 1.3 1.3 1.4 1.4 1.4 1.4 1.3 1.4
September 1.4 1.5 1.3 1.4 1.2 1.3 1.4 1.3
October 1.4 1.4 1.3 1.2 1.4 1.4 1.6 1.5 1.2 1.2
November 1.2 1.1 1.2 1.2 1.5 1.5 1.0 1.3
December 1.2 1.2 1.5 1.5 1.6 1.6 1.3 1.3 1.2 1.2
January, 1999 1.5 1.6 1.3 1.4 1.3 1.4 1.1 1.1 1.5 1.5 a Overall mean. Continued …
64 Table 16.16 - continued
1998
Date Target value a Assayed value (mmol/l) (mmol/l) February, 1999 1.5 1.6 1.6 1.7 1.5 1.7 1.5 1.6 1.3 1.4
March 1.3 1.4 1.2 1.2 1.1 1.0 1.2 1.2 1.3 1.3 a Overall mean.
65 Table 16.17 External quality assessment results for Gamma gt
1998
Date Target value a Assayed value (U/L) (U/L) April – June, 1998 132 127
July 72 68 149 136
August 133 127 92 91
September 44 45 92 91
October 269 260 96 93
November 142 135 89 85 89 85
December 125 118
January, 1999 70 69 93 91
February 142 136 94 89
March 48 49 70 68
April 89 86 92 92 a All laboratory trimmed mean.
66 Table 16.18 External quality assessment results for C-reactive protein (CRP)
1998
Date Target value a Assayed value (mg/l) (mg/l) April, 1998 82.6 87.7
May 97.4 108.0
July 117.4 118.0
August 147.2 152.0
September 11.5 13.5
October 21.7 24.2
November 33.6 36.6
December 59.3 59.3
January, 1999 82.0 79.6
February 85.4 80.2
March 26.4 22.6
April 34.0 31.3 a All laboratory trimmed mean.
67 Table 16.19 External quality assessment results for ferritin
1998
Date Target value a Assayed value (ug/l) (ug/l) April, 1998 103.4 93.0 2220.0 2073.0
May 16.9 17.6 33.0 34.0
June 102.8 91.8 103.0 88.1
July 28.6 26.0 14.5 13.9
August 921.2 986.0 8.3 8.3
September 40.9 41.0 7.6 8.7
October 89.0 83.0 139.0 129.0
November 27.2 23.3 37.8 32.7
January, 1999 2607.0 2505.0 19.1 16.0
February 73.1 69.0 30.1 27.0
March 36.1 30.0 10.4 9.0
April 22.1 21.4 61.8 58.0 a All laboratory trimmed mean.
68 Table 16.20 External quality assessment results for haemoglobin
1998
Date Target value a Assayed value (g/dl) (g/dl) April, 1998 125 125
May 112 112
June 116 116
July 106 108
August 83 85
September 108 110
October 121 121
November 74 76
December 113 115
January, 1999 114 114
February 82 82
March 125 125
April 112 114 a All laboratory trimmed mean.
69 Table 16.21 External quality assessment results (UKNEQAS) for fibrinogen
1998
Date Target value a Assayed value (g/l) (g/l) May, 1998 2.6 2.6
November 2.2 2.0
January, 1999 2.5 2.7 a All laboratory trimmed mean.
Table 16.22 External quality assessment results (Central QAS) for fibrinogen
1998
Date Target value a Assayed value (g/l) (g/l) April, 1998 0.9 0.9 0.9 0.8
May 2.4 2.4 1.0 0.8
June 0.9 0.7
July 2.5 2.3 1.0 0.8 0.9 0.9
August 0.7 0.6
September 2.5 2.3 0.9 0.8
October 1.2 1.3 2.3 2.3
November 1.2 1.2 0.9 0.9
December 0.6 0.6
January, 1999 2.1 2.4
February 5.6 4.8 1.5 1.5
March 0.6 0.6 3.1 3.6
April 2.1 2.1 2.6 2.6 a All laboratory trimmed mean.
70 Table 16.23 External quality assessment results for Total IgE
1998
Date Target value a Assayed value (kU/L) (kU/L) August, 1998 71 62 284 329 71 73 71 67
September 36 37 35 281 288 331 331
October 63 60
December 238 210
January, 1999 85 94 79 83
March 69 75 67 65 a All laboratory trimmed mean.
Table 16.24 External quality assessment results for HDM specific IgE
1998
Date Target value a Assayed value (kU/L) (kU/L) August, 1998 7.3 6.0
January, 1999 8.9 8.5 a All laboratory trimmed mean.
71 Table 16.25 External quality assessment results for blood lead
1998
Date Target value a Assayed value (µmol/L) (µmol/L) July, 1998b 0.76 0.77
August 1.33 1.29 1.81 1.80
September 1.15 1.06 2.26 2.10
October 1.04 0.90 0.91 0.90
November 0.75 0.74 0.50 0.44
December 1.46 1.49
February, 1999 0.31 0.25 1.05 1.05
March 0.12 0.06 1.84 2.01
April 1.38 1.44 0.46 0.43 a All laboratory trimmed mean. The EQA scheme reports blood lead in units of µmol/L. To convert µmol/L to µg/dL divide by 0.048. For example an informant with a blood lead of 1.2 µmol/L can also be said to have a blood lead of 25 µg/dL. b Lead was only measured in children and the Health Survey did not begin collecting blood from children until July 1998. Therefore, quality control results for this analyte begin in July rather than April.
Table 16.26 External quality control (Round Robin 12) for vitamin C – fourth analysis period (February – April 1999) 1998
Serum sample (unknown) Ascorbic acid (µmol/l serum)
Target/Achieved S.D. Achieveda March, 1999 Level 1 20.4/22.8 ±2
Level 2 63.4/63.4 <1 a Within 1 SD of assigned value = exceptional performance, within 2 SD = acceptable performance, within 3 SD = marginal performance, more than 3 SD = poor performance.
72 Table 16.27 External quality control (Round Robin 42) for vitamins A, E and carotenoids.
1998
Analyte Target/Achieved S.D. Achieveda First analysis period (April – July 1998) Retinol NIST serum 239 0.520/0.493 ±1 NIST serum 240 0.694/0.663 ±1 NIST serum 241 0.426/0.440 ±1 NIST serum 242 0.929/0.855 ±1
α-Tocopherol NIST serum 239 8.60/7.53 ±2 NIST serum 240 14.20/14.80 ±2 NIST serum 241 6.50/7.00 ±2 NIST serum 242 20.50/19.96 ±2
Total-β-Carotene NIST serum 239 0.081/0.090 >2 NIST serum 240 0.533/0.446 >2 NIST serum 241 0.182/0.157 >2 NIST serum 242 0.689/0.429 >2
Trans-β-Carotene NIST serum 239 0.077/0.085 ±2 NIST serum 240 0.513/0.427 ±2 NIST serum 241 0.178/0.149 ±2 NIST serum 242 0.650/0.403 ±2
α-Carotene NIST serum 239 0.014/0.025 ng NIST serum 240 0.229/0.160 ng NIST serum 241 0.289/0.330 ng NIST serum 242 0.079/0.120 ng
β-Crptoxanthin NIST serum 239 0.068/0.071 ng NIST serum 240 0.128/0.101 ng NIST serum 241 0.066/0.055 ng NIST serum 242 0.160/0.132 ng
‘Lutein’ NIST serum 239 0.061/0.068 ng NIST serum 240 0.270/>0.200 ng NIST serum 241 0.049/0.061 ng NIST serum 242 0.462/>0.200 ng
‘Zeaxanthin’ NIST serum 239 0.029/0.049 ng NIST serum 240 0.199/0.191 ng NIST serum 241 0.120/0.145 ng NIST serum 242 0.052/0.073 ng a Within 1 SD of assigned value = exceptional performance, within 2 SD = acceptable performance, within 3 SD = marginal performance, more than 3 SD = poor performance, ng = not given by NIST.
Continued…
73 Table 16.27 - continued
1998
Analyte Target/Achieved S.D. Achieveda Second analysis period (August – October 1998) Retinol NIST serum 243 0.462/0.499 ±2 NIST serum 244 0.369/0.400 ±2 NIST serum 245 0.191/0.233 ±2 NIST serum 246 0.723/0.722 ±2
α-Tocopherol NIST serum 243 7.01/7.89 ±2 NIST serum 244 7.08/7.74 ±2 NIST serum 245 3.92/4.33 ±2 NIST serum 246 14.51/13.50 ±2
Total-β-Carotene NIST serum 243 0.074/0.087 ±2 NIST serum 244 0.359/0.341 ±2 NIST serum 245 0.146/0.184 ±2 NIST serum 246 0.680/0.698 ±2
Trans-β-Carotene NIST serum 243 0.070/0.082 ±1 NIST serum 244 0.342/0.310 ±1 NIST serum 245 0.133/0.161 ±1 NIST serum 246 0.598/0.631 ±1
α-Carotene NIST serum 243 ng/0.047 ng NIST serum 244 0.022/0.024 ng NIST serum 245 ng/0.013 ng NIST serum 246 0.0390.049 ng
β-Crptoxanthin NIST serum 243 0.052/0.057 ng NIST serum 244 0.011/0.012 ng NIST serum 245 ng/0.006 ng NIST serum 246 0.016/0.022 ng
‘Lutein’ NIST serum 243 0.079/0.090 ng NIST serum 244 0.026/0.030 ng NIST serum 245 0.013/0.015 ng NIST serum 246 0.054/0.057 ng
‘Zeaxanthin’ NIST serum 243 0.039/0.047 ng NIST serum 244 0.010/0.012 ng NIST serum 245 0.005/0.010 ng NIST serum 246 0.021/0.023 ng a Within 1 SD of assigned value = exceptional performance, within 2 SD = acceptable performance, within 3 SD = marginal performance, more than 3 SD = poor performance, ng = not given by NIST.
Continued…
74 Table 16.27 - continued
1998
Analyte Target/Achieved S.D. Achieveda Third analysis period (November 1998 – January 1999) Retinol NIST serum 247 0.669/0.706 ±2 NIST serum 248 0.844/0.800 ±2 NIST serum 249 0.483/0.434 ±2 NIST serum 250 1.060/1.137 ±2
α-Tocopherol NIST serum 247 11.771/12.57 ±2 NIST serum 248 7.455/7.80 ±2 NIST serum 249 16.750/17.10 ±2 NIST serum 250 6.998/8.05 ±2
Total-β-Carotene NIST serum 247 0.330/0.355 ±2 NIST serum 248 0.177/0.185 ±2 NIST serum 249 0.429/0.441 ±2 NIST serum 250 0.564/0.671 ±2 trans-β-Carotene NIST serum 247 0.311/0.324 ±3 NIST serum 248 0.159/0.170 ±3 NIST serum 249 0.394/0.399 ±3 NIST serum 250 0.494/0.614 ±3 trans-α-Caroteneb NIST serum 247 0.054/0.046 ng NIST serum 248 0.017/0.014 ng NIST serum 249 0.098/0.086 ng NIST serum 250 0.017/0.017 ng
β-Crptoxanthin NIST serum 247 0.056/0.059 ±1 NIST serum 248 0.075/0.081 ±1 NIST serum 249 0.032/0.032 ±1 NIST serum 250 0.046/0.059 ±1
‘Lutein’ NIST serum 247 0.073/0.049 ng NIST serum 248 0.058/0.036 ng NIST serum 249 0.090/0.061 ng NIST serum 250 0.080/0.061 ng
‘Zeaxanthin’ NIST serum 247 0.028/0.074 ng NIST serum 248 0.032/0.064 ng NIST serum 249 0.025/0.085 ng NIST serum 250 0.041/0.101 ng a Within 1 SD of assigned value = exceptional performance, within 2 SD = acceptable performance, within 3 SD = marginal performance, more than 3 SD = poor performance, ng = not given by NIST. b Two samples of each serum – mean values shown
75 76 APPENDIX A: FIELDWORK DOCUMENTS A
Stage 1 Leaflet - Interviewer 78-79
Stage 2 Leaflet - Nurse 80-81
Household questionnaire 82-83
Individual questionnaire 84-121
Nurse schedule 122-137
Show Cards 138-150
Self-completion booklet for young adults 151-159
Self-completion booklet for 13-15 year olds 160-165
Self-completion booklet for 8-12 year olds 166-168
Self-completion booklet for adults 169-172
Consent Booklet, Despatch notes 173-180
Measurement Record Card 181-182
77 • What is it about? The Scottish Office commissioned the first Scottish Health Survey in 1995 because it was concerned about the lack of information about the health of the population in Scotland. The detailed information provided by the survey proved very valuable in developing ways of improving both people s health and the provision of health services. This year s survey will expand on the information collected in 1995, as well as bringing it up to date.
The 1998 survey is concentrating on children, asthma and other breathing problems, and heart disease and related behaviour such as smoking, drinking and exercise. The Scottish Office is particularly interested in having this information because at present there is some concern about the prevalence of asthma, particularly among children, THE SCOTTISH HEAL TH SURV EY: 1998 while the rates of heart disease in Scotland are among the highest in the world. The survey will also collect, if you agree, some physical measurements such as height, weight, blood pressure, lung function, a saliva sample and (if you are aged 11 or over) a blood sample. This survey is being carried out for the Some personal details such as age, sex and employment are needed to interpret this information.
78 Scottish Office Department of Health, by SCPR (Social & Community Planning Research), an • Why have we come to your household? independent research institute, and the To visit every household in Scotland would take too long and cost too Department of Epidemiology and Public Health at much money. Instead we select a sample of addresses in such a way that all addresses in the country have an equal chance of being UCL (University College London). selected. Yours is one of those chosen for the 1998 survey. You will represent thousands of other people in the country. The addresses were taken from the Postcode Address File, a list compiled by the Post Office of addresses to which mail is delivered. Once an address is This leaflet tells you more about the survey and selected, we randomly select one person aged between 16 and 74 why it is being done. and up to two children aged between 2 and 15 at that address. We cannot substitute one address with another, nor one individual with anyone else. If we did so, we could not be sure that all types of people were represented in the survey.
Some people think that they are not typical enough to be of any help in the survey, or that they are very different from other people and would distort the findings. On the contrary, it is essential to include such people. The community consists of a great many different types of people and we need to represent them all in our sample survey. The results will present a more accurate picture if everyone we P1731/2 STAGE 1 approach agrees to take part, and we hope you will. • hat will happen after the interview? • Is the survey confidential? W Yes. We take very great care to protect the confidentiality of the After the interview, if you agree, the interviewer will arrange for a information we are given. The survey results will not be in a form which qualified nurse to visit - at a time convenient for you - so that some can reveal you or your family s identity. This will only be known to the measurements can be taken. The nurse will measure your waist and SCPR and UCL research teams. hip circumferences (if you are aged between 16 and 74), your upper arm circumference (if you are aged between 2 and 15), and the length If you agree, however, your name, address and date of birth, but no of your arm (if you are aged between 65 and 74). The nurse will also other information, will be passed to National Health Service registers. measure blood pressure for those aged between 5 and 74, and lung This would help us if we wanted to follow you up in future. function for those aged between 7 and 74. For those aged between 4 and 74, the nurse will ask for agreement to take a sample of saliva (spit). • Is the survey compulsory? If you are aged 11 or over the nurse will also ask your agreement to No. In all our surveys we rely on voluntary co-operation. The success take a small blood sample from your arm. The nurse will have to get of the survey depends on the goodwill and co-operation of those your written permission before a blood sample can be taken. For asked to take part. The more people who do take part, the more children aged 11 to 15, the nurse will offer to use an anaesthetic representative and accurate the results will be. However, you are free cream on the skin before taking the blood sample. You are of course to withdraw from any part of the survey at any time. free to choose not to give a blood sample, even if you are willing to help the nurse with everything else.
The analysis of all the measurements and blood samples will tell us a 79 • Do I get anything from the survey? lot about the health of the population. During the visit, the nurse will If you wish, you may have a record of your physical measurements be able to explain the importance of these measurements and answer and blood pressure. Also, if you wish, results from the blood pressure any questions. and blood sample will be sent to your GP who will be able to interpret them for you and give you advice if necessary. Your GP may also • If I have any other questions? want to include the results in any future report about you. We hope this leaflet answers some of the questions you might have, Other benefits from the survey will be indirect and in due course will and that it shows the importance of the survey. If you have any more come via any improvements in health and in health services which questions please do not hesitate to ring one of the contacts listed result from the survey. below.
Your co-operation is very much appreciated.
Steven Finch Anne McMunn SCPR Department of Epidemiology 35 Northampton Square and Public Health London University College London EC1V 0AX 1-19 Torrington Place London WC1E 6BT
Tel: 0171 250 1866 Tel: 0171 391 1730 • Lung function (Age 7 years and over) We would like to measure the amount of air you can breathe out of your lungs (FVC) and how quickly you can get it out (FEV). This involves blowing into a tube. The amount of air you are able to breathe out depends partly upon your height, your age, and how fit you are. Your result can only be interpreted in the light of these factors. These measures will give the Scottish Office valuable information on whether the THE SCOTTISH HEALTH SURVEY: 1998 population is becoming more healthy or not.
• Waist-to-hip ratio (Age 16 years and over) L This survey is being carried out for the Scottish ately there has been much discussion about the relationship between weight and health. We have already recorded your weight and height but another important factor is Office, by SCPR (Social & Community Planning thought to be the distribution of weight over the body. The ratio of your waist to hip Research) and the Department of Epidemiology and measurements is most useful for assessing this.
Public Health at UCL (University College London). • Mid-upper arm circumference (Age 2 -15 years) You have already participated in the first stage of T he circumference of the arm is measured using a tape measure. This will provide the survey which consisted of an interview and important information on changes over time in the size of children in the population. some measurements (height and weight). • Demi-span (Age 65 years and over) The demi-span is the length of the arm stretching from the bottom of the middle finger This leaflet tells you more about the second stage and ring finger to the sternal notch (the gap between the collar bones). It is strongly of the survey. related to a person s height and is particularly useful if height cannot be measured easily. It simply involves measuring the length of the arm with a tape measure. 80 • Saliva sample (Age 4 years and over) We would like to take a sample of saliva (spit). This simply involves dribbling saliva down a straw into a tube, or sucking on a piece of cotton wool. The sample will be analysed for cotinine. Cotinine is related to the intake of cigarette smoke and is of THE SECOND STAGE P1731/2 STAGE 2 particular interest to see whether non-smokers may have raised levels as a result of passive smoking. A registered nurse will ask you some further questions and will ask permission to take
some measurements. The measurements are described overleaf. You need not have • Blood sample (Age 11 years and over) any measurements taken if you do not wish but, of course, we very much hope you will W agree to them as they are a very important part of this survey. If the survey results are to e would be very grateful if you would agree to provide us with a sample of blood. be useful to the Scottish Office, it is important that we obtain information from all types This is an important part of the survey, as the analysis of the blood samples will tell us a lot about the health of the population. You are of course free to choose not to give a of people in all states of health. blood sample, and the nurse will ask for your written permission before a blood sample is taken. MEASUREMENTS This part of the survey involves a qualified nurse taking a small amount of blood (no • Blood pressure (Age 5 years and over) more than 25ml) from your arm. The blood sample will be sent to a medical laboratory, H and for adults (16+) it will be analysed to determine the amounts of the following: total igh blood pressure can be a problem. However, blood pressure is difficult to measure cholesterol, accurately. A person’s blood pressure is influenced by age and can vary from day to day and moment to moment with emotion, meals, tobacco, alcohol, medication, temperature and pain. Although the nurse can tell you your blood pressure and give an indication of its meaning, a diagnosis cannot be made on a measurement taken on a single occasion. Blood pressure is measured using an inflatable cuff that goes around the upper arm. HDL cholesterol, fibrinogen, haemoglobin, ferritin, Gamma GT and C-reactive protein. Might there be implications for insurance cover? Some of the blood samples will also be tested for vitamins. For children (11-15), blood If you agree to your results being sent to your GP then s/he may use them in medical will be analysed for: haemoglobin, ferritin, total and house dust mite specific IgE, and reports about you. This may occur if you apply for a new life assurance policy, or for a lead. new job. Insurance companies may ask those who apply for new policies if they have Cholesterol is a type of fat present in the blood, related to our diet. Too much had any medical tests. If so, the insurance company may ask if they can obtain a cholesterol in the blood increases the risk of heart disease. But HDL cholesterol is a medical report from the GP. Because of the Access to Medical Reports Act 1988, an good type of cholesterol which is thought to be protective. Fibrinogen is a protein insurance company cannot ask your GP for a medical report on you without your necessary for blood clotting and high levels are also associated with a higher risk of permission. Having given your permission, you then have the right to see the report heart disease. before your GP sends it to the insurance company and you can ask for the report to be amended if you consider it to be incorrect or misleading. Haemoglobin is the red pigment in the blood which carries oxygen. A low level of haemoglobin in the blood is called anaemia. One reason for a low level of haemoglobin The purpose of a medical report is for the company to judge whether to charge may be a shortage of iron. Ferritin is a measure of the body’s iron stores. normal premiums, whether to charge higher premiums or whether, in exceptional circumstances, to turn down life insurance on account of the person’s health. Gamma GT is an enzyme present in the liver and its level in the blood can provide an indication of alcohol consumption and health of the liver. Insurance companies look for a history of illness or factors affecting health and some things concern them more than others. One measurement from the survey is very The level of C-reactive protein in the blood gives information on inflammatory activity in unlikely by itself to affect the company’s decision. Please remember that we are not the body, and it is also associated with risk of heart disease. testing for the AIDS virus (HIV) or for any other virus.
Vitamins are important for good health, and a lack of them can cause disorders. It is We believe that the chances of anyone being refused life insurance or being charged now thought that some vitamins offer protection against certain diseases. higher premiums on life insurance as a result of the survey are very small. Existing life insurance policies would not be affected in any way. We hope that you will be willing IgE is a substance in the blood, and the level of IgE is higher in some people who have to have your results sent to your GP. If you have any questions please discuss them allergies. House dust mite specific IgE indicates allergy to dust mites. The Scottish with the nurse. 81 Office is very keen to know whether the level of allergy in the population is increasing or SCPR is insured for negligent injury to people who take part in the study. not and, if so, to what extent this is linked to dust mites.
We would like to store a small amount of blood. Medical tests of blood samples are ANSWERING OTHER QUESTIONS becoming more advanced and specialised. This means that we may be able to learn more about the health of the population by re-testing blood in the future. We will ask We hope this leaflet answers many of the questions you may have. If you have separately for permission to store blood. others, please contact one of the people listed below:- The sample will not be tested for viruses such as the HIV (AIDS) virus.
LETTING YOUR GP KNOW THE RESULTS Steven Finch Anne McMunn With your agreement we would like to send your blood pressure, lung function and Social & Community Department of Epidemiology and Public Health blood sample results to your GP because we believe that this may help you to take Planning Research University College London steps to keep in good health. Your GP can interpret the results in the light of your 35 Northampton Square 1-19 Torrington Place medical history. We believe that this may help to improve your health. London EC1V 0AX London WC1E 6BT
If your results showed, for example, that your blood pressure or cholesterol levels were Tel: 0171 250 1866 Tel: 0171 391 1730 above what is usual for someone of your sex and age, your GP may wish to measure it again. This may help to see whether you have any condition that would benefit from treatment. Often it is possible to reduce blood pressure or cholesterol levels by Thank you very much for your help with this important survey. treatment or by changing your diet. It is for you and your GP to decide what is the best action to take, if any.
If the GP considers your results to be satisfactory then nothing further will be done. Person Scottish Health Survey 1998 – Household Questionnaire Person number in Household Grid. Range: 0..12 Point SAMPLE POINT NUMBER: Name Range:1..997 First name from WhoHere
Address Sex ADDRESS NUMBER: INTERVIEWER: CODE (name of respondent’s) SEX. Range:1..97 1 Male 2 Female Hhold HOUSEHOLD NUMBER: AgeOf Range:1..3 Can I check, what was (name of respondent’s) age last birthday? Range:0..120 AdrField PLEASE ENTER THE FIRST TEN CHARACTERS OF THE FIRST LINE OF THE ADDRESS TAKEN FROM IF AgeOf=Dk/Ref THEN A.R.F. ADDRESS LABEL. MAKE SURE TO TYPE IT EXACTLY AS IT IS PRINTED. AgeEst Text: Maximum 10 characters INTERVIEWER CODE: ASK IF NECESSARY ARE YOU (IS HE/SHE), AGED UNDER 2 YEARS, AT LEAST 2 UP TO 15 YEARS, OR 16 YEARS OR OLDER? IF NOT KNOW, TRY TO GET First BEST ESTIMATE. INTERVIEWER FOR INFORMATION… You are in the Questionnaire for 1 Under 2 years Point no: (Point number) 2 2 to 15 years Address no: (Address number) 3 16-74 years Household no: (Household number) 4 75 years or older ENDIF - TO UPDATE ADMIN DETAILS, PRESS
- OTHERWISE PRESS 1 AND
82 YOU LATER HAVE TO CODE 1 OR MORE AS REFUSALS. 1 Yes IntDate 2 No PLEASE ENTER THE DATE OF THIS INTERVIEW. ENTER DAY OF MONTH IN NUMBERS, NAME OF MONTH IN WORDS (FIRST THREE LETTERS), YEAR IN IF Select=1 THEN NUMBERS, EG. 2 Jan 72.: DoB Date: What is (name of respondent’s) date of birth? WhoHere Enter Day of month in numbers, Name of month in words (first three letters), Year in numbers Eg. 2 Jan 72 INTERVIEWER: COLLECT NAMES OF ALL THE PEOPLE IN THIS HOUSEHOLD. START WITH THE OLDEST PERSON, THEN LIST OTHERS IN DESCENDING ORDER OF AGE. IF Age of Respondent is 16 or over THEN 1 Continue Marital IF First person in household OR More=Yes THEN Are you (is he/she)... Name ASK OR RECORD. CODE FIRST THAT APPLIES. (NEXT) 1 ...single, that is never married, ENTER THE NAME OF THE OLDEST PERSON IN THE HOUSEHOLD. 2 married and living with husband/wife, 3 married and separated from husband/wife, More 4 divorced, Is there anyone else in this household? 5 or, widowed? 1 Yes ENDIF 2No ENDIF IF (Age of Respondent is 2 to 15 years) THEN (Name and More repeated for up to 12 household members) LegPar Can I check, do either of (name of respondent’s) parents, or someone who has legal parental SizeConf responsibility for him/her, live in this household? So, can I check, altogether there are ( (x) number) people in your household? 1 Yes 1 Yes 2No 2 No, more than (x) 3 No, less than (x) Par1 3 Terraced/end of terrace whole house or bungalow Which of the people in this household are (name of respondent’s) parents or have legal parental 4 Flat or maisonette in a purpose built block: basement to 3rd floor responsibility for him/her on a permanent basis? 5 Flat or maisonette in a purpose built block: 4th floor or higher CODE FIRST PERSON AT THIS QUESTION. IF Not a household member/dead, CODE 97 6 Flat or maisonette in a converted house or some other kind of building Range:1..12, 97 7 Caravan, mobile home or houseboat 8 Some other kind of accommodation Par1B IF TypDwell = Other THEN (name of respondent s) Is this person ’ …READ OUT…parent, or someone else with legal TypDwOth parental responsibility for him/her? PLEASE SPECIFY OTHER DWELLING TYPE. 1 Parent Text: Maximum 40 characters. 2 Legal Parental responsibility ENDIF
EthMix IF Par1 IN [1..12] THEN ETHNIC MIX OF AREA Par2 1 Predominantly white Which other person in this household is (name of respondent’s) parent or have legal parental 2 Predominantly black/brown responsibility for him/her on a permanent basis? 3 Mixed CODE SECOND PERSON AT THIS QUESTION. IF No-one else in the household, CODE 97 Range:1..14, 97
Par2B Is this person (name of respondent’s) …READ OUT…parent, or someone else with legal parental responsibility for him/her? 1 Parent 2 Legal Parental responsibility
ENDIF ENDIF ENDIF
HHResp
83 INTERVIEWER CODE: WHO WAS THE PERSON RESPONSIBLE FOR ANSWERING THE GRIDS IN THIS QUESTIONNAIRE? (Code frame of adult household members)
INTERVIEWER CODING FROM OBSERVATION
AreaType TYPE OF AREA 1 Inner city 2 Other dense urban/town centre 3 Suburban residential (city/large town outskirts) 4 Rural residential/village centre 5 Rural agricultural with isolated dwellings or small hamlets
BldType PREDOMINANT RESIDENTIAL BUILDING TYPE 1 Terraced houses 2 Semi-detached houses 3 Detached houses 4 Mixed houses 5 Low rise flats (5 storey blocks or less) 6 High rise flats (blocks over 5 storeys) 7 Flats with commercial (flats/maisonettes over parades of shops 8 Flats mixed (high and low rise) 9 Mixed houses and flats
TypDwell HOUSEHOLD DWELLING TYPE 1 Detached whole house or bungalow 2 Semi-detached whole house or bungalow 65 (ie between 60 - 69) Scottish Health Survey 1998 – Individual Questionnaire 75 (ie between 70 - 79) 85 (ie 80+) ENDIF ENDIF Introduction ENDIF ALL AllocP PLEASE CHOOSE THE (first/second/third/fourth) PERSON YOU WISH TO INTERVIEW IN THIS QUESTIONNAIRE FROM THE LIST BELOW. YOU CAN INTERVIEW AT THE MOST 4 PERSONS IN THE SAME QUESTIONNAIRE. (List of household members)
IF AgeP=2-12 THEN AdResp WHO IS ANSWERING ON BEHALF OF (Name of selected child aged <13)? (List of adult household members) ENDIF
ALL PersDisp INTERVIEWER: FOR YOUR INFORMATION... the person(s) now allocated to this interview are: (List of allocated household members)
OwnDoB Can I just check, what is your date of birth? ENTER DAY OF MONTH IN NUMBERS, NAME OF MONTH IN WORDS (FIRST THREE LETTERS), YEAR IN NUMBERS. IF (Name) DOES NOT KNOW HIS/HER DATE OF BIRTH, PLEASE GET AN ESTIMATE.
IF OwnDoB=Response THEN 84 OwnAge Can I just check, your age is (computed age)? 1 Yes 2No ENDIF
IF OwnDoB=Not known/Refused THEN OwnAgeE Can you tell me your age last birthday? IF NECESSARY: What do you estimate your age to be? Range: 1..120
IF OwnAgeE=Not known/Refused THEN IF Estimated age from household grid <16 THEN AgeCEst INTERVIEWER: ESTIMATE NEAREST AGE: 3 3 years 5 5 years 7 7 years 9 9 years 11 11 years 13 13 years 15 15 years
ELSE IF Estimated age from household grid >=16 THEN AgeAEst INTERVIEWER: ESTIMATE NEAREST AGE: 18 (ie between 16 - 19) 25 (ie between 20 - 29) 35 (ie between 30 - 39) 45 (ie between 40 - 49) 55 (ie between 50 - 59) General health module Cardiovascular disease and use of services
ASK ALL ASK ALL AGE 16+ GenHelf Chest How is your health in general? Would you say it was ...READ OUT.. I am now going to ask you some questions mainly about symptoms of the chest. Have you ever had any 1 ...very good, pain or discomfort in your chest? 2 good, 1 Yes 3 fair, 2No 4 bad, or 5 very bad? IF Chest = Yes THEN UpHill LongIll Do you get it when you walk uphill or hurry? Do you have any long-standing illness, disability or infirmity? By long-standing I mean anything that 1 Yes has troubled you over a period of time, or that is likely to affect you over a period of time? 2No 1 Yes 3 Sometimes/ Occasionally 2No 4 Never walks uphill or hurries 5 (Cannot walk) IF LongIll=Yes THEN FOR i=1 to 6 DO IF Uphill = Sometimes/Occasionally THEN IF (i = 1) OR (More[i - 1] = Yes) THEN Most1 Records up to six long-standing illnesses Does this happen on most occasions? (IllsM[i]) 1 Yes What (else) is the matter with you? 2No INTERVIEWER: RECORD FULLY. PROBE FOR DETAIL. ENDIF IF MORE THAN ONE MENTIONED, ENTER ONE HERE ONLY. Text: Maximum 60 characters IF Uphill = Yes, Sometimes/Occasionally or Never walks uphill or hurries THEN OrdPace Do you get it when you walk at an ordinary pace on the level? IF (i < 6) THEN 1 Yes LimitAct [i] 2No 3 Sometimes/Occasionally
85 Does this illness or disability limit your activities in any way? 1 Yes 4 Never walks at an ordinary pace on the level 2No More[i] IF OrdPace = Sometimes/Occasionally THEN (Can I check) do you have any other long-standing illness, disability or infirmity? Most2 1 Yes Does this happen on most occasions? 2No 1 Yes ENDIF 2No ENDIF ENDIF ENDDO ENDIF ENDIF IF (Uphill=Yes) OR (OrdPace=Yes) OR (Most1=Yes) OR (Most2=Yes) THEN ASK ALL WalkDo LastFort What do you do if you get it while you are walking? Do you stop, slow down or carry on? Now I'd like you to think about the two weeks ending yesterday. During those two weeks did you have IF RESPONDENT UNSURE, PROBE: What do you do on most occasions? to cut down on any of the things you usually do about the house or at (school/work) or in your free 1 Stop time because of (a condition you have just told me about or some other) illness or injury? 2 Slow down 1 Yes 3 Carry on 2No IF Walkdo = Stop or SlowDown THEN IF Lastfort = Yes THEN PainAway DaysCut If you stand still does the pain go away or not? How many days was this in all during these 2 weeks, including Saturdays and Sundays? IF RESPONDENT UNSURE, PROBE: What happens to the pain on most occasions? Range: 1..14 1 Pain goes away ENDIF 2 Pain doesn't go away
IF PainAway = Pain goes away THEN SoonAway How soon does the pain go away? does it go in ...READ OUT... 1 10 minutes or less, 2 or more than 10 minutes?
IF SoonAway = 10 minutes or less THEN ShowPain 1 Yes Will you show me where you get this pain or discomfort? 2No INTERVIEWER: USE SHOW CARD A TO HELP CODE POSITION OF PAIN OR DISCOMFORT. CODE ALL THAT APPLY. PROBE: Where else? IF Flegm = No or Don’t know THEN 1 Sternum (upper or middle) FleDa 2 Sternum lower Do you usually bring up any phlegm from your chest, during the day or at night in the winter? 3 Left anterior chest 1 Yes 4 Left arm 2No 5 Right anterior chest ENDIF 6 Right arm 7 (Somewhere else) IF Flegm=Yes OR FleDa=Yes THEN ENDIF FreFl ENDIF Do you bring up phlegm like this on most days for as much as three months each year? ENDIF 1 Yes ENDIF 2No ENDIF SevPain IF Uphill <>Cannot walk THEN Have you ever had a severe pain across the front of your chest lasting for half an hour or more? 1 Yes SoBUp 2No Are you troubled by shortness of breath when hurrying on level ground or walking up a slight hill? 1 Yes 2No IF SevPain=Yes THEN DocSee 3 Never walks uphill or hurries 4 Cannot walk Did you see a doctor because of this pain? 1 Yes IF SoBUp = Yes, Never walks uphill or hurries or Don’t know THEN 2No SoBAg Do you get short of breath walking with other people of your own age on level ground? IF DocSee = Yes THEN 1 Yes DocWhat 2No What did the doctor say it was? 3 Never walks with people of own age on level ground CODE ALL THAT APPLY 86 1 Angina IF SoBAg = Yes or No THEN 2 Heart attack SoLev 3 Did not say Do you have to stop for breath when walking at your own pace on level ground? 4 Other 1 Yes ENDIF 2No ENDIF ENDIF ENDIF ENDIF ENDIF ASK ALL AGE 16+ ASK ALL AGE 16+ ECGEver Wheeze Have you ever had an electrical recording of your heart (ECG) performed? Have you had attacks of wheezing or whistling in your chest at any time in the last 12 months? 1 Yes 1 Yes 2No 2No IF ECGEver = Yes THEN ShBrth WhereECG Have you at any time in the past 12 months been woken at night by an attack of shortness of breath? Where did you have it? 1 Yes CODE ALL THAT APPLY. PROBE: Where else? 2No 1 Hospital (inpatient) WhzAttk 2 Hospital (outpatient) Have you ever had attacks of shortness of breath with wheezing? 3 GP Surgery 1 Yes 4 Other 2No WhenECG IF Whzattk=Yes THEN How long ago was this? TYPE IN NUMBER OF YEARS AGO. IF MORE THAN ONE, TAKE LAST OCCASION. Normal LESS THAN ONE YEAR = 0 Is/Was your breathing absolutely normal between attacks? Range: 0..110 1 Yes 2No ENDIF ENDIF
ASK ALL AGE 16+ IF Uphill <> Cannot Walk AND SoBUp <>Cannot Walk Flegm LegPain Do you usually bring up any phlegm from your chest, first thing in the morning in winter? Do you get a pain or discomfort in either of yout legs which comes on when you walk? And do you now have, or have you ever had...READ OUT ...a heart murmur? INTERVIEWER: EXCLUDE NON-CARDIOVASCULAR PROBLEMS SUCH AS RHEUMATISM AND 1 Yes SCIATICA 2No 1 Yes 2 No CVD5 3 Cannot walk ...abnormal heart rhythm? 1 Yes IF LegPain = Yes 2No StanSit Does this pain ever begin when you are standing still or sitting? CVD6 1 Yes ...any other heart trouble? 2 No 1 Yes 2No WalkUp Do you get it if you walk uphill or hurry? IF CVD6 = Yes THEN 1 Yes CVDOth 2 No What is that condition? INTERVIEWER: RECORD FULLY. PROBE FOR DETAIL. 3 Never walks uphill or hurries Text: Maximum 50 characters ENDIF LevelOr Do you get it when you walk at an ordinary pace on the level? ASK ALL AGE 16+ 1 Yes CVD7 2 No Have you ever had a stroke? 3 Never walks at an ordinary pace on the level 1 Yes 2No Still What happens if you stand still? Does the pain usually ...READ OUT... 1 ...continue for more than 10 minutes, CVD8 2 or disappear in 10 minutes or less? Do you now have, or have you ever had diabetes? 1 Yes WhereP 2No
87 Where do you get this pain or discomfort? IF CVD2 = Yes THEN CODE ALL THAT APPLY. 1 Calf muscle DocTold2 2 Thigh or buttocks You said that you had Angina. Were you told by a doctor that you had angina? 3 Other area 1 Yes ENDIF 2No ENDIF IF DocTold2 = Yes THEN AgeTold2 ASK ALL AGE 16+ Approximately how old were you when you were first told by a doctor that you had angina? IntroCVD TYPE IN AGE IN YEARS INTERVIEWER READ OUT: You have already talked to me about your health, and now I would like to Range: 0..110 go on and talk in more detail about some particular conditions. (They may include some of the things you have already mentioned.) PastYr2 Have you had angina during the past 12 months? CVD1 1 Yes Do you now have, or have you ever had...READ OUT ...high blood pressure (sometimes called 2No hypertension)? ENDIF ENDIF 1 Yes 2No IF CVD3 = Yes THEN CVD2 DocTold3 Have you ever had angina? Were you told by a doctor that you had a heart attack (including myocardial infarction or coronary 1 Yes thrombosis)? 2No 1 Yes 2No
CVD3 IF DocTold3 = Yes THEN Have you ever had a heart attack (including myocardial infarction or coronary thrombosis)? AgeTold3 1 Yes 2No Approximately how old were you when you were first told by a doctor that you had a heart attack (including myocardial infarction and coronary thrombosis)? TYPE IN AGE IN YEARS CVD4 Range: 0..110 PastYr3 ENDIF Have you had a heart attack (including myocardial infarction and coronary thrombosis) during the ENDIF past 12 months? 1 Yes IF (CVD2 = Yes) OR (CVD3 = Yes) OR (CVD5 = Yes) OR (CVD6 = Yes) OR (CVD7 = Yes) THEN 2No Medicin ENDIF Are you currently taking any medicines, tablets or pills because of your (heart condition or stroke)? ENDIF 1 Yes 2No IF CVD5 = Yes THEN DocTold5 IF (CVD2 = Yes) OR (CVD3 = Yes) OR (CVD5 = Yes) OR (CVD6 = Yes) THEN Were you told by a doctor that you had abnormal heart rhythm? Surgery 1 Yes Have you ever undergone any surgery or operation because of your heart condition? 2No 1 Yes 2No IF DocTold5 = Yes THEN AgeTold5 IF (Surgery = Yes) THEN Approximately how old were you when you were first told by a doctor that you had abnormal WhenSur heart rhythm? How long ago was this? TYPE IN AGE IN YEARS, IF BORN WITH IT, CODE 0 TYPE IN NUMBER OF YEARS AGO. IF MORE THAN ONE OPERATION, TAKE LAST OCCASION. Range: 0..110 LESS THAN ONE YEAR = 0 Range: 0..110 PastYr5 ENDIF Have you had abnormal heart rhythm during the past 12 months? 1 Yes Waiting 2No Can I just check, are you currently on a waiting list for any such surgery or operation? ENDIF 1 Yes ENDIF 2No ENDIF IF CVD6 = Yes THEN DocTold6 OthTrt Were you told by a doctor that you had (name of ‘other heart condition’)? Are you currently receiving any (other) treatment or advice because of your (heart condition or 1 Yes 88 stroke)? INCLUDE REGULAR CHECK-UPS 2No 1 Yes 2No IF DocTold6 = Yes THEN AgeTold6 IF OthTrt = Yes THEN Approximately how old were you when you were first told by a doctor that you had (name of WhatOth ‘other heart condition’)? What (other) treatment or advice are you currently receiving because of your (heart condition or TYPE IN AGE IN YEARS, IF BORN WITH IT, CODE 0 stroke)? PROBE: What else? CODE ALL THAT APPLY Range: 0..110 1 Special diet 2 Regular check-up with GP/hospital/clinic PastYr6 3 Taking medication Have you had (name of ‘other heart condition’) during the past 12 months? 4 Other (RECORD AT NEXT QUESTION) 1 Yes 2No IF WhatOth = Other THEN ENDIF WhatOSp ENDIF PLEASE SPECIFY... Text: Maximum 60 characters IF CVD7 = Yes THEN ENDIF DocTold7 ENDIF Were you told by a doctor that you had a stroke? ENDIF 1 Yes 2No IF CVD1 = Yes THEN DocBP IF DocTold7 = Yes THEN You mentioned that you have had high blood pressure. Were you told by a doctor or nurse that AgeTold7 you had high blood pressure? Approximately how old were you when you were first told by a doctor that you had a stroke? 1 Yes TYPE IN AGE IN YEARS 2No Range: 0..110 IF (DocBP = Yes) AND (Sex = Female) THEN PastYr7 PregBP Have you had a stroke during the past 12 months? Can I just check, were you pregnant when you were told that you had high blood pressure? 1 Yes 1 Yes 2No 2No IF PregBP = Yes THEN PLEASE SPECIFY... OthBP Text: Maximum 50 characters Have you ever had high blood pressure apart from when you were pregnant? ENDIF 1 Yes ENDIF 2No ENDIF ENDIF IF CVD8 = Yes THEN ENDIF Diabetes ENDIF Were you told by a doctor that you had diabetes? 1 Yes IF (DocBP = Yes) AND (OthBP <> No) THEN 2No AgeBP (Apart from when you were pregnant, approximately/Approximately) how old were you when you IF (Diabetes = Yes) AND (Sex = Female) THEN were first told by a (doctor/nurse) that you had high blood pressure? ENTER AGE IN YEARS DiPreg Range: 0..110 Can I just check, were you pregnant when you were told that you had diabetes? 1 Yes MedBP 2No Are you currently taking any medicines, tablets or pills for high blood pressure? IF DiPreg = Yes THEN 1 Yes 2No DiOth Have you ever had diabetes apart from when you were pregnant? IF MedBP = No, Don’t know or refused THEN 1 Yes BPStill 2No ENDIF ASK OR RECORD: Do you still have high blood pressure? ENDIF 1 Yes 2No IF (Diabetes = Yes) AND (DiOth <> No) THEN DiAge EverMed (Apart from when you were pregnant, approximately/Approximately) how old were you when you Have you ever taken medicines, tablets, or pills for high blood pressure in the past? 1 Yes were first told by a doctor that you had diabetes? ENTER AGE IN YEARS 2No Range: 0..110 Insulin 89 IF EverMed = Yes THEN StopMed Do you currently inject insulin for diabetes? 1 Yes Why did you stop taking (medicines/tablets/pills) for high blood pressure? PROBE: What other 2No reason? TAKE LAST OCCASION. CODE ALL THAT APPLY 1 Doctor advised me to stop due to: improvement 2 lack of improvement DiMed 3 other problem Are you currently taking any medicines, tablets or pills (other than insulin injections) for 4 Respondent decided to stop: because felt better diabetes? 5 ... for other reason 1 Yes 6 Other reason 2No ENDIF ENDIF OthDi Are you currently receiving any (other) treatment or advice for diabetes? INCLUDE REGULAR OthAdv CHECK-UPS. Are you receiving any (other) treatment or advice because of your high blood pressure? INCLUDE 1 Yes REGULAR CHECK-UPS 2No 1 Yes 2No IF (OthDi = Yes) THEN OtherDi IF OthAdv = Yes THEN What (other) treatment or advice are you currently receiving for diabetes? WhatTrt PROBE: What else? CODE ALL THAT APPLY What other treatment or advice are you currently receiving because of your high blood pressure? 1 Special diet PROBE: What else? CODE ALL THAT APPLY 2 Regular check-up with GP/hospital/clinic 1 Blood pressure monitored by GP/nurse 3 Other (RECORD AT NEXT QUESTION) 2 Advice or treatment to lose weight 3 Blood tests IF OtherDi = Other THEN 4 Change diet WhatDSp 5 Stop smoking PLEASE SPECIFY... 6 Reduce stress Text: Maximum 50 characters 7 Other (RECORD AT NEXT QUESTION) ENDIF ENDIF IF WhatTrt = Other THEN ENDIF WhatTSp ENDIF IF CVD4 = Yes THEN INTERVIEWER: RECORD FULLY. PROBE FOR DETAIL. Murmur (MurDoc) Text: Maximum 50 characters You mentioned that you have had a heart murmur. Were you told by a doctor that you had a heart ENDIF murmur? ENDIF ENDIF 1 Yes 2No IF Yes at any of CVD1, CVD2, CVD3, CVD5, CVD6, CVD7 CVD8 THEN IF (Murmur = Yes) AND (Sex = Female) THEN DocTalk PregMur During the 2 weeks ending yesterday, apart from any visit to a hospital, have you talked to a doctor Can I just check, were you pregnant when you were told that you had a heart murmur? on your own behalf, either in person or by telephone? 1 Yes EXCLUDE CONSULTATIONS MADE ON BEHALF OF OTHERS 2No 1 Yes 2No IF PregMur = Yes THEN ENDIF NoPregM Have you ever had a heart murmur apart from when you were pregnant? IF DocTalk = Yes THEN 1 Yes DocNum 2No How many times have you talked to a doctor in these 2 weeks? ENDIF ENDIF Range: 0..14
IF (Murmur = Yes) AND (NoPregM <> No) THEN Consul AgeMur (Were any of these consultations/Was this consultation) about your (heart condition or (Apart from when you were pregnant, approximately/Approximately) how old were you when you stroke)...READ OUT... were first told by a doctor that you had a heart murmur? CODE ALL THAT APPLY ENTER AGE IN YEARS. IF BORN WITH IT ENTER 0 1No Range: 0..110 2 Yes, about: high blood pressure 3 Angina MurYr 4 Heart attack Have you had a heart murmur during the past twelve months? 5 Heart murmur 6 Abnormal heart rhythm 1 Yes 7 Other heart trouble 2No 8 Stroke 90 9 Diabetes MedMur ENDIF Are you currently taking any medicines, tablets or pills because of your heart murmur? 1 Yes IF Yes at any of CVD1, CVD2, CVD3, CVD5, CVD6, CVD7 CVD8 THEN 2No OutPat During the last 12 months, that is since (date a year ago), did you attend hospital as an out-patient, SurgMur day-patient or casualty? Have you ever undergone any surgery or operation because of your heart murmur? 1 Yes 1 Yes 2No 2No ENDIF
IF SurgMur = Yes THEN IF OutPat = Yes THEN LongMur WhyOutP How long ago was this? Was this because of your (heart condition or stoke)? ENTER NUMBER OF YEARS AGO. IF MORE THAN ONE OPERATION, TAKE LAST OCCASION. 1 Yes LESS THAN ONE YEAR AGO = 0 2No Range: 0..110 ENDIF ENDIF IF Yes at any of CVD1, CVD2, CVD3, CVD5, CVD6, CVD7 CVD8 THEN WaitMur InPat Can I just check, are you currently on a waiting list for any such surgery or operation? During the last 12 months, that is since (date a year ago), have you been in hospital as an in- 1 Yes patient, overnight or longer? 2No 1 Yes 2No OthMur ENDIF Are you currently receiving any (other) treatment or advice because of your heart murmur? IF InPat = Yes INCLUDE REGULAR CHECK-UPS 1 Yes WhyInp 2No Was this because of your (heart condition or stroke)? IF OthMur = Yes THEN 1 Yes MurOth 2No What other treatment or advice are you currently receiving because of your heart murmur? ENDIF IF CVD1= No AND CVD2=NO AND CVD3=NO AND CVD5=NO AND CVD6=NO AND CVD7=NO AND IF (NormBP = High) AND CVD1 <> Yes) THEN CVD8=NO OR Age of Respondent is between 2 and 15 years THEN OnlyHi DocTalkN Is this the only time your blood pressure has been higher than normal or has it been higher than During the 2 weeks ending yesterday, apart from any visit to a hospital, have you talked to a doctor normal a number of times? on your own behalf, either in person or by telephone? 1 Only time 1 Yes 2 A number of times 2No ENDIF ENDIF ENDIF
IF DocTalkN = Yes THEN ASK ALL AGE 16+ DocNumN CHMeas How many times have you talked to a doctor in these 2 weeks? Have you ever had your blood cholesterol level measured by a doctor or nurse? Range: 0..14 1 Yes ENDIF 2No
IF DocTalkN <> Yes AND DocTalk <> YesTHEN IF CHMeas = Yes THEN LastDocN LastCH Apart from any visit to a hospital, when was the last time you talked to a doctor on your own When was the last time your blood cholesterol level was measured by a doctor or nurse? Was it ... behalf? READ OUT ... PROMPT 1 ...during the last 12 months, 1 Less than two weeks ago 2 at least a year but less than 3 years ago, 2 2 weeks ago but less than a month ago 3 at least 3 years but less than 5 years ago 3 1 month ago but less than 3 months ago 4 or five years ago or more? 4 3 months ago but less than 6 months ago 5 6 months ago but less than a year ago NormCH 6 A year or more ago Thinking about the last time your blood cholesterol level was measured, were you told it was ... 7 Never consulted a doctor READ OUT.. .INTERVIEWER: CODES 1,2,3 = TOLD WITH OR WITHOUT RESPONDENT ASKING. ENDIF 1 normal (alright/fine), 2 higher than normal, IF CVD1= No AND CVD2=NO AND CVD3=NO AND CVD5=NO AND CVD6=NO AND CVD7=NO AND 3 lower than normal, CVD8=NO OR Age of Respondent is between 2 and 15 years THEN 4 or were you not told anything? OutPatN ENDIF 91 During the last 12 months, that is since (date a year ago), did you attend hospital as an out-patient, day-patient or casualty? HNotAsk 1 Yes Can I check, do you have any other health problems that I have not asked you about? 2No 1 Yes InPatN 2 No During the last 12 months, that is since (date a year ago) have you been in hospital as an in-patient, IF HnotAsk=Yes THEN overnight or longer? HnoWhat 1 Yes 2No What are these health problems? ENDIF DO NOT PROBE Text: 100 characters ASK ALL AGE 16+ ENDIF BPMeas May I just check, have you ever had your blood pressure measured by a doctor or nurse? 1 Yes 2No
IF BPMeas = Yes THEN LastBP When was the last time your blood pressure was measured by a doctor or nurse? Was it ...READ OUT. 1 ...during the last 12 months, 2 at least a year but less than 3 years ago, 3 at least 3 years but less than 5 years ago, 4 or 5 years ago or more? NormBP Thinking about the last time your blood pressure was measured, were you told it was ... READ OUT ... INTERVIEWER: CODES 1,2,3 = TOLD WITH OR WITHOUT RESPONDENT ASKING 1 normal (alright/fine), 2 higher than normal, 3 lower than normal, 4 or were you not told anything? 3 One to five years ago Asthma module 4 More than 5 years ago ENDIF ASK ALL EverW ConDr I am now going to ask you some questions about your breathing. Did a doctor ever tell you that you had asthma? Have you ever had wheezing or whistling in the chest at any time, either now or in the past? EXCLUDE: HOMEOPATHS, ETC. 1 Yes 1 Yes 2No 2No
IF EverW = Yes THEN IF ConDr = Yes AND (EverW=No OR EverW= Don t Know) OR (EverW=Yes AND TweWz=No or Don’t NoCol Know) Have you ever had this wheezing or whistling when you did not have a cold? AsTwe 1 Yes When was your most recent attack of asthma? 2No PROMPT IF NECESSARY. 1 Less than 4 weeks ago BrWhy 2 More than 4 weeks but within the last 12 months 3 One to five years ago Have you ever been at all breathless when the wheezing or whistling noise was present? 4 More than 5 years ago 1 Yes ENDIF 2No IF ((EverW=No OR ConDr=Yes) AND AstWe OR RecAtW = between less than 4 weeks ago…One to Five years ago) THEN TweWz TrtWze Have you ever had wheezing or whistling in the chest in the last 12 months? SHOW CARD B 1 Yes Have you received any treatment or advice for your (asthma/wheezing or whistling) from any of the 2No people on this card? 1 Yes IF TweWz=Yes THEN 2No Attak How many attacks of wheezing/whistling have you had in the last 12 months? IF TrtWze=Yes THEN IF DK, OBTAIN ESTIMATE. TrtWh PROMPT IF REQUIRED:
92 Which ones? PROBE: Any others? CODE ALL THAT APPLY 1 1 to 3 1 A general practitioner (GP) 2 4 to 12 2 Nurse at GP surgery/Health centre 3 More than 12 attacks 3 Community, School or District Nurse 4 Hospital casualty/Accident and Emergency department SleTw 5 Consultant/Specialist or other doctor at hospital outpatients In the last 12 months, how often on average has your sleep been disturbed due to 6 Consultant/Specialist or other doctor elsewhere wheezing/whistling? Have you ...READ OUT... 7 Homeopath 1 ...never woken with wheezing, 8 Acupuncturist 2 woken less than 1 night per week, 9 Other alternative medicine professional 3 woken one or more nights per week? IF DK, OBTAIN ESTIMATE. IF TrtWh=A General Practioner (GP) Speke TrTim1 In the last 12 months, has the wheezing/whistling ever been severe enough to limit your How many times were you treated by a general practitioner for your (asthma/wheezing or speech to only one or two words at a time between breaths? whistling) in the last 12 months? 1 Yes Range:0..52 2No ENDIF IF TrtWh=A Nurse at GP Surgery/Health Centre NaDLi TrTim2 In the last 12 months, how much did wheezing/whistling interfere with your normal daily How many times were you treated by a nurse at a GP surgery/Health centre for your activities ...READ OUT... (asthma/wheezing or whistling) in the last 12 months? Range:0..52 1 ...not at all, ENDIF 2 a little, IF TrtWh=Community, School or District nurse 3 quite a bit, 4 or a lot? TrTim3 ENDIF How many times were you treated by a Community, School or District nurse for your (asthma/wheezing or whistling) in the last 12 months? RecAtW Range: 0..52 ENDIF When was most recent attack of wheezing/whistling? IF TrtWh= hospital casualty or Accident and Emergency Department PROMPT IF NECESSARY. 1 Less than 4 weeks ago TrTim4 2 More than 4 weeks but within the last 12 months How many times were you treated at a hospital casualty or Accident and Emergency Department for your (asthma/wheezing or whistling) in the last 12 months? Range: 0..52 ENDIF Accidents IF TrtWh=Consultant/Specialist or other doctor at hospital outpatients TrTim5 ASK ALL How many times were you treated by a Consultant/Specialist or other doctor at hospital PreAcc outpatients for your (asthma/wheezing or whistling) in the last 12 months? Now I would like to ask you about accidents that may have happened to you recently. Range: 0..52 BY ACCIDENTS I MEAN ACCIDENTAL EVENTS WHICH RESULTED IN INJURY OR PHYSICAL ENDIF HARM TO YOU PERSONALLY IF TrtWh=Consultant/Specialist or other doctor elsewhere TrTim6 DrAcc How many times were you treated by a Consultant/Specialist or other doctor elsewhere for In the last 12 months have you had any kind of accident which caused you to see a doctor, nurse or your (asthma/wheezing or whistling) in the last 12 months? other health professional, or to take time off work (or school)? Range: 0..52 1 Yes ENDIF 2No ENDIF ENDIF IF DrAcc=Yes THEN NDrAcc How many accidents have you had in the last 12 months where you saw a doctor or went to hospital?" Range: 1..10
DrWyr SHOW CARD C Now can we talk about the (most recent) accident. Where did the accident happen? INTERVIEWER PLEASE READ OUT AND CODE ONE ONLY. 1 On a pavement or a pedestrian area 2 On a road 3 In a home or garden (either your own or someone else's) 4 In a place used for sports, play or recreation (including sports facility at a school or college) 5 In some other part of a school or college 6 In an office, factory, shop, pub, restaurant or other public building
93 7 Other (SPECIFY AT NEXT QUESTION)
IF DrWyr=Other THEN WyrOth PLEASE SPECIFY.... Text: maximum 50 characters ENDIF
AxCause What caused this accident? CODE ALL THAT APPLY 1 Hit by a falling object 2 Fall, slip or trip 3 Road traffic accident 4 Sports or recreational accident 5 Caused by tool, implement or piece of electrical or mechanical equipment 6 Burn/scald 7 Animal/insect bite or sting 8 Caused by another person (e.g. attacked) 9 Other (SPECIFY AT NEXT QUESTION) 10 Lifting
IF AxCause=Other THEN CauseOth PLEASE SPECIFY... Text: maximum 50 characters ENDIF IF DrAcc=Yes AND Age of Respondent is between 13 and 74 years THEN DrJob At the time of the accident, did you have a paid job? 1 Yes 2No
IF DrJob=Yes THEN DrWrk prevent it? (Can I check,) did the accident happen while you were at work? CODE ALL THAT APPLY 1 Yes 1 Yes - by respondent 2No 2 Yes - by others 3No IF DrWrk =Yes THEN ENDIF InOut Did the accident happen outdoors or indoors? 1 Outdoors 2 Indoors ENDIF ENDIF ENDIF IF (DrJob=Yes AND Age of Respondent is 16 to 74 years) OR Age of Respondent is 4 to 15 years THEN TimeOff As a result of the accident did you have to take any time off (work/school or college)? 1 Yes 2No ENDIF
DrInj SHOW CARD D (Can I check,) which of the types of injury described on this card did you suffer? PROBE: What else? CODE ALL THAT APPLY 1 Broken bones 2 Dislocated joints 3 Losing consciousness 4 Straining or twisting a part of the body 5 Cutting, piercing or grazing a part of the body 6 Bruising, pinching or crushing a part of the body 7 Swelling or tenderness in some part of the body
94 8 Getting something stuck in the eye, throat, ear or other part of the body 9 Burning or scalding 10 Poisoning 11 Other injury to internal parts of the body 12 Animal or insect bite or sting 13 Other. PLEASE SPECIFY
IF DrInj=Other THEN InjOth PLEASE SPECIFY.... Text: maximum 50 characters ENDIF
DrAid SHOW CARD E (Can I check,) from which of the people on this card did you get help or advice about the injury you suffered? PROBE: Who else? CODE ALL THAT APPLY. 1 Hospital 2 GP/Family Doctor 3 Nurse at GP surgery 4 Nurse at place of work, school or college 5 Doctor at place of work, school or college 6 Other doctor or nurse 7 Ambulance staff 8 Volunteer first aider 9 Chemist or pharmacist 10 Family, friends, colleagues, passers-by 11 Looked after self 12 Other person/s
Prevent Thinking back to the way the accident happened, do you think anything could have been done to ago)? Adult physical activity module (16+) 1 Yes 2No ASK ALL AGE 16+ IF Garden = Yes THEN Work GardList I'd like to ask you about some of the things you have done in the past four weeks that involve physical SHOW CARD H activity, this could be at work (school/college) or in your free time. (Can I just check) were you in paid Have you done any gardening, DIY or building work listed on this card? employment or self-employed in the past four weeks? 1 Yes 1 Yes 2No 2No IF Work = Yes THEN ManWork SHOW CARD I Active Have you done any gardening, DIY or building work from this other card, or any similar heavy Thinking about your job in general would you say that you are ...READ OUT.. manual work? 1 ...very physically active, 1 Yes 2 ...fairly physically active, 2No 3 ...not very physically active, 4 ...or, not at all physically active in your job? IF ManWork = Yes THEN ENDIF ManDays During the past 4 weeks on how many days have you done this kind of heavy manual gardening ASK ALL AGE 16+ or DIY? Housewrk Range: 1..28 I'd like you to think about the physical activities you have done in the last few weeks (when you were not doing your paid job.) Have you done any housework in the past four weeks, that is from (date four HrsDIY weeks ago) up to yesterday? On the days you did heavy manual gardening or DIY, how long did you usually spend? 1 Yes RECORD HOURS SPENT BELOW. ENTER 0 IF LESS THAN 1 HOUR.RECORD MINUTES AT NEXT 2No QUESTION. Range: 0..12 IF Housewrk = Yes THEN HWrkList MinDIY SHOW CARD F RECORD MINUTES SPENT ON GARDENING OR DIY. Have you done any housework listed on this card? Range: 0..59
95 1 Yes DIYTim 2No Computed total time from HrsDIY and MinDIY. Range: 0..779 HevyHWrk ENDIF SHOW CARD G ENDIF Some kinds of housework are heavier than others. This card gives some examples of heavy housework. It does not include everything, these are just examples. Was any of the housework you ASK ALL AGE 16+ did in the last four weeks this kind of heavy housework? Wlk5Int 1 Yes I'd like you to think about all the walking you have done in the past 4 weeks either locally or away 2No from here. Please include any country walks, walking to and from work and any other walks that you IF HevyHWrk = Yes THEN have done. In the past four weeks, that is since (date four weeks ago), have you done a continuous HeavyDay walk that lasted at least 5 minutes? During the past four weeks on how many days have you done this kind of heavy housework? 1 Yes Range: 1..28 2No 3 Can't walk at all HrsHHW On the days you did heavy housework, how long did you usually spend? IF Wlk5Int = Yes THEN RECORD HOURS SPENT BELOW. ENTER 0 IF LESS THAN 1 HOUR. RECORD MINUTES AT NEXT Wlk15M QUESTION In the past four weeks, have you done a continuous walk that lasted at least 15 minutes? (That is Range: 0..12 since (date four weeks ago)) 1 Yes MinHHW 2No RECORD MINUTES SPENT ON HEAVY HOUSEWORK. Range: 0..59 IF Wlk15M = Yes THEN HWTim DayWlk Computed total time from HRSHHW and MINHHW. During the past four weeks, on how many days did you do a walk of at least 15 minutes? (That is Range: 0..779 since (date four weeks ago)) ENDIF Range: 1..28 ENDIF ASK ALL AGE 16+ Day1Wlk Garden On that day (any of those days) did you do more than one walk lasting at least 15 minutes? Have you done any gardening, DIY or building work in the past four weeks, that is since (date four weeks 1 Yes, more than one walk of 15+ mins (on at least one day) 2 No, only one walk of 15+ mins a day IF (OActQ = Yes) THEN OthAct[i] IF (DayWlk in [2..28]) AND (Day1Wlk = Yes) THEN PROBE FOR NAME OF SPORT OR EXERCISE. WRITE IN. Day2Wlk ARRAY[11..16] OF STRING[20] On how many days in the last four weeks did you do more than one walk that lasted at least (coded to Actax, Actbx..Actfx) 15 minutes? Range: 1..28 ENDIF ENDIF ENDIF ENDDO IF Wlk15M = Yes THEN HrsWlk DayExc to ExcSwt repeated for each sport/exercise coded at WhtAct or mentioned at OthAct (Renamed for each Sport/Exercise eg swimocc, swimhrs, swimmin, swimeff) How long did you usually spend walking each time you did a walk for 15 minutes or more? IF VERY DIFFERENT LENGTHS, PROBE FOR MOST REGULAR. RECORD HOURS SPENT FOR ActVar := 1 TO 16 DO BELOW. ENTER 0 IF LESS THAN 1 HOUR.RECORD MINUTES AT NEXT QUESTION. IF ((ActVar in [1..10]) AND (ActVar IN WhtAct)) OR ((ActVar in [11..16]) AND (OActQ[ActVar] = Yes)) Range: 0..12 THEN DayExc MinWlk Can you tell me on how many separate days did you do (name of activity) for at least 15 minutes a RECORD HERE MINUTES SPENT WALKING. time during the past four weeks, that is since (date four weeks ago)? IF ONLY DONE FOR LESS Range: 0..59 THAN 15 MINUTES ENTER 0. TotTim Range: 0..28 Computed total time from HrsWlk and MinWlk. Range:0..779 IF DayExc is between 1 and 56 THEN ENDIF ExcHrs ENDIF How much time did you usually spend doing (name of activity) on each day? (Only count times WalkPace you did it for at least 15 minutes.) Which of the following best describes your usual walking pace ...READ OUT... RECORD HOURS SPENT BELOW. ENTER 0 IF LESS THAN 1 HOUR. RECORD MINUTES AT 1 ...a slow pace, NEXT QUESTION. 2 ...a steady average pace, Range: 0..12 3 ...a fairly brisk pace, 4 ...or, a fast pace - at least 4 mph? ExcMin 5 (none of these) RECORD MINUTES HERE. 96 ENDIF Range: :0..59
ASK ALL AGE 16+ ExcTim ActPhy Computed total time from ExcHrs and ExcMin. SHOW CARD J Range: 0..779 Can you tell me if you have done any activities on this card during the last 4 weeks, that is since (date four weeks ago)? Include teaching, coaching, training and practice sessions. ExcSwt 1 Yes During the past four weeks, was the effort of (name of activity) usually enough to make you 2No out of breath or sweaty? 1 Yes IF ActPhy = Yes THEN 2No WhtAct ENDIF ENDIF Which have you done in the last four weeks? PROBE: Any others? CODE ALL THAT APPLY. ENDDO 1 Swimming, 2 Cycling, 3 Workout at a gym/Exercise bike/ Weight training 4 Aerobics/Keep fit/Gymnastics/ Dance for fitness 5 Any other type of dancing 6 Running/jogging 7 Football/rugby 8 Badminton/tennis 9 Squash 10 Exercises (e.g. press-ups, sit ups) ENDIF
Repeat for up to 6 additional sports:
FOR ActVar := 11 TO 16 DO IF (ActVar = 11) OR (OActQ[ActVar - 1] = Yes) THEN OactQ[i] Have you done any other sport or exercise not listed on the card? ARRAY[11..16] OF Yes, No 4 ... or, a fast pace - at least 4 mph? Child physical activity module (2-15) 5 (None of these) ENDIF ENDIF IF Age of Respondent is 4 years THEN IF Age of Respondent is 8-15 years THEN ChSch HWkCh Can I just check, is (name of child) at school in reception class yet? In the last week have you done any housework or gardening which involved pulling or pushing, like 1 Yes hoovering, cleaning a car, mowing grass or sweeping up leaves for at least 15 minutes a time? 2No 1 Yes ENDIF 2No ASK ALL AGE 2-15 IF HWkCh = Yes THEN Wlk5Ch DHWkCh Now I'd like to ask you about some of the things you have done in the last week. By last week I mean On how many days in the last week have you done any housework or gardening of this type for at last (day seven days ago) up to yesterday. In the last week, have you done a continuous walk that least 15 minutes a time? lasted at least 5 minutes (not counting things done as part of school lessons)? 1 One day 1 Yes 2 Two days 2No 3 Three days IF Wlk5Ch = Yes THEN 4 Four days DaysWlk 5 Five days 6 Six days On how many days in the last week did you do a continuous walk that lasted at least 5 minutes (not 7 Every day counting things done as part of school lessons)? 1 One day THwk 2 Two days SHOW CARD K 3 Three days On each day that you did any housework or gardening of this type for at least 15 minutes a time, 4 Four days how long did you spend? 5 Five days Please give an answer from this card. 6 Six days 3 15 minutes, less than 30 minutes 7 Every day 4 30 minutes, less than 1 hour 1 5 1 hour, less than 1 /2 hours DayWlkT 1 61/2 hours, less than 2 hours SHOW CARD K 1
97 7 2 hours, less than 2 /2 hours On each day that you did a walk like this for at least 5 minutes, how long did you spend walking 1 82/2 hours, less than 3 hours altogether? Please give an answer from this card 1 9 3 hours, less than 3 /2 hours INTERVIEWER NOTE: COUNT TOTAL TIME SPENT WALKING. SO TWO WALKS OF 10 MINUTES 1 10 3 /2 hours, less than 4 hours EACH = 20 MINUTES WALKING 11 4 hours or more (please specify how long) 2 5 minutes, less than 15 minutes 3 15 minutes, less than 30 minutes IF THWk = 4 hours or more THEN 4 30 minutes, less than 1 hour HWkHrs 1 5 1 hour, less than 1 /2 hours 1 How long did you spend doing housework or gardening on each day? 61/2 hours, less than 2 hours 1 RECORD HOURS SPEND BELOW. RECORD MINUTES AT NEXT QUESTION. 7 2 hours, less than 2 /2 hours 1 Range: 4..12 82/2 hours, less than 3 hours 1 9 3 hours, less than 3 /2 hours HWkMin 1 10 3 /2 hours, less than 4 hours RECORD HERE MINUTES SPENT DOING HOUSEWORK/GARDENING. 11 4 hours or more (please specify how long) Range: 0..59 IF DayWlkT = 4 hours or more THEN HWkTot WlkHrs Computed total time from HWkHrs and9997 HwkMin; Range:0.. How long did you spend walking on each day? ENDIF RECORD HOURS SPENT BELOW. RECORD MINUTES AT NEXT QUESTION ENDIF Range: 4..12 ENDIF WlkMin ASK ALL AGE 2-15 RECORD HERE MINUTES SPENT WALKING. SPORT Range: 0..59 I would now like to ask you about any sports or exercise activities that you have done. I will then go on to ask about other active things you may have done like running about, riding a bike, kicking a ball WlkTot Computed total time from WlkHrs and 9997WlkMin; Range:0.. around and things like that. For the following questions please (include any activities done at a nursery ENDIF or playgroup/don’t count any activities done as part of school lessons). IF Age of Respondent is 13-15 years THEN SportDo ChPace SHOW CARD L Which of the following describes your usual walking pace ... READ OUT ... In the last week, that is last (day 7 days ago) up to yesterday, have you done any sports or exercise 1 ... a slow pace, activities (not counting things done as part of school lessons)? This card shows some of the things you 2 ... a steady average pace, might have done; please also include any other sports or exercise activities like these. 3 ... a fairly brisk pace, INTERVIEWER: DO NOT COUNT ANYTHING DONE TODAY. 1 Yes 4 30 minutes, less than 1 hour 1 2No 5 1 hour, less than 1 /2 hours 1 61/2 hours, less than 2 hours IF SportDo = Yes THEN 1 7 2 hours, less than 2 /2 hours 1 WESpDo 82/2 hours, less than 3 hours 1 Did you do any of these sports or exercise activities at the weekend, that is last Saturday and Sunday 9 3 hours, less than 3 /2 hours 1 (yesterday and last Sunday)? 10 3 /2 hours, less than 4 hours 1 Yes 11 4 hours or more (please specify how long) 2No IF WkSpor = 4 hours or more THEN IF WEspDo = Yes THEN WkSpH DWEsp How long did you spend doing these sports or exercise activities on each weekday? Was that on Saturday or Sunday or on both days? RECORD HOURS SPENT BELOW.RECORD MINUTES AT NEXT QUESTION 1 Saturday only Range 4..12 2 Sunday only 3 Both Saturday and Sunday WkSpM RECORD HERE MINUTES SPENT DOING SPORTS OR EXERCISE ACTIVITIES WeSpor Range: 0..59 SHOW CARD K WkSpT On (Saturday/Sunday/Saturday and Sunday) when you did these sports or exercise activities, how Computed total time from WkSpH and 9997WkSpM; Range:0.. long did you spend (on each day)? Please give an answer from this card. ENDIF INTERVIEWER: IF IT VARIED, TAKE AVERAGE ENDIF 1 Less than 5 minutes ENDIF 2 5 minutes, less than 15 minutes 3 15 minutes, less than 30 minutes ASK ALL AGE 2-15 4 30 minutes, less than 1 hour WEActDo 1 5 1 hour, less than 1 /2 hours SHOW CARD M 1 61/2 hours, less than 2 hours 1 Now I would like to know about when you do active things, like the things on this card or other 7 2 hours, less than 2 /2 hours activities like these. Did you do any active things like these at the weekend, that is last Saturday and 821 /2 hours, less than 3 hours Sunday (yesterday and last Sunday)? 9 3 hours, less than 31 /2 hours INTERVIEWER NOTE: DO NOT INCLUDE ANY ACTIVITIES ALREADY COVERED UNDER SPORTS AND 1/ hours, less than 4 hours 10 3 2 EXERCISE ACTIVITIES 11 4 hours or more (please specify how long) 1 Yes
98 IF WeSpor = 4 hours or more THEN 2No WeSpH IF WEActDo = Yes THEN How long did you spend doing these sports or exercise activities? DWEAct RECORD HOURS SPENT BELOW. RECORD MINUTES AT NEXT QUESTION. Was that on Saturday or Sunday or on both days? Range: 4..12 1 Saturday only WeSpM 2 Sunday only 3 Both Saturday and Sunday RECORD HERE MINUTES SPEND DOING SPORTS OR EXERCISE ACTIVITIES. Range: 0..59 WeAct WeSpT SHOW CARD K Computed total time from WeSpH and WeSpM On (Saturday/Sunday/Saturday and Sunday) when you did active things like these, how long did you Range: 0..9997 spend (on each day)? Please give an answer from this card. ENDIF INTERVIEWER: IF IT VARIED, TAKE AVERAGE ENDIF 1 Less than 5 minutes 2 5 minutes, less than 15 minutes DaySp 3 15 minutes, less than 30 minutes Still thinking about last week. On how many of the weekdays did you do any of these sports or 4 30 minutes, less than 1 hour 5 1 hour, less than 11 exercise activities? (Please remember not to count things done as part of school lessons) /2 hours 1/ hours, less than 2 hours 0 None in last week 612 7 2 hours, less than 21 1 1 day /2 hours 1/ hours, less than 3 hours 2 2 days 822 9 3 hours, less than 31 3 3 days /2 hours 1/ hours, less than 4 hours 4 4 days 10 3 2 11 4 hours or more (please specify how long) 5 5 days IF WeAct= 4 hours or more THEN IF DaySp = 1 day to 5 days THEN WkSpor WeActH SHOW CARD K How long did you spend doing active things like these? On each weekday that you did these sports or exercise activities, how long did you spend? Please RECORD HOURS SPENT BELOW.RECORD MINUTES AT NEXT QUESTION. Range: 4..12 give an answer from this card. 1 Less than 5 minutes WeActM 2 5 minutes, less than 15 minutes RECORD HERE MINUTES SPENT DOING ACTIVE THINGS LIKE THESE 3 15 minutes, less than 30 minutes Range: 0..59 1 NO - same as usual WeActT 2 YES DIFFERENT - usually do MORE Computed total time from WeACtH 9997and WeActM; Range:0.. 3 YES DIFFERENT - usually do LESS ENDIF ENDIF ASK ALL AGE 2-15 WkActDo SHOW CARD M Still thinking about last week. On how many of the weekdays did you do active things, like the things on this card or other activities like these (not counting things done as part of school lessons)? INTERVIEWER NOTE: DO NOT INCLUDE ANY ACTIVITIES ALREADY COVERED UNDER SPORTS AND EXERCISE ACTIVITIES 0 None in last week 1 1 day 2 2 days 3 3 days 4 4 days 5 5 days IF WkActDo = 1 day to 5 days THEN WkAct SHOW CARD D On each weekday that you did active things like these, how long did you spend? Please give an answer from this card. 1 Less than 5 minutes 2 5 minutes, less than 15 minutes 3 15 minutes, less than 30 minutes 4 30 minutes, less than 1 hour 1 5 1 hour, less than 1 /2 hours 1 61/2 hours, less than 2 hours 1 7 2 hours, less than 2 /2 hours 1 82/2 hours, less than 3 hours 1 9 3 hours, less than 3 /2 hours
99 1 10 3 /2 hours, less than 4 hours 11 4 hours or more (please specify how long) IF WkAct = 4 hours or more THEN WkActH How long did you spend doing active things like these on each weekday? RECORD HOURS SPENT BELOW.RECORD MINUTES AT NEXT QUESTION Range: 4..12 WkActM RECORD HERE MINUTES SPENT DOING ACTIVE THINGS LIKE THESE. Range: 0..59 WkActT Computed total time from WkActH and WkActM;9997 Range:0.. ENDIF ENDIF ASK ALL AGE 2-15 DaysTot Now thinking about all the activities during the past week you have just told me about including any walking, (gardening, housework,) sports or other active things. On how many days in the last week in total did you do any of these activities (not counting things done as part of school lessons)? 0 None 1 One day 2 Two days 3 Three days 4 Four days 5 Five days 6 Six days 7 Every day
Usual Were the activities you did last week different from what you would usually do for any reason? IF YES PROBE: Would you usually do more physical activity or less? When you have fried foods at home, what kind of fat or oil are the foods usually cooked in? Please Eating habits module look at SHOW CARD O and tell me which type of fat or oil is used most often? 1 Solid cooking fat (including butter, dripping lard, ghee, white cap, cookeen) ASK ALL 2 Half-fat butter UsBread 3 Polyunsaturated, sunflower or olive margarine What kind of bread or rolls do you usually eat? Is it ...READ OUT... 4 Other hard or soft margarine or dairy blend, (including Flora, Clover, Willow) CODE ONE ONLY. IF NO USUAL TYPE ASK WHICH TYPE IS EATEN MOST OFTEN 5 Low fat spreads 1 white (INCL CHOLLAH), 6 Vegetable oil (including olive, sunflower, soya, corn, peanut, rapeseed 2 brown, granary, wheatmeal, (INCL WHEATGERM, SOFTGRAIN, RYE, GERMAN), 7 Some other kind of fat/oil 3 wholemeal (INCL HIGHBRAN), 8 (Does not eat fried food) 4 or, some other kind of bread? SPONTANEOUS: IF FryFat=Other THEN 5 Does not have a usual type 6 Does not eat any type of bread FryOther IF BROWN, CHECK IF WHOLEMEAL OR SOME OTHER SORT OF BROWN BREAD. What is the other fat or oil your food is usually fried in? IF PITTA/NAN/SODA BREAD ETC, CHECK IF WHITE OR WHOLEMEAL. Open answer: up to 30 characters ENDIF IF UsBread = OTHER THEN BreadOth ASK ALL What other kind of bread or rolls do you usually eat? Milk Text: Maximum 20 characters What kind of milk do you usually use for drinks, in tea or coffee and on cereals? Is it ...READ OUT... ENDIF 1 whole milk, 2 semi-skimmed (INCL DRIED SEMI-SKIMMED), IF (UsBread IN [White..Does not have usual type]) THEN 3 skimmed (INCL DRIED SKIMMED, BOOTS DRIED POWDER, CO-OP POWDER), BrSlice* 4 or, some other kind of milk? Now looking at SHOW CARD N. How many rolls, pieces or slices of bread of any kind do you 5 Evaporated/Condensed milk usually eat on any one day? IF VARIES, ASK FOR AN AVERAGE. . 6 Soya/Veg-based milk 1 6 or more a dayLess than 1 a day, SPONTANEOUS: 2 4 or 5 a day, 7 Does not have usual type 3 2 or 3 a day, 8 Does not drink milk 4 One a day IF Milk = OTHER THEN 5 Less than one per day 100 ENDIF MilkOth What is the other kind of milk? ASK ALL Text: Maximum 15 characters Spr ENDIF What type of spread do you usually use on bread, sandwiches, toast, potatoes or vegetables? CODE ONE ONLY. REFER TO CODING LIST 1. IF (Milk IN [Whole..NoUsual Type]) THEN 1 Butter or margarine MilkAmt 2 Low fat or reduced fat spread, or half-fat butter About how much milk of any kind do you use each day (for drinks, in tea and coffee, on cereals 3 Spread not on coding list etc)? SPONTANEOUS: Is it ...READ OUT... 4 Does not have usual type INTERVIEWER 1 LITRES = 2 PINTS APPROX 5 Does not use fat spread 1 less than a quarter of a pint, 2 about a quarter of a pint, IF Spr = OTHER THEN 3 about half a pint, OthSpr 4 or, one pint or more? What other kind of spread do you usually eat? ENDIF Text: Maximum 40 characters ENDIF ASK ALL SugTea IF (Spr IN [Butter..NoType]) THEN Do you usually have sugar in your tea? EatPats DO NOT INCLUDE SWEETENERS On average, how many pats or rounded teaspoons of margarine, butter or other spread do you use 1 Yes, usually have sugar in tea each day, for example on bread, sandwiches, toast, potatoes or vegetables? 2 NO INTERVIEWER EXPLAIN AS NECESSARY. A ‘pat‘ is about the size of the wrapped portions of 3 Does not drink tea butter or margarune which are provided in restaurants or cafes. INTERVIEWER: DO NOT INCLUDE AMOUNT USED FOR COOKING. ENTER NUMBER OF PATS OR ROUNDED TEASPOONS SugCoff Range: 0..99 ENDIF Do you usually have sugar in your coffee? DO NOT INCLUDE SWEETENERS ASK ALL 1 Yes, usually have sugar in coffee FryFat 2 NO 3 Does not drink coffee TabSalt 7 Once a week At the table do you ...READ OUT... 8 1 to 3 times per month 1 usually add salt to your food without tasting it first, 9 Less often of never 2 taste the food, but then generally add salt, 3 taste the food, but only occasionally add salt, Potatoes 4 rarely, or never, add salt at the table? SHOW CARD P Other than chips, how often do you eat potatoes, pasta or rice? NCereal 1 6 or more times a day Which type of breakfast cereal do you usually eat? 2 4 or 5 times a day CODE ONE ONLY. USE CODING LIST 2 FOR QUERIES. 3 2 or 3 times a day 1 Bran cereal on coding list (e.g. AllBran, Branflakes, Sultana Bran) 4 Once a day 2 Oat or wheat cereal on coding list (e.g. Shredded Wheat, Muesli, porridge, Weetabix) 5 5 or 6 times a week 3 Bran, oat or wheat cereal not on coding list 6 2 to 4 times a week 4 Others (e.g. Cornflakes, Rice Krispies, Special K, Sugar Puffs, Honey Smacks) 7 Once a week SPONTANEOUS: 8 1 to 3 times per month 5 Does not have usual type 9 Less often of never 6 Does not eat breakfast cereal GreenVeg IF NCereal = Bran, oat or wheat cereal not on coding list THEN SHOW CARD P OthCer How often do you eat cooked green vegatables, such as peas, broccoli, cabbage, spinach, cauliflower, INTERVIEWER: SPECIFY NAME OF BRAN, OAT OR WHEAT CEREAL. green beans and so on? Text: Maximum 40 characters 1 6 or more times a day ENDIF 2 4 or 5 times a day IF (NCereal IN [Bran..No Usual Type]) THEN 3 2 or 3 times a day 4 Once a day Cereals 5 5 or 6 times a week SHOW CARD P 6 2 to 4 times a week How often, on average, do you eat breakfast cereals of any kind, including porridge? Please choose 7 Once a week an answer from this card. 8 1 to 3 times per month 1 6 or more times a day 9 Less often of never 2 4 or 5 times a day 3 2 or 3 times a day RootVeg 101 4 Once a day 7 5 or 6 times a week SHOW CARD P 8 2 to 4 times a week How often do you eat cooked root vegetables, such as carrots, parsnips, turnips and so on? 9 Once a week 1 6 or more times a day 10 1 to 3 times per month 2 4 or 5 times a day 11 Less often or never 3 2 or 3 times a day ENDIF 4 Once a day 5 5 or 6 times a week 6 2 to 4 times a week ASK ALL 7 Once a week Fruit 8 1 to 3 times per month SHOW CARD P 9 Less often of never I would like to ask about some foods which you may eat. Can you tell me how often on average you eat each of these food by chossing an answer from this card. RawVeg How often do you eat fresh fruit? 1 6 or more times a day SHOW CARD P 2 4 or 5 times a day How often do you eat raw vegetables, or salad? 3 2 or 3 times a day INCLUDE TOMATOES. DO NOT INCLUDE SALAD IN A SANDWICH 4 Once a day 1 6 or more times a day 5 5 or 6 times a week 2 4 or 5 times a day 6 2 to 4 times a week 3 2 or 3 times a day 7 Once a week 4 Once a day 8 1 to 3 times per month 5 5 or 6 times a week 9 Less often or never 6 2 to 4 times a week 7 Once a week 8 1 to 3 times per month Fried 9 Less often or never SHOW CARD P How often do you eat fried food, including fried fish, chips, cooked breakfast, samosas? 1 6 or more times a day Meat 2 4 or 5 times a day SHOW CARD P 3 2 or 3 times a day How often do you eat MEAT, SUCH AS beef, lamb, pork ETC? 4 Once a day INCLUDE BEEFBURGERS, SAUSAGE, BACON, MEAT PIES, MINCE AND PROCESSED MEAT. 5 5 or 6 times a week DO NOT INCLUDE POULTRY 6 2 to 4 times a week 1 6 or more times a day 2 4 or 5 times a day Pulses 3 2 or 3 times a day SHOW CARD P 4 Once a day How often do you eat peas, lentils or beans including baked beans, dried beans and pulses? 5 5 or 6 times a week 1 6 or more times a day 6 2 to 4 times a week 2 4 or 5 times a day 7 Once a week 3 2 or 3 times a day 8 1 to 3 times per month 4 Once a day 9 Less often or never 5 5 or 6 times a week 6 2 to 4 times a week Poultry 7 Once a week SHOW CARD P 8 1 to 3 times per month How often do you eat poultry, such as chicken or turkey? 9 Less often or never INCLUDE CHICKEN OR TURKEY IN BURGERS, SAUSAGES, MEAT PIES, MINCE AND PROCESSED MEAT 1 6 or more times a day Confec 2 4 or 5 times a day SHOW CARD P 3 2 or 3 times a day How often do you eat chocolates, crisps or biscuits, including savoury biscuits such as cream 4 Once a day crackers? 5 5 or 6 times a week 1 6 or more times a day 6 2 to 4 times a week 2 4 or 5 times a day 7 Once a week 3 2 or 3 times a day 8 1 to 3 times per month 4 Once a day 9 Less often or never 5 5 or 6 times a week 6 2 to 4 times a week WFish 7 Once a week 8 1 to 3 times per month SHOW CARD P 9 Less often or never How often do you eat white fish, such as cod, haddock, whiting, sole or plaice? INCLUDE FRESH, FROZEN OR CANNED 1 6 or more times a day IceCream 2 4 or 5 times a day SHOW CARD P 3 2 or 3 times a day How often do you eat sweets or ice-cream? 4 Once a day 1 6 or more times a day 102 5 5 or 6 times a week 2 4 or 5 times a day 6 2 to 4 times a week 3 2 or 3 times a day 7 Once a week 4 Once a day 8 1 to 3 times per month 5 5 or 6 times a week 9 Less often or never 6 2 to 4 times a week 7 Once a week 8 1 to 3 times per month FishOil 9 Less often or never SHOW CARD P How often do you eat other types of fish, such as herring, tuna, mackrel, salmon or kippers? INCLUDE FRESH, FROZEN OR CANNED 1 6 or more times a day CakesEtc 2 4 or 5 times a day SHOW CARD P 3 2 or 3 times a day 4 Once a day How often do you eat cakes, scones sweet pies, pastries or puddings? 5 5 or 6 times a week 1 6 or more times a day 6 2 to 4 times a week 2 4 or 5 times a day 7 Once a week 3 2 or 3 times a day 8 1 to 3 times per month 4 Once a day 9 Less often or never 5 5 or 6 times a week 6 2 to 4 times a week 7 Once a week Cheese 8 1 to 3 times per month SHOW CARD P 9 Less often or never How often do you eat cheese, not including cottage cheese or other reduced fat cheeses? 1 6 or more times a day 2 4 or 5 times a day SoftDr 3 2 or 3 times a day SHOW CARD P 4 Once a day How often do you drink soft drinks, not including diet or low-calorie drinks? 5 5 or 6 times a week 6 2 to 4 times a week INCLUDE SQUASHES AND FIZZY DRINKS. INCLUDE CANS, BOTTLES AND MIXERS. DO NOT 7 Once a week INCLUDE FRESH FRUIT JUICE 8 1 to 3 times per month 1 6 or more times a day 9 Less often or never 2 4 or 5 times a day 3 2 or 3 times a day 4 Once a day 5 5 or 6 times a week Smoking module 6 2 to 4 times a week 7 Once a week IF Age of Respondent is 18 or 19 years THEN 8 1 to 3 times per month BookChc 9 Less often or never INTERVIEWER CHECK: (Name of respondent) IS AGED (age of respondent). RESPONDENT TO BE... 1 Asked Smoking/Drinking questions JuiceDr 2 Given ORANGE SELF-COMPLETION BOOKLET FOR YOUNG ADULTS SHOW CARD P ENDIF How often do you drink fresh fruit juice? IF (Age of Respondent is 20 years or over) OR (BookChc = Asked) THEN 1 6 or more times a day 2 4 or 5 times a day SmokEver 3 2 or 3 times a day May I just check, have you ever smoked a cigarette, a cigar or a pipe? 4 Once a day 1 Yes 5 5 or 6 times a week 2No 6 2 to 4 times a week 7 Once a week IF SmokEver = Yes THEN 8 1 to 3 times per month SmokeNow 9 Less often or never Do you smoke cigarettes at all nowadays? 1 Yes 2No
IF SmokeNow = Yes THEN DlySmoke * Question asked in 2nd, 3rd and 4th quarters of fieldwork. About how many cigarettes a day do you usually smoke on weekdays? INTERVIEWER: IF LESS THAN ONE A DAY, ENTER 0. IF RANGE GIVEN AND CAN'T ESTIMATE, ENTER MID POINT. IF RESPONDENT SMOKES ROLL UPS AND CANNOT GIVE NUMBER OF CIGARETTES, CODE 97. Range: 0..97
IF DlySmoke = 97 THEN RolDly 103 How much tobacco do you usually smoke on weekdays? CODE HERE WHETHER AMOUNT IS TO BE CODED IN GRAMS OR OUNCES. ENTER THE AMOUNT AT THE NEXT QUESTION. 1 Grams 2 Ounces
IF RolDly = grams THEN GramRol ENTER AMOUNT IN GRAMS Range: 0..100
ELSEIF RolDly = ounces THEN OuncRol ENTER AMOUNT IN GRAMS Range: 0..100 ENDIF
RolDly Computed: estimated tobacco consumption in ounces. Range:1..97 ENDIF For analysis purposes ounces or grams af tobacco are converted to number of cigarettes and stored in the variable DlySmoke.
WkndSmok And about how many cigarettes a day do you usually smoke at weekends? INTERVIEWER: IF RANGE GIVEN AND CAN'T ESTIMATE, ENTER MID POINT. IF RESPONDENT SMOKES ROLL UPS AND CANNOT GIVE NUMBER OF CIGARETTES, CODE 97. Range: 0..97
IF WkndSmok = 97 THEN RolWknd How much tobacco do you usually smoke on weekends? ENTER AMOUNT IN GRAMS CODE HERE WHETHER AMOUNT IS TO BE CODED IN GRAMS OR OUNCES. ENTER THE Range: 0..100 AMOUNT AT THE NEXT QUESTION. ELSEIF RolNum = ounces THEN 1 Grams 2 Ounces OuncExS ENTER AMOUNT IN OUNCES IF RolWknd = grams THEN Range: 0...100 GramWknd ENDIF ENTER AMOUNT IN GRAMS RolNum Range: 0..100 Computed: estimated tobacco consumption in ounces. Range:1..97 ELSEIF RolWknd = ounces THEN ENDIF OuncWknd For analysis purposes ounces or grams af tobacco are converted to number of cigarettes and ENTER AMOUNT IN OUNCES stored in the variable NumSmoke. Range: 0..100 ENDIF TarEx RolWknd What is the tar level of the cigarettes you usually smoke? Computed: estimated tobacco consumption in ounces. REFER TO CIGARETTE CODING LIST Range:1..97 1 High Tar (over 18mg) ENDIF 2 Middle Tar (15 < 18mg) 3 Low to middle tar (10 < 15 mg) For analysis purposes ounces or grams af tobacco are converted to number of cigarettes and stored in 4 Low Tar (1 < 10 mg) the variable WkndSmoke. 5 (Varies)
Tar SmokYrs What is the tar level of the cigarettes you usually smoke? And for approximately how many years did you smoke regularly? REFER TO CIGARETTE CODING LIST INTERVIEWER: IF LESS THAN ONE YEAR, CODE 0. 1 High Tar (over 18mg) Range: 0..97 2 Middle Tar (15 < 18mg) ENDIF 3 Low to middle tar (10 < 15 mg) 4 Low Tar (1 < 10 mg) IF SmokeReg = Smoked cigarettes regularly OR Smoked them only occasionally THEN 104 5 (Varies) EndSmoke ELSE (Smokes, but not nowadays) How long ago did you stop smoking cigarettes? SmokeCig INTERVIEWER: ENTER NUMBER OF YEARS. IF LESS THAN ONE YEAR AGO, CODE 0. Have you ever smoked cigarettes? Range: 0..64 1 Yes IF EndSmoke = 0 THEN 2No LongEnd IF SmokeCig = Yes THEN How many months ago was that? SmokeReg 1 Less than six months ago 2 Six months, but less than one year Did you smoke cigarettes regularly, that is at least one cigarette a day, or did you smoke ENDIF them only occasionally? ENDIF 1 Smoked cigarettes regularly, at least 1 per day ENDIF 2 Smoked them only occasionally ENDIF 3 SPONTANEOUS: Never really smoked cigarettes, just tried them once or twice IF (SmokeNow = Yes) OR (SmokeReg = Smoked cigarettes regularly) THEN IF SmokeReg = Smoked cigarettes regularly THEN StartSmk NumSmok How old were you when you started to smoke cigarettes regularly? About how many cigarettes did you smoke in a day? INTERVIEWER: IF Never smoked regularly CODE 97 INTERVIEWER: IF RANGE GIVEN AND CAN'T ESTIMATE, ENTER MID POINT. IF Range: 1..97 RESPONDENT SMOKES ROLL UPS AND CANNOT GIVE NUMBER OF CIGARETTES, ENDIF CODE 97. Range: 0..97 IF (Sex = Female) AND (Age of Respondent is 18 to 49 years THEN IF (EndSmoke <> EMPTY ) AND (EndSmoke < 2) THEN IF NumSmok = 97 THEN IsPreg RolNum Can I check, are you pregnant now? About how much tobacco did you smoke a day? 1 Yes CODE HERE WHETHER AMOUNT IS TO BE CODED IN GRAMS OR OUNCES. ENTER 2No THE AMOUNT AT THE NEXT QUESTION. 1 Grams IF IsPreg = Yes THEN 2 Ounces SmokePrg IF RolNum = grams THEN Have you smoked at all since you've known you've been pregnant? GramExS IF YES, PROBE: All the time or just some of the time? 1 Yes, all the time 11 Diabetes 2 Yes, some of the time 12 Any other (SPECIFY IN NEXT QUESTION) 3 No, not at all IF SmokCond = Other THEN IF SmokePrg = Yes, some of the time OR No, not at all THEN SmokOth StopPreg PLEASE SPECIFY.... Did you stop smoking specifically because of your pregnancy, or for some other Open answer: up to 40 characters reason? ENDIF 1 Because of pregnancy ENDIF 2 For some other reason ENDIF AdSmoke ENDIF ENDIF (Has (did) a medical person, e.g. doctor or nurse) ever advised (advise) you to stop smoking altogether because of your health? IF (IsPreg <> Empty AND IsPreg <> Yes) OR (SmokeNow = Yes) THEN 1 Yes PregRec 2No Can I check, have you been pregnant in the last twelve months? IF AdSmoke = Yes THEN 1 Currently pregnant AdGiven 2 Was pregnant in last twelve months but not now 3 Not pregnant in last twelve months How long ago was that? 1 Within the last twelve months IF PregRec = Was pregnant in last twelve months but not now THEN 2 Over twelve months ago ENDIF PregSmok ENDIF Did you smoke at all during pregnancy? (I.E. DURING TIME WHEN KNEW SHE WAS PREGNANT) IF YES, PROBE:All the time or just some of the time? CigEver 1 Yes, all the time Have you ever smoked cigars? 2 Yes, some of the time 1 Yes 3 No, not at all 2 No IF PregSmok = Yes, some of the time OR No, not at all THEN PregStop IF CigEver = Yes THEN CigarNow
105 Did you stop smoking specifically because of your pregnancy, or for some other reason? Do you smoke cigars at all nowadays? 1 Because of pregnancy 1 Yes 2 For some other reason 2No ENDIF ENDIF IF CigarNow = Yes THEN ENDIF CigarReg ENDIF Do you smoke cigars regularly, that is at least one cigar a month, or do you smoke them only occasionally? IF (SmokeNow = Yes) OR (SmokeReg = Smoked cigarettes regularly OR Smoked them only 1 Smoke at least one cigar a month occasionally) THEN 2 Smoke them only occasionally SmokeTry (Apart from any attempts during this/that pregnancy,) have (did) you ever tried (try) to give CigarWk up smoking because of a particular health condition you had at the time (include any previous About how many cigars do you usually smoke in a week? pregnancies)? ENTER NUMBER SMOKED A WEEK. IF CAN ONLY GIVE RANGE, TAKE MID- 1 Yes POINT. 2No IF LESS THAN ONE A WEEK CODE 0. Range: 0 997 IF SmokeTry=Yes THEN ENDIF SmokCond IF CigarNow=No OR CigarReg=Smoke them only occasionally THEN SHOW CARD Q CigReg Here is a list of health conditions that may lead people to try to give up smoking. Can you Have you smoked cigars regularly, that is at least one cigar a month, or did you always tell me which conditions you had? PROBE: What else? CODE ALL THAT APPLY. smoke them occasionally? 1 Heart trouble/problem 1 Regularly, that is at least one cigar a month 2 High blood pressure 2 Always smoked them only occasionally 3 Cancer ENDIF 4 Bronchitis ENDIF 5 Cough IF Sex = Male THEN 6 Shortness of breath 7 Other respiratory problems (including asthma) PipeEver 8 Cold/flu/virus Have you ever smoked a pipe? 9 Pregnancy 1 Yes 10 Ulcer or other gastro-intestinal problem 2 No IF PipeEver = Yes THEN PipeNowA Drinking module Do you smoke a pipe at all nowadays? 1 Yes IF (Age of Respondent is 20 years or over) OR (BookChc = Asked) 2No Drink ENDIF I am now going to ask you a few questions about what you drink - that is if you drink. Do you ever ENDIF drink alcohol nowadays, including drinks you brew or make at home? IF SmokeNow = Yes THEN 1 Yes SmokStop 2No Can I check, how many times, if any, have you tried to give up smoking? 1 Never tried to stop smoking IF Drink = No THEN 2 Once or twice DrinkAny 3 Three times or more Could I just check, does that mean you never have an alcoholic drink nowadays, or do you have an alcoholic drink very occasionally, perhaps for medicinal purposes or on special occasions like StopWant Christmas and New Year? Would you like to give up smoking? 1 Very occasionally 1 Yes 2 Never 2 No ENDIF ENDIF IF (Drink = Yes) OR (DrinkAny = Very occasionally) THEN ENDIF Intro IF SmokeNow = No OR SmokEver = No THEN INTERVIEWER - READ OUT: I'd like to ask you (all) whether you have drunk different types of Passive alcoholic drink in the last 12 months. I do not need to know about non-alcoholic or low alcohol SHOW CARD R drinks. Are you regularly exposed to other people's tobacco smoke in any of these places? PROBE: Where else? CODE ALL THAT APPLY NBeer 1 At own home SHOW CARD S 2 At work I'd like to ask you first about normal strength beer or cider which has less than 6% alcohol. How 3 In other people's homes often have you had a drink of normal strength BEER, LAGER, STOUT, CIDER or SHANDY 4 On public transport (excluding cans and bottles of shandy) during the last 12 months? (NORMAL = less than 6% Alcohol by volume)
106 5 In pubs 6 In other public places INTERVIEWER: IF RESPONDENT DOES NOT KNOW WHETHER BEER ETC DRUNK IS STRONG OR 7 No, none of these NORMAL, INCLUDE HERE AS NORMAL. 1 Almost every day 2 Five or six days a week IF Passive NOT=No, none of these THEN 3 Three or four days a week Bother 4 Once or twice a week Does this bother you at all? 5 Once or twice a month 1 Yes 6 Once every couple of months 2 No 7 Once or twice a year 8 Not at all in the last 12 months ENDIF ENDIF IF Nbeer IN [Almost every day...Once or twice a year] THEN ENDIF NBeerM How much NORMAL STRENGTH BEER, LAGER, STOUT, CIDER or SHANDY (excluding cans and bottles of shandy) have you usually drunk on any one day? INTERVIEWER: CODE MEASURES THAT YOU ARE GOING TO USE. 1 Half pints 2 Small cans 3 Large cans 4 Bottles
IF NbeerM = Half pints THEN NBeerQ[1] ASK OR CODE: How many half pints of NORMAL STRENGTH BEER, LAGER, STOUT, CIDER OR SHANDY (excluding cans and bottles of shandy) have you usually drunk on any one day? ARRAY[1..4] OF Range: 1..97 ENDIF
IF NbeerM = Small cans THEN NBeerQ[2] ASK OR CODE: How many small cans of NORMAL STRENGTH BEER, LAGER, STOUT or CIDER have you usually drunk on any one day? ARRAY[1..4] OF ARRAY[1..4] OF Range: 1..97 Range: 1..97 ENDIF ENDIF IF SbeerM = Small cans THEN IF NbeerM = Large cans THEN SBeerQ[2] NBeerQ[3] ASK OR CODE: How many small cans of STRONG BEER, LAGER, STOUT or CIDER have ASK OR CODE: How many large cans of NORMAL STRENGTH BEER, LAGER, STOUT or you usually drunk on any one day? CIDER have you usually drunk on any one day? ARRAY[1..4] OF ARRAY[1..4] OF Range: 1..97 Range: 1..97 ENDIF ENDIF IF SbeerM = Large cans THEN IF NbeerM = Bottles THEN SBeerQ[3] NBeerQ[4] ASK OR CODE: How many large cans of STRONG BEER, LAGER, STOUT or CIDER have ASK OR CODE: How many bottles of NORMAL STRENGTH BEER, LAGER, STOUT or you usually drunk on any one day? CIDER have you usually drunk on any one day? ARRAY[1..4] OF ARRAY[1..4] OF Range: 1..97 Range: 1..97 ENDIF
NBottle IF SbeerM = Bottles THEN ASK OR CODE: What make of NORMAL STRENGTH BEER, LAGER, STOUT or CIDER SBeerQ[4] do you usually drink from bottles? ASK OR CODE: How many bottles of STRONG BEER, LAGER, STOUT or CIDER have INTERVIEWER: IF RESPONDENT DOES NOT KNOW WHAT MAKE, OR RESPONDENT you usually drunk on any one day? DRINKS DIFFERENT MAKES OF NORMAL STRENGTH BEER, LAGER, STOUT OR CIDER, ARRAY[1..4] OF PROBE: What make have you drunk most frequently or most recently? Range: 1..97 Text: Maximum 21 characters SBottle NCodeEq ASK OR CODE: What make of STRONG BEER, LAGER, STOUT or CIDER do you usually PLEASE LOOK UP AND ENTER PINT EQUIVALENT OF A BOTTLE OF (Name of drink from bottles? Bottle) INTERVIEWER: IF RESPONDENT DOES KNOW MAKE, OR RESPONDENT DRINKS
107 DIFFERENT MAKES OF STRONG BEER, LAGER, STOUT OR CIDER. VALID ENTRIES ARE 0.44, 0.48, 0.58, 0.77, AND 0.88. ENDIF PROBE: What make have you drunk most frequently or most recently? ENDIF Text: Maximum 21 characters
SBeer SCodeEq SHOW CARD S PLEASE LOOK UP AND ENTER PINT EQUIVALENT OF A BOTTLE OF (Name of Now I'd like to ask you about strong beer or cider which has 6% or more alcohol (e.g. Tennants Bottle) Extra, Special Brew, Diamond White). How often have you had a drink of strong BEER, LAGER, VALID ENTRIES ARE 0.44, 0.48, 0.58, 0.77, AND 0.88. STOUT or CIDER during the last 12 months? (STRONG=6% and over Alcohol by volume) ENDIF INTERVIEWER: IF RESPONDENT DOES NOT KNOW WHETHER BEER ETC DRUNK IS STRONG OR ENDIF NORMAL, INCLUDE AS NORMAL STRENGTH AT NBeer ABOVE. 1 Almost every day Spirits 2 Five or six days a week SHOW CARD S 3 Three or four days a week How often have you had a drink of spirits or liqueurs, such as gin, whisky, brandy, rum, vodka, 4 Once or twice a week advocaat or cocktails during the last 12 months? 5 Once or twice a month 1 Almost every day 6 Once every couple of months 2 Five or six days a week 7 Once or twice a year 3 Three or four days a week 8 Not at all in the last 12 months 4 Once or twice a week 5 Once or twice a month IF SBeer IN [Almost every day Once or twice a year] THEN 6 Once every couple of months SBeerM 7 Once or twice a year How much STRONG BEER, LAGER, STOUT or CIDER have you usually drunk on any one 8 Not at all in the last 12 months day? INTERVIEWER: CODE MEASURES THAT YOU ARE GOING TO USE. 1 Half pints IF Spirits IN [Almost every day Once or twice a year] THEN 2 Small cans SpiritsQ 3 Large cans How much spirits or liqueurs (such as gin, whisky, brandy, rum, vodka, advocaat or cocktails) 4 Bottles have you usually drunk on any one day? CODE THE NUMBER OF SINGLES - COUNT DOUBLES AS TWO SINGLES. IF SbeerM = Half pints THEN Range: 1..97 SBeerQ[1] ENDIF ASK OR CODE: How many half pints of STRONG BEER, LAGER, STOUT or CIDER have you usually drunk on any one day? Sherry ARRAY[1..2] OF SHOW CARD Q Range: 1..97 How often have you had a drink of sherry or martini including port, vermouth, Cinzano and ENDIF Dubonnet, during the last 12 months? IF PopsM = Bottles THEN 1 Almost every day 2 Five or six days a week PopsQ[2] 3 Three or four days a week ASK OR CODE: How many bottles of alcoholic soft drink ('alcopop') have you usually drunk 4 Once or twice a week on any one day? 5 Once or twice a month ARRAY[1..2] OF 6 Once every couple of months Range: 1..97 7 Once or twice a year ENDIF 8 Not at all in the last 12 months ENDIF
IF Sherry IN [Almost every day...Once or twice a year] THEN Cooler SherryQ SHOW CARD S How much sherry or martini, including port, vermouth, Cinzano and Dubonnet have you How often have you had a drink of cooler/mixer/blender type drinks (eg. Bacardi Breezer, usually drunk on any one day? Castaway), during the last 12 months? CODE THE NUMBER OF GLASSES 1 Almost every day Range: 1..97 2 Five or six days a week ENDIF 3 Three or four days a week 4 Once or twice a week Wine 5 Once or twice a month SHOW CARD S 6 Once every couple of months How often have you had a drink of wine, including Babycham and champagne, during the last 12 7 Once or twice a year months? 8 Not at all in the last 12 months 1 Almost every day 2 Five or six days a week IF Cooler IN [Almost every day...Once or twice a year] THEN 3 Three or four days a week 4 Once or twice a week CoolerQ 5 Once or twice a month How much cooler/mixer/blender type drinks have you usually drunk on any one day? 6 Once every couple of months CODE THE NUMBER OF BOTTLES 7 Once or twice a year Range: 1..97 108 8 Not at all in the last 12 months ENDIF IF Wine IN [Almost every day...Once or twice a year] THEN WineQ AlcotA How much wine, including Babycham and champagne, have you usually drunk on any one day? Have you drunk any other types of alcoholic drink in the last 12 months? CODE THE NUMBER OF GLASSES.1 BOTTLE = 6 GLASSES, 1 LITRE = 8 GLASSES 1 Yes Range: 1..97 2No ENDIF IF AlcotA = Yes THEN Pops OthDrnkA What other type of alcoholic drink have you drunk in the last 12 months? SHOW CARD S How often have you had a drink of alcoholic soft drink ('alcopop'), such as Hooch, Two Dogs or CODE FIRST MENTIONED ONLY. Text: Maximun 30 characters Alcola, in the last 12 months? 1 Almost every day 2 Five or six days a week FreqA 3 Three or four days a week SHOW CARD S 4 Once or twice a week How often have you had a drink of (name of ‘other’ alcoholic drink) in the last 12 months? 5 Once or twice a month 1 Almost every day 6 Once every couple of months 2 Five or six days a week 7 Once or twice a year 3 Three or four days a week 8 Not at all in the last 12 months 4 Once or twice a week 5 Once or twice a month IF Pops IN [Almost every day...Once or twice a year] THEN 6 Once every couple of months PopsM 7 Once or twice a year How much alcoholic soft drink ('alcopop') have you usually drunk on any one day? 8 Not at all in the last 12 months INTERVIEWER CODE THE MEASURE(S) THAT YOU ARE GOING TO USE. IF FreqA IN [Almost every day...Once or twice a year] THEN 1 Small cans 2 Bottles OthQMA How much (name of ‘other’ alcoholic drink) have you usually drunk on any one day? IF PopsM = Small cans THEN INTERVIEWER: CODE MEASURES THAT YOU ARE GOING TO USE. PopsQ[1] 1 Half pints 2 Singles ASK OR CODE: How many small cans of alcoholic soft drink ('alcopop') have you usually 3 Glasses drunk on any one day? 4 Bottles 1 Yes 5 Other 2No
IF OthQMA = Other THEN IF AlcotC = Yes THEN OthQOA OthDrnkC WHAT OTHER MEASURE? What other type of alcoholic drink have you drunk in the last 12 months? Text: Maximum 12 characters CODE FIRST MENTIONED ONLY. ENDIF Text: Maximum 30 characters FreqC OthQA SHOW CARD S ASK OR CODE: How many (half pints/singles/glasses/bottles/ other measures) of (name of ‘ ’ How often have you had a drink of (name of ‘other‘ alcoholic drink) in the last 12 months? ‘other’ alcoholic drink have you usually drunk on any one day? 1 Almost every day Range: 0..97 2 Five or six days a week ENDIF 3 Three or four days a week Note: All drinks recorded under OthDrnkA backcoded into Nbeer-Wine 4 Once or twice a week 5 Once or twice a month AlcotB 6 Once every couple of months Have you drunk any other types of alcoholic drink in the last 12 months? 7 Once or twice a year 1 Yes 8 Not at all in the last 12 months 2No IF FreqC IN [Almost every day...Once or twice a year] THEN IF AlcotB = Yes THEN OthQMC OthDrnkB How much (name of ‘other’ alcoholic drink) have you usually drunk on any one day? INTERVIEWER: CODE MEASURES THAT YOU ARE GOING TO USE. What other type of alcoholic drink have you drunk in the last 12 months? 1 Half pints CODE FIRST MENTIONED ONLY. 2 Singles Text: Maximum 30 characters 3 Glasses 4 Bottles FreqB 5 Other SHOW CARD S How often have you had a drink of (name of ‘other’ alcoholic drink) in the last 12 months? IF OthQMC = Other THEN 1 Almost every day OthQOC
109 2 Five or six days a week WHAT OTHER MEASURE? 3 Three or four days a week Text: Maximum 12 characters 4 Once or twice a week ENDIF 5 Once or twice a month 6 Once every couple of months OthQC 7 Once or twice a year ASK OR CODE: How many (half pints/singles/glasses/bottles/’other’ measures) of (name 8 Not at all in the last 12 months of ‘other’ alcoholic drink) have you usually drunk on any one day? Range: 0..97 IF FreqB IN [Amost every day...Once or twice a year] THEN ENDIF OthQMB ENDIF How much (name of ‘other’ alcoholic drink) have you usually drunk on any one day? ENDIF INTERVIEWER: CODE MEASURES THAT YOU ARE GOING TO USE. 1 Half pints Note: All drinks recorded under OthDrnkC backcoded into Nbeer-Wine 2 Singles 3 Glasses DrinkOft 4 Bottles SHOW CARD S 5 Other Thinking now about all kinds of drinks, how often have you had an alcoholic drink of any kind IF OthQMB = Other THEN during the last 12 months? 1 Almost every day OthQOB 2 Five or six days a week WHAT OTHER MEASURE? 3 Three or four days a week Text: Maximum 12 characters 4 Once or twice a week ENDIF 5 Once or twice a month 6 Once every couple of months OthQB 7 Once or twice a year ASK OR CODE: How many (half pints/singles/glasses/bottles/’other’ measure) of (name 8 Not at all in the last 12 months of ‘other’ alcoholic drink) have you usually drunk on any one day? Range: 0..97 IF DrinkOft <> NotYr THEN ENDIF DrinkL7 ENDIF You have told me what you have drunk over the last 12 months, but we know that what people Note: All drinks recorded under OthDrnkB backcoded into Nbeer-Wine drink can vary a lot from week to week, so I'd like to ask you a few questions about last week. Did you have an alcoholic drink in the seven days ending yesterday? AlcotC 1 Yes Have you drunk any other types of alcoholic drink in the last 12 months? 2No IF DrinkL7=Yes THEN NBrL7Q[3] DrnkDay ASK OR CODE: How many large cans of NORMAL STRENGTH BEER, LAGER, On how many days out of the last seven did you have an alcoholic drink? STOUT or CIDER did you drink that day? Range: 1..7 ARRAY[1..4] OF Range: 1..97 IF DrnkDay = 2 to7 days THEN ENDIF DrnkSame IF NBrL7=Bottles THEN Did you drink more on one of the days (some days than others), or did you drink about NBrL7Q[4] the same on both (each of those) days? ASK OR CODE: How many bottles of NORMAL STRENGTH BEER, LAGER, 1 Drank more on one/some day(s) than other(s) 2 Same each day STOUT or CIDER did you drink that day? ARRAY[1..4] OF ENDIF Range: 1..97 WhichDay NBotL7 Which day (last week) did you (last have an alcoholic drink/ have the most to drink)? ASK OR CODE: What make of NORMAL STRENGTH BEER, LAGER, STOUT or 1 Sunday CIDER did you drink from bottles on that day? 2 Monday INTERVIEWER: IF RESPONDENT DRANK DIFFERENT MAKES CODE WHICH THEY 3 Tuesday DRANK MOST. 4 Wednesday Text: Maximum 21 characters 5 Thursday 6 Friday 7 Saturday L7NcodEq PLEASE LOOK UP AND ENTER PINT EQUIVALENT OF A BOTTLE OF (Name DrnkType of Bottle) VALID ENTRIES ARE 0.44, 0.48, 0.58, 0.77, AND 0.88. SHOW CARD T Thinking about last (answer to WhichDay), what types of drink did you have that day? ENDIF CODE ALL THAT APPLY. ENDIF 1 Normal strength beer/lager/cider/shandy 2 Strong beer/lager/cider IF DrnkType=Strong beer/lager/cider THEN 3 Spirits or liqueurs SBrL7 4 Sherry or martini Still thinking about last (answer to WhichDay), how much STRONG BEER, LAGER,
110 5 Wine STOUT or CIDER did you drink that day? 6 Alcoholic lemonades/colas INTERVIEWER: CODE MEASURES THAT YOU ARE GOING TO USE. 7 Other alcoholic drinks 1 Half pints 8 Low alcohol drinks 2 Small cans 3 Large cans IF DrnkType=Normal strength beer/lager/cider/shandy THEN 4 Bottles NBrL7 Still thinking about last (answer to WhichDay), how much NORMAL STRENGTH BEER, IF SBrL7=Half pintsTHEN LAGER, STOUT, CIDER or SHANDY (excluding cans and bottles of shandy) did you SBrL7Q[1] drink that day? ASK OR CODE: How many half pints of STRONG BEER, LAGER, STOUT or CIDER INTERVIEWER: CODE MEASURES THAT YOU ARE GOING TO USE. did you drink on that day? 1 Half pints ARRAY[1..4] OF 2 Small cans Range: 1..97 3 Large cans ENDIF 4 Bottles IF SBrL7=Small cans THEN IF NBrL7=Half pints THEN SBrL7Q[2] NBrL7Q[1] ASK OR CODE: How many small cans of STRONG BEER, LAGER, STOUT or ASK OR CODE: How many half pints of NORMAL STRENGTH BEER, LAGER, CIDER did you drink on that day? STOUT, CIDER or SHANDY (excluding cans and bottles of shandy) did you drink ARRAY[1..4] OF that day? Range: 1..97 ARRAY[1..4] OF ENDIF Range: 1..97 ENDIF IF SBrL7=Large cans THEN IF NBrL7=Small cans THEN SBrL7Q[3] NBrL7Q[2] ASK OR CODE: How many large cans of STRONG BEER, LAGER, STOUT or CIDER did you drink on that day? ASK OR CODE: How many small cans of NORMAL STRENGTH BEER, LAGER, ARRAY[1..4] OF STOUT or CIDER did you drink that day? Range: 1..97 ARRAY[1..4] OF ENDIF Range: 1..97 ENDIF IF SBrL7=Bottles THEN IF NBrL7=Large cans THEN SBrL7Q[4] ASK OR CODE: How many bottles of STRONG BEER, LAGER, STOUT or CIDER Range: 1..97 did you drink on that day? ENDIF ARRAY[1..4] OF ENDIF Range: 1..97 IF DrnkType=Other THEN SBotL7 OthL7TA ASK OR CODE: What make of STRONG BEER, LAGER, STOUT or CIDER Still thinking about last (answer to WhichDay), what other type of alcoholic drink did did you drink from bottles on that day? you drink on that day? INTERVIEWER: IF RESPONDENT DRANK DIFFERENT MAKES CODE WHICH THEY CODE FIRST MENTIONED ONLY DRANK MOST. Text: Maximum 30 characters Text: Maximum 21 characters OthL7QA L7SCodEq How much (name of ‘other’ alcoholic drink) did you drink on that day? PLEASE LOOK UP AND ENTER PINT EQUIVALENT OF A BOTTLE OF (Name WRITE IN HOW MUCH. REMEMBER TO SPECIFY HALF PINTS/ SINGLES/ of Bottle) GLASSES/ BOTTLES. VALID ENTRIES ARE 0.44, 0.48, 0.58, 0.77, AND 0.88. Text: Maximum 30 characters ENDIF ENDIF OthL7B Did you drink any other type of alcoholic drink on that day? IF DrnkType=Spirits THEN 1 Yes SpirL7 2No Still thinking about last (answer to WhichDay), how much spirits or liqueurs (such as gin, IF OthL7B=Yes THEN whisky, brandy, rum, vodka, advocaat or cocktails) did you drink on that day? CODE THE NUMBER OF SINGLES - COUNT DOUBLES AS TWO SINGLES. OthL7TB Range: 1..97 Still thinking about last (answer to WhichDay), what other type of alcoholic drink did ENDIF you drink on that day? CODE FIRST MENTIONED ONLY. IF DrnkType=Sherry THEN Text: Maximum 30 characters ShryL7 Still thinking about last (answer to WhichDay), how much sherry or martini, including OthL7QB port, vermouth, Cinzano and Dubonnet did you drink on that day? How much (name of ‘other’ alcoholic drink) did you drink on that day? 111 CODE THE NUMBER OF GLASSES. WRITE IN HOW MUCH. REMEMBER TO SPECIFY HALF PINTS/ SINGLES/ Range: 1..97 GLASSES/ BOTTLES. ENDIF Text: Maximum 30 characters
IF DrnkType=Wine THEN OthL7C WineL7 Did you drink any other type of alcoholic drink on that day? Still thinking about last (answer to WhichDay), how much wine, including Babycham and 1Yes champagne, did you drink on that day? 2No CODE THE NUMBER OF GLASSES 1 BOTTLE = 6 GLASSES. 1 LITRE = 8 GLASSES. Range: 1..97 IF OthL7C=Yes THEN ENDIF OthL7TC Still thinking about last (answer to WhichDay), what other type of alcoholic drink IF DrnkType=Alcoholic lemonades/colas THEN did you drink on that day? PopsL7 CODE FIRST MENTIONED ONLY. Still thinking about last (answer to Which Day), how much ALCOHOLIC SOFT DRINK Text: Maximum 30 characters ('alcopop') did you drink on that day? INTERVIEWER: CODE MEASURES THAT YOU ARE GOING TO USE. OthL7QC 1 Small cans How much (name of ‘other’ alcoholic drink) did you drink on that day? 2 Bottles WRITE IN HOW MUCH. REMEMBER TO SPECIFY HALF PINTS/ SINGLES/GLASSES/ BOTTLES. IF PopsL7=Small cans THEN Text: Maximum 30 characters PopsL7Q[1] ENDIF ASK OR CODE: How many small cans of ALCOHOLIC SOFT DRINK ('alcopop') did ENDIF you drink on that day? ENDIF ARRAY[1..2] OF ENDIF Range: 1..97 ENDIF ENDIF DrAmount IF PopsL7=Bottles THEN Compared to five years ago, would you say that on the whole you drink more, about the same or PopsL7Q[2] less nowadays? ASK OR CODE: How many bottles of ALCOHOLIC SOFT DRINK ('alcopop') did you 1 More nowadays drink on that day? 2 About the same ARRAY[1..2] OF 3 Less nowadays ENDIF Dental Health module IF DrinkAny = Never THEN AlwaysTT ASK ALL Have you always been a non-drinker or did you stop drinking for some reason? FalseT 1 Always a non-drinker Can I check, have you all your own teeth including crowns and caps or are some of them false? 2 Used to drink but stopped 1 All own teeth 2 Some false/some own IF AlwaysTT = Used to drink but stopped THEN 3 All false teeth WhyTT Did you stop drinking because of a particular health condition that you had at the time? IF FalseT=All own teeth/some false/some own OR FalseT= Don t Know/Refusal THEN INTERVIEWER: IF RESPONDENT SAYS PREGNANCY, CODE YES. ToothP 1 Yes 2No Now a couple of questions about your teeth. ENDIF What type of toothpaste do you use...READ OUT... ENDIF 1 ...fluoride ENDIF 2 or non-fluoride? 3 (Don't use toothpaste)
IF ToothP = RESPONSE THEN TthFreq How frequently do you brush your teeth. Do you brush them...READ OUT... 1 More than once a day 2 Once a day 3 or Less than once a day? ENDIF
Dentist On average, how often do you attend a dentist for a routine check-up...READ OUT... 1 more frequently than once every six months"
112 2 every six months 3 every 12 months 4 every 24 months 5 at longer intervals 6 or never? ENDIF
IF Age of Respondent is 5 to 15 years THEN Tnow Can I check, are your teeth...READ OUT... 1 milk (or baby) teeth or 2 your second (or adult) teeth or, 3 a mixture of both? ENDIF
IF Age of Respondent is 2 to 15 years THEN Dentsurg Have you ever been to the dentist's surgery, either for treatment or for a check-up? 1 Yes 2 No
IF DentSurg=Yes THEN Dentage Thinking about the first time that you ever went to the dentist, how old were you then? ENTER IN YEARS FOLLOWED BY MONTHS
AgeYrs INTERVIEWER: ENTER NUMBER OF YEARS Range: 0..15
AgeMths INTERVIEWER: ENTER NUMBER OF MONTHS ENDIF Range: 0..11 Dhealth* WhyDent And how would you describe your dental health at present. Would you say your teeth ...READ Why did you go to the dentist the first time. Please choose the phrase on this card which is the OUT... most appropriate? CODE ONE ONLY SHOW CARD U INTERVIEWER: IF RESPONDENT SEEKS CLARIFICATION, INTERVIEWER CODE ONE ONLY PERFECTLY HEALTHY = NO FILLINGS, NO OBVIOUS DECAY 1 He/she was having trouble with his/her teeth or SOME DECAY = FILLINGS, SOME OPEN DECAY 2 We had a note from the school dentist or LOT OF DECAY 5+ TEETH = AFFECTED BY DENTAL DECAY 3 He/she went for a check up or 1 ...are perfectly healthy or, 4 He/she just went to get used to going to the dentist 2 have some d ecay or, 5 Or for some other reason? 3 have a lot of decay?
IF WhyDent= Other THEN ENDIF OthDent AgeBrush What was the reason? Thinking about the first time that you started brushing your teeth, how old were you then? Open answer: up to 40 characters ENTER IN YEARS FOLLOWED BY MONTHS ENDIF AgeYrs Treat1* INTERVIEWER: ENTER NUMBER OF YEARS Which of these kinds of treatment have you had on your teeth? Range: 0..15 Any fillings? 1 Yes AgeMths 2 No INTERVIEWER: ENTER NUMBER OF MONTHS Range: 1..11 Treat2* ENDIF (And which of these kinds of treatment have you had on your teeth?) Any teeth taken out due to decay? * Questions asked in 2nd, 3rd and 4th quarters of fieldwork. 1 Yes 113 2 No
IF Treat2=Yes THEN Treat2a* Was that done with or without general anaesthetic? 1 With a general anaesthetic 2 Without a general anaesthetic ENDIF
Treat3* (And which of these kinds of treatment have you had on your teeth?) Any treatment to stop your teeth decaying or going bad, such as painting and/or sealing? 1 Yes 2 No
Treat4* (And which of these kinds of treatment have you had on your teeth?) Orthodontics, that is straightening of the teeth with a brace? 1 Yes 2 No
Treat5* (And which of these kinds of treatment have you had on your teeth?) Any other treatment?" 1 Yes 2 No
IF Treat5=Yes THEN Otht* What other kinds of treatment have you had on your teeth? Open answer: up to 40 characters Economic Activity module MatUsed IF RELEVANT: What materials or machinery do (did/will) you use? IF NONE USED, WRITE IN `NONE'. ASK ALL AGE 16+ Text: Maximum 50 characters Activ SHOW CARD V SkilNeed Which of these descriptions applies to what you were doing last week, that is in the seven days ending What skills or qualifications are (were) needed for the job? (date last Sunday)? Text: Maximum 100 characters CODE FIRST TO APPLY 1. Going to school or college full-time (including on vacation) Employee 2. In paid employment or self-employment (or away temporarily) Are you (were you/will you be) ...READ OUT... 3. Waiting to take up paid work already obtained 1 an employee, 4. Looking for work 2 or, self-employed 5. Intending to look for work but prevented by temporary sickness or injury (CHECK 28 DAYS OR LESS) IF Employee = Self-employed THEN 6. Permanently unable to work because of long-term sickness or disability (USE ONLY FOR MEN Dirctr AGED 16-64 OR WOMEN AGED 16-59) Can I just check, in this job are you (were you/will you be) a Director of a limited company? 7. Retired (FOR WOMEN CHECK AGE STOPPED WORK AND USE THIS CODE ONLY IF 1 Yes STOPPED WHEN 50 OR OVER) 2No 8. Looking after the home or family 9. Doing something else (SPECIFY) ENDIF
IF Activ= Doing something else THEN IF Employee=an employee OR Dirctr=Yes THEN ActivO EmpStat OTHER: PLEASE SPECIFY Are you (were you/will you be) a ...READ OUT... Text: Maximum 40 characters 1 manager, ENDIF 2 foreman or supervisor, IF Activ= Going to school or college full-time (including on vacation), Looking for work, Intending to look for 3 or other employee? work but prevented by temporary sickness or injury, Permanently unable to work because of long-term sickness or disability, Retired, Looking after the home or family or Doing something else THEN NEmplee
114 EverJob Including yourself, about how many people are (were) employed at the place where you usually Have you ever been in paid employment or self-employed (apart from holiday jobs or part-time jobs work (usually worked/will work)? and while a student)? 11 or 2 1 Yes 23-24 2No 3 25-499 ENDIF 4 500+
IF Activ=Waiting to take up paid work already obtained THEN ELSEIF Employee=Self-employed AND Dirctr=No THEN OthPaid SNEmplee Apart from the job you are waiting to take up, have you ever been in paid employment or self- Do (did/will) you have any employees? employed? 1 None 1 Yes 2 1-24 2No 3 25-499 ENDIF 4 500+ ENDIF IF (EverJob = Yes) OR (Activ IN [In paid employment or self-employment, Waiting to take up paid work already obtained]) OR (Activ = Retired) AND (EverJob = No) THEN IF Employee=Employ THEN JobTitle Ind I'd like to ask you some details about the job you were doing last week (your most recent job/the main What does (did) your employer make or do at the place where you usually work (usually job you had/the job you are waiting to take up). What is (was/will be) the name or title of the job? worked/will work)? (IF 2+ JOBS, ASK ABOUT MAIN JOB) Text: Maximum 100 characters Text: Maximum 50 characters ELSEIF Employee=Self-employed THEN FtPtime SlfWtMad Are you (were you/will you be) working full-time or part-time? What do (did/will) you make or do in your business? (FULL-TIME = MORE THAN 30 HOURS PART-TIME = 30 HOURS OR LESS) Text: Maximum 100 characters 1 Full-time ENDIF 2 Part-time ENDIF WtWork If (Activ IN [Waiting to take up paid work already obtained, Looking for work, Intending to look for work What kind of work do (did/will) you do most of the time? but prevented by temporary sickness or injury]) THEN Text: Maximum 50 characters CurUnEmp How long altogether have you been out of employment but wanting work (in this current period of unemployment)? 1 Going to school or college full-time (including on vacation) 1 Less than six months 2 In paid employment or self-employed (or away temporarily) 2 Six months but less than twelve months 3 Waiting to take up paid work already obtained 3 Twelve months but less than two years ago 4 Looking for work 4 Two years or more 5 Intending to look for work but prevented by temporary sickness or injury (CHECK 28 ENDIF DAYS OR LESS) 6 Permanently unable to work because of long-term sickness or disability (USE ONLY IF Activ = In paid employment or self-employment (or away temporarily) THEN FOR MEN AGED 16-64 OR WOMEN AGED 16-59) MainSit 7 Retired (FOR WOMEN CHECK AGE STOPPED WORK AND USE THIS CODE ONLY When you’re at work are you mainly sitting down, standing up or walking about? IF STOPPED WHEN 50 OR OVER) CODE ONE ONLY 8 Looking after the home or family 1 Sitting down 9 Doing something else (SPECIFY) 2 Standing up 3 Walking about IF CIEAct = Other THEN 4 Equal time spent doing 2 or more of these CIEActO MovFloor OTHER: PLEASE SPECIFY Does your work involve you moving between floors? Text: Maximum 40 characters ENDIF 1 Yes 2 No IF (CIEAct IN [school or college full-time (including on vacation), Looking for work, Intending to look for work but prevented by temporary sickness or injury, Permanently unable to work because of long-term IF MovFloor <> No THEN sickness or disability, Retired, Looking after the home or family or Doing something else] THEN LiftClimb CIEEvJob Do you mainly take the lift or climb the stairs? Has (chief income earner’s name) ever been in paid employment or self-employed (apart from 1 Lift holiday jobs or part-time jobs and while a student)? 2 Stairs 1 Yes 3 Lift up/stairs down 2 No ENDIF ENDIF
Climb IF CIEAct = Waiting to take up paid work already obtained THEN 115 Do you do any (other) climbing in the course of your work (ladders, scaffolding etc.)? CIEOthP 1 Yes Apart from the job (chief income earner’s name) is waiting to take up, has he/she ever been in 2No paid employment or self-employed? 1 Yes LiftCarr 2 No Do you usually have to lift or carry things at work which you find heavy? ENDIF IF YES, PROMPT: Is that just lifting or lifting and carrying? 1 Lift heavy loads If (CIEAct IN [In paid employment or self-employed (or away temporarily), Waiting to take up paid work 2 Lift and carry heavy loads already obtained]) OR (CIEEvJob = Yes) OR ((CIEAct = Retired) AND CIEEVJob – No)) THEN 3No CIETitle I’d like to ask you some details about the job (chief income earner’s name) was doing last week Demand (the chief income earner’s most recent job/ the main job chief income earner had/the job chief So overall, would you say that in terms of physical effort your work is…READ OUT… income earner is waiting to take up). What is (was/will be) the name or title of his (her) job? 1 …very demanding (IF 2+ jobs, ASK ABOUT MAIN JOB) 2 fairly demaning Text: Maximum 50 characters 3 or not very demanding ENDIF CIEFtPt Is (was/will be) (chief income earner’s name) working full-time or part-time? IF (NOFAd > 1) THEN FULL-TIME = MORE THAN 30 HOURS CincEarn PART-TIME = 30 HOURS OR LESS Which member of your household is the person with the largest income, whether from employment, 1 Full-time pensions, state benefits, investments or any other source? 2 Part-time (textfill name of all adults in household) Range: 1..12 CIEWtWk ENDIF What kind of work does (did/will) (chief income earner’s name) do most of the time? Text: Maximum 50 characters IF RESPONDENT IS NOT CHIEF INCOME EARNER THEN CIEAct CIEMatUs SHOW CARD V IF RELEVANT: What materials or machinery does (did/will) (chief income earner’s name) use? Which of these descriptions applies to what (chief income earner s name) was doing last week, that ’ IF NONE USED, WRITE IN ‘NONE’. is in the seven days ending last Sunday? Text: Maximum 50 characters CIESkil What skills or qualifications are (were/willbe) needed for his (her) job? Education module Text: Maximum 100 characters ASK ALL age 16+ CIEEmp EducEnd Is (was/will be) (chief income earner s name) READ OUT ’ … … At what age did you finish your continuous full-time education at school or college? 1 An employee 2 Or, self-employeed 1 Not yet finished 2 Never went to school IF CIEEMP = Self-employed THEN 3 14 or under CIEDir 415 516 Can I just check, in this job is (was/will be) (chief income earner’s name) a Director of a Limited company? 617 718 1 Yes 8 19 or over 2 No ENDIF TopQual IF (CIEEmp= Employ) OR (CIEDir =Yes) THEN SHOW CARD W CIEEmpST Please look at this card and tell me whether you have any of the qualifications listed. Look down the list Is (was/will be) (chief income earner’s name) a…READ OUT… and tell me the first one you come to that you have got. CODE FIRST TO APPLY. 1. Manager 1 Degree/degree level qualification (including higher degree) 2. Foreman or supervisor 2 SCE Higher/CSYS (Certificate of Sixth Year Studies)/ A-levels 3. Or, other employee 3 SCE Ordinary (‘O’ Grades) Bands A – C CIENEmp 4 Standard Grade (Level 1 - 3) Including (chief income earner’s name), about how many people are (were) employed at the 5 SLC Lower place where he (she) usually works (usually worked/will work)? 6 SUPE Lower or Ordinary 1 1 or 2 7 ‘O’ level passes (Grade A – C if after 1975) 2 3– 24 8 GCSE (Grade A – C) 3 25 – 499 9 CSE Grade 1 4 500+ 10 School Certificate or Matric 11 SCE Ordinary ( O Grades) Bands D & E ELSEIF (CIEEMP = Self-employed) AND (CIEDir = No) THEN ‘ ’ 12 Standard Grade (Level 4, 5)
116 CIESNEmp Does (did/will) (chief income earner’s name) have any employes? 13 CSE Grades 2 – 5 1 None 14 GCE ‘O’ Grades D & E (if after 1975) 2 1-24 15 GCSE (Grades D, E, F, G) 3 25-499 16 CSE ungraded 4 500+ 17 Foreign qualifications (PLEASE SAY WHAT) ENDIF 18 Other academic qualifications (PLEASE SAY WHAT) 19 NO ACADEMIC QUALIFICATIONS IF (CIEEMP = Employed) THEN CIEInd What does (did/will) (chief income earner’s ‘name’) employer make or do at the place where IF (TopQual IN [Foreign qualifications, Other academic qualifications] THEN he (she) usually works (usually worked/will work)? Text: Maximum 100 characters AcOthSP PLEASE SPECIFY ELSEIF (CIEEmp = Self-employed) THEN Text: Maximum 25 characters CIESlf ENDIF What does (did) (chief income earner’s ‘name’) make or do in his (her) business? Text: Maximum 100 characters ENDIF TopVocat ENDIF SHOWCARD X Please look at this card and tell me whther you have any of the quallifications listed. If you have more IF (CIEAct IN [Waiting to take up paid work already obtained, Looking for work, Intending to look for than one, please tell me about all of them. PROBE: What else? CODE ALL THAT APPLY. work but prevented by temporary sickness or injury]) THEN 1 SCOTVEC National Certificate Modules CIEUnEmp 2 HNC/HND, BEC/TEC Higher, BTEC Higher How long altogether has (chief income earner’s ‘name’) been out of employment but wanting 3 ONC/OND/BEC/TEC not higher work (in this current period of unemployment)? 4 City and Guilds Full Technological Certificate 1 Less than six months 5 City and Guilds Advanced/Final Level 2 Six months but less than twelve months 6 City and Guilds Craft/Ordinary Level 3 Twelve months but less than two years 7 Nursing qualifications (SRN, RGN, RMN, SEN, RSCN, RM, RHV) 4 Two years or more ENDIF 8 Teaching qualification ENDIF 9 SVQ/NVQ Level V 10 SVQ/NVQ Level IV 11 SVQ/NVQ Level III/Advanced level GNVQ 12 SVQ/NVQ Level II/Intermediate level GNVQ 13 SVQ/NVQ Level I/Foundation level GNVQ Parental History module 14 Clerical or Commercial Qualification (e.g. typing/book-keeping/commerce) 15 Recognised Trade Apprenticeship completed 16 Other vocational or professional qualification (SPECIFY AT NEXT QUESTION) ASK ALL AGE 16+ 17 NO VOCATIONAL / PROFESSIONAL QUALIFICATIONS LiveMaB Is your natural mother still alive? IF (Other vocational or professional qualification IN TopVocat) THEN 1 Yes VocOthSp 2No PLEASE SPECIFY Text: Maximum 25 characters IF (LIVEMaB = Yes) THEN ENDIF AgeMA How old is your natural mother? PoB Range: 1..120 In which country were you born? ELSEIF LiveMaB = No THEN 1 Scotland 2 England ConsMaB 3 Wales SHOW CARD Z 4 Northern Ireland Did your mother die from any of the conditions on the card? 5 Outside of UK CODE ONE ONLY 1 High blood pressure (sometimes called hypertension) Ethnic 2 Angina SHOW CARD Y 3 Heart attack (including myocardial infarction and coronary thrombosis) To which of the groups on this card do you consider you belong? 4 Stroke 1 White 5 Other heart trouble (incl. heart murmur, damaged heart valves, trachycardia or rapid heart) 2 Black - Caribbean 6 Diabetes 3 Black - African 7 None of the above conditions 4 Black - Other 5 Indian AgeMaB 6 Pakistani How old was your mother when she died? 7 Bangladeshi Range: 10..120
117 8 Chinese ENDIF 9 Other (SPECIFY AT NEXT QUESTION) LivePaB IF (Ethnic IN [Black - Other, Other]) THEN Is your natural father still alive? OthEthni 1 Yes How would you describe the racial or ethnic group to which you belong? 2 No Text: Maximum 15 characters ENDIF IF LivePaB=Yes THEN AgePa How old is your natural father? Range: 10..120
ELSEIF LivePaB=No THEN ConsPaB SHOW CARD Z Did your father die from any of the conditions on the card? CODE ONE ONLY 1 High blood pressure (sometimes called hypertension) 2 Angina 3 Heart attack (including myocardial infarction and coronary thrombosis) 4 Stroke 5 Other heart trouble (incl. heart murmur, damaged heart valves, trachycardia or rapid heart) 6 Diabetes 7 None of the above conditions
AgePaB How old was your father when he died? Range: 1..120 ENDIF General Household module IncSup At the present time, do you or anyone else in your household receive Income Support? 1 Yes ASK ALL AGED 16+ 2 No OwnORent Now, I'd like to get some general information about your household. FamCred Does your household own or rent this accommodation? And do you or anyone else in your household receive Family Credit? PROBE FOR DETAILS. 1 Yes 1 Owns with mortgage/loan 2 No 2 Owns outright 3 Rents from local authority/new town 4 Rents from housing association CounTax 5 Rents - priv ately, unfurnished And do you or anyone else in your household receive Council Tax Benefit? 6 Rents - priv ately, furnished 1 Yes 7 Rents from employer 2 No 8 Rents - other with payment 9 Rent free IF OwnORent is NOT Owns with mortgage/loan or Owns outright THEN Bedrooms HouseBen How many bedrooms does your household have, including bedsitting rooms and spare bedrooms? And the present time, do you or your partner get any Housing Benefit to help pay the rent? EXCLUDE BEDROOMS CONVERTED TO OTHER USES. 1 Yes Range: 1..20 2 No ENDIF
CentHeat Benefits Does your household have any form of central heating, including electric storage heaters, in your (part Can I check, do you personally receive any of these benefits... of the) accommodation? READ OUT AND CODE ALL THAT APPLY... CENTRAL HEATING = 2 OR MORE ROOMS, (INC. KITCHENS, HALLS, LANDINGS, BATH/WC) 1 ...Unemployment benefit HEATED FROM ONE CENTRAL SOURCE. 2 Sickness/Invalidity Benefit 1 Yes 3 Severe Disablement Allowance 2 No 4 or Disability Living Allowance? 118 5 None of these SmkDet Do you have at least one smoke detector in the household? Telephon IF YES, PROBE FOR WHETHER MAINS OR BATTERY-OPERATED. CODE ONE ONLY Does your household have a telephone in your (part of the) accommodation? 1 Yes - mains SHARED TELEPHONES LOCATED IN PUBLIC HALLWAYS TO BE INCLUDED ONLY IF THIS 2 Yes - battery operated HOUSEHOLD IS RESPONSIBLE FOR PAYING THE ACCOUNT." 3 Yes - at least one of each type 1 Yes 4 Yes - but don't know which 2 No 5 No
IF SmkDet=Yes THEN SmkWork And can I check, is it (at least one) currently in working order? 1 Yes 2 No ENDIF
Car Is there a car or van normally available for use by you or any members of your household? INCLUDE: ANY PROVIDED BY EMPLOYERS IF NORMALLY AVAILABLE FOR PRIVATE USE BY RESPONDENT OR MEMBERS OF HOUSEHOLD. 1 Yes 2 No
IF CAR=Yes THEN NumCars How many are available? 1 One 2 Two 3 Three or more ENDIF Self-completion booklets IF SComp6=Other THEN SComp6O PLEASE SPECIFY OTHER REASON: IF Age of Respondent is13 years or over THEN Text: Maximum 60 characters SCIntro ENDIF PREPARE (GREY/CREAM/LILAC) SELF-COMPLETION BOOKLET BY ENTERING SERIAL ENDIF NUMBERS.CHECK YOU HAVE CORRECT PERSON NUMBER. IF SComp3=Fully completed OR Partially completed THEN ELSEIF Age of Respondent is 8 to 12 years THEN SComp5A SCIntCh INTERVIEWER: CODE WHO WAS PRESENT IN ROOM WHILE (name of respondent) COMPLETED Here is a little booklet which I would like to ask (name of child) to complete for (him/herself). It SELF-COMPLETION. INCLUDE YOURSELF, ANYONE INTERVIEWED AT THE SAME TIME AS asks children if they have ever tried cigarettes or alcohol. May I explain it to him/her? RESPONDENT, PARENT ANSWERING ON BEHALF OF 8-12 YEAR OLDS OR OTHERS IN THE IF ASKED, SHOW YELLOW BOOKLET TO PARENT(S). IF AGREES, PREPARE YELLOW BOOKLET BY ROOM.CODE ALL THAT APPLY. EMTERING SERIAL NUMBERS. SEE CHILD. EXPLAIN HOW TO COMPLETE.REMEMBER TO USE A 1 Spouse / partner BLACK PEN. 2 Parent(s) (incl step-/foster-) ENDIF 3 Brother(s)/Sister(s) 4 Own/Related child(ren)(incl step-/ foster-/ partner's) IF Age of Respondent is 13 to 120 years THEN 5 Other relative(s) IF (DrinkAny = Never) OR (DrinkOft=Once or twice a year OR Not at all in the last twelve months) THEN 6 Unrelated adult(s) PagEx 7 Unrelated child(ren) 8 Interviewer INTERVIEWER NOTE: This respondent does not drink (or drinks once or twice a year or less). Cross out the 9 No-one else present Drinking Experiences questions before handing over the self-completion booklet. ENDIF ENDIF ENDIF SComp2 I would now like you to answer some questions by completing this booklet on your own. The questions cover (smoking, (and) drinking (and some about your) general health). EXPLAIN HOW TO COMPLETE BOOKLET. REMEMBER TO USE A BLACK PEN: ENDIF
SCCheck
119 INTERVIEWER: WAIT UNTIL RESPONDENT(S) HAVE FINISHED AND THEN CHECK EACH BOOKLET COMPLETED. IF NOT, ASK IF QUESTIONS MISSED IN ERROR. IF IN ERROR, ASK RESPONDENT TO COMPLETE.
IF Age of respondent is 8 years or over THEN SComp3 INTERVIEWER CHECK: WAS THE (YELLOW/LILAC) BOOKLET (8-12/13-15) COMPLETED? 1 Fully completed 2 Partially completed 3 Not completed
IF SComp3=Fully completed or Partially completed THEN SC3Acc Was it completed without assistance?: 1 Completed independently 2 (Assistance from other children) 3 Assistance from other household member (Assistance from adult(s) (not interviewer) 4 Assistance from interviewer 5 Interviewer ENDIF
IF SComp3=Partially completed OR Not completed THEN SComp6 INTERVIEWER: RECORD WHY BOOKLET NOT COMPLETED / PARTIALLY COMPLETED. CODE ALL THAT APPLY 1 Child away from home during fieldwork period 2 Eyesight problems 3 Language problems 4 Reading/writing/comprehension problems 5 Respondent bored/fed up/tired 6 Questions too sensitive/invasion of privacy 7 Too long/too busy/taken long enough already 8 Refused to complete booklet (no other reason given) 9 Other (SPECIFY) Measurements module NoHitM CODE REASON FOR NOT OBTAINING HEIGHT.CODE ALL THAT APPLY. 1 Child: away from home during fieldwork period (specify in a Note) ASK ALL 2 Respondent is unsteady on feet Intro 3 Respondent cannot stand upright/too stooped 4 Respondent is chairbound PREAMBLE: I would now like to measure height and weight. There is interest in how people's weight, 5 Child: subject would not stand still given their height, is associated with their health. MAKE OUT GREY COLOURED MRC FOR EACH 6 Ill or in pain PERSON: 7 Stadiometer faulty or not available 8 Other - specify RespHts MEASURE HEIGHT AND CODE.INCLUDE 'DISGUISED' REFUSALS SUCH AS 'IT WILL TAKE TOO LONG','I IF (OTHER IN NoHitM) THEN HAVE TO GO OUT' ETC. AT CODE 2: Height refused. NoHitMO 1 Height measured PLEASE SPECIFY OTHER REASON. 2 Height refused Text: Maximum 60 characters 3 Height attempted, not obtained ENDIF 4 Height not attempted ENDIF
IF RespHts = Height measured THEN IF RespHts=Height refused, Height attempted, not obtained OR Height not attempted THEN Height EHtCh ENTER HEIGHT. INTERVIEWER: ASK (respondent) FOR AN ESTIMATED HEIGHT. WILL IT BE GIVEN IN METRES OR IN Range: 60.0..244.0 FEET AND INCHES? 1 Metres RelHite 2 Feet and inches INTERVIEWER CODE ONE ONLY 1 No problems experienced reliable height measurement obtained IF EHtCh = Metres THEN Problems experienced - measurement likely to be: EHtm 2 Reliable PLEASE RECORD ESTIMATED HEIGHT IN METRES. 3 Unreliable Range: 0.01..2.44
IF RelHite = Unreliable THEN ELSEIF EHtCh = Feet and inches THEN HiNRel EHtFt 120 WHAT CAUSED THE HEIGHT MEASUREMENT TO BE UNRELIABLE? PLEASE RECORD ESTIMATED HEIGHT. ENTER FEET. 1 Hairstyle or wig Range: 0..7 2 Turban or other religious headgear 3 Respondent stooped 4 Child respondent refused stretching EHtIn 5 Respondent would not stand still PLEASE RECORD ESTIMATED HEIGHT. ENTER INCHES. 6 Respondent wore shoes Range: 0..11 7 Other, please specify ENDIF 8 Difficulty standing ENDIF
IF HiNRel = Other THEN EMHeight Final measured or estimated height (cm), to be fed into household admin. OHiNRel PLEASE SPECIFY WHAT CAUSED UNRELIABLE HEIGHT MEASUREMENT. IF (Sex = Female) AND (Age of Respondent is 16 to 49) THEN Text: Maximum 49 characters PregNowB ENDIF May I check, are you pregnant now? ENDIF 1 Yes 2No MBookHt ENDIF INTERVIEWER: CHECK HEIGHT RECORDED ON MEASUREMENT RECORD CARD. HEIGHT: (x) cm OR (x) feet (x) inches. IF PregNowB <> Yes THEN RespWts ELSEIF RespHts = Height refused THEN MEASURE WEIGHT AND CODE. (INTERVIEWER: IF RESPONDENT WEIGHS MORE THAN 130KG (20 _ ResNHi STONES) DO NOT WEIGH. CODE AS ‘WEIGHT NOT OBTAINED’) INCLUDE 'DISGUISED' REFUSALS GIVE REASONS FOR REFUSAL. SUCH AS 'IT WILL TAKE TOO LONG', 'I HAVE TO GO OUT' ETC. AT CODE 2: Weight refused. 1 Cannot see point/Height already known/Doctor has measurement 0 If Age 2-5 years: Weight obtained (child held by adult)/If Age over 5 years: DO NOT USE THIS CODE 2 Too busy/Taken too long already/ No time 1 Weight obtained (subject on own) 3 Respondent too ill/frail/tired 2 Weight refused 4 Considered intrusive information 3 Weight attempted, not obtained 5 Respondent too anxious/nervous/ shy/embarrassed 4 Weight not attempted 6 Refused (no other reason given) 7 Other IF RespWtsMeas=Weight obtained (subject on own) OR Weight obtained (child held by adult) THEN IF RespWts = Weight obtained (subject on own) THEN ELSEIF RespHts = Height attempted, not obtained OR Height not attempted THEN Weight RECORD WEIGHT. Range: 10.0..130.0 Text: Maximum 60 characters ENDIF ELSEIF RespWts = Weight obtained (child held by adult) THEN WtAdult EWtCh ENTER WEIGHT OF ADULT ON HIS/HER OWN. INTERVIEWER: ASK (respondent) FOR AN ESTIMATED WEIGHT. WILL IT BE GIVEN IN KILOGRAMS Range: 15.0..130.0 OR IN STONES AND POUNDS 1 Kilograms 2 Stones and pounds WtChAd ENTER WEIGHT OF ADULT HOLDING CHILD. IF EWtCh = Kilograms THEN Range: 15.0..130.0 EWtkg ENDIF PLEASE RECORD ESTIMATED WEIGHT IN KILOGRAMS. Range: 1.0..210.0 FWeight Measured weight, either Weight or WtChAd - WtAdult Range: 0.0..140.0 ELSEIF EWtCh = Stones and pounds THEN EWtSt FloorM PLEASE RECORD ESTIMATED WEIGHT. ENTER STONES. SCALES PLACED ON? Range: 1..32 1 Uneven floor 2 Carpet 3 Neither EWtL PLEASE RECORD ESTIMATED WEIGHT. ENTER POUNDS. Range: 0..13 RelWaitB ENDIF INTERVIEWER CODE ONE ONLY. ENDIF 1 No problems experienced, reliable weight measurement obtained Problems experienced - measurement likely to be: 2 Reliable EMWeight Final measured or estimated weight (kg), computed 3 Unreliable ENDIF ENDIF
MBookWt INTERVIEWER: CHECK WEIGHT RECORDED ON MEASUREMENT RECORD CARD. 121 WEIGHT: (x) kg OR (x) stones (x) pounds. IF WEIGHT LOOKS WRONG, GO BACK TO 'Weight' AND REWEIGH. ENDIF
IF RespWts = Weight refused, Weight attempted, not obtained OR Weight not attempted THEN IF RespWts = Weight refused THEN ResNWt GIVE REASONS FOR REFUSAL. 1 Cannot see point/Weight already known/Doctor has measurement 2 Too busy/Taken long enough already/No time 3 Respondent too ill/frail/tired 4 Considered intrusive information 5 Respondent too anxious/nervous/shy/embarrassed 6 Child refused to be held by parent 7 Parent refused to hold child 8 Refused (no other reason given) 9 Other
ELSEIF RespWts = Weight attempted, not obtained OR Weight not attempted THEN NoWaitM CODE REASON FOR NOT OBTAINING WEIGHT.CODE ALL THAT APPLY. 1 Child: away from home during fieldwork period (specify in a Note) 2 Respondent is unsteady on feet 3 Respondent cannot stand upright 4 Respondent is chairbound 5 Respondent weighs more than 130 kg 6 Ill or in pain 7 Scales not working 8 Parent unable to hold child 9 Other - specify
IF NoWaitM = Other THEN NoWaitMO PLEASE SPECIFY OTHER REASON. Scottish Health Survey 1998 Nurse Questionnaire OpenDisp … HERE ARE THE PEOPLE AT THIS HOUSEHOLD WHO HAVE BEEN SEEN BY THE INTERVIEWER (NB. N/Y UNDER Nurse MEANS 'Not yet' or 'Not ever'.) No Name Sex Age Nurse Par1 NatPs1 Par2 NatPs2 Household grid PRESS 1 AND
Name PRESS
Sex Sex of person who was interviewed 1Male 2Female
Age Age of person who was interviewed Range 2..120
OC Interview outcome of person who was interviewed 1 Agreed Nurse Visit 2 Refused Nurse Visit 3 No outcome yet
IF (AGE IN [2..15]) THEN 122 P1 Person number of child’s Parent 1 Range 01..12
NatPs1 Parent type of Parent 1 1 Parent 2 Legal parental responsibility
P2 Person number of child’s Parent 2 (code 97=no Parent 2 in household) Range 01..97
IF (P2 IN [01..12]) THEN NatPs2 Parent type of Parent 2 1 Parent 2 Legal parental responsibility ENDIF ENDIF
AdrField PLEASE ENTER THE FIRST TEN CHARACTERS OF THE FIRST LINE OF THE ADDRESS TAKEN FROM N.R.F. ADDRESS LABEL. MAKE SURE TO TYPE IT EXACTLY AS IT IS PRINTED.: Text: Maximum 10 characters
HHDate NURSE: ENTER THE DATE OF THE ORIGINAL HOUSEHOLD INTERVIEW FROM Q2 ON THE NRF (OR INTERIM APPOINTMENT RECORD). ENTER DAY OF MONTH IN NUMBER, NAME OF MONTH IN WORDS (FIRST THREE LETTERS) AND YEAR IN NUMBERS, EG 2 JAN 97. Introduction Prescribed medicines and drug coding IF OC = 1 THEN Info ALL WITH A NURSE VISIT You are in the Nurse Schedule for: MedCNJD Person Number: Are you taking or using any medicines, pills, syrups, ointments, puffers or injections prescribed for you Name: Age: by a doctor? Sex: 1Yes Can you interview this person? TO LEAVE THIS SCHEDULE FOR NOW, PRESS
IF (Age IN [2..15]) THEN IF MedCNJD = Yes THEN CParInt NURSE: A child can be interviewed only with the permission of, and in the presence of, their parent Drug coding block or person who has (permanent) legal parental responsibility, (’parent’). No measurements should be be carried out without the agreement of both parent and the child. DIntro ENTER ’1’ TO CONTINUE NURSE: PLEASE COMPLETE DRUG CODING FOR Person (person no.) (person name). CParNo PRESS 1 AND
124 2 No, not told me she is pregnant ENDIF
IF Age of Respondent is over 15 years THEN Smoke Can I ask, do you smoke cigarettes, cigars or a pipe at all these days? CODE ALL THAT APPLY. IF RESPONDENT USED TO SMOKE BUT DOES NOT ANY MORE, CODE 'NO'. 1 Yes, cigarettes 2 Yes, cigars 3 Yes, pipe 4No
IF (Smoke = Yes, cigarettes) OR (Smoke = Yes, cigars) OR (Smoke = Yes, pipe) THEN LastSmok How long is it since you last smoked a (cigarette, (and/or a) cigar, (and/or a) pipe)? 1 Within the last 30 minutes 2 Within the last 31-60 minutes 3 Over an hour ago, but within the last 2 hours 4 Over two hours ago, but within the last 24 hours 5 More than 24 hours ago ENDIF
UseGum We are also interested in whether people use any of the nicotine replacement products that are now available, such as nicotine chewing gum or patches. First, in the last seven days have you used any nicotine chewing gum? 1Yes 2No
IF UseGum=Yes THEN GumMG What strength is the nicotine chewing gum you are using - is it 2mg or 4mg? CODE ONE ONLY. IF BOTH - WHICH MOST RECENTLY? IF CAN'T SAY - ASK TO SEE PACKET 12mg Food Poisoning 24mg 3 Can't say (and no packet available) ENDIF ASK ALL WITH A NURSE VISIT Diarr UsePat In the past six months, have you suffered from any illness involving diarrhoea which you believe may In the last seven days have you used nicotine patches that you stick on your skin? have been due to food poisoning? 1Yes DIARRHOEA = 3+ LOOSE BOWEL MOVEMENTS IN 24 HOURS" 2No 1Yes 2No IF UsePat=Yes THEN 3 Can't remember NicPats Can you tell me which brand and strength of nicotine patches you use? Vomit CODE ONE ONLY. DO NOT PROMPT. In the past six months, have you suffered from any illness involving vomiting which you believe may IF MORE THAN ONE TYPE - WHICH MOST RECENTLY? IF NOT SURE - ASK TO SEE PACKET 1 Niconil: 11mg have been due to food poisoning? 2 Niconil: 22mg VOMITING = 3+ TIMES IN 24 HOURS 3 Nicorette: 5mg 1Yes 4 Nicorette: 10mg 2No 5 Nicorette: 15mg 3 Can't remember 6 Nicotinell TTS: 10 (7mg) 7 Nicotinell TTS: 20 (14mg) IF Diarr=Yes OR Vomit=Yes THEN 8 Nicotinell TTS: 30 (21mg) NoDiaVom 9 Other (SPECIFY AT NEXT QUESTION) How many times did you have such an illness in the last six months? Was it ...READ OUT... 10 Can't say (and no packet available) 1 Once IF NicPats=Other THEN 2 Twice OthNic 3 3 Times 4 or more than 3 times? STATE NAME AND STRENGTH OF NICOTINE PATCHES Text: Maximum 140 characters ENDIF YDiaVom
125 ENDIF How long did the (diarrhoea/diarrhoea and vomiting) last? READ OUT UseNas MOST RECENT ILLNESS IF MORE THAN ONE In the last seven days, have you used nicotine nasal spray or a nicotine inhaler? 1 Less than one week 1Yes 2 1 - 2 weeks 2No 3 More than two weeks? ENDIF 4 (Can't remember)"
ConsGP Did you consult your GP or another doctor about this illness, either by phone or by visiting the surgery or hospital? 1 Yes, did consult GP/doctor 2 No, GP/doctor not consulted
IF ConsGP=Yes THEN GPDiag Did your GP/doctor diagnose this illness as food poisoning, gastroenteritis, or some other illness? CODE ONE ONLY 1 Food poisoning 2 Gastroenteritis 3 Other (SPECIFY) 4 Respondent not given diagnosis 5 Can't remember/Don't know
IF GPDiag =Other THEN OthDiag What was the diagnosis? INTERVIEWER: ENTER DIAGNOSIS Text: Maximum 40 characters ENDIF
Stool Did the doctor ask you to supply a stool for testing? Upper arm circumference 1 Yes 2No IF (Age of Respondent is less than 16 years) AND (UPreg <> Pregnant) THEN IF Stool=Yes THEN UAIntro StoolTst ENTER '1' TO CONTINUE. And did you give the doctor a stool sample for testing? 1 Yes MUACInt 2No (As I mentioned earlier,) I would like to measure your (name of child’s) upper arm circumference. IF ASKED: This gives us information about the distribution of fat. IF StoolTst=Yes THEN 1 Respondent agrees to have upper arm circumference measured GermB 2 Respondent refuses to have upper arm circumference measured 3 Unable to measure upper arm circumference for reason other than refusal Were you told what type of germ or bacteria was causing the illness? 1 Yes Mid-upper arm circumference measurement repeated up to 3 times. 2No Third measurement taken only if first two measurements differ by more than 1.5cm. 3 Told but can't remember 4 Can't remember if told IF MUACInt=Agrees THEN FOR Loop:= 1 TO 3 DO ENDIF IF (Loop IN [1..2]) OR ((Loop = 3) AND (Measure[1].CUpArm <> 99.9) AND (Measure[2].CUpArm ENDIF <> 99.9) AND (ABS(Measure[1].CUpArm - Measure[2].CUpArm) > 1.5)) THEN ENDIF CUpArm[i] MEASURE CIRCUMFERENCE OF LEFT ARM AND RECORD IN CENTIMETRES. IF IllDay MEASUREMENT NOT OBTAINED, ENTER '99.9 What effect did this illness have on your daily routine. Were you ... Range: 10.0..100.0 READ OUT 1 Admitted to hospital IF CUpArm IN [10.0..99.8] THEN 2 At home but took time off paid work CUpRel[i] 3 Not off work/school Is the (first/second/third) measurement reliable? 4 Not working at this time? 1Yes 2No 126 ENDIF ENDIF ENDIF ENDDO
IF NO MEASUREMENT OBTAINED (CUpArm1 = 99.9 AND CUpArm2 = 99.9) THEN CRespUp NURSE CHECK: 1 Both measurements refused 2 Attempted not obtained 3 Measurement not attempted ENDIF
IF AT LEAST ONE MEASUREMENT OBTAINED (CupArm1 <> 99.9 OR CUpArm2 <> 99.9) THEN CUpMeas NURSE CHECK: Arm circumference measured with respondent: 1 Standing 2 Sitting 3 Lying down 4 Measured on right arm as left arm unsuitable ENDIF ENDIF
IF NO OR ONE MEASUREMENT OBTAINED (MUACInt=Refuses OR Unable OR CupArm1 = 99.9 OR CUpArm2 = 99.9) THEN NoCUpArm GIVE REASON(S) FOR (ONLY OBTAINING ONE MEASUREMENT/REFUSAL/NOT OBTAINING MEASUREMENT/MEASUREMENT NOT BEING ATTEMPTED) Text: Maximum 140 characters ENDIF
IF MEASUREMENT OBTAINED (CUpArm1 IN [10.0..99.8] OR CUpArm2 IN [10.0..99.8]) THEN ArmRes OFFER TO WRITE RESULTS OF ARM CIRCUMFERENCE MEASUREMENT ON RESPONDENT'S MEASUREMENT RECORD CARD. COMPLETE NEW CARD IF REQUIRED. Upper arm circumference: (First measurement) Blood pressure (Second measurement) ENTER '1' TO CONTINUE ENDIF IF Age of Respondent is 2 to 4 years THEN ENDIF NoBP NO BLOOD PRESSURE READING TO BE DONE.ENTER '1' TO CONTINUE. 1 Continue ENDIF
IF (PregNTJ = Yes) OR (UPreg = Pregnant) THEN PregMes RESPONDENT IS PREGNANT. NO MEASUREMENTS TO BE DONE. ENTER '1' TO CONTINUE. 1 Continue ENDIF
ALL AGED OVER 4 YEARS (EXCEPT PREGNANT WOMEN) BPMod NURSE: NOW FOLLOWS THE BLOOD PRESSURE MODULE. ENTER '1' TO CONTINUE: 1 Continue
IF Age of Respondent is over 15 years THEN BPIntro (As I mentioned earlier) We would like to measure your blood pressure. IF ASKED: The analysis of blood pressure readings will tell us a lot about the health of the population. ENTER '1' TO CONTINUE 1 Continue
ELSE (Respondent aged 5-15) BPBlurb
127 READ OUT TO PARENT/PARENTS:(As I mentioned earlier) we would like to measure (name of child’s) blood pressure. If you wish, I will write the results on (his/her) Measurement Record Card. I will not, however, be able to tell you what the results mean. This has to be calculated using (his/her) age, sex and height. Also blood pressure can vary from day to day and throughout the day, so one high reading would not necessarily mean that your child has a high blood pressure. However if you would like us to, we will send your results to your GP who is better placed to interpret them. In the unlikely event that your child should be found to have a high blood pressure for (his/her) age and height, we shall advise (his/her) GP (with your permission) that (name of child’s) blood pressure should be measured again. ENTER '1' TO CONTINUE. 1 Continue ENDIF
BPConst Are you willing to have your blood pressure measured? 1 Yes, agrees 2 No, refuses 3 Unable to measure BP for reason other than refusal
IF BPConst = Yes, agrees THEN IF Age of Respondent is 13 years or over THEN ConSubX May I just check, have you eaten, smoked, drunk alcohol or done any vigorous exercise in the past 30 minutes? CODE ALL THAT APPLY. 1 Eaten 2 Smoked 3 Drunk alcohol 4 Done vigorous exercise 5 (None of these)
ELSEIF (Age of Respondent is 5 to 12 years AND BPConst = Yes, agrees) THEN ConSubX2 May I just check, has (name of child) eaten, or done any vigorous exercise, in the past 30 (computed from YnoBp/BpConst and Full) minutes? RespBPS CODE ALL THAT APPLY. RESPONSE TO BLOOD PRESSURE READINGS 1 Eaten 1 Three readings obtained 2 Done vigorous exercise 2 Two readings obtained 3 Neither 3 One reading obtained ENDIF 4 Attempted not obtained 5 Not attempted DINNo 6 Refused RECORD DINAMAP SERIAL NUMBER: Range: 001..999 IF BLOOD PRESSURE MEASUREMENT REFUSED OR NOT ATTEMPTED, OR FEWER THAN THREE FULL READINGS OBTAINED THEN CufSize NAttBP SELECT CUFF AND ASK RESPONDENT TO SIT STILL FOR FIVE MINUTES. RECORD CUFF SIZE RECORD WHY (ONLY TWO READINGS OBTAINED/ONLY ONE READING OBTAINED/READING CHOSEN. NOT OBTAINED/READING NOT ATTEMPTED/READING REFUSED/UNABLE TO TAKE READING). 1 Child (12-19 cm) CODE ALL THAT APPLY. 2 Small adult (17-25 cm) 1 Respondent upset/anxious/nervous 3 Adult (23-33 cm) 2 Error 844' reading 4 Large adult (31-40 cm) 3 (IF AGED UNDER 16: Too shy) 5 Extra large adult (38-50 cm) 4 (IF AGED UNDER 16: Child would not sit still long enough) 5 Other reason(s) (SPECIFY AT NEXT QUESTION) AirTemp ENDIF ENTER AMBIENT AIR TEMPERATURE IN CELSIUS. IF NattBP = Other THEN Range: 00.0..40.0 OthNBP Map to Dias repeated for up to 3 blood pressure measurements ENTER FULL DETAILS OF OTHER REASON(S) FOR NOT OBTAINING/ATTEMPTING THREE BP READINGS: FOR I:= 1 TO 3 DO Text: Maximum 140 characters Map[i] ENDIF TAKE THREE MEASUREMENTS FROM RIGHT ARM. IF ONE, TWO OR THREE FULL BLOOD PRESSURE READINGS OBTAINED THEN ENTER (FIRST/SECOND/THIRD) MAP READING (mmHg). 128 IF READING NOT OBTAINED, ENTER 999. DifBP IF YOU ARE NOT GOING TO GET ANY BP READINGS AT ALL ENTER ‘996’. RECORD ANY PROBLEMS TAKING READINGS. CODE ALL THAT APPLY. Range:001..999 1 No problems taking blood pressure 2 Reading taken on left arm because right arm not suitable Pulse[i] 3 Respondent was upset/anxious/nervous 4 Other problems (SPECIFY AT NEXT QUESTION) ENTER (FIRST/SECOND/THIRD) PULSE READING (bpm). ENDIF IF READING NOT OBTAINED, ENTER 999. Range:001..999 IF DifBP=Other THEN Sys[i] OthDifBP NURSE: RECORD FULL DETAILS OF OTHER PROBLEM(S) TAKING READINGS. ENTER (FIRST/SECOND/THIRD) SYSTOLIC READING (mmHg). Text: Maximum 140 characters IF READING NOT OBTAINED, ENTER 999. ENDIF Range:001..999 IF ONE, TWO OR THREE FULL BLOOD PRESSURE READINGS OBTAINED THEN Dias[i] GPRegB ENTER (FIRST/SECOND/THIRD) DIASTOLIC READING (mmHg). IF READING NOT OBTAINED, ENTER 999.": 001..999 Are you registered with a GP? 1Yes 2No Full [i] ALL READINGS OK? IF GPRegB = Yes THEN 1 Yes GPSend 2 No May we send your blood pressure readings to your GP? ENDDO 1Yes 2No IF NO FULL MEASUREMENT OBTAINED (at least one ‘999’ reading in all 3 sets of 4 readings) THEN IF GPSend = No THEN YNoBP GPRefM ENTER REASON FOR NOT RECORDING ANY FULL BP READINGS SPECIFY REASON(S) FOR REFUSAL TO ALLOW BP READINGS TO BE SENT TO GP. 1 Blood pressure measurement attempted but not obtained CODE ALL THAT APPLY. 2 Blood pressure measurement not attempted 1 Hardly/Never sees GP 3 Blood pressure measurement refused 2 GP knows respondent's BP level ENDIF 3 Does not want to bother GP 4 Other (SPECIFY AT NEXT QUESTION) IF GPRefM = Other THEN Demispan OthRefM NURSE: GIVE FULL DETAILS OF REASON(S) FOR REFUSAL Text: Maximum 140 characters IF Age of Respondent is over 64 THEN ENDIF SpanIntro ENDIF NURSE: NOW FOLLOWS THE MEASUREMENT OF DEMI-SPAN. ENTER '1' TO CONTINUE. ENDIF 1 Continue IF (GPRegB <> Yes) OR (GPSend = No) THEN SpanInt Code022 I would now like to measure the length of your arm. Like height, it is an indicator of size. Would you CIRCLE CONSENT CODE 02 ON FRONT OF CONSENT BOOKLET. be willing for mw to measure the length of your arm? ENTER '1' TO CONTINUE 1 Respondent agrees to have demispan measured 1 Continue 2 Respondent refuses to have demispan measured 3 Unable to measure demispan for reason other than refusal ELSEIF GPSend = Yes THEN ConsFrm1 Repeat for up to three demispan measurements. a) COMPLETE 'BLOOD PRESSURE TO GP CONSENT FORM (CHILD UNDER 16: FORM BP Third measurement taken only if first two differ by more than 3cm. (C)/ADULT 16+: FORM BP (A)) b) ASK (RESPONDENT/RESPONDENT’S PARENT/’PARENT’) TO READ, SIGN AND DATE IT. IF SpanInt=Agrees THEN c) CHECK GP NAME, ADDRESS AND PHONE NO. ARE RECORDED ON CONSENT FORM. FOR Loop:= 1 TO 3 DO d) CHECK NAME BY WHICH GP KNOWS RESPONDENT. e) CIRCLE CONSENT CODE 01 ON FRONT OF CONSENT BOOKLET. IF (Loop IN [1..2]) OR ((Loop = 3) AND (Span1 <> 999.9) AND (Span2 <> 999.9) AND (ABS(Span1 ENTER '1' TO CONTINUE. - Span2) > 3)) THEN 1 Continue Span[i] ENDIF ENTER (FIRST/SECOND/THIRD) MEASUREMENT IN CENTIMETRES. IF MEASUREMENT NOT OBTAINED, ENTER '999.9'. BPOffer Range: 45.0..1000.0 OFFER BLOOD PRESSURE RESULTS TO (RESPONDENT/PARENT/’PARENT’) Pulse Systolic Diastolic IF Span <> 999.9 THEN i) (First Pulse reading) (First Systolic reading) (First Diastolic reading) SpanRel[i] ii) (Second Pulse reading) (Second Systolic reading) (Second Diastolic reading) Is the (First/Second/Third) measurement reliable? 129 iii) (Third Pulse reading) (Third Systolic reading) (Third Diastolic reading) 1Yes 2No ENTER ON THEIR MEASUREMENT RECORD CARD (COMPLETE NEW RECORD ENDIF CARD IF REQUIRED). ENDIF ENDDO ADVICE TO RESPONDENTS ON BLOOD PRESSURE READING (AGE 16+ ONLY)
IF Systolic reading >179 OR Diastolic reading >114 THEN IF (Span1 = 999.9) AND (Span2 = 999.9) THEN TICK THE CONSIDERABLY RAISED BOX AND READ OUT TO RESPONDENT: Your blood pressure is high YNoSpan today. Blood pressure can vary from day to day and throughout the day so that one high reading does not NURSE: GIVE REASON FOR NOT OBTAINING AT LEAST ONE DEMI-SPAN MEASUREMENT. necessarily mean that you suffer from high blood pressure. You are strongly advised to visit your GP within 5 1 Both measurements refused days to have a further blood pressure reading to see whether this is a once-off finding or not. 2 Attempted but not obtained NURSE: IF RESPONDENT IS ELDERLY, ADVISE HIM/HER TO CONTACT GP WITHIN NEXT 7-10 DAYS. 3 Measurement not attempted IF Systolic reading 160-179 OR Diastolic reading 100-114 (Men aged 16-49 OR Women aged 16+) ENDIF OR IF Systolic reading 170-179 OR Diastolic reading 105-114 (Men aged 50+) THEN ENDIF TICK THE MODERATELY RAISED BOX AND READ OUT TO RESPONDENT: Your blood pressure is a bit high today. Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure. You are advised to visit your GP within 2-3 weeks (computed from YnoSpan, Span and Spanel) to have a further blood pressure reading to see whether this is a once-off finding or not. RespDS RESPONSE TO DEMI-SPAN MEASUREMENT IF Systolic reading 140-159 OR Diastolic reading 85-99 (Men aged 16-49 OR Women aged 16+) 1 Both measurements obtained OR IF Systolic reading 160-169 OR Diastolic reading 96-104 (Men aged 50+) THEN TICK THE MILDLY RAISED BOX AND READ OUT TO RESPONDENT: Your blood pressure is a bit high today. 2 One measurement obtained Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily 3 Refused mean that you suffer from high blood pressure. You are advised to visit your GP within 3 months to have a 4 Attempted not obtained further blood pressure reading to see whether this is a once-off finding or not. 5 Not attempted IF Systolic reading <140 AND Diastolic reading <85 (Men aged 16-49 OR Women aged 16+) OR IF Systolic reading <160 AND Diastolic reading <95 (Men aged 50+) THEN IF NO MEASUREMENT OBTAINED (SpanInt=Refuse OR SpanInt=Unable OR (Span1=999.9 AND TICK THE NORMAL BOX AND READ OUT TO RESPONDENT: Your blood pressure is normal. Span2=999.9) THEN ENDIF NotAttM ENDIF NURSE: GIVE REASON FOR (REFUSAL/NOT OBTAINING MEASUREMENT/MEASUREMENT NOT ENDIF BEING ATTEMPTED). 1 Cannot straighten arms 2 Other IF NotAttM = Other THEN Waist and hip circumference OthAttM NURSE: GIVE FULL DETAILS OF OTHER REASON FOR (REFUSAL/NOT OBTAINING MEASUREMENT/MEASUREMENT NOT BEING ATTEMPTED) ALL AGED OVER 15 YEARS (EXCEPT PREGNANT WOMEN) Text: Maximum 140 characters WHMod ENDIF NURSE: NOW FOLLOWS THE WAIST AND HIP CIRCUMFERENCE MEASUREMENT. ENTER '1' TO CONTINUE ELSE (If at least one measurement obtained) 1 Continue SpnM NURSE CHECK: Demi-span was measured with the respondent: CODE ALL THAT APPLY. WHIntro 1 Standing against the wall I would now like to measure your waist and hips. Would you be willing to have your waist and hip 2 Standing not against the wall circumference measured? 3 Sitting IF ASKED: The waist relative to hip measurement is very useful for assessing the distribution of 4 Lying down weight over the body. 5 Demi-span measured on left arm due to unsuitable right arm 1 Respondent agrees to have waist/hip ratio measured 2 Respondent refuses to have waist/hip ratio measured DSCard 3 Unable to measure waist/hip ratio for reason other than refusal WRITE RESULTS OF DEMI-SPAN MEASUREMENT ON RESPONDENT'S MEASUREMENTRECORD CARD. Demi-span : (Measurement 1 and 2 displayed) IF (WHIntro=Agree) THEN ENTER '1' TO CONTINUE. 1 Continue Repeat for up to three waist-hip measurements. Third measurement taken only if difference between first two measurements is greater than 3cm. ENDIF ENDIF FOR Loop:= 1 TO 3 DO IF (Loop IN [1..2]) OR ((Loop = 3) AND (Measure[1].Waist <> 999.9) AND (Measure[2].Waist <> 999.9) AND (ABS(Measure[1].Waist - Measure[2].Waist) > 3)) THEN Waist NURSE: MEASURE THE WAIST AND HIP CIRCUMFERENCES TO THE NEAREST MM. ENTER (FIRST/SECOND/THIRD) WAIST MEASUREMENT IN CENTIMETRES (Remember to include the decimal point). IF MEASUREMENT NOT OBTAINED, ENTER '999.9'. 130 Range: 45.0..1000.0 ENDIF
IF (Loop IN [1..2]) OR ((Loop = 3) AND (Measure[1].Hip <> 999.9) AND (Measure[2].Hip <> 999.9) AND (ABS(Measure[1].Hip - Measure[2].Hip) > 3)) THEN Hip NURSE: MEASURE THE WAIST AND HIP CIRCUMFERENCES TO THE NEAREST MM. ENTER (FIRST/SECOND/THIRD) MEASUREMENT OF HIP CIRCUMFERENCE IN CENTIMETRES (Remember to include the decimal point). IF MEASUREMENT NOT OBTAINED, ENTER '999.9'. Range: 75.0..1000.0 ENDIF ENDDO
IF (Waist1 = 999.9) OR (Waist2 = 999.9) OR (Hip1 = 999.9) OR (Hip2 = 999.9) THEN YNoWH ENTER REASON FOR NOT GETTING BOTH MEASUREMENTS 1 Both measurements refused 2 Attempted but not obtained 3 Measurement not attempted ENDIF ENDIF
(computed from WHIntro, Waist and Hip) RespWH RESPONSE TO WAIST-HIP MEASUREMENT 1 Both measurements obtained 2 One measurement obtained 3 Refused 4 Not attempted
IF NO OR ONE MEASUREMENT OBTAINED ((WHIntro=Refuse OR Unable) OR Only one waist/hip measurement obtained) THEN WHPNABM GIVE REASON(S) (FOR REFUSAL/WHY UNABLE/FOR NOT OBTAINING MEASUREMENT/FOR NOT Lung Function ATTEMPTING/WHY ONLY ONE MEASUREMENT OBTAINED).CODE ALL THAT APPLY. 1 Respondent is chairbound 2 Other (SPECIFY AT NEXT QUESTION) ALL AGED 7 YEARS AND OVER (EXCEPT PREGNANT WOMEN) BlInt IF WHPNABM = Other THEN Now follows the lung function module OthWH GIVE FULL DETAILS OF 'OTHER' REASON(S) FOR NOT GETTING FULL WAIST/HIP HaSurg MEASUREMENT: Text: Maximum 140 characters Can I check, have you had abdominal or chest surgery in the past three weeks? ENDIF 1Yes ENDIF 2No
IF AT LEAST ONE WAIST MEASUREMENT OBTAINED (IF (Waist1 <> 999.9 AND Waist1 <> IF HaSurg=No THEN EMPTY) OR (Waist2 <> 999.9 AND Waist2 <> EMPTY)) THEN HaStro WJRel Have you been admitted to hospital for a heart complaint or stroke in the past six weeks? RECORD ANY PROBLEMS WITH WAIST MEASUREMENT: 1Yes 1 No problems experienced, RELIABLE waist measurement 2No 2 Problems experienced - waist measurement likely to be RELIABLE 3 Problems experienced - waist measurement likely to be SLIGHTLY UNRELIABLE ChestInf 4 Problems experienced - waist measurement likely to be UNRELIABLE In the past three weeks, have you had any respiratory infections such as influenza, pneumonia, IF WJRel = Problems experienced THEN bronchitis or a severe cold? ProbWJ 1Yes RECORD WHETHER PROBLEMS EXPERIENCED ARE LIKELY TO INCREASE OR 2No DECREASE THE WAIST MEASUREMENT. 1 Increases measurement Inhaler 2 Decreases measurement (Can I just check), have you used an inhaler, puffer or any medication for your breathing in the last ENDIF 24 hours? ENDIF 1Yes 2No
131 IF AT LEAST ONE HIP MEASUREMENT OBTAINED (IF (Hip1 <> 999.9 AND Hip1 <> EMPTY) OR (Hip2 <> 999.9 AND Hip2 <> EMPTY)) THEN IF Inhaler=Yes THEN HJRel InHalHrs RECORD ANY PROBLEMS WITH HIP MEASUREMENT: 1 No problems experienced, RELIABLE hip measurement How many hours ago did you use it? 2 Problems experienced - hip measurement likely to be RELIABLE INTERVIEWER, ENTER NUMBER OF HOURS. IF LESS THAN ONE HOUR, CODE 0 3 Problems experienced - hip measurement likely to be SLIGHTLY UNRELIABLE Range: 0..24 4 Problems experienced - hip measurement likely to be UNRELIABLE ENDIF
IF HJRel = Problems experienced THEN IF HaStro=No AND Age of Respondent is over 15 years THEN ProbHJ LFIntro1 RECORD WHETHER PROBLEMS EXPERIENCED ARE LIKELY TO INCREASE OR (As I mentioned earlier). We would like to measure your lung function which will help us to find DECREASE THE HIP MEASUREMENT. out more about the health of the population. 1 Increases measurement ENTER '1' TO CONTINUE" 2 Decreases measurement 1 ContinuE ENDIF ENDIF ENDIF IF HaStro=No AND Age of Respondent is between 7 and 15 years THEN IF ONE OR TWO WAIST/HIP MEASUREMENTS OBTAINED THEN LFIntro2 WHRes (As I mentioned earlier) We would like to measure (name of child s) lung function. If you wish, I OFFER TO WRITE RESULTS OF WAIST AND HIP MEASUREMENTS, WHERE APPLICABLE, ONTO will write the result of the test on (his/her) Measurement Record Card. I will not, however, be able RESPONDENT'S MEASUREMENT RECORD CARD. Waist: (Write in waist measurements 1 and 2) to tell you what the results mean. This has to be calculated using age, sex and height. If you would Hip: (Write in hip measurements 1 and 2) like us to, we will also send (his/her) results to (his/her) GP who is better placed to interpret them. ENTER '1' TO CONTINUE. IF ASKED: There is a wide range that can be considered acceptable. A low result can simply be due ENDIF to unfitness and does not necessarily indicate any disease. People's results vary from day to day, ENDIF so a diagnosis cannot be made on the basis of measurements taken on a single occasion. 1 Continue
ENDIF ENDIF
IF HaSurg=No AND NOT HaStro=Yes THEN LFWill LFStand Would you be willing to have your Lung Function measured? NURSE: MEASUREMENTS TAKEN WHILE RESPONDENT WAS STANDING OR SITTING? 1Yes 1 Standing 2No 2 Sitting
IF LFWill=Yes THEN LFResp SpirNo NURSE CHECK: CODE ONE ONLY NURSE: CALIBRATE THE SPIROMETER. 1 All 5 technically satisfactory blows obtained ENTER THE THREE-DIGIT SPIROMETER SERIAL NUMBER 2 Some blows, but less than 5 technically satisfactory blows obtained Range: 1..999 3 All blows refused 4 None attempted LFTemp NURSE: RECORD THE AMBIENT AIR TEMPERATURE ENDIF ENTER THE TEMPERATURE IN CENTIGRADE TO ONE DECIMAL PLACE. Range: 0..40 IF LFResp=Some blows, but less than 5 technically satisfactory blows obtained THEN ProbLF LFRec NURSE: GIVE REASONS WHY LESS THAN 5 BLOWS OBTAINED. CODE ALL THAT APPLY. EXPLAIN THE PROCEDURE AND DEMONSTRATE THE TEST 1 Refused to continue RECORD THE RESULTS OF FIVE BLOWS BY THE RESPONDENT IN THE BOXES BELOW. 2 Breathlessness RECORD EACH BLOW AS IT IS CARRIED OUT. 3 Coughing fit FOR EACH BLOW, ENTER ALL THREE MEASURES AND CODE WHETHER TECHNIQUE 4 Other (SPECIFY AT NEXT QUESTION) WAS SATIFACTORY. ENTER '1' TO CONTINUE 1 Continue IF ProbLF=Other THEN OthProb (FVC to Technique) repeated for up to 5 blows. NURSE: GIVE DETAILS OF WHY LESS THAN 5 BLOWS OBTAINED. FVC Text: Maximum 40 characters IF NO READING OBTAINED ENTER '0' AND SUPPRESS ALL CHECKS ENDIF Range: 0..10 ENDIF 132 FEV IF LFWill=No OR LFResp=Refused OR LFResp=None Attempted THEN IF NO READING OBTAINED ENTER '0' AND SUPPRESS ALL CHECKS NoAttLF Range: 0..10 LUNG FUNCTION READING NOT OBTAINED CIRCLE CONSENT CODE 04 ON FRONT OF CONSENT BOOKLET PF GIVE REASON WHY LUNG FUNCTION MEASUREMENTS WERE NOT IF NO READING OBTAINED ENTER '0' AND SUPPRESS ALL CHECKS ATTEMPTED/REFUSED Range: 0..995 CODE ONE ONLY 1 Temperature of house too cold TECHNIQUE 2 Temperature of house too hot 3 Equipment failure TECHNIQUE SATISFACTORY ? 4 Breathlessness 1 YES 5 Unwell 2NO 6 Other reason why measurements not attempted/refused (SPECIFY AT NEXT QUESTION)
IF NoAttLF = Other THEN NLSATLF OthNoAt SATISFACTORY BLOWS NURSE: GIVE DETAILS OF WHY LUNG FUNCTION MEASUREMENTS WERE NOT Range: 1..2 ATTEMPTED/REFUSED. Text: Maximum 40 characters HTFVC ENDIF COMPUTES HIGHEST TECHNICALLY SATISFACTORY VALUE FOR FVC ENDIF Range: 0..10 IF LFResp=None THEN HTFEV LFCODE3 COMPUTES HIGHEST TECHNICALLY SATISFACTORY VALUE FOR FEV NURSE: CIRCLE CONSENT CODE 04 ON FRONT OF CONSENT BOOKLET Range: 0..10 ENTER '1' TO CONTINUE 1 Continue
HTPF ENDIF COMPUTES HIGHEST TECHNICALLY SATISFACTORY VALUE FOR PF Range: 0..996 IF BPConst=Refused OR BPConst=Unable THEN LFSam NURSE: IF NOT ALREADY ASKED CIRCLE CONSENT CODE 03 ON FRONT OF CONSENT BOOKLET. (Can I just check) are you registered with a GP? 1 Continue 1 Respondent registered with GP ENDIF 2 Respondent not registered with GP ENDIF IF LFResp=All OR LFResp-Some THEN NCIns2 IF Registered with a Doctor AND at least one technically satisfactory blow THEN LUNG FUNCTION MEASURED GPSendLF OFFER LUNG FUNCTION RESULTS TO RESPONDENT May we send your lung function test results to your GP? ENTER THEIR HIGHEST FVC AND HIGHEST FEV AND HIGHEST PF READINGS ON 1 Yes MRC. (COMPLETE NEW RECORD CARD IF REQUIRED). 2No HIGHEST READINGS LISTED BELOW ENDIF HIGHEST FVC: HTFVC HIGHEST FEV: HTFEV IF GPSendLF=No THEN HIGHEST PF: HTPF LFCODE4 1 Continue NURSE: CIRCLE CONSENT CODE 04 ON FRONT OF CONSENT BOOKLET ENDIF ENTER '1' TO CONTINUE ENDIF 1 Continue IF HaSurg=YES OR HaStro = YES THEN LFCODE2 GPRLFM NO LUNG FUNCTION TEST TO BE DONE SPECIFY REASON(S) FOR REFUSAL TO ALLOW LF READINGS TO BE SENT TO GP. ENTER '1' TO CONTINUE. CODE ALL THAT APPLY. CIRCLE CONSENT PntCODE 04 ON FRONT OF CONSENT BOOKLET. 1 Hardly/Never sees GP 1 Continue 2 GP knows respondent's LF level ENDIF 3 Does not want to bother GP 4 Other (SPECIFY AT NEXT QUESTION)
IF GPRLFM = Other THEN
133 OthRefM NURSE GIVE FULL DETAILS OF REASON FOR REFUSAL: Range: 0..140 ENDIF ENDIF
IF (GpRegB <> Yes OR GPSend=NO) AND GPSendLF=No THEN LFCODE5 NURSE: CIRCLE CONSENT CODE 04 ON FRONT OF CONSENT BOOKLET ENTER '1' TO CONTINUE" 1 Continue ENDIF
IF GPSendLF=Yes AND Age of Respondent is over 15 years THEN NCIns1 NURSE: COMPLETE LUNG FUNCTION TO GP CONSENT FORM (ADULT 16+) LF(A) ASK RESPONDENT TO SIGN AND DATE IT. CHECK GP NAME, ADDRESS AND PHONE NUMBER ARE RECORDED ON FRONT OF CONSENT BOOKLET. CHECK NAME BY WHICH GP KNOWS RESPONDENT CIRCLE CONSENT CODE 03 ON FRONT OF CONSENT BOOKLET. 1 Continue ENDIF
IF GPSendLF=Yes AND Age of Respondent is between 7 and 15 years THEN NCIns1c RESULTS CAN BE SENT TO GP NURSE: COMPLETE LUNG FUNCTION TO GP CONSENT FORM (AGES 7-15) LF(C) ASK RESPONDENT TO SIGN AND DATE IT. CHECK GP NAME, ADDRESS AND PHONE NUMBER ARE RECORDED ON FRONT OF CONSENT BOOKLET. CHECK NAME BY WHICH GP KNOWS RESPONDENT EMLA CREAM CANNOT BE USED. IS RESPONDENT WILLING TO GIVE BLOOD SAMPLE Blood sample WITHOUT EMLA CREAM? Code 1 if yes, willing to give blood sample without EMLA cream Code 2 if no, not ALL AGED 11+ (EXCEPT PREGNANT WOMEN)* willing to give blood sample without EMLA. BlIntro 1 Yes, willing NURSE: NOW FOLLOWS THE BLOOD SAMPLE MODULE. ENTER '1' TO CONTINUE. 2 No, no blood sample 1 Continue ELSEIF Allergy = No THEN EMLANow IF (Age of Respondent is 11 to 15 years) OR (Age of Respondent is over 15 years) THEN NURSE CODE: ARE YOU GOING TO APPLY EMLA DURING THE FIRST VISIT, OR ClotB RETURN FOR A SECOND VISIT? 1 During the first visit EXPLAIN PURPOSE AND PROCEDURE FOR TAKING BLOOD. May I just check, do you have a 2 Return for a second visit clotting or bleeding disorder or are you currently on anti-coagulant drugs such as Warfarin? (NB ASPIRIN THERAPY IS NOT A CONTRAINDICATION FOR BLOOD SAMPLE.) IF EMLANow = Return for a second visit THEN 1Yes 2No Later NURSE: CODE 1 TO CONTINUE WITH REST OF SCHEDULE ON THE FIRST VISIT. IF ClotB = No THEN CODE 2 IF THIS IS THE RETURN VISIT. 1 Finish rest of schedule now (ONLY APPLIES TO FIRST VISIT) Fit 2 This is the return visit and ready to take blood sample May I just check, have you ever had a fit (including epileptic fit, convulsion, convulsion ENDIF associated with high fever)? ENDIF 1Yes ENDIF 2No ENDIF ENDIF ENDIF ENDIF IF (BSWill = No OR CBSConst = No) THEN IF Fit = No THEN RefBS IF Age of Respondent is 11 to 15 years THEN RECORD WHY BLOOD SAMPLE REFUSED. CODE ALL THAT APPLY. EMLA 1 Previous difficulties with venepuncture Explain that there is the option of using EMLA cream, but that a sample can be given without 2 Dislike/fear of needles 3 Respondent recently had blood test/health check
134 EMLA.Give parent/respondent the EMLA information sheet and allow them time to read it. ENTER '1' TO CONTINUE. 4 Refused because of current illness 1 Continue 5 Worried about HIV or AIDS 6 Other IF Age of Respondent is 11 to 15 years THEN CBSConst IF RefBS = Other THEN OthRefBS ASK PARENT/ PARENT Are you willing for your child to have a blood sample taken? ’ ’. GIVE FULL DETAILS OF OTHER REASON(S) FOR REFUSING BLOOD SAMPLE. 1Yes Text: Maximum 135 characters 2No ENDIF ENDIF ENDIF ELSEIF BSWill = Yes THEN ENDIF IF (Age of Respondent is 11 to 17 years) AND (EMLAUse = No OR EMLANow = Now OR Later = Return OR NoEMLA = Yes) THEN IF (Fit = No) AND (CBSConst <> No) THEN BSConsC BSWill EXPLAIN NEED FOR WRITTEN CONSENT (FROM PARENT/‘PARENT’): Before I can take any Would you be willing to have a blood sample taken? blood, I have to obtain (written consent from you/the written consent of both parent and 1Yes child.).ENTER '1' TO CONTINUE. 2No 1 Continue IF Age of Respondent is 11 to 15 years AND BSWill = Yes THEN ENDIF EMLAUse IF (Age of respondent is 11 to 74 years) THEN Do you want EMLA cream to be used? BSCons 1Yes FILL IN (RESPONDENT’S/CHILD’S) NAME AND YOUR NAME AT TOP OF FORM(BS(C) CHILD 2No AGED 11-17/BS(A) ADULT AGED 18+) IN CONSENT BOOKLET. (If aged 11-15: TICK THE BOX: (With the use of EMLA/Without the use of EMLA)). IF EMLAuse = Yes THEN ASK (RESPONDENT/CHILD AND PARENT/’PARENT’) TO READ, SIGN AND DATE PART I OF Allergy BLOOD SAMPLE CONSENT FORM. Have you ever had a bad reaction to a local or general anaesthetic bought over the counter CIRCLE CONSENT CODE 05 ON THE FRONT OF THE CONSENT BOOKLET. at a chemist, or given at the doctor, the dentist or in hospital? ENTER '1' TO CONTINUE. 1Yes 1 Continue. 2No ENDIF ENDIF IF Allergy = Yes THEN NoEMLA IF (NoEMLA <> No) AND (Later <> Now) THEN IF (BSWill = Yes) AND (Age of Respondent is 2 to 15 years AND CBSConst = Yes) OR (Ageof 1 Continue respondent is 16-74 years)) THEN ENDIF GPSam NURSE CHECK: IF (EMLAuse = Yes AND NoEMLA <> Yes) THEN 1 Respondent registered with GP DoEMLA 2 Respondent not registered with GP CHECK YOU HAVE ALL APPLICABLE SIGNATURES. ENDIF APPLY EMLA CREAM FOLLOWING INSTRUCTIONS. IF (GPRegB = Yes OR GPSam = GP) THEN WAIT AT LEAST ONE HOUR BEFORE ATTEMPTING BLOOD SAMPLE. ENTER '1' TO COMPLETE REST OF SCHEDULE OR OTHER SCHEDULES WHILE WAITING. SendSam ENTER '2' WHEN THE HOUR HAS PASSED TO TAKE BLOOD SAMPLE. May we send the results of your blood sample analysis to your GP? 1 Complete rest of schedule 1Yes 2 The hour has passed, ready to take blood sample 2No ENDIF
IF SendSam = NO THEN IF (DoEMLA <> Rest) THEN SenSam TakeSam Why do you not want your blood sample results sent to your GP? CHECK YOU HAVE ALL APPLICABLE SIGNATURES. 1 Hardly/never sees GP TAKE BLOOD SAMPLES: FILL (1 Plain (red) tube and 1 EDTA (purple) tube/1 Plain (red) tube, 2 GP recently took blood sample 1 EDTA (purple) tube and 1 citrate (blue) tube) (in this order). 3 Does not want to bother GP WRITE THE SERIAL NUMBER AND DATE OF BIRTH ONTO THE RED LABEL USING A 4Other BLUE BIRO. DO ONE LABEL PER TUBE. Serial number: (displays serial number) IF SenSam=Other THEN Date of birth: (displays date of birth) OthSam CHECK THE DATE OF BIRTH AGAIN WITH THE RESPONDENT. STICK THE RED LABEL OVER THE LABEL WHICH IS ALREADY ON THE TUBE. GIVE FULL DETAILS OF REASON(S) FOR NOT WANTING RESULTS SENT TO GP. ENTER '1' TO CONTINUE. Text: Maximum 140 characters 1 Continue ENDIF ENDIF SampF1 ENDIF CODE IF PLAIN RED TUBE FILLED (INCLUDE PARTIALLY FILLED TUBE) IF GPSam=NoGP OR SendSam=No THEN 1Yes Code08 2No CIRCLE CONSENT CODE 08 ON FRONT OF CONSENT BOOKLET. 135 ENTER '1' TO CONTINUE. IF Age of Respondent is 11 to 15 years 1 Continue SampF2A ENDIF CODE IF FIRST EDTA LIGHT PURPLE TUBE (2ml) FILLED (INCLUDE PARTIALLY IF SendSam=Yes FILLED TUBE): BSSign 1Yes 2No OBTAIN (SIGNATURES OF RESPONDENT AND PARENT/’PARENT’/SIGNATURE) FOR PART II OF BLOOD SAMPLE CONSENT FORM. CHECK NAME BY WHICH GP KNOWS RESPONDENT. CHECK GP NAME, ADDRESS AND SampF2B PHONE NO. ARE RECORDED ON FRONT OF CONSENT BOOKLET. CODE IF SECOND EDTA LIGHT PURPLE TUBE (2ml) FILLED (INCLUDE PARTIALLY CIRCLE CONSENT CODE 07 ON FRONT OF CONSENT BOOKLET. FILLED TUBE): ENTER '1' TO CONTINUE. 1Yes 1 Continue 2No
ENDIF ENDIF IF (Age of Respondent is between 2 and 15 years AND CBSConst=Yes) OR (Age of Respondent is 16 IF Age of Respondent is 16 years or over THEN to 120 years AND BSWill=Yes) THEN SampF2 ConStorB CODE IF EDTA PURPLE TUBE FILLED (INCLUDE PARTIALLY-FILLED TUBE): ASK (PARENT/’PARENT’/RESPONDENT): May we have your consent to store any remaining 1Yes blood for future analysis? 2No 1 Storage consent given 2 Consent refused SampF3 CODE IF CITRATE (BLUE) TUBE FILLED (INCLUDE PARTIALLY-FILLED TUBE): IF ConStorB = Yes THEN 1Yes Code09 2 No OBTAIN (SIGNATURES OF RESPONDENT AND PARENT/’PARENT’/SIGNATURE OF RESPONDENT) AT PART III OF BLOOD SAMPLE CONSENT FORM. SampF4** CIRCLE CONSENT CODE 09 ON FRONT OF CONSENT BOOKLET. CODE IF VITAMIN TUBE FILLED ENTER '1' TO CONTINUE. ENDIF 1 Continue (computed from SampF1, F2, F2A, F2B, F3, F4) ELSEIF ConStorB = No THEN SampTak Code10 CIRCLE CONSENT CODE 10 ON FRONT OF CONSENT BOOKLET. ENTER '1' TO CONTINUE. RESPONSE TO BLOOD SAMPLE ELSEIF SampF1<>Yes AND SampF2<>Yes AND SampF3<>Yes SampF4<>Yes OR 1 Blood sample obtained SampF2A<>Yes OR SampF2B<>Yes THEN 2 No Blood sample obtained NoBSM CODE REASON(S) NO BLOOD OBTAINED. IF SampF1=Yes OR SampF2=Yes OR SampF3 = Yes OR SampF4=Yes OR SampF2A=Yes CODE ALL THAT APPLY. OR SampF2B=Yes THEN 1 No suitable or no palpable vein/collapsed veins SampArm 2 Respondent was too anxious/nervous RECORD WHICH ARM BLOOD TAKEN FROM: 3 Respondent felt faint/fainted 1Right 4 Other 2 Left 3Both IF NoBSM = Other THEN OthNoBSM SamDif GIVE FULL DETAILS OF REASON(S) NO BLOOD OBTAINED. RECORD ANY PROBLEMS IN TAKING BLOOD SAMPLE. Text: Maximum 140 characters CODE ALL THAT APPLY ENDIF 1 No problem 2 Incomplete sample Code12 3 Collapsing/poor veins CROSS OUT CONSENT CODES 05, 07, AND 09 IF ALREADY CIRCLED ON FRONT OF 4 Second attempt necessary CONSENT BOOKLET. 5 Some blood obtained, but respondent felt faint/fainted REPLACE WITH CONSENT CODES 06, 08, 10 AND 12 ON FRONT OF CONSENT 6 Unable to use tourniquet BOOKLET. 7 Other (SPECIFY AT NEXT QUESTION) ENTER '1' TO CONTINUE. 1 Continue IF SamDif = Other THEN ENDIF OthBDif ENDIF GIVE FULL DETAILS OF OTHER PROBLEM(S) IN TAKING BLOOD SAMPLE. ENDIF Text: Maximum 140 characters ENDIF ENDIF ENDIF ENDIF IF SampF4=Yes VitEat6 * Blood samples were taken from children aged 11-15 in the 2nd, 3rd and 4th quarters of fieldwork. 136 Can I check, when did you last have any fresh fruit or fruit juice? Was it ** Blood samples for vitamin analysis were taken from a sub-sample of respondents ...READ OUT... NURSE: IF 'NEVER EATS' USE CODE 3 1 Within one hour 2 1 - 4 hours ago 3 More than 4 hours ago 4 (Can't say)
WhenEat And when did you last have anything to eat or drink? Was it ...READ OUT..." 1 Within one hour 2 1 - 4 hours ago 3 More than 4 hours ago 4 (Can't say) ENDIF
SnDrSam Would you like to be sent the results of your blood sample analysis? 1Yes 2No
IF SnDrSam = Yes THEN Code11 CIRCLE CONSENT CODE 11 ON FRONT OF CONSENT BOOKLET. ENTER '1' TO CONTINUE. 1 Continue
ELSEIF SnDrSam = No THEN Code122 CIRCLE CONSENT CODE 12 ON FRONT OF CONSENT BOOKLET. ENTER '1' TO CONTINUE. 1 Continue ENDIF Saliva sample
ALL AGED 4+ (EXCEPT PREGNANT WOMEN) SalInt1 NURSE: NOW FOLLOWS THE SALIVARY SAMPLE. ENTER '1' TO CONTINUE. 1 Continue SalIntr1 NURSE: IF YOU HAVE NOT ALREADY DONE SO, ASK RESPONDENT FOR A SALIVA SAMPLE. READ OUT: I would like to take a sample of saliva (spit). This simply involves (dribbling saliva down a straw into a tube/keeping a dental roll in your mouth for a few minutes) Are you willing to have a saliva sample taken? IF ASKED: The sample will be analysed for cotinine, which is related to the intake of tobacco smoke and is of particular interest to see if non-smokers may have raised levels as a result of 'passive' smoking 1 Respondent agrees to give saliva sample 2 Respondent refuses to give saliva sample 3 Unable to obtain saliva sample for reason other than refusal IF SalIntr1=Agree THEN SalInst (ASK CHILD TO DRIBBLE THROUGH STRAW INTO TUBE/ASK RESPONDENT TO INSERT DENTAL ROLL IN MOUTH AND PROVIDE SALIVA SAMPLE) ENTER '1' TO CONTINUE. 1 Continue SalObt1 NURSE CHECK 1 Saliva sample obtained 2 Saliva sample refused 137 3 Saliva sample not attempted 4 Attempted but not obtained ENDIF IF (SalObt1=Refused, Not attempted or Attempted, not obtained) OR (SalIntr1=Unable) THEN SalNObt RECORD WHY SALIVA SAMPLE NOT OBTAINED. CODE ALL THAT APPLY. 1 Parent/‘Parent’ refused 2 Respondent refused 3 Respondent not able to produce any saliva 4 Other (SPECIFY AT NEXT QUESTION) IF SalNObt = Other THEN OthNObt GIVE FULL DETAILS OF REASON(S) WHY SALIVA SAMPLE NOT OBTAINED. Text: Maximum 140 characters ENDIF ENDIF ENDIF ENDIF AllCheck CHECK BEFORE LEAVING RESPONDENT: • THAT ALL (CHILDREN AGED 2-15/RESPONDENTS) HAVE A CONSENT BOOKLET. • THAT FULL GP DETAILS ARE ENTERED ON FRONT OF CONSENT BOOKLET. • THE NAME BY WHICH GP KNOWS RESPONDENT. • THAT ALL DETAILS ARE COMPLETED ON FRONT OF CONSENT BOOKLET. • THAT ALL NECESSARY SIGNATURES HAVE BEEN COLLECTED. • THAT THERE ARE SIX APPROPRIATE CONSENT CODES RINGED ON FRONT OFCONSENT BOOKLET. 1 Continue Thank NURSE: END OF QUESTIONNAIRE REACHED. THANK RESPONDENTS FOR THEIR CO-OPERATION. THEN ENTER '1' TO FINISH. SHS 98 P 1731 SHS 98 P 1731
ShowPain TrtWze CARD A CARD B
A general practitioner (GP)
Nurse at GP surgery/Health centre
Community, School or District Nurse
Hospital casualty/Accident & Emergency department
Consultant/Specialist or other doctor at hospital outpatients 138 Consultant/Specialist or other doctor elsewhere
Homeopath
Acupuncturist
Other alternative medicine professional SHS 98 P 1731 SHS 98 P 1731
DrWyr DrInj CARD C CARD D
On a pavement or a pedestrian area 1. Broken bones
On a road 2. Dislocated joints
In a home or garden 3. Losing consciousness (either your own or someone else’s) 4. Straining or twisting a part of the body
In a place used for sports, play or recreation 5. Cutting, piercing or grazing a part of the body (including sports facility at a school or college) 6. Bruising, pinching or crushing a part of the In some other part of a school or college body 139 In an office, factory, shop, pub, restaurant or other 7. Swelling or tenderness in some part of the public building body 8. Getting something stuck in the eye, throat, Somewhere else (PLEASE SPECIFY) ear or other part of the body
9. Burning or scalding
10. Poisoning
11. Other injury to internal parts of the body
12. Animal or insect bite or sting
13. Other (PLEASE SPECIFY) SHS 98 P 1731 SHS 98 P 1731
HWrkList DrAid CARD E CARD F
1. Hospital HOUSEWORK 2. GP/Family Doctor 3. Nurse at GP surgery Hoovering 4. Nurse at place of work, school or college 5. Doctor at place of work, school or college Dusting
6. Other doctor or nurse Ironing 7. Ambulance staff General tidying 8. Volunteer first aider 9. Chemist or pharmacist Washing floors and paint work 140 10. Family, friends, colleagues, passers-by 11. Looked after self 12. Other person/s SHS 98 P 1731 SHS 98 P 1731
HevyHWrk GardList CARD G CARD H
HEAVY HOUSEWORK GARDENING, DIY AND BUILDING WORK
Moving heavy furniture Hoeing, weeding, pruning
Spring cleaning Mowing with a power mower
Walking with heavy shopping Planting flowers/seeds (for more than 5 minutes) Decorating Cleaning windows
141 Minor household repairs Scrubbing floors with a scrubbing brush Car washing and polishing
Car repairs and maintenance SHS 98 P 1731 SHS 98 P 1731
ManWork ActPhy CARD I CARD J
HEAVY MANUAL WORK 1 Swimming
2 Cycling
Digging, clearing rough ground 3 Workout at a gym / Exercise bike / Weight training Building in stone/bricklaying 4 Aerobics / Keep fit / Gymnastics / Dance for Mowing large areas with a hand mower fitness
Felling trees, chopping wood 5 Any other type of dancing
142 Mixing/laying concrete 6 Running / Jogging
Moving heavy loads 7 Football / Rugby
Refitting a kitchen or bathroom 8 Badminton / Tennis
9 Squash
10 Exercises (e.g. press-ups, sit-ups)
Please also include teaching, coaching and training/practice sessions SHS 98 P 1731 SHS 98 P 1731
DayWlkT etc SportDo
CARD K CARD L
Less than 5 minutes SPORTS AND EXERCISE ACTIVITIES
5 minutes, less than 15 minutes INCLUDE any sports and exercise activities like: 15 minutes, less than 30 minutes
30 minutes, less than 1 hour Playing football, rugby or netball in a include playing in: team,or any other organised team a practice session a match 2 games 1 hour, less than 1 hours a club Playing tennis, squash or badminton out-of-school lesson 1 2 hours, less than 2 hours 143 2 2 hours, less than 2 hours Going swimming or swimming lessons 2 2 hours, less than 3 hours Gymnastics (include Toddler Gym, Tumble Tots etc)
Dance lessons, ballet lessons, ice skating 3 hours, less than 3 2 hours Horse riding 3 2 hours, less than 4 hours Disco dancing 4 hours or more (please say how long)
Any other organised sports, team sports or exercise activities SHS 98 P 1731 SHS 98 P 1731
WeActDo/WkActDo BrSlice CARD M CARD N
Other active things like: 6 or more a day
4 or 5 a day Ride a bike 2 or 3 a day Kick a ball around One a day Run about (outdoors or indoors) Less than one a day Play active games Jump around 144
Any other things like these SHS 98 P 1731 SHS 98 P 1731
FryFat Cereals etc CARD O CARD P
Solid cooking fat 6 or more times a day (including butter, dripping, lard, ghee, white cap, cookeen) 4 or 5 times a day
Half-fat butter 2 or 3 times a day
Polyunsaturated, sunflower or olive margarine Once a day
Other hard or soft margarine or dairy blend 5 or 6 times a week (including Flora, Clover, Willow) 2 to 4 times a week Low-fat spreads 145 Once a week Vegetable oil (including olive, sunflower, soya, corn, peanut, 1 to 3 times per month rapeseed) Less often or never Some other kind of fat / oil SHS 98 P1731 SHS 98 P 1731
SmokCond Passive CARD R CARD Q
1. At own home 1. Heart trouble/problem 2. At work 2. High blood pressure 3. In other people’s homes 3. Cancer 4. On public transport 4. Bronchitis 5. In pubs 5. Cough 6. In other public places 6. Shortness of breath 7. Other respiratory problems (incl. asthma)
146 8. Cold/flu/virus 9. Pregnancy 10. Ulcer or other gastro-intestinal problem 11. Diabetes 12. Any other condition (PLEASE SAY WHAT) SHS 98 P 1731 SHS 98 P 1731
NBeer etc DrnkType CARD S CARD T
1 Almost every day 1. Normal strength ( less than 6 % alcohol ) beer, lager, stout, cider, or shandy ( excluding cans or 2 Five or six days a week bottles of shandy )
3 Three or four days a week 2. Strong beer, lager, stout or cider ( 6% alcohol or more ) 4 Once or twice a week ( eg. Tennants Extra, Special Brew, Diamond White ) 5 Once or twice a month 3. Spirits or Liqueurs ( e.g. Gin, Whiskey, Brandy, 6 Once every couple of months Rum, Vodka, Advocaat, Cocktails )
7 Once or twice a year 4. Sherry or Martini ( including Port, Vermouth, 147 Cinzano and Dubonnet ) 8 Not at all in the last twelve months 5. Wine ( including Babycham and Champagne )
6. Alcoholic soft drinks or alcopops (such as Hooch, Two Dogs, Alcola )
7. Other alcoholic drinks
8. Low alcohol drinks only SHS 98 P 1731 SHS 98 P 1731
Activ / CIEAct WhyDent CARD U CARD V
1. Going to school or college full-time (including S/He was having trouble with their teeth on vacation) We had a note from the school dentist 2. In paid employment or self-employed (or S/He went for a check-up away temporarily)
S/He just went to get used to going to the dentist 3. Waiting to take up paid work already obtained Or for some other reason (PLEASE SPECIFY) 4. Looking for work
5. Intending to look for work but prevented by temporary sickness 148
6. Permanently unable to work because of long- term sickness or disability
7. Retired
8. Looking after the home or family
9. Doing something else (PLEASE SPECIFY) SHS 98 P 1731 SHS 98 P 1731
TopVocat CARD W CARD X
1. Degree or degree level qualification (incl. Higher 1. SCOTVEC National Certificate Modules degree 2. SCE Higher/ CSYS (Certificate of Sixth Year 2. HNC/HND, BEC/TEC Higher, BTEC Higher Studies)/ A levels 3. ONC, OND, BEC/TEC not higher 3. SCE Ordinary ( O Grades) Bands A - C 4. City and Guilds Full Technological Certificate 4. Standard Grade (Level 1 - 3) 5. City and Guilds Advanced/Final level 6. City and Guilds Craft/Ordinary level 5. SLC Lower 7. Nursing qualifications (SRN, RGN, RMN, SEN, 6. SUPE Lower or Ordinary RSCN,RM, RHV) 7. ‘O’ level passes (Grade A - C if after 1975) 8. Teaching qualification 8. GCSE (grade A - C)
149 9. SVQ/NVQ Level V 9. CSE Grade 1 10. SVQ/NVQ Level IV 10. School Certificate or Matric 11. SVQ/NVQ Level III/Advanced level GNVQ 12. SVQ/NVQ Level II/Intermediate level GNVQ 11. SCE Ordinary ( O Grades) Bands D & E 13. SVQ/NVQ Level I/Foundation level GNVQ 12. Standard Grade (Level 4, 5) 14. Clerical or commercial qualifications (such as typing, 13. CSE Grades 2 - 5 bookkeeping, commerce) 15. Recognised Trade Apprenticeship completed 14. GCE ‘O’ Levels D & E (if after 1975) 15. GCSE (Grades D, E, F, G) 16. Other vocational or professional qualification 16. CSE ungraded (PLEASE SAY WHAT) 17. Foreign qualifications - (PLEASE SAY WHAT) 17. NO VOCATIONAL/PROFESSIONAL 18. Other academic qualifications (PLEASE SAY QUALIFICATIONS WHAT) 19. NO ACADEMIC QUALIFICATIONS SHS 98 P 1731 SHS 98 P 1731
Ethnic ConsMaB, ConsPaB CARD Y CARD Z
1. White 1. High Blood Pressure 2. Black - Caribbean 2. Angina 3. Black - African 3. Heart Attack 4. Black - Other 4. Stroke 5. Indian 5. Other Heart Trouble 6. Pakistani 6. Diabetes
150 7. Bangladeshi
8. Chinese
9. None of these ✓ 08 ✓
151 152 153 154 155 156 157 158 159 08 ✓ ✓
160 161 162 163 164 165 ✓ 166 10 167 168 ✓ 08 ✓
169 170 171 172 173 174 175 176 177 178 Spr NCereal
CODING LIST 1 CODING LIST 2 FOR CODING BUTTER/MARGARINE FOR CODING BREAKFAST CEREALS NB: All the cereals listed on this card are high in fibre and should be coded 1 or 2 as indicated. For any NB:All brands of butter and hard/block margarine code 1. cereal not on the list with bran, oats or wheat in the name, code 3 and enter the name at OthCer.
Anchor Half Fat Spread...... 2 Olive Gold Light (Sainsbury’s)...... 2 BRAN CEREALS CODE 1 Anchor Low Fat Spread ...... 2 Olivio...... 1 All Bran (any brand) Asda Country Blend 1 Olivite 2 ...... Bran Breakfast (Tesco’s) Asda Golden Soft ...... 2 Outline ...... 2 Asda Hi-Life ...... 2 Pact with Omega 3 fatty acids ...... 1 Bran Buds Asda Sunflower low fat spread...... 2 Safeway Branflakes (any brand) Banquet soft margarine...... 1 Golden Low Fat Spread ...... 2 Branflakes with sultanas (any brand) Blue Band soft margarine...... 1 Low Fat Sunflower Spread ...... 2 High Fibre Bran (Sainsbury’s) Blue Leaf soft margarine...... 1 Meadow ...... 1 Nabisco Team Butter (any variety)...... 1 Olive ...... 1 Natural Bran Butterlicious (Sainsbury’s) ...... 1 Reduced Fat Soft Spread...... 1 Sultana Bran (any brand) Clover ...... 1 Soft margarine...... 1 Team (Nabisco) Clover, lightly salted ...... 1 Very Low Fat Spread (Simplese)...... 2 Clover Extra Lite / Diet...... 2 Sainsbury OAT OR WHEAT CEREALS CODE 2 Co-op Good Life low fat sunflower spread...... 2 Butterlicious...... 1 Allinson s Tropical Break Wholeflakes Nutri-Grain Co-op Red Seal Soft Spread 1 County Light 2 ...... Alpen Oat and Bran flakes (any brand) County Light ...... 2 County Spread...... 1 Alpen with Tropical Fruit Oat Bran flakes (any brand) Dairy Crest Willow...... 1 Half Fat Spread...... 2 Dalesby’s...... 1 Luxury Soft Margarine ...... 1 Apricot Wheats (Sainsbury’s) Oat Bran flakes with added fruit (any brand) Delight ...... 2 Olive Gold ...... 1 Balance (Sainsbury’s) Oat Krunchies Delight Extra Low / Diet...... 2 Olive Gold Light...... 2 Billington s Organic Muesli Oat and wheat bran (any brand) e.g. Weetabix Echo hard margarine...... 1 Soft Spread...... 1 Cherry Wheats (Sainsbury’s) Organically grown oat flakes (Sainsbury’s) Encore Sol...... 1 Sunflower Low Fat Spread ...... 2 Cheshire Natural Muesli Porridge Oats (any brand) Encore Sol Light ...... 2 Sunflower Very Low Fat Spread ...... 2 Cheshire Fruit and Fibre Muesli Porridge with Bran (any brand) 179 Encore Supersoft Luxury Margarine ...... 1 Shape Sunflower Spread ...... 2 Clusters Puffed Wheat (any brand) Flora / Flora Buttery / Flora Reduced Salt 1 Slimmers Gold Sunflower Low Fat Spread 2 ...... Coco Shreddies Quaker Harvest Oat Krunchies Flora Light...... 2 Somerfield Low Fat Sunflower ...... 2 Quaker Oat Bran Gold (St. Ivel) 2 Somerfield Supersoft 1 Common Sense (Kellogg’s) ...... Quaker Oat Bran Crispies Gold Extra Light / Lowest (St. Ivel) ...... 2 Soya Margarine (own brands)...... 1 Country Store muesli Quaker Oats Golden Crown (Kraft) (Golden Churn)...... 1 St Ivel Gold ...... 2 Crunchy Oat Cereal (Sainsbury’s) Golden Crown Light ...... 1 St Ivel Gold Lowest ...... 2 Crunchy muesli Raisin Splitz Golden Olive...... 2 St Ivel Mono...... 1 Cubs (mini Shreddies) Raisin Wheats (Sainsbury’s) Golden Vale...... 1 Stork / Stork SB...... 1 Deeside Apricot and Yoghurt Cereal Ready Brek (any variety / brand) Granose...... 1 Stork Rich Blend...... 1 Frosted Shreddies Ryvita Cornflakes - High Fibre only Half Fat Anchor...... 2 Stork Light Blend...... 1 Fruit and Fibre (any brand) Scottish Oatflakes with wheatbran (Sainsbury’s) Half Fat butters (own brand)...... 2 Summer County...... 1 Fruit filled mini shredded wheat Shredded Wheat (includes Bite Size) Hard margarine (own brand) 1 Sunflower margarine (own brands) 1 ...... Harvest Crunch muesli Shredded Malt Wheats (Tesco) I can t believe it s not butter...... 1 Sunflower low fat spreads (own brands)...... 2 Instant hot oat cereal (any brand) Shreddies (any brand) I can t believe it s not butter Light...... 2 Sunflower very low fat spreads (own brands) ...... 2 Squared Malt Bites (Safeway) Kerrygold Light...... 2 Tesco Instant porridge (any brand) Kraft Special Soft...... 1 Butter Me Up...... 1 Jordan’s Crispy Muesli Start Krona Gold ...... 1 Golden Blend...... 1 Jordan’s Oat Bran Hearts Strawberry Wheats (Sainsbury’s) Krona Spreadable...... 1 Healthy Eating _ Fat Sunflower Spread...... 2 Jordan’s Original Crunchy Muesli Strike Latta...... 2 Healthy Eating Very Low Fat Spread...... 2 Jordan’s Porridge Oats Sustain Marks and Spencer Healthy Eating Lowest Ever Soft Spread...... 2 Jordan’s Special Recipe Muesli Swiss Style Muesli (any brand) English Churn ...... 1 Tomor hard margarine ...... 1 Malties Toppas Sunglow...... 2 Utterly Butterly...... 1 Maple and Nut Flakes (Sainsbury’s) Weetabix Sunflower Lite...... 2 Vitalite ...... 1 Weetaflakes Mini Shredded Wheat Meadowcup ...... 1 Vitalite Light ...... 2 Wheatflakes (any brand) Mello 1 Vitaquelle 2 Mini Wheats ...... Wheatflakes with fruit (any brand) Mono (St Ivel)...... 1 Weight Watchers ...... 2 Mornflakes Chocolate Fruit and Nut Crunch Wholewheat biscuits (e.g Weetabix) Olive Gold (Sainsbury’s)...... 1 Willow (Dairy Crest) ...... 1 Muesli (any brand/variety) Wholewheat Mini-Flakes Nut Feast (Kellogg’s) Wholewheat Muesli (any brand) INTERVIEWER CARD
Coding Frame for Heart Murmur, Abnormal Heart Rhythm and other Heart Trouble
Coding Medical Term Lay Term Category
Heart Bruit Heart Murmur
Heart Valvular Heart Disease Damaged Heart Valves Murmur (most commonly called mitral and aortic) Rheumatic Fever Rheumatic Heart Disease (affecting the heart)
Palpitations (heart Palpitations arrhythmias) Rapid Heart Abnormal Tachycardia Heart Slow Heart 180 Rhythm Bradycardia (heart block) Flutter Heart Fibrillation
Congestive Cardiac Failure
Right Sided Heart Failure Heart Failure Weakening Heart Other Left Sided Heart Failure Heart Trouble Congenital Heart Disease Born with Heart Problem
Other Various
This is a list of conditions which might come up in the Diagnosis & Treatment section of the CVD module, and/or in the Parental History section of the Other Classification module 181 182 APPENDIX B: MEASUREMENT PROTOCOLSB
1. HEIGHT AND WEIGHT MEASUREMENTS
1.1 The Equipment You are provided with a portable stadiometer. It is a collapsible device with a sliding head plate, a base plate and three connecting rods marked with a measuring scale.
Please take great care of this equipment. It is delicate and expensive. Particular care needs to be taken when assembling and disassembling the stadiometer and when carrying or repacking it in the box provided.
- Do not bend the head or base plate - Do not bend the rods - Do not drop it and be careful not to knock the corners of the rods or base plate pin - Assemble and disassemble the stadiometer slowly and carefully
The stadiometer will be sent to you in a special cardboard box. Always store the stadiometer in the box when it is not in use and always pack the stadiometer carefully in the box whenever you are sending it on by courier. Inside the box with the stadiometer is a special bag that you should use for carrying the stadiometer around when you are out on assignment.
The rods There are three rods marked with a measuring scale divided into centimetres and then further subdivided into millimetres. (If you are not familiar with the metric system note that there are ten millimetres in a centimetre and that one hundred centimetres make a metre). The rods are made of aluminium and you must avoid putting any kind of pressure on them which could cause them to bend. Be very careful not to damage the corners of the rods as this will prevent them from fitting together properly and will lead to a loss of accuracy in the measurements.
The base plate Be careful not to damage the corners of the base plate as this could lead to a loss of accuracy in the measurements.
Protruding from the base plate is a pin onto which you attach the rods in order to assemble the stadiometer. Damage to the corners of this pin may mean that the rods do not stand at the correct angle to the base plate when the stadiometer is assembled and the measurements could be affected.
The head plate There are two parts to the head plate; the blade and the cuff. The blade is the part that rests on the respondent’s head while the measurement is taken and the cuff is the part of the head plate that slips over the measurement rods and slides up and down the rods. The whole unit
183 is made of plastic and will snap if subjected to excessive pressure. Grasp the head plate by the cuff whenever you are moving the headplate up or down the rods, this will prevent any unnecessary pressure being applied to the blade which may cause it to break.
You will receive your stadiometer disassembled with the three rods banded together and the head plate attached to the pin so that the blade lies flat against the base plate. Do not remove the head plate from this pin.
Note that the pin on the base plate and the rods are numbered to guide you through the stages of assembly. (There is also a number on the side of the rods, this is the serial number of the stadiometer). The stages are as follows:-
1 Lie the base plate flat on the floor area where you are to conduct the measurements.
2 Take the rod marked number 2. Making sure the yellow measuring scale is on the right hand side of the rod as you look at the stadiometer face on, place rod 2 onto the base plate pin. It should fit snugly without you having to use force.
3 Take the rod marked number 3. Again make sure that the yellow measuring scale connects with the scale on rod 2 and that the numbers run on from one another. (If they do not, check that you have the correct rod). Put this rod onto rod number 2 in the same way you put rod 2 onto the base plate pin.
4 Take the remaining rod and put it onto rod 3.
Disassembling the stadiometer Follow these rules:-
1 Before you begin to disassemble the stadiometer you must remember to lower the head plate to its lowest position, so that the blade is lying flat against the base plate
2 Remove one rod at a time
1.2 The Protocol - Adults (16+) 1. Ask the respondent to remove their shoes in order to obtain a measurement that is as accurate as possible.
2. Assemble the stadiometer and raise the headplate to allow sufficient room for the respondent to stand underneath it. Double check that you have assembled the stadiometer correctly.
3. The respondent should stand with their feet flat on the centre of the base plate, feet together and heels against the rod. The respondent’s back should be as straight as possible, preferably against the rod but NOT leaning on it. They should have their arms hanging loosely by their sides. They should be facing forwards.
4. Move the respondent’s head so that the Frankfort Plane is in a horizontal position (ie parallel to the floor). The Frankfort Plane is an imaginary line passing through the external ear canal and across the top of the lower bone of the eye socket, immediately under the eye. This position is important if an accurate reading is to be obtained. An additional check is to ensure that the measuring arm rests on the crown of the head, ie the top back half.
184 To make sure that the Frankfort Plane is horizontal, you can use the Frankfort Plane Card to line up the bottom of the eye socket with the flap of skin on the ear. The Frankfort Plane is horizontal when the card is parallel to the stadiometer arm.
5. Instruct the respondent to keep their eyes focused on a point straight ahead, to breathe in deeply and to stretch to their fullest height. If after stretching up the respondent’s head is no longer horizontal, repeat the procedure. It can be difficult to determine whether the stadiometer headplate is resting on the respondent’s head. If so, ask the respondent to tell you when s/he feels it touching their head.
6. Ask the respondent to step forwards. If the measurement has been done correctly the respondent will be able to step off the stadiometer without ducking their head. Make sure that the head plate does not move when the respondent does this.
7. Look at the bottom edge of the head plate cuff. There is a green arrowhead pointing to the measuring scale. Take the reading from this point and record the respondent’s height in centimetres and millimetres, that is in the form 123.4, at the question “Height.” You may at this time record the respondent’s height onto their Measurement Record Card and at the question “MbookHt” you will be asked to check that you have done so. At that point the computer will display the recorded height in both centimetres and in feet and inches. At RelHiteB you will be asked to code whether the measurement you obtained was reliable or unreliable.
8. Note that you should record the measurement to the nearest even millimetre. This means that if the reading should fall over an odd number but not quite to the full even number, then you should record to the even number anyway. Eg. for a reading 165.1 where the measurement is actually over the one millimetre mark but not quite up to the two, you would nevertheless record 165.2.
9. Push the head plate high enough to avoid someone hitting their head against it when getting ready to be measured.
1.3 The Protocol - Children (2-15) The protocol for measuring children differs slightly to that for adults. You must get the co- operation of an adult household member. You will need their assistance in order to carry out the protocol, and children are much more likely to be co-operative themselves if another household member is involved in the measurement. If possible measure children last so that they can see what is going on before they are measured themselves.
Children’s bodies are much more elastic than those of adults. Unlike adults they will need your help in order to stretch to their fullest height. This is done by stretching them. This is essential in order to get an accurate measurement. It causes no pain and simply helps support the child while they stretch to their tallest height.
It is important that you practice theses measurement techniques on any young children among your family or friends. The more practice you get before going into the field the better your technique will be.
1. In addition to removing their shoes, children should remove their socks as well. This is not because socks affect the measurement. It is so that you can make sure that children don’t lift their heels off the base plate (see 3 below).
2. Assemble the stadiometer and raise the head plate to allow sufficient room for the child to stand underneath it.
185 3. The child should stand with their feet flat on the centre of the base plate, feet together and heels against the rod. The child’s back should be a straight as possible, preferably against the rod, and their arms hanging loosely by their sides. They should be facing forwards.
4. Place the measuring arm just above the child’s head.
5. Move the child’s head so that the Frankfort plane is in a horizontal position. This position is as important when measuring children as it is when measuring adults if the measurements are to be accurate. To make sure that the Frankfort Plane is horizontal, you can use the Frankfort plane card to line up the bottom of the eye socket with the flap of skin on the ear. The Frankfort plane is horizontal when the card is parallel to the stadiometer arm.
6. Cup the child’s head in your hands, placing the heels of your palms on either side of the chin. Your fingers should come to rest just under the ears.
7. Firmly but gently, apply upward pressure lifting the child’s head upwards towards the stadiometer headplate and thus stretching the child to their maximum height. Avoid jerky movements, perform the procedure smoothly and take care not to tilt the head at an angle; you must keep it in the Frankfort plane. Explain what you are doing and tell the child that you want them to stand up straight and tall but not to move their head or stand on their tip-toes.
8. Ask the household member who is helping you to lower the head plate down gently onto the child’s head. Make sure the headplate touches the skull and that it is not pressing down too hard.
9. Still holding the child’s head, relieve traction and allow the child to stand relaxed. If the measurement has been done properly the child should be about to step off the stadiometer without ducking their head. Make sure that the child does not knock the headplate as they step off.
10. Read the height value in metric units to the nearest millimetre and enter the reading into the computer at the question “Height”. At the question “MBookHt” you will be asked to check that you have entered the child’s height onto their measurement record Card. At that point the computer will display the recorded height both in centimetres and in feet and inches.
11. Push the head plate high enough to avoid any member of the household hitting their head against it when getting ready to be measured.
Height refused, not attempted or attempted but not obtained At HtResp you are asked to code whether the measurement was taken, refused, attempted but not obtained or not attempted. If for any reason you cannot get a height measurement, enter the appropriate code at this question and you will automatically be routed to the relevant follow up questions (ResNHi and NoHitM) which will allow you to say why no measurement was obtained.
Additional points 1. If the respondent cannot stand upright with their back against the stadiometer and have their heels against the rod (eg those with protruding bottoms) then give priority to standing upright.
186 2. If the respondent has a hair style which stands well above the top of their head, (or is wearing a turban), bring the headplate down until it touches the hair/turban. With some hairstyles you can compress the hair to touch the head. If you can not lower the headplate to touch the head, and think that this will lead to an unreliable measure, record this at question “HtAffM.” If it is a hairstyle that can be altered, eg a bun, if possible ask the respondent to change/undo it.
3. If the respondent is tall, it can be difficult to line up the Frankfort Plane in the way described. When you think that the plane is horizontal, take one step back to check from a short distance that this is the case.
PROTOCOL FOR TAKING WEIGHT MEASUREMENT 1.4 The Equipment The Soehnle scales are turned on by pressing the top of the scale (eg with your foot). There is no switch to turn the scales off, they turn off automatically. When you are storing the scales, or sending them through the post, please make sure that you remove the battery - to stop the scales turning themselves on.
Batteries The scales take 1 x 9v rectangular MN1604 6LR61 batteries. It should not be necessary to have to replace the batteries, but if the display indicates .7.2.5, or another series of numbers separated by decimal points, it is indicating low output. Always ensure that you have some spare batteries with you in case this happens. If you need to change the battery, please buy one and claim for it. This type of battery is commonly available.
The battery compartment is on the bottom of the scales. When you receive your scales you will need to reconnect the battery. Before going out to work, reconnect the battery and check that the scales work. If they do not, check that the battery is connected properly and try new batteries. If they still do not work, report the fault to your Area Manager.
The reading is only in metric units, but as for height, the computer provides a conversion. If the respondent would like to know their weight in stones and pounds you will be able to tell them when the computer has done the calculation.
IMPORTANT WARNING The scales have an inbuilt memory which stores the weight for 10 minutes. If during this time you weigh another object that differs in weight by less than 500 grams, the stored weight will be displayed and not the weight that is being measured. This means that if you make an error and need to weigh someone for a second time, you could be given the wrong reading.
So if you get an identical reading for a second reading when you would not expect one, make sure that the memory has been cleared. Clear the memory from the last reading by weighing an object that is more than 500 grams lighter (ie a pile of books, your briefcase or even the stadiometer). You will then get the correct weight when you weigh the second time.
187 1.5 The Protocol 1. Turn the display on by pressing firmly with your hand or foot on the top of the scales (the scales will turn themselves off after a short while). The readout should display 888.8 momentarily as a check for the operation - if this is not displayed check the batteries, if this is not the cause you may need to report the problem to SCPR. While the scales read 888.8 do not attempt to weigh anyone.
2. Ask the respondent to remove shoes, heavy outer garments such as jackets and cardigans, heavy jewellery, loose change and keys.
3. Turn the scales on with your foot again. Wait for a beep and display of 0.0 before the respondent stands on the scales.
4. Ask the respondent to stand with their feet together in the centre and their heels against the back edge of the scales. Arms should be hanging loosely at their sides and head facing forward. Ensure that they keep looking ahead - it may be tempting for the respondent to look down at their weight reading. Ask them not to do this and assure them that you will tell them their weight afterwards if they want to know.
The posture of the respondent is important. If they stand to one side, look down, or do not otherwise have their weight evenly spread, it can affect the reading.
5. The scales will take a short while to stabilize and will read ‘C’ until they have done so. If the respondent moves excessively while the scales are stabilizing you may get a false reading. If you think this is the case reweigh, but first ensure that you have erased the memory.
6. The Soehnle scales have been calibrated in kilograms and 100 gram units (0.1 kg). Record the reading into the computer at the question “Weight” before the respondent steps off the scales. At question “MBookWt” you will be asked to check that you have entered the respondent’s weight onto their Measurement Record Card. At that point the computer will display the measured weight in both kilos and in stones and pounds.
WARNING The maximum weight registering accurately on the scales is 130kg (20_ stone). If you think the respondent exceeds this limit code them as “Weight not attempted” at “WtResp”. The computer will display a question asking them for an estimate. Do not attempt to weigh them.
Additional note Pregnant women do not have their weight measured. For women respondents aged 16-49, the computer displays a question asking them whether they are pregnant and then enforces the appropriate routing.
188 SUPPLEMENTARY INSTRUCTIONS FOR ALTERNATIVE MEASURING EQUIPMENT
PROTOCOL FOR TAKING HEIGHT MEASUREMENT USING THE LEICESTER HEIGHT MEASURE
1.6 The Equipment Like the metal stadiometer also used for this survey, The Leicester height measure is a portable stadiometer which is collapsible and consists of a base plate, a head plate and some connecting rods marked with a measuring scale. The Leicester height measure differs from the metal stadiometer in that it is made of plastic and is constructed from four rods instead of three.
Please take great care of this equipment. Being made of plastic it is relatively vulnerable to breakage or other damage. Particular care is needed when handling the head plate and base.
The Leicester height measure is provided in a cardboard box. Always store the stadiometer in this box.
How to pack the height measure Always pack the height measure before placing it in its box. First slot the four rods horizontally into the back of the base plate so that the thick ends connect with the base plate and the thin ends are free, with the metal measuring scale uppermost. There is space for two rods on each side of the base plate. Hold each pair of rods in position using an elastic band. Then secure the head plate to one pair of rods and the two stabilisers to the other pair, using elastic bands. Finally, place the secured equipment in the cardboard box. It should fit in neatly. Check that all parts are secured with elastic bands so that they are not free to move about when the box is carried.
The rods There are four rods. Each is marked with two scales: • a black and white scale showing feet and inches. This must not be used. • a yellow scale metal scale showing centimetres. This must always be used. The metal strip has been individually calibrated for that equipment and so is more accurate than the scale which was pre-printed on the plastic rod.
Be very careful not to bend or damage the rods or separate the yellow metal scale from the plastic rod. If you find that the equipment is damaged in any way contact the office to let them know.
How to assemble the height measure 1. Place the base plate on the floor. Take the first rod (which has an arrow and a diagram marked at one end) into the base plate to that the scale can be read from the right side of the person when s/he is standing on the base plate. 2. Place the first stabilizer over the top of the first rod so that it points towards the wall, at the back of the stadiometer. 3. Attach the second rod (2 and 3 feet; ensure that the symbols at the end of rods match). 4. Attach the third rod (4 and 5 feet; ensure that the symbols match) 5. Attach the fourth rod (6 feet; ensure that the symbols match) 6. Place the head plate over the fourth rod and bring it down to a little above head height. 7. Place the second stabilizer over the top of the fourth rod, pointing towards the wall, above the head plate.
To disassemble the stadiometer remove one piece at a time in the reverse order from that above (i.e. from 7 through to 1).
189 1.6 The Protocol This is exactly the same as for the metal stadiometer (see above).
2. BLOOD PRESSURE MEASUREMENTS AND HEART RATE READINGS ages 5-74 BPIntro-BPOffer 2.1 Purpose: High blood pressure is an important risk factor for cardiovascular disease. During the first visit, the interviewer will have asked the respondent if he/she has ever had high blood pressure. If this is the case more detailed information will have been collected.
However, it is important that we look at the blood pressure of everyone in the survey using a standard method so we can see the distribution of blood pressure across the population. This is vital for monitoring change over time, and monitoring progress towards lower blood pressure.
2.2 Eligibility: All children aged 5 and over are eligible for this measurement. The technique is exactly the same as with adults. The survey equipment is not suitable for taking the blood pressure of younger children. The only people not eligible for blood pressure measurement are those who are pregnant. However, if a pregnant woman wishes to have her blood pressure measured, you may do so, but do not record the readings in the computer.
All other respondents are eligible, unless they do not wish to give their permission.
2.3 Equipment: Dinamap 8100 blood pressure monitor Blue pneumatic hose Child cuff (12-19 cm) Small adult cuff (17-25 cm) Standard adult cuff (23-33 cm) Large adult cuff (31-40 cm) Power cord
Extra large cuffs are also available from your Nurse Supervisor, should you require one.
The Dinamap 8100 blood pressure monitor is an automated machine. It is designed to measure systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP) and pulse rate automatically at pre-selected time intervals. On this survey three readings are collected at one minute intervals.
The Dinamap is equipped with a rechargeable battery, which can run for a minimum of six hours when fully charged. It is essential to keep the battery charged as fully as possible. A yellow battery light will flash as a warning sign on the monitor to alert the user when the charge has fallen below 10%. To recharge the battery, connect the monitor to the mains and press the rear panel AC power switch to the ON (‘I’) position. The green MAINS AC light will indicate that the battery is charging. An overnight charge (eight hours) will provide about four hours of operation.
PLEASE REMEMBER TO CHARGE THE BATTERY !!
When the Dinamap is switched on the monitor momentarily displays eights (888s) in all the digital displays and all indicators will flash as a check for the operation of all LEDs. The audio alarm is also sounded as a check for its operation. If on turning on the monitor any
190 of the displays fail to show the 888s, contact the nurse supervisor immediately and inform them that there is a problem with the monitor.
2.4 Preparing the respondent: As with adults, a child’s blood pressure reading on a single occasion is not enough to define whether a child’s blood pressure is normal or abnormal. In addition, the level at which a child’s blood pressure is considered to be abnormal will be dependent on that child’s age, height and sex. Because of this, unlike the adult situation, you will not be given statements to read out regarding blood pressure for children. Instead we wish you to explain to the parents what the measurement will mean in advance of doing the measurement. The computer will prompt you with a statement at BPBlurb to read out before taking a child’s blood pressure. This procedure must always be followed. Otherwise, the parent may feel you are withholding information later because their child has an unsatisfactory result.
BPConst - If you code ‘refused’ here, the computer will skip you past the measurement. You should code ‘unable’ if the respondent is prepared to co-operate, but for some reason it is not possible to take the measurement (eg. the Dinamap is
broken or there is some physical reason).
ConSubX - The respondent should not have eaten, smoked, drunk alcohol or taken vigorous exercise in the 30 minutes preceding the blood pressure measurement as blood pressure can be higher than normal immediately after any of these activities. As already suggested, if you can juggle respondents within a household around to avoid having to break this “half-hour rule”, do so. But sometimes this will not be possible and you will have to take their blood pressure within this time period, in which case enter all the codes that apply.
DINNo - Always note down the SCPR number for the Dinamap you are using. Sometimes we identify an equipment problem and wish to be able to track down all readings that have been taken using the particular piece of equipment.
Ask the respondent to remove outer garments (e.g. jumper, cardigan, jacket) and expose the right upper arm. The sleeve should be rolled or slid up to allow sufficient room to place the cuff. If the sleeve constricts the arm, restricting the circulation of blood, ask the respondent if they would mind taking their arm out of the sleeve for the measurement.
CufSize - Selecting the correct cuff
Adults aged 16-74: Do not measure the upper arm circumference. Instead, choose the correct cuff size based on the acceptable range which is marked on the inside of the cuff. You will note that there is some overlap between the cuffs. If the respondent falls within this overlap range then use the standard cuff where possible. If you have a particularly large respondent and the large adult cuff is too small, contact your Nurse Supervisor. She holds a small stock of thigh cuffs which can be used to take the blood pressure of very large people. These are used on the arm in the same way as the ordinary cuffs. If you use one of these cuffs, record in the computer Extra large adult.
Children aged 5 to 15: It is important to select the correct cuff size. The appropriate cuff is the largest cuff which fits between the axilla (underarm) and the antecubital fossa (front of elbow) without obscuring the brachial pulse
191 and so that the index line is within the range marked on the inside of the cuff. You will be provided with a child’s cuff as well as the other adult cuffs. Many children will not need the children’s cuff and instead will require a small adult cuff or a standard adult cuff. You should choose the cuff that is appropriate to the circumference of the arm.
Adults and Children: The appropriate cuff should be connected via the blue pneumatic hose to the two cuff connectors at the bottom of the display. It is important to ensure these screw connectors are properly connected to avoid any air leak. However do not over-tighten. The pneumatic seal is not made by tightening the connector.
2.5 Procedure Wrap the correct sized cuff round the upper right arm and check that the index line falls within the range lines. Use the left arm only if it is impossible to use the right. If the left arm is used, record this on the schedule. Locate the brachial pulse just medial to the biceps tendon and position the arrow on the cuff over the brachial artery. The lower edge should be about 2 cm above the cubital fossa (elbow crease).
Do not put the cuff on too tightly as bruising may occur on inflation. Ideally, it should be possible to insert two fingers between cuff and arm. However the cuff should not be applied too loosely, as this will result in an inaccurate measurement.
The respondent should be sitting in a comfortable chair with a suitable support so that the right arm will be resting at a level to bring the antecubital fossa (elbow) to approximately heart level. They should be seated in a comfortable position with cuff applied, legs uncrossed and feet flat on the floor.
Explain that before the blood pressure measurement we need them to sit quietly for five minutes to rest. They should not smoke, eat, drink or during this time. Explain that during the measurement the cuff will inflate three times and they will feel some pressure on their arm during the procedure.
It is important that children as well as adults rest for five minutes before the measurement is taken. However, making children sit still for five minutes can be unrealistic. They may move around a little, but they should not be running or taking vigorous exercise. As with adults, they should not eat or drink during this time.
After five minutes explain you are starting the measurement. Ask the respondent to relax and not to speak until the measurement is completed as this may affect their reading.
1. Switch the monitor ‘ON’.
2. Press the SILENCE button until the yellow triangle above it lights up.
3. Press the AUTO/MANUAL button until the green triangle above it lights up. The cuff will now start to inflate and take the first measurement.
4. Press the cycle SET button until the number 1 lights up in the minutes box. Blood pressure will then be recorded at one minute intervals thereafter. After each interval record the reading on the computer.
5. It is possible to retrieve any of the three readings if they need to be checked or if you didn’t record them for any reason. To do this wait until the three readings have been
192 taken then press the AUTO/MANUAL button followed by the PRIOR DATA button. This will display the previous reading i.e. the second blood pressure. Press the PRIOR DATA button again to display the first blood pressure reading, and once again to return to the final reading. The minutes display indicates how long ago the measurement was taken. IT IS NOT POSSIBLE to retrieve the readings once the monitor has been switched off.
6. After the three measurements are complete and recorded on the computer switch the monitor ‘OFF’ and remove the cuff.
If there are any problems during the blood pressure measurements or the measurement is disturbed for any reason, press the red cancel button or the power OFF button and start the procedure again. If the respondent has to get up to do something, then ask them to sit and rest for five minutes again.
2.6 Error readings The most common error reading is 844. This is displayed if one measurement exceeds 120 seconds. This is usually caused by the respondent moving during the measurement. Ask the respondent to sit as still as possible and take the measurement again. Do not palpate the pulse and do not tell the respondent their pulse is erratic. If you still get another 844 error reading, record that it wasn’t possible to get a reading and explain to the respondent that this sometimes happens.
Other error readings are detailed on the side of the Dinamap itself.
Readings - Record the blood pressure readings in the order shown on the screen. Double check each entry as you make it to ensure you have correctly entered the reading. If you have got to this point and then become aware that you are not going to be able to get a reading after all, you should enter ‘999’ then press
YNoBP - If you did not get any full readings, you are asked to enter one of three codes. Code 1 should be used if you attempted to take a blood pressure measurement but were unsuccessful. Use code 2 if you did not attempt to take blood pressure for reasons other than a refusal. If you got a refusal, use code 3.
NAttBP - If you failed to get a reading or you managed to obtain only one or two readings, enter a code to show what the problem was. If necessary, write full details at OthNBP.
DifBP - Code whether you experienced any problems obtaining the blood pressure readings.
GPRegB - If you obtained at least one blood pressure reading, you are asked to collect details of the respondent’s GP. If the person agrees to the results going to their GP, turn to the second page of the Consent Booklet (Blood Pressure to GP Consent Form — sheet BP(A) for adults and BP(C) for children under 16 years). Explain you have to get written consent in order to send the blood pressure readings. Fill in the respondent (parent/child) name at the top of the form. Ask the respondent/parent to sign and date the form.
Then turn to the front of the Consent Booklet and ring consent code 01. Ask the respondent for the name, address and telephone number of their GP. If possible, obtain the postcode.
193 Record this at items 7 and 8 of the Consent Booklet (if you have not already done so). If your respondent does not know their GP’s full address and/or postcode, look it up in the relevant telephone directory later (public libraries hold telephone directories for the whole country). You may find it useful to keep a notebook containing the address details of local GPs given by previous respondents, as if you are working the same area, you will almost definitely come across several people with the same GP, and this will save you having to keep looking up the same GP’s details if a respondent cannot give them to you.
2.7 Informing respondents of their blood pressure readings If the respondent wishes, record details of the three readings on their Measurement Record Card.
Child respondents (aged 5 to 15): We do not wish you to comment on the child’s blood pressure readings to the parents. If they seek comment, reiterate what you have already said about not being able to interpret a single blood pressure measurement without checking to see whether it is normal for the child’s age and height. Reassure them that if it is found to be abnormal and if they have given consent for the results to go to the GP, then the GP will get in touch to have the measurement repeated. This rule applies for all readings you obtain.
Adult respondents (aged 16 to 74): In answering queries about the respondent’s blood pressure, it is VERY IMPORTANT to remember that it is not the purpose of the survey to provide respondents with medical advice, nor are you in a position to do so as you do not have the respondent’s full medical history. But, if an adult respondent has a raised blood pressure, you will need to say something. This will be calculated by the computer and will appear on the screen for you to read out exactly as written. Write any advice given onto the MRC. The computer will decide which advice is appropriate based on the following guidelines. (You have been given a Blood Pressure Guide Card which summarises these rules).
Comments are based on the last two of the three readings. The first reading can be high because people are nervous of having their pressure taken.
Definitions of raised blood pressure differ slightly. It has been decided to adopt the ones given overleaf for this survey.
If the blood pressure is Normal, you will be prompted to say, ‘Your blood pressure is normal’.
If the blood pressure is Mildly raised, you will be prompted to say, ‘Your blood pressure is a bit high today. Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure. You are advised to visit your GP within 3 months to have a further blood pressure reading to see whether this is a once-off finding or not.’
194 SURVEY DEFINITION OF BLOOD PRESSURE RATINGS For all women, and men aged less than 50
Rating Systolic Diastolic Normal < 140 and < 85 Mildly raised 140 – 159 or 85 - 99 Moderately raised 160-179 or 100 - 114 Severely raised 180 or higher or 115 or higher Men aged 50 or over Normal < 160 and < 95 Mildly raised 160 – 169 or 96 - 104 Moderately raised 170 – 179 or 105 - 114 Severely raised 180 or higher or 115 or higher
NB: < means ‘less than’
If blood pressure is Moderately raised, you will be prompted to say, ‘Your blood pressure is a bit high today. Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure. You are advised to visit your GP within 2-3 weeks to have a further blood pressure reading to see whether this is a once-off finding or not.’
If blood pressure is Severely raised, you will be prompted to say, ‘Your blood pressure is high today. Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure. You are strongly advised to visit your GP within 5 days to have a further blood pressure reading to see whether this is a once-off finding or not.’
Note: If the respondent is elderly and has severely raised blood pressure, amend your advice so that they are advised to contact their GP within the next week or so about this reading. This is because in many cases the GP will be well aware of their high blood pressure and we do not want to worry the respondent unduly. It is however important that they do contact their GP about the reading within 7 to 10 days. In the meantime, we will have informed the GP of their result (providing the respondent has given their permission).
2.8 Action to be taken by the nurse after the visit The action you should take after the visit in respect of raised blood pressure readings, differ for children and adults. If you need to contact the Survey Doctor, do not do this from the respondent’s home — you will cause unnecessary distress.
Pulse: for all respondents the survey doctor routinely checks fast and slow pulse rates so no further action is necessary.
Children: No further action is required after taking blood pressure readings on children. All high readings are viewed routinely by the Survey team. However, in the rare event that you encounter a child with a very high blood pressure, ie. systolic 160 or above or diastolic 100 or above, please call the Survey Doctor.
195 Adults: The chart below summarises what action you should take as a result of the knowledge you have gained from taking the blood pressure readings. For this purpose you should only take into account the last two readings as the first reading from the Dinamap is prone to error for the reason stated above.
The Survey Doctor is responsible for dealing with queries regarding blood pressure readings NEVER leave any details about the respondent on the pager, eg. respondent’s name or telephone number, as this would constitute a breach of confidence.
BLOOD PRESSURE ACTION
Normal/mild/moderate bp No further action necessary
Systolic < 180 mmHg and If you feel that the circumstances demand further Diastolic < 115 mmHg action, inform The Survey Doctor who will then inform the respondent’s GP immediately if he deems it necessary.
Severely raised bp
Systolic ≥ 180 mmHg or Contact The Survey Doctor at the earliest Diastolic ≥ 115 mmHg opportunity who will inform the respondent’s GP.
If the respondent has any symptoms of a hypertensive crisis* contact The Survey Doctor immediately or call an ambulance. The Survey Doctor must be informed as soon as possible.
*A hypertensive crisis is an extremely rare complication of high blood pressure. Its signs and symptoms include: diastolic bp > 135 mmHg, headache, confusion, sleepiness, stupor, visual loss, seizures, coma, cardiac failure, oliguria, nausea & vomiting.
3. MEASUREMENT OF DEMISPAN — AGES 65-74 SpanInt-DsCard 3.1 Purpose: When the interviewer visited the respondent s/he attempted to measure the respondent’s height and weight. However, measuring height can be quite difficult if the respondent cannot stand straight or is unsteady on their feet. This can occur with some elderly people, and with people who have particular disabilities. Additionally, height decreases with age. This decrease varies from person to person and may be considerable. It is becoming increasingly important to have information about the health of the elderly. Therefore an alternative measure of skeletal size, the demi-span, was developed which can be measured easily and does not cause unnecessary discomfort or distress to the elderly.
The demi-span measurement is the distance between the sternal notch and the finger roots with arm out-stretched laterally.
3.2 Eligibility: Only those aged 65 to 74 are eligible for the demi-span measurement. Respondents aged 65 to 74 who cannot straighten either arm, should not have this measurement taken.
196 NotAttM - Record any reasons why demi-span measurement was refused, not attempted or only one was obtained.
3.3 Equipment: a thin retractable demi-span tape calibrated in cm and mm and a skin marker pencil. A hook is attached to the tape and this is anchored between the middle and ring fingers at the finger roots. The tape is then extended horizontally to the sternal notch (see illustration below). The tape is easily damaged if it is bent.
3.4 Preparing the respondent: The measurement is made on the right arm unless this arm cannot be fully stretched in which case the left arm may be used.
SpnM - Record which arm was used and whether the respondent was standing, sitting or lying down.
Although the measurement requires minimal undressing, certain items that might distort the measurement will need to be removed. These include: Ties Jackets, jumpers and other thick garments Jewellery items such as chunky necklaces/bracelets Shoulder pads High heeled shoes Shirts should be unbuttoned at the neck. If the respondent does not wish to remove any item that you think might affect the measurement, you should record that the measurement was not reliable (code 2) when prompted by the computer.
3.5 Procedure 1. Locate a wall where there is room for the respondent to stretch his/her arm. They should stand with their back to the wall but not support themselves on it. Ask the respondent to stand about 3 inches (7cm) away from it.
2. Ask the respondent to stand with weight evenly distributed on both feet, head facing forward.
3. Ask the respondent to raise their right arm until it is horizontal. The right wrist should be in neutral rotation and neutral inflexion. Rest your left arm against the wall allowing the respondent’s right wrist to rest on your left wrist.
4. When the respondent is standing in the correct position mark the skin at the centre of the sternal notch using the skin marker pencil. (Explain to the respondent that this mark will wash off afterwards). It is important to mark the sternal notch while the respondent is standing in the correct position.
If the sternal notch is obscured by clothing or jewellery, use a piece micropore tape on the clothing or jewellery. If the respondent will not allow use of either the marker pencil or the micropore tape, proceed with the measurement but record the measurement as unreliable and explain why in a notepad.
5. Ask the respondent to relax while you get the demi-span tape.
6. Place the hook between the middle and ring fingers so that the tape runs smoothly along the arm.
7. Ask the respondent to raise their arm. Check they are in the correct position, the arm horizontal, the wrist in neutral flexion and rotation.
197 8. Extend the tape to the sternal notch. If no mark was made, feel the correct position and extend the tape to this position.
9. When ready to record the measurement ask the respondent to stretch his/her arm. Check that:
The respondent is in the right position; no extension or flexion at the wrist or at the shoulders. The hook has not slipped forward and the zero remains anchored at the finger roots. The respondent is not leaning against the wall or bending at the waist.
10. Record the measurement in cms and to the nearest mm when prompted by the computer. If the length lies half-way between two millimetres, then round to the nearest even millimetre. For example, if the measurement is halfway between 68.3 and 68.4, round up to 68.4; if the measurement is halfway between 68.8 and 68.9, round down to 68.8. Always record the response to one decimal point (eg. 55.4). The computer will not allow you to enter a response without a decimal point, so even if the measurement come to, say exactly 56cm, you must enter 56.0. If you do enter a measurement ending in 0, the computer will ask you to confirm this.
11. Ask the respondent to relax and loosen up the right arm by shaking it.
12. Repeat the measurement from steps 4-11. Explain to the respondent that this is to improve accuracy. If your second measurement differs from the first by 3cm or more, the computer will give you an error message, and instruct you to either amend one of your previous responses, or to take a third measurement. Amend a previous response if you have made a mistake when entering the measurement, eg. entered 65.2 instead of 75.2. Take a third measurement if there is another reason for the measurements being different. If in doubt, take a third measurement rather than over- writing one of the previous two. The computer will automatically work out which two to use.
13. Offer to write the measurements onto the respondent’s Measurement Record Card. If the respondent would like the measurement in inches, there is a conversion chart on the back of your drug coding booklet.
Using the tape The tape is fairly fragile. It can be easily damaged and will dent or snap, if bent or pressed too firmly against the respondent’s skin. Also the ring connecting the hook to the tape is a relatively weak point. Avoid putting more strain on this ring than necessary to make the measurements. When extending the tape, hold the tape case rather than the tape itself as this puts less strain on the hook and tape. When holding the tape to the sternal notch, do not press into the sternal notch so much that the tape kinks.
Seated and lying measurements If the respondent is unable to stand in the correct position, or finds it difficult to stand steadily, ask them to sit for the measurement. Use an upright chair and position it close to a wall. Still try to support the arm if possible. You may need to sit or kneel to take the reading. If the respondent is much taller than you, take the measurement with the respondent sitting. If the respondent finds both standing and sitting in the correct position difficult, the measurement can be taken with the respondent lying down. If the respondent’s arm is much longer than yours, support the arm close to the elbow rather than wrist level. Your arm must not be between
198 the elbow and shoulder as this will not provide sufficient support. Record at SpnM how the measurement was taken (ie. with respondent standing, sitting, lying down, etc.)
4. MEASUREMENT OF WAIST AND HIP CIRCUMFERENCES — ADULTS ONLY
WHMod-WHRes 4.1 Purpose: There has been increasing interest in the distribution of body fat as an important indicator of increased risk of cardiovascular disease. The waist-to-hip ratio is a measure of distribution of body fat (both subcutaneous and intra-abdominal). Analyses suggest that this ratio is a predictor of health risk like the body mass index (weight relative to height).
4.2 Eligibility: Waist and hip measurements are taken from all respondents aged 16 to 74, except those who are: pregnant, chairbound or have a colostomy/ileostomy. If any of these apply, record code 3 at WHIntro and indicate which reason applies. If the respondent refuses to have his/her waist and hip measured, record code 2 at WHIntro and indicate why.
4.3 Equipment: Insertion tape calibrated in mm, with a metal loop at one end which is connected to a spring balance.
4.4 Preparing the respondent: The interviewer will have asked the respondent to wear light clothing for your visit. Explain to the respondent the importance of this measurement and that clothing can substantially affect the reading.
If possible, without embarrassing you or the respondent, ensure that the following items of clothing are removed:
- all outer layers of clothing, such as jackets, heavy or baggy jumpers, cardigans and waistcoats
- shoes with heels
- tight garments intended to alter the shape of the body, such as corsets, lycra body suits and support tights
If the respondent is wearing a belt, ask them if it would be possible to remove it or loosen it for the measurement.
Pockets should be emptied.
If the respondent is not willing to remove bulky outer garments or tight garments and you are of the opinion that this will significantly affect the measurement, record this when asked by the computer about problems measuring waist, at WJRel, or hip, at HJRel.
If possible, ask the respondent to empty their bladder before taking the measurement.
4.5 Procedure 1. Ensure the respondent is standing erect in a relaxed manner and breathing normally. Weight should be evenly balanced on both feet and the feet should be about 25-30cm (1 foot) apart. The arms should be hanging loosely at their sides.
2. If possible, kneel or sit on a chair to the side of the respondent.
199 3. Pass the tape around the body of the respondent and through the loop. To check the tape is horizontal you have to position the tape on the right flank and look round the participant’s back from his/her left flank to check that it is level. This will be easier if you are kneeling or sitting on a chair to the side of the respondent. If the respondent is large, ask him/her to pass the tape around rather than having to “hug” them. Remember though to check that the tape is correctly placed for the measurement being taken and that the tape is horizontal all the way around.
4. Hold the loop flat against the body and flatten the end of the tape. At the same time pull the spring balance to the mark around 600g and then read the measurement from the outer edge of the loop. Do not pull the tape or spring balance towards you, as this will lift away from the respondent’s body, affecting the measurement.
Measuring the waist 5. The waist is defined as the point midway between the iliac crest and the costal margin or lower rib. To locate the levels of the costal margin and the iliac crest use the fingers of the right hand held straight and pointing in front of the participant to slide upward over the iliac crest. Men’s waists tend to be above the top of their trousers whereas women’s waists are often under the waistband of their trousers or skirts. If you have problems palpating the rib, ask the respondent to breathe in very deeply. Locate the rib and as the respondent breathes out, follow the rib as it moves down with your finger.
6. Do not try to avoid the effects of waistbands by measuring the circumferences at a different position or by lifting or lowering clothing items. For example, if the respondent has a waistband at the correct level of the waist (midway between the lower rib margin and the iliac crest) measure the waist circumference over the waistband. If your respondent has a bow at the back of her skirt, this should be untied as it may add a substantial amount to the waist circumference. Female respondents wearing jeans may present a problem if the waistband of the jeans is on the waist at the back but dips down at the front. It is essential that the waist measurement is taken midway between the iliac crest and the lower rib and that the tape is horizontal. Therefore in this circumstance the waist measurement would be taken on the waist band at the back and off the waist band at the front. Only if the waistband is over the waist all the way around can the measurement be taken on the waistband. If there are belt loops, the tape should be threaded through these so they don’t add to the measurement.
7. Ensure the tape is horizontal. Ask the participant to breathe out gently and to look straight ahead (to prevent the respondent from contracting their muscles or holding their breath). Take the measurement at the end of a normal expiration. Measure to the nearest millimetre and record this into the computer. All measurements should be taken to the nearest millimetre. If the length lies halfway between two millimetres, then round to the nearest even millimetre. For example, if the measurement is halfway between 68.3 and 8.4, round up to 68.4; if the measurement is halfway between 68.8 and 68.9, round down to 68.8.
8. Repeat this measurement again. If your second measurement differs from the first by 3cm or more, the computer will give you an error message, and instruct you to either amend one of your previous responses, or to take a third measurement. Amend a previous response if you have made a mistake when entering the measurement, eg. entered 65.2 instead of 75.2. Take a third measurement if there is another reason for the measurements being different. If in doubt, take a third measurement rather than over-writing one of the previous two. The computer will automatically work out
200 which two to use. If you do decide to take a third measurement, the computer will ask you to enter both waist and hip measurements again, even if only one of the two sets of measurements was more than 3cm apart.
9. If you are of the opinion that clothing, posture or any other factor is significantly affecting the waist measurement, record this when asked about problems measuring waist, at WJRel. We only want to record problems that will affect the measurement by more than would be expected when measuring over light clothing. As a rough guide only record a problem if you feel it affected the measurements by more than 0.5cm. We particularly want to know if waist and hip are affected differently.
Measurement of the hip 10. The hip circumference is defined as being the widest circumference over the buttocks and below the iliac crest. To obtain an accurate measurement you should measure the circumference at several positions and record the widest circumference.
11. Check the tape is horizontal and the respondent is not contracting the gluteal muscles. Pull the tape, allowing it to maintain its position but not to cause indentation. Record the measurement into the computer to the nearest millimetre, e.g. 095.3. If the measurement falls between two millimetres, the measurement should be recorded to the nearest even millimetre.
12. Repeat this measurement again. If your second measurement differs from the first by 3cm or more, the computer will give you an error message, and instruct you to either amend one of your previous responses, or to take a third measurement. Amend a previous response if you have made a mistake when entering the measurement, eg. entered 65.2 instead of 75.2. Take a third measurement if there is another reason for the measurements being different. If in doubt, take a third measurement rather than over-writing one of the previous two. The computer will automatically work out which two to use. If you do decide to take a third measurement, the computer will ask you to enter both waist and hip measurements again, even if only one of the two sets of measurements was more than 3cm apart.
13. If clothing is significantly affecting the measurement, record this when asked by the computer about problems measuring hip, at HJRel. We only want to record problems that will affect the measurement by more than would be expected when measuring over light clothing. As a rough guide only record a problem if you feel it affected the measurements by more than 0.5cm. We particularly want to know if waist and hip are affected differently.
14. Offer to write the measurements on the Measurement Record Card. You can use the conversion chart on the drug coding booklet, if the respondent wants to know the measurements in inches.
5. MEASUREMENT OF LUNG FUNCTION — ages 7 to 74 only
HASurg-NoCodes 5.1 Purpose: Lung function tests objectively assess respiratory impairment if it is present. We will be measuring forced expiratory volume in one second (FEV 1), forced vital capacity (FVC) and peak expiratory flow (PEF). These measures can be reduced for a wide range of reasons, e.g. physical unfitness, smoking, chronic bronchitis, those who have had poorly controlled asthma for many years, some muscular disorders and many others. At a population level, these measures tell us a lot about the respiratory health of the population, and are also indicators of general health.
201 The definition of an acceptable level of lung function depends on the person’s age, sex and height. A diagnosis of abnormality is not based on measurement on a single occasion but is rather based on several measurements and on the person’s clinical history. Prior to making the measurement, we wish you to explain this to the respondents. CAPI will prompt you to read a statement you should always read out before carrying out this test. Explain to the respondent that we are very happy to send the results to their GP if they so wish and the GP can then interpret them in light of their knowledge about the respondent.
5.2 Eligibility: Respondents aged 7 to 74, including those chairbound, EXCEPT:
a) Those who are pregnant. b) Those who have had abdominal or chest surgery in the preceding three weeks. The computer prompts you to ask and record this information at HASurg. c) Those who have been admitted to hospital with a HEART complaint or stroke in the preceding six weeks. The computer prompts you to ask and record this information at HaStro.
5.3 Equipment: The Vitalograph Escort spirometer and case Power pack 1 litre calibration syringe Disposable cardboard mouthpieces 2 spare mesh filters
5.4 Procedure Since air is a gas, its volume changes with changes in temperature. For this reason room temperature is of critical importance when measuring lung function. To take account of air temperature (and humidity) the spirometer MUST be calibrated in each household prior to the first measurement carried out. In addition, the room temperature must be noted and entered into the spirometer prior to measuring each respondent. It is also important that your equipment is at room temperature when you use it. For this reason, take it out of its container as soon as possible when you enter the house. Otherwise it will be too cold (or in summer too hot!) from being in the boot of your car.
5.5 Calibrating the spirometer Remember, the spirometer MUST be calibrated in the household prior to measuring each respondent.
SpirNo The computer will prompt you to calibrate the spirometer and enter the three- digit spirometer serial number here.
1. The first step is to circulate the room air through the calibration syringe and the spirometer. To do this, connect the syringe to the flow head and simply pump through a few litres of air.
2. Next you enter the calibration routine of the spirometer. To do this, hold the spirometer level, press the arrow button and blue “on” button at the same time, then release both buttons.
3. You will see an equipment number displayed, followed by the message “zeroing sensor”, then “please wait”. The message “pump air” is then displayed.
4. Making sure the syringe handle is fully extended, connect the syringe to the flow head. The handle of the spirometer should be pointing upwards. Pump in the volume
202 of air from the syringe in a smooth swift stroke, taking approximately 1 second to do so. It is important that the air is pumped in smoothly and swiftly in this way. Be careful not to occlude the outlet of the spirometer with your hand.
5. During calibration the message “sampling flow” is displayed. Following this “*” is displayed if the spirometer is calibrated. If a volume is displayed rather than “*”, then the unit is not fully calibrated and you must repeat the procedure again by pumping in another litre of air from the syringe. Do this until “*” is displayed. If you encounter problems during calibration consult the “troubleshooting advice” at the end of this section. If after six attempts the spirometer has not calibrated, remove cone and end cap, check that you have not forgotten to insert a mesh and ensure the cone and end cap are replaced tightly. If calibration is still not possible, abandon procedure and record it on the schedule. Check the equipment later and contact the Field Office immediately for a replacement.
6. Then press the C button to switch off.
LFTemp - The computer will prompt you to record the ambient air temperature in centigrade to one decimal place here.
5.6 Performing the test 1. The first step is to measure the room temperature. Switch on your thermometer as before. Allow it to settle, then record the temperature on your schedule and switch off.
2. Holding the spirometer level, press the blue ON button. The last temperature entered will be displayed. Enter the temperature you have just recorded to the nearest degree. Do this by pressing the arrow button until the correct temperature is displayed. The arrow button allows you to scroll through to 40ºC. Note that the lowest temperature you can enter is 10ºC. If the temperature is lower than 10ºC or higher than 40ºC reliable measurements cannot be made and spirometry must be deferred until the room heats up/cools down, or be abandoned. If the latter is the case, note it on the appropriate section of the computer schedule.
3. When the correct temperature is displayed, press the on button again. The display will read “zeroing sensor” followed by “please wait”, then “perform test”.
4. Instruct the respondent to blow as described in the next section. As the respondent is blowing the message “sampling flow” is displayed. The FVC is then displayed in litres (L). Record this into the computer where prompted. Press the arrow button again and the FEV1 will be displayed. Record this too. Press the arrow again and the PEF (Peak Flow) will be displayed. Record this. Then record whether the blow has been technically satisfactory (this is defined below).
5. Press the C button to clear the results and then press the ON button to start again. The temperature will be displayed again. This time you can ignore it as the room temperature will not have changed much from the first blow. It is very important that you press the C button before the ON button. If you do not do this the screen will go on to tell you the results of the best blow rather than each individual blow.
6. Press the on button again, and get the respondent to blow as before. Repeat the procedure until you have recorded five blows. Don’t forget to switch off by pressing the C button.
203 7. GPSend LF - Once you have entered details of the five blows into the computer, obtain consent to send the results of the lung function to the respondent’s GP. If the respondent agrees, have them sign LF(A) Lung Function to GP Consent Form (Adults 16+) if they are aged 16 to 74 or have the respondent’s parents sign LF(C) Lung Function Result to GP Consent Form (Ages 7-15) if the respondent is aged 7 to 15. Circle code 04 on the front of the Consent Booklet if consent is obtained to send the respondent’s lung function results to the GP, or 03 if consent is not obtained.
8. NCIns2 - Offer to record the lung function readings on the respondent’s Measurement Record Card. Never attempt to interpret these readings. This has to be done in the office, taking other information about the respondent into account.
Instructing the respondent to blow 1. LFStand - After the five blows, record whether the respondent was standing or sitting. The respondent should be in the standing position. If the respondent is chairbound you can still carry out the test.
2 Tight clothing should be loosened.
3. Dentures should be worn unless they fit so badly that they become loose and obstruct the airflow.
4. Explain to the respondent that the aim of the test is to find out how much air they can blow out and how quickly it is blown out. Then explain that “you must try to blow out as much air as possible as hard and as fast and as completely as you can”.
5. You should demonstrate the correct technique first, using a mouthpiece unconnected to the spirometer. Explain that the mouthpiece should be held in place by the lips rather than the teeth and the lips should be wrapped firmly around it. Demonstrate a blow.
6. Attach a clean disposable mouthpiece to the flow head. Explain to the respondent that they must now make their first attempt.
7. Instruct the respondent to take as deep a breath as possible and then to hold the mouthpiece with their lips. The respondent should hold the spirometer with the handle downwards.
8. Then say “now blow”. As the respondent is blowing encourage her/him by saying “keep going, keep going, keep going”.
9. It is important to observe the respondent closely during the blow so that you can note whether it was technically satisfactory and advise her/him how to do it better.
10. LFRes/ProbLF — Record whether you obtained 5 technically satisfactory blows and, if not, why not. You must attempt to get five blows from each respondent. However, there will be some respondents, e.g. some elderly respondents or those with severe lung disease who are unable to complete five attempts. You must strike the right balance between encouragement and over-insistence.
204 Technically unsatisfactory blows A technically unsatisfactory blow is any of the following:
1. An unsatisfactory start, e.g. excessive hesitating or a “false start”. If you see * on either side of the *FEV1* then this tells you that it is an excessively slow start.
2. Laughing or coughing especially during the first second of the blow. Many people will cough a little towards the end of their effort but this is acceptable.
3. Holding the breath in (i.e. a valsalva manoeuvre).
4. A leak in the system or around the mouthpiece. This would include those where the mouthpiece is not firmly held by the lips.
5. An obstructed mouthpiece e.g. tongue in front of the mouthpiece or false teeth obstructing the mouthpiece.
6. Note that a result of 0.00 on an FEV1 also means that the test has not been carried out properly.
Guidelines on expected values of lung function Please note that for any individual their expected level of lung function is calculated using their height, age and sex. The values given here are for your guidance only and are based on the best expected levels in persons of average height. There is in fact wide variation in the normal level acceptable so these values are just a rough guide. They will give you an idea of whether a respondent is not blowing adequately so that you can encourage them to improve. You should not say to respondents that their lung function is poor since the variation in acceptable values is so wide.
FOR NURSE GUIDANCE ONLY:
Male Female Adults: Aged 16-39: FVC 4.5 FVC 3.5 FEV 4.0 FEV 3.0 PF 550 PF 400
Aged 40-64: FVC 4.0 FVC 3.0 FEV 3.0 FEV 2.5 PF 500 PF 350
Aged 65+: FVC 3.5 FVC 2.5 FEV 2.5 FEV 2.0 PF 450 PF 320 Children: Aged 7-9: FVC 2.3 FVC 2.3 FEV 2.0 FEV 2.0 PF 300 PF 300
Aged 10-15: FVC 3.2 FVC 3.2 FEV 3.0 FEV 3.0 PF 400 PF 400
205 5.7 Cleaning procedure for the Escort spirometer For the respondent’s safety, the mouthpieces you use are valved so that it is not possible to inhale through them. Please always ensure that you use a new disposable mouthpiece for each respondent. The mouthpiece may be given to the respondent to dispose of in their own household rubbish. It is not necessary to clean equipment between households. It is essential, however, that the filters are removed and cleaned each evening (see diagram below).
1. Remove the cone (1) and end cap (2) from each end of the flowhead. Do not disassemble the remaining part of the spirometer.
2. Remove the filter meshes (3).
3. Replace with the two clean spare mesh filters. Put the deep edge of the plastic rim facing towards the centre of the spirometer. 4. Wash the soiled filters carefully in warm soapy water and rinse thoroughly with clean water. The filters should be left overnight to dry out completely.
5.8 Important points to note 1. When fully charged from the power supply unit provided, a test duration of at least 90 minutes can be expected. After the “LOW BATTERY” message first flashes on the screen, only a further 1 minute of valid testing can be guaranteed after which the unit must be recharged or operated from the mains supply to carry out further tests.
The spirometer should be charged immediately before each visit. Take the power pack with you in case of battery failure.
2. Whenever the “ON” button is pressed to perform a new test, ensure that the spirometer is placed on a flat surface with the mouthpiece pointing upwards.
3. The respondent should hold the unit with the handle pointing downwards during the testing. This is different to the procedure during calibration when the handle should be pointing upwards.
6. BLOOD SAMPLE — AGES 16 TO 74 (AGES 11 TO 15 ADDED DURING THE SECOND QUARTER OF THE STUDY)
BlIntro-Code11 6.1 Purpose: The blood sample is being taken to obtain indicators of risk factors for cardiovascular disease and of other measures of health and nutrition. The blood will be analysed for total serum cholesterol, HDL cholesterol, fibrinogen, haemoglobin, ferritin, gamma GT and C Reactive Protein. For a sub-group of adults (in 5 sampling points each month), the blood will also be analysed for vitamins A,C,E and carotenoids; respondents receiving these additional blood tests are shown as “BT:V” on the address label on the NRF.
Cholesterol and fibrinogen are being measured because raised levels are associated with higher risks of heart attacks. C Reactive Protein is an indictor of inflammatory activity in the body which is also associated with risk of heart disease. Haemoglobin and ferritin are being measured as indicators of iron status. Gamma GT levels are affected by alcohol consumption. Vitamins are being measured because it is thought that they might offer protection against heart disease.
The blood will not be tested for any viruses, such as HIV/AIDS.
206 6.2 Eligibility: All adult respondents aged 16 to 74 will be eligible to provide a blood sample EXCEPT respondents who are: a) Pregnant. b) Have a clotting or bleeding disorder. By clotting or bleeding disorders we mean conditions such as haemophilia, low platelets or thrombocytopenia. There are many different types of bleeding/clotting disorders but they are all quite rare. These respondents are excluded from blood sampling because the integrity of their veins is extremely precious and we do not wish to cause prolonged blood loss. For purposes of blood sampling, those who have had, for example, a past history of thrombophlebitis, a deep venous thrombosis, a stroke caused by a clot, a myocardial infarction an embolus are not considered to have clotting disorders. c) Aged 16 or 17, who do not live with a parent or guardian and whose parent or guardian cannot be contacted to provide written consent. d) Not willing to give their consent in writing. e) Are currently on Warfarin therapy. Warfarin thins the blood so that respondents would not stop bleeding easily. f) Anyone who has ever had any kind of fit.
Aspirin therapy is not a contraindication to blood sampling.
ClotB - Record whether the respondent has a clotting or bleeding disorder or is currently on Warfarin.
Fit - Record whether the respondent has ever had a fit (eg. epileptic fit, convulsion). Respondents who have ever had a fit will not be asked to provide a blood sample. This applies even if the fit(s) occurred some years ago.
The computer will decide whether the respondent is eligible to provide a blood sample based on the information you have recorded.
6.3 Equipment: All nurses will have the following equipment: Needle holders Alcohol swabs/cotton balls/plasters Vacutainer needles 21G Butterfly needles 23G Rubber gloves Needle disposal box Vacutainer 6 ml plain tubes (red) Plastic postal cocoons Vacutainer 4 ml EDTA tubes (purple) Prepaid addressed padded mailing envelope Vacutainer 4.5 ml citrate tubes (blue) Resealable plastic bags Micropore tape Set of labels for blood sample tubes
Nurses working in sampling points where “BT:V” is shown will also have cold box Vacutainer 6 ml plain tube (red) cold packs plastic bags (large and small) padded envelope
207 The tubes should be filled in the following order: Plain tube (red cap) (6ml) EDTA tube (lavender cap) (4ml) Citrate tube (blue cap) (4.5ml)
When vitamins are being analysed (BT:V sampling points), a fourth tube should then be filled: Plain tube (6ml)
Getting consent: As blood taking is an invasive procedure, we need to obtain written consent in all cases.
BSWill - Ask the respondent whether they are willing to have a blood sample taken. BSConsC/BSCons - Obtain written consent before taking the blood sample. On no account should you ever take blood before you have obtained written consent to do so from the respondent. If you cannot obtain written consent, the computer will direct you to circle consent codes 06, 08, 10 and 12 on the Consent Booklet and filter you around the remaining questions. As there are two other written consents we wish to obtain with respect to blood sampling — consent to send the results to the GP and consent to store a small amount of the blood — you should seek to obtain all these consents before you take any blood. SendSam/BSSign - Obtain written consent to send results of the blood sample analysis to the respondent’s GP. ConStorB/Code09 - Obtain written consent for storage of any remaining blood from the sample.
The Blood Sample Consent Forms (BS) are divided into three sections — one for each of these consents. If the respondent agrees to all three, s/he will have to sign the Consent Form three times. Small quantities of blood are being stored in special freezers in order that further analysis may be undertaken in the future. Future analysis will definitely not involve a test for viruses (eg. HIV/AIDS).
Remember: 1. Ask the respondent if they would be willing to have a blood sample taken. Try to reassure respondents about the process, and be prepared to answer their concerns. You will need to explain to the respondent the need for written consent and how important it is. 2. Obtain written consents on the appropriate Blood Sample Consent Form. Remember to enter your name at the head of this form before asking the respondent to sign. 3. Obtain consent to send results to GP 4. Obtain consent to store blood. 5. Check that you have circled the correct consent codes on the front of the Consent Booklet. There should be a code ringed in each row at Item 9b)-9e).
Before taking blood from both 16-17 year olds, you must make sure that you always get both the respondent’s own signature and the signature of their parent or person who has legal parental responsibility. Remember that even if a 16 or 17 year old respondent is married and not living with their parent or person who has legal parental responsibility, you cannot take blood until you have their parent’s consent. It is not sufficient to simply have one signature - you must make sure you have all relevant signatures.
208 6.4 Preparing the respondent Ask the respondent if they have had any problems taking blood before.
1. Explain the procedure to the respondent. They should be seated comfortably in a chair, or if they wish , lying down on a bed or sofa. Cover the respondent’s furniture with kitchen roll.
2. Ask the respondent to roll up their left sleeve and rest their arm on a suitable surface. Ask them to remove their jacket or any thick clothing, if it is difficult for them to roll up their sleeve.
The antecubital fossae may then be inspected. It may be necessary to inspect both arms for a suiable choice to be made, and the respondent may have to be repositioned accordingly. If both arms are suitable, use the left arm. Do not ask the respondent to clench his/her fist.
3. Select a suitable vein and apply the tourniquet around the subject’s arm. Blood may not be collected from the respondent’s wrist. However, it is desirable to use the tourniquet applying minimal pressure and for the shortest duration of time. Do not leave the tourniquet in place for longer than 2 minutes.
Ask the respondent to keep his/her arm as still as possible during the procedure.
4. Put on your rubber gloves at this point. You are required to wear rubber gloves when collecting blood for the survey.
5. Clean the venepuncture site gently with an alcohol swab. Allow the area to dry completely before the sample is drawn.
6.5 Taking the sample 1. Venepuncture is performed with a green twenty gauge vacutainer needle or butterfly.
2. Grasp the respondent’s arm firmly at the elbow to control the natural tendency for the respondent to pull the arm away when the skin is punctured.
3. Place your thumb an inch or two below the vein and pull gently to make the skin a little taut. This will anchor the vein and make it more visible.
4. Ensure the needle is bevelled upwards. Do not bend needles for venepuncture. Enter the vein in a smooth continuous motion.
5. Remember to take the tubes in the correct order. The first tube should always be the large plain tube with the red cap followed by the mauve EDTA tube.
6. The vacutainers should be filled to capacity in turn and inverted gently on removal to ensure complete mixing of blood and preservative.
TakeSam - The computer will prompt you to take the tubes in the correct order.
SampF1 - Enter whether the plain tube (red) has been filled. This tube should always be filled first for adults and children.
SampF2 - Enter whether the EDTA tube (lavender)has been filled. This tube should always be filled second.
209 SampF3 - Enter whether the Citrate tube (blue) has been filled. This tube should always be filled third for adults.
SampF4 - In BT:V sampling points, Enter whether the additional plain tube has been filled.
7. Release the tourniquet (if not already loosened) as the blood starts to be drawn into the tube. Remove the needle and place a cotton ball firmly placed over the venepuncture site. Ask the respondent to hold the pad firmly for three minutes to prevent haematoma formation.
SampArm - Record which arm the sample was drawn from.
8. Remove the needle from the vacutainer holder by inserting it into the slot at the top of the needle disposal box. Push it towards the narrow end of the slot until the hub fins are engaged. Twist the holder anti-clockwise to unthread the needle. Then slide the holder towards the centre of the slot, allowing the needle to drop into the container.
IMPORTANT WARNING
Never re-sheath the needle after use.
Do not allow the disposal box to become overfull as this can present a potential hazard.
9. Check on the venepuncture site and affix an plaster /adhesive dressing, if the respondent is not allergic to them. If they are allergic, use a cotton ball secured with micropore.
SamDif - Record whether you had any problems taking the blood sample and what they were.
NoBSM - If you did not manage to get any blood, explain why and circle codes 06, 08, 10 and 12 on the front of the Consent Booklet.
SnDrSam/Code11 - Ask the respondent whether they would like to be sent the results of their blood sample analysis. The computer will prompt you to circle 11 or 12 on the front of the Consent Booklet depending on the response.
6.6 Fainting respondents If a respondent looks or feels faint during the procedure, it should be discontinued. The respondent should be asked to place their head between their knees. They should subsequently be asked to lie down.
If they are happy for the test to be continued after a suitable length of time, it should be done so with the respondent supine and the circumstances should be recorded. They may wish to discontinue the procedure at this point, but be willing to give the blood sample at a later time.
210 6.7 Disposal of needles and other materials Place the used cotton wool balls, gloves, etc. in the self-seal disposal bag. This bag, together with the needle disposable box, should be taken to your local hospital for incineration. Telephone them beforehand, if you are not sure where to go. If you come across any problems with the disposal, contact Anne McMunn (0171-391-1730) at UCL who will contact your local hospital.
6.8 Needle stick injuries Any nurse who sustains such an injury should seek immediate advice from their GP. The nurse should inform his/her nurse supervisor of the incident, and the nurse supervisor should inform Anne McMunn at UCL.
6.9 Respondents who are HIV or Hepatitis B positive If a respondent volunteers that they are HIV or Hepatitis B positive, do not take a blood sample. Record this as the reason on the Schedule. You should never, of course, seek this information.
7. SALIVA SAMPLE — AGES 4 TO 74 ONLY SalInt1-SalObt1 7.1 Purpose: We wish to obtain a measure of exposure to both smoking and passive smoking in both children and adults. This can be detected by measuring the level of cotinine in saliva. Cotinine is a derivative of nicotine and shows recent exposure to tobacco smoke, either because the individual is a smoker or because they have been exposed to other people’s tobacco smoke. Note that the respondents’ cotinine analysis results will not be sent to them or their GP.
7.2 Eligibility: A saliva sample should be obtained from everyone aged 4 to 74 inclusive.
7.3 Equipment: Adults aged 16 to 74: Dental rolls Plain 5ml tubes kitchen roll
Children aged 4 to 15: Short wide bore straws Plain 5ml tubes Kitchen roll
7.4 Procedure
Adults aged 16 to 74
1. SalIntr1 - Introduce the saliva sample to the respondent.
2. SalInst - Respondent takes the dental roll from the tube, inserts it in his / her mouth and leaves it there until it is soaked.
3. Ask the respondent to move the roll around the mouth, without chewing. 3 minutes will be ample. 4. The respondent needs to get the dental roll saturated in order for the lab to be able to do the analysis. If the respondent has a dry mouth, ask them to drink some water. Wait some time before starting again in order to obtain saliva rather than water.
211 5. Check that the roll is soaked.
6. SalObt1 - Code if saliva has been obtained, even if it is only a small amount SalNObt - If no saliva is obtained, please code reasons and give fuller explanations a appropriate.
Children aged 4 to 15
1. SalIntr1 - Introduce the saliva sample to the respondent
2. Remove the cap from the plain tube.
3. SalInst - Ask the respondent to gather up their saliva and to dribble through the straw into the tube. Discourage the child from clearing his / her chest before spitting.
4. Give the straw to the child and allow up to three minutes to do this. Collect as much as you can in this time. The saliva will be frothy, so it is easy to think you have collected more than you actually have. Do not give up too soon.
5. If the child finds it difficult to use the straw, s/he may dribble into the tube directly. This is acceptable, but encourage them to use the straw where possible.
6. If the child’s mouth is excessively dry and s/he cannot produce saliva, allow him/her to have a drink of plain water. Wait for a few minutes to ensure that no water is retained when they provide the saliva sample.
7. SalObt1 - Code if saliva has been obtained, even if it is only a small amount. SalNObt - If no saliva is obtained, please code reasons and give fuller explanations a appropriate.
7.5 Labelling and Sending Blood and Saliva Samples to the Royal Victoria Infirmary Laboratory in Newcastle. The blood samples (first 3 tubes) and the saliva sample are to be sent to the Royal Victoria Infirmary Laboratory in Newcastle. It is important that the blood is sent properly labelled and safely packaged and that it is despatched immediately after it has been taken. (If you are in a BT:V sampling point and have taken 4 tubes of blood, the following instructions apply to the first 3 tubes only; the fourth tube will be taken to a local processing laboratory - see section 14.4.14..)
7.6 Labelling and Packaging the Saliva tube: 1. Make sure that the lid of the saliva tube is secure.
2. Write the respondent’s serial number and date of birth on the label and attach the label to the tube horizontally. It is vital that you write on the labels clearly and do not confuse respondents’ saliva or blood tubes.
3. Wrap the tube in kitchen towel and place it in a resealable plastic bag.
4. Place the tube and bag in the padded envelope with the respondent’s blood samples and despatch form. Each respondent’s samples must be packed separately unless none of the respondents in the household are providing blood, in which case, saliva
212 only samples may be put in the same envelope for the same household. Put the despatch notes loose in the envelope.
7.7 Labelling the Blood Tubes: Label the tubes as you take the blood. It is vital that you do not confuse respondents’ blood tubes.
Write the respondent’s serial number and date of birth on each label as clearly and carefully as possible — the laboratory has had problems reading some nurses’ writing in the past. Attach the label to the vacutainer tube. Attach a serial number label to every tube that you send to the lab. Make sure you use black biro - it will not run if it gets damp. Check the date of birth with the respondent again verbally.
Stick the label over the label already on the tube. The laboratory needs to be able to see on receipt how much blood there is in the tube.
We cannot stress too much the importance of ensuring that you label each tube with the correct serial number for the person from whom the blood was obtained. Apart from the risk of matching up the findings of the blood analyses to the wrong person’s data, we will be sending the GP the wrong results. Imagine if we detect an abnormality and you have attached the wrong label to the tube!
7.8 Packaging the blood samples: Pack the tubes for each respondent separately from those of other respondents. All the tubes from one person can be packed together in one container.
The following procedures are designed to minimise accidental damage and, should there be any damage, any blood spillage.
1. You are supplied with plastic containers designed to take tubes. Place the filled tubes in a container. Press the two halves of the container firmly together.
2. Wrap a piece of kitchen towelling paper around the plastic container.
3. Place the wrapped container into the resealable plastic bag (in your supplies), with the opening of the bag covering the hinged part of the plastic container. Ensure that the bag is sealed.
4. Place the wrapped container with the saliva sample into the pre-addressed envelope, inserting it so that the opening of the plastic bag goes in first (i.e. away from the entrance to the envelope).
5. Put the Blood Sample Despatch Note 1 in the envelope.
6. Fold over the end of the envelope, and seal firmly with sellotape. Wrap the tape right round the envelope.
NEVER use staples to seal the envelope
Staples can cut post office workers’ hands. When blood is transported this can be dangerous.
7. Post the envelope immediately. It will go by special delivery. This ensures that it arrives the next day.
If you do your interview too late to catch the last post, post it to catch the next post. If you miss the Saturday post collection, take the envelope to a box that has a Sunday collection. The blood should not be refrigerated.
213 8. When you have posted the blood samples, fill in the time and date of posting on the office copy of the Blood Sample Despatch Form 2.
7.9 Completing the Blood Despatch Form (DESPATCH 1)
The Consent Booklet contains a despatch note that should be filled in and sent to the laboratory with the blood sample. Be sure you use the correct despatch note; use DESPATCH 1 for sending blood samples to the Newcastle laboratory.
* Enter the respondent’s serial number very carefully. This should correspond both to your entry on page 1 of the Consent Booklet and to the serial numbers you have recorded on the tubes. * Complete items 2 and 3. * At Item 4, circle the code for the age of the respondent and at Item 5 tick a box for each tube you are sending to the laboratory. It may be that you only managed to obtain two tubes from the respondent, in which case you would ring the appropriate codes. * Complete Item 6. * At Item 7, circle a code to tell the laboratory whether or not permission has been obtained to store part of the blood. Your entry here should correspond to your entry at d) in the ‘Summary of Consents’ on the front page of the booklet. * At Item 8 enter your SCPR Nurse Number.
Tear off this despatch note and send with the blood to the laboratory.
Complete the Office Despatch Form (DESPATCH 2) on the next page of the Consent Booklet. This tells us the date you sent samples to the lab and indicates what we should expect back from the laboratory. You complete the top part only (Q1, 2, and 3) for tubes sent to the Newcastle lab.
7.10 Delivering blood to local processing laboratories
If you are working in a BT:V sampling point, you will have taken a fourth tube of blood which will be analysed for vitamins. This needs to be taken to one of the local processing laboratories within 4 hours of venepuncture.
You will be given the name of your local processing laboratory and a contact name there before you start work. You should contact this person before delivering your first sample to warn him/her when to expect deliveries on a regular basis. If you require any assistance, contact your nurse supervisor for advice.
7.11 Packaging and delivering the blood sample: 1 You should meet with your contact at the local lab before you begin work to agree procedures for delivery and become familiar with the lab.
2 Label the fourth tube (which is a 6ml plain tube) as clearly as possible with the serial number and date of birth label using a black biro.
3 After venepuncture, the tube should immediately be placed inside a plastic bag, then placed in a small padded envelope with Despatch Form 3, then placed inside a larger plastic resealable bag and onto a pre-frozen cold pack in the cold box. It is
214 your responsibility to keep the cold pack cold. If you are working at another job and do not have facilities to keep the cool pack frozen at your place of employment, you will need to return home to collect your cool box before going the household.
4 Deliver the tube as soon as possible (and definitely within 4 hours of venepuncture) to your contact at the local hospital laboratory. If the named contact at the laboratory is unavailable for any reason, ask to speak to a colleague of the named person instead. Do not leave the sample in Reception, but always make sure that you hand them over to someone who can deal with them immediately. If you do not keep the sample cold and deliver it promptly it will no longer be of use to us.
5 You should also write the serial number and date of birth on two extra green labels; these should be left at the lab along with the despatch note (see below).
7.12 Completing the Blood Delivery Note (DESPATCH 3)
The Consent Booklet contains a delivery note that should be filled in and handed over to the laboratory with the blood sample. Be sure you use the correct despatch note; use DESPATCH 3 when delivering blood samples to the local laboratory.
You need only complete the top half of despatch note 3:
* Enter the respondent’s serial number very carefully. This should both correspond to your entry on page 1 of the Consent Booklet and to the serial number you have recorded on the tube. * Complete items 2-5. * At Item 6 enter your SCPR Nurse Number. * At Item 7, write in the name of the hospital/laboratory you delivered the blood to.
Do not complete the bottom half of the form; this will be completed by the local laboratory.
Tear off this despatch note and hand it over with the blood to the laboratory, along with two more serial number/date of birth labels.
Complete the bottom part of Office Despatch Form (DESPATCH 2) in the Consent Booklet. This tells us the name of the lab you delivered the blood to along with the date of delivery. Complete the bottom part only for tubes delivered to local labs.
215 216 APPENDIX C: HEALTH BOARD AREAS C
0 10 20 30 40 50 60 70 80 Kilometres Miles 0 1020304050 The Stationery Office Cartographic Centre J12187 5/97
217 218 APPENDIX D: GLOSSARY D
This glossary explains selected terms used in the report. Others are described fully in particular chapters.
Acute sickness An illness or injury which caused the informant to cut down on any of the things he or she usually does about the house, at work or school or in his or her free time (in the two weeks prior to the interview).
Age standardisation Age standardisation has been extensively used in this report in order to enable groups to be compared after adjusting for the effects of any differences in their age distributions.
When proportions are compared across different sub-groups in respect of a variable on which age has an important influence, any differences in age distributions between these sub-groups are likely to affect the observed differences in the proportions of interest. The objective of the direct age standardisation procedure used in this report was to enable proportions to be presented across sub-groups after adjustment for the effects of age. Direct standardisation estimates the values of the proportions of interest in the case where the compared sub-groups have the same age distribution. However, it should be stressed that age-standardised proportions provide only a summary reflecting the average relationship between the variables across all age bands and that age standardisation adjusts only for age and not for other factors that may affect the variable of interest.
Age standardisation was carried out (separately for men and women) by ten-year age groups. The standard population to which the age distribution of sub-groups was adjusted was the mid-1998 population estimates for Scotland. The age-standardised proportion P' was calculated as follows, where Pi is the age specific proportion in age group i and Ni is the standard population size in age group i:
∑i Ni Pi P' = ∑i Ni
Therefore p' can be viewed as a weighted mean of pi using the weights Ni . Age standardisation was carried out using the age groups: 16-24, 25-34, 35-44, 45-54, 55-64 and 65-74. The variance of the standardised proportion can be estimated by:
2 ∑i (Ni pi qi / ni) var (p') = 2 (∑i Ni)
where qi =1-pi .
219 Body mass index Body mass index (BMI) is weight in kilos divided by the square of height in metres. In adults, ‘overweight’ is defined by values of more than 25.0 but no greater than 30.0; ‘Obese’ is used to describe values over 30.0. In children, there are no generally accepted reference values.
Cholesterol An important component of blood lipids transported in plasma. For the purpose (total and HDL) of this survey total cholesterol was considered to be raised at a level of 6.5 mmol/l or over. In a normal individual, high density lipoprotein (HDL) constitutes approximately 20% of total plasma cholesterol. HDL-cholesterol was considered low at a level of 0.9 mmol/l or less.
Cotinine Cotinine is a metabolite of nicotine. It is one of several biological markers that are indicators of smoking (others include carbon monoxide and thiocyanate), and is generally considered the most useful. It can be measured in, among other things, saliva and serum. It has a half-life in the body of between 16 and 20 hours, which means that it will detect regular smoking but may not detect occasional smoking if the last occasion was several days ago. Saliva and serum yield different estimates of cotinine levels, but they are very highly correlated and experiments have enabled serum values to be converted to equivalents of saliva values, so that they can be aggregated in analysis. Using saliva values, anyone with a level of 15 nanograms per millilitre or more is highly likely to be a smoker.
C-reactive protein C-reactive protein (CRP) is the major protein indicating inflammation activity in acute illness in humans. It is also a marker of cardiovascular risk. No recommendation for a C-reactive protein thresholds appear in the literature so quintile distributions have been presented in this report.
Demi-span Demi-span is an alternative to height as a measure of skeletal size in elderly people. It is defined as the distance between the mid-point of the sternal notch and the finger roots with the arm outstretched laterally.
Ferritin Ferritin is the main form in which iron is stored in the liver, spleen and bone marrow. A small fraction of ferritin circulates in the bloodstream and this fraction correlates well with body iron status.
FEV1 Forced Expiratory Volume: the amount of air (in litres) that a subject can breath out of his/her lungs during the first second of an expiration with maximal effort, starting from full inspiration.
FVC Forced Vital Capacity: the volume of gas (in litres) delivered during an expiration made as forcefully and as completely as possible starting from full inspiration.
Fibrinogen Fibrinogen is a soluble protein involved in the blood clotting mechanism. Prospective population studies have established that fibrinogen is an independent predictor for ischaemic heart disease and stroke.
Reference: Maresca G, Di Blasio A. Marchioli R, Di Minno G. Measuring plasma fibrinogen to predict stroke and myocardial infarction. Arterioscler Thromb Vasc Biol 1999; 19:1368-1377.
Geometric mean The geometric mean is a measure of central tendency. It is sometimes preferable to the arithmetic mean, since it takes account of positive skewness in a distribution. The geometric mean of a continuous variable is calculated by taking the antilog of the mean of the logged values.
220 Haemoglobin The iron-containing molecule in red blood cells. Low haemoglobin (anaemia) is most commonly caused by iron deficiency.
HDL-cholesterol See Cholesterol.
Household A household was defined as one person or a group of people who have the accommodation as their only or main residence and who either share at least one meal a day or share the living accommodation.
Logistic regression Logistic regression was used to investigate the effect of two or more independent or predictor variables on a two-category (binary) outcome variable. The independent variables can be continuous or categorical (grouped) variables. The parameter estimates from a logistic regression model for each independent variable give an estimate of the effect of that variable on the outcome variable, adjusted for all other independent variables in the model.
Logistic regression models the log ‘odds’ of a binary outcome variable. The ‘odds’ of an outcome is the ratio of the probability of its occurring to the probability of its not occurring. The parameter estimates obtained from a logistic regression model have been presented as odds ratios for ease of interpretation.
For continuous independent variables, the odds ratio gives the change in the odds of the outcome occurring for a one unit change in the value of the predictor variable.
Parameter estimates for categorical independent variables may be presented in two ways. One category of the categorical variable may be selected as a baseline or reference category, with all other categories compared to it. Therefore there is no parameter estimate for the reference category and odds ratios for all other categories are the ratio of the odds of the outcome occurring between each category and the reference category, adjusted for all other variables in the model. In other cases, where there is no obvious reference category, the odds ratios for a given category of a categorical independent variable gives the change in the odds of the outcome occurring compared to the overall odds (‘to average’).
The statistical significance of independent variables in models was assessed by the likelihood ratio test and its associated p value. 95% confidence intervals were also calculated for the odds ratios. These can be interpreted as meaning that there is a 95% chance that the given interval for the sample will contain the true population parameter of interest. In logistic regression a 95% confidence interval which does not include 1.0 indicates the given parameter estimate is statistically significant.
References: Norusis MJ. SPSS for Windows: Advanced statistics release 6.0. SPSS Inc, Chicago, 1993.
Hosmer DW Jr. and Lemeshow. Applied logistic regression. John Wiley & Sons, New York, 1989. Mean Unless otherwise specified, means in this report are arithmetic means (the sum of the values for cases divided by the number of cases).
Median The value of a distribution which divides it into two equal parts such that half the cases have values below the median and half the cases have values above the median.
221 Mid-upper arm The circumference taken at the mid-point between the shoulder and elbow of the circumference child’s bare left arm using an insertion tape, as described in Appendix B.
Moving averages The large sample sizes in the Scottish Health Survey provide the opportunity to analyse by individual years of age instead of the more usual discrete age groups. However, even with several hundred per group there is necessarily some random fluctuation that may obscure the underlying trends or patterns. The amount of such fluctuation varies from one variable to another, and depends to a considerable extent, though not solely, on the size of the sub-group to whom the question is addressed. To minimise random variation and to bring out the underlying pattern more clearly, the method of moving averages has been adopted in the construction of graphs. In some cases three years have been averaged and in others five, depending on, among other things, the amount of perceived variability in the data.
In constructing a three year moving average, the percentages shown for each of the first three age years (often but not always 2, 3 and 4) are summed and divided by three to give the first value, which is plotted against the central year (age 3). The next value is obtained by summing the percentages for ages 3, 4 and 5, dividing by three, and plotting the result against age 4. The procedure continues to the final value, which is plotted against the last but one year in the span covered.
Alternative methods of construction are possible, for example weighting the percentage shown for each individual year by the (estimated) proportion of the sample falling into that year.
The advantage of moving averages is the removal of ‘noise’ in the data, and they work well when change is relatively slow and uniform. Their disadvantage is that if the real underlying pattern involves sharp changes of direction (for example, if values of a variable initially decline sharply with age, then increase to a marked peak and then decrease) moving averages will tend to iron out the turning points. Five year moving averages will have a greater tendency to do this than three year periods, but they also remove more of the ‘noise’.
Odds ratio See Logistic regression.
PEF Peak Expiratory Flow: the maximal flow in litres per minute recorded during a forced expiration. In healthy subjects this index reflects the calibre of central airways and the force exerted by the expiratory muscles.
Percentile The value of a distribution which partitions the cases into groups of a specified size. For example, the 20th percentile is the value of the distribution where 20 percent of the cases have values below the 20th percentile and 80 percent have values above it. The 50th percentile is the median.
Phlegm Phlegm was classified according to the MRC Respiratory Questionnaire as phlegm produced in the morning or during the day or at night for at least three consecutive months.
Quintile Quintiles are percentiles which divide a distribution into fifths i.e. the 20th, 40th, 60th and 80th percentiles.
Tertiles Tertiles are percentiles which divide a distribution into thirds.
222 Unit of alcohol A unit of alcohol is 8 gms. of ethanol, and is the amount contained in half a pint of ordinary beer or lager, or in a small glass of wine, or in a measure of spirits.
Waist-hip ratio Waist-hip ratio (WHR) was defined as the waist circumference divided by the hip circumference, i.e. waist girth (m)/ hip girth (m). WHR is a measure of deposition abdominal fat ie. “central obesity”. Unlike BMI there is no consensus to define cut-off point for WHR and several were proposed in a recent review. For consistency the cut-off values as in the 1995 report have been used. A raised WHR has been taken to be 0.95 or more in men and 0.85 or more in women. Reference: Molarius A, Seidell JC. Selection of anthropometric indicators for classification of abdominal fatness - a critical review. Int J Obes 1998; 22:719- 727.
223 224