HARVARD MEDICAL SCHOOL NURSES’ HEALTH STUDY

Channing Laboratory
181 Longwood Avenue
Boston, MA 02115-5804
(617) 525-2279 Fax (617) 525-2008
www.NursesHealthStudy.org

This is your ID

Dear Colleague:

In the summer of 1976 you and 121,700 other registered nurses embarked on a remarkable journey
to expand our understanding of the health of women. Twenty-eight years later, the fruits of our
collaboration are bountiful. Hundreds of scientific papers have been published and, as a result,
many of the facts that people take for granted about health and diet have come from the Nurses'
Health Study. We humbly thank you for making this possible through your dedication,
enthusiasm and loyal participation.
3/8” spine
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The attached questionnaire updates your health status and continues our work. As always, your
answers will be kept strictly confidential and used for medical statistical purposes only. Your
prompt reply is helpful and greatly appreciated.

We value each member of the Nurses' Health Study as a colleague in our research, regardless of
your employment (or retirement) status. Also, whether your health has been excellent or if you
have been ill, your response is equally important. In short, no matter what your circumstances,
we need to hear from you!

Your continued participation by documenting your lifestyle is fundamental to the validity of the
study. It is with our deepest gratitude that we thank you again for the time and care that you have
continued to offer to help us all learn more about women’s health.

Best Regards,

Graham A. Colditz, MD, DrPH Frank E. Speizer, MD

Principal Investigator Founding Principal Investigator

Do you have an e-mail address?

If you do, please print your e-mail address in the box so that we may send you occasional updates
on the progress of the Nurses’ Health Study.

We will not release

your e-mail address
Please print neatly and differentiate numbers and letters (e.g., 1 vs I or i, 0 vs O, 5 vs S) to anyone!
 INSTRUCTIONS
Please use an ordinary No. 2 pencil to answer all questions. Fill in the appropriate
response circles completely. The form is designed to be read by optical-scanning
equipment, so it is important that you keep any write-in responses within the spaces
provided and erase any incorrect marks completely. If you have comments, please write
them on a separate piece of paper.
Please fill in the Do not mark this
circles completely. way: ✓ ✗
1. Current
EXAMPLE 1: Write your weight in Weight
POUNDS
the boxes… 1 4 0 NOTE: It is important that
…and fill in the circle 0 0 0 you write in your
corresponding to the 1 1 1 weight in addition
2 2 2
figure at the head of to completing the
3 3 3
each column. 4 4 4
corresponding
5 5 5 circles. This allows
6 6 6
us to confirm that
7 7
8 8
the correct circles
9 9 have been filled in.

EXAMPLE 2: Mark “Yes” bubble and Year of Diagnosis bubble for each illness you
have had diagnosed.
16.

3/8” spine
Since June 2002, have you had YEAR OF 16

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any of these clinician-diagnosed DIAGNOSIS
illnesses? BEFORE JUNE ’02 AFTER
LEAVE BLANK FOR “NO”. MARK HERE FOR “YES” JUNE 1 TO JUNE 1
2002 MAY 2004 2004

Fibrocystic/other benign breast disease Y 1

Confirmed by breast biopsy? N No Y Yes a

Breast cancer Y 2

Cancer of the uterus (endometrium) Y 3

• Please tear off the cover letter (to preserve confidentiality) and return the
questionnaire in the enclosed postage-paid envelope.
• If your name and address as printed on this questionnaire are no longer
correct or are incomplete, or if you are providing your e-mail address,
please make any necessary changes on the letter and return it to us.
• Thank you for completing the 2004 Nurses’ Health Study Questionnaire.

Federal research regulations require us to include the following information:

There are no direct benefits to you from participating in this study.
The risk of breach of confidentiality associated with participation in this
study is very small.
Your choice to participate in this study is completely voluntary and you may
decline or withdraw at any time without penalty.
Although complete information is important to the study, you may skip any
question you do not wish to answer.
You will not receive monetary compensation for participating.
If you have any questions regarding your rights as a research participant,
you are encouraged to call a representative of the Human Subjects Committee
at the Brigham and Women’s Hospital (617-525-3170).
 HARVARD MEDICAL SCHOOL Page 1 NURSES’ HEALTH STUDY
1 2 3 4 5
PLEASE USE PENCIL! 6 7 8 9 10

1. What is your 2. What is the difference between your highest and lowest weight during the last 2 years? 04 05 06 11 12

current weight? No change 2–4 lbs. 5–9 lbs. 10–14 lbs. 15–29 lbs. 30–49 lbs. 50+ lbs. 2

3. Do you currently smoke cigarettes? 3

No Yes How many/day? 1–4 5–14 15–24 25–34 35–44 45+ a

0 0 0 4. Have you had your uterus removed? 4
1 1 1 No Yes Date of surgery: Before June 1, 2002 After June 1, 2002 a
2 2 2 5. Have you ever had either of your ovaries surgically removed? 5
3 3 3 No Yes a) How many ovaries do you have remaining? None One a
4 4 4 6. In the last 10 years, have you experienced pain, discomfort or burning in your pelvis or bladder 6
5 5 5 for more than 3 months in a row and accompanied by urinary frequency or urgency?
6 6 6 Yes No
7 7 7. On average, how many times do you get out of bed each night to urinate? 7
8 8 Zero One Two Three Four or more
9 9 8. On average, how many times do you urinate each day (from the time you get up, until you go to bed)? 8

Four or less 5 to 8 9 to 12 13 to 15 More than 15

9. During the last 12 months, how often have you leaked or lost control of your urine? 9

Never Less than once/month Once/month 2–3 times/month About once/week Almost every day
i) When you lose your urine, how much usually leaks? i

A few drops Enough to wet your underwear Enough to wet your outerclothing Enough to wet the floor
ii) When you lose urine, what is the usual cause? ii

a Coughing, sneezing, laughing, or doing physical activity b A sudden and urgent need to go to the bathroom
c Both a) and b) equally d In other circumstances
10. Since June 2002, have you used Evista (raloxifene) or Nolvadex (tamoxifen)? 10

Yes a) How many months have you used each drug during the 24 month period between June 2002 and June 2004? a

No Evista Not Used 1–4 months 5–9 10–14 15–19 20–24 months Used only after 6/04 E

Nolvadex Not Used 1–4 months 5–9 10–14 15–19 20–24 months Used only after 6/04 N
3/8” spine

b) Are you currently using Evista or Nolvadex? No, not currently Yes, Evista Yes, Nolvadex b
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11. Are you currently using any over-the-counter (e.g., “herbal,” “natural,” or soy-based) preparations for hormone 11
replacement or to treat post-menopausal symptoms? (Do NOT include food sources like tofu, soy milk, etc.) a

No Yes What type(s)? Soy estrogen products Natural progesterone cream or wild yam cream
Dong quai (e.g., Rejuvex) Black cohosh (e.g., Remifemin) Other
12. Since June 2002, have you used prescription female hormones? 0 0 0 12

Yes a) How many months did you use hormones since June 2002? 1 1 1 a

No 1–4 months 5–9 10–14 15–19 20–25 26–30 31–35 36+ months 2 2 2

b) Are you currently using them (within the last month)? Yes No If No, skip to Part e. 3 3 3 b

c) Mark the type(s) of hormones you are CURRENTLY using: 4 4 4 c

Combined: Prempro (cream) Prempro (gold) Prempro (peach) Prempro (light blue) 5 5 5

Premphase Combipatch FemHRT 6 6 6

Estrogen: Oral Premarin Patch Estrogen Vaginal Estrogen Ogen 7 7 7

Estrace Estratest Other Estrogen (specify in box below) 8 8 8

Progesterone/Progestin: Provera/Cycrin/MPA Vaginal Micronized (e.g., Prometrium) 9 9 9

Other progesterone (specify type in box below) 0 0 0

Other hormones CURRENTLY used (e.g., Tri-est), Specify: 1 1 1

2 2 2

d) Since June 2002, how many months have you used the preparation(s) you marked in Part c? 3 3 3 d

1–4 months 5–9 10–14 15–19 20–25 26–30 31–35 36+ months 4 4 4

e) If you used oral conjugated estrogen (e.g., Premarin) what dose did you usually take? 5 5 5 e

.30 mg/day or less .45 mg/day .625 mg/day .9 mg/day 6 6 6

1.25 mg/day or higher Unsure Did not take oral conjugated estrogen 7 7 7

f) If you used oral medroxyprogesterone (e.g., Provera, Cycrin), what dose did you usually take? 8 8 8 f

2.5 mg or less 5–9 mg 10 mg More than 10 mg Unsure Not used 9 9 9

g) What was your pattern of hormone use (Days per Month)? g

Oral or Patch Estrogen: Days per Month Not used <1 day/mo. 1–8 days 9–18 19–26 27+ days/mo. 1

Progesterone: Days per Month Not used <1 day/mo. 1–8 days 9–18 19–26 27+ days/mo. 2

13. Do you usually use a cane or walker? No Yes 13

14. Do you have difficulty with your balance? No Yes 14

15. Number of times you have fallen to the ground in the past year: 15

None 1 2 3 4 5 6 7 8 9 or more
a) Did you lose consciousness when you fell? No Yes, each time Yes, some times a

EliteView™ forms by NCS Pearson EM-224730-4:654321 Printed in U.S.A.

 Page 2 NHS 04 L
16. Since June 2002, have you had YEAR OF 16
17. Have you ever had any of these clinician-diagnosed 17

any of these clinician-diagnosed DIAGNOSIS illnesses or procedures?

illnesses?
YEAR OF FIRST DIAGNOSIS
BEFORE JUNE ’02 AFTER LEAVE BLANK FOR “NO”.
LEAVE BLANK FOR “NO”. MARK HERE FOR “YES” JUNE 1 TO JUNE 1 1996 or 1997–
2002 MAY 2004 2004 MARK HERE FOR “YES” Before 2001 2002 2003 2004

Fibrocystic/other benign breast disease Y 1 Amyotrophic Lat. Sclerosis (A.L.S.) Y

Confirmed by breast biopsy? N No Y Yes a Seizure (1 or more)/Epilepsy Y

Breast cancer Y 2 Chronic renal failure Y

Cancer of the uterus (endometrium) Y 3 Barrett’s esophagus Y

Cancer of the ovary Y 4 Shingles Y

Colon or rectal polyp (benign) Y 5 Increased eye pressure in

Cancer of the colon or rectum Y 6 either eye (over 25 mm/Hg) Y

Cancer of the lung Y 7 Pneumonia, x-ray confirmed Y

Melanoma Y 8 Osteoarthritis Y

Basal cell skin cancer Y 9 Alzheimer’s disease Y

Squamous cell skin cancer Y 10 Splenectomy Y

Chronic lymphocytic leukemia Y 11 ICD-Implantable Defibrillator Y

Other cancer Y 12 18. In the past two years have you had: Yes, for Yes, for
18

Specify site of other cancer (If yes, mark all that apply) No screening symptoms
A physical exam? N Y Y

Diabetes mellitus Y 13 Exam by eye doctor? N Y Y

Elevated cholesterol Y 14 Mammogram? N Y Y

High blood pressure Y 15 Fasting blood sugar? N Y Y

Myocardial infarction (heart attack) Y 16 (Virtual) CT Colonoscopy? N No Y Yes

Hospitalized for MI? N No Y Yes a Colonoscopy? N No Y Yes

Angina pectoris Y 17 Sigmoidoscopy? N No Y Yes

Confirmed by angiogram? N No Y Yes a Initial reason(s) you had Colonoscopy/Sigmoidoscopy? a

Coronary bypass, angioplasty, or stent Y 18 Visible blood Occult fecal blood Abdominal pain
Congestive heart failure Y 19 Diarrhea/constipation Family history of colon cancer

3/8” spine
Stroke (CVA) Y 20 Barium enema Follow-up of (virtual) CT colonoscopy

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TIA (Transient ischemic attack) Y 21 Prior polyps Asymptomatic or routine screening
Peripheral artery disease or Y 22
19. Indicate each year in which you have had the following 19

claudication of legs (not varicose veins) procedures: YEAR(S) OF PROCEDURES

Confirmed by angiogram/surgery? N No Y Yes a (Mark all that apply) 1993 or Never earlier ’94–’95 ’96–’97 ’98–’99 ’00–’01 ’02+
Carotid surgery (Endarterectomy) Y 23

Pulmonary embolus Y 24 Sigmoidoscopy

Atrial fibrillation Y 25 Colonoscopy
Osteoporosis Y 26 Upper endoscopy
Hip replacement Y 27 (esophagus/stomach)
Fractures: Wrist or Colles’ Fracture Y 28 20. Blood Cholesterol (most recent, within last 5 years): 20

Hip fracture Y 29 Unknown/Not checked within 5 yrs <140 mg/dl 140–159

Graves’ Disease/Hyperthyroidism Y 30 160–179 180–199 200–219 220–239
Glaucoma Y 31 240–269 270-299 300–329 330+ mg/dl
Macular degeneration of retina Y 32 21. Current usual blood pressure (if checked within 2 years): 21

Cataract—1st Diagnosis (Dx) Y 33 Systolic: Unknown/Not checked within 2 years a

Cataract extraction Y 34 <105 mmHg 105–114 115–124 125–134

Asthma, Doctor diagnosed Y 35 135–144 145–154 155–164 165–174 175+
Emphysema or Chronic bronchitis, Dr. Dx Y 36 Diastolic: Unknown/Not checked within 2 years b

Parkinson’s Disease Y 37 <65 mmHg 65–74 75–84 85–89

Ulcerative colitis/Crohn’s Y 38 90–94 95–104 105+
Kidney stones Y 39 22. In the past two years, did you forgo any of the following 23

Pernicious Anemia/B12 deficiency Y 40 for financial reasons? (Mark all that apply)
Multiple sclerosis Y 41 Medical care Medical screening Dental care
SLE (systemic lupus) Y 42 Eye care Mental health care None of these
Rheumatoid arthritis, clinician Dx Y 43 23. Is this your correct date of birth? 23

Gout Y 44 Yes If no, please

Depression, clinician Dx Y 45 No write correct
Other major illness or surgery since Y 46 date. MONTH DAY YEAR

June 2002 1 2 4 8 P
Please specify: Date:
0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 4 8 P 1 2 4 8 P A

0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 1 2 4 8 P 1 2 4 8 P B

0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 1 2 4 8 P 1 2 4 8 P C
 HARVARD MEDICAL SCHOOL Page 3 NURSES’ HEALTH STUDY
24. Regular Medication (Mark if used regularly in past 2 years) 24 27. Have any of the following Relative’s Age at First Diagnosis
(Do not count half siblings.)
27

Acetaminophen (e.g., Tylenol) biological relatives had... Age

Before Age 50 Age 60 Age
Days/week: 1 2–3 4–5 6+ days Ovarian Cancer? age 50 to 59 to 69 70+ unknown

Total tabs/wk: 1–2 3–5 6–14 15+ tab No Mother Y

“Baby” or low dose aspirin (100 mg/tablet or less) Sister Y

Days/week: 1 2–3 4–5 6+ days Daughter Y O

Total tabs/wk: 1–2 3–5 6–14 15+ tab Breast Cancer?

Aspirin or aspirin-containing products (325 mg/tablet or more) No Mother Y

Days/week: 1 2–3 4–5 6+ days One Sister Y

Total tabs/wk: 1–2 3–5 6–14 15+ tab Additional Sister Y

Ibuprofen (e.g., Advil, Motrin, Nuprin) Daughter Y B

Days/week: 1 2–3 4–5 6+ days Colon or Rectal Cancer?

Total tabs/wk: 1–2 3–5 6–14 15+ tab No Parent Y
Celebrex,Vioxx or Bextra (COX-2 inhibitors) One Sibling Y
Days/week: 1 2–3 4–5 6+ days Additional Sibling Y

Other anti-inflammatory analgesics, 2+ times/week Offspring Y C

(e.g., Aleve, Naprosyn, Relafen, Ketoprofen, Anaprox) 28. Have your parents or any siblings had dementia? 28

Thiazide diuretic Lasix Potassium Mother: No Yes < age 55 age 55–64 65+
Calcium blocker (e.g., Calan, Procardia, Cardizem) Father: No Yes < age 55 age 55–64 65+
Beta-blocker (e.g., Inderal, Lopressor, Tenormin, Corgard) Sibling: No Yes < age 55 age 55–64 65+
ACE Inhibitors (e.g., Capoten, Vasotec, Zestril) 29. Do you consider yourself to be 29

Other antihypertensive (e.g., losartan, doxazosin) Spanish/Hispanic/Latina? No Yes

Coumadin Digoxin Antiarrhythmic 30. Which categories best describe your race? 30

“Statin” cholesterol-lowering drug: (Mark one or more to indicate what your consider yourself to be.)
Mevacor (Iovastatin) Zocor (simvastatin) Crestor White Black or African American Asian
Pravachol (pravastatin) Lipitor (atorvastatin) Lescol American Indian/Alaska native
Other cholesterol-lowering drug [e.g., niacin, Lopid (gemfibrozil), Native Hawaiian or Pacific Islander Other
Tricor (fenofibrate), Questran (cholestyramine), Colestin, Zetia] 31. Do you currently take a multi-vitamin? 31
3/8” spine

Steroids taken orally (e.g., Prednisone, Decadron, Medrol) (Please report other individual vitamins in question 31)
perf

Insulin Oral hypoglycemic medication Yes a) How many do you take per week? a

SSRI’s (e.g., Prozac, Zoloft, Paxil, Celexa) No 2 or less 3–5 6–9 10 or more
Other antidepressants (e.g., Elavil, Tofranil, Pamelor) 32. Do you take any of the following separate preparations 32

Minor tranquilizers (e.g., Valium, Xanax, Ativan, Librium) on a regular basis? DO NOT REPORT CONTENTS OF
Prilosec, Nexium, Prevacid (Iansoprazole), Protonix, Aciphex MULTI-VITAMINS MENTIONED ABOVE.
Years used: 0–2 yrs 3–5 yrs 6–9 yrs 10+ yrs Vitamin C Vitamin E Calcium
H2 blocker (e.g., Pepcid, Tagamet, Zantac, Axid) Vitamin A Beta Carotene Folic Acid
Aricept Namenda Vitamin D B-Complex Iron
Fosamax, Actonel, or other bisphosphonate Zinc Selenium Niacin
No regular medication 33. Since June 2000, did you receive an influenza vaccination? 33

Other regular medications (no need to specify) Yes In what years? (Mark all that apply)
25. For each of the following periods of your life, please 25 No 2000 2001 2002 2003 2004
add up the TOTAL amount of time you used antibiotics. 34. In a typical week during the past year, on how many days 34
(Exclude skin creams, mouthwash or Isoniazid.) did you consume an alcoholic beverage of any type?
Total Time Using Antibiotics No days 1 day 2 days 3 days 4 days
Less 15 days 5 days 6 days 7 days
than to 2–4 4 Mos– 2–3 3–5 5+
None 15 days 2 Months Months 2 Years Years Years Years 35. In a typical month during the past year, what was the 35

Age 20–39 largest number of drinks of beer, wine and/or liquor

Age 40–59 you may have had in one day?
Age 60 to None 1–2 3–5 6–9 10–14 15 or more
the present 36. How many squamous or basal cell carcinoma 36

a) What was the most common reason that you used an antibiotic? a lesions have you ever had removed by surgery,
cryotherapy or other means? (Include only new
Respiratory infection UTI Acne/Rosacea
primary cancers. Exclude melanoma and benign
Chronic bronchitis Dental Other lesions like moles or actinic keratoses.)
26. Have you ever had gastrointestinal bleeding that 26 Never had squamous or basal cell carcinoma
required hospitalization or a transfusion? a 1 2–4 5–10 11+
Yes a) What was the site of the bleeding? (Mark all that apply) 37. What is your usual walking pace outdoors? 37

No Esophagus Stomach Duodenum Easy, casual (less than 2 mph) 1 1 1 1 1 1 1

Colon/rectum Other Site unknown Normal, average (2–2.9 mph) 2 2 2 2 2 2 2

b) What year(s) did this happen? (Mark all that apply) b Brisk pace (3–3.9 mph) 4 4 4 4 4 4 4

Before 1990 ’90–’91 ’92–’93 ’94–’95 Very brisk/striding (4 mph or faster) 8 8 8 8 8 8 8

’96–’97 ’98–’99 2000-’01 2002+ Unable to walk P P P P P P P

HARVARD MEDICAL SCHOOL Page 4 NURSES’ HEALTH STUDY
38. Following are questions about your physical activity at various times in your life and at various intensity levels. 38

For each age range below, please estimate the average amount of time that you spent in these activities. We
recognize that this is a difficult task, but we ask that you average your activity over seasons and years during the
given age categories.
a) Walking to and from Average hours per WEEK b) TV Watching Average hours per WEEK a b
School or Work None 0.5 1–2 3–4 5–6 7–10 11+ None 1 2–5 6–10 11–20 21–40 41–60 61–90 91+
Grades 7–8 Grades 7–8
Grades 9–12 Grades 9–12
Ages 18–22 Ages 18–22
Ages 23–29 Ages 23–29
Ages 30–34 Ages 30–34
c) Strenuous Recreational Activity d) Moderate Recreational Activity
c d
Causing increased breathing, heart-rate, or sweating e.g., hiking, walking for exercise, casual cycling, yard work
(e.g., running, aerobics, lap swimming) (do not count activities already reported)
Average hours per WEEK Average hours per WEEK
None 0.5 1–2 3–4 5–6 7–10 11+ None 0.5 1–2 3–4 5–6 7–10 11+
Grades 7–8 Grades 7–8
Grades 9–12 Grades 9–12
Ages 18–22 Ages 18–22
Ages 23–29 Ages 23–29
Ages 30–34 Ages 30–34

TIME PER WEEK

39. DURING THE PAST YEAR, what was your average time PER
1–4 5–19 20–59 One 1–1.5 2–3 4–6 7–10 11+
39
WEEK spent at each of the following recreational activities? Zero Min. Min. Min. Hour Hrs. Hrs. Hrs. Hrs. Hrs.
Walking for exercise or walking to work
Jogging (slower than 10 minutes/mile)
Running (10 minutes/mile or faster)
Bicycling (include stationary machine)

3/8” spine
Tennis, squash, racquetball

perf
Lap swimming
Other aerobic exercise (aerobic, dance, ski or stair machine, etc.)
Lower intensity exercise (yoga, stretching, toning)
Other vigorous activities (e.g., lawn mowing)
Weight training or resistance exercises Arm weights
(Include free weights or machines such as Nautilus) Leg weights

TIME PER WEEK

40. DURING THE PAST YEAR, on average, how many HOURS
Zero One 2–5 6–10 11–20 21–40 41–60 61–90 Over
40
PER WEEK did you spend: Hrs. Hour Hrs. Hrs. Hrs. Hrs. Hrs. Hrs. 90 Hrs.
Standing or walking around at work or away from home? (hrs./week)
Standing or walking around at home? (hrs./week)
Sitting at work or away from home or while driving? (hrs./week)
Sitting at home while watching TV/VCR? (hrs./week)
Other sitting at home (e.g., reading, meal times, at desk)? (hrs./week)

41. How many flights of stairs (not individual steps) do you climb daily? 41

2 flights or less 3–4 5–9 10–14 15 or more flights

42. The following items are about activities you might currently do during a typical day. 42

Does your health now limit you in these activities? Yes, limited Yes, limited No, not
If so, how much? (Mark one response on each line.) a lot a little limited at all
Vigorous activities, such as running, lifting heavy objects,
participating in strenuous sports
Moderate activities, such as moving a table, pushing a
vacuum cleaner, bowling, or playing golf
Lifting or carrying groceries
Climbing several flights of stairs
Climbing one flight of stairs
Bending, kneeling, or stooping
Walking more than a mile
Walking several blocks
Walking one block
Bathing or dressing yourself
 HARVARD MEDICAL SCHOOL Page 5 NURSES’ HEALTH STUDY
43. What is your current status? 43

Married Divorced Widowed Separated Never married Domestic Partnership

44. Your living arrangement: (Mark all that apply) 44

Alone With spouse or partner With other family Nursing home Assisted living facility Other
45. What is your current work status: (Mark all that apply) 45

Retired Full-time non-nursing employment Nursing full-time

Homemaker Part-time non-nursing employment Nursing part-time
46. How many hours each week do you participate in any groups such as a social or work group, church-connected 46

group, self-help group, charity, public service or community group?

None 1 to 2 hours 3 to 5 hours 6 to 10 hours 11 to 15 hours 16 or more hours
47. How often do you go to religious meetings or services? 47

More than once a week Once a week 1 to 3 times per month Less than once per month Never or almost never
48. Apart from your children, how many relatives do you have with whom you feel close? 48

None 1 to 2 3 to 5 6 to 9 10 or more
49. How many close friends do you have? 49

None 1 to 2 3 to 5 6 to 9 10 or more
50. Is there any one special person you know that you feel very close to; someone you feel you can share 50
confidences and feelings with?
Yes a) How often do you see or talk to this person?
No Daily Weekly Monthly Several times/year Once/year or less a

51. Can you count on anyone to provide you with emotional support (talking over problems or helping you make a 51
difficult decision)?
None of the time A little of the time Some of the time Most of the time All of the time
52. How many people can you count on to provide you with emotional support? 52

None One Two Three or more

53. Outside of your employment, do you provide regular care to any HOURS PER WEEK 53

of the following? (Mark one response on each line. For people to

Zero 1–8 9–20 21–35 36–72 73+
whom you do not provide regular care, mark “Zero hours”.) Hrs. Hrs. Hrs. Hrs. Hrs. Hrs.
3/8” spine

Your grandchildren
perf

Disabled or ill spouse/partner

Disabled or ill parent or other person
54. In your lifetime, have you ever had two weeks or longer when nearly 54

every day you felt sad, blue, or depressed for most of the day? No Yes

55. Below is a list of some of the ways you may have felt or behaved during
55
the past month. Please indicate how often you have felt this way. Occasionally or
Rarely or none Some or a little of a moderate All of
During the past month... (Mark one answer per line) of the time the time amount of time the time
I was bothered by things that usually don’t bother me
I had trouble keeping my mind on what I was doing
I felt depressed
I felt that everything I did was an effort
I felt hopeful about the future
I felt fearful
My sleep was restless
I was happy
I felt lonely
I could not “get going”
56. Below is a list of statements which people have used to describe themselves.
Please mark the response that indicates how you generally feel. 56
Almost
Almost never Sometimes Often always
I feel nervous and restless
I feel satisfied with myself
I wish I could be as happy as others seem to be
I feel like a failure
I worry too much over something that really doesn’t matter
I lack self-confidence
I feel secure
I feel inadequate
I am a steady person
I get in a state of tension or turmoil as I think over my
recent concerns and interests
 Page 6 NURSES’ HEALTH STUDY
57. Please indicate the extent to which you agree or disagree with the following statements. 57

Disagree Disagree Neither agree Agree Agree

strongly a little nor disagree a little strongly
In uncertain times I usually expect the best
If something can go wrong with me, it will
I’m always optimistic about my future
I hardly ever expect things to go my way
I rarely count on good things happening to me
Overall, I expect more good things to happen to me than bad

58. In the past year, how often did you participate

58
in each of the following activities? Daily or about Several times Several times A few times Once per
every day per week per month per year year or less
Play cards
Play board games
Read books
Read magazines or newspapers
Crossword or other puzzles
59. Do you have an unreasonable fear of being in enclosed spaces, such as stores, elevators, etc.? 59

Often Sometimes Never

60. Do you find yourself worrying about 60
getting some incurable illness? Often Sometimes Never
61. Are you scared of heights? Very Moderately Not at all 61

62. Do you feel panicky in crowds? Always Sometimes Never 62

63. Do you worry unduly when relatives 63

are late coming home? Yes No
64. Do you feel more relaxed indoors? Definitely Sometimes Not particularly 64

65. Do you dislike going out alone? Yes No 65

66. Do you feel more uneasy traveling on buses or trains, even if they are not crowded? 66

3/8” spine
Very A little Not at all

perf
67. How tall was YOUR MOTHER, without shoes on, at her maximum adult height? 67

Under 5 feet 5' to 5'3" 5'4 to 5'6" 5'7" to 5'10" 5'11"+ Don’t know
68. How tall was YOUR FATHER, without shoes on, at his maximum adult height? 68

Under 5 feet 5' to 5'8" 5'9" to 5'10" 5'11" to 6' 6'1" to 6'3" 6'4"+ Don’t know
69. What was your birth order, relative to your siblings? 69

Only child 1st born 2nd 3rd 4th 5th 6th 7th 8th 9th or later
70. Did your parents own a home at the time of your birth or infancy? 70

Yes No
71. Did your mother smoke cigarettes during her pregnancy with you? 71

Don’t know No Yes

72. Did your father smoke cigarettes or a pipe during the year when your mother was pregnant with you? 72

Don’t know No Yes

73. Please mark true or false for each of the following statements, 73
as they apply to you: True False
I do not like to exercise, so I rarely stick with an exercise program. a

I make myself exercise in order not to gain weight. b

If I eat too much, I exercise to make up for it. c

74. Would a weight fluctuation of 5 lbs. affect the way you live your life? 74

Not at all Slightly Moderately Very much

75. Do you eat sensibly in front of others and splurge alone? 75

Never Rarely Often Always

76. Do you have feelings of guilt after overeating? 76

Never Rarely Often Always

77. Please indicate the name of someone at a DIFFERENT PERMANENT ADDRESS 77
to whom we might write in the event we are unable to contact you:
Name:

Address:
1 1 1 1 1 1 1

2 2 2 2 2 2 2

4 4 4 4 4 4 4
Phone or E-mail:
8 8 8 8 8 8 8
Thank you! Please return form to: Dr. Graham Colditz, 181 Longwood Avenue, Boston, MA 02115. P P P P P P P