Epic-f2-052006

Please see our newsletter inside
To help us read your answers, please write as clearly as possible with a black pen and complete the questionnaire by putting a cross in the appropriate box(es) Study of Nutrition and Health
OR putting numbers in the appropriate box(es) We would like you to answer every question.
If you are uncertain please do the best you can.
If you have any queries you can telephone us
(01865) 289611
or email us queries@epic-oxford.org
If your name and/or your address has changed or is incorrect, please give the correct details below:
If you have an email address, would you be prepared for the study organisers to contact you about this study in the
future? If yes, please write down your email address:
PLEASE COMPLETE USING A BLACK PEN IF POSSIBLE
1. What is your
5. Do you eat any dairy products? Yes
date of birth?
(including milk, cheese, butter, yoghurt) If no, how old were you when
2. What is
today's date?
6. Do you eat any eggs?
(including eggs in cakes and other baked foods) 3. Do you eat any meat?
If yes, how many eggs
(including bacon, poultry, game, meat pies, sausages) do you eat each week?put '0' if eaten less than once a week If yes, how many times a week
If no, how old were you when
(remember bacon for breakfast and meat in sandwiches) If no, how old were you when
7. What type of milk do you use most often?
4. Do you eat any fish?
If yes, how many times a month do you eat the following?
put '0' if eaten less than once a month How much milk do you drink each day, including milk
with tea, coffee, cereals, etc.?
If no, how old were you when
EPIC in Oxford is supported by Cancer Research UK, the Medical Research Council, the World Health Organization, and the European Commission. Cancer Research UK is a registered charity No. 1089464 8. What type of spread do you normally use on bread,
15. Do you smoke cigars?
crispbreads, etc. ?
16. Do you smoke a pipe?
17. Do you currently have a paid job?
If yes, we would like to know the type and amount of physical
activity involved in your work. Please put a cross in the appropriate box Sedentary occupation
you spend most of your time sitting (such as in an office)
Which type of bread do you normally eat?
Standing or walking occupation
you spend most of your time standing or walking, but your work does not require intense physical effort (e.g. shop assistant, hairdresser, guard) Manual work
this involves some physical effort including handling of heavy objects
and use of tools (e.g. plumber, electrician, carpenter) 10. What type of breakfast cereal do you normally eat?
Heavy manual work
this involves very vigorous physical activity including handling very heavy objects (e.g. bricklayer, construction worker) 18. How do you normally travel to work?
11. How often do you eat the following foods?
19. How would you describe your normal walking pace?
20. In a typical week during the past year, how many hours
did you spend per week on each of the following
activities? put '0' if none
Walking, including to work,shopping and during leisure time 12. How often do you eat the following soya foods? Once or
21. In a typical week during the past 12 months, did you
13. How much alcohol do you drink each week?
practise any activity vigorously enough to cause
sweating or a faster heart beat?
If yes, for how many hours per week in total did you
22. What is your weight now?
QUESTIONS ABOUT YOUR LIFESTYLE
14. Have you ever smoked cigarettes? Yes
23. Compared with two years ago, has your weight
changed?
Yes, lost weight through dieting/exercise 24. What are your present waist and hip measurements?
29. Have you had a hip replacement?
if yes, in what year?
30. Have you had a knee replacement?
if yes, in what year?
31. Has your doctor ever told you that you had any of the
25. Has your height decreased since you were 20 years
following?
26. What is your marital status?
QUESTIONS ABOUT YOUR HEALTH
27. Do you regularly take any vitamins, minerals or other
supplements?
If yes, do you take: (you can cross more than one box)
28. Have you taken any medications for most of the last
If yes, was it: (you can cross more than one box)
Other significant illnesses or operations, excluding hysterectomy - see Q.42Please give details, including year first diagnosed. 32. In the last ten years, have you had any broken/fractured
38. Have you ever taken Hormone Yes
Replacement Therapy ( HRT)?
bones? Yes, once
If yes, at what age did
If yes, please indicate which bones
Are you currently taking HRT? Yes
If yes, what brand of HRT are you currently using?
If you no longer take HRT,
at what age did you stop?
33. How would you describe your health now?
39. During the last six years, have you had any children?
QUESTIONS FOR MEN ONLY
If yes, please enter the year(s) of birth and sex below:
34. Have you had a vasectomy?
If yes, at what age?
35. Have you had a PSA (prostate
specific antigen) test?
If yes, at what age?
40. Are you currently pregnant?
QUESTIONS FOR WOMEN ONLY
35. Have you been through your menopause?
41. Have you ever had a son born with either of the
following conditions?
Not sure because of irregular periods, taking HRT etc.
Yes - If yes, how old were you when
42. Have you had a hysterectomy
36. How many natural periods have you had in the
(womb removed)?
last 12 months? (put '0' if none)
Do not count bleeding while taking If yes, at what age?
37. Have you ever taken the
43. Have you had an operation to remove one or both
contraceptive pill?
ovaries?
If yes, at what age did
If yes, were one or both ovaries removed?
44. Have you ever had breast screening by
Are you currently taking
the contraceptive pill?
mammography (x-ray)?
If yes, is it the "mini pill"?
If yes, how many times
When did you last have
a breast screen? (please enter year)
If no, at what age did you stop?
THANK YOU VERY MUCH FOR YOUR HELP Please return this questionnaire in the pre-paid envelope
We guarantee that all information will be treated with absolute confidentiality and will only be used for medical research
PROF T KEY, EPIC STUDY, EPIDEMIOLOGY UNIT, UNIVERSITY OF OXFORD, RICHARD DOLL BUILDING, ROOSEVELT DRIVE, HEADINGTON, OXFORD OX3 7LF

Source: http://www.epic-oxford.org/files/epic-followup2-200605.pdf