








- | |
---|---|
1 - Yes and consulted doctor 2 - Yes but did not consult doctor 3 - No |
|
anxiety or 'nerves' | |
depression | |
headache or migraine | |
backache | |
indigestion | |
cough or cold | |
haemorrhoids/piles | |
influenza | |
wheezing | |
bronchitis | |
stomach ulcer | |
eczema | |
psoriasis | |
arthritis | |
rheumatism | |
urinary infection | |
problems with your periods | |
problems with a pregnancy |
- | |
---|---|
1 - Every day 2 - Often 3 - Sometimes 4 - Not at all |
|
sleeping pills | |
vitamins | |
cannabis/marihuana | |
tranquillisers | |
pills for depression | |
hormone tablets | |
antibiotics | |
painkillers (aspirin paracetamol, etc.) | |
amphetamines or other stimulants | |
contraceptive pill | |
iron | |
heroin, methadone, crack, cocaine | |
anticonvulsants | |
steroids |
Check Have you included the contraceptive pill, iron tablets, laxatives, vitamins, sleeping tablets, aspirin, cough mixtures, pain killers, herbal medicine, homeopathic medicine and ointments?
What did you take: | About how many days did you take or use it? | How often per day? | |
---|---|---|---|
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | |
1 | |||
2 | |||
3 | |||
4 | |||
5 | |||
6 | |||
7 | |||
8 | |||
9 | |||
10 |

How old was your study child? ... months | What were the reasons for your admission? (please describe) | How long did you stay? ... days | Did any child stay in hospital with you? | If yes, Was this your study child? | |
---|---|---|---|---|---|
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
|
1st admission | |||||
2nd admission | |||||
3rd admission |
- | |
---|---|
1 - Almost all the time 2 - Sometimes 3 - Not at all |
|
backache | |
headaches or migraines | |
urinary infection | |
nausea | |
vomiting | |
diarrhoea | |
haemorrhoids or piles | |
feeling weepy/tearful | |
feeling irritable | |
feeling exhausted | |
varicose veins | |
passing urine very often | |
problem holding urine when you jump, sneeze etc. | |
indigestion | |
feeling dizzy/fainting | |
flashing lights/spots before eyes | |
shoulder ache | |
tingling in hands/fingers | |
tingling in feet/toes | |
neck ache | |
feeling depressed |





- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than once a day |
|
Oat cereals (e.g. porridge, Ready Brek, muesli) | |
Wholegrain or bran cereals (e.g. All Bran, Bran Flakes, Weetabix, Wheatflakes, Fruit & Fibre, Shredded Wheat) | |
Other cereals (e.g. Cornflakes, Rice Krispies, Special K, Frosties) | |
Sausages, Burgers | |
Meat Pies, Pasties (pork pie, steak/meat pie, Cornish pastie etc.) | |
Vegetarian Pies, Pasties (cheese and onion pasty, vegetable samosa, onion bhaji, vegetable grills etc.) | |
Ham, bacon, pate and cold meats (e.g. salami, luncheon meat, garlic sausage etc.) | |
Meat: roast, chops and stews etc. (e.g. beef, lamb, pork, mince) | |
Liver, kidney, heart and other offal | |
Chicken/Turkey in crispy coating (e.g. chicken nuggets, turkey burgers, chicken fingers etc.) | |
Poultry: roast, baked or stewed (chicken, turkey etc.) | |
Shellfish (prawns, scampi, crab, cockles, mussels etc.) | |
White fish in breadcumbs or batter (e.g. fishfingers, chip shop fish, breaded cod, plaice or haddock,) | |
White fish without coating (e.g. grilled fish, cod in parsley sauce etc.) | |
Tuna | |
Other fish (pilchards, sardines, mackerel, herrings, kippers, trout, salmon etc.) | |
Eggs, quiche/flans, omelettes etc. | |
Cheese | |
Pizza | |
Oven chips | |
Fried chips, potato waffles and croquettes, Alphabites etc. | |
Roast potatoes (cooked in fat or oil) | |
Boiled, mashed, jacket potatoes | |
Rice (boiled, or fried, not rice pudding) | |
Canned pasta (e.g. spaghetti rings, ravioli, macaroni cheese etc.) Pot Noodles, Super Noodles etc. | |
Boiled pasta (e.g. spaghetti, fusilli, lasagne) bulgar wheat and cous-cous |
- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than once a day |
|
Baked beans | |
Peas, broad beans | |
Sweetcorn | |
Cabbage, brussel sprouts, spinach, broccoli and other dark green leafy vegetables | |
Other green vegetables (cauliflower, runner beans, leeks, courgettes etc.) | |
Carrots | |
Other root vegetables (turnip, swede, parsnip etc.) | |
Tomatoes (cooked or raw) | |
Salads | |
Pulses - dried peas, beans, lentils, chick peas etc. | |
Soya 'Meat', TVP, Soya-type Vegeburgers, Bean Curd (Tofu, Miso etc.) | |
Nuts (eg peanuts, cashews), nut roast etc. | |
Fresh citrus fruit e.g. oranges, grapefruit, satsumas, tangerines etc. | |
Other fresh fruit e.g. apple, banana, pear, bunch of grapes, peach etc. | |
Canned fruit | |
Yoghurt, Fromage Frais, Milk puddings (e.g. rice pudding, semolina) mousse | |
Ice cream, choc ice, chocolate ice cream bar etc. | |
Pudding e.g. fruit pie, crumble, cheesecake, gateaux | |
Custard, cream, Elmlea, Tip-Top, evaporated milk etc. on puddings | |
Cakes or buns (fruit cake, sponge, teacake, doughnut, flapjack, scone, custard tart, cream cake etc.) | |
Crispbreads (Ryvita, crackerbread etc.) | |
Full-coated chocolate biscuits eg. Club, Kit Kat, Penguin, Breakaway etc. | |
Other biscuits eg. rich tea, shortcake, digestive and chocolate digestive, Hob Nobs | |
Chocolate (dairy milk or plain, nut, fruit, filled etc.) | |
Sweets (peppermints, boiled sweets, toffees etc.) | |
Crisps, corn snacks (e.g. Wotsits, Quavers), tortilla chips etc. |
- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than once a day |
|
Fruit juice from a carton, tin or freshly squeezed including tomato juice | |
Squash, fruit drinks or Ribena | |
Cola drinks eg. Coca Cola, Pepsi etc. | |
Other fizzy drinks e.g. lemonade | |
Bottled water | |
Water from tap | |
Milk on its own | |
Flavoured milk drinks (e.g. Horlicks, Ovaltine, milkshakes) or yoghurt drinks |
on bread or vegetables | for frying | |
---|---|---|
1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No |
1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No |
|
Butter, Ghee, Dripping, Lard , solid cooking fat | ||
Polyunsaturated margarine eg Flora, sunflower margarine, Vitalite | ||
Hard or soft margarine e.g. Blue Band, Stork, supermarket own brand | ||
Low fat spread e.g. Delight, St Ivel Gold, Flora Xtra Light | ||
Sunflower oil, corn oil, soya oil | ||
Olive oil, hazelnut oil, rapeseed oil | ||
Other vegetable oil | ||
Other (please describe ) |

Mon. | Tues. | Wed. | Thurs. | Frid. | Sat. | Sun. | |
---|---|---|---|---|---|---|---|
How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | |
Beer, lager or cider (no. of 1/2 pints) | |||||||
Wine (no. of glasses) | |||||||
Spirits (no. of single pub measures) | |||||||
Other alcoholic drinks (please describe) (no. of glasses or measures) | |||||||
Low alcohol drink (no. of glasses or 1/2 pints) |












Name | Age | - | |
---|---|---|---|
Age 1 - Boy 2 - Girl Generic textAge1 - Boy 2 - Girl Generic text1 - Boy 2 - Girl Generic textAge |
Age 1 - Boy 2 - Girl Generic textAge1 - Boy 2 - Girl Generic text1 - Boy 2 - Girl Generic textAge |
Age 1 - Boy 2 - Girl Generic textAge1 - Boy 2 - Girl Generic text1 - Boy 2 - Girl Generic textAge |
|
1 | |||
2 | |||
3 | |||
4 | |||
5 |
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Likes to be with this older child
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Quarrels with this older child
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Is upset if parted from this older child
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Is unhappy/jealous if you do things just with this older child
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Wants to play with this older child
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Is not much interested in this older child
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Is unhappy/jealous if your partner does things just with this older child
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Misses this older child when not there
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Has a lot of fun with this older child
(If your study child is a twin, answer for the oldest/first born)
We would like to ask about the way your 4 year old study child reacts to this older child. How often does your 4 year old study child react in the following way: My 4 year old: Teases/needles this older child
(If your study child is a twin, answer for the oldest/first born)
- | |
---|---|
1 - Doesn't apply 2 - Applies somewhat 3 - Certainly applies |
|
Is considerate of other people's feelings | |
Is restless, overactive, cannot stay still for long | |
Often complains of headaches, stomach-aches or sickness | |
Shares readily with other children (treats, toys, pencils, etc.) | |
Often has temper tantrums or hot tempers | |
Is rather solitary, tends to play alone | |
Is generally obedient, usually does what adults request | |
Has many worries, often seems worried | |
Is helpful if someone is hurt, upset or feeling ill | |
Is constantly fidgeting or squirming | |
Has at least one good friend | |
Often fights with other children or bullies them | |
Is often unhappy, down hearted or tearful | |
Is generally liked by other children | |
Is easily distracted, concentration wanders | |
Is nervous or clingy in new situations, easily loses confidence | |
Is kind to younger children | |
Often lies or cheats | |
Is picked on or bullied by other children | |
Often volunteers to help others (parents, teachers, other children) | |
Thinks things out before acting | |
Steals from home, school or elsewhere | |
Gets on better with adults than with other children | |
Has many fears, is easily scared | |
Sees tasks through to the end, has good attention span |



- | |
---|---|
1 - Yes 2 - No 3 - Can't say |
|
The natural parent really loves this child | |
The natural parent often gets very irritated with this child | |
The natural parent dislikes the mess and noise that surrounds this child | |
This older child makes the natural parent pretty happy | |
The natural parent has frequent battles of will with this child | |
This older child is very affectionate to the natural parent | |
This older child gets on the natural parent's nerves | |
The natural parent seems to feel very close to this child |

- | |
---|---|
1 - Yes 2 - No |
|
My partner really loves this child | |
My partner often gets very irritated with this child | |
My partner dislikes the mess and noise that surrounds this child | |
This older child makes my partner pretty happy | |
My partner has frequent battles of will with this child | |
This older child is very affectionate to my partner | |
This older child gets on my partner's nerves | |
My partner seems to feel very close to this child |

- | |
---|---|
1 - Yes 2 - No |
|
I really love this child | |
I often get very irritated with this child | |
I dislike the mess and noise that surrounds this child | |
This older child makes me pretty happy | |
I have frequent battles of will with this child | |
This older child is very affectionate to me | |
This older child gets on my nerves | |
I feel very close to this child |
- | |
---|---|
1 - Doesn't apply 2 - Applies somewhat 3 - Certainly applies |
|
Is considerate of other people's feelings | |
Is restless, overactive, cannot stay still for long | |
Often complains of headaches, stomach-aches or sickness | |
Shares readily with other children (treats, toys, pencils etc.) | |
Often has temper tantrums or hot tempers | |
Is rather solitary, tends to play alone | |
Is generally obedient, usually does what adults request | |
Has many worries, often seems worried | |
Is helpful if someone is hurt, upset or feeling ill | |
Is constantly fidgeting or squirming | |
Has at least one good friend | |
Often fights with other children or bullies them | |
Is often unhappy, down hearted or tearful | |
Is generally liked by other children | |
Is easily distracted, concentration wanders | |
Is nervous or clingy in new situations, easily loses confidence | |
Is kind to younger children | |
Often lies or cheats | |
Is picked on or bullied by other children | |
Often volunteers to help others (parents, teachers, other children) | |
Thinks things out before acting | |
Steals from home, school or elsewhere | |
Gets on better with adults than with other children | |
Has many fears, is easily scared | |
Sees tasks through to the end, has good attention span |

- | |
---|---|
1 - Yes 2 - No |
|
I really love this child | |
I often get very irritated with this child | |
I dislike the mess and noise that surrounds this child | |
This child makes me pretty happy | |
I have frequent battles of will with this child | |
This child is very affectionate to me | |
This child gets on my nerves | |
I feel very close to this child |

- | |
---|---|
1 - Yes 2 - No |
|
My partner really loves this child | |
My partner often gets very irritated with this child | |
My partner dislikes the mess and noise that surrounds this child | |
This child makes my partner pretty happy | |
My partner has frequent battles of will with this child | |
This child is very affectionate to my partner | |
This child gets on my partner's nerves | |
My partner seems to feel very close to this child |






Which of the following statements about alcohol best applies to your partner:


- | |
---|---|
1 - Every day 2 - Most days 3 - About once a week 4 - Less than once a week 5 - Not at all |
|
disinfectant | |
bleach | |
window cleaner | |
chemical carpet cleaner | |
oven/drain cleaner | |
dry cleaning fluid | |
turpentine/white spirit | |
paint stripper | |
household paint or varnish | |
weed killers | |
pesticides/insect killers | |
air fresheners (spray, stick or aerosol) | |
other aerosols or sprays including hair spray | |
vacuum cleaner | |
broom/carpet sweeper | |
glue | |
nail varnish/acetone | |
metal cleaners/degreasers polishers | |
petrol | |
moth repellent (moth balls) |

If your doctor has prescribed medicine or tablets for your child's health problems, have you usually: (tick one)
Thinking of the last 6 months, can you say how much your study child's health problems have cost the family? Please add up carefully all the costs you can think of (e.g: for travel to the doctor counted at 15p per mile, loss of pay, extra medicines, extra child-care, etc.)




alspac_95_mnq
SECTION A: YOUR HEALTH
Have you had any of the following in the past year?
- | |
---|---|
1 - Yes and consulted doctor 2 - Yes but did not consult doctor 3 - No |
|
anxiety or 'nerves' | |
depression | |
headache or migraine | |
backache | |
indigestion | |
cough or cold | |
haemorrhoids/piles | |
influenza | |
wheezing | |
bronchitis | |
stomach ulcer | |
eczema | |
psoriasis | |
arthritis | |
rheumatism | |
urinary infection | |
problems with your periods | |
problems with a pregnancy |
In the past year how often have you taken or used the following?
- | |
---|---|
1 - Every day 2 - Often 3 - Sometimes 4 - Not at all |
|
sleeping pills | |
vitamins | |
cannabis/marihuana | |
tranquillisers | |
pills for depression | |
hormone tablets | |
antibiotics | |
painkillers (aspirin paracetamol, etc.) | |
amphetamines or other stimulants | |
contraceptive pill | |
iron | |
heroin, methadone, crack, cocaine | |
anticonvulsants | |
steroids |
Please list all the names of the actual medicines, pills or ointments that you have taken in the past month:
What did you take: | About how many days did you take or use it? | How often per day? | |
---|---|---|---|
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | |
1 | |||
2 | |||
3 | |||
4 | |||
5 | |||
6 | |||
7 | |||
8 | |||
9 | |||
10 |
Please describe for each admission.
How old was your study child? ... months | What were the reasons for your admission? (please describe) | How long did you stay? ... days | Did any child stay in hospital with you? | If yes, Was this your study child? | |
---|---|---|---|---|---|
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
How many 1 - Yes 2 - No Generic text1 - Yes 2 - No Age in monthsHow manyAge in months1 - Yes 2 - No Generic text1 - Yes 2 - No Age in months1 - Yes 2 - No 1 - Yes 2 - No How manyGeneric textGeneric text1 - Yes 2 - No How manyAge in months1 - Yes 2 - No Age in monthsHow many1 - Yes 2 - No Generic text1 - Yes 2 - No |
|
1st admission | |||||
2nd admission | |||||
3rd admission |
In the past month, how often have you had the following:
- | |
---|---|
1 - Almost all the time 2 - Sometimes 3 - Not at all |
|
backache | |
headaches or migraines | |
urinary infection | |
nausea | |
vomiting | |
diarrhoea | |
haemorrhoids or piles | |
feeling weepy/tearful | |
feeling irritable | |
feeling exhausted | |
varicose veins | |
passing urine very often | |
problem holding urine when you jump, sneeze etc. | |
indigestion | |
feeling dizzy/fainting | |
flashing lights/spots before eyes | |
shoulder ache | |
tingling in hands/fingers | |
tingling in feet/toes | |
neck ache | |
feeling depressed |
What forms of contraception are you using now? (tick all that you have used in the past month or so)
- | |
---|---|
1 - Yes |
|
withdrawal | |
the pill | |
IUCD/coil | |
condom/sheath | |
calendar/rhythm method | |
diaphragm/cap | |
spermicide | |
none |
(_pregnancy <= qc_A9_a) && (_pregnancy < 7)
SECTION B: YOUR DIET
Mothers eat a variety of different things. How often nowadays do you eat the following foods? Please answer every question even if you never eat the food (in this case tick "Never or rarely").
- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than once a day |
|
Oat cereals (e.g. porridge, Ready Brek, muesli) | |
Wholegrain or bran cereals (e.g. All Bran, Bran Flakes, Weetabix, Wheatflakes, Fruit & Fibre, Shredded Wheat) | |
Other cereals (e.g. Cornflakes, Rice Krispies, Special K, Frosties) | |
Sausages, Burgers | |
Meat Pies, Pasties (pork pie, steak/meat pie, Cornish pastie etc.) | |
Vegetarian Pies, Pasties (cheese and onion pasty, vegetable samosa, onion bhaji, vegetable grills etc.) | |
Ham, bacon, pate and cold meats (e.g. salami, luncheon meat, garlic sausage etc.) | |
Meat: roast, chops and stews etc. (e.g. beef, lamb, pork, mince) | |
Liver, kidney, heart and other offal | |
Chicken/Turkey in crispy coating (e.g. chicken nuggets, turkey burgers, chicken fingers etc.) | |
Poultry: roast, baked or stewed (chicken, turkey etc.) | |
Shellfish (prawns, scampi, crab, cockles, mussels etc.) | |
White fish in breadcumbs or batter (e.g. fishfingers, chip shop fish, breaded cod, plaice or haddock,) | |
White fish without coating (e.g. grilled fish, cod in parsley sauce etc.) | |
Tuna | |
Other fish (pilchards, sardines, mackerel, herrings, kippers, trout, salmon etc.) | |
Eggs, quiche/flans, omelettes etc. | |
Cheese | |
Pizza | |
Oven chips | |
Fried chips, potato waffles and croquettes, Alphabites etc. | |
Roast potatoes (cooked in fat or oil) | |
Boiled, mashed, jacket potatoes | |
Rice (boiled, or fried, not rice pudding) | |
Canned pasta (e.g. spaghetti rings, ravioli, macaroni cheese etc.) Pot Noodles, Super Noodles etc. | |
Boiled pasta (e.g. spaghetti, fusilli, lasagne) bulgar wheat and cous-cous |
How many times nowadays do you eat:
- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than once a day |
|
Baked beans | |
Peas, broad beans | |
Sweetcorn | |
Cabbage, brussel sprouts, spinach, broccoli and other dark green leafy vegetables | |
Other green vegetables (cauliflower, runner beans, leeks, courgettes etc.) | |
Carrots | |
Other root vegetables (turnip, swede, parsnip etc.) | |
Tomatoes (cooked or raw) | |
Salads | |
Pulses - dried peas, beans, lentils, chick peas etc. | |
Soya 'Meat', TVP, Soya-type Vegeburgers, Bean Curd (Tofu, Miso etc.) | |
Nuts (eg peanuts, cashews), nut roast etc. | |
Fresh citrus fruit e.g. oranges, grapefruit, satsumas, tangerines etc. | |
Other fresh fruit e.g. apple, banana, pear, bunch of grapes, peach etc. | |
Canned fruit | |
Yoghurt, Fromage Frais, Milk puddings (e.g. rice pudding, semolina) mousse | |
Ice cream, choc ice, chocolate ice cream bar etc. | |
Pudding e.g. fruit pie, crumble, cheesecake, gateaux | |
Custard, cream, Elmlea, Tip-Top, evaporated milk etc. on puddings | |
Cakes or buns (fruit cake, sponge, teacake, doughnut, flapjack, scone, custard tart, cream cake etc.) | |
Crispbreads (Ryvita, crackerbread etc.) | |
Full-coated chocolate biscuits eg. Club, Kit Kat, Penguin, Breakaway etc. | |
Other biscuits eg. rich tea, shortcake, digestive and chocolate digestive, Hob Nobs | |
Chocolate (dairy milk or plain, nut, fruit, filled etc.) | |
Sweets (peppermints, boiled sweets, toffees etc.) | |
Crisps, corn snacks (e.g. Wotsits, Quavers), tortilla chips etc. |
How many times a week nowadays do you drink
- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than once a day |
|
Fruit juice from a carton, tin or freshly squeezed including tomato juice | |
Squash, fruit drinks or Ribena | |
Cola drinks eg. Coca Cola, Pepsi etc. | |
Other fizzy drinks e.g. lemonade | |
Bottled water | |
Water from tap | |
Milk on its own | |
Flavoured milk drinks (e.g. Horlicks, Ovaltine, milkshakes) or yoghurt drinks |
What sort of fat do you mainly use:
on bread or vegetables | for frying | |
---|---|---|
1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No |
1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No |
|
Butter, Ghee, Dripping, Lard , solid cooking fat | ||
Polyunsaturated margarine eg Flora, sunflower margarine, Vitalite | ||
Hard or soft margarine e.g. Blue Band, Stork, supermarket own brand | ||
Low fat spread e.g. Delight, St Ivel Gold, Flora Xtra Light | ||
Sunflower oil, corn oil, soya oil | ||
Olive oil, hazelnut oil, rapeseed oil | ||
Other vegetable oil | ||
Other (please describe ) |
During the last week how many of each type of alcoholic drink did you have on each day? (Please put a number.)
Mon. | Tues. | Wed. | Thurs. | Frid. | Sat. | Sun. | |
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How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many | |
Beer, lager or cider (no. of 1/2 pints) | |||||||
Wine (no. of glasses) | |||||||
Spirits (no. of single pub measures) | |||||||
Other alcoholic drinks (please describe) (no. of glasses or measures) | |||||||
Low alcohol drink (no. of glasses or 1/2 pints) |