















Natural mother | Natural father | |
---|---|---|
1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know |
1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know |
|
diabetes treated with insulin | ||
other diabetes | ||
coronary heart disease | ||
rheumatism | ||
arthritis | ||
multiple sclerosis | ||
breast cancer (mother) prostate cancer (father) | ||
other cancer* | ||
hypertension (high blood pressure) | ||
an alcohol problem | ||
schizophrenia | ||
chronic bronchitis | ||
a stroke | ||
depression or 'nerves' | ||
other problem* |

- | |
---|---|
1 - Yes, most of the time 2 - Yes sometimes 3 - No, not at all |
|
I like to try different foods | |
I prefer to eat familiar foods | |
I prefer to eat the sort of foods I ate when I was a child | |
I would like to try different foods but my partner/family only like familiar foods | |
I would be willing to try almost any food if it were offered to me | |
I greatly enjoy eating | |
I eat because I need to, not because I enjoy it |
- | |
---|---|
1 - A lot 2 - Quite a bit 3 - A little 4 - Not at all |
|
Cost | |
What your children prefer to eat | |
What you prefer to eat | |
What other people prefer to eat (e.g. partner, other adult) | |
Convenience of preparation | |
What is good (healthy) for us to eat | |
The special offers available when shopping | |
Adverts on the television/radio | |
Articles about food and recipes in newspapers/magazines | |
Dietary requirements of a member of the family |







Your self | Your wife/partner | Your mother* | Your father* | |
---|---|---|---|---|
1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - |
1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - |
1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - |
1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - |
|
CSE or GCSE (D, E, F or G) | ||||
O-level or GCSE (A, B, or C) | ||||
A-level | ||||
Qualifications in shorthand/ typing/or other skills, e.g. hairdressing | ||||
Apprenticeship | ||||
State enrolled nurse | ||||
State registered nurse | ||||
City & Guilds intermediate technical | ||||
City & Guilds final technical | ||||
City & Guilds full technical | ||||
Teaching qualification | ||||
University degree | ||||
No qualifications | ||||
Qualifications not known | ||||
Other (Please tick & describe) |

Yourself | Your wife or partner | |
---|---|---|
1 - 1 - 1 - 1 - |
1 - 1 - 1 - 1 - |
|
Working for an employer full-time (more than 30 hours a week) | ||
Working for an employer part-time (one hour or more a week) | ||
Self-employed, employing other people | ||
Self-employed, not employing other people | ||
On a government employment or training scheme | ||
Waiting to start a job already accepted | ||
Unemployed and looking for a job | ||
At school or in other full-time education | ||
Unable to work because of long-term sickness or disability | ||
Retired from paid work | ||
Looking after the home or family | ||
Carrying out voluntary work | ||
Other (please tick & describe) |

(If you have more than one job, answer for the main job)
- | |
---|---|
1 - Yes usually 2 - Yes sometimes 3 - No |
|
Can you decide yourself when to have a holiday? | |
Can you decide what you do at work? | |
Can you decide the order in which you do your different tasks at work? | |
Can you decide when to take a break? | |
Is your work monotonous? | |
Do you have scope for on-the-job development? | |
Does the job fit well with your educational background and/or experience? | |
Do you have to work at a fast pace? |









- | |
---|---|
1 - Doesn't apply 2 - Applies a bit 3 - Moderately applies 4 - Certainly applies |
|
I feel calm | |
I feel secure | |
I feel tense | |
I feel strained | |
I feel at ease | |
I feel upset | |
I am presently worrying over possible misfortunes | |
I feel satisfied | |
I feel frightened | |
I feel comfortable | |
I feel self-confident | |
I feel nervous | |
I am jittery | |
I feel indecisive | |
I am relaxed | |
I feel content | |
I am worried | |
I feel confused | |
I feel steady | |
I feel pleasant |
- | |
---|---|
1 - Doesn't apply 2 - Applies a bit 3 - Moderately applies 4 - Certainly applies |
|
I feel pleasant | |
I tire quickly | |
I feel like crying | |
I wish I could be as happy as others seem to be | |
I am losing out on things because I can't make up my mind soon enough | |
I feel rested | |
I am 'calm, cool and collected' | |
I feel that difficulties are piling up so that I cannot overcome them | |
I worry too much over something that doesn't really matter | |
I am happy | |
I am inclined to take things hard | |
I lack self-confidence | |
I feel secure | |
I try to avoid facing a crisis or difficulty | |
I feel blue | |
I am content | |
Some unimportant thought runs through my mind and bothers me | |
I take disappointments so keenly that I can't put them out of my mind | |
I am a steady person | |
I become tense and upset when I think about my present concerns |




- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than 7 times a week |
|
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, paté and cold meats (e.g. salami, luncheon meat, garlic sausage etc.) | |
Beef: roast, stews, mince etc. | |
Lamb or pork: roast, chops, stews etc. | |
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 breadcrumbs 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 or 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 7 times a week |
|
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 or raw vegetables | |
Pulses - dried peas, beans, lentils, chick peas etc. | |
Soya 'Meat', TVP, Soya-type Vegeburgers, Bean Curd (Tofu, Miso etc.) | |
Peanuts (salted or roast, peanut butter) | |
Other nuts (e.g. almonds, cashews), and 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) | |
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 (e.g. Club, Kit Kat, Penguin, Breakaway etc.) | |
Other biscuits e.g. rich tea, shortcakes, 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 7 times a week |
|
Fruit juice from a carton, tin or freshly squeezed including tomato juice | |
Squash, fruit drinks or Ribena | |
Cola drinks (e.g. 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 e.g. Flora, sunflower margarine, Vitalite, I-Can't-Believe-its-Not-Butter | ||
Hard or soft margarine e.g. Blue Band, Stork, Clover, supermarket own brand | ||
Low fat spread e.g. Delight, St Ivel Gold, Flora Xtra Light | ||
Olive oil or monounsaturated spread e.g. Olivio, Olive Gold, Mono | ||
Sunflower oil, corn oil, soya oil | ||
Olive oil, hazelnut oil, rapeseed oil | ||
Other vegetable oil | ||
Other (please tick and describe) |

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) | Other alcoholic drinks (please describe) (no. of glasses or measures) | Low alcohol drink (no. of glasses or 1/2 pints) | |
---|---|---|---|---|---|---|
How manyHow manyHow manyHow manyHow manyOtherHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow many | How manyHow manyHow manyHow manyHow manyOtherHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow many | How manyHow manyHow manyHow manyHow manyOtherHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow many | How manyHow manyHow manyHow manyHow manyOtherHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow many | How manyHow manyHow manyHow manyHow manyOtherHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow many | How manyHow manyHow manyHow manyHow manyOtherHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyHow manyHow manyHow manyHow manyOtherHow manyHow manyHow manyOtherHow manyHow many | |
Mon. | ||||||
Tues. | ||||||
Wed. | ||||||
Thurs | ||||||
Frid. | ||||||
Sat. | ||||||
Sun. |








alspac_99_fatf
SECTION A: YOUR MEDICAL HISTORY
please describe the problem and regular treatment or medicine:
Problem | Treatment or medicine | |
---|---|---|
Generic textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric text | |
1 | ||
2 | ||
3 | ||
4 |
Have you had any of the following in the past two years:
- | |
---|---|
1 - Yes often 2 - Yes, sometimes 3 - No, not at all |
|
attacks of wheezing with whistling on the chest | |
a dry itchy rash | |
a blotchy blistery rash (hives) | |
sneezing attacks | |
runny nose | |
watery eyes | |
attacks of breathlessness | |
cough often during the night | |
cough often when you wake in the morning |
What is your size nowadays in:-
ins. | cms | |
---|---|---|
InchesCentimetresInchesCentimetres | InchesCentimetresInchesCentimetres | |
hips | ||
waist | ||
chest |
Your hearing
Your eyesight
When you were a child, what was the maximum number of brothers and sisters that lived with you at any one time? (Include half-brothers and sisters, step-brothers and sisters)
brothers | sisters | |
---|---|---|
How manyHow manyHow manyHow many | How manyHow manyHow manyHow many | |
older than you | ||
younger than you | ||
a twin to you |
SECTION B: ABOUT THE HEALTH OF YOUR PARENTS
Has your natural mother and/or natural father ever had any of the following:
Natural mother | Natural father | |
---|---|---|
1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know |
1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know 1 - Yes 2 - No 9 - Don't know |
|
diabetes treated with insulin | ||
other diabetes | ||
coronary heart disease | ||
rheumatism | ||
arthritis | ||
multiple sclerosis | ||
breast cancer (mother) prostate cancer (father) | ||
other cancer* | ||
hypertension (high blood pressure) | ||
an alcohol problem | ||
schizophrenia | ||
chronic bronchitis | ||
a stroke | ||
depression or 'nerves' | ||
other problem* |
SECTION C: YOU AND FOOD
How far do the following statements describe you?
- | |
---|---|
1 - Yes, most of the time 2 - Yes sometimes 3 - No, not at all |
|
I like to try different foods | |
I prefer to eat familiar foods | |
I prefer to eat the sort of foods I ate when I was a child | |
I would like to try different foods but my partner/family only like familiar foods | |
I would be willing to try almost any food if it were offered to me | |
I greatly enjoy eating | |
I eat because I need to, not because I enjoy it |
When you are choosing food for meals, how much do the following influence your choice?
- | |
---|---|
1 - A lot 2 - Quite a bit 3 - A little 4 - Not at all |
|
Cost | |
What your children prefer to eat | |
What you prefer to eat | |
What other people prefer to eat (e.g. partner, other adult) | |
Convenience of preparation | |
What is good (healthy) for us to eat | |
The special offers available when shopping | |
Adverts on the television/radio | |
Articles about food and recipes in newspapers/magazines | |
Dietary requirements of a member of the family |
How often do you yourself usually eat something at each of the following meals?
- | |
---|---|
1 - Never 2 - Less than once a week 3 - Once a week 4 - 2-4 times a week 5 - 5-6 times a week 6 - Every day |
|
Breakfast | |
Mid-morning snack | |
Mid-day meal/ snack | |
Mid-afternoon snack | |
Evening meal/snack | |
Late night snack/ supper |
SECTION D: YOU AND YOUR CURRENT PARTNER
SECTION E: EDUCATION AND OCCUPATION
What educational qualifications do you, your wife or partner, your mother, and your father have? Please tick all that apply. (By wife or partner we mean your current live-in wife or partner).
Your self | Your wife/partner | Your mother* | Your father* | |
---|---|---|---|---|
1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - |
1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - |
1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - |
1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - |
|
CSE or GCSE (D, E, F or G) | ||||
O-level or GCSE (A, B, or C) | ||||
A-level | ||||
Qualifications in shorthand/ typing/or other skills, e.g. hairdressing | ||||
Apprenticeship | ||||
State enrolled nurse | ||||
State registered nurse | ||||
City & Guilds intermediate technical | ||||
City & Guilds final technical | ||||
City & Guilds full technical | ||||
Teaching qualification | ||||
University degree | ||||
No qualifications | ||||
Qualifications not known | ||||
Other (Please tick & describe) |
What is the present employment situation of yourself and your current live-in wife or partner? Please tick all that apply.
Yourself | Your wife or partner | |
---|---|---|
1 - 1 - 1 - 1 - |
1 - 1 - 1 - 1 - |
|
Working for an employer full-time (more than 30 hours a week) | ||
Working for an employer part-time (one hour or more a week) | ||
Self-employed, employing other people | ||
Self-employed, not employing other people | ||
On a government employment or training scheme | ||
Waiting to start a job already accepted | ||
Unemployed and looking for a job | ||
At school or in other full-time education | ||
Unable to work because of long-term sickness or disability | ||
Retired from paid work | ||
Looking after the home or family | ||
Carrying out voluntary work | ||
Other (please tick & describe) |