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alspac_91_yaye
YOU AND YOUR ENVIRONMENT (PARTNER'S)
This questionnaire asks about your health, your partner, your childhood and your beliefs and attitudes. Your answers will help us to understand how your health and background might affect your partner's pregnancy.
All the answers you give are confidential. Your name and address will not be on the questionnaire.
We would be grateful if you would help us by answering as many of these questions as possible but if there is any question you do not want to answer that is fine. Just leave it blank.
THANK YOU VERY MUCH FOR YOUR HELP
SECTION A: YOUR HOME ENVIRONMENT
A1

How long have you lived in or near Avon?

1
less than 1 year
2
1 - 4 years
3
5 - 9 years
4
10 years or more
5
all my life
A2 a

When did you move to your present address?

Generic date
A2 b

How many times have you moved home in the last 5 years?

How many
A3 a

In the coldest time of year, describe the temperature in your: living rooms

1
Very warm
2
Warm
3
About right
4
Cold
5
Very cold
A3 b

In the coldest time of year, describe the temperature in your: bedrooms

1
Very warm
2
Warm
3
About right
4
Cold
5
Very cold
A4

Which of the following best describes your feelings about your home?

1
satisfied
2
fairly satisfied
3
dissatisfied
4
very dissatisfied
A5 a

What do you think of your neighbourhood as a place to live?

1
a very good place to live
2
a fairly good place to live
3
not a very good place to live
4
not at all a good place to live
A5 b(i)

Do the other people in your neighbourhood: visit your home

1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 b(ii)

Do the other people in your neighbourhood: argue with you

1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 b(iii)

Do the other people in your neighbourhood: look after your children

1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 b(iv)

Do the other people in your neighbourhood: keep to themselves

1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 c(i)

Do you: visit the home of your neighbours

1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 c(ii)

Do you: argue with your neighbours

1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 c(iii)

Do you: look after your neighbours children

1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 c(iv)

Do you: keep to yourself

1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A6 a-d
How worried are you that in your neighbourhood:
-

1 - Very worried

2 - Fairly worried

3 - Not very worried

4 - Not at all worried

9 - Don't know
you might have your home broken into and something stolen
you might be mugged or robbed
you might be sexually assaulted or pestered
you might have your home or property damaged by vandals
A7 i

Is your neighbourhood: lively

1
Yes usually
2
Yes sometimes
3
No not at all
A7 ii

Is your neighbourhood: friendly

1
Yes usually
2
Yes sometimes
3
No not at all
A7 iii

Is your neighbourhood: noisy

1
Yes usually
2
Yes sometimes
3
No not at all
A7 iv

Is your neighbourhood: clean

1
Yes usually
2
Yes sometimes
3
No not at all
A7 v

Is your neighbourhood: attractive

1
Yes usually
2
Yes sometimes
3
No not at all
A7 vi

Is your neighbourhood: polluted/dirty

1
Yes usually
2
Yes sometimes
3
No not at all
SECTION B: CHEMICALS IN YOUR ENVIRONMENT
B1 a-zd
Just before your partner became pregnant, how often did you use the following (whether at home or at work):
-

1 - Every day

2 - Most days

3 - About once a week

4 - Less than once a month

5 - Not at all
disinfectant
bleach
window cleaner
carpet cleaner
oven/drain cleaner
dry cleaning fluid
turpentine/white spirit
paint stripper
household paint or varnish
weed killers
pesticides/insect killers
aerosols or sprays including hair spray
hair dye/bleach
deodorants
air fresheners (spray, stick or aerosol)
dental amalgam
ceramics/enamels
soldering
electroplating
glues
leather working
fabric/textiles
dyes
radiation (x-ray or other)
plastics
metal cleaners/degreasers, polishers
petrol
machining
photographic chemicals/other chemicals
electrical wiring
B1 ze

Just before your partner became pregnant, how often did you use the following (whether at home or at work): other chemical (please describe)

1
Every day
2
Most days
3
About once a week
4
Less than once a month
5
Not at all
Other
B2
What jobs have you had since the age of 16? Include part-time and voluntary work. If you have not worked write 'None'.

If there is not enough space please continue on the back cover.

Job Materials/machines or chemicals used Date started (month-year) Date stopped (month-year)
Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
SECTION C: YOUR HOUSEHOLD
C1 a

How long have you lived together with your partner? ... years ... months

Years
Months
C1 b

Are you the father of your partner's study child?

1
Yes
2
No
3
Not sure
C2

How would you assess your partner's physical health

1
always fit and well
2
usually fit and well
3
sometimes unwell
4
often unwell
5
always unwell
C3 a

What is your present marital status?

1
never married
2
widowed
3
divorced
4
separated
5
married (once only)
6
married for second or third time
If married,
qc_C3_a == 5 || qc_C3_a == 6
C3 b

what was the date of the most recent marriage?

Generic date
C3 c

How many other marriages/live-in partners have you had?

How many
C4 a-c
Please indicate how many of the children (aged 18 or under) apart from the study child living with you have:
Number of children
How many
you and your partner as their natural parents
you as their natural father (but their natural mother is not present)
your partner as the natural mother (but you are not their natural father)
C4 d

Please indicate how many of the children (aged 18 or under) apart from the study child living with you have: neither you nor your partner as natural parents (please describe whether you have adopted, fostered etc.)

How many
Other
C5 a-c
Are there other children of yourself or your partner who do not live with you?
-

1 - Yes

2 - No
children of my partner
children of myself
children of partner & self
SECTION D: YOUR MEDICAL HISTORY
D1 a

What is your weight?

(Please state whether stones, pounds or kilos)

Generic text
D1 b

Are you certain of this?

1
Yes
2
No
D1 c(i)

What is your size in: hips ... ins

(if you don't know write NK)

Inches
D1 c(ii)

What is your size in: waist ... ins

(if you don't know write NK)

Inches
D1 c(iii)

What is your size in: chest ... ins

(if you don't know write NK)

Inches
D1 c(iv)

What is your size in: collar ... ins

(if you don't know write NK)

Inches
D1 c(v)

What is your size in: inside leg ... ins

(if you don't know write NK)

Inches
D2 a

How tall are you ?

(Please state whether feet, inches or metres)

Generic text
D2 b

Are you certain of this?

1
Yes
2
No
D3 a

Have you ever had any of the following infections: measles

1
Yes
2
No never
9
Don't know
D3 b

Have you ever had any of the following infections: mumps

1
Yes
2
No never
9
Don't know
D3 c

Have you ever had any of the following infections: chicken pox

1
Yes
2
No never
9
Don't know
D3 d

Have you ever had any of the following infections: whooping cough

1
Yes
2
No never
9
Don't know
D3 e

Have you ever had any of the following infections: cold sores

1
Yes
2
No never
9
Don't know
D3 f

Have you ever had any of the following infections: meningitis

1
Yes
2
No never
9
Don't know
D3 g

Have you ever had any of the following infections: genital herpes

1
Yes
2
No never
9
Don't know
D3 h

Have you ever had any of the following infections: syphilis

1
Yes
2
No never
9
Don't know
D3 i

Have you ever had any of the following infections: gonorrhea

1
Yes
2
No never
9
Don't know
D3 j

Have you ever had any of the following infections: urinary infection, cystitis, pyelitis

1
Yes
2
No never
9
Don't know
D4 a

Have you ever had any of the following operations: tonsils out

1
Yes
2
No
D4 b

Have you ever had any of the following operations: adenoids out

1
Yes
2
No
D4 c

Have you ever had any of the following operations: hernia repair

1
Yes
2
No
D4 d

Have you ever had any of the following operations: appendix out

1
Yes
2
No
D4 e

Have you ever had any of the following operations: gall bladder out

1
Yes
2
No
D4 f

Have you ever had any of the following operations: circumcision

1
Yes
2
No
D4 g

Have you ever had any of the following operations: pyloric stenosis operation

1
Yes
2
No
D4 h

Have you ever had any of the following operations: squint repaired

1
Yes
2
No
D4 i

Have you ever had any of the following operations: plastic surgery

1
Yes
2
No
D4 j

Have you ever had any of the following operations: grommets in your ears

1
Yes
2
No
D4 k

Have you ever had any of the following operations: other type of operation (please tick and describe)

1
Yes
2
No
Other
D5 a-r
Have any of the following ever happened?

(tick one in each row, and add age if you had such an incident)

- Age this first happened

1 - Yes and stayed in hospital

2 - Yes saw doctor, did not stay in hospital

3 - Yes treated at home only

4 - No never happened

Age

1 - Yes and stayed in hospital

2 - Yes saw doctor, did not stay in hospital

3 - Yes treated at home only

4 - No never happened

Age

1 - Yes and stayed in hospital

2 - Yes saw doctor, did not stay in hospital

3 - Yes treated at home only

4 - No never happened

Age

1 - Yes and stayed in hospital

2 - Yes saw doctor, did not stay in hospital

3 - Yes treated at home only

4 - No never happened

Age
You were badly burnt
You were badly scalded
You took a lot of pills or medicine
You broke an arm or hand
You broke a leg or foot
You nearly drowned
You were in a road traffic accident
You were sexually assaulted
You were injured playing sports or games
You had an accident while on a bicycle
You were injured in a fight
Your parents hurt you
You were hurt by someone else
Your head was hit
You were badly cut
You had a bad fall
You attempted suicide
You had another type of accident or injury (please describe)
D5 r

Have any of the following ever happened? You had another type of accident or injury(please describe)

Other
D6 a-w
Have you ever had any of the following problems:
-

1 - Yes had it recently

2 - Yes in past, not now

3 - No never

9 - Don't know
hay fever
indigestion
bulimia
asthma
eczema
epilepsy
convulsions with a fever
migraine
back pain/slipped disc
kidney disease
varicose veins
haemorrhoids/piles
rheumatism
arthritis
psoriasis
stomach ulcer
other repeated pains in your stomach
drug addiction
alcoholism
schizophrenia
anorexia nervosa
severe depression
other psychiatric problem
D6 x

Have you ever had any of the following problems: other problem (please tick & describe)

1
Yes had it recently
2
Yes in past, not now
3
No never
9
Don't know
Other
D7 a

Are there any problems for which you have regular treatment or medicine?

1
Yes
2
No
If yes,
qc_D7_a == 1
D7 b
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
D8 a

Would you say that you were allergic to anything?

1
Yes
2
No
If yes,
qc_D8_a == 1
D8 b(i)

is it to: cat

1
Yes
2
No
9
Don't know
D8 b(ii)

is it to: pollen

1
Yes
2
No
9
Don't know
D8 b(iii)

is it to: dust

1
Yes
2
No
9
Don't know
D8 b(iv)

is it to: insect bites or stings

1
Yes
2
No
9
Don't know
D8 b(v)

is it to: something else (please describe)

1
Yes
2
No
9
Don't know
Other
D9 a-i
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
D10 a

Do you know how much you weighed when you were born?

1
Yes
2
No
If yes,
qc_D10_a == 1
D10 aa

give weight:

Generic text
D10 b

Were you born:

1
more than 3 weeks before your expected date
2
at around the date expected
3
more than 3 weeks late
9
don't know
D10 c(i)

Were you born with any of the following: hare lip

1
Yes
2
No
D10 c(ii)

Were you born with any of the following: birthmark

1
Yes
2
No
D10 c(iii)

Were you born with any of the following: cleft palate

1
Yes
2
No
D10 c(iv)

Were you born with any of the following: heart disease

1
Yes
2
No
D10 c(v)

Were you born with any of the following: malformed feet

1
Yes
2
No
D10 c(vi)

Were you born with any of the following: unusual shaped head

1
Yes
2
No
D10 c(vii)

Were you born with any of the following: spina bifida

1
Yes
2
No
D10 c(viii)

Were you born with any of the following: extra finger

1
Yes
2
No
D10 c(ix)

Were you born with any of the following: extra toe

1
Yes
2
No
D10 c(x)

Were you born with any of the following: funny shaped fingers or hands

1
Yes
2
No
D10 c(xi)

Were you born with any of the following: missing part of body

1
Yes
2
No
D10 c(xii)

Were you born with any of the following: other (please describe all such problems below)

1
Yes
2
No
Other
D10 d(i)

Were you born in a hospital?

1
Yes
2
No
9
Don't know
If yes,
qc_D10_d_i == 1
D10 d(ii)

please give: Name of hospital:

Generic text
D10 e(i)

Where were your parents living at the time you were born? Town:

Generic text
D10 e(ii)

Where were your parents living at the time you were born? County:

Generic text
D10 e(iii)

Where were your parents living at the time you were born? Country:

Generic text
Your hearing
D11 i

How would you rate your hearing in each ear? Left ear

1
always very good
2
occasional problems (eg.infections or glue ear)
3
there are some sounds I can not hear
4
never very good
5
I cannot hear much at all
D11 ii

How would you rate your hearing in each ear? Right ear

1
always very good
2
occasional problems (eg.infections or glue ear)
3
there are some sounds I can not hear
4
never very good
5
I cannot hear much at all
Your eyesight
D12 a(i)

How would you rate your sight without glasses ? Left eye

1
always very good
2
I can't see clearly at a distance
3
I can't see clearly close up
4
I can't see much at all
D12 a(ii)

How would you rate your sight without glasses ? Right eye

1
always very good
2
I can't see clearly at a distance
3
I can't see clearly close up
4
I can't see much at all
D12 b

Are you colour blind?

1
Yes
2
No
9
Don't know
D13 a

When you were a child did you ever go to any of the following? physiotherapist

1
Yes
2
No
9
Not known
If yes,
qc_D13_a == 1
D13 a(i)

what for:

Generic text
D13 b

When you were a child did you ever go to any of the following? child guidance or child psychiatrist

1
Yes
2
No
9
Not known
If yes,
qc_D13_b == 1
D13 b(i)

what for:

Generic text
D13 c

When you were a child did you ever go to any of the following? speech therapist

1
Yes
2
No
9
Not known
If yes,
qc_D13_c == 1
D13 c(i)

what for:

Generic text
D13 d

When you were a child did you ever go to any of the following? special schooling

1
Yes
2
No
9
Not known
If yes,
qc_D13_d == 1
D13 d(i)

what for:

Generic text
D14 a-d
Did you or any of your family have a problem of bedwetting or daytime wetting? (when older than 5 years)
-

1 - Yes, bed-wetting

2 - Yes, daytime wetting

4 - No not at all

9 - Don't know
you
brother or sister
mother
father
D15 a

Have you had a wetting accident yourself in the past year, either during the night or day?

1
Yes
2
No
If yes,
qc_D15_a == 1
D15 b(i)

Could you please indicate how many nights or days this has occurred within the past month: during the night:

How many
D15 b(ii)

Could you please indicate how many nights or days this has occurred within the past month: during the day:

How many
D16

Have you ever been a blood donor?

1
Yes
2
No
D17 a-l
Many people have X-rays, barium meals and other procedures. Please indicate whether you have ever had any of the following types of X-ray.
During this pregnancy In the year before this pregnancy Any other time during your life

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

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

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

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No
arm or hand
chest
leg or foot
dental
head or neck
back
barium meal
barium enema
IVP (intravenous pyelogram)
hips or pelvis
stomach or abdomen
any other (please describe)
D17 l

Many people have X-rays, barium meals and other procedures. Please indicate whether you have ever had any of the following types of X-ray. any other (please describe)

Other
SECTION E: YOUR PARTNER
The following questions are about how you and your partner behave towards each other. Please indicate how often you and your partner behave in the ways listed.
E1

Is your partner affectionate toward you?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E2

Does your partner get angry with you?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E3

Does your partner listen to you when you want to talk about your feelings?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E4

Do you have arguments with your partner?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E5

Does your partner talk to you about her problems and feelings?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E6

Do you get angry with your partner?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E7

Do you enjoy the company of your partner?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E8

Does your partner show her approval of you?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E9

Do you behave affectionately toward your partner?

1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
SECTION F: YOU AND YOUR PARENTS
F1 a

Were you legally adopted?

1
Yes
2
No
If yes,
qc_F1_a == 1
F1 b

what age were you?

Age
F2

Were you ever "in care" of either a local authority or voluntary agency e.g. Barnados?

1
Yes
2
No
3
Unsure
F3 a

Did your parents divorce or separate before your 18th birthday?

1
Yes
2
No
If no, go to F4, on page 25.
If yes,
qc_F3_a == 1
F3 b

what age were you?

Age
F3 c

who did you mainly live with after this?

1
mother
2
father
3
sometimes mother, sometimes father
4
someone else (please say who)
Generic text
F4 i-iv
Did you ever live away from home with any of the following (other than for holidays/or short visits) before you were 18 years old?
-

1 - Yes

2 - No
grandparents
other relatives
friends
foster parents
F4 v

Did you ever live away from home with any of the following (other than for holidays/or short visits) before you were 18 years old? other (please describe)

1
Yes
2
No
Other
F5 i-v
Did you ever stay away from home in any of the following places before you were 18 years old?
-

1 - No

2 - Yes for less than a week

3 - Yes for 1 week - 1 month

4 - Yes for 1 - 6 months

5 - Yes over 6 months
hospital
boarding school
children's home
hostel
in custody (detention centre, remand home, borstal etc)
F5 vi

Did you ever stay away from home in any of the following places before you were 18 years old? other (please describe)

1
No
2
Yes for less than a week
3
Yes for 1 week - 1 month
4
Yes for 1 - 6 months
5
Yes over 6 months
Other
F6 a

Did you leave home before your 18th birthday?

1
Yes
2
No
If no, go to F7, on page 26.
If yes,
qc_F6_a == 1
F6 b

At that time where did you first live?

1
college residence
2
hostel
3
bedsit
4
shared flat or house
5
other (please describe)
Other
F7 i(a-m)
At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 0-5 years
-

1 - Yes
mother
father
brother(s)
sister(s)
step-mother
step-father
step-brother(s)
step-sister(s)
mother's partner
father's partner
grandmother
grandfather
family friend
F7 i(n)

At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 0-5 years other (please describe)

1
Yes
Other
F7 ii(a-m)
At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 6-11 years
-

1 - Yes
mother
father
brother(s)
sister(s)
step-mother
step-father
step-brother(s)
step-sister(s)
mother's partner
father's partner
grandmother
grandfather
family friend
F7 ii(n)

At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 6-11 years other (please describe)

1
Yes
Other
F7 iii(a-m)
At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 12-16 years
-

1 - Yes
mother
father
brother(s)
sister(s)
step-mother
step-father
step-brother(s)
step-sister(s)
mother's partner
father's partner
grandmother
grandfather
family friend
F7 iii(n)

At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 12_16 years other (please describe)

1
Yes
Other
F8 a

Who would you say brought you up? mother

1
Yes
2
No
3
Did not have
F8 b

Who would you say brought you up? father

1
Yes
2
No
3
Did not have
F8 c

Who would you say brought you up? brother(s)

1
Yes
2
No
3
Did not have
F8 d

Who would you say brought you up? sister(s)

1
Yes
2
No
3
Did not have
F8 e

Who would you say brought you up? step-mother

1
Yes
2
No
3
Did not have
F8 f

Who would you say brought you up? step-father

1
Yes
2
No
3
Did not have
F8 g

Who would you say brought you up? step-brother(s)

1
Yes
2
No
3
Did not have
F8 h

Who would you say brought you up? step-sister(s)

1
Yes
2
No
3
Did not have
F8 i

Who would you say brought you up? mother's partner

1
Yes
2
No
3
Did not have
F8 j

Who would you say brought you up? father's partner

1
Yes
2
No
3
Did not have
F8 k

Who would you say brought you up? grandmother

1
Yes
2
No
3
Did not have
F8 l

Who would you say brought you up? grandfather

1
Yes
2
No
3
Did not have
F8 m

Who would you say brought you up? adoptive mother

1
Yes
2
No
3
Did not have
F8 n

Who would you say brought you up? adoptive father

1
Yes
2
No
3
Did not have
F8 o

Who would you say brought you up? foster mother

1
Yes
2
No
3
Did not have
F8 p

Who would you say brought you up? foster father

1
Yes
2
No
3
Did not have
F8 q

Who would you say brought you up? family friend

1
Yes
2
No
3
Did not have
F8 r

Who would you say brought you up? other (please describe)

1
Yes
2
No
3
Did not have
Other
F9 a-o
Has your natural mother and/or mother figure had any of the following:

(If you only had a natural mother, answer only under 'natural mother')

Natural mother Mother figure

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
other cancer
hypertension (high blood pressure)
an alcohol problem
schizophrenia
chronic bronchitis
a stroke
depression or 'nerves'
other problem (please describe)
F9 o

Has your natural mother and/or mother figure had any of the following: other problem (please describe)

(If you only had a natural mother, answer only under 'natural mother')

Other
F10 a

Would you say that your mother (or mother figure) was disabled in any way?

1
Yes
2
No
If yes,
qc_F10_a == 1
F10 b

please describe:

Generic text
F11 a

Would you say that any problems in your mother's (or mother figure's) health affected the way you were brought up?

4
she had no problems
1
yes, major effect
2
yes, minor effect
3
she had some problems, but they did not affect my upbringing
If yes,
qc_F11_a == 1 || qc_F11_a == 2
F11 b

please describe:

Generic text
F12 a-o
Has your natural father and/or father figure had any of the following:

(If you only had a natural father, answer only under 'natural father')

Natural father Father figure

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
prostate cancer
other cancer
hypertension (high blood pressure)
an alcohol problem
schizophrenia
chronic bronchitis
a stroke
depression or 'nerves'
other problem (please describe)
F12 o

Has your natural father and/or father figure had any of the following: other problem (please describe)

(If you only had a natural father, answer only under 'natural father')

Other
F13 a

Would you say that your father (or father figure) was disabled in any way?

1
Yes
2
No
7
No father figure
If yes,
qc_F13_a == 1
F13 b

please describe:

Generic text
F14 a

Would you say that any problems in your father's (or father figure's) health affected the way you were brought up?

4
he had no problems
1
yes, major effect
2
yes, minor effect
3
he had some problems, but they did not affect my upbringing
7
no such person
If yes,
qc_F14_a == 1 || qc_F14_a == 2
F14 b

please describe:

Generic text
F15 a(i-iv)
Before you were 17 did a parent or person who cared for you die?
-

1 - Yes

2 - No

9 - Don't know
mother
father
mother figure
father figure
F15 a(v)

Before you were 17 did a parent or person who cared for you die? other (please describe)

1
Yes
2
No
9
Don't know
Other
If yes,
qc_F15_a_i-iv == 1 || qc_F15_a_v == 1
F15 b(i)

what age were you: mother died when I was: ... years old

Age
F15 b(ii)

what age were you: father died when I was: ... years old

Age
F15 b(iii)

what age were you: mother figure died when I was: ... years old

Age
F15 b(iv)

what age were you: father figure died when I was: ... years old

Age
F15 b(v)

what age were you: other figure died when I was ... years old

Age
F15 c(i)

If either parent died, who cared for you after their death(s)? other parent

1
Yes
2
No
F15 c(ii)

If either parent died, who cared for you after their death(s)? relative

1
Yes
2
No
F15 c(iii)

If either parent died, who cared for you after their death(s)? foster parents

1
Yes
2
No
F15 c(iv)

If either parent died, who cared for you after their death(s)? adopted parent

1
Yes
2
No
F15 c(v)

If either parent died, who cared for you after their death(s)? other (please describe)

1
Yes
2
No
Other
We would like to know how you and your mother got on when you were a child. This will probably have varied over your childhood and in different situations but we would like a general impression. Please tick the box to indicate how you mostly remember your mother in your first 16 years.
Mother (or person that took the place of your mother)
F16 a

My mother - Spoke to me with a warm and friendly voice

1
Never
2
Sometimes
3
Usually
F16 b

My mother - Helped me as much as I needed

1
Never
2
Sometimes
3
Usually
F16 c

My mother - Let me do those things I liked doing

1
Never
2
Sometimes
3
Usually
F16 d

My mother - Seemed emotionally cold to me

1
Never
2
Sometimes
3
Usually
F16 e

My mother - Appeared to understand my problems and worries

1
Never
2
Sometimes
3
Usually
F16 f

My mother - Was affectionate to me

1
Never
2
Sometimes
3
Usually
F16 g

My mother - Tried to control what I did

1
Never
2
Sometimes
3
Usually
F16 h

My mother - Invaded my privacy

1
Never
2
Sometimes
3
Usually
F16 i

My mother - Let me decide things for myself

1
Never
2
Sometimes
3
Usually
F16 j

My mother - Made me feel I wasn't wanted

1
Never
2
Sometimes
3
Usually
F16 k

My mother - Talked things over with me

1
Never
2
Sometimes
3
Usually
F16 l

My mother - Gave me the freedom I wanted

1
Never
2
Sometimes
3
Usually
F16 m

My mother - Praised me

1
Never
2
Sometimes
3
Usually
F16 n

My mother - Enjoyed talking things over with me

1
YES
2
NO
F16 o

My mother - Frequently smiled at me

1
YES
2
NO
F16 p

My mother - Tended to baby me

1
YES
2
NO
F16 q

My mother - Seemed to understand what I needed or wanted

1
YES
2
NO
F16 r

My mother - Could make me feel better when I was upset

1
YES
2
NO
F16 s

My mother - Felt I could not look after myself unless she was around

1
YES
2
NO
F16 t

My mother - Let me go out as often as I wanted

1
YES
2
NO
F16 u

My mother - Was overprotective of me

1
YES
2
NO
F16 v

My mother - Let me dress in any way I pleased

1
YES
2
NO
F17 a

Was your parent's behaviour stable and predictable to you as a child? mother

1
Always
2
Mostly
3
Rarely
4
Never
7
Not applicable
F17 b

Was your parent's behaviour stable and predictable to you as a child? father

1
Always
2
Mostly
3
Rarely
4
Never
7
Not applicable
F17 c

Was your parent's behaviour stable and predictable to you as a child? mother figure

1
Always
2
Mostly
3
Rarely
4
Never
7
Not applicable
F17 d

Was your parent's behaviour stable and predictable to you as a child? father figure

1
Always
2
Mostly
3
Rarely
4
Never
7
Not applicable
F18 i-iii
Looking back would you call your childhood happy? Please indicate for each age range:
-

1 - Yes very happy

2 - Yes moderately happy

3 - Not really happy

4 - No quite unhappy

5 - No very unhappy

6 - Can't remember
0-5 years
6-11 years
12-15 years
F19

Are there any comments you would like to add?

Long text
SECTION G: YOUR OUTLOOK ON LIFE
G1

Did getting good marks at school mean a great deal to you?

1
Yes
2
No
G2

Are you often blamed for things that just aren't your fault?

1
Yes
2
No
G3

Do you feel that most of the time it doesn't pay to try hard because things never turn out right anyway?

1
Yes
2
No
G4

Do you feel that if things start out well in the morning that it's going to be a good day no matter what you do?

1
Yes
2
No
G5

Do you believe that whether or not people like you depends on how you act?

1
Yes
2
No
G6

Do you believe that when bad things are going to happen they are just going to happen no matter what you try to do to stop them?

1
Yes
2
No
G7

Do you feel that when good things happen they happen because of hard work?

1
Yes
2
No
G8

Do you feel that when someone doesn't like you there's little you can do about it?

1
Yes
2
No
G9

Did you usually feel that it was almost useless to try in school because most other children were cleverer than you?

1
Yes
2
No
G10

Are you the kind of person who believes that planning ahead makes things turn out better?

1
Yes
2
No
G11

Most of the time, do you feel that you have little to say about what your family decides to do?

1
Yes
2
No
G12

Do you think it's better to be clever than to be lucky?

1
Yes
2
No
SECTION H
H1

Please put the date of completing this questionnaire:

Generic date
H2

Please give your date of birth:

Generic date
H i

Space for any comments you might like to make:

Long text
VERY MANY THANKS FOR ALL YOUR HELP
When completed, put in the envelope provided and either bring to the clinic or post to:
Dr. Jean Golding, Children of the Nineties - ALSPAC, Institute of Child Health, 24 Tyndall Avenue, Bristol. BS8 1BR.
Please remember, because this is strictly confidential, the people who look at this booklet will not know your name. They will be unable to give you any help or contact anyone after reading what you have written. If you feel you need advice, please feel free to contact our special help line (Bristol 256260 during office hours). Alternatively your General Practitioner should be able to advise you.
End

alspac_91_yaye

s_intro_i
YOU AND YOUR ENVIRONMENT (PARTNER'S)
s_intro_ii
This questionnaire asks about your health, your partner, your childhood and your beliefs and attitudes. Your answers will help us to understand how your health and background might affect your partner's pregnancy.
s_intro_iii
All the answers you give are confidential. Your name and address will not be on the questionnaire.
s_intro_iv
We would be grateful if you would help us by answering as many of these questions as possible but if there is any question you do not want to answer that is fine. Just leave it blank.
s_intro_v
THANK YOU VERY MUCH FOR YOUR HELP

SECTION A: YOUR HOME ENVIRONMENT

A1
How long have you lived in or near Avon?
1
less than 1 year
2
1 - 4 years
3
5 - 9 years
4
10 years or more
5
all my life
A2 a
When did you move to your present address?
Generic date
A2 b
How many times have you moved home in the last 5 years?
How many
A3 a
In the coldest time of year, describe the temperature in your: living rooms
1
Very warm
2
Warm
3
About right
4
Cold
5
Very cold
A3 b
In the coldest time of year, describe the temperature in your: bedrooms
1
Very warm
2
Warm
3
About right
4
Cold
5
Very cold
A4
Which of the following best describes your feelings about your home?
1
satisfied
2
fairly satisfied
3
dissatisfied
4
very dissatisfied
A5 a
What do you think of your neighbourhood as a place to live?
1
a very good place to live
2
a fairly good place to live
3
not a very good place to live
4
not at all a good place to live
A5 b(i)
Do the other people in your neighbourhood: visit your home
1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 b(ii)
Do the other people in your neighbourhood: argue with you
1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 b(iii)
Do the other people in your neighbourhood: look after your children
1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 b(iv)
Do the other people in your neighbourhood: keep to themselves
1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 c(i)
Do you: visit the home of your neighbours
1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 c(ii)
Do you: argue with your neighbours
1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 c(iii)
Do you: look after your neighbours children
1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A5 c(iv)
Do you: keep to yourself
1
No,never
2
Rarely
3
Sometimes
4
Often
5
Always
A6 a-d

How worried are you that in your neighbourhood:

-

1 - Very worried

2 - Fairly worried

3 - Not very worried

4 - Not at all worried

9 - Don't know
you might have your home broken into and something stolen
you might be mugged or robbed
you might be sexually assaulted or pestered
you might have your home or property damaged by vandals
A7 i
Is your neighbourhood: lively
1
Yes usually
2
Yes sometimes
3
No not at all
A7 ii
Is your neighbourhood: friendly
1
Yes usually
2
Yes sometimes
3
No not at all
A7 iii
Is your neighbourhood: noisy
1
Yes usually
2
Yes sometimes
3
No not at all
A7 iv
Is your neighbourhood: clean
1
Yes usually
2
Yes sometimes
3
No not at all
A7 v
Is your neighbourhood: attractive
1
Yes usually
2
Yes sometimes
3
No not at all
A7 vi
Is your neighbourhood: polluted/dirty
1
Yes usually
2
Yes sometimes
3
No not at all

SECTION B: CHEMICALS IN YOUR ENVIRONMENT

B1 a-zd

Just before your partner became pregnant, how often did you use the following (whether at home or at work):

-

1 - Every day

2 - Most days

3 - About once a week

4 - Less than once a month

5 - Not at all
disinfectant
bleach
window cleaner
carpet cleaner
oven/drain cleaner
dry cleaning fluid
turpentine/white spirit
paint stripper
household paint or varnish
weed killers
pesticides/insect killers
aerosols or sprays including hair spray
hair dye/bleach
deodorants
air fresheners (spray, stick or aerosol)
dental amalgam
ceramics/enamels
soldering
electroplating
glues
leather working
fabric/textiles
dyes
radiation (x-ray or other)
plastics
metal cleaners/degreasers, polishers
petrol
machining
photographic chemicals/other chemicals
electrical wiring
B1 ze
Just before your partner became pregnant, how often did you use the following (whether at home or at work): other chemical (please describe)
1
Every day
2
Most days
3
About once a week
4
Less than once a month
5
Not at all
Other
B2

What jobs have you had since the age of 16? Include part-time and voluntary work. If you have not worked write 'None'.

Job Materials/machines or chemicals used Date started (month-year) Date stopped (month-year)
Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

SECTION C: YOUR HOUSEHOLD

C1 a
How long have you lived together with your partner? ... years ... months
Years
Months
C1 b
Are you the father of your partner's study child?
1
Yes
2
No
3
Not sure
C2
How would you assess your partner's physical health
1
always fit and well
2
usually fit and well
3
sometimes unwell
4
often unwell
5
always unwell
C3 a
What is your present marital status?
1
never married
2
widowed
3
divorced
4
separated
5
married (once only)
6
married for second or third time
C3 b
what was the date of the most recent marriage?
Generic date
If married,
C3 c
How many other marriages/live-in partners have you had?
How many
C4 a-c

Please indicate how many of the children (aged 18 or under) apart from the study child living with you have:

Number of children
How many
you and your partner as their natural parents
you as their natural father (but their natural mother is not present)
your partner as the natural mother (but you are not their natural father)
C4 d
Please indicate how many of the children (aged 18 or under) apart from the study child living with you have: neither you nor your partner as natural parents (please describe whether you have adopted, fostered etc.)
How many
Other
C5 a-c

Are there other children of yourself or your partner who do not live with you?

-

1 - Yes

2 - No
children of my partner
children of myself
children of partner & self

SECTION D: YOUR MEDICAL HISTORY

D1 a
What is your weight?
Generic text
D1 b
Are you certain of this?
1
Yes
2
No
D1 c(i)
What is your size in: hips ... ins
Inches
D1 c(ii)
What is your size in: waist ... ins
Inches
D1 c(iii)
What is your size in: chest ... ins
Inches
D1 c(iv)
What is your size in: collar ... ins
Inches
D1 c(v)
What is your size in: inside leg ... ins
Inches
D2 a
How tall are you ?
Generic text
D2 b
Are you certain of this?
1
Yes
2
No
D3 a
Have you ever had any of the following infections: measles
1
Yes
2
No never
9
Don't know
D3 b
Have you ever had any of the following infections: mumps
1
Yes
2
No never
9
Don't know
D3 c
Have you ever had any of the following infections: chicken pox
1
Yes
2
No never
9
Don't know
D3 d
Have you ever had any of the following infections: whooping cough
1
Yes
2
No never
9
Don't know
D3 e
Have you ever had any of the following infections: cold sores
1
Yes
2
No never
9
Don't know
D3 f
Have you ever had any of the following infections: meningitis
1
Yes
2
No never
9
Don't know
D3 g
Have you ever had any of the following infections: genital herpes
1
Yes
2
No never
9
Don't know
D3 h
Have you ever had any of the following infections: syphilis
1
Yes
2
No never
9
Don't know
D3 i
Have you ever had any of the following infections: gonorrhea
1
Yes
2
No never
9
Don't know
D3 j
Have you ever had any of the following infections: urinary infection, cystitis, pyelitis
1
Yes
2
No never
9
Don't know
D4 a
Have you ever had any of the following operations: tonsils out
1
Yes
2
No
D4 b
Have you ever had any of the following operations: adenoids out
1
Yes
2
No
D4 c
Have you ever had any of the following operations: hernia repair
1
Yes
2
No
D4 d
Have you ever had any of the following operations: appendix out
1
Yes
2
No
D4 e
Have you ever had any of the following operations: gall bladder out
1
Yes
2
No
D4 f
Have you ever had any of the following operations: circumcision
1
Yes
2
No
D4 g
Have you ever had any of the following operations: pyloric stenosis operation
1
Yes
2
No
D4 h
Have you ever had any of the following operations: squint repaired
1
Yes
2
No
D4 i
Have you ever had any of the following operations: plastic surgery
1
Yes
2
No
D4 j
Have you ever had any of the following operations: grommets in your ears
1
Yes
2
No
D4 k
Have you ever had any of the following operations: other type of operation (please tick and describe)
1
Yes
2
No
Other
D5 a-r

Have any of the following ever happened?

- Age this first happened

1 - Yes and stayed in hospital

2 - Yes saw doctor, did not stay in hospital

3 - Yes treated at home only

4 - No never happened

Age

1 - Yes and stayed in hospital

2 - Yes saw doctor, did not stay in hospital

3 - Yes treated at home only

4 - No never happened

Age

1 - Yes and stayed in hospital

2 - Yes saw doctor, did not stay in hospital

3 - Yes treated at home only

4 - No never happened

Age

1 - Yes and stayed in hospital

2 - Yes saw doctor, did not stay in hospital

3 - Yes treated at home only

4 - No never happened

Age
You were badly burnt
You were badly scalded
You took a lot of pills or medicine
You broke an arm or hand
You broke a leg or foot
You nearly drowned
You were in a road traffic accident
You were sexually assaulted
You were injured playing sports or games
You had an accident while on a bicycle
You were injured in a fight
Your parents hurt you
You were hurt by someone else
Your head was hit
You were badly cut
You had a bad fall
You attempted suicide
You had another type of accident or injury (please describe)
D5 r
Have any of the following ever happened? You had another type of accident or injury(please describe)
Other
D6 a-w

Have you ever had any of the following problems:

-

1 - Yes had it recently

2 - Yes in past, not now

3 - No never

9 - Don't know
hay fever
indigestion
bulimia
asthma
eczema
epilepsy
convulsions with a fever
migraine
back pain/slipped disc
kidney disease
varicose veins
haemorrhoids/piles
rheumatism
arthritis
psoriasis
stomach ulcer
other repeated pains in your stomach
drug addiction
alcoholism
schizophrenia
anorexia nervosa
severe depression
other psychiatric problem
D6 x
Have you ever had any of the following problems: other problem (please tick & describe)
1
Yes had it recently
2
Yes in past, not now
3
No never
9
Don't know
Other
D7 a
Are there any problems for which you have regular treatment or medicine?
1
Yes
2
No
D7 b

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
If yes,
D8 a
Would you say that you were allergic to anything?
1
Yes
2
No
D8 b(i)
is it to: cat
1
Yes
2
No
9
Don't know
If yes,
D8 b(ii)
is it to: pollen
1
Yes
2
No
9
Don't know
If yes,
D8 b(iii)
is it to: dust
1
Yes
2
No
9
Don't know
If yes,
D8 b(iv)
is it to: insect bites or stings
1
Yes
2
No
9
Don't know
If yes,
D8 b(v)
is it to: something else (please describe)
1
Yes
2
No
9
Don't know
Other
If yes,
D9 a-i

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
D10 a
Do you know how much you weighed when you were born?
1
Yes
2
No
D10 aa
give weight:
Generic text
If yes,
D10 b
Were you born:
1
more than 3 weeks before your expected date
2
at around the date expected
3
more than 3 weeks late
9
don't know
D10 c(i)
Were you born with any of the following: hare lip
1
Yes
2
No
D10 c(ii)
Were you born with any of the following: birthmark
1
Yes
2
No
D10 c(iii)
Were you born with any of the following: cleft palate
1
Yes
2
No
D10 c(iv)
Were you born with any of the following: heart disease
1
Yes
2
No
D10 c(v)
Were you born with any of the following: malformed feet
1
Yes
2
No
D10 c(vi)
Were you born with any of the following: unusual shaped head
1
Yes
2
No
D10 c(vii)
Were you born with any of the following: spina bifida
1
Yes
2
No
D10 c(viii)
Were you born with any of the following: extra finger
1
Yes
2
No
D10 c(ix)
Were you born with any of the following: extra toe
1
Yes
2
No
D10 c(x)
Were you born with any of the following: funny shaped fingers or hands
1
Yes
2
No
D10 c(xi)
Were you born with any of the following: missing part of body
1
Yes
2
No
D10 c(xii)
Were you born with any of the following: other (please describe all such problems below)
1
Yes
2
No
Other
D10 d(i)
Were you born in a hospital?
1
Yes
2
No
9
Don't know
D10 d(ii)
please give: Name of hospital:
Generic text
If yes,
D10 e(i)
Where were your parents living at the time you were born? Town:
Generic text
D10 e(ii)
Where were your parents living at the time you were born? County:
Generic text
D10 e(iii)
Where were your parents living at the time you were born? Country:
Generic text

Your hearing

D11 i
How would you rate your hearing in each ear? Left ear
1
always very good
2
occasional problems (eg.infections or glue ear)
3
there are some sounds I can not hear
4
never very good
5
I cannot hear much at all
D11 ii
How would you rate your hearing in each ear? Right ear
1
always very good
2
occasional problems (eg.infections or glue ear)
3
there are some sounds I can not hear
4
never very good
5
I cannot hear much at all

Your eyesight

D12 a(i)
How would you rate your sight without glasses ? Left eye
1
always very good
2
I can't see clearly at a distance
3
I can't see clearly close up
4
I can't see much at all
D12 a(ii)
How would you rate your sight without glasses ? Right eye
1
always very good
2
I can't see clearly at a distance
3
I can't see clearly close up
4
I can't see much at all
D12 b
Are you colour blind?
1
Yes
2
No
9
Don't know
D13 a
When you were a child did you ever go to any of the following? physiotherapist
1
Yes
2
No
9
Not known
D13 a(i)
what for:
Generic text
If yes,
D13 b
When you were a child did you ever go to any of the following? child guidance or child psychiatrist
1
Yes
2
No
9
Not known
D13 b(i)
what for:
Generic text
If yes,
D13 c
When you were a child did you ever go to any of the following? speech therapist
1
Yes
2
No
9
Not known
D13 c(i)
what for:
Generic text
If yes,
D13 d
When you were a child did you ever go to any of the following? special schooling
1
Yes
2
No
9
Not known
D13 d(i)
what for:
Generic text
If yes,
D14 a-d

Did you or any of your family have a problem of bedwetting or daytime wetting? (when older than 5 years)

-

1 - Yes, bed-wetting

2 - Yes, daytime wetting

4 - No not at all

9 - Don't know
you
brother or sister
mother
father
D15 a
Have you had a wetting accident yourself in the past year, either during the night or day?
1
Yes
2
No
D15 b(i)
Could you please indicate how many nights or days this has occurred within the past month: during the night:
How many
If yes,
D15 b(ii)
Could you please indicate how many nights or days this has occurred within the past month: during the day:
How many
If yes,
D16
Have you ever been a blood donor?
1
Yes
2
No
D17 a-l

Many people have X-rays, barium meals and other procedures. Please indicate whether you have ever had any of the following types of X-ray.

During this pregnancy In the year before this pregnancy Any other time during your life

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

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

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

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No
arm or hand
chest
leg or foot
dental
head or neck
back
barium meal
barium enema
IVP (intravenous pyelogram)
hips or pelvis
stomach or abdomen
any other (please describe)
D17 l
Many people have X-rays, barium meals and other procedures. Please indicate whether you have ever had any of the following types of X-ray. any other (please describe)
Other

SECTION E: YOUR PARTNER

s_section_E
The following questions are about how you and your partner behave towards each other. Please indicate how often you and your partner behave in the ways listed.
E1
Is your partner affectionate toward you?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E2
Does your partner get angry with you?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E3
Does your partner listen to you when you want to talk about your feelings?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E4
Do you have arguments with your partner?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E5
Does your partner talk to you about her problems and feelings?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E6
Do you get angry with your partner?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E7
Do you enjoy the company of your partner?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E8
Does your partner show her approval of you?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never
E9
Do you behave affectionately toward your partner?
1
Almost always
2
Often
3
Sometimes
4
Rarely
5
Never

SECTION F: YOU AND YOUR PARENTS

F1 a
Were you legally adopted?
1
Yes
2
No
F1 b
what age were you?
Age
If yes,
F2
Were you ever "in care" of either a local authority or voluntary agency e.g. Barnados?
1
Yes
2
No
3
Unsure
F3 a
Did your parents divorce or separate before your 18th birthday?
1
Yes
2
No
s_qF3a
If no, go to F4, on page 25.
F3 b
what age were you?
Age
If yes,
F3 c
who did you mainly live with after this?
1
mother
2
father
3
sometimes mother, sometimes father
4
someone else (please say who)
Generic text
If yes,
F4 i-iv

Did you ever live away from home with any of the following (other than for holidays/or short visits) before you were 18 years old?

-

1 - Yes

2 - No
grandparents
other relatives
friends
foster parents
F4 v
Did you ever live away from home with any of the following (other than for holidays/or short visits) before you were 18 years old? other (please describe)
1
Yes
2
No
Other
F5 i-v

Did you ever stay away from home in any of the following places before you were 18 years old?

-

1 - No

2 - Yes for less than a week

3 - Yes for 1 week - 1 month

4 - Yes for 1 - 6 months

5 - Yes over 6 months
hospital
boarding school
children's home
hostel
in custody (detention centre, remand home, borstal etc)
F5 vi
Did you ever stay away from home in any of the following places before you were 18 years old? other (please describe)
1
No
2
Yes for less than a week
3
Yes for 1 week - 1 month
4
Yes for 1 - 6 months
5
Yes over 6 months
Other
F6 a
Did you leave home before your 18th birthday?
1
Yes
2
No
s_qF6a
If no, go to F7, on page 26.
F6 b
At that time where did you first live?
1
college residence
2
hostel
3
bedsit
4
shared flat or house
5
other (please describe)
Other
If yes,
F7 i(a-m)

At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 0-5 years

-

1 - Yes
mother
father
brother(s)
sister(s)
step-mother
step-father
step-brother(s)
step-sister(s)
mother's partner
father's partner
grandmother
grandfather
family friend
F7 i(n)
At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 0-5 years other (please describe)
1
Yes
Other
F7 ii(a-m)

At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 6-11 years

-

1 - Yes
mother
father
brother(s)
sister(s)
step-mother
step-father
step-brother(s)
step-sister(s)
mother's partner
father's partner
grandmother
grandfather
family friend
F7 ii(n)
At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 6-11 years other (please describe)
1
Yes
Other
F7 iii(a-m)

At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 12-16 years

-

1 - Yes
mother
father
brother(s)
sister(s)
step-mother
step-father
step-brother(s)
step-sister(s)
mother's partner
father's partner
grandmother
grandfather
family friend
F7 iii(n)
At each of the time periods given, during your childhood, who of the following lived in your home?(other than for holidays or short visits) When I was aged: 12_16 years other (please describe)
1
Yes
Other
F8 a
Who would you say brought you up? mother
1
Yes
2
No
3
Did not have
F8 b
Who would you say brought you up? father
1
Yes
2
No
3
Did not have
F8 c
Who would you say brought you up? brother(s)
1
Yes
2
No
3
Did not have
F8 d
Who would you say brought you up? sister(s)
1
Yes
2
No
3
Did not have
F8 e
Who would you say brought you up? step-mother
1
Yes
2
No
3
Did not have
F8 f
Who would you say brought you up? step-father
1
Yes
2
No
3
Did not have
F8 g
Who would you say brought you up? step-brother(s)
1
Yes
2
No
3
Did not have
F8 h
Who would you say brought you up? step-sister(s)
1
Yes
2
No
3
Did not have
F8 i
Who would you say brought you up? mother's partner
1
Yes
2
No
3
Did not have
F8 j
Who would you say brought you up? father's partner
1
Yes
2
No
3
Did not have
F8 k
Who would you say brought you up? grandmother
1
Yes
2
No
3
Did not have
F8 l
Who would you say brought you up? grandfather
1
Yes
2
No
3
Did not have
F8 m
Who would you say brought you up? adoptive mother
1
Yes
2
No
3
Did not have
F8 n
Who would you say brought you up? adoptive father
1
Yes
2
No
3
Did not have
F8 o
Who would you say brought you up? foster mother
1
Yes
2
No
3
Did not have
F8 p
Who would you say brought you up? foster father
1
Yes
2
No
3
Did not have
F8 q
Who would you say brought you up? family friend
1
Yes
2
No
3
Did not have
F8 r
Who would you say brought you up? other (please describe)
1
Yes
2
No
3
Did not have
Other
F9 a-o

Has your natural mother and/or mother figure had any of the following:

Natural mother Mother figure

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
other cancer
hypertension (high blood pressure)
an alcohol problem
schizophrenia
chronic bronchitis
a stroke
depression or 'nerves'
other problem (please describe)
F9 o
Has your natural mother and/or mother figure had any of the following: other problem (please describe)
Other
F10 a
Would you say that your mother (or mother figure) was disabled in any way?
1
Yes
2
No
F10 b
please describe:
Generic text
If yes,
F11 a
Would you say that any problems in your mother's (or mother figure's) health affected the way you were brought up?
4
she had no problems
1
yes, major effect
2
yes, minor effect
3
she had some problems, but they did not affect my upbringing
F11 b
please describe:
Generic text
If yes,
F12 a-o

Has your natural father and/or father figure had any of the following:

Natural father Father figure

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
prostate cancer
other cancer
hypertension (high blood pressure)
an alcohol problem
schizophrenia
chronic bronchitis
a stroke
depression or 'nerves'
other problem (please describe)
F12 o
Has your natural father and/or father figure had any of the following: other problem (please describe)
Other
F13 a
Would you say that your father (or father figure) was disabled in any way?
1
Yes
2
No
7
No father figure
F13 b
please describe:
Generic text
If yes,
F14 a
Would you say that any problems in your father's (or father figure's) health affected the way you were brought up?
4
he had no problems
1
yes, major effect
2
yes, minor effect
3
he had some problems, but they did not affect my upbringing
7
no such person
F14 b
please describe:
Generic text
If yes,
F15 a(i-iv)

Before you were 17 did a parent or person who cared for you die?

-

1 - Yes

2 - No

9 - Don't know
mother
father
mother figure
father figure
F15 a(v)
Before you were 17 did a parent or person who cared for you die? other (please describe)
1
Yes
2
No
9
Don't know
Other
F15 b(i)
what age were you: mother died when I was: ... years old
Age
If yes,
F15 b(ii)
what age were you: father died when I was: ... years old
Age
If yes,
F15 b(iii)
what age were you: mother figure died when I was: ... years old
Age
If yes,
F15 b(iv)
what age were you: father figure died when I was: ... years old
Age
If yes,
F15 b(v)
what age were you: other figure died when I was ... years old
Age
If yes,
F15 c(i)
If either parent died, who cared for you after their death(s)? other parent
1
Yes
2
No
If yes,
F15 c(ii)
If either parent died, who cared for you after their death(s)? relative
1
Yes
2
No
If yes,
F15 c(iii)
If either parent died, who cared for you after their death(s)? foster parents
1
Yes
2
No
If yes,
F15 c(iv)
If either parent died, who cared for you after their death(s)? adopted parent
1
Yes
2
No
If yes,
F15 c(v)
If either parent died, who cared for you after their death(s)? other (please describe)
1
Yes
2
No
Other
If yes,
s_qF15c
We would like to know how you and your mother got on when you were a child. This will probably have varied over your childhood and in different situations but we would like a general impression. Please tick the box to indicate how you mostly remember your mother in your first 16 years.

Mother (or person that took the place of your mother)

F16 a
My mother - Spoke to me with a warm and friendly voice
1
Never
2
Sometimes
3
Usually
F16 b
My mother - Helped me as much as I needed
1
Never
2
Sometimes
3
Usually
F16 c
My mother - Let me do those things I liked doing
1
Never
2
Sometimes
3
Usually
F16 d
My mother - Seemed emotionally cold to me
1
Never
2
Sometimes
3
Usually
F16 e
My mother - Appeared to understand my problems and worries
1
Never
2
Sometimes
3
Usually
F16 f
My mother - Was affectionate to me
1
Never
2
Sometimes
3
Usually
F16 g
My mother - Tried to control what I did
1
Never
2
Sometimes
3
Usually
F16 h
My mother - Invaded my privacy
1
Never
2
Sometimes
3
Usually
F16 i
My mother - Let me decide things for myself
1
Never
2
Sometimes
3
Usually
F16 j
My mother - Made me feel I wasn't wanted
1
Never
2
Sometimes
3
Usually
F16 k
My mother - Talked things over with me
1
Never
2
Sometimes
3
Usually
F16 l
My mother - Gave me the freedom I wanted
1
Never
2
Sometimes
3
Usually
F16 m
My mother - Praised me
1
Never
2
Sometimes
3
Usually
F16 n
My mother - Enjoyed talking things over with me
1
YES
2
NO
F16 o
My mother - Frequently smiled at me
1
YES
2
NO
F16 p
My mother - Tended to baby me
1
YES
2
NO
F16 q
My mother - Seemed to understand what I needed or wanted
1
YES
2
NO
F16 r
My mother - Could make me feel better when I was upset
1
YES
2
NO
F16 s
My mother - Felt I could not look after myself unless she was around
1
YES
2
NO
F16 t
My mother - Let me go out as often as I wanted
1
YES
2
NO
F16 u
My mother - Was overprotective of me
1
YES
2
NO
F16 v
My mother - Let me dress in any way I pleased
1
YES
2
NO
F17 a
Was your parent's behaviour stable and predictable to you as a child? mother
1
Always
2
Mostly
3
Rarely
4
Never
7
Not applicable
F17 b
Was your parent's behaviour stable and predictable to you as a child? father
1
Always
2
Mostly
3
Rarely
4
Never
7
Not applicable
F17 c
Was your parent's behaviour stable and predictable to you as a child? mother figure
1
Always
2
Mostly
3
Rarely
4
Never
7
Not applicable
F17 d
Was your parent's behaviour stable and predictable to you as a child? father figure
1
Always
2
Mostly
3
Rarely
4
Never
7
Not applicable
F18 i-iii

Looking back would you call your childhood happy? Please indicate for each age range:

-

1 - Yes very happy

2 - Yes moderately happy

3 - Not really happy

4 - No quite unhappy

5 - No very unhappy

6 - Can't remember
0-5 years
6-11 years
12-15 years
F19
Are there any comments you would like to add?
Long text

SECTION G: YOUR OUTLOOK ON LIFE

G1
Did getting good marks at school mean a great deal to you?
1
Yes
2
No
G2
Are you often blamed for things that just aren't your fault?
1
Yes
2
No
G3
Do you feel that most of the time it doesn't pay to try hard because things never turn out right anyway?
1
Yes
2
No
G4
Do you feel that if things start out well in the morning that it's going to be a good day no matter what you do?
1
Yes
2
No
G5
Do you believe that whether or not people like you depends on how you act?
1
Yes
2
No
G6
Do you believe that when bad things are going to happen they are just going to happen no matter what you try to do to stop them?
1
Yes
2
No
G7
Do you feel that when good things happen they happen because of hard work?
1
Yes
2
No
G8
Do you feel that when someone doesn't like you there's little you can do about it?
1
Yes
2
No
G9
Did you usually feel that it was almost useless to try in school because most other children were cleverer than you?
1
Yes
2
No
G10
Are you the kind of person who believes that planning ahead makes things turn out better?
1
Yes
2
No
G11
Most of the time, do you feel that you have little to say about what your family decides to do?
1
Yes
2
No
G12
Do you think it's better to be clever than to be lucky?
1
Yes
2
No

SECTION H

H1
Please put the date of completing this questionnaire:
Generic date
H2
Please give your date of birth:
Generic date
H i
Space for any comments you might like to make:
Long text
s_outro_i
VERY MANY THANKS FOR ALL YOUR HELP
s_outro_ii
When completed, put in the envelope provided and either bring to the clinic or post to:
s_outro_iii
Dr. Jean Golding, Children of the Nineties - ALSPAC, Institute of Child Health, 24 Tyndall Avenue, Bristol. BS8 1BR.
s_outro_iv
Please remember, because this is strictly confidential, the people who look at this booklet will not know your name. They will be unable to give you any help or contact anyone after reading what you have written. If you feel you need advice, please feel free to contact our special help line (Bristol 256260 during office hours). Alternatively your General Practitioner should be able to advise you.
Name

You and Your Environment - Partner