Start
nshd_65_smsc
NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
STRICTLY CONFIDENTIAL
M.R.C. Unit, London School of Economics,
H1A
1965

Ref. No.

Generic text

Name and Address

Generic text
You remember that you are one of this group of 5,000 people that we have followed up since they were born in March 1946.
This year we would like just a little information so that we can keep in touch and keep our records up to date.
All you have to do to answer the questions is to write the answer in the space provided. If we have given you a choice of answers, all you do is put a circle round the number next to the right answer like this:
Everything you tell us is kept very strictly confidential. We keep complete secrecy and we never mention anyone by name in any reports we write.
When you have answered the questions, just fold the form, put it in the special envelope and post it. You don't need to put a stamp on.
PERSONAL INFORMATION

Is this your correct name and permanent address? (If it is not correct, please write the new or corrected address here. If you are a girl and are now married, please put your married name.) New name: (if married)

Generic text

Is this your correct name and permanent address? (If it is not correct, please write the new or corrected address here. If you are a girl and are now married, please put your married name.) New address:

(temporary address in pencil)

Generic text

Are you

1
Married?
2
Engaged?
0
Neither
If Married? to question 2
qc_2 == 1

(date of marriage

Generic date
If Engaged? to question 2
qc_2 == 2

[date of marriage, if fixed

Generic date

future married name, and address if known:

Generic text
(If married)
qc_2 == 1

Have you any children?

1
Yes
0
No
(if "yes")
qc_3 == 1
_children < 3 _children < 3

NAME

Generic text

SEX

Generic text

DATE OF BIRTH

Date of birth
GENERAL HEALTH

The last accident we have recorded for you was ... We have no accidents recorded for you for a long time. Have you had any accident since then in recent years in which you were burnt or scalded, you broke a bone, you were badly cut or bruised, or injured by a chemical?

1
Yes
0
No
(if "yes"
qc_4 == 1
please give the following details about each accident, starting with the earliest)
What sort of injury? (i.e. burn, cut, broken bone etc.) What part was hurt? When did it happen? Where was it treated? Who by? What sort of scar or trouble does it still give you? How did the accident happen? Where did it happen?
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ACCIDENT 1
ACCIDENT 2
ACCIDENT 3

The last hospital admission we have recorded for you was ... We have no hospital admissions recorded for you for a long time. Have you been in hospital as an inpatient since then?/in recent years?

1
Yes
0
No
(if "yes")
qc_5_a == 1

What hospital was it?

Generic text

When did you go in?

Generic text

What were you in hospital for?

Generic text

How long were you in hospital?

Generic text

What was the doctor's name who looked after you?

Generic text

Since January 1963, have you attended a hospital out-patient department or clinic?

1
Yes
0
No
(if "yes")
qc_6 == 1

What hospital/clinic was it?

Generic text

When did you go first?

Generic text

Why did you go?

Generic text

Are you registered with a Doctor?

1
Yes, in this district
2
Yes, in home district (if living away from home)
3
Yes, in old district (if recently moved)
0
No

Please give the name of the doctor and his address. Dr

Generic text

Have you seen a family Doctor in the National Health Service since this time last year?

1
Yes
0
No
(if "yes")
qc_8_a == 1

About how many times did you attend the Doctor's surgery?

How many

About how many times did the Doctor visit you at home?

How many
(if total more than 2)
qc_8_a_i > '2' || qc_8_a_ii > '2' || (qc_8_a_i == '1' && qc_8_a_ii > '1') || (qc_8_a_i > '1' && qc_8_a_ii == '1') || (qc_8_a_i == '0' && qc_8_a_ii > '2') || (qc_8_a_i > '2' && qc_8_a_ii == '0')
Were these visits all about the same time, or were they spread out at intervals?

(Tick the box against the right answer - more than one if necessary)

TICK REASON FOR VISITS

1 - TICK

Generic text

1 - TICK

Generic text

1 - TICK

Generic text

1 - TICK

Generic text
All grouped within a few weeks during a period of acute illness or disability
Spread over a period of 1-3 months
Spread throughout the year

Were these visits all about the same time, or were they spread out at intervals? Further comment if necessary:

(Tick the box against the right answer - more than one if necessary)

Generic text

Have you seen any other Doctor since this time last year? For example a Doctor at work or a private Doctor?

1
Yes
0
No
("if yes")
qc_9 == 1
_visit < 2 _visit < 2

COMPLAINT

Generic text

NUMBER OF VISITS

How many

TYPE OF DOCTOR

Generic text

Have you been off work through accident or illness since you started work? since January 1963?

1
Yes
0
No
_accident < 3 _accident < 3

APPROXIMATE DATE

Generic date

NATURE OF ACCIDENT, ILLNESS

Generic text

TIME OFF WORK

Generic text
EMPLOYMENT
When we last contacted you, you were in the occupation we have written in red. What are you doing now? If you are still doing the same work at the same firm, write "still there". If you have been promoted or changed your work but still work at the same firm, write your new job and "same firm". If you have left that job, fill in the date of leaving in column 5 and write why you left in column 6, then give the details of any jobs you have done since. If you are not working (from choice) write "not working". If you are out of work, write "unemployed". If you are a full-time student please give the name of the college and the course.
Serial no. of job Type of job (i.e. what do YOU do?) Type of firm (i.e. what do THEY do?) Date started e.g.1.7.63 Date left e.g.15.8.63 Reason for leaving
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1
2
3
4
5

Have you been out of work at all since this time last year? (i.e. looking for work)

1
Yes
0
No
_outofwork < 2 _outofwork < 2

APPROXIMATE DATE

Generic date

LENGTH OF SPELL

Generic text

CIRCUMSTANCES

Generic text

Have you been taking any part-time day or evening classes, a correpondence course, or studying at home since last September?

0
No
1
Yes, college
2
Yes, correspondence
3
Yes, at home
_classes < 2 _classes < 2

Name of COLLEGE or of CORRESPONDENCE COURSE

Generic text

Name of COURSE or SUBJECTS STUDIED

Generic text

DAY or EVENING, or "HOME"

Generic text

Queries arising from earlier surveys

Long text

Has anything important happened to you in the last year that we haven't asked about?

Long text

Are you willing to be interviewed next time or would you prefer to answer the questions directly by post?

1
Interview
2
By post

Today's date:

Generic date
THANK YOU VERY MUCH FOR CONTINUING TO HELP
End

nshd_65_smsc

NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
STRICTLY CONFIDENTIAL
M.R.C. Unit, London School of Economics,
Ref. No.
Generic text
Name and Address
Generic text
You remember that you are one of this group of 5,000 people that we have followed up since they were born in March 1946.
This year we would like just a little information so that we can keep in touch and keep our records up to date.
All you have to do to answer the questions is to write the answer in the space provided. If we have given you a choice of answers, all you do is put a circle round the number next to the right answer like this:
Everything you tell us is kept very strictly confidential. We keep complete secrecy and we never mention anyone by name in any reports we write.
When you have answered the questions, just fold the form, put it in the special envelope and post it. You don't need to put a stamp on.

PERSONAL INFORMATION

Is this your correct name and permanent address? (If it is not correct, please write the new or corrected address here. If you are a girl and are now married, please put your married name.) New name: (if married)
Generic text
Is this your correct name and permanent address? (If it is not correct, please write the new or corrected address here. If you are a girl and are now married, please put your married name.) New address:
Generic text
Are you
1
Married?
2
Engaged?
0
Neither
(date of marriage
Generic date
[date of marriage, if fixed
Generic date
future married name, and address if known:
Generic text
Have you any children?
1
Yes
0
No

_children < 3

NAME
Generic text
SEX
Generic text
DATE OF BIRTH
Date of birth

GENERAL HEALTH

The last accident we have recorded for you was ... We have no accidents recorded for you for a long time. Have you had any accident since then in recent years in which you were burnt or scalded, you broke a bone, you were badly cut or bruised, or injured by a chemical?
1
Yes
0
No

please give the following details about each accident, starting with the earliest)

What sort of injury? (i.e. burn, cut, broken bone etc.) What part was hurt? When did it happen? Where was it treated? Who by? What sort of scar or trouble does it still give you? How did the accident happen? Where did it happen?
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric 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textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
ACCIDENT 1
ACCIDENT 2
ACCIDENT 3
The last hospital admission we have recorded for you was ... We have no hospital admissions recorded for you for a long time. Have you been in hospital as an inpatient since then?/in recent years?
1
Yes
0
No
What hospital was it?
Generic text
When did you go in?
Generic text
What were you in hospital for?
Generic text
How long were you in hospital?
Generic text
What was the doctor's name who looked after you?
Generic text
Since January 1963, have you attended a hospital out-patient department or clinic?
1
Yes
0
No
What hospital/clinic was it?
Generic text
When did you go first?
Generic text
Why did you go?
Generic text
Are you registered with a Doctor?
1
Yes, in this district
2
Yes, in home district (if living away from home)
3
Yes, in old district (if recently moved)
0
No
Please give the name of the doctor and his address. Dr
Generic text
Have you seen a family Doctor in the National Health Service since this time last year?
1
Yes
0
No
About how many times did you attend the Doctor's surgery?
How many
About how many times did the Doctor visit you at home?
How many

Were these visits all about the same time, or were they spread out at intervals?

TICK REASON FOR VISITS

1 - TICK

Generic text

1 - TICK

Generic text

1 - TICK

Generic text

1 - TICK

Generic text
All grouped within a few weeks during a period of acute illness or disability
Spread over a period of 1-3 months
Spread throughout the year
Were these visits all about the same time, or were they spread out at intervals? Further comment if necessary:
Generic text
Have you seen any other Doctor since this time last year? For example a Doctor at work or a private Doctor?
1
Yes
0
No

_visit < 2

COMPLAINT
Generic text
NUMBER OF VISITS
How many
TYPE OF DOCTOR
Generic text
Have you been off work through accident or illness since you started work? since January 1963?
1
Yes
0
No

_accident < 3

APPROXIMATE DATE
Generic date
NATURE OF ACCIDENT, ILLNESS
Generic text
TIME OFF WORK
Generic text

EMPLOYMENT

When we last contacted you, you were in the occupation we have written in red. What are you doing now? If you are still doing the same work at the same firm, write "still there". If you have been promoted or changed your work but still work at the same firm, write your new job and "same firm". If you have left that job, fill in the date of leaving in column 5 and write why you left in column 6, then give the details of any jobs you have done since. If you are not working (from choice) write "not working". If you are out of work, write "unemployed". If you are a full-time student please give the name of the college and the course.

Serial no. of job Type of job (i.e. what do YOU do?) Type of firm (i.e. what do THEY do?) Date started e.g.1.7.63 Date left e.g.15.8.63 Reason for leaving
Generic textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text
1
2
3
4
5
Have you been out of work at all since this time last year? (i.e. looking for work)
1
Yes
0
No

_outofwork < 2

APPROXIMATE DATE
Generic date
LENGTH OF SPELL
Generic text
CIRCUMSTANCES
Generic text
Have you been taking any part-time day or evening classes, a correpondence course, or studying at home since last September?
0
No
1
Yes, college
2
Yes, correspondence
3
Yes, at home

_classes < 2

Name of COLLEGE or of CORRESPONDENCE COURSE
Generic text
Name of COURSE or SUBJECTS STUDIED
Generic text
DAY or EVENING, or "HOME"
Generic text
Queries arising from earlier surveys
Long text
Has anything important happened to you in the last year that we haven't asked about?
Long text
Are you willing to be interviewed next time or would you prefer to answer the questions directly by post?
1
Interview
2
By post
Today's date:
Generic date
THANK YOU VERY MUCH FOR CONTINUING TO HELP
Name

1965 Study Member Self Completion