Long-Term Health Effects of Participation in Project SHAD (Shipboard Hazard and Defense) (2007) / Chapter Skim
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Appendix B Questionnaire
Appendix B Questionnaire
Pages 101-118
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Appendix B Questionnaire 0
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The Department of Veterans Affairs has funded IOM to do this survey to determine the present health of Project SHAD participants and a comparable group of non-participants. It is important for us to hear from you because our records indicate that you were a participant in tests in which active chemical or biological warfare agents were used, and your response is the only way we can get accurate and complete information about the current health of these participants.
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If you choose not to participate, that will not affect your relationship with the Department of Veterans Affairs or your right to health care or other services to which you are otherwise entitled. If you decide to participate, you are free to withdraw your consent and discontinue participation at any time without prejudice.
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To minimize the risk of anyone breaking into the data files, those files will be maintained on computers protected by computer security measures. All members of the research team with access to the data files will be trained on computer security procedures specifically designed to protect sensitive data.
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? Separated Divorced pounds Widowed What is the highest level of education that you 6.
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Excellent. MUCH BETTER than one year ago Very good Somewhat BETTER than one year ago Good About the SAME as one year ago Fair Somewhat WORSE than one year ago Poor MUCH WORSE than one year ago 13.
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? None Not at all Very mild A little bit Mild Moderately Moderate Quite a bit Severe Extremely Very Severe 19.
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I have a hard time remembering people's names._ _ _ _ 1 2 3 4 5 b. I forget the names of common things.
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Yes No e. Any other heart condition (please specify)
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Yes No HOSPITAL CARE 26. This question relates to your medical care while you were in the Navy.
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27c. When was the most recent time that you were Not counting accidents or injuries, since your hospitalized overnight or longer for an illness discharge from active duty, have you been a or medical condition?
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37b. Did you think the risk of serious long term physical health effects from the testing was high, moderate or low?
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38b. Did you think the risk of serious long term emotional or mental health effects from the testing was high, moderate or low?
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How likely do you think it is that those tests had any serious long-term effects on your physical any serious long-term effects on your mental health? Do you think it is ......
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