Review of NASA's Longitudinal Study of Astronaut Health (2004) / Chapter Skim
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Appendix C: Health Lifestyle Questionnaire
Appendix C: Health Lifestyle Questionnaire
Pages 69-79
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C Health Lifestyle Questionnaire 69
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70 LONGITUDINAL STUDY OF ASTRONAUT HEALTH LONGITUDINAL STUDY OF ASTRONAUT HEALTH Manual of Procedures Revision Date: 6/1/98 Chapter 4: Data Management Section 4.1.3.8.1 LSAH08a Form LSAH Health Lifestyle Questionnaire The Longitudinal Study of Astronaut Health (LSAH) Health Lifestyle Questionnaire, shown on the following pages, was developed in 1993 to collect needed data that were not consistently collected (or not collected at all)
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APPENDIX C 71 Longitudinal Study of Astronaut Health Health Lifestyle Questionnaire This questionnaire is intended to obtain demographic information, family medical history, and personal health risk factors which are not otherwise obtained in a systematic manner for all LSAH participants. If you do not have, or if you choose not to provide, some of the information requested in this questionnaire, please skip that question and continue to the next question.
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72 LONGITUDINAL STUDY OF ASTRONAUT HEALTH 8. If ever married, please complete for each marriage: If Marriage Ended Year (date)
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APPENDIX C 73 ___ Yes ___ No If "yes," how many (total number)
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d,e e(s) ceas Caus Death DefI of Describe Year d,e eathD Day ceas of DefI Month Date ve or Ha ribec esses des Child llnI es s,eyfI Do,g Conditions No viniLfI Chronicy An Yes No - y g Cur rentl viniL Yes htriBl ors at ,sey itane mitierof esentrP hrt If describe De Bi Cong s,tcef No sorders Di Yes De Unknown of le ma Fe Sex Child Male Unknown of y ncange Months Weeks Duration Pr or yc Year rthiB nang Day of Pre Ended Month Date Date Abortion ck y e g Miscarria ncange (che in one)
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APPENDIX C 75 Stress-related Information 15. How satisfied are you with life (circle only one choice)
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76 LONGITUDINAL STUDY OF ASTRONAUT HEALTH 24. What is your current smoking status?
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APPENDIX C 77 29. How many aspirin do you usually take in a single dose?
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78 LONGITUDINAL STUDY OF ASTRONAUT HEALTH 34. During the past year, has your weight fluctuated more than 5 pounds (circle only one choice)
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APPENDIX C 79 42. If "yes," approximately how many hours did you fly during the past year (do not include hours logged as a pilot)
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