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Appendix B Questionnaire
Pages 101-118

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From page 101...
... Appendix B Questionnaire 0
From page 103...
... 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.
From page 104...
... 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.
From page 108...
... 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.
From page 109...
... ? Separated Divorced pounds Widowed What is the highest level of education that you 6.
From page 110...
... Yes, Yes, No a little a lot a. The kinds or amounts of vigorous activities you can do like lifting heavy objects, running or participating in strenuous sports _ _ _ _ _ _ _ _ _ _ b.
From page 111...
... ? None Not at all Very mild A little bit Mild Moderately Moderate Quite a bit Severe Extremely Very Severe 19.
From page 112...
... I have a hard time remembering people's names._ _ _ _ 1 2 3 4 5 b. I forget the names of common things.
From page 113...
... _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Yes No e. Any other heart condition (please specify)
From page 114...
... _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Yes No HOSPITAL CARE 26. This question relates to your medical care while you were in the Navy.
From page 115...
... 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?
From page 116...
... 37b. Did you think the risk of serious long term physical health effects from the testing was high, moderate or low?
From page 117...
... 38b. Did you think the risk of serious long term emotional or mental health effects from the testing was high, moderate or low?
From page 118...
... 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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