!!ousehold Vo.
Animal No. I Use Sign Code |
from Question 8(a)
.
Sign Sign Sign Sign
Sign 1 Sign Sign
How often? 1 Use Frequency Code |
3 For how lonft?
O
Vet consulted?
0)
What did he/she say?
(Vi
1
flter the pesticide was used, was condition worse(l), better (2), or no change (3)?
'
How often did condition occur? 1 Use Frequency Code |
/
If worse: How long after exposure did onset of
worsened condition occur? (days)
-
0) How lonR did it persist? (days) .
3
10
Vet consulted?
a
What did he/she say?
u a
0
Did your animal die?
-
If not, is animal better now? [no (1), mostly (2), completely (3)] Did you consume any of this animal's
products?
-19-
Interviewer: In Question 9, fill in the following table for all subjects. In the first part of the table, ask "unexposed" regarding symptoms last sumnier and "exposed" regarding symptoms before the pes¬
ticide incident. For the second part of the
table, ask the "unexposed" regarding their current
symptoms and the "exposed" regarding symptoms following exposure. Inform the "exposed" that
many of the health effects listed are not
thought to be related to pesticide exposure; they are simply included for the sake of tho¬
roughness. Ask them to be accurate and to re-
frain from exaggeration.________________________.
The following questions seek information about your health,
Frequency :ode
A All the time .
B 5 X / day C X / day D X / week £ X / week r X / month G X / season H X / year
I X every few years
J X
K Never
Severity Code
Sign Code (Animals)
A unsteady gait /walks funny
B vomiting wheezing
skin or hair problems miscarriages diarrhea hyperactivity sluggishness itching change in appetite
change in milk production change in any food products from
this animal
M other
1 Slight (e.g., mildly irritating) 2 Moderate (e.g., interferes with
usual activities)
3 Severe (e.g., incapacitating)
Symptom Code (People)
1 Headaches 2 Dizziness 3 Fainting 4 Blurred vision 5 Seizures ^ Ringing ears 7 Swollen/puffy eyes 8 Nausea 9 Vomiting 10 Vomiting blood 11 Upset stomach 12 Lack of appetite 13 Fatigue/lack of energy
14 Constipation ("bound up") 15 Bleeding/painful gums 16 Easy bruising
17 Easy cracking of fingernails 18 Burning on breathing 19 Coughing 20 Wheezing 21 Asthma 22 Hay Fever 23 Sinus congestion 24 Runny nose 25 Difficulty breathing 26 Swollen glands 27 Skin rash 28 Skin peeling 29 Hair loss 30 Burning eyes/redness
31 Bloody or dark urine
32 Burning on urination ("passing water"
33 Aching_Joints
34 Arthritis
35 Emphysema
OQ 36 High blood pressure ("high hbod")
o 37 Anemia ("low blood")
4J 38 Chest pain/angina c o 39 Diabetes 40 Liver disease
41 Jaundice (yellowing of eyes) 42 Cancer (state type under diagnosis)
If a woman:
43 Irregular menstruation
44 Miscarriages
,
Synptom
Use Symptom Code |
Symptom Sy»»toiii Svmotom i Symotom Syraptom
How often?j Use Frequency Code |
How had? | Use Severity Code |
' For how long?
Did yoa go to a doctor/clinic? If yes, what were you told? Were you given any medications? If yes, what were they?
Did you take any other medications?
If so. which ones?
If "unexposed", had you ever had this before?
- Did this get worse (1), better (2), or no change (3)7 Freauencv 1 Use Frequency Code |
How bad?
If worse: Doctor/clinic consulted?
What were you told?
Were you given any medications?
If so, which ones?
Did you take any other medications?
If so, which ones?
«
01 O
J"
How long after exposure did onset of • worsened condition occur? (days) How long did it persist? (days)
Did your doctor relate it to the pesticide Are you better now?
[no (1), mostly (2), completely (3)]
Interviewer: Ask Question 10 if subject Is a Gorgus resident"; ask "unexposed" Gorgus residents re: guests last July. 0. Did you have any family or friends from outside the neighborhood visiting during the time the pesticide was
used or within a month afterwards? (any visit within a week, any visit for more than a day the rest of the
month)
yes DK
Name Visited during time
pesticide was being applied?
If not, visited Stayed for how Any signs of If so. May we Address how long long after the health changes? describe contact
afterwards? (days) pesticide was changes. him/her? used? (days) 1. 2. 3. ͣ 4. / 5. 6. 7. 'ͣ', 8. 9. 10. -
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VII. Attitude Survey
1. Do you live in the country for any of the following reasons ?
(check any that apply)
grew up here_____ I ͣ ͣ . ' I . family _____ | job/like to farm_____ environment _____ health _____
don't like the city ' cost of living or housing is less other DK R (Specify)
Do you like living here because you:
feel closer to nature _____ like fresh air _____ don't like pollution _____
other ____________
(Specify)
DK _____
Interviewer: If subject does not use pesticides
(see Part VI, Q 1 § 2) ask Question 3, with following statement as lead-in. If subject
does use pesticides, go straight to Question
4, still using following statement as
lead-in.
Earlier you said you (did/did not) use pesticides around your home.
3. Do you not use pesticides because:
no pest problem
an concerned about possible health effects____
too expensive____
don't care about pests
other _________________
(specify) DK____
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4. If a pesticide is used according to instructions on the label,
do you think that:
all government approved pesticides are safe for
humans _____ 01
some approved pesticides are safe for humans and