Question Verbatim Question Response categories and comments Number 25h During the past 30 days, how Range:0-999 many times did you ride in a . car or other vehicle driven by someone who had been drinking alcohol? Number of times 26 Have you ever had a problem 1=yes with your use of alcohol? 2=no 27 Have you ever considered 1=yes yourself to be an alcoholic? 2=no 28a During your first 18 years of life 1=yes did you live with anyone who 2=no was a problem drinker or alcoholic? 28b If check all who were: “yes” father 1= if box checked mother 1=if box checked brothers 1=if boxed checked other relatives 1=if box checked other non-relative 1=if box checked sisters 1=if box checked 29 Have you ever been married to 1=yes someone (or lived with 2=no someone as if you were married) who was a problem drinker or alcoholic? 30a Have you ever used street 1=yes drugs? 2=no 30b If how old were you the Range:0-99 “yes” first time you used them? Age
Question Number Verbatim Question Response categories and comments 25h During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been drinking alcohol? Number of times Range:0-999 . 26 Have you ever had a problem with your use of alcohol? 1=yes 2=no 27 Have you ever considered yourself to be an alcoholic? 1=yes 2=no 28a During your first 18 years of life did you live with anyone who was a problem drinker or alcoholic? 1=yes 2=no 28b If “yes” check all who were: father 1= if box checked mother 1=if box checked brothers 1=if boxed checked other relatives 1=if box checked other non-relative 1=if box checked sisters 1=if box checked 29 Have you ever been married to someone (or lived with someone as if you were married) who was a problem drinker or alcoholic? 1=yes 2=no 30a Have you ever used street drugs? 1=yes 2=no 30b If “yes” how old were you the first time you used them? Age Range:0-99
Family_Health_Questionnaire_-_Female_Version_ACE_Study.docx