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Your Environment. Your Health.

Questionnaires

Agricultural Health Study (AHS)

Agricultural Health (AHS)

The questionnaires  used in the Agricultural Health Study (AHS) may be obtained through the AHS Web site.  They were developed in collaboration with the National Cancer Institute, the Environmental Protection Agency and NIOSH. For more information about the questionnaires, contact Jane Hoppin, Sc.D., at NIEHS or Joe Coble, Ph.D., or Michael Alavanja, Ph.D., at the National Cancer Institute.

 

Phase 1 Questionnaires

Enrollment Questionnaire: Private Applicator

 

  • The questionnaire administered at enrollment.

 

Farmer Applicator Questionnaire

 

  • The take home questionnaire completed by private pesticide applicators.

 

Commercial Applicator Questionnaire

 

  • The take home questionnaire completed by commercial pesticide applicators.

 

Spouse Questionnaire

 

  • The take home questionnaire completed by spouses of private pesticide applicators.

 

Female and Family Health Questionnaire

 

  • The take home questionnaire completed by the female pesticide applicators and spouses of male applicators.

 

Follow-up Questionnaire

 

  • A subset of the questions in the Enrollment Questionnaire, which was administered by telephone to people who had partially completed the Enrollment questionnaire but skipped a number of key questions.

 

Phase 2 Questionnaires

  • Cooking Practices Module
  • Follow-up Health Questionnaire for Women (Version A)
  • Follow-up Health Questionnaire for Women (Version C-Applicator, Spouse before 04/01/00)
  • Follow-up Health Questionnaire for Women (Version C-Spouse)
  • Health Module for Men
  • Pesticide Use Module: Spouse
  • Pesticide Use Module: Private Pesticide Applicator

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