PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| 1. Current weight (in lbs) | spaq_1 | N | text | - | - | - | |
| 2. Years of education | spaq_2 | N | dropdown | 1, Less than four years of high school | 2, High school only | 3, 1-3 years post high school | 4, 4 or more years post high school | - | - | |
| 3. Sex | spaq_3 | N | dropdown | 1, Male | 2, Female | - | - | |
| 4. Marital Status | spaq_4 | N | dropdown | 1, Single | 2, Married | 3, Separated/Divorced | 4, Widowed | - | - | |
| 5. Occupation | spaq_5 | N | text | - | - | - | |
| 6. How many years have you lived in this climactic area? | spaq_6 | N | text | - | - | - | |
| a. Sleep length | spaq_7a | N | radio | 0, 0 No Change | 1, 1 Slight Change | 2, 2 Moderate Change | 3, 3 Marked Change | 4, 4 Extremely Marked CHange | - | 7. To what degree do the following change with the seasons?_x000D_ _x000D_ The purpose of this form is to find out how your mood and behavior change over time. Please fill in all the relevant circles. Note: We are interested in your experience; not others you may have observed. | |
| b. Social activity | spaq_7b | N | radio | 0, 0 No Change | 1, 1 Slight Change | 2, 2 Moderate Change | 3, 3 Marked Change | 4, 4 Extremely Marked CHange | - | - | |
| c. Mood (overall feeling of well being) | spaq_7c | N | radio | 0, 0 No Change | 1, 1 Slight Change | 2, 2 Moderate Change | 3, 3 Marked Change | 4, 4 Extremely Marked CHange | - | - | |
| d. Weight | spaq_7d | N | radio | 0, 0 No Change | 1, 1 Slight Change | 2, 2 Moderate Change | 3, 3 Marked Change | 4, 4 Extremely Marked CHange | - | - | |
| e. Appetite | spaq_7e | N | radio | 0, 0 No Change | 1, 1 Slight Change | 2, 2 Moderate Change | 3, 3 Marked Change | 4, 4 Extremely Marked CHange | - | - | |
| f. Energy level | spaq_7f | N | radio | 0, 0 No Change | 1, 1 Slight Change | 2, 2 Moderate Change | 3, 3 Marked Change | 4, 4 Extremely Marked CHange | - | - | |
| a. Feel Best | spaq_8a | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | 8. In the following questions check the box for all applicable months. This may be a single month •, a cluster of months • • •, or any other grouping._x000D_ _x000D_ At what time of year do you..._x000D_ | |
| b. Gain most weight | spaq_8b | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| b. Gain most weight | spaq_8c | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| d. Sleep least | spaq_8d | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| e. Eat most | spaq_8e | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| f. Lose most weight | spaq_8f | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| g. Socialize least | spaq_8g | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| h. Feel worst | spaq_8h | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| i. Eat least | spaq_8i | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| j. Sleep most | spaq_8j | N | checkbox | 1, Jan. | 2, Feb. | 3, March | 4, April | 5, May | 6, June | 7, July | 8, Aug. | 9, Sept. | 10, Oct. | 11, Nov. | 12, Dec. | 13, OR No particular months stand out as extreme on a regular basis | - | - | |
| 9. How much does your weight fluctuate during the course of the year? | spaq_9 | N | dropdown | 1, 0-3 lbs | 2, 4-7 lbs | 3, 8-11 lbs | 4, 12-15 lbs | 5, 16-20 | 6, Over 20 lbs | - | - | |
| Winter | spaq_10_winter | N | text | - | Hours Sleeping | 10. Approximately how many hours of each 24-hour day do you sleep during each season (including naps)? | |
| Spring | spaq_10_spring | N | text | - | Hours Sleeping | - | |
| Summer | spaq_10_summer | N | text | - | Hours Sleeping | - | |
| Fall | spaq_10_fall | N | text | - | Hours Sleeping | - | |
| 11. Do you notice a change in food preference during the different seasons? | spaq_11 | N | yesno | - | - | - | |
| 11. Please specify: | spaq_11_specify | N | text | - | - | - | |
| 12. If you experience changes with the seasons, do you feel that these are problems for you? | spaq_12 | N | yesno | - | - | - | |
| 12. If yes, is this problem... | spaq_12_specify | N | radio | 1, mild | 2, moderate | 3, marked | 4, severe | 5, disabling | - | - | |
| Notes | spaq_notes | Y | notes | - | - | - |