5. Is your natural mother still alive?
	yes no don't know

	5.1 How old was she when she died? (Please guess as closely as you can.)	Choose One<4950-5960-6970-7980-8990-9999+

	5.2 How old is she now? (Please guess as closely as you can.)	Choose One<4950-5960-6970-7980-8990-9999+

6. Is your natural father still alive?
	yes no don't know

	6.1 How old was he when he died? (Please guess as closely as you can.)	Choose One<4950-5960-6970-7980-8990-9999+

	6.2 How old is he now? (Please guess as closely as you can.)	Choose One<4950-5960-6970-7980-8990-9999+

7. Did your mother, father, full-blooded sisters, full-blooded brothers, daughters, or sons ever have sugar diabetes or high blood sugar that first appeared as an adult?
	yes no don't know

	7.1 How many of these relatives had diabetes?	Choose One1234+

8. Did your mother, father, full-blooded sisters, full-blooded brothers, daughters, or sons ever have a heart attack or myocardial infarction?
	No (Skip to Question 9) Don't know (Skip to Question 9) Yes

Please answer the following questions for each of your relatives. If you do not have a full-blooded sister, full-blooded brother, daughter, or son, leave the bubble blank.

		Age of First Heart Attack
		< 55	55 - 59	60 - 64	65+	Don't Know

Mother

Father

Sister

Sister

Sister

Brother

Brother

Brother

Daughter

Daughter

Son

Son

9. Did your mother, father, full-blooded sisters, full-blooded brothers, daughters, or sons ever have a stroke?
	yes no don't know

	9.1 How many of these relatives had a stroke?	Choose One1234+

These next questions are about cancers your relatives may have had. For each question, mark "Yes" only if it describes the area where the relative's cancer started. Often cancers will start in one place and then spread. We are interested in where the cancer started.

Female relatives

10. Did any of your female relatives ever have cancer? For female relatives, please answer about your mother, full-blooded sisters, daughters, and grandmothers. Do not include aunts, cousins, and nieces.)
	No (Skip to Question 16) Don't know (Skip to Question 16) Yes

11. Did your mother, full-blooded sisters, daughters, or grandmothers ever have breast cancer?
	No (Skip to Question 12) Don't know (Skip to Question 12) Yes

	11.1 Please answer the following questions for each of your female relatives who had breast cancer. If you do not have a full-blooded sister or daughter, leave the spaces blank. Please note that the age category is different than for the question about heart attacks in relatives.

		Age of Detection of Breast Cancer
		< 45	45+	Don't Know Age

Mother

Sister

Sister

Sister

Daughter

Daughter

Daughter

Maternal Grandmother (Mother's Mother)

	Paternal Grandmother (Father's Mother)

12. Did your mother, full-blooded sisters, daughters, or grandmothers ever have cancer of the colon, rectum, intestine, or bowel?
	No (Skip to Question 13) Don't know (Skip to Question 13) Yes

	12.1 Please answer the following questions for each of your female relatives who had colon, rectum, intestine, or bowel cancer. If you do not have a full-blooded sister or daughter, leave the spaces blank.

		Age of Detection of Colon, Rectum, Intestinal Cancer
		< 45	45+	Don't Know Age

Mother

Sister

Sister

Sister

Daughter

Daughter

Daughter

Maternal Grandmother (Mother's Mother)

	Paternal Grandmother (Father's Mother)

13. Did your mother, full-blooded sisters, or daughters ever have cancer of the cervix (opening to the womb)?
	yes no don't know

	13.1 How many of these relatives had cancer of the cervix?	Choose One1234+

14. Did your mother, full-blooded sisters, or daughters ever have cancer of the uterus, womb, or endometrium (lining of the womb)?
	yes no don't know

	14.1 How many of these relatives had cancer of the uterus, womb, or endometrium?	Choose One1234+

15. Did your mother, full-blooded sisters, or daughters ever have cancer of the ovaries?
	yes no don't know

	15.1 How many of these relatives had cancer of the ovaries?	Choose One1234+

Male relatives

16. Did any of your male relatives ever have cancer? (For male relatives, please answer about your father, full-blooded brothers, sons, and grandfathers. Do not include uncles, cousins, and nephews.)
	No (Skip to Question 19) Don't know (Skip to Question 19) Yes

17. Did your father, full-blooded brothers, or sons ever have cancer of the colon, rectum, intestine, or bowel?
	No (Skip to Question 18) Don't know (Skip to Question 18) Yes

	17.1 Please answer the following questions for each of your male relatives who had colon, rectum, intestine, or bowel cancer. If you do not have a full-blooded brother or son, leave those bubbles blank.

		Age of Detection of Colon, Rectum, Intestinal Cancer
		< 45	45+	Don't Know Age

Father

Brother

Brother

Brother

Son

Son

Son

Maternal Grandfather (Mother's Father)

Paternal Grandfather (Father's Father)

18. Did your father, full-blooded brothers, or sons ever have cancer of the prostate (male gland)?
	yes no don't know

	18.1 How many of these relatives had cancer of the prostate?	Choose One1234+

Finally we want to ask some questions about your parent's bones.

19. Did your mother ever break or fracture a bone after she was 40 years old?
	No (Skip to Question 20) Don't know (Skip to Question 20) Yes

19.1 Please answer the following questions for each of the bones listed below. If she broke the bone more than once, mark her age when it was first broken.

		Age of First Broken Bone
		40 - 55	55+	Don't Know Age

a) Hip

b) Spine (Back/Vertebra)

c) Upper Arm (humerus)

d) Lower arm or wrist

	e) Other (specify):

20. Did your father ever break or fracture a bone after he was 40 years old?
	No (Skip to Question 21) Don't know (Skip to Question 21) Yes

20.1 Please answer the following questions for each of the bones listed below. If he broke the bone more than once, mark his age when it was first broken.

		Age of First Broken Bone
		40 - 55	55+	Don't Know Age

a) Hip

b) Spine (Back/Vertebra)

c) Upper Arm (humerus)

d) Lower arm or wrist

	e) Other (specify):

21. Other illnesses. Please answer the following questions for all full-blooded family members that experienced the following medical conditions. If NONE of your blood relatives have experienced the medical conditions listed, leave the bubbles blank.

	21a. Heart problems other than heart attack:	Mother Father Sister Brother	Daughter Son Paternal Grandmother Paternal Grandfather	Maternal Grandmother Maternal Grandfather Aunt Uncle

	21b. High blood pressure:	Mother Father Sister Brother	Daughter Son Paternal Grandmother Paternal Grandfather	Maternal Grandmother Maternal Grandfather Aunt Uncle

	21c. Sudden, unexplained death:	Mother Father Sister Brother	Daughter Son Paternal Grandmother Paternal Grandfather	Maternal Grandmother Maternal Grandfather Aunt Uncle

	21d. High Cholesterol:	Mother Father Sister Brother	Daughter Son Paternal Grandmother Paternal Grandfather	Maternal Grandmother Maternal Grandfather Aunt Uncle

	21e. Diabetes:	Mother Father Sister Brother	Daughter Son Paternal Grandmother Paternal Grandfather	Maternal Grandmother Maternal Grandfather Aunt Uncle

	21f. Osteoporosis:	Mother Father Sister Brother	Daughter Son Paternal Grandmother Paternal Grandfather	Maternal Grandmother Maternal Grandfather Aunt Uncle

	21g. Obesity:	Mother Father Sister Brother	Daughter Son Paternal Grandmother Paternal Grandfather	Maternal Grandmother Maternal Grandfather Aunt Uncle

	21h. Thyroid disease:	Mother Father Sister Brother	Daughter Son Paternal Grandmother Paternal Grandfather	Maternal Grandmother Maternal Grandfather Aunt Uncle