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Questionnaires

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Julie Cusack edited this page Jan 26, 2023 · 28 revisions
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Questionnaire Administration

Questionnaires are administered electronically through the MyConnect app, which is accessible on any computer, tablet, or smartphone. Participants receive email notifications to complete the baseline modules when they join Connect and periodically for follow-up questionnaires in the subsequent years.

Baseline Questionnaire

The baseline questionnaire consists of four modules.

Module 1: Background and Overall Health

  • Background Information (Age, Marital Status, Race/Ethnicity, 1st Language Spoken, Height/Weight)
  • Sex & Gender (Sex Assigned at Birth, Organ Inventory, Gender Identity and Expression, Sexual Orientation)
  • Medical History (Surgeries, Blood Transfusions, Cardiovascular and Kidney Diseases, Digestive System and Systemic Problems, Thyroid Disorder, Diabetes, Graves’, STDs/STIs, and Respiratory, Urinary, Reproductive & Systemic Problems)
  • Family History of Cancer (Parents, Siblings, & Children)
  • General Health (Pain, Hair Pattern & Loss, Acne)
  • Education (Level and Status)
  • Occupation (SOCcer, Household Income & Inhabitants)

Module 2: Medications, Reproductive Health, Exercise, and Sleep

  • Medications (Pain Relivers, Cholesterol and Blood Pressure Medications, Metformin, Insulin, Acid Suppressive Drugs)
  • Menstrual Periods
  • Pregnancy & Fertility
  • Hormone Medications, Contraceptives, and Therapy
  • Physical Activity
  • Sleep
  • Shift work

Module 3: Smoking, Alcohol, and Sun Exposure

  • Tobacco & Nicotine (type, mode, frequency, duration)
  • Marijuana (type, mode, frequency, duration)
  • Alcohol (type, frequency, duration)
  • Sun Exposure (burn history, sunscreen and tanning bed use)
  • Freckling and Natural eye, hair, and skin color

Module 4: Where you Live and Work

  • Residential, childhood, and seasonal/vacation home history
  • Home water source and use
  • Adult tap water intake and use
  • Work commute (Pre-Pandemic (current) and historical)
  • Student commute (current and historical)

Biospecimen Questionnaires

The biospecimen questionnaires are triggered following sample donation. The Research Appointment Questionnaire is administered when blood, urine, and mouthwash samples are collected at a research appointment. The Clinical Collection Questionnaire is administered when the participant provides only blood and urine samples in a clinical collection setting. The At-Home Mouthwash Questionnaire is administered when the participant completes the mouthwash saliva sample at home. The following summarizes data collected by sample donation.

Blood and Urine Data Collection

  • Behavior Before Sample Donation
  • OTC Medication Use (Pain Relievers & Stomach Acid Suppressors)
  • Menstrual Period
  • Pregnant & Breastfeeding Status
  • Contraceptive Use & Hormone Therapy
  • COVID-19 (Testing, Symptoms, Hospitalization, Long-term Effects, Vaccination)

Mouthwash Data Collection

  • Behavior Before Sample Donation
  • Oral Hygiene Practices & Product Use
  • Tooth Loss
  • Denture/Dental Appliance Use
  • Professional Dental Cleaning History
  • Cavities
  • Periodontal Disease
  • Antibiotics Use

Call for New Concepts

The Connect Team is not currently soliciting concepts for new questionnaire topics and enhancements to existing questionnaire modules. For more information on submission requirements and future calls please visit the Call for New Concepts page.