questionnaires

Bone health in Female runners Intervention Trial Questionnaire (A)

NAME: ___________________________

Instructions:
The following questionnaire covers several areas, including questions about your training, injuries, menstrual cycle, oral contraceptive use, and dietary behaviors. You will also complete a separate food intake questionnaire which follows. Please answer all questions as completely as possible. If you do not understand the directions provided, you can e-mail us or call us toll-free at 1-877-RUN-BFIT (1-877-786-2348) anytime for clarification. Please keep in mind that you may leave blank any questions that you do not feel comfortable answering. However, all answers will be confidential and your name will not be used. Information collected will be presented as group statistics. Please try to be as accurate and honest as possible when giving your answers. The entire questionnaire should take about 40 minutes to complete. Thank you for your help.

SECTION A: TRAINING

1. During the cross country season (September – November), approximately how many miles of running do you average per week? (Circle one.)

< 25 miles 25-29
miles 30-34 miles 35-39 miles 40-44
miles 45-49
miles 50-54
miles 55-59
miles 60-64
miles 65-69
miles 70-74
miles 75-79
miles 80-84
miles 85 or >
miles

2. Approximately how many miles of running per week did you average during the past summer (July-August) in preparation for cross country? (Circle one.)

< 25
miles 25-29
miles 30-34
miles 35-39
miles 40-44
miles 45-49
miles 50-54
miles 55-59
miles 60-64
miles 65-69
miles 70-74
miles 75-79
miles 80-84
miles 85 or >
miles

3. Approximately how many miles of running did you average per week during the past spring season (April-June)? (Circle one.)

< 25
miles 25-29
miles 30-34
miles 35-39
miles 40-44
miles 45-49
miles 50-54
miles 55-59
miles 60-64
miles 65-69
miles 70-74
miles 75-79
miles 80-84
miles 85 or >
miles

4. Approximately how many miles of running did you average per week during the past winter season (December-March) (Circle one.)

< 25
miles 25-29
miles 30-34
miles 35-39
miles 40-44
miles 45-49
miles 50-54
miles 55-59
miles 60-64
miles 65-69
miles 70-74
miles 75-79
miles 80-84
miles 85 or >
miles

5. How old were you when you first started competing for a running team (either a club or school team)? _________ years of age

6. How many cross country seasons have you competed in (in which you have completed at least two cross country races) since you started running? _________ seasons

7. How many indoor track seasons have you competed in (in which you completed at least three track races) since you started running? _________ seasons

8. How many outdoor track seasons have you competed in (in which you completed at least three track races) since you started running? _________ seasons

9. Do you plan to compete in indoor track for your team this coming winter? (Circle yes or no.)

Yes No

9a. If you circled No, do you plan to participate either in another competitive sport or in a conditioning program during the winter (December-March)?

Yes No

9b. If you circled Yes to 9a, write the type of sport(s) or program(s) in which you will participate.

10. Do you plan to compete in outdoor track for your team this coming spring?

Yes No

10a. If you circled No, do you plan to participate either in another competitive sport or in a conditioning program during the spring (April-June)?

Yes No

10b. If you circled Yes to 10a, write the type of sport(s) or program(s) in which you will participate.

11. On average, how often do you engage in weight training, either nautilus or free weights, during the year? (Circle one.)

never less than once per month once per month two to three times per month once per week twice per week three or more times per week

IF you circled “never", then go to question 12.

11a. Approximately how many minutes does your typical weight session last? ____ minutes

12. Approximately what percentage of your miles (including all racing and interval training) are run on pavement or concrete? (Circle one.)

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

SECTION B: STRESS FRACTURE HISTORY

1. Have you ever had a stress fracture? (Circle yes, no, or don’t know.)

Yes No Don’t Know

If you circled Yes, answer question 2..

If you circled No or Don’t Know, go to the next section (section C).

2. Please fill out the chart below regarding your stress fracture(s). Record the site of the stress fracture, whether or not the fracture was diagnosed by a doctor, and whether or not the stress fracture was diagnosed using an x-ray, bone scan, and/or MRI. **If you don’t know answers to any of these questions, write “DK” and answer 2a on the next page.

What bone was stress fractured? Was this stress fracture diagnosed from an x-ray? (Date?) Was this stress fracture diagnosed by a doctor?
(Date?) Was this stress fracture diagnosed from a bone scan? (Date?) Was this stress fracture diagnosed from an MRI? (Date?)

Example 1
right tibial bone yes 4/5/00 no yes 4/12/00 no

Example 2
left femur yes 3/15/00 DK DK no

Stress Fracture 1

Stress Fracture 2

Stress Fracture 3

Stress Fracture 4

SECTION C: HISTORY OF INJURIES OTHER THAN STRESS FRACTURES

1. In the past 12 months, have you had to miss 4 or more consecutive weeks of training due to an injury other than a stress fracture? (Circle yes or no.)

Yes No

If you circled No, go to the next section (section D).

If you circled Yes, answer question 2.

2. Please describe the injury(s) below. Record whether or not the injury occurred as a result of running, a brief description of the injury, and the approximate amount of time lost from training and competition. If you don’t know, write “DK.”

Did this injury occur as a result of running? (yes/no) To the best of your ability, briefly describe the nature of the injury. How much training/
competition time was lost due to the injury?

Example 1:
no broken collar bone from a bike accident 5 weeks

Example 2:
yes torn right achilles tendon 3 months

Injury 1

Injury 2

Injury 3

Injury 4

SECTION D: REPRODUCTIVE HISTORY

1. Have you ever been pregnant? (Circle Yes or No.)

Yes No

If you circled No, go to the next section (section E).

If you circled Yes, answer questions 2 and 3.

2. Including any livebirths, stillbirths, induced abortions, and miscarriages (also called spontaneous abortions), how many times have you been pregnant? ___________ times

3. For each pregnancy, please record the length of the pregnancy and the number of months (if any) spent breastfeeding.

Pregnancy number Length of pregnancy (in months) Number of months of breast-feeding

Example: 1 3 months 0 months

SECTION E: ORAL CONTRACEPTIVE HISTORY

1. Have you ever been refused a prescription for any oral contraceptive? (Circle Yes or No.)

Yes No

1a. If you circled Yes, what was the medical reason that the doctor refused to give you a prescription? ___________________________________________________________

2. Have you ever used any oral contraceptive pill for any reason? (Circle Yes or No.)

Yes No

If you circled Yes, please answer question 3.

If you circled No, go to the next section (section F).

3. Please record, to the best of your ability, information about all oral contraceptives used. If you know the name of the oral contraceptive that you were using, please write it in the appropriate column; if not, write “DK” and answer (3a), on the next page.** Also record the reason(s) for use (to regulate menstruation, to prevent pregnancy, or other) and the approximate dates used.

Pill Name** Reason used (i.e., to regulate menstruation, to prevent pregnancy, etc.) Approximate Start date of use (month/year) Approximate End date of use
(month/year)

Example 1
Lo/Ovral to regulate menstruation January/1993 October/1994

Example 2
Lo/Ovral to prevent pregnancy March/1995 May/1996

Example 3
Ortho-cyclen to prevent cramps
and pregnancy July/1997 Sept./1997

first oral contraceptive used

second oral contraceptive used

third oral contraceptive used

fourth oral contraceptive used

fifth oral contraceptive used

sixth oral contraceptive used

Section E is continued on the next page…
SECTION F: MENSTRUAL HISTORY

1. Have you EVER had a menstrual period? (Circle Yes or No).

Yes No

If you circled No, go to the next section (section G).

If you circled Yes, complete the questions in this section.

2. At what age did you have your first menstrual period? _______ years

3. Approximately how many times did you menstruate in the past 12 months? _________ times

4. During the past 12 months, did your menstrual flow usually start within 4 days of the day you expected it to start? By “usually” we mean for at least half of your periods.
a. no
b. yes
c. don’t know

5. Please fill in the following chart. For each year of age up to, and including, your current age, please place a check in the box that indicates the approximate number of times that you menstruated during that year. Do not check off a box for any ages that you have not yet reached. For example, if you are currently 20 years old, check off boxes for ages 10 through 20 only. For your current age, check off the number of times you have menstruated so far since your most recent birthday.

Your Age Number of periods you had

0 periods 0-3 periods 4-9 periods 10 or more periods

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

SECTION G: THOUGHTS AND FEELINGS ABOUT SELF AND FOOD

Directions for this section: Read each question and check the box for the answer that applies best to you.

1. I feel mad at myself when I eat sweets.

Always Usually Many Times Once in a While Almost Never Never

2. I think that my stomach is too big.

Always Usually Many Times Once in a While Almost Never Never

3. I eat when I am upset.

Always Usually Many Times Once in a While Almost Never Never

4. I stuff myself with food.

Always Usually Many Times Once in a While Almost Never Never

5. I think about dieting.

Always Usually Many Times Once in a While Almost Never Never

6. I think that my thighs are too big.

Always Usually Many Times Once in a While Almost Never Never

7. I feel very guilty if I eat too much.

Always Usually Many Times Once in a While Almost Never Never

8. I think that my stomach is just the right
size.

Always Usually Many Times Once in a While Almost Never Never

9. I am very afraid of gaining weight.

Always Usually Many Times Once in a While Almost Never Never

10. I feel satisfied with the shape of my body.

Always Usually Many Times Once in a While Almost Never Never

11. I care too much about my weight.

Always Usually Many Times Once in a While Almost Never Never

12. Sometimes I have started eating too much and could not stop.

Always Usually Many Times Once in a While Almost Never Never

13. I like the shape of my body.

Always Usually Many Times Once in a While Almost Never Never

14. I think about being thinner a lot.

Always Usually Many Times Once in a While Almost Never Never

15. I think about eating a lot of food at one time.

Always Usually Many Times Once in a While Almost Never Never

16. I think my hips are too big.

Always Usually Many Times Once in a While Almost Never Never

17. I eat OK when other people are around, but I stuff myself when they’re gone.

Always Usually Many Times Once in a While Almost Never Never

18. If I gain a pound, I worry that I will keep gaining.

Always Usually Many Times Once in a While Almost Never Never

19. I think about trying to throw up to lose weight.

Always Usually Many Times Once in a While Almost Never Never

20. I think that my thighs are just the right size.

Always Usually Many Times Once in a While Almost Never Never

21. I think my behind is too large.

Always Usually Many Times Once in a While Almost Never Never

22. I sneak food or drink so people won’t know.

Always Usually Many Times Once in a While Almost Never Never

23. I think that my hips are just the right size.

Always Usually Many Times Once in a While Almost Never Never

SECTION G, continued.

Directions: Indicate how strongly you agree or disagree with each of the items below by checking a box to the right of the item.

24. In uncertain times, I usually expect the best.

Strongly Agree Agree Neutral Disagree Strongly Disagree

25. It’s easy for me to relax.

Strongly Agree Agree Neutral Disagree Strongly Disagree

26. If something can go wrong for me, it will.

Strongly Agree Agree Neutral Disagree Strongly Disagree

27. I always look on the bright side of things.

Strongly Agree Agree Neutral Disagree Strongly Disagree

28. I’m always optimistic about my future.

Strongly Agree Agree Neutral Disagree Strongly Disagree

29. I enjoy my friends a lot.

Strongly Agree Agree Neutral Disagree Strongly Disagree

30. It’s important for me to keep busy.

Strongly Agree Agree Neutral Disagree Strongly Disagree

31. I hardly ever expect things to go my way.

Strongly Agree Agree Neutral Disagree Strongly Disagree

32. Things never work out the way I want them to.

Strongly Agree Agree Neutral Disagree Strongly Disagree

33. I don’t get upset too easily.

Strongly Agree Agree Neutral Disagree Strongly Disagree

34. I’m a believer in the idea that “every cloud has a silver lining”.

Strongly Agree Agree Neutral Disagree Strongly Disagree

35. I rarely count on good things happening to me.

Strongly Agree Agree Neutral Disagree Strongly Disagree

SECTION H: DIETARY BEHAVIORS

1. Do you follow a vegan diet (meaning that you never eat animal products, including eggs, dairy, fish, chicken or meat)? (Circle Yes or No.)

Yes No

2. Do you follow a vegetarian diet (meaning that you never eat fish, chicken, or meat, but you do eat eggs and dairy)?

Yes No

3. Do you follow a demi-vegetarian diet (meaning that you never eat red meat (pork, beef, etc.) but that you do eat fish and/or chicken)?

Yes No

4. Have you ever been diagnosed by a doctor as having anorexia nervosa? (Circle Yes, No, or Don’t Know.)

Yes No Don’t Know

5. Have you ever been diagnosed by a doctor as having bulimia?

Yes No Don’t Know

6. Are you currently taking diet pills?

Yes No

7. Have you ever taken diet pills in the past?

Yes No

8. Approximately how often did you take diuretics in the past year? (Circle one.)

never less then once per month once per month 2-3 times per month once per week twice per week 3-4 times per week 5-6 times per week once per day twice per day 3 or more times per day

9. Approximately how often did you take laxatives in the past year? (Circle one.)

never less then once per month once per month 2-3 times per month once per week twice per week 3-4 times per week 5-6 times per week once per day twice per day 3 or more times per day

YOU HAVE NOW COMPLETED THIS PART OF THE QUESTIONNAIRE. PLEASE PROCEED TO THE ATTACHED FOOD QUESTIONNAIRE AND FOLLOW THE INSTRUCTIONS PROVIDED.

What bone was stress fractured?	Was this stress fracture diagnosed from an x-ray? (Date?)	Was this stress fracture diagnosed by a doctor? (Date?)	Was this stress fracture diagnosed from a bone scan? (Date?)	Was this stress fracture diagnosed from an MRI? (Date?)
Example 1 right tibial bone	yes 4/5/00	no	yes 4/12/00	no
Example 2 left femur	yes 3/15/00	DK	DK	no
Stress Fracture 1
Stress Fracture 2
Stress Fracture 3
Stress Fracture 4

Did this injury occur as a result of running? (yes/no)	To the best of your ability, briefly describe the nature of the injury.	How much training/ competition time was lost due to the injury?
Example 1: no	broken collar bone from a bike accident	5 weeks
Example 2: yes	torn right achilles tendon	3 months
Injury 1
Injury 2
Injury 3
Injury 4

Pregnancy number	Length of pregnancy (in months)	Number of months of breast-feeding
Example: 1	3 months	0 months

Pill Name**	Reason used (i.e., to regulate menstruation, to prevent pregnancy, etc.)	Approximate Start date of use (month/year)	Approximate End date of use (month/year)
Example 1 Lo/Ovral	to regulate menstruation	January/1993	October/1994
Example 2 Lo/Ovral	to prevent pregnancy	March/1995	May/1996
Example 3 Ortho-cyclen	to prevent cramps and pregnancy	July/1997	Sept./1997
first oral contraceptive used
second oral contraceptive used
third oral contraceptive used
fourth oral contraceptive used
fifth oral contraceptive used
sixth oral contraceptive used

	0 periods	0-3 periods	4-9 periods	10 or more periods
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27