ACT Form 78 Summary

Data Description

ACT Form 78 collects information on self-reported epidemiologic health and behavioral exposures on ACT participants. A high-level overview of the content areas is shown below.

Occupational History

• Employment or retirement status
• Longest and second longest occupation, type of company / department
• Occupational substance exposure and effects 

Smoking / Alcohol / Other Health Habits

• Cigarette, pipe, cigar smoking including duration and intensity
• Alcohol use and problems with alcohol
• Antiperspirants, antacids

Injuries 

• Injuries (TBI, drowning, electric shock, trauma, other) resulting in loss of consciousness

Other Medical History (not captured on Form 77)

• Rheumatoid arthritis, lupus, other autoimmune disorder
• Organ / bone marrow transplant, chemotherapy, other immunosuppressing procedure
• Lymphoma, leukemia, anemia, other blood diseases / disorders
• Surgery with anesthesia, blood transfusions

Mental Health History

• Self-reported episodes of depression
• Treatments, hospitalizations, other psychiatric disorders 

Family History

• Diseases, congenital defects, or conditions
• Maternal and paternal ages at participant’s birth 
• Handedness

Important Note: Form contents have changed over the years so all the above items may not be collected over the full duration of the ACT study. 

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Data Structure 

This Form 78 dataset contains one row per visit at which the study form was collected. 

 

Historical Data Collection Forms

For Baseline and Biennial Visits (PDFs)