Survey for recently diagnosed U.S. patients

Dear Crohn's co-sufferer,

I hope to find you in good health and to ask you for a few minutes of your time for a common cause. I am an independent Crohn's disease researcher whose partial findings can be read at http://geocities.datacellar.net/HotSprings/Spa/7959/ My goal is to find out as much as possible and share the knowledge with the rest of you and the health community about this unfortunate disease. This survey is for more recently diagnosed (less than 5 years ago) patients since it asks you to go back in time prior to the onset of Crohn's symptoms and recall details of your dietary habits. It is restricted for now to U.S. patients since I just have data to compare to for this country. I plan to publish the results in a medical journal and on the Internet, while your participation may be totally anonymous. Your participation is very important since results have more meaning if they are derived from larger number of replies. After this lengthy intro, here are the questions:
1. Your gender: female male

2. Your age at the onset of symptoms ( ).

3. Time between the onset and diagnosis - diagnostic delay ( ).

4. Marital status at the onset of symptoms: .

5. Employment status: and / or school enrollment at the onset of symptoms.

How here is the meat of the survey!-) Please take your time answering next two questions in order to give the most precise estimate for the first, and most detail for the second:

6. Eating out habits prior to the onset of symptoms for breakfast, lunch and diner each: how often a week have you prepared the above meal at home (0-7), eaten this meal in a restaurant or away from home(0-7), or skipped it (0-7). Of course, for each of the 3 meals the sum of numbers between prepared, eaten out and skipped needs to be 7 per week.

Away-from-home and home foods are defined here according to where the foods were obtained, NOT where they were eaten. Food at home consists of foods purchased at retail stores, such as the grocery store or supermarket (not prepared meals or TV diners) and prepared by you or someone you know. Food away from home consists of foods obtained from foodservice and entertainment establishments. Away-from-home foods include those from restaurants, fast food, self-service and carry-out eating places and cafeterias, schools, including day-care centers and summer camps, vending machines, community feeding programs, and someone else’s home.

BREAKFAST (times a week, total to be 7)
at home , away from home , or skipped .

LUNCH (times a week, total to be 7)
at home , away from home , or skipped .

DINER (times a week, total to be 7)
at home , away from home , or skipped .

For the last two questions, just type answers in the text box without hitting enter/return

7. Prior to the onset of your symptoms have you been in contact with someone who had chronic gastrointestinal disease (which?) - a friend, relative, roommate (please specify the relationship, its duration, have you shared a household, having meals at their house or prepared by them, etc.)?

8. Your e-mail (in the unlikely event that I need to contact you)

Thank you for sending in the survey.

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