Over time, the study expanded. Most notably, a dietary questionnaire was added in 1980 due to investigators recognizing the impact of diet and nutrition on the development of chronic disease. Blood, urine, saliva, and other physical samples were received and tested beginning in 1982. Experimenters followed up reports of morbidity using the National Death Index. Where possible and permitted, cancer diagnoses were reviewed. Although reports of other diseases were not followed up, self-reporting has been confirmed by medical records and doctors unaware of the answers to the study's questions.