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hear

[p. 63]

R1
Q.'s 5-37

For persons 19 years old or over, show who responded for (or was present during the asking of) Q.'s 5-37.

If persons responded for self, show whether entirely or partly. For persons under 19 show who responded for them.

1 [] Responded for self-entirely
2 [] Responded for self-partly
Person ____ was respondent

For each person with an entry of "A," "B," or "37" in C2, ask Q.'s 38-41.


38. Has -- ever used a hearing aid?

[] Y
[] N


Please look at this card -- (Show Card H)
Card H


Which statement best describes your hearing in your LEFT ear (without a hearing aid)?

1. Hearing is good
2. Little trouble hearing
3. Lot of trouble hearing
4. Deaf


Which statement best describes your hearing in your RIGHT ear (without a hearing aid)?

1. Hearing is good
2. Little trouble hearing
3. Lot of trouble hearing
4. Deaf


39a. Which statement best describes --'s hearing in his LEFT ear (without a hearing aid)?

1 [] Good
2 [] Little trouble
3 []S Lot of trouble
4 []S Deaf


b. Which statement best describes --'s hearing in his RIGHT ear (without a hearing aid)?

1 [] Good
2 [] Little trouble
3 []S Lot of trouble
4 []S Deaf

If under 3, go to 41a

40a. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person WHISPERS to him from across a quiet room?

[] Y (41a)
[] N


b. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person TALKS IN A NORMAL VOICE to him from across a quiet room?

[] Y (41a)
[] N


c. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person SHOUTS to him from across a quiet room?

[] Y (41b)
[] N


d. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND a person if that person SPEAKS LOUDLY into his better ear?

[] Y (41b)
[] N


e. (Without a hearing aid) Can -- usually tell the sound of speech from other sounds and noises?

[] Y (41b)
[] N


f. (Without a hearing aid) Can -- usually tell one kind of noise from another?

[] Y (41b)
[] N


g. (Without a hearing aid) Can -- hear loud noises?

[] Y (41b)
[] N (41b)


41 a. How old was -- when he began to have trouble hearing?

[] At birth
[] Less than 1 year
Years old ____
[] DK
[] No trouble


b. How old was -- when he began to have serious trouble hearing or became deaf?

[] At birth
[] Less than 1 year
Years old ____
[] DK
[] No trouble


Complete Q. 41c from entry in 41a and b or age. If "DK" in Q.'s 41a and b AND 21 or older, ask:

c. Was it before or after --'s twenty-first birthday?

[] Before 21
[] After 21 (R2)

INTERVIEWER CHECK ITEM
A. "S" in BOTH ears in Q. 39?

[] Y
[] N

B. "N" in Q. 40c?

[] Y
[]N

If "Y" in A or B fill Hearing Supplement after the interview.

[] Hearing Supplement


R2
Q.'s 38-41

For persons 19 years old or over, show who responded for (or was present during the asking of) Q.'s 38-41.

If persons responded for self, show whether entirely or partly. For persons under 19 show how responded for them.

1 [] Responded for self-entirely
2 [] Responded for self-partly
Person _____ was respondent

HEARING SUPPLEMENT CHECK ITEM

Number of supplements ____ Enter number here and in Item N on Household page.