[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.
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?
[] N
Please look at this card -- (Show Card H)
Card H
2. Little trouble hearing
3. Lot of trouble hearing
4. Deaf
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)?
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)?
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?
[] 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?
[] 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?
[] N
d. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND a person if that person SPEAKS LOUDLY into his better ear?
[] N
e. (Without a hearing aid) Can -- usually tell the sound of speech from other sounds and noises?
[] N
f. (Without a hearing aid) Can -- usually tell one kind of noise from another?
[] N
g. (Without a hearing aid) Can -- hear loud noises?
[] N (41b)
41 a. How old was -- when he began to have trouble hearing?
[] Less than 1 year
Years old ____
[] DK
[] No trouble
b. How old was -- when he began to have serious trouble hearing or became deaf?
[] 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?
[] After 21 (R2)
INTERVIEWER CHECK ITEM
A. "S" in BOTH ears in Q. 39?
[] N
B. "N" in Q. 40c?
[]N
If "Y" in A or B fill Hearing Supplement after the interview.
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.
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.