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smok
[p.81]


U.S Health Interview Survey: Smoking Supplement

1. Book ____ of ____ books

2. R.O number ____

3. Sample ____

4. Control number

PSU ____
Segment ____
Serial ____

5. Interviewer's name ____

Code ____

6. Telephone (Q. 15)

1[] Y
2[] N

[p.82]


[Three sets of answers for each question in the original documents not presented here. For example: One set may include: person no, first and last names and, age and sex]

S1. For each sample person enter name, person number, age, and sex from HIS-1.

Person No ____
First name ____
Last name ____
Age ____
Sex
1[] M
2[] F
Coders use ____

S2.

1[] Under 17 (NP)
2[] 17+ callback req (NP)
3[] 17+ available


1. Have you smoked at least 100 cigarettes in your entire life?

1[] Y
2[] N (NP)


2a. About how old were you when you first started smoking cigarettes fairly regularly?

Years ____ (3)
00[] Never smoked regularly


b. Do you smoke cigarettes now?

1[] Y
2[] N (NP)


c. On the average, about how many cigarettes a day do you smoke?

Number ____


3. During the period when you were smoking the most, about how many cigarettes a day did you usually smoke?

Number ____

4a. Do you smoke cigarettes now?

1[] Y (5)
2[] N


b. About how long has it been since you last smoked cigarettes fairly regularly?

Number ____
2[] Days (S3)
3[] Weeks (S3)
4[] Months (S3)
5[] Years (S3)

5. On the average, about how many cigarettes a day do you now smoke?

Number ____

S3.

1[] "Y" in 4a (6)
2[] Less than 1 year in 4b (6)
3[] 1+ years in 4b (NP)


6a. What brand of cigarettes do (did) you usually smoke?

Brand name(s) ________

If more than one brand ask:
b. Which brand do (did) you smoke the most?

Brand name ________


7. What type of cigarettes are the (brand) that you smoke (smoked)? Are they:


a. Filter tip OR non-filter tip?

1[] FT
2[] NFT


b. Plain or Menthol?

1[] P
2[] M


c. Hard pack or Soft pack?

1[] HP
2[] SP

[p.83]


d. Regular OR king size or 100 millimeter?

1[] R
2[] K
3[] 100

S4

1[] "N" in 4a (NP)
2[] "Y" in 4a


8a. Have you ever made a serious attempt to stop smoking cigarettes?

1[] Y
2[] N (NP)


b. About how many times would you say you made a fairly serious attempt to stop smoking cigarettes entirely?

0[] Never (NP)
[] 1
[] 2
[] 3
[] 4
[] 5+


c. During the past 12 months, that is since (date) a year ago, about how many times would you say you made a fairly serious attempt to stop smoking cigarettes entirely?

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5+


9. How long ago was the START of the LAST time you tried to stop entirely?

Number ____
2[] Days
3[] Weeks
4[] Months
5[] Years


10. How long did you actually stay off cigarettes the last time?

Number ____
2[] Days
3[] Weeks
4[] Months
5[] Years

000[] Did not stay off

S5. Transcribe for each sample person 17+ after leaving household.

00[] None

1a. Highest grade attended in school (Q 2a, p.48)

[] Elem
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] High
[] 9
[] 10
[] 11
[] 12
[] College
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6+

b. Finished grade (Q 2b, p.48)

1[] Y
2[] N

2. Racial background (Q 4a, b, P. 48)
(If single entry in 4a, transcribe that entry. If multiplpe entry in 4a, transcribe entry in 4b).

[] 1
[] 2
[] 3
[] 4
[] 5 - Specify ____

3. Family income (Q 12, p. 52)

00[] A
01[] B
02[] C
03[] D
04[] E
05[] F
06[] G
07[] H
08[] I
09[] J
10[] K


S6. Final Status

1[] Complete - personal visit
2[] Complete - telephone
3[] Refused
4[] Not at home - repeated calls
5[] Temporarily absent
8[] Other - Specify ____