[p. 198]
Section N -- ACCULTURATION
ITEM N1
SP Status
2[] Callback required (Household page)
3[] Noninterview (Section Z)
Refer to Hispanic origin in 4e and f on the page 2 and 3 of HIS-1 and expected language for this supplement.
2[] Hispanic/Spanish Supp. interview (1b)
8[] Other (Section O)
Read to respondent:
I'm going to be asking questions that are related to health concerns, such as smoking, eating practices, vitamin use and so forth. Before I ask these questions I would like to ask a few questions about the language you use most often.
1a. Do you speak any Spanish?
2[] No (4)
Read to respondent:
I'm going to be asking questions that are related to health concerns, such as smoking, eating practices, vitamin use and so forth. Before I ask these questions I would like to ask a few questions about the language you use most often.
b. Do you speak any English?
2[] No (4)
2. Would you say that you speak mostly Spanish, mostly English, or do you speak Spanish and English about the same?
2[] Mostly English
3[] Both about the same
3. What language do you prefer: Spanish only, mostly Spanish, mostly English, English only, or Spanish and English about equally?
Mark only one.
2[] Mostly Spanish
3[] Mostly English
4[] English only
5[] Spanish and English equally
2[] No
2[] No
Ask if "Yes" to both 4 and 5; otherwise skip to 7.
6. In which language do you read better?
2[] English
3[] Both the same
2[] No
2[] No
Ask if "Yes" to both 7 and 8; otherwise skip to 10.
9. In which language do you write better?
2[] English
3[] Both the same
10. Which of these groups best describes your national origin?
HAND CARD B. Read categories if telephone interview.
CARD B
02. Cuban
03. Cuban American
04. Mexican/Mexicano
05. Mexican American
06. Chicano
07. Hispano
08. Other Latin American
09. Other Spanish or Hispanic
10. American
11. Anglo American
88. Other (Specify)
Mark only one.
02[] Cuban
03[] Cuban American
04[] Mexican/Mexicano
05[] Mexican American
06[] Chicano
07[] Hispano
08[] Other Latin American
09[] Other Spanish or Hispanic
10[] American
11[] Anglo American
8[]8 Other (Specify) ____
11. Which of these groups best describes your mother's national region?
Mark only one.
02[] Cuban
03[] Cuban American
04[] Mexican/Mexicano
05[] Mexican American
06[] Chicano
07[] Hispano
08[] Other Latin American
09[] Other Spanish or Hispanic
10[] American
11[] Anglo American
8[]8 Other (Specify) ____
12. Which of these groups best describes your father's national origin?
Mark only one.
02[] Cuban
03[] Cuban American
04[] Mexican/Mexicano
05[] Mexican American
06[] Chicano
07[] Hispano
08[] Other Latin American
09[] Other Spanish or Hispanic
10[] American
11[] Anglo American
8[]8 Other (Specify) ____
[p. 199]
Section N -- ACCULTURATION -- Continued
13a. In what country were you born?
2[] Puerto Rico (13b)
3[] Cuba (13b)
4[] Mexican (13b)
8[] Other (Specify) ____ (13b)
b. Altogether, how many years have you lived in the United States?
2[] 1 yr., less than 5
3[] 5 yrs., less than 10
4[] 10 yrs., less than 15
5[] 15 yrs. or more
9[] DK
14. In what country was your father born?
2[] Puerto Rico
3[] Cuba
4[] Mexico
8[] Other (Specify) -- ____
9[] DK
15. In what country was your mother born?
2[] Puerto Rico
3[] Cuba
4[] Mexico
8[] Other (Specify) ____
9[] DK
[p. 200]
Section O -- ACCESS TO MEDICAL CARE
1a. Is there one particular clinic, health center, doctor's office, or other place that you usually go to if you are sick or need advice about your health?
2[] No (2)
3[] There is more than one (1b)
b. Is there one of those places you go to most often when you are sick or need advice about your health?
2[] No (2)
2a. Which of these is the main reason you do not have a particular place or person you usually go to?
HAND CARD O1. Read all categories if telephone interview.
CARD O1
2. I haven't needed a doctor/Don't have a doctor
3. My previous doctor is no longer available
4. No care is available/Care is too far away
5. I haven't been able to find the right doctor
6. I don't have insurance/Can't afford it
8. Other reason
Mark only one.
2[] I haven't needed a doctor/Don't have a doctor (Item O1)
3[] My previous doctor is no longer available (Item O1)
4[] No care is available/Care is too far away (Item O1)
5[] I haven't been able to find the right doctor (Item O1)
6[] I don't have insurance/Can't afford it (Item O1)
8[] Other reason (Item O1)
9[] DK (Item O1)
b. Is there one of those places you go to most often when you are sick or need advice about your health?
2[] No (Item O1)
3. What type of place is it -- a doctor's office, a hospital, a clinic or some other place?
If hospital: Do you usually go to an outpatient clinic or an emergency room?
If clinic: Is this a public health clinic or some other kind of clinic?
IF NAME GIVEN, RECORD NAME: ____
Is this an HMO, a clinic, a doctor's office or some other place?
2[] Hospital emergency room
3[] Hospital outpatient clinic
4[] Health center
5[] HMO (Health Maintenance Organization)
6[] Public health clinic
8[] Other
9[] DK
4a. About how long does it usually take you to travel to this (place in question 3)?
2[] Hours
003[] It varies
999[] DK
b. Once you get to this (place in question 3), about how long do you usually have to wait before you get medical care?
2[] Hours
003[] It varies
999[] DK
5. Is there currently a particular person you see at this place?
2[] No
9[] DK
6. When was the last time you went to this place?
2[] 1 to 3 years ago
3[] More than 3 years ago
9[] DK
ITEM O1
Refer to sex of SP.
2[] Female (7)
7a. When was the last time you saw a gynecologist?
2[] 1 to 3 years ago (7b)
3[] More than 3 years ago (Section P)
4[] Never (Section P)
9[] DK (Section P)
b. Was this visit for a check-up, for a specific gynecological problem or for some other problem?
2[] Gynecological problem
3[] Other problem
9[] DK
[p. 201]
Section P -- HEIGHT AND WEIGHT
Refer to HIS-1.
[] SP was NOT household respondent for HIS-1 (1)
1. About how tall are you without shoes?
Inches ____
2. About how much do you weigh without shoes?
Note: If SP is pregnant, weight referred to is pre-pregnancy weight.
[p. 202]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE
The next questions are about certain kinds of medical tests and examinations.
1a. Have you ever had a test for oral cancer in which the doctor or dentist pulls on your tongue, sometimes with gauze wrapped around it, and feels under the tongue and inside the cheeks?
1[] Yes (1b)
2[] No (5)
7[] Refused (5)
9[] DK, not sure (5)
b. How many times have you been checked for oral cancer in your lifetime?
99[] DK (1c)
c. Is it less than 10, 10 to 20, or more than 20 times?
2[] 10 to 20
3[] More than 20
9[] DK
2a. When did you have your most recent oral cancer exam?
Year 19____ [if 3 years ago or less (3); if more than 3 years ago (5)]
OR
Number ____
2[] Weeks ago [if 3 years ago or less (3); if more than 3 years ago (5)]
3[] Months ago [if 3 years ago or less (3); if more than 3 years ago (5)]
4[] Years ago [if 3 years ago or less (3); if more than 3 years ago (5)]
999[] DK (2b)
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years ago (3)
3[] Over 3 years ago (5)
9[] DK (5)
3. What type of medical person examined you when you had your last check-up for oral cancer?
2[] Dentist
3[] Dental hygienist
8[] Other (Specify) -- ____
9[] DK
4. What was the main reason you had this check-up?
HAND CARD Q1. Read categories if telephone interview.
CARD Q1
2. Follow-up to a previous oral problem
3. Part of a routine physical exam
4. Part of a routine dental exam
8. Other (Specify)
Mark only one.
2[] Follow-up to a previous oral problem
3[] Part of a routine physical exam
4[] Part of a routine dental exam
8[] Other (Specify) -- ____
9[] DK
5. Which of these do you think increases a person's chances of getting oral cancer, that is cancer of the lip, mouth, tongue, or throat?
HAND CARD Q2. Read categories if telephone interview.
CARD Q2
2. Excessive drinking of alcoholic beverages
3. Excessive coffee drinking
4. Smoking cigarettes, cigars, or a pipe
5. Use of chewing tobacco or snuff
8. Something else (Specify)
9. Don't know
(Please give me the numbers from the card.)
Mark each that applies.
2[] Excessive drinking of alcoholic beverages
3[] Excessive coffee drinking
4[] Smoking cigarettes, cigars, or a pipe
5[] Use of chewing tobacco or snuff
7[] Refused
8[] Something else (Specify) -- ____
9[] DK
[p. 203]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE -- Continued
6a. Have you ever had your skin checked for cancer either by a dermatologist or some other kind of doctor?
2[] No (10)
7[] Refused (10)
9[] DK (10)
b. How many times have you had your skin checked for cancer in your lifetime?
99[] DK
7a. When did you have your most recent skin exam?
Year 19____ [if 3 years ago or less (8); if more than 3 years ago (10)]
OR
Number ____
2[] Weeks ago [if 3 years ago or less (8); if more than 3 years ago (10)]
3[] Months ago [if 3 years ago or less (8); if more than 3 years ago (10)]
4[] Years ago [if 3 years ago or less (8); if more than 3 years ago (10)]
999[] DK (7b)
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years ago (8)
3[] Over 3 years ago (10)
9[] DK (10)
8. What kind of doctor checked your skin for cancer the last time you had a skin exam?
2[] Dermatologist
8[] Other (Specify) -- ____
9[] DK
HAND CARD Q3. Read categories if telephone interview.
CARD Q3
2. Follow-up to a previous skin problem
3. Part of a routine physical exam/As a screening exam
8. Other (Specify)
9. What was the main reason you had this skin exam?
Mark only one.
2[] Follow-up to a previous skin problem
3[] Part of a routine physical exam/As a screening exam
8[] Other (Specify) -- ____
9[] DK
10. If you were to go outside on a very sunny day for more than one hour --
a. How likely are you to wear protective clothing such as wide brimmed hats or long sleeved shirts? Would you say very likely, somewhat likely, or unlikely?
2[] Somewhat likely
3[] Unlikely
b. How likely are you to avoid the sun by staying in the shade; very likely, somewhat likely, or unlikely?
2[] Somewhat likely
3[] Unlikely
c. How likely are you to use sunscreen or sunblock lotion; very likely, somewhat likely, or unlikely?
2[] Somewhat likely
3[] Unlikely
HAND CARD Q4. Read categories if telephone interview.
CARD Q4
2. A severe sunburn for a few days with peeling
3. Mildly burned with some tanning
4. Turn darker without sunburn
5. Nothing would happen in an hour
8. Other (Specify)
11a. After several months of not being in the sun, if you then went out in the sun without sunscreen or protective clothing for an hour, which of these would happen to your skin?
(Please give me a number from the card.)
Mark only one.
2[] A severe sunburn for a few days with peeling
3[] Mildly burned with some tanning
4[] Turning darker without sunburn
5[] Nothing would happen in an hour
8[] Other (Specify) -- ____
9[] DK
b. If you were out in the sun for a long time repeatedly, which one of these things would happen to your skin?
HAND CARD Q5. Read categories if telephone interview.
CARD Q5
2. Moderately tanned
3. Mildly tanned
4. Only freckled or no suntan at all
5. Repeated sunburns
8. Other (Specify)
(Please give me a number from the card.)
Mark only one.
2[] Moderately tanned
3[] Mildly tanned
4[] Only freckled or no suntan at all
5[] Repeated sunburns
8[] Other (Specify) ____
9[] DK
12. In your opinion, how sensitive is your skin to sunlight; is it extremely sensitive, moderately sensitive, mildly sensitive, or not sensitive at all?
2[] Moderately sensitive
3[] Mildly sensitive
4[] Not sensitive at all
9[] DK
[p. 204]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE -- Continued
ITEM Q1
Refer to age and sex.
2[] Male, 40+ (31)
3[] Female (13)
13a. Have you ever had a Pap smear test?
Read if necessary: A Pap smear is a routine gynecologic test in which the doctor examines the cervix and sends a cell sample to the lab.
2[] No (16)
7[] Refused (Item Q2)
9[] DK (Item Q2)
b. How many Pap smear tests have you ever had in your lifetime? Less than 10, 10 to 20, or more than 20?
2[] 10 to 20
3[] More than 20
9[] DK
14a. When did you have your most recent Pap smear test?
Year 19____ [if 3 years ago or less (15); if more than 3 years ago (16)]
OR
Number ____
2[] Weeks ago [if 3 years ago or less (15); if more than 3 years ago (16)]
3[] Months ago [if 3 years ago or less (15); if more than 3 years ago (16)]
4[] Years ago [if 3 years ago or less (15); if more than 3 years ago (16)]
999[] DK (14b)
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years ago (15)
3[] Over 3 years ago (16)
9[] DK (16)
15a. What was the main reason you had this Pap smear test?
HAND CARD Q6. Read categories if telephone interview.
CARD Q6
2. Follow-up to a previous gynecological problem
3. Part of a routine physical (or pregnancy) exam
8. Other (Specify)
Mark only one.
2[] Follow-up to a previous gynecological problem (17)
3[] Part of a routine physical (or pregnancy) exam (17)
8[] Other (Specify) -- ____ (17)
9[] DK (17)
b. What was the problem?
Mark all mentioned, do not probe.
2[] Pain (17)
3[] Discharge (17)
4[] Itching (17)
5[] Burning (17)
6[] Infection (17)
8[] Other (Specify) ____ (17)
9[] DK (17)
16. What is the most important reason why you have (never had a Pap smear test/not had a Pap smear test in the past few years)?
Mark only one.
1[] Not needed/Haven't had any problems
2[] Put it off/Laziness
3[] Costs too much/No insurance
4[] Doctor didn't recommend it
5[] Don't go to or don't like doctors
6[] Had a hysterectomy
8[] Other (Specify) -- ____
9[] DK
17a. What is the recommended age a woman should start having Pap smears?
OR
95[] When she starts having periods
96[] When she starts having sex
97[] Refused
98[] Other (Specify) ____
99[] DK
b. At what age do women no longer need to have Pap smears or is there no age limit?
or
95[] When menstrual periods stop (naturally or artificially)
96[] No age limit
97[] Refused
98[] Other (Specify) ____
99[] DK
[p. 205]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE -- Continued
ITEM Q2
Refer to age and question 16 for hysterectomy status.
2[] 60+ (19)
8[] Other (18)
18a. Do you have menstrual periods?
2[] No (18b)
3[] Never had periods (18c)
7[] Refused (Item Q3)
b. Did they stop due to surgery, such as a hysterectomy?
2[] No (Item Q3)
3[] Never had periods (18c)
c. Was this due to surgery, such as a hysterectomy?
2[] No
ITEM Q3
Refer to age.
2[] 30 and over (19)
19a. A mammogram is an x-ray taken only of the breasts by a machine that presses the breast against a plate. Have you ever heard of a mammogram?
2[] No (26)
3[] Refused (26)
9[] DK (26)
b. Have you ever had a mammogram?
2[] No (24)
7[] Refused (25)
9[] DK (25)
c. About how many mammograms have you ever had in your lifetime?
99[] DK
20a. When did you have your (most recent) mammogram?
Year 19____ [if 3 years ago or less (21); if more than 3 years ago (24)]
OR
Number ____
2[] Weeks [if 3 years ago or less (21); if more than 3 years ago (24)]
3[] Months ago [if 3 years ago or less (21); if more than 3 years ago (24)]
4[] Years ago [if 3 years ago or less (21); if more than 3 years ago (24)]
999[] DK (20b)
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years (21)
3[] Over 3 years ago (24)
9[] DK (24)
21. Where was this mammogram done -- in a doctor's office, a clinic, a hospital, an x-ray or radiology lab, or some other place?
2[] Clinic
3[] Hospital
4[] X-ray or radiology lab
5[] Mammogram van
8[] Other (Specify) -- ____
9[] DK
22a. What was the main reason you had this mammogram?
HAND CARD Q7. Read categories if telephone interview.
CARD Q7
2. Follow-up to a previous breast problem
3. Baseline mammogram
4. Part of a routine physical exam/As a screening test
8. Other (Specify)
Mark only one.
2[] Follow-up to a previous breast problem (23)
3[] Baseline mammogram (23)
4[] Part of a routine physical exam/As a screening test (23)
8[] Others (Specify) ____ (23)
9[] DK (23)
b. What was the problem?
Mark all mentioned. Do not probe.
2[] Pain
3[] Swelling
4[] Lumps
5[] Fibrocystic breast disease
8[] Other (Specify) ____
9[] DK
[p. 206]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE -- Continued
23. Who made the decision that you should have this mammogram?
Mark only one.
2[] My doctor ordered it (25)
3[] Both my doctor and I agreed on it (25)
8[] Other (Specify) ____ (25)
9[] DK (25)
24. What is the most important reason why you have (never had a mammogram/not had a mammogram in the past few years)?
Mark only one.
1[] Not needed/Haven't had any problems
2[] Put it off/Laziness
3[] Costs too much/No insurance
4[] Doctor didn't recommend it
5[] Don't go to or don't like doctors
6[] Not old enough
8[] Other
9[] DK
25. What is the age doctors recommend a woman should start having mammograms?
OR
96[] When she starts having periods
97[] Refused
98[] Other (Specify) ____
99[] DK
A breast physical exam is when the breast is felt for lumps by a doctor or medical assistant.
26a. Have you ever had a breast physical exam done by a doctor or medical assistant?
2[] No (30)
7[] Refused (30)
9[] DK (30)
b. How many breast physical exams have you ever had in your lifetime? Was it less than 10, 10 to 20, or more than 20?
2[] 10 to 20
3[] More than 20
9[] DK
27a. When did you have your most recent breast physical exam?
Year 19____ [if 3 years ago or less (28); if more than 3 years ago (29)]
OR
Number ____
2[] Weeks [if 3 years ago or less (28); if more than 3 years ago (29)]
3[] Months ago [if 3 years ago or less (28); if more than 3 years ago (29)]
4[] Years ago [if 3 years ago or less (28); if more than 3 years ago (29)]
999[] DK (27b)
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years ago (28)
3[] Over 3 years ago (29)
9[] DK (29)
[p. 207]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE -- Continued
28a. What was the main reason you had this breast physical exam?
HAND CARD Q8. Read categories if telephone interview.
CARD Q8
2. Follow-up to a previous breast exam
3. Part of a routine physical (or pregnancy) exam
8. Other (Specify)
Mark only one.
2[] Follow-up to a previous breast problem (29)
3[] Part of a routine physical (or pregnancy) exam (29)
8[] Other (Specify) ____ (29)
9[] DK (29)
b. What was the problem?
Mark all mentioned, do not probe.
2[] Pain
3[] Swelling
4[] Lumps
5[] Fibrocystic breast disease
8[] Other (Specify) ____
9[] DK
29. At what age do doctors recommend that a woman should start having breast physical exams?
OR
95[] When she starts developing breasts
96[] When she starts having periods
97[] Refused
98[] Other (Specify) ____
99[] DK
30a. Do you know how to examine your own breasts for lumps?
2[] No (Item Q4)
7[] Refused (Item Q4)
b. About how often do you examine your breasts for lumps?
2[] Week
3[] Month
4[] Year
000[] Never
888[] Other (specify) ____
999[] DK
ITEM Q4
Refer to age.
2[] 40 and over (31)
31a. Have you ever had a chest x-ray?
2[] No (34)
9[] DK (34)
b. How many chest x-rays have you ever had in your lifetime? Was it less than 10, 10 to 20, or more than 20?
2[] 10 to 20
3[] More than 20
9[] DK
32a. When did you have your most recent chest x-ray?
Year 19____ [if 3 years ago or less (33); if more than 3 years ago (34)]
OR
Number ____
2[] Weeks ago [if 3 years ago or less (33); if more than 3 years ago (34)]
3[] Months ago [if 3 years ago or less (33); if more than 3 years ago (34)]
4[] Years ago [if 3 years ago or less (33); if more than 3 years ago (34)]
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years ago (33)
3[] Over 3 years ago (34)
9[] DK (34)
[p. 208]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE -- Continued
33a. What was the main reason you had this chest x-ray?
HAND CARD Q9. Read categories if telephone interview.
CARD Q9
2. Follow-up to a previous chest problem
3. Part of a routine physical exam/As a screening test
4. For employment reasons
5. Because of hospitalization
8. Other (Specify)
Mark only one.
2[] Follow-up to a previous chest problem (34)
3[] Part of a routine physical exam/As a screening test (34)
4[] For employment reasons (34)
5[] Because of hospitalization (34)
8[] Other (Specify) ____ (34)
9[] DK (34)
b. What was the problem?
Mark all mentioned, do not probe.
2[] Chest pain
3[] Pneumonia
4[] Bronchitis
5[] Emphysema
6[] Shortness of breath
7[] Injury
8[] Other (Specify) ____
9[] DK/Refused
34a. A protoscopic exam is when a tube is inserted in the rectum to check for problems. Have you ever heard of a protoscopic exam?
2[] No (37)
7[] Refused (37)
9[] DK (37)
b. Have you ever had a protoscopic exam?
2[] No (37)
7[] Refused (37)
9[] DK (37)
c. How many protoscopic exams have you ever had in your lifetime?
99[] DK
35a. When did you have your (most recent) protoscopic exam?
Year 19____ [if 3 years ago or less (36); if more than 3 years ago (37)]
OR
Number ____
2[] Weeks ago [if 3 years ago or less (36); if more than 3 years ago (37)]
3[] Months ago [if 3 years ago or less (36); if more than 3 years ago (37)]
4[] Years ago [if 3 years ago or less (36); if more than 3 years ago (37)]
999[] DK (35b)
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years ago (36)
3[] Over 3 years ago (37)
9[] DK (37)
36a. What was the main reason you had this protoscopic exam?
HAND CARD Q10. Read categories if telephone interview.
CARD Q10
2. Follow-up to a previous health problem
3. Part of a routine physical exam/As a screening test
8. Other (Specify)
Mark only one.
2[] Follow-up to a previous health problem (37)
3[] Part of a routine physical exam/As a screening test (37)
8[] Other (Specify) ____ (37)
9[] DK
b. What was the problem?
Mark all mentioned, do not probe.
2[] Pain
3[] Constipation
4[] Bowel trouble
5[] Blood in stool
8[] Other (Specify) ____
9[] DK
[p. 209]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE -- Continued
37a. A digital rectal exam is when a finger is inserted in the rectum to check for problems. Have you ever heard of this exam?
2[] No (41)
7[] Refused (41)
9[] DK (41)
b. Have you ever had a digital rectal exam?
2[] No (40)
7[] Refused (41)
9[] DK (41)
c. How many digital rectal exams have you ever had in your lifetime? Was it less than 10, 10 to 20, or more than 20?
2[] 10 to 20
3[] More than 20
9[] DK
38a. When did you have your most recent digital rectal exam?
Year 19____ [if 3 years ago or less (39); if more than 3 years ago (40)]
OR
Number ____ [if 3 years ago or less (39); if more than 3 years ago (40)]
2[] Weeks ago [if 3 years ago or less (39); if more than 3 years ago (40)]
3[] Months ago [if 3 years ago or less (39); if more than 3 years ago (40)]
4[] Years ago [if 3 years ago or less (39); if more than 3 years ago (40)]
999[] DK (38b)
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years ago (39)
3[] Over 3 years ago (40)
9[] DK (40)
39a. What was the main reason you had this digital rectal exam?
HAND CARD Q10. Read categories if telephone interview.
CARD Q10
2. Follow-up to a previous health problem
3. Part of a routine physical exam/As a screening test
8. Other (Specify)
Mark only one.
2[] Follow-up to a previous health problem (41)
3[] Part of a routine physical exam/As a screening test (41)
8[] Other (Specify) ____ (41)
9[] DK (41)
b. What was the problem?
Mark all mentioned, do not probe.
02[] Pain (41)
03[] Constipation (41)
04[] Bowel trouble (41)
05[] Difficulty urinating (41)
06[] Prostate enlargement (41)
07[] Bleeding (41)
08[] Hemorrhoids (41)
09[] Diverticulitis (41)
98[] Other (Specify) ____ (41)
99[] DK/Refused (41)
40. What is the most important reason why you have (never had a digital rectal exam/not had a digital rectal exam in the past few years)?
Mark only one.
1[] Not needed/Haven't had any problems
2[] Put it off/Laziness
3[] Costs too much/No insurance
4[] Doctor didn't recommend it
5[] Don't go to or don't like doctors
8[] Other
9[] DK
[p. 210]
Section Q -- CANCER SCREENING KNOWLEDGE AND PRACTICE -- Continued
41a. A blood stool test is when the stool is examined to determine whether it contains blood. Have you ever heard of a blood stool test?
2[] No (Section R)
7[] Refused (Section R)
9[] DK (Section R)
b. Have you ever had a blood stool test?
2[] No (46)
7[] Refused (Section R)
9[] DK (Section R)
c. About how many blood stool tests have you ever had in your lifetime?
99[] DK
42a. When did you have your (most recent) blood stool test?
Year 19____ [if 3 years ago or less (43); if more than 3 years ago (46)]
OR
Number ____ [if 3 years ago or less (43); if more than 3 years ago (46)]
2[] Weeks ago [if 3 years ago or less (43); if more than 3 years ago (46)]
3[] Months ago [if 3 years ago or less (43); if more than 3 years ago (46)]
4[] Years ago [if 3 years ago or less (43); if more than 3 years ago (46)]
999[] DK (42b)
b. Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
2[] 1 to 3 years ago (43)
3[] Over 3 years ago (46)
9[] DK (46)
43. Did you perform this blood stool test yourself or was it done by a doctor or other medical person?
2[] Doctor/medical person
9[] DK
44a. What was the main reason you had this blood stool test?
HAND CARD Q10. Read categories if telephone interview.
CARD Q10
2. Follow-up to a previous health problem
3. Part of a routine physical exam/As a screening test
8. Other (Specify)
Mark only one.
2[] Follow-up to a previous health problem (45)
3[] Part of a routine physical exam/As a screening test (45)
8[] Other (Specify) -- ____ (45)
9[] DK (45)
b. What was the problem?
Mark all mentioned, do not probe.
2[] Pain
3[] Bleeding
4[] Constipation
5[] Bowel trouble
6[] Blood in stool
7[] Ulcers
8[] Other (Specify) ____
9[] DK/Refused
45. Who made the decision that you should have this blood stool test?
Mark only one.
2[] My doctor ordered it (Section R)
3[] Both my doctor and I agreed on it (Section R)
8[] Other (Specify) ____ (Section R)
9[] DK (Section R)
46. What is the most important reason why you have (never had a blood stool test/not had a blood stool test in the past few years)?
Mark only one.
1[] Not needed/Haven't had any problems
2[] Put it off/Laziness
3[] Costs too much/No insurance
4[] Doctor didn't recommend it
5[] Don't go to or don't like doctors
8[] Other
9[] DK
[p. 211]
Section R -- CANCER SURVIVORSHIP
1. Has a medical doctor ever told you that you had cancer of any kind (including any cancer you have already mentioned)?
2[] No (Section S)
2. How many different kinds of cancer have you had?
9[] DK (If 1 cancer (3), If 2 or more cancers (4))
3a. What kind of cancer was it
b. What part of the body was affected
c. In what year was this cancer first diagnosed?
99[] DK (3d)
d. How old were you when this cancer was first diagnosed?
99[] DK
e. (Please look at this card and tell me) how was your cancer first detected?
HAND CARD G1. Read categories if telephone interview.
CARD G1
2. I noticed something was wrong and went to a doctor
3. I noticed something was wrong but did not talk to a doctor about it until my regular physical exam
8. It was detected in some other way (Specify)
Mark only one.
2[] I noticed something was wrong and went to a doctor
3[] I noticed something was wrong but did not talk to a doctor about it until my regular physical exam
8[] It was detected in some other way (Specify) ____
9[] DK
ITEM R1
Refer to question 3c or 3d for when the cancer was first diagnosed.
2[] 10 or fewer years ago (6)
4a. What kind of cancer was diagnosed first
b. What part of the body was affected
c. What year was this cancer first diagnosed?
99[] DK (4d)
d. How old were you when this cancer was first diagnosed?
99[] DK
e. (Please look at this card and tell me) how was the (cancer in 4a) first detected?
HAND CARD G1. Read categories if telephone interview.
CARD G1
2. I noticed something was wrong and went to a doctor
3. I noticed something was wrong but did not talk to a doctor about it until my regular physical exam
8. It was detected in some other way (Specify)
Mark only one.
2[] I noticed something was wrong and went to a doctor
3[] I noticed something was wrong but did not talk to a doctor about it until my regular physical exam
8[] It was detected in some other way (Specify) ____
9[] DK
[p. 212]
Section R -- CANCER SURVIVORSHIP -- Continued
5a. What kind of cancer was diagnosed most recently
b. What part of the body was affected
c. In what year was this cancer first diagnosed?
99[] DK (5d)
d. How old were you when this cancer was first diagnosed?
99[] DK
ITEM R2
Refer to question 5c or 5d for when the most recent cancer was first diagnosed.
2[] 10 or fewer years ago (6)
The following questions refer only to the (cancer in questions 3a or 5a).
HAND CARD G2. Read each category if telephone interview.
CARD G2
2. Cancer specialist (oncologist)
3. General Surgeon
4. Cancer Surgeon
5. Reconstructive Surgeon
6. Radiologist
8. Other specialist (Specify)
6. What types of doctors did you see for your diagnosis and treatment?
Mark each that applies.
2[] Cancer specialist (oncologist)
3[] General surgeon
4[] Cancer surgeon
5[] Plastic surgeon/Reconstructive surgeon
6[] Radiologist
8[] Other specialist (Specify) ____
9[] DK
7a. Did you get more than one opinion about the type of treatment you should have?
2[] No
9[] DK
b. What types of treatment did you receive for this cancer?
HAND CARD G3. Read each category if telephone interview.
CARD G3
2. Radiation
3. Chemotherapy
4. Special diets
5. Self healing techniques, including imaging
8. Other (Specify)
Mark each that applies.
2[] Radiation
3[] Chemotherapy
4[] Special diets
5[] Self healing techniques, including imaging
8[] Other (Specify) ____
9[] DK
8. After your cancer was diagnosed, did you receive any counseling or join any support groups to help you cope?
2[] No (9)
9[] DK (10)
9a. What was the main reason you did not get counseling?
HAND CARD G4. Read categories if telephone interview.
CARD G4
2. I didn't want it
3. I didn't think I needed it
8. Some other reason (Specify)
Mark only one.
2[] I didn't want it (10)
3[] I didn't think I needed it (10)
8[] Some other reason (Specify) ____ (10)
9[] DK (10)
b. Would you have been interested in receiving counseling if you had known about it?
2[] No
9[] DK
10. Did a doctor, nurse, or social worker give you written information about your cancer or its treatment?
If NO, ASK --
Even though no one gave you any written information did you pick any up on your own?
If Yes, mark box 3.
If No, mark box 2.
2[] No, no information given (12)
3[] No, but I picked it up myself (12)
9[] DK (12)
[p. 213]
Section R -- CANCER SURVIVORSHIP -- Continued
11a. What subjects did the materials cover? (Anything else?)
HAND CARD G5. Read each category if telephone interview.
CARD G5
2. Information about your specific type of cancer
3. Cancer treatment options
4. Coping with the physical side effects of cancer treatment
5. Coping with the emotional effects of cancer
8. Other (Specify)
Mark each that applies.
2[] Information about your specific type of cancer
3[] Cancer treatment options
4[] Coping with the physical side effects of cancer treatment
5[] Coping with the emotional effects of cancer
8[] Other (Specify) ____
9[] DK
b. (Was this/Were any of these) material(s) helpful?
2[] No
9[] DK
HAND CARD G6. Read 12b categories if telephone interview.
12a. After you were diagnosed with cancer, did you contact any of these cancer organizations?
2[] No (13)
b. Which cancer organizations did you contact? (Any others?)
Mark each that applies.
2[] National Cancer Institute
3[] The 1-800-4-CANCER HOTLINE
8[] Other
9[] Don't know
13. Did you participate in a research study or clinical trial as a part of your cancer treatment?
2[] No
9[] DK
14a. Not counting Medicare or Medicaid, did you have health insurance that paid for all or part of your treatment?
2[] No (15)
9[] DK (15)
b. Did your health insurance change in any of these ways because of your cancer?
HAND CARD G7. Read all categories if telephone interview.
CARD G7
2. Yes -- My insurance was cancelled or not renewed
8. Yes -- Other change (Specify)
0. No -- Did not change
Mark only one.
2[] Yes - My insurance was cancelled or not renewed
8[] Yes - Other change (Specify) -- ____
0[] No - Did not change
15a. Were you ever denied health or life insurance coverage because of your cancer?
2[] No
9[] DK
b. Were you ever asked to waive coverage of your cancer in order to get health insurance?
2[] No
9[] DK
c. Did your employer have a long-term disability plan that covered cancer?
2[] No (18)
9[] DK (18)
17a. Have you ever worked at a job for pay after your cancer was diagnosed?
2[] No (Section S)
b. Were you self-employed?
2[] No (18)
18. Some people have problems with employment because of cancer. Have you ever...
a. Faced on-the-job problems from your employer or supervisor directly related to your cancer?
2[] No
b. Been fired or laid off form your job because of your cancer?
2[] No
c. Felt you couldn't change jobs because of your cancer?
2[] No
d. Felt you couldn't take a new job because of a change in insurance related to your cancer?
2[] No
e. Refrained from applying for a new job because you didn't want your medicla records made public?
2[] No
Section S -- GENERAL KNOWLEDGE AND ATTITUDES
Now, I'm going to ask your opinion about certain health problems. For these questions, if you are not sure, feel free to tell me that.
HAND CARD S1. Read categories if telephone interview.
CARD S1
2. AIDS
3. Diabetes
4. Cancer
1. Of these four diseases, which one do you think is the country's most serious health problem?
Mark only one.
2[] AIDS
3[] Diabetes
4[] Cancer
7[] Refused
9[] DK
2. To the best of your knowledge, which two of these diseases caused the most deaths in the United States in the PAST YEAR?
REFER TO CARD S1. Read categories if telephone interview.
CARD S1
2. AIDS
3. Diabetes
4. Cancer
Mark only two.
2[] AIDS
3[] Diabetes
4[] Cancer
7[] Refused
9[] DK
a. the American Cancer Society?
2[] No
7[] Refused
9[] DK
b. the Cancer Information Service?
2[] No
7[] Refused
9[] DK
c. the National Cancer Institute?
2[] No
7[] Refused
9[] DK
d. the 1-800-4-Cancer Hotline?
2[] No
7[] Refused
9[] DK
4. In your opinion, how much progress has been made overall in the fight against cancer in the past twenty years? Would you say a great deal of progress, some progress, very little progress, or no progress?
2[] Some progress
3[] Very little
4[] No progress
5[] Depends on type of cancer
7[] Refused
9[] DK
5. Please tell me which of these you think causes more cancer in the United States.
HAND CARD S2.
CARD S2
OR
B. Factors you have little control over, such as environmental pollution or family history.
A. Personal behaviors, such as smoking or eating habits. OR
B. Factors you have little control over, such as environmental pollution or family history.
2[] B, environment
3[] Both
7[] Refused
8[] Neither/other (Specify) -- ____
9[] DK
ITEM S1
Refer to sex of SP
2[] Male (8)
HAND CARD S3.
CARD S3
2. Fair
3. Poor
4. Don't know/Not sure
6. (If cancer of the (body part) is detected early, what is a person's chance of surviving? Would you say good, fair, poor or you are not sure?)
a. breast
2[] Fair
3[] Poor
7[] Refused
9[] DK/ not sure
b. cervix?
2[] Fair
3[] Poor
7[] Refused
9[] DK/ not sure
c. colon or rectum?
2[] Fair
3[] Poor
7[] Refused
9[] DK/ not sure
d. lung?
2[] Fair
3[] Poor
7[] Refused
9[] DK/ not sure
e. liver?
2[] Fair
3[] Poor
7[] Refused
9[] DK/ not sure
Section S -- GENERAL KNOWLEDGE AND ATTITUDES -- Continued
7a. Which of these things do you think increases a woman's chance of getting cancer of the breast?
HAND CARD S4. Reach each category if telephone interview.
CARD S4
2. High fat diet
3. Low fiber diet
4. Smoking
5. Family history
6. Having multiple sexual partners
0. None of these
(Please give me numbers from the card.)
Mark each that applies.
1[] Increasing age
2[] High fat diet
3[] Low fiber diet
4[] Smoking
5[] Family history
6[] Having multiple sexual partners
7[] Refused
9[] DK
b. Which of these things do you think increases a woman's chance of getting cancer of the cervix?
REFER TO CARD S4. Read each category if telephone interview.
CARD S4
2. High fat diet
3. Low fiber diet
4. Smoking
5. Family history
6. Having multiple sexual partners
0. None of these
(Please give me the numbers from the card.)
Mark each that applies.
1[] Increasing age
2[] High fat diet
3[] Low fiber diet
4[] Smoking
5[] Family history
6[] Having multiple sexual partners
7[] Refused
9[] DK
c. Which of these things do you think increases a woman's chance of getting cancer of the colon or rectum?
REFER TO CARD S4. Read each category if telephone interview.
CARD S4
2. High fat diet
3. Low fiber diet
4. Smoking
5. Family history
6. Having multiple sexual partners
0. None of these
(Please give me the numbers from the card.)
Mark each that applies.
1[] Increasing age (Item S2)
2[] High fat diet (Item S2)
3[] Low fiber diet (Item S2)
4[] Smoking (Item S2)
5[] Family history (Item S2)
6[] Having multiple sexual partners (Item S2)
7[] Refused (Item S2)
9[] DK (Item S2)
8. (If cancer of the (body part) is detected early, what is a person's chance of surviving? Would you say good, fair, poor or you are not sure?)
HAND CARD S3.
CARD S3
2. Fair
3. Poor
4. Don't know/Not sure
a. prostate
2[] Fair
3[] Poor
7[] Refused
9[] DK/not sure
b. colon or rectum?
2[] Fair
3[] Poor
7[] Refused
9[] DK/not sure
c. lung?
2[] Fair
3[] Poor
7[] Refused
9[] DK/not sure
d. liver?
2[] Fair
3[] Poor
7[] Refused
9[] DK/not sure
HAND CARD S4. Read each category if telephone interview.
CARD S4
2. High fat diet
3. Low fiber diet
4. Smoking
5. Family history
6. Having multiple sexual partners
0. None of these
9a. Which of these things do you think increases a man's chance of getting cancer of the prostate?
(Please give me the numbers from the card.)
Mark each that applies.
1[] Increasing age
2[] High fat diet
3[] Low fiber diet
4[] Smoking
5[] Family history
6[] Having multiple sexual partners
7[] Refused
9[] DK
b. Which of these things do you think increases a man's chance of getting cancer of the colon or rectum?
REFER TO CARD S4. Read each category if telephone interview.
CARD S4
2. High fat diet
3. Low fiber diet
4. Smoking
5. Family history
6. Having multiple sexual partners
0. None of these
(Please give me the numbers from the card.)
Mark each that applies.
1[] Increasing age
2[] High fat diet
3[] Low fiber diet
4[] Smoking
5[] Family history
6[] Having multiple sexual partners
7[] Refused
9[] DK
ITEM S2
Refer to Question 1 in Section R on page 17 to determine if SP reported having cancer.
2[] All other (10)
10. How concerned are you about getting cancer in the future? Would you say you are very concerned, somewhat concerned, or not at all concerned?
2[] Somewhat concerned
3[] Not at all concerned
7[] Refused
9[] DK
[p. 216]
Section T -- SMOKING HABITS
These next questions are about cigarette smoking.
1. Have you smoked at least 100 cigarettes in your entire life?
If asked: approximately 5 packs
2[] No (Section W)
9[] DK (Section W)
2. How old were you when you first started smoking cigarettes fairly regularly?
00[] Never smoked regularly
99[] DK
3. Do you smoke cigarettes now?
2[] No (5)
4. Do you now smoke cigarettes every day or some days?
2[] Some days (7)
5. Do you now smoke cigarettes "not at all" or "some days"?
2[] Some days (7)
6. On the average, how many cigarettes do you now smoke a day?
99[] DK(Section U)
7a. On how many of the past 30 days did you smoke cigarettes?
Days ____ (7b)
99[] DK (7b)
b. On the average, when you smoked, about how many cigarettes did you smoke a day?
99[] DK (Section U)
[p. 217]
Section U -- CURRENT SMOKER
ITEM U1
Refer to question 4, page 22, Section T to determine if SP now smokes every day.
2[] All others (1)
1. Have you ever smoked cigarettes every day for at least 6 months?
2[] No (12)
9[] DK (12)
2a. About how long has it been since you last smoked cigarettes every day?
2[] Weeks (3)
3[] Month [if 1 year or 12 months ago, go to 2b; otherwise go to 3]
4[] Years [if 1 year or 12 months ago, go to 2b; otherwise go to 3]
b. Was it within the past year or a year or more ago?
2[] 1 year or more
9[] DK
3a. On the average, how many cigarettes did you smoke a day when you last smoked every day?
99[] DK
b. What is the total number of years you smoked every day? Do not include any time you stayed off cigarettes for at least 6 months or longer?
Years ____ (12)
99[] DK (12)
4. What is the total number of years you have smoked every day? Do not include any time you stayed off cigarettes for at least 6 months or longer.
Years ____
99[] DK
5a. Have you ever stopped smoking for one day or longer?
2[] No (12)
9[] DK (12)
b. In your whole life how many times have you stopped smoking for one day or longer, including the last time?
99[] DK
6a. During the past 12 months, have you stopped smoking for one day or longer?
2[] No (6c)
9[] DK (6c)
b. How many times during the past 12 months have you stopped smoking for one day or longer?
99[] DK (7)
c. How long ago was the last time you stopped smoking for one day or longer?
2[] 6-10 years
3[] 10 years or more
9[] DK
7. How long did you actually stay off cigarettes the last time you stopped smoking?
2[] Weeks
3[] Month
4[] Years
8. The last time you stopped smoking did you stop on purpose, were you sic, or was there some other reason you couldn't smoke?
HAND CARD U1.
CARD U1
2. I could not smoke because I was sick
8. I could not smoke for some other reason
Mark all that apply.
2[] I could not smoke because I was sick
8[] I could not smoke for some other reason
9[] DK
[p. 218]
Section U -- CURRENT SMOKER -- Continued
2[] All others (9)
HAND CARD U2. Read each category if telephone interview.
CARD U2
2. Concern about my health at the time
3. Pressure from family and friends
4. Cost of cigarettes
5. Pregnancy
8. Some other reason (Specify)
9. The last time you stopped smoking, what were the reasons you stopped?
Mark each that applies.
2[] Concern about my health at the time
3[] Pressure from family and friends
4[] Cost of cigarettes
5[] Pregnancy
8[] Some other reason (Specify) ____
9[] DK
10. The last time you stopped smoking, did you --
2[] No
9[] DK
2[] No
9[] DK
2[] No
9[] DK
2[] No
9[] DK
2[] No
9[] DK
2[] No
9[] DK
11. When trying to stop smoking, have you ever --
a. gradually decreased the number of cigarettes you smoked in a day?
2[] No
9[] DK
b. switched to lower tar or nicotine cigarettes?
2[] No
9[] DK
12. Do you think that your smoking affects your health now?
2[] No
9[] DK
13. How likely do you think it is that you will have serious health problems from smoking if you continue to smoke? Do you think it is unlikely, somewhat likely, or very likely?
2[] Somewhat likely
3[] Very likely
14a. In the past year have you seen a --
2[] No
9[] DK
2[] No
9[] DK
Ask for each "Yes" in 14a.
b. During the past year, did any ... advise you to stop smoking?
2[] No
9[] DK
ITEM U3
Refer to question 14b(1) and 14b(2) to determine if medical doctor or dentist advised the SP to stop smoking.
2[] All others (15)
15. Has a medical doctor or dentist ever advised you to stop smoking?
2[] No
9[] DK
16a. Are you seriously considering stopping within the next 6 months?
2[] No (17)
9[] DK (16b)
b. Are you planning to stop within the next 30 days?
2[] No
9[] DK
17. About how often in the past 12 months has anyone asked you not to smoke when you were smoking or were about to smoke? Never, once or twice, several times, or many times?
1[] Once or twice (Section W)
2[] Several times (Section W)
3[] Many times (Section W)
[p. 219]
Section V -- FORMER SMOKER
1. Have you ever smoked cigarettes every day for at least 6 months?
2[] No (2)
9[] DK (2)
2. How long has it been since you completely stopped smoking cigarettes?
2[] Weeks (7)
3[] Months (7)
4[] Years (7)
999[] DK (7)
3a. About how long has it been since you last smoked cigarettes every day?
2[] Weeks (4)
3[] Months (if 1 year or 12 months ago, go to 3b; otherwise go to 4)
4[] Years (if 1 year or 12 months ago, go to 3b; otherwise go to 4)
b. Was it within the past year or a year or more ago?
2[] 1 year or more
9[] DK
4. On the average, how many cigarettes did you smoke a day when you last smoked every day?
99[] DK
5. What is the total number of years you smoked every day? Do not include any time you stayed off cigarettes for at least 6 months or longer.
Years ____
6. In your whole life, how many times have you stopped smoking for one day or longer, including the last time?
99[] DK
7. When you stopped smoking completely, did you stop on purpose, were you sick, or ws there some other reason you couldn't smoke?
HAND CARD U1.
CARD U1
2. I could not smoke because I was sick
8. I could not smoke for some other reason
Mark each that applies.
2[] I could not smoke because I was sick
8[] I could not smoke for some other reason
9[] DK
2[] All others (8)
HAND CARD U2. Read each category if telephone interview.
CARD U2
2. Concern about my health at the time
3. Pressure from family and friends
4. Cost of cigarettes
5. Pregnancy
8. Some other reason (Specify)
8. When you stopped smoking completely, what were the reasons you stopped?
Mark each that applies.
2[] Concern about my health at the time
3[] Pressure form family and friends
4[] Cost of cigarettes
5[] Pregnancy
8[] Some other reason (Specify) -- ____
9[] DK
9. When you stopped smoking cigarettes completely, did you --
2[] No
9[] DK
2[] No
9[] DK
2[] No
9[] DK
2[] No
9[] DK
2[] No
9[] DK
2[] No
9[] DK
10. When trying to stop smoking, did you ever --
a. gradually decrease the number of cigarettes you smoked in a day?
2[] No
9[] DK
b. switch to lower tar or nicotine cigarettes?
2[] No
9[] DK
Section W -- OTHER TOBACCO USE
These next questions are about other tobacco products.
1a. Have you ever smoked a pipe?
2[] No (2)
9[] DK (2)
b. Have you smoked a pipe at least 50 times in your entire life?
2[] No (2)
9[] DK (2)
2[] No (2)
d. On the average, how many days per month do you smoke a pipe?
Days per month ____
30[] Every day
99[] DK
2a. Have you ever smoked cigars?
2[] No (3)
9[] DK (3)
b. Have you smoked at least 50 cigars in your entire life?
2[] No (3)
9[] DK (3)
2[] No (3)
d. On the average, how many days per month do you smoke cigars?
Days per month ____
30[] Every day
99[] DK
3a. Have you ever used snuff, such as Skoal, Skoal bandits, or Copenhagen?
2[] No (4)
9[] DK (4)
b. Have you used snuff at least 20 times in your entire life?
2[] No (4)
9[] DK (4)
c. How old were you when you first used snuff?
99[] DK
2[] No
e. Altogether, about how long (have you used/did you use) snuff?
____
2[] Years
99[] DK
f. On the average, how many days per month (do/did) you use it?
Days per month ____
30[] Every day
99[] DK
g. On the days that you use(d) snuff, how many times (do/did) you use it?
Time(s) per day ____
99[] DK
h. (Do/Did) you use snuff by sniffing it or by placing it in your mouth?
Mark only one.
2[] Mouth
3[] Both
[p. 221]
Section W -- OTHER TOBACCO USE -- Continued
3i. Have you ever been advised to stop using snuff by a --
2[] No
9[] DK
2[] No
9[] DK
4a. Have you ever used chewing tobacco, such as Redman, Levi Garrett, or Beechnut?
2[] No (5)
9[] DK (5)
b. Have you used chewing tobacco at least 20 times in your entire life?
2[] No (5)
9[] DK (5)
c. How old were you when you first used chewing tobacco?
99[] DK
d. Do you use chewing tobacco now?
2[] No
e. Altogether, about how long (have you used/did you use) chewing tobacco?
____
2[] Years
999[] DK
f. On the average, how many days per month (do/did) you use it?
Days per month ____
30[] Every day
99[] DK
g. On the days that you use(d) chewing tobacco, how many times (do/did) you use it?
Time(s) per day ____
99[] DK
h. Have you EVER been advised to stop using chewing tobacco by a --
2[] No
9[] DK
2[] No
9[] DK
5. Now I am going to read a list of statements about cigarette smoking. After I read each one, please tell me whether you agree, disagree, or have no opinion.
a. So many things cause cancer that it doesn't really matter if you smoke.
2[] Disagree/No
9[] No opinion/DK
b. Smoking by a pregnant woman may harm the baby
2[] Disagree/No
9[] No opinion/DK
c. The smoke from other people's cigarettes is harmful to you
2[] Disagree/No
9[] No opinion/DK
d. Most deaths from LUNG CANCER are caused by cigarette smoking
2[] Disagree/No
9[] No opinion/DK
e. Smoking should not be allowed in indoor public places
2[] Disagree/No
9[] No opinion/DK
f. Even if a person has smoked for more than 20 years, there is a health benefit to quitting
2[] Disagree/No
9[] No opinion/DK
[p. 222]
Section W -- OTHER TOBACCO USE -- Continued
6a. Do you think smoking is a habit, an addiction, neither, or both?
2[] Addiction
3[] Neither
4[] Both
9[] DK
b. In general, would you say that the smoke from other people's cigarettes is not at all annoying to you, somewhat annoying to you, or very annoying to you?
1[] Somewhat annoying
2[] Very annoying
9[] DK
ITEM W1
Refer to question 3, page 22, Section T, to determine if SP smokes cigarettes now.
8[] All others (8)
7. When you are inside a public place that has no rules about smoking, what are you most likely to do?
HAND CARD W. Read categories if telephone interview.
CARD W
2. Look around to see if others are smoking and then light up
3. Ask if others would mind
4. Just not smoke
8. Something else (Special)
Mark only one.
2[] Look around to see if others are smoking and then light up
3[] Ask if others would mind
4[] Just not smoke
8[] Do something else (Specify) -- ____
9[] DK
8. When you are inside a public place that has no rules about smoking and someone else lights up a cigarette, what are you most likely to do -- ask the person not to smoke, move away, do nothing, or something else?
2[] Move away
3[] Do nothing
8[] Do something else (Specify) -- ____
9[] DK
9. Does anyone smoke cigarettes, cigars, or pipes anywhere inside this home?
2[] No (Section X)
9[] DK (Section X)
10. On an average week day, how many people smoke anywhere inside this home?
9[] DK
11. On the average, about how many days per week is there smoking anywhere inside this home?
7[] Every day
Days per week ____
9[] DK
[p. 223]
Section X -- WORKPLACE TOBACCO SMOKE
ITEM X1
Refer to SP's "Wa/Wb" boxes in C1 on HIS-1.
8[] Other (Section Y)
Refer to SP's 6g, page 44 or 45 on HIS-1.
8[] Other (Section Y)
These next questions are about smoking in the workplace.
1. Earlier (you told me/I was told) that you were employed during the past two weeks. Is that correct?
2[] No (Section Y)
9[] DK (2)
2a. Altogether, does your employer have 50 or more employees?
2[] No (2c)
9[] DK (2c)
b. Does your employer have 50 or more employees at the building or location where you work?
2[] No (2c)
9[] DK (2c)
c. Does your employer have 50 or more employees at the building or location where you work?
2[] No
9[] DK
3. Which of these best describes the are in which you work most of the time?
HAND CARD X1. Read ALL categories if telephone interview.
CARD X1
02. Enclosed office space with door shared with one or more other persons
03. Cubicle
04. Open area
05. Classroom
06. Hospital (not an office)
07. In at home
08. In one building, but no regular work area
09. Mainly work outdoors
10. Travel to different buildings or sites
11. In a motor vehicle
98. Other (Specify)
Mark only one.
02[] Enclosed office with door shared with one or more other persons
03[] Cubicle
04[] Open area
05[] Classroom
06[] Hospital (not an office)
07[] In a home
08[] In one building, but no regular work area (5)
09[] Mainly work outdoors (5)
10[] Travel to different buildings or sites (7)
11[] In a motor vehicle (7)
98[] Other (Specify) -- ____
99[] DK
4a. During the past 2 weeks, has anyone smoked in your immediate work area?
2[] No (5)
3[] Did not work in past 2 weeks (5)
9[] DK (4b)
b. During the past 2 weeks, have you ever been bothered by cigarette smoke in your immediate work area?
2[] No
9[] DK
5a. Does your employer have an official policy that restricts smoking in any way?
2[] No (Item X3)
9[] DK (Item X3)
b. Which of these best describes your employer's smoking policy for indoor public or common areas, such as lobbies, rest rooms, and lunch rooms?
HAND CARD X2. Read ALL categories if telephone interview.
CARD X2
2. Allowed in SOME public areas, including designated smoking areas
3. Allowed in ALL indoor or common public areas
4. Not applicable, no policy for these areas
Mark only one.
2[] Allowed in some public areas, including designated smoking areas
3[] Allowed in all indoor or common public areas
4[] Not applicable, no policy for these areas
9[] DK
c. Which of these best describes your employer's smoking policy for work areas?
HAND CARD X3. Read ALL categories if telephone interview.
CARD X3
2. Allowed in SOME work areas
3. Allowed in ALL work areas
4. Not applicable, no policy for these areas
Mark only one.
2[] Allowed in SOME work areas (5d)
3[] Allowed in ALL work areas (Item X3)
4[] Not applicable, no policy for these areas (5d)
9[] DK (5d)
d. Is smoking allowed in your immediate work area?
2[] No (6)
9[] DK (6)
[p. 224]
Section X -- WORKPLACE TOBACCO SMOKE -- Continued
6a. Are there ever customers or clients in your work area, that is, people who do not work for your employer?
2[] No (Item X3)
9[] DK (Item X3)
b. Are these people allowed to smoke in your work area?
2[] No
9[] DK
7. Does your employer offer a stop smoking program or any other help to employees who want to quit smoking?
2[] No (Section Y)
9[] DK (Section Y)
ITEM X3
Refer to question 3, page 22, Section T, to determine if SP is a current smoker.
2[] "No," former smoker (9)
8[] Other (Section Y)
8a. Do you ever smoke during the time you are at work?
2[] No (8c)
9[] DK (8c)
b. Where?
HAND CARD X4.
CARD X4
2. In a public area such as a restroom, lunchroom, lobby, or other smoking area
3. Outside the building
4. Not applicable -- I work outside or at different sites
Mark all that apply.
2[] In a public area, such as a restroom, lunchroom, lobby, or other smoking area
3[] Outside the building
4[] Not applicable -- I work outside or at different sites
9[] DK
c. Do you feel that you smoke fewer cigarettes per day because of your employer's smoking policy?
2[] No
ASK OR VERIFY:
9. Have you joined any quit smoking programs at work in the past year?
2[] No
3[] Quit more than 1 year ago
9[] DK