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[p. 1]


ADULT CORE: Section I -- IDENTIFICATION

SADULT
FR: THE NEXT QUESTIONS MUST BE ANSWERED BY THE SELECTED SAMPLE ADULT- NO PROXIES ARE PERMITTED. NO EMANCIPATED MINORS ARE
PERMITTED.

(1) Available
(2) Not Available
(3) Non-interview
Check Item AIDCCI1: [If the FAMILY respondent and Sample Adult are the same person, go to ACN.010; Else go to AID.030.]
AID.030

FR: PLEASE VERIFY THE FOLLOWING INFORMATION:
AIDVERF1
Gender ={male/female} Is it correct?
(1) Yes
(2) No
AIDVERF2
Age = {3 digit format} Is it correct?
(1) Yes
(2) No
AIDVERF3
Birthday = {word format} Is it correct?
(1) Yes
(2) No
Check Item AIDCCI2: [If AIDVERF1 equals (2) go to AID.040; If AIDVERF2 equals (2) go to AID.050; If AIDVERF3 equals (2) go to AID.060; Else go to ACN.010. If no changes or when changes complete, go to next section -- Conditions]
AID.040

Is {sample adult} male or female?
AIDSEX
(1) Male
(2) Female
(7) Refused
(9) DK

(Go to AIDCCI2)

[Update revised sex AIDSEX in SEX]

AID.050

How old is {sample adult}?
AIDAGE
(00-99) 0-99 years old
(997) Refused
(999) DK(Go to AIDCCI2)

[Update revised age AIDAGE in AGE]

[p. 2]

AID.060

What is {sample adult's} birthday?
AIDDOB_M
MONTH:
(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
AIDDOB_D

:

DAY
(01-31) 1-31
(97) Refused
(99) DK
AIDDOB_Y
YEAR
(1900-1997) 1900-1997
(9997) Refused
(9999) DK

(Go to AIDCCI2)

[Update revised birthdate in DOB_M, DOB_BDAY, and DOB_Y]

[Note: Variables in the AID section are used to verify information collected from the
family respondent. They do not exist as separate variables on the analytic file.]

(Go to next section -- Conditions)

[p. 3]


Section II -- CONDITIONS
Now I am going to ask you about certain medical conditions.

ACN.010

Have you EVER been told by a doctor or other health professional that you had...
Hypertension, also called high blood pressure?
HYPEV
(1) Yes (ACN.020)
(2) No (ACN.031)
(7) Refused (ACN.031)
(9) DK (ACN.031)


ACN.020

Were you told on two or more DIFFERENT visits that you had hypertension, also called high blood pressure?
HYPDIFV
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.031

Have you EVER been told by a doctor or other health professional that you had ...

(1) Yes
(2) No
(7) Refused
(9) DK
CHDEV...Coronary heart disease?
ANGEV...Angina, also called angina pectoris?
MIEV... A heart attack (also called myocardial infarction)?
HRTEV...Any kind of heart condition or heart disease (other than the ones I just asked about)?
STREV...A stroke?
EPHEV...Emphysema?


ACN.080

Have you EVER been told by a doctor or other health professional that you had ..Asthma?
AASMEV
(1) Yes (ACN.090)
(2) No (ACN.110)
(7) Refused (ACN.110)
(9) DK (ACN.110)


ACN.090

During the PAST 12 MONTHS, have you had an episode of asthma or asthma attack?
AASMYR
(1) Yes (ACN.100)
(2) No (ACN.110)
(7) Refused (ACN.110)
(9) DK (ACN.110)


ACN.100

During the PAST 12 MONTHS, have you had to visit an emergency room or urgent care center because of asthma?
AASMERYR
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.110

Have you EVER been told by a doctor or other health professional that you had ....An ulcer? This could be a stomach, duodenal or peptic ulcer.
ULCEV
(1) Yes (ACN.120)
(2) No (ACN.130)
(7) Refused (ACN.130)
(9) DK (ACN.130)

[p. 4]


ACN.120

During the PAST 12 MONTHS have you had an ulcer?
ULCYR
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.130

Have you EVER been told by a doctor or other health professional that you had ...Cancer or a malignancy of any kind?
CANEV
(1) Yes (ACN.140)
(2) No (ACN.160)
(7) Refused (ACN.160)
(9) DK (ACN.160)


ACN.140

What kind of cancer was it?
FR: MARK UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3, CODE '96', (CNKIND31) IN THE FOURTH BOX. ENTER 'N' FOR NO MORE.
CNKIND
(1) Bladder
(2) Blood
(3) Bone
(4) Brain
(5) Breast
(6) Cervix
(7) Colon
(8) Esophagus
(9) Gallbladder
(10) Kidney
(11) Larynx-windpipe
(12) Leukemia
(13) Liver
(14) Lung
(15) Lymphoma
(16) Melanoma
(17) Mouth/tongue/lip
(18) Ovary
(19) Pancreas
(20) Prostate
(21) Rectum
(22) Skin (non-melanoma
(23) Skin (DK what kind)
(24) Soft Tissue (muscle or fat)
(25) Stomach
(26) Testis
(27) Throat - pharynx
(28) Thyroid
(29) Uterus
(30) Other
(97) Refused
(96) More than 3 kinds
(99) DK
[ ]
[ ]
[ ]
[ ]


ACN.150

How old were you when cancer was first diagnosed?
CANAGE_1
(001-100) 1-100 years
(997) Refused
(999) DK
CANAGE_2
(001-100) 1-100 years
(997) Refused
(999) DK
CANAGE_3
(001-100) 1-100 years
(997) Refused
(999) DK


ACN.160

[ If Female, add: ]
Other than during pregnancy,

[ Else ]
Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?
DIBEV
(1) Yes (ACN.170)
(2) No (ACN.201)
(3) Borderline (ACN.201)
(7) Refused (ACN.201)
(9) DK (ACN.201)


ACN.170

How old were you when a doctor FIRST told you that you had diabetes or sugar diabetes?
DIBAGE
(001-100) 1-100 years
(997) Refused
(999) DK


ACN.180

Are you NOW taking insulin?
INSLN
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.190

Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes called oral agents or oral hypoglycemic agents.
DIBPILL
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.201

During the PAST 12 MONTHS, have you been told by a doctor or other health professional that you had...
(1) Yes
(2) No
(7) Refused
(9) DK
AHAYFYR... Hay fever?
SINYR... Sinusitis?
CBRCHYR... Chronic bronchitis?
KIDWKYR... Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.
LIVYR... Any kind of liver condition?


ACN.250

FR: SHOW CARD A1
During the PAST 12 MONTHS, have you had pain, aching, stiffness or swelling in or around a joint?
Card Al
[drawing of a human form labeled as follows:]
Right and Left:
Shoulders - 1,2 [includes both Front and Back of body]
Elbows - 3,4
Hips - 5,6
Wrists - 7,8
Knees - 9,10 [includes both Front and Back of body]
Ankles - 11,12
Toes - 13,14
Fingers, Thumb - 15,16
JNTYR
(1) Yes (ACN.260)
(2) No (ACN.300)
(7) Refused (ACN.300)
(9) DK (ACN.300)


ACN.260

Were these symptoms present on MOST DAYS FOR AT LEAST ONE MONTH?
JNTMO
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.270

Did these symptoms begin only because of an injury?
JNTIJ
(1) Yes (ACN.280)
(2) No (ACN.290)
(7) Refused (ACN.290)
(9) DK (ACN.290)

[p. 6]


ACN.280

How many weeks or months, in the past year, did you have joint symptoms due to an injury?
JNTIJLN
[ ] NUMBER

(01-52) 1-52 units
(96) Entire year
(97) Refused
(99) DK
JNTIJLT
[ ] TIME PERIOD

(1) Weeks
(2) Months
(7) Refused
(9) DK


ACN.290

Which joints are affected?
FR: MARK ALL THAT APPLY. ENTER 'N' FOR NO MORE.
JNTYR
(1) Shoulder-right
(2) Shoulder-left
(3) Elbow-right
(4) Elbow-left
(5) Hip-right
(6) Hip-left
(7) Wrist-right
(8) Wrist-left
(9) Knee-right
(10) Knee-left
(11) Ankle-right
(12) Ankle-left
(13) Toes-right
(14) Toes-left
(15) Fingers/thumb-right
(16) Fingers/thumb-left
(17) Other joint not listed
(97) Refused
(99) DK
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]


The following questions are about pain you may have experienced in the PAST THREE MONTHS. Please refer to pain that LASTED A WHOLE DAY OR MORE. Do not report aches and pains that are fleeting or minor.


ACN.300

During the PAST THREE MONTHS, did you have...Neck pain?
PAINECK
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.310

During the PAST THREE MONTHS, did you have...Low back pain?
PAINLB
(1) Yes (ACN.320)
(2) No (ACN.331)
(7) Refused (ACN.331)
(9) DK (ACN.331)

ACN.320

Did this pain spread down either leg to areas below the knees?
PAINLEG
(1) Yes
(2) No
(7) Refused
(9) DK

[p. 7]


ACN.331

During the PAST THREE MONTHS, did you have...

(1) Yes
(2) No
(7) Refused
(9) DK
PAINFACE... Facial ache or pain in the jaw muscles or the joint in front of the ear?
AMIGR... Severe headache or migraine?

ACN.350

FR: SHOW CALENDAR CARD
These next questions are about your recent health during the TWO WEEKS outlined on that calendar.


Did you have a head cold or chest cold that started during those TWO WEEKS?
ACOLD2W
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.360

Did you have a stomach or intestinal illness with vomiting or diarrhea that started during those TWO WEEKS?
AINTIL2W
(1) Yes
(2) No
(7) Refused
(9) DK


Check item ACNCCI1: If sex is male go to ACN.410; Else go to Check item ACNCCI2.
Check item ACNCCI2: If age is less than 50 go to ACN.370; Else go to ACN.410

ACN.370

Are you currently pregnant?
PREGNOW
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.410

These next questions are about your hearing, vision, and teeth.
Have you ever worn a hearing aid?
HEARAID
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.420

Which statement best describes your hearing (without a hearing aid): good, a little trouble, a lot of trouble, deaf?
AHEARST
(1) Good
(2) Little trouble
(3) Lot of trouble
(4) Deaf
(7) Refused
(9) DK


ACN.430

Do you have any trouble seeing, even when wearing glasses or contact lenses?
AVISION
(1) Yes (ACN.440)
(2) No (ACN.451)
(7) Refused (ACN.451)
(9) DK (ACN.451)

[p. 8]


ACN.440

Are you blind or unable to see at all?
ABLIND
(1) Yes
(2) No
(7) Refused
(9) DK


ACN.451

Have you lost all of your..

(1) Yes
(2) No
(7) Refused
(9) DK
UPPERT... upper natural (permanent) teeth?
LOWERT... lower natural (permanent) teeth?


ACN.471

Now I am going to ask you some questions about feelings you may have experienced over the
PAST 30 DAYS.

FR: SHOW CARD A2

During the PAST 30 DAYS, how often did you feel...
(1) ALL of the time
(2) MOST of the time
(3) SOME of the time
(4) A LITTLE of the time
(5) NONE of the time
(7) REFUSED
(9) DK
Card A2
1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
SAD... So sad that nothing could cheer you up?
NERVOUS... Nervous?
RESTLESS... Restless or fidgety
HOPELESS... Hopeless
EFFORT... That everything was an effort?
WORTHLS... Worthless?


Check item ACNCCI4: If any of the responses are 1 - 3, then go to ACN.530; Else, go to the next section.-- Health Status and Limitation of Activities.

ACN.530

We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings interfere with your life or activities: a lot, some, a little, or not at all?
MHAMTMO
(1) A lot
(2) Some
(3) A little
(4) Not at all
(7) Refused
(9) DK

(Go to next section -- Health Status and Limitation of Activities)
[p. 9]


Section III -- HEALTH STATUS AND LIMITATION OF ACTIVITIES

Part A -- Health Indicators


AHS.010

FR: VERIFY OR ASK:
Earlier I recorded that you were working last week. Is that correct?
AHS_CCI1
(1) Yes (AHS.040)
(2) No (AHS.030)
(7) Refused (AHS.030)
(9) DK (AHS.030)

AHS.020

FR: VERIFY OR ASK:
Earlier I recorded that you were not working last week. Is that correct?
AHS_CCI2
(1) Yes (AHS.030)
(2) No (AHS.040)
(7) Refused (AHS.030)
(9) DK (AHS.030)

AHS.030

Although you did not work last week, did you have a job or business at any time in the PAST 12 MONTHS?
WRKLYR2
(1) Yes (AHS.040)
(2) No (AHS.050)
(7) Refused (AHS.050)
(9) DK (AHS.050)


AHS.040

During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did you miss work at a job or business because of illness or injury (do not include maternity leave)?
WKDAYR
(000) None
(001-366) 1-366 days
(997) Refused
(999) DK


AHS.050

During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did illness or injury keep you in bed more than half of the day? (Include days while an overnight patient in a hospital).
BEDDAYR
(000) None
(001-366) 1-366 days
(997) Refused
(999) DK (Go to AHS.060)


AHS.060

Compared with 12 MONTHS AGO, would you say your health is better, worse, or about the same?
AHSTATYR
(1) Better
(2) Worse
(3) About the same
(7) Refused
(9) DK

[p. 10]

Part B -- Limitation of Activities


AHS.070

Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?
SPECEQ
(1) Yes
(2) No
(7) Refused
(9) DK


AHS.091

The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM. By "health problem" we mean any physical, mental, or emotional problem or illness (not including pregnancy).

FR: SHOW CARD A3.

By yourself, and without using any special equipment, how difficult is it for you to...
(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(7) REFUSED
(9) DK
Card A3
0. Not difficult at all
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
FLWALK... Walk a quarter of a mile - about 3 city blocks?
FLCLIMB... Walk up 10 steps without resting?
FLSTAND... Stand or be on your feet for about 2 hours?
FLSIT... Sit for about 2 hours?
FLSTOOP... Stoop, bend, or kneel?
FLREACH... Reach up over your head?

AHS.141

By yourself, and without using any special equipment, how difficult is it for you to...
(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(7) REFUSED
(9) DK
FLGRASP... Use your fingers to grasp or handle small objects?
FLCARRY... Lift or carry something as heavy as 10 pounds such as a full bag of groceries?
FLPUSH... Push or pull large objects like a living room chair?
FR: SHOW CARD A4.

AHS.171

By yourself, and without using any special equipment, how difficult is it for you to...
(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(7) REFUSED
(9) DK
Card A4
0. Not difficult at all
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
FLSHOP... Go out to things like shopping, movies, or sporting events?
FLSOCL... Participate in social activities such as visiting friends, attending clubs and meetings, going to parties...?
FLRELAX... Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music...)?

[p. 11]


Check item AHS_CCI3: If any of the above answers in AHS.091, AHS.141, or AHS.171 = 1-4 go to AHS.200; Else go to the next section.--Health Behaviors.

AHS.200

What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

FR: SHOW CARD A5. ENTER ALL THAT APPLY UP TO 5 (but do not probe).
IF OLD AGE IS REPORTED, PROBE FOR SPECIFIC CONDITION(S) CAUSED BY OLD AGE.
Card A5
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g. cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
19. Other impairment/problem
AFLHCA
(1) Vision/problem seeing
(2) Hearing problem
(3) Arthritis/rheumatism
(4) Back or neck problem
(5) Fractures, bone/joint injury
(6) Other injury
(7) Heart problem
(8) Stroke problem
(9) Hypertension/high blood
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (as cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem pressure
(19) Other impairment/problem
(20) Other impairment/problem
(97) Refused
(99) DK
[ ]
[ ]
[ ]
[ ]
[ ]

[If answers equal (1) - (12) and (14) - (18) then go to AHS.300; if answer equals (19) and/or (20) go to AHS.201; else go to next section--Health Behaviors.]

AHS.201

FR: THESE SHOULD BE NAMES OF SPECIFIC CONDITIONS THAT ARE NOT ON THE CONDITION LIST.
AFLSPEC1 First condition: _______________
AFLSPEC2 Second condition: _____________


AHS.300

How long have you had {name the first condition AFLHCA1}?
AFLHCLN_1
[ ] NUMBER
(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) DK
AFLHCLT_1
[ ] TIME PERIOD
(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) DK

AHS.301

How long have you had {name the second condition AFLHCA2}?
AFLHCLN_2
[ ] NUMBER
(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) DK
AFLHCLT_2
[ ] TIME PERIOD
(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) DK

AHS.302

How long have you had {name the third condition AFLHCA3}?
AFLHCLN_3
[ ] NUMBER
(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) DK
AFLHCLT_3
[ ]TIME PERIOD
(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) DK

AHS.303

How long have you had {name the fourth condition AFLHCA4}?
AFLHCLN_4
[ ] NUMBER
(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) DK
AFLHCLT_4
[ ]TIME PERIOD
(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) DK

AHS.304

How long have you had {name the fifth condition AFLHCA5}?
AFLHCLN_5
[ ] NUMBER
(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) DK
AFLHCLT_5
[ ]TIME PERIOD
(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) DK

[p. 14]


Section IV - HEALTH BEHAVIORS

Part A - Tobacco


AHB.010

These next questions are about cigarette smoking.
Have you smoked at least 100 cigarettes in your ENTIRE LIFE?
SMKEV
(1) Yes (AHB.020)
(2) No (AHB.090)
(7) Refused (AHB.090)
(9) DK (AHB.090)


AHB.020

How old were you when you FIRST started to smoke fairly regularly?
FR: IF LESS THAN 6 YEARS OLD, ENTER "
SMKREG
(06-94) 6-94 years of age
(95) 95 years or older
(96) Never smoked regularly
(97) Refused
(99) DK


AHB.030

Do you NOW smoke cigarettes every day, some days or not at all?
SMKNOW
(1) Every day (AHB.050)
(2) Some days (AHB.060)
(3) Not at all (AHB.040)
(7) Refused (AHB.060)
(9) DK (AHB.060)


AHB.040

How long has it been since you quit smoking cigarettes?
SMKQTNO
[ ] NUMBER
(01-94) 1-94
(95)95+
(97)Refused
(99)DK
SMKQTTP
[ ] TIME PERIOD
(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) DK(AHB.090)


AHB.045

Have you quit smoking since {current month 1 year ago)
SMKQTD2
(1) Yes
(2) No
(7) Refused
(9) DK(AHB.090)


AHB.050

On the average, how many cigarettes do you now smoke a day?
FR: IF LESS THAN ", ENTER "1"
CIGSDA1
(01-94) 1-94 cigarettes
(95) 95+ cigarettes
(97) Refused
(99) DK(AHB.080)

[p. 15]


AHB.060

On how many of the PAST 30 DAYS did you smoke a cigarette?
CIGDAMO
(00) None (AHB.080)
(01-30) 1-30 Days (AHB.070)
(97) Refused (AHB.070)
(99) DK (AHB.070)


AHB.070

On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day?
FR: IF LESS THAN "1", ENTER "1"
CIGSDA2
(01-94) 1-94 cigarettes
(95) 95+ cigarettes
(97) Refused
(99) DK


AHB.080

During the PAST 12 MONTHS, have you stopped smoking for more than one day BECAUSE YOU WERE TRYING TO QUIT SMOKING?
CIGQTYR
(1) Yes
(2) No
(7) Refused
(9) DK

[p. 16]

Part B - Physical Activity

AHB.090

The next questions are about physical activities (exercise, sports, physically active hobbies...) that you may do in your LEISURE time.

How often do you do VIGOROUS activities for AT LEAST 10 MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?
VIGNO
[ ] NUMBER OF TIMES
(000)Never
(001-995) 1-995 times
(996)Unable to do this type of activity
(997) Refused
(999) DK
VIGTP
[ ] TIME PERIOD
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this activity
(7) Refused
(9) DK

AHB.100

About how long do you do these vigorous activities each time?
VIGLNGNO
[ ] NUMBER
(001-720) 1-720
(997) Refused
(999) DK
VIGLNGTP
[ ] TIME PERIOD
(1) Minutes (AHB.110)
(2) Hours (AHB.110)
(7) Refused (AHB.110)
(9) DK (AHB.108)

AHB.108

Each time you do these vigorous activities, do you do them 20 minutes or more, or less than 20 minutes?
VIGLONGD
(1) Less than 20 minutes
(2) 20 Minutes or more
(7) Refused
(9) Don't know

[p. 17]


AHB.110

How often do you do LIGHT OR MODERATE activities for AT LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?
MODNO
[ ] NUMBER OF TIMES per
(000) Never
(001-995) 1-995
(996) Unable to do this type activity
(997) Refused
(999) DK
MODTP
[ ] TIME PERIOD
(0) Never (AHB.130)
(1) Day (AHB.120)
(2) Week (AHB.120)
(3) Month (AHB.120)
(4) Year (AHB.120)
(6) Unable to do this type activity (AHB.130)
(7) Refused (AHB.130)
(9) DK (AHB.130)

AHB.120

About how long do you do these light or moderate activities each time?
MODLNGNO
[ ] NUMBER
(001-995) 1-995
(997) Refused
(999) DK
MODLNGTP
[ ] TIME PERIOD
(1) Minutes (AHB.130)
(2) Hours (AHB.130)
(7) Refused (AHB.130)
(9) DK (AHB.128)

AHB.128

Each time you do these light or moderate activities, do you do them 20 minutes or more, or less than 20 minutes?
MODLONGD
(1) Less than 20 minutes
(2) 20 Minutes or more
(7) Refused
(9) DK


AHB.130

How often do you do physical activities specifically designed to STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)
STRNGNO
[ ] NUMBER OF TIMES per
(000) Never
(001-995) 1-995
(996)Unable to do this type activity
(997) Refused
(999) DK
STRNGTP
[ ] TIME PERIOD
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(7) Refused
(9) DK

[p. 18]

PART C - Alcohol


AHB.140

These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, winecoolers, and any other type of alcoholic beverage. In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?
ALC1YR
(1) Yes (AHB.160)
(2) No (AHB.150)
(7) Refused (AHB.150)
(9) DK (AHB.150)


AHB.150

In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?
ALCLIFE
(1) Yes (AHB.160)
(2) No (AHB.190)
(7) Refused (AHB.190)
(9) DK (AHB.190)


AHB.160

In the PAST YEAR, how often did you drink any type of alcoholic beverage?
ALC12MNO
[ ] NUMBER OF DAYS per
(000) Never
(001-365) 1-365 days
(997) Refused
(999) DK
ALC12MTP
[ ] TIME PERIOD
(0) Never/None
(1) Week
(2) Month
(3) Year
(7) Refused
(9) DK


AHB.170

In the PAST YEAR, on those days that you drank alcoholic beverages, on the average, how many drinks did you have?
ALCAMT
(01-94) 1-94 drinks
(95) 95 and more
(97) Refused
(99) DK


AHB.180

In the PAST YEAR, on how many DAYS did you have 5 or more drinks of any alcoholic beverage?
ALC5UPNO
[ ] NUMBER OF DAYS per

(000) Never/none
(001-365) 1-365 days
(997) Refused
(999) DK
ALC5UPTP
[ ] TIME PERIOD
(0) Never/None
(1) Week
(2) Month
(3) Year
(7) Refused
(9) DK

[p. 19]




AHB.190

About how tall are you without shoes?
FR: ALLOW RESPONSES IN METRIC IF VOLUNTEERED.
AHEIGHTF
Feet ____________________
(03-07) 3-7 feet
(97) Refused
(99) DK
AHEIGHTI
Inches __________________

(00-11) 0-11 inches
(97) Refused
(99) DK
AHEIGHTM
Meters ______________
(0-2) 0-2 meters
(7) Refused
(9) DK
AHEIGHTC
Centimeters _______________
(090-241) 90-241 centimeters
(997) Refused
(999) DK


AHB.200

About how much do you weigh without shoes?
FR: ALLOW RESPONSES IN METRIC IF VOLUNTEERED.
WT_LB
Pounds _____________

(050-500) 50-500 pounds
(997) Refused
(999) DK
WT_KG
Kilograms ____________
(0227-2268) 22.7-226.8 kilograms



(Goto next section -- Health Care Access and Utilization)
[p. 20]


Section V - HEALTH CARE ACCESS AND UTILIZATION


AAU.020

The next questions are about health care.
Is there a place that you USUALLY go to when you are sick or need advice about your health?
AUSUALPL
(1) Yes (AAU.030)
(2) There is NO place (AAU.037)
(3) There is MORE THAN ONE place (AAU.030)
(7) Refused (AAU.037)
(9) DK (AAU.037)


AAU.030

[If AAU.020 equals 1 read:]
APLKIND
What kind of place is it - a clinic, doctor's office, emergency room, or some other place?
[If AAU.020 equals 3 read:]

What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place?

(1) Clinic or health center (AAU.035)
(2) Doctor's office or HMO (AAU.035)
(3) Hospital emergency room (AAU.035)
(4) Hospital outpatient department (AAU.035)
(5) Some other place (AAU.035)
(7) Refused (AAU.037)
(9) DK (AAU.037)


AAU.035

Is that {full name from AAU.030 APLKIND} the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?
AHCPLROU
(1) Yes (AAU.040)
(2) No (AAU.037)
(7) Refused (AAU.037)
(9) DK (AAU.037)


AAU.037

What kind of place do you go to when you need routine preventive care, such as a physical examination or check-up?
AHCPLKND
(0) Doesn't get preventive care anywhere
(1) Clinic or health center
(2) Doctor's office or HMO
(3) Hospital emergency room
(4) Hospital outpatient department
(5) Some other place
(7) Refused
(9) DK


Check item AAUCCI1: If AAU.020 equals 2, 7, or 9, then go to AAU.061; Else go to AAU.040.

AAU.040

At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?
AHCCHGYR
(1) Yes (AAU.050)
(2) No (AAU.061)
(7) Refused (AAU.061)
(9) DK (AAU.061)

AAU.050

Was this change for a reason related to health insurance?
AHCCHGHI
(1) Yes
(2) No
(7) Refused
(9) DK

[p. 21]


AAU.061

There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?

(1) Yes
(2) No
(7) Refused
(9) DK
AHCDLYR1 You couldn't get through on the telephone.
AHCDLYR2 You couldn't get an appointment soon enough.
AHCDLYR3 Once you get there, you have to wait too long to see the doctor.
AHCDLYR4 The clinic/doctor's office wasn't open when you could get there.
AHCDLYR5You didn't have transportation


AAU.111

During the PAST 12 MONTHS, was there any time when you needed any of the following but didn't get it because you couldn't afford it?

(1) Yes
(2) No
(7) Refused
(9) DK
AHCAFYR1 Prescription medicines
AHCAFYR2 Mental health care or counseling
AHCAFYR3 Dental care (including check-ups)

[p. 22]


Part B - Dental Care

AAU.135

FR: SHOW CARD A6.

About how long has it been since you last saw or talked to a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
Card A6
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 3 years ago
4. More than 3 years
5. Never
ADENLONG
(1) 6 months or less
(2) More than 6 months, but not more than 1 year ago
(3) More than 1 year, but not more than 3 years ago
(4) More than 3 years
(5) Never
(7) Refused
(9) DK

[p. 23]

Part C - Health Care Provider Contacts


AAU.141

During the PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?

(1) Yes
(2) No
(7) Refused
(9) DK
AHCSYR1 A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
AHCSYR2 An optometrist, optician, or eye doctor (someone who prescribes eyeglasses)?
AHCSYR3 A foot doctor?
AHCSYR4 A chiropractor?
AHCSYR5 A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational ...therapist?
AHCSYR6 A nurse practitioner, physician assistant, or midwife?


Check item AAUCCI2: If Male then go to AAU.211; Else go to AAU.200.

AAU.200

During the PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?
A doctor who specializes in women's health (an obstetrician/gynecologist)?
AHCSYR7
(1) Yes
(2) No
(7) Refused
(9) DK


AAU.211

During the PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?

(1) Yes
(2) No
(7) Refused
(9) DK
AHCSYR8 A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist, psychiatrist, or ophthalmologist)?

AHCSYR9 A general doctor who treats a variety of illnesses (a doctor in general practice, family medicine, or internal medicine)?


AAU.230

Does that doctor treat children and adults (a doctor in general practice or family medicine)?
AHCSYR10
(1) Yes
(2) No
(7) Refused
(9) DK


AAU.240

During the PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about your own health? (This includes emergency room visits that resulted in a hospital admission.)
FR: SHOW CARD A7.
Card A7
0.None
1.1
2.2-3
3.4-9
4.10-12
5.13 or more
AHERNOYR
(0) None
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK

[p. 24]


AAU.250

During the PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?
AHCHYR
(1) Yes (AAU.260)
(2) No (AAU.280)
(7) Refused (AAU.280)
(9) DK (AAU.280)


AAU.260

During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional
AHCHMOYR
(01-12) 1-12 months
(7)Refused
(9)DK


AAU.270

What was the total number of home visits received during {that month/those months}?

FR: SHOW CARD A8.
AHCHNOYR
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK


AAU.280

During the PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about your own health at a DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? DO NOT INCLUDE TIMES YOU WERE HOSPITALIZED OVERNIGHT, VISITS TO HOSPITAL EMERGENCY ROOMS, HOME VISITS, OR TELEPHONE CALLS.

FR: SHOW CARD A7

.

Card A8

1.1
2.2-3
3.4-9
4.10-12
5. 13 or more
AHCNOYR
(0) None
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK


AAU.290

During the PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or outpatient?
ASRGYR
(1) Yes (AAU.300)
(2) No (AAUCCI3)
(7) Refused (AAUCCI3)
(9) DK ( AAUCCI3)


AAU.300

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery during the PAST 12 MONTHS?
ASRGNOYR
(01-94) 1-94 times
(95) 95+ times
(97) Refused
(99) DK


Check item AAUCCI3:If the sample adult has had a doctor visit in the last two weeks as indicated in the family core (FAU.180 = 1 and FAU.190 = the adult sample person), then AAU.305 = 1 and go to AAU.310; Else got to AAU.305.

AAU.305

About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.
FR: SHOW CARD A6

.

Card A6

1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 3 years ago
4. More than 3 years
5. Never
AMDLONG
(1) 6 months or less
(2) More than 6 months but not more than 1 year ago
(3) More than 1 year, but not more than 3 years ago
(4) More than 3 years
(5) Never
(7) Refused
(9) DK

[p. 26]

Part D - IMMUNIZATIONS


AAU.310

During the PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.
SHTFLUYR
(1) Yes
(2) No
(7) Refused
(9) DK


AAU.320

Have you EVER had a pneumonia vaccination? This shot is usually given only once in a person's lifetime and is different from the flu shot.
SHTPNUYR
(1) Yes
(2) No
(7) Refused
(9) DK

(Go to next section -- Demographics)
[p. 27]


Section VI - DEMOGRAPHICS
Check item ASDCCI1:If the respondent gave an answer to the question in the Family Core which asks what the sample Adult was doing last week (FSD.050/DOINGLW = 1-4), then go to ASD.050; Else go to the next section -- AIDS

.

ASD.050

Earlier I recorded that in the last week you were {Fill answer code description from FSD.050}. Is that correct?
WRKVER
(1) Yes (Check item ASDCCI3)
(2) No (ASD.060)
(7) Refused (ADS.010)
(9) DK (ADS.010)
Check item ASDCCI2:If the respondent indicated in the Family Core that the sample Adult had a job or business last week (FSD.050/DOINGLW = 1-2) then go to ASD.070; Else go to next section -- AIDS

.

ASD.060

What is your correct working status?
WRKCOR
(1) Working at a job or business (ASD.070)
(2) With a job or business but not at work (ASD.070)
(3) Looking for work (ADS.010)
(4) Not working at a job or business (ADS.010)
(7) Refused (ADS.010)
(9) DK (ADS.010)

ASD.070

For whom did you work at your MAIN job or business? (Name of company, business, organization or employer)
WHOWRK
Job or Business: _____________
(7) Refused
(9) DK

ASD.080

What kind of business or industry is this? (For example: TV and radio mgt., retail shoe store, State Department of Labor)
KINDIND
Kind of Business: _______________
(7) Refused
(9) DK

ASD.090

What kind of work were you doing? (For example: farming, mail clerk, computer specialist.)
KINDWRK
Kind of Work: _______________
(7) Refused
(9) DK

ASD.100

What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates printing press.)
IMPACT
Activities: _________________
(7) Refused
(9) DK

[p. 28]


ASD.110

FR: SHOW CARD 9.
Looking at the card, which of these best describes your current job or work situation?
Card A9
1. An employee of a PRIVATE company, business, or individual for wages, salary, or commission
2. A FEDERAL government employee
3. A STATE government employee
4. A LOCAL government employee
5. Self-employed on OWN business, professional practice or farm
6. Working WITHOUT pay in family business or farm
WRKCAT
(1) An employee of a PRIVATE company, business, or individual for wages, salary, or commission?
(2) A FEDERAL government employee?
(3) A STATE government employee?
(4) A LOCAL government employee?
(5) Self-employed in OWN business, professional practice or farm?
(6) Working WITHOUT PAY in family business or farm?
(7) Refused
(9) DK


ASD.120

FR: SHOW CARD 10.
Thinking about this MAIN job or business, how many people are employed there full and part time, including employees at all locations?
Card A10
1. l-9 employees
2.10-24 employee
3.25-49 employee
4.50-99 employee
5. 100-249 employee
6. 250-499 employee
7. 500-999 employee
8. 1000 employees or more
LOCALLNO
(01) 1- 9 employees (ASD.140)
(02) 10-24 employees (ASD.130)
(03) 25-49 employees (ASD.130)
(04) 50-99 employees (ASD.130)
(05) 100-249 employees (ASD.130)
(06) 250-499 employees (ASD.130)
(07) 500-999 employees (ASD.130)
(08) 1000 employees or more (ASD.130)
(97) Refused (ASD.130)
(99) DK (ASD.130)

ASD.130

Thinking about the particular location or facility where you worked last week, how many people are employed there full and part time?
LOCPRTNO
(01) 1- 9 employees
(02) 10-24 employees
(03) 25-49 employees
(04) 50-99 employees
(05) 100-249 employees
(06) 250-499 employees
(07) 500-999 employees
(08) 1000 employees or more
(97) Refused
(99) DK

ASD.140

About how long have you worked at this MAIN job or business?
WRKLONG1
[ ] NUMBER
(001-365)1-365
(997) Refused
(999) DK
WRKLONG2
[ ]TIME PERIOD
(1) Day(s) (ASD.150)
(2) Week(s) (ASD.150)
(3) Month(s) (ASD.150)
(4) Year(s) (ASD.150)
(7) Refused (ASD.150)
(9) DK (ASD.145)

ASD.145

Have you worked at this MAIN job or business for one year or less, or more than one year?
WRKLONGD
(1) One year or less
(2) More than one year
(7) Refused
(9) DK

[p. 29]


ASD.150

Are you paid by the hour on this MAIN job or business?
HOURPD
(1) Yes
(2) No
(7) Refused
(9) DK


ASD.160

Do you have paid sick leave on this MAIN job or business?
PDSICK
(1) Yes
(2) No
(7) Refused
(9) DK

ASD.170

Do you have more than one job or business?
ONEJOB
(1) Yes (ASD.180)
(2) No (ADS.010)
(7) Refused (ADS.010)
(9) DK (ADS.010)

ASD.180

In your other jobs/businesses, do you work for an employer, are you self-employed, or both?
WRKCATOT
(1) Employee only (ADS.010)
(2) Self-employed only (ASD.190)
(3) Both (ADS.010)
(7) Refused (ADS.010)
(9) DK (ADS.010)

ASD.190

Is this business incorporated?
BUSINC
(1) Yes
(2) No
(7) Refused
(9) DK

(Go to next section --AIDS)

[p. 30]


Section VII - AIDS

ADS.010

Now, I am going to ask about giving blood donations to a blood bank such as the American Red Cross. This does NOT include blood drawn at a doctor's office for laboratory analysis.


Have you given blood since March 1985?
BLDGV
(1) Yes (ADS.020)
(2) No(ADS.040)
(7) Refused (ADS.040)
(9) DK (ADS.040)


ADS.020

During the past 12 months, that is, since {12-month ref. date}, have you donated blood?
BLDG12M
(1) Yes
(2) No
(7) Refused
(9) DK

ADS.040

The next questions are about the test for the AIDS virus infection. No questions will ask what the results are of any tests that you may have had.


[If ADS.010 equals 1 read:]
Except for tests you may have had as part of blood donations, have you ever been tested for the AIDS virus infection?

[Else read:]
Have you ever been tested for the AIDS virus infection?
AIDSTST
(1) Yes (ADS.060)
(2) No (ADS.050)
(7) Refused (ADS.110)
(9) DK (ADS.110)


ADS.050

Is there any particular reason why you have not been tested?
FR: IF "YES" ASK: What is the reason? Any other?
WHYTSU
(01) No reason (ADS.110)
(02) Don't consider myself at risk of AIDS (ADS.110)
(03) Doctor/HMO did not recommend it (ADS.110)
(04) Don't believe test results are accurate (ADS.110)
(05) Don't believe anything can be done if I am positive (ADS.110)
(06) Don't like needles (ADS.110)
(07) Don't trust results to be confidential (ADS.110)
(08) Afraid of losing job, insurance, housing, friends, family, if people knew I was positive for AIDS infection (ADS.110)
(09) Other reason - specify(ADS.055)
(10) Other reason - specify(ADS.056)
(97) Refused (ADS.110)
(99) DK (ADS.110)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

ADS.055

Specify the additional reason for not having been tested.
WHYSPEC1 First reason: _____________________

ADS.056

Specify the additional reason for not having been tested.
WHYSPEC2 Second reason: _____________


ADS.060

[If ADS.020 equals 1 read:]
Not including blood donations, during the past 12 months, that is, since {12-month ref. date}, have you been tested?

[Else read:]
During the past 12 months, that is, since {12-month ref. date}, have you been tested for the AIDS virus infection?
TST12M
(1) Yes (ADS.065)
(2) No (ADS.110)
(7) Refused (ADS.110)
(9) DK (ADS.110)

FR: SHOW CARD A11.
Card A11
1.Just to find out/Worried that you are infected
2.Because a doctor asked you to
3.Because the health department asked you to
4.Because sex partner asked you to
5.For hospitalization or surgical procedure
6.To apply for health insurance or life insurance
7.To comply with guidelines for health workers
8.To apply for a new job
9.For military induction, separation, or during military service
10.For immigration
11.Because of pregnancy
12. For some other reason


ADS.065

[If ADS.020 equals 1 read:]
Not including your blood donations, which of these would you say were the reasons for your last AIDS test?
[Else read:]

Which of these would you say were the reasons for your last AIDS test?
REATOT
(1) Just to find out/Worried that you are infected (ADS.070)
(2) Because a doctor asked you to (ADS.070)
(3) Because the Health Department asked you to (ADS.070)
(4) Because sex partner asked you to (ADS.070)
(5) For hospitalization or surgical procedure (ADS.070)
(6) To apply for health insurance or life insurance (ADS.070)
(7) To comply with guidelines for health workers (ADS.070)
(8) To apply for a new job (ADS.070)
(9) For military induction, separation, or during military service (ADS.070)
(10) For immigration (ADS.070)
(11) Because of pregnancy (ADS.070)
(12) Other reason - specify (ADS.067)
(13) Other reason - specify (ADS.068)
(97) Refused (ADS.070)
(99) DK(ADS.070)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

ADS.067

Specify the additional reason for the last AIDS test.
REASPEC1 First reason: _______________

ADS.068

Specify the additional reason for the last AIDS test.
REASPEC2Second reason: ____________


ADS.070

[If ADS.020 equals 1, then read:]
Not including your blood donations, where did you have your last test for the AIDS virus?
[Else read:]
Where did you have your last test for the AIDS virus?
LASTST
(01) AIDS clinic/counseling/testing site (ADS.080)
(02) Community health clinic (ADS.080)
(03) Clinic run by employer (ADS.080)
(04) STD clinic (ADS.080)
(05) Family planning (ADS.080)
(06) Prenatal clinic (ADS.080)
(07) Other clinic (ADS.080)
(08) Doctor/HMO (ADS.080)
(09) Hospital/emergency room/outpatient clinic (ADS.080)
(10) Military induction, separation or military service site (ADS.080)
(11) Immigration site (ADS.080)
(12) At home/home visits by nurse/health worker (ADS.080)
(13) At home - self testing kit (ADS.080)
(14) Other location - specify (ADS.075)
(97) Refused (ADS.080)
(99) DK (ADS.080)

ADS.075

Specify the location of the last test.
LASTSPEC Location: ______________


ADS.080

Did you get the results of your last test?
ALTST
(1) Yes (ADS.090)
(2) No (ADS.110)
(3) Only notified if there was a problem (ADS.110)
(7) Refused (ADS.110)
(9) DK (ADS.110)


ADS.090

Did a health professional talk with you about AIDS when you were GIVEN THE RESULTS of your last test?
TALKHP
(1) Yes
(2) No
(7) Refused
(9) DK


ADS.100

Were the results given in person, by telephone, by mail, or in some other way?
RSGVN
(1) In person
(2) By telephone
(3) By mail
(4) In some other way
(7) Refused
(9) DK

[p. 33]


ADS.110

[If ADS.040 equals 1, then read:]
Do you expect to have another test for the AIDS virus infection in the next 12 months, not including through blood donation?

[Else, read:]
Do you expect to have a test for the AIDS virus infection in the next 12 months, not including through blood donation?
EXTST12M
(1) Yes (ADS.120)
(2) No (ADS.140)
(7) Refused (ADS.140)
(9) DK (ADS.140)


ADS.120

I am going to read some reasons people might have the test for the AIDS virus infection.
FR: SHOW CARD A12.
Tell me which of these statements explain WHY YOU expect to have the test in the next 12 months? (Anything else?)
Card A12
1. Because you want to find out if you are infected
2. Because it will be part of hospitalization or surgery you expect to have
3. Because you expect to apply for life or health insurance
4. Because you expect to apply for a job
5. Because you expect to join the military
6. Because of guidelines for health care workers
7. Because it will be a required part of some other activity that includes automatic AIDS testing
8. Because it is required in your non-health care employment
9. Because you plan to have/begin sexual relationship
10. Because you are pregnant or expect to become pregnant
11. For some other reason (Specify)
WHY12U
(01) Because you want to find out if you are infected (ADS.130)
(02) Because it will be part of hospitalization or surgery you expect to have (ADS.130)
(03) Because you expect to apply for life or health insurance (ADS.130)
(04) Because you expect to apply for a job (ADS.130)
(05) Because you expect to join the military (ADS.130)
(06) Because of guidelines for health care workers (ADS.130)
(07) Because it will be a required part of some other activity that includes automatic AIDS
testing (ADS.130)
(08) Because it is required in your non-health care employment (ADS.130)
(09) Because you plan to have/begin sexual relationship (ADS.130)
(10) Because you are pregnant or expect to become pregnant (ADS.130)
(11) Other reason - specify (ADS.125)
(12) Other reason - specify (ADS.126)
(97) Refused (ADS.130)
(99) DK (ADS.130)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
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[ ]

ADS.125

Specify the additional reason for the test.
W12SPEC1 First reason: _____________

ADS.126

Specify the additional reason for the test.
W12SPEC2 Second reason: _________________

[p. 34]


ADS.130

Where will you have a test for the AIDS virus infection?
WHERTST
(1) AIDS clinic/counseling/testing site (ADS.140)
(2) Community Health Clinic (ADS.140)
(3) Clinic run by employer (ADS.140)
(4) STD clinic (ADS.140)
(5) Family planning (ADS.140)
(6) Prenatal clinic (ADS.140)
(7) Other clinic (ADS.140)
(8) Doctor/HMO (ADS.140)
(9) Hospital/emergency room/outpatient (ADS.140)
(10) Military induction/separation or military service site (ADS.140)
(11) Red Cross/blood bank/blood drive (ADS.140)
(12) At home/home visit by nurse/health practitioner (ADS.140)
(13) At home - self testing kit (ADS.140)
(14) Other location (specify) (ADS.135)
(97) Refused (ADS.140)
(99) DK (ADS.140)

ADS.135

Specify the location of the test.
WHERSPEC Location: __________________


ADS.140

What are your chances of GETTING the AIDS virus, would you say high, medium, low, or none?
CHNSADS
(1) High
(2) Medium
(3) Low
(4) None
(5) Already have AIDS or AIDS virus
(7) Refused
(9) DK

FR: SHOW CARD A13.
Card A13
A. You have hemophilia and have received clotting factor concentrations
B. You are a man who has had sex with another man at some time since 1980, even one time
C. You have taken street drugs by needle at any time since 1980
D. You have traded sex for money or drugs at any time since 1980
E. Since 1980, you are or have been the sex partner of any person who would answer "Yes" to any of the items on this card

ADS.150

Tell me if ANY of these statements is true for YOU. Do NOT tell me WHICH Statement or statements are true for you. Just IF ANY of them are.
(a) You have hemophilia and have received clotting factor concentrations.
(b) You are a man who has had sex with another man at some time since 1980, even one time.
(c) You have taken street drugs by needle at any time since 1980.
(d) You have traded sex for money or drugs at any time since 1980.
(e) Since 1980, you are or have been the sex partner of any person who would answer "Yes" to (any of the items on this card/any of the items I have read).
STMTRU
(1) Yes to at least one statement
(2) No to all statements
(7) Refused
(9) DK

(Go to next section)