Check item CHILD BEGIN: If no sample child or sample child section is completed, go to Immunization Questionnaire; Else if KNOWSC (person who knows sample child) equals blank, go to CID.015/KNOAVAIL, Else go to CID.001.

FR: ENTER THE NUMBER OF THE PERSON TO WHOM YOU ARE SPEAKING.

CURRES__________(1-30) Person number

[If the same person in CID.001 is identified as a person knowledgeable about child's health (FID.650/KNOWSC) go to CID.005; Else go to CSPEDIT.]

The next questions are about {Sample Child name}. Are you able to answer questions about {his/her} health at this time?

(1) Yes (CID.030)
(2) No (Check item CSPEDIT)
(7) Refused (Check item CSPEDIT)
(9) DK (Check item CSPEDIT)

Check item CSPEDIT: Check the content from FID.630, First section of Family Core: Plug names in CID.010 {KNOWSC name} for persons identified as knowledgeable about the child's health (FID.630/KNOWSC marked 'X') and go to CSDPEDIT2. If KNOWSC for CID.010 equals 7 or 9 (Refused or DK) go to Check Item CSPEDIT2.
Check item CSPEDIT2: Check the first person identified as knowledgeable about the child's health (FID.630/KNOWSC marked 'X'); if not available, check next person with KNOWSC marked 'X'; If all the KNOWSC are not available, go to CID.015/KNOAVAIL; if no one else in the family is available, go to CSPEDIT3.
Check item CSPEDIT3: Arrange a callback; go to next questionnaire.

Is {KNOWSC name} available to answer some questions about {sample child name}'s health?

(1) Available (CID.030)
(2) Not available (Check Item CSPEDIT)
(7) Refused (Check Item CSPEDIT)
(9) DK (Check Item CSPEDIT)

Is there any family member available who can answer questions about {sample child name}'s health?

(1) Yes (CID.020)
(2) No (Immunization Questionnaire)

Enter the person number of the respondent.

CSRESPNO _________(1-30) Person number

FR: SHOW CARD C1.ENTER ONLY 1.
What is {CSRESPNO name}'s relationship to {sample child name}?

1. Parent (Biological, Adoptive or Step)
2.Grandparent
3.Aunt/Uncle
4.Brother/Sister
5.Other relative
6.Legal guardian
7.Foster parent
8.Other non-relative

(1) Parent (Biological adoptive, or step)
(2) Grandparent
(3) Aunt/Uncle
(4) Brother/Sister
(5) Other relative
(6) Legal guardian
(7) Foster parent
(8) Other non-relative
(97) Refused
(99) DK

Check item CIDCCI1: If CSRESPNO is the Family Respondent, go to next section -- Conditions, Limitations, Health Status; Else go to CID.040.

FR: PLEASE VERIFY THE FOLLOWING INFORMATION ABOUT THE SAMPLE CHILD BEFORE PROCEEDING:

(1) Yes
(2) No

CSPVERF1 Gender = {male/female} Is it correct?
CSPVERF2 Age = {3 digit format}Is it correct?
CSPVERF3 Birthday = {spoken word format}Is it correct?

Check item CIDCCI1A: If CSPVERF1 equals 2 then go to CID.042; If CSPVERF2 equals 2 then go to CID.044; If SPVERF3 equals 2 then go to CID.046; If any changes in age or birth date have been made in CID.040, go to CAGECHK; If age is 18+, skip the rest of the Child questionnaire and Immunization questionnaire; If no changes or when changes complete go to next section -- Child Condition, Limitation, Health Status.

Is {sample child name} Male or Female?

(1) Male
(2) Female

(Go to Check item CIDCCI1A)

[Update revised sex - NEWSEX in SEX]

How old is {sample child name}?

(0-96)years old
(97) Refused
(99) DK(Go to Check item CIDCCI1A)

[Update revised age - NEWAGE in AGE]

What is {sample child name} birthday?

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

DAY: ________
(01-31) 1-31
(97)Refused
(99)DK

YEAR: ____________
(1979-1999)1979-1999
(9997) Refused
(9999) DK

[Update Birthdates in DOB_M, DOB_BDAY, and DOB_Y]

Check item CAGECHK: Verify that the age and birthdate are consistent. If not, go to CID.040, re-enter age or birth date.

(Go to next section--Conditions, Limitations, Health Status)

What was {S.C.name}'s birth weight?

FR: ALLOW THE RESPONSES IN METRIC IF VOLUNTEERED.

Pounds _________
(01-15) 0-15 pounds
(997) Refused
(999) DK

Ounces ________
(00-15) ounces
(97) Refused
(99) DK

Grams ______________
(0500) 500 grams or less
(0501-5484) 501-5484 grams
(9997) Refused
(9999) DK

About how tall is {S.C.name} now?
FR: ALLOW ALL RESPONSES TO BE IN METRIC IF VOLUNTEERED.

Feet _________
(00-07) 0-7 feet
(97)Refused
(99)DK

Inches __________
(00-36) 0-36 inches
(97) Refused
(99) DK

Meters _____________
(00-02) 0-2 meters
(7) Refused
(9) DK

Centimeters ____________
(00-241) 0-241 centimeters
(997) Refused
(999) DK

About how much does {S.C.name} weigh now? (without shoes)
FR: ALLOW RESPONSES IN METRIC IF VOLUNTEERED.

Pounds _______________
(001-500) 1-500 pounds
(997) Refused
(999) DK

Kilograms ___________
(0002-0226) 2-226 kilograms
(9997) Refused
(9999) DK

Check Item CHSCCI1:[If age is greater than or equal to 2 go to CHS.032; If the age is less than 2 then go to CHS.031]

Has a doctor or health professional ever told you that {S.C.name} had:

(1) Yes
(2) No
(7) Refused
(9) DK

AMR1 Mental Retardation?
AODD1 Any other developmental delay?

[Update Birthdates in DOB_M, DOB_BDAY, and DOB_Y]

FR: SHOW CARD C2.

Looking at this list, has a doctor or health professional ever told you that {S.C.name} had any of these conditions?

1. Down's Syndrome
2. Cerebral Palsy
3. Muscular Dystrophy
4. Cystic Fibrosis
5. Sickle Cell Anemia
6. Autism
7. Diabetes
8. Arthritis
9. Congenital Heart Disease
10. Other Heart Condition

(0) None
(1) Down's syndrome
(2) Cerebral Palsy
(3) Muscular Dystrophy
(4) Cystic Fibrosis
(5) Sickle cell anemia
(6) Autism
(7) Diabetes
(8) Arthritis
(9) Congenital heart disease
(10) Other heart condition
(97) Refused
(99) DK
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

Has {S.C.name} EVER had chickenpox?

(1) Yes
(2) No
(7) Refused
(9) DK

Has a doctor or other health professional EVER told you that {S.C.name} had asthma?

(1) Yes (CHS.090)
(2) No (Check Item CHSCCI2)
(7) Refused (Check Item CHSCCI2)
(9) DK (Check Item CHSCCI2)

Check Item CHSCCI2:[If CHS.080 = 1 go to CHS.090. If CHS.080 equals 2, 7, or 9, and the age is greater than 2 then go to CHS.115; If CHS.080 equals 2, 7, 9 and the age is less than or equal to 2 then go to CHS.111]

During the past 12 months, has {S.C.name} had an episode of asthma or an asthma attack?

(1) Yes (CHS.100)
(2) No (Check item CHSCCI3)
(7) Refused (Check item CHSCCI3)
(9) DK (Check item CHSCCI3)

Check Item CHSCCI3: [If CHS.090 = 1 go to CHS.100. If CHS.090 equals 2, 7, or 9, and the age is greater than 2 then go to CHS.115; If CHS.080 equals 2, 7, 9 and the age is less than or equal to 2 then go to CHS.111]

During the past 12 months, did {S.C.name} have to visit an emergency room or urgent care center because of asthma?

(1) Yes
(2) No
(7) Refused
(9) DK

Check Item CHSCCI4: [If the age is greater than to 2 then go to CHS.115; If the age is less than or equal to 2 then go to CHS.111]

During the past 12 months, has {S.C.name} had any of the following conditions?

(1) Yes
(2) No
(7) Refused
(9) DK

HAYF1 Hay fever?
RALLG1 Any kind of respiratory allergy?
DALLG1 Any kind of food or digestive allergy?
SALLG1 Eczema or any kind of skin allergy?
DIARH1 Frequent or repeated diarrhea or colitis?
ANEMIA1 Anemia?
EARINF1 Three or more ear infections?
SEIZE1 Seizures?

(Go to CHS.210)

During the past 12 months, has {S.C.name} had any of the following conditions?

(1) Yes
(2) No
(7) Refused
(9) DK

HAYF2 Hay fever?
RALLG2 Any kind of respiratory allergy?
DALLG2 Any kind of food or digestive allergy?
SALLG2 Eczema or any kind of skin allergy?
DIARH2 Frequent or repeated diarrhea or colitis?
ANEMIA2 Anemia?
FHEAD Frequent or severe headaches, including migraines?
EARINF2 Three or more ear infections?
SEIZE2 Seizures?
STUTTER Stuttering or stammering?

Compared with 12 months ago, would you say {S.C.name}'s health is now BETTER, WORSE, or ABOUT THE SAME?

(1)Better
(2)Worse
(3)About the same
(7)Refused
(9)DK

Check Item CHSCCI5:[If the age is greater than 4 go to CHS.220; If age is less than or equal to 4 go to CHS.230]

During the past 12 months, that is, since {12-month ref. date}, about how many days did{S.C. name} miss school because of illness or injury?

(000) none
(001-240) 1-240 Days
(996) Did not go to school
(997) Refused
(999) DK

These next questions are about {S.C.name}'s recent health during the 2 weeks outlined on that calendar.

Did {S.C.name} have a head cold or chest cold that started during those two weeks?

(1) Yes
(2) No
(7) Refused
(9) DK

Did {S.C.name} have a stomach or intestinal illness with vomiting or diarrhea that started during those two weeks?

(1) Yes
(2) No
(7) Refused
(9) DK

Which statement best describes {S.C.name}'s hearing (without a hearing aid): GOOD, A LITTLE TROUBLE, A LOT OF TROUBLE, or DEAF?

(1) Good
(2) Little trouble
(3) Lot of trouble
(4) Deaf
(7) Refused
(9) DK

Does {S.C.name} have any trouble seeing?

[If child's age is 2 or more add:]
Even when wearing glasses or contact lenses?

(1) Yes (CHS.270)
(2) No (CHS.290)
(7) Refused (CHS.290)
(9) DK (CHS.290)

Is {S.C.name} blind or unable to see at all?

(1) Yes
(2) No
(7) Refused
(9) DK

Does {S.C.name} have any impairment or health problem that requires {him/her} to use special equipment, such as a brace, a wheelchair, or a hearing aid (excluding ordinary eyeglasses or corrective shoes)?

(1) Yes
(2) No
(7) Refused
(9) DK

Does {S.C.name} have an impairment or health problem that limits {his/her} ability to (crawl), walk, run, or play?

(1) Yes (CHS.310)
(2) No (CHS.311)
(7) Refused (CHS.311)
(9) DK (CHS.311)

Is this an impairment or health problem that has lasted, or is expected to last 12 months or longer?

(1) Yes
(2) No
(7) Refused
(9) DK

Does {S.C.name}NOW have a problem for which {he/she} has regularly taken prescription medication for at least three months?

(1) Yes
(2) No
(7) Refused
(9) DK

Check Item CHSCCI6:[If age is less than or equal to 1 go to next section -- Health Care Access and Utilization. CAU.020; If the age is equal to 2 go to CHSCCI7; If the age is greater than or equal to 3 go to CHS.312]

Has a representative from a school or a health professional ever told you that {S.C.name} had a learning disability?

(1) Yes
(2) No
(7) Refused
(9) DK

Check item CHSCCI7:If AGE = 2-3 and RPSEX is male, then go to CHS.321;
If AGE = 2-3 and RPSEX is female, then, go to CHS.361;
If AGE = 4-11 and RPSEX is male, then go to CHS.401;
If AGE = 4-11 and RPSEX is female, then go to CHS.441;
If AGE = 12-17 and RPSEX is male, then go to CHS.481;
If AGE = 12-17 and RPSEX is female, then go to CHS.521.

I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of {S.C.name} during the past 2 months.

FR: SHOW CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

HE:

CMHAGM12 Has been uncooperative?
CMHAGM13 Has trouble getting to sleep?
CMHAGM14 Has speech problems?
CMHAGM15 Has been unhappy, sad, or depressed?

(Go to CAU.020)

(Go to next section -- Health Care Access and Utilization)

I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of {S.C.name} during the past 6 months.

FR: SHOW CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

HE:

0. Not true
1. Sometimes true
2. Often true

CMHAGM22 Doesn't get along with other kids?
CMHAGM23 Can't concentrate or pay attention long?
CMHAGM24 Feels worthless or inferior?
CMHAGM25 Has been unhappy, sad, or depressed?

(Go to next section -- Health Care Access and Utilization)

(Go to next section -- Health Care Access and Utilization)

(Go to next section -- Health Care Access and Utilization)

I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, that during the past 6 months, {S.C.name}:

FR: HAND CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

SHE:

0. Not true
1. Sometimes true
2. Often true

CMHAGF32 Lies or cheats?
CMHAGF33 Does poorly at school work?
CMHAGF34 Has trouble sleeping?
CMHAGF35 Has been unhappy, sad, or depressed?

(Go to next section-Health Care Access and Utilization)

The next questions are about Health Care.
Is there a place that {S.C.name} USUALLY goes when {he/she} is sick or you need advice about {his/her} health?

(1) Yes (CAU.030)
(2) There is NO place (CAU.037)
(3) There is MORE THAN ONE place (CAU.030)
(7) Refused (CAU.037)
(9) DK (CAU.037)

[If CAU.020 equal 1, then read:]
What kind of place is it ...

[Else CAU.020 equal 3, then read:]
What kind of place does {S.C.name} go to most often .. A clinic, doctor's office, emergency room, or some other place?

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

Is that {place selected in CAU.030} the same place {S.C.name} usually goes when {he/she} needs routine or preventive care, such as a physical examination or well baby/child check-up?

(1) Yes (CAU.040)
(2) No (CAU.037)
(7) Refused (CAU.037)
(9) DK (CAU.037)

What kind of place does {S.C.name} go to when {he/she} needs routine preventive care, such as a physical examination or well baby/child check-up?

(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 CAUCCI1: If CAU.020 equals 2, 7, or 9, then go to CAU.080; Else go to CAU.040.

At any time in the past 12 months did you CHANGE the place(s) to which {S.C.name} USUALLY goes for health care?

(1) Yes (CAU.050)
(2) No (CAU.080)
(7) Refused (CAU.080)
(9) DK (CAU.080)

Was this change for a reason related to health insurance?

(1) Yes
(2) No
(7) Refused
(9) DK

There are many reasons people delay getting medical care. Have you delayed getting care for {S.C.name} for any of the following reasons in the past 12 months?

(1) Yes
(2) No
(7) Refused
(9) DK

CHCDLYR1 You couldn't get through on the telephone.
CHCDLYR2 You couldn't get an appointment for {S.C.name} soon enough.
CHCDLYR3 Once you get there, {S.C.name} has to wait too long to see the doctor.
CHCDLYR4 The clinic/doctor's office wasn't open when you could get there.
CHCDLYR5 You didn't have transportation

Check Item CAUCCI2:[If age is greater than or equal to 2 go to CAU.135; Else go to CAU.130]

During the past 12 months, was there any time when {S.C.name} needed any of the following, but didn't get it because you couldn't afford it? Prescription medicines?

(1) Yes
(2) No
(7) Refused
(9) DK

(Go to CAU.170)

During the past 12 months, was there any time when {S.C.name} needed any of the following, but didn't get it because you couldn't afford it:

(1) Yes
(2) No
(3) Refused
(9) DK

CHCAFYR1 Prescription medicines?
CHCAFYR2 Mental health care or counseling?
CHCAFYR3 Dental care (including check-ups)?

FR: SHOW CARD C4.

About how long has it been since {S.C.name} 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.

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

(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

Check Item CAUCCI3:[If age is greater than or equal to 2 go to CAU.175; Else go to CAU.170.]

During the past 12 months, that is since {12-month ref. date}, has anyone in the family seen or talked to any of the following health care providers about {S.C.name}'s health?

(1) Yes
(2) No
(3) Refused
(9) DK

CHCSYR11 An optometrist, optician, or eye doctor (someone who prescribes eyeglasses)?
CHCSYR12 A foot doctor?
CHCSYR13 A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
CHCSYR14 A nurse practitioner, physician assistant or midwife?(Go to Check Item CAUCCI4)

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 {S.C.name}'s health?

(1) Yes
(2) No
(3) Refused
(9) DK

CHCSYR1 A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
CHCSYR2 An optometrist, optician, or eye doctor (someone who prescribes eyeglasses)?
CHCSYR3 A foot doctor?
CHCSYR4 A chiropractor?
CHCSYR5 A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
CHCSYR6 A nurse practitioner, physician assistant or midwife?

Check Item CAUCCI4: [If female and age is greater than 14 then go to CAU.230; Else go to CAU.240]

During the past 12 months, have you seen or talked to a doctor who specializes in women's health (an obstetrician/gynecologist) about {S.C.name}'s health?

(1) Yes
(2) No
(7) Refused
(9) DK

During the past 12 months, have you seen or talked to the following about {S.C.name}'s health?

(1) Yes
(2) No
(7) Refused
(9) DK

CHCSYR81 A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist, psychiatrist or ophthalmologist)?
CHCSYR82 A general doctor who treats a variety of illnesses (a doctor in general practice, pediatrics, family medicine, or internal medicine)?

Check Item CAUCCI5: [If CHCSYR82 = 1 go to CAU.260; Else go to CAU.270]

Does that doctor treat children and adults (a doctor in general practice or family medicine)?

(1) Yes
(2) No
(7) Refused
(9) DK

During the past 12 months did {S.C.name} receive a physical examination or well baby/child check-up?

(1) Yes
(2) No
(7) Refused
(9) DK

During the past 12 months, HOW MANY TIMES has {S.C.name} gone to a HOSPITAL EMERGENCY ROOM about {his/her} health? (This includes emergency room visits that resulted in a hospital admission.)

FR: SHOW CARD C5.

0. None
1. 1
2. 2-3
3. 4-9
4. 10-12
5. 13 or more

(0) None
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK

During the past 12 months, did {S.C.name} receive care AT HOME from a nurse or other health care professional?

(1) Yes (CAU.300)
(2) No (CAU.320)
(7) Refused (CAU.320)
(9) DK (CAU.320)

During how many of the past 12 months did {S.C.name} receive care at home from a health care professional?

(01-12) 1-12 months
(97) Refused
(99) DK

What was the total number of home visits received for {S.C.name} during that/those months?

FR: SHOW CARD C6

1. 1
2. 2-3
3. 4-9
4. 10-12
5. 13 or more

(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK

During the past 12 months, HOW MANY TIMES has {S.C.name} seen a doctor or other health care professional about {his/her} health at A DOCTOR's OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times {S.C.name} was hospitalized overnight, visits to hospital emergency rooms, home visits, or telephone calls.

FR: SHOW CARD C5

0. None
1. 1
2. 2-3
3. 4-9
4. 10-12
5. 13 or more

(0) None
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK

During the past 12 months has {S.C.name} had SURGERY or other surgical procedures either as an inpatient or outpatient?

(1) Yes (CAU.340)
(2) No (Check item CAUCCI6)
(7) Refused (Check item CAUCCI6)
(9) DK (Check item CAUCCI6)

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES has {S.C. name} had surgery done as an outpatient during the past 12 months?

(00-94) 0-94 times
(95) 95+ times
(97) Refused
(99) DK

Check item CAUCCI6: If sample child had a doctor visit in the last 2 weeks as indicated in the family core, that is: If FAU.180 equals 1 and sample child's person number is in FAU.190, then CAU.345 equals 1 and go to next questionnaire--Immunization; Else go to CAU.345.

About how long has it been since anyone in the family last saw or talked to a doctor or other health care professional about {S.C.name}'s health? Include doctors seen while {he/she} was a patient in a hospital.

(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

(Go to next questionnaire -- Immunization)